Fracture Strength of Endodontically Treated Teeth Restored with Composite Overlays with and without Glass-fiber Reinforcement.

PURPOSE: To evaluate the fracture strength and the failure mode of endodontically treated teeth restored with composite resin overlays with and without glass-fiber reinforcement. MATERIALS AND METHODS: A total of 32 extracted molars were divided into four equal groups. In the NFR-NFRC (no foundation restoration, no fiber-reinforced composite) and NFR-FRC (no foundation restoration, fiber-reinforced composite) groups, only a 5-mm-thick composite resin layer sealed the pulp chamber floors, whereas in the FR-NFRC (foundation restoration, no fiber-reinforced composite) and FR-FRC (foundation restoration, fiber-reinforced composite) groups, a 3.0-mm foundation restoration was used. NFR-NFRC and FR-NFRC groups were restored with composite resin overlays, whereas NFR-FRC and FR-FRC groups were restored with fiber-reinforced composite resin overlays. All specimens were subjected to mechanical loading in a computer-controlled masticator and then the fracture resistance was evaluated. Differences in means were compared using two-way ANOVA and Tukey's test. The level of significance was set at ɑ = 0.05. RESULTS: All specimens successfully completed the fatigue test. The least fracture-resistant group was NFR-FRC, exceeded by FR-NFRC, NFR-NFRC, and FR-FRC, in that order, with FR-FRC being the most fracture-resistant group. Statistically significant differences were detected between the pairs NFR-NFRC/FR-FRC (p = 0.001), NFR-FRC/FR-FRC (p = 0.001), and FR-NFRC/FR-FRC (p = 0.001). Eight vertical root fractures occurred in group FR-NFRC, six in group NFR-NFRC, four in group NFR-FRC, and none occurred in group FR-FRC. CONCLUSIONS: Within the limitations of this in vitro study, the incorporation of glass fibers and the presence of a foundation restoration were found to increase the fracture resistance and can favorably influence the fracture mode.

The Effect of Diode Laser With Different Parameters on Root Fracture During Irrigation Procedure.

The aim of this study is to compare the effect of a single diode laser application and agitation of EDTA with diode laser with different parameters at different time intervals on root fracture. Ninety mandibular incisors were instrumented except the negative control group. The specimens were divided randomly into 10 groups according to final irrigation procedure: (G1) non-instrumented; (G2) distilled water; (G3) 15% EDTA; (G4) ultrasonically agitated EDTA; (G5) single 1.5W/100 Hz Diode laser; (G6) single 3W/100 Hz Diode laser; (G7) 1.5W/100 Hz Diode laser agitation of EDTA for 20 s; (G8) 1.5W/100 Hz Diode laser agitation of EDTA for 40 s; (G9) 3W/100 Hz Diode laser agitation of EDTA for 20 s; and (G10) 3W/100 Hz Diode laser agitation of EDTA for 40 s. The specimens were filled, mounted in acrylic resin, and compression strength test was performed on each specimen. Statistical analysis was carried out using one way ANOVA and Tukey's post hoc tests (P = 0.05). The statistical analysis revealed that there were statistically significant differences among the groups (P < 0.05). Laser-agitated irrigation with a 3W/100 Hz Diode laser for both 20 s and 40 s decreased the fracture resistance of teeth.

Fractura radicular en piezas primarias / Root fracture in primary teeth

Los traumatismos dentarios constituyen uno de los motivos más frecuentes en la consulta odontopediátrica. Si bien las fracturas radiculares en dentición primaria son las lesiones traumáticas menos prevalentes (2-4 por ciento), son de difícil resolución y ocasionan la pérdida de dichas piezas en la mayoría de los casos. Objetivo: describir la resolución del traumatismo con fractura radicular en ambos incisivos centrales superiores primarios. Diagnóstico de la situación inicial: paciente masculino de 4 años que acude con su madre a la Cátedra de Odontología Integral Niños de la FOUBA presentando un traumatismo dental de 2 horas de evolución. Diagnóstico clínico-radiográfico: fractura radicular horizontal de tercio medio del 5.1 y 6.1 (sin reabsorción fisiológica radicular), sin desplazamiento del fragmento coronario, con laceración de labio superior y encía marginal. Secuencia de procedimientos operatorios: historia clínica con consentimiento informado; anamnesis médica y odontológica; examen clínico y radiográfico de 5.1 y 6.1 y antagonistas; limpieza de tejidos blandos con clorhexidina; impresión con alginato; confección de placa posicionadora para ferulización; prueba e instalación de la placa; indicaciones al paciente y a su madre: uso permanente durante 45 días y uso nocturno, para comer y hacer deportes 45 días más. Recomendaciones de higiene; controles inmediatos: 30 y 45 días y 3 y 6 meses. Resolución del caso: en todos los controles, ambas piezas se presentaron asintomáticas. A los 6 meses se observa la correcta cicatrización radicular y la presencia de vitalidad en ambos incisivos. Conclusiones: el tratamiento temprano y los controles posteriores son fundamentales para preservar la salud pulpar y conseguir la reparación de los tejidos duros afectados.

Effect of ferrule location on the fracture resistance of crowned mandibular premolars: An in vitro study.

STATEMENT OF PROBLEM: How the location of a ferrule affects the fracture resistance of endodontically treated mandibular premolars is unclear. PURPOSE: The purpose of this in vitro study was to compare the effect of ferrule location on the fracture resistance of endodontically treated mandibular premolars. MATERIAL AND METHODS: Seventy-two extracted human mandibular premolars were selected and divided into 6 test groups (n = 12) according to ferrule location: control group, GHT; endodontically treated teeth without endodontic posts and crowns, GCF; teeth with a 2 mm circumferential ferrule, GBF; teeth with a 2 mm buccal ferrule; GLF, teeth with a 2 mm lingual ferrule; GBLF, teeth with a 2 mm buccal and lingual ferrule; and teeth without ferrule, GWF. After glass fiber posts were cemented with a self-adhesive resin cement and foundation restorations were placed, NiCr crowns were luted to each prepared tooth. All specimens were quasistatically loaded at 30 degrees in a universal testing machine until fractured. Data were then analyzed with 1-way ANOVA, followed by multiple comparisons using the Tukey honestly significant difference test (α=.05). RESULTS: Mean ± SD failure loads for groups ranged from 791.1 ± 177.5 N to 1086.1 ± 181.1 N. One-way ANOVA revealed a statistically significant difference between the groups (P ≤ .05). However, no statistically significant differences were observed among groups (P > .05), except between GHT (control group) and groups GBLF and GWF (P = .025, P = .022). CONCLUSIONS: Within the limitations of this study, the location of the ferrule had no significant effect on the fracture resistance of endodontically treated mandibular premolars.

Periodontal healing after application of enamel matrix derivative in surgical supra/infrabony periodontal defects in rats with streptozotocin-induced diabetes.

BACKGROUND AND OBJECTIVE: Epidemiologic and clinical studies have indicated that diabetes is a risk factor for periodontal disease progression and healing. The aim of the present study was to evaluate short-term healing after enamel matrix derivative (EMD) application in combined supra/infrabony periodontal defects in diabetic rats. MATERIAL AND METHODS: Thirty male Wistar rats were initially divided into two groups, one with streptozotocin-induced diabetes and another one with healthy (non-diabetic) animals. Bony defects were surgically created on the mesial root of the first maxillary molars. After root surface planing and EDTA conditioning, EMD was applied to the roots at one side of the maxillae, while those on the contralateral sides were left untreated. Animals were killed 3 wk after surgery, and block sections were prepared for histologic and histomorphometric analysis. RESULTS: There was statistically significant more gingival recession in diabetic animals than in non-diabetic animals. The length of the junctional epithelium was significantly shorter in the EMD-treated sites in both diabetic and normoglycemic rats. Sulcus depth and length of supracrestal soft connective tissue showed no statistically significant differences between groups. In all animals, new bone formation was observed. Although new bone occurred more frequently in healthy animals, the extent of new bone was not significantly different between groups. In none of the teeth, a layer of new cementum was detectable. EMD had no influence on bone or cementum regeneration. Adverse reactions such as excessive inflammation due to bacterial root colonization, ankylosis and bone fractures were exclusively observed in diabetic animals, irrespective of EMD treatment. CONCLUSION: Within the limits of the present study, it can be concluded that periodontal healing was impaired in streptozotocin-induced diabetic rats. EMD had no beneficial effects on new bone and cementum formation during short-term healing in this defect model and could not ameliorate the adverse effects in the systemically compromised animals.

The effect of medicaments used in endodontic regeneration on root fracture and microhardness of radicular dentine.

AIM: To investigate the effect of medicaments used in endodontic regeneration on root fracture resistance and microhardness of radicular dentine. METHODOLOGY: The root canals of mandibular premolars (n = 180) were instrumented and randomized into three treatment groups and an untreated control group. Each treatment group received either triple antibiotic paste (TAP), double antibiotic paste (DAP) or calcium hydroxide paste [Ca(OH)2] intracanal medicament. Teeth were kept in saline for 1 week, 1 month or 3 months. After each time-point, 15 teeth were randomly selected from each group and two root cylinders were obtained from each tooth. One cylinder was subjected to a fracture resistance test, and the other cylinder was used for a microhardness test. Two-way ANOVA and Tukey's pairwise comparisons were used for statistical analysis. RESULTS: For the microhardness test, the two-way interaction between group and time was significant (P < 0.001). The intracanal application of TAP and DAP caused significant and continuous decrease in root dentine microhardness after one (P < 0.05) and 3 months (P < 0.001), respectively. The three-month intracanal application of Ca(OH)2 significantly increased the microhardness of root dentine (P < 0.05). The time factor had a significant effect on fracture resistance (P < 0.001). The three intracanal medicaments caused significant decreases in fracture resistance ranging between 19% and 30% after 3-month application compared to 1-week application. CONCLUSION: In this laboratory study, the 3-month application of triple antibiotic paste, double antibiotic paste or calcium hydroxide paste medicaments significantly reduced the root fracture resistance of extracted teeth compared to a 1-week application.

A comparative study of temperature elevation on human teeth root surfaces during Nd:YAG laser irradiation in root canals.

The purpose of this study was to evaluate the temperatures on the root surfaces during Nd:YAG laser irradiation in root canals using pulse durations of 180 and 320 µs. Thirty extracted human teeth were used in this study. The teeth were enlarged up to ISO 40 (multi-rooted) or up to ISO 60 (single-rooted) by conventional technique using K-files. Then the teeth were placed into a water bath with a constant temperature of 37 °C and then irradiated with an Nd:YAG laser having an output power of 1.5 W, a frequency of 15 Hz, using an optic fiber of 200 µm diameter. The temperature on the root surface was measured by means of attaching thermocouples in three areas (coronal, mesial, and apical regions) of the root canals. The thermographic study showed that the average temperature elevation for both pulse durations on the root surfaces was less than 9 °C. There was no significant difference in the observed temperatures in coronal and mesial areas. Though a higher increase of temperature was observed in the apical region when the pulse length of the Nd:YAG laser was 320 µs. The results of the study showed that the temperature rises during Nd:YAG laser irradiation with parameters used in this study minimal to cause damage on bone and periodontal tissues. Moreover, it was suggested that in order to have lower temperature in the apical region, an Nd:YAG laser with a pulse length of 180 µs is preferred than one with a pulse length of 320 µs.

Portland cement with additives in the repair of furcation perforations in dogs.

PURPOSE: To evaluate the use of Portland cements with additives as furcation perforation repair materials and assess their biocompatibility. METHODS: The four maxillary and mandibular premolars of ten male mongrel dogs (1-1.5 years old, weighing 10-15 kg) received endodontic treatment (n=80 teeth). The furcations were perforated with a round diamond bur (1016 HL). The perforations involved the dentin, cementum, periodontal ligament, and alveolar bone. A calcium sulfate barrier was placed into the perforated bone to prevent extrusion of obturation material into the periradicular space. The obturation materials MTA (control), white, Type II, and Type V Portland cements were randomly allocated to the teeth. Treated teeth were restored with composite resin. After 120 days, the animals were sacrificed and samples containing the teeth were collected and prepared for histological analysis. RESULTS: There were no significant differences in the amount of newly formed bone between teeth treated with the different obturation materials (p=0.879). CONCLUSION: Biomineralization occurred for all obturation materials tested, suggesting that these materials have similar biocompatibility.

Portland cement with additives in the repair of furcation perforations in dogs / Cimento Portland com aditivos na reparação de perfurações radiculares em cães

PURPOSE: To evaluate the use of Portland cements with additives as furcation perforation repair materials and assess their biocompatibility. METHODS: The four maxillary and mandibular premolars of ten male mongrel dogs (1-1.5 years old, weighing 10-15 kg) received endodontic treatment (n=80 teeth). The furcations were perforated with a round diamond bur (1016 HL). The perforations involved the dentin, cementum, periodontal ligament, and alveolar bone. A calcium sulfate barrier was placed into the perforated bone to prevent extrusion of obturation material into the periradicular space. The obturation materials MTA (control), white, Type II, and Type V Portland cements were randomly allocated to the teeth. Treated teeth were restored with composite resin. After 120 days, the animals were sacrificed and samples containing the teeth were collected and prepared for histological analysis. RESULTS: There were no significant differences in the amount of newly formed bone between teeth treated with the different obturation materials (p=0.879). CONCLUSION: Biomineralization occurred for all obturation materials tested, suggesting that these materials have similar biocompatibility.

OBJETIVO: Avaliar o uso de cimentos Portland aditivados na reparação de perfurações radiculares e a biocompatibilidade destes materiais. MÉTODOS: Oitenta pré-molares, quatro da arcada dentária superior e quatro da arcada inferior de 10 cães machos, sem raça definida, com idade em torno de um a um ano e meio, pesando entre 10 e 15 kg foram submetidos a tratamento endodôntico, sendo realizadas perfurações nas furcas com broca de diamante 1016 HL. A cavidade envolveu dentina e cemento, como também periodonto e o osso alveolar. Na porção óssea da obturação, barreira de sulfato de cálcio foi utilizada evitando extravasamento do cimento para o espaço periodontal. Foi realizada a distribuição randomizada dos cimentos MTA (controle), Portland tipo II, Portland tipo V e Portland branco estrutural nas obturações. Os dentes foram restaurados com resina composta. Após 120 dias realizou-se eutanásia, retirada dos dentes, preparação e análise histológica. RESULTADOS: Entre os cimentos não houve diferença estatística significante quanto à neoformação óssea (p=0,879). CONCLUSÃO: Ocorreu biomineralização com os diferentes cimentos usados no estudo, sugerindo que estes são similares em termos de biocompatibilidade.

Preservation of an injured vital tooth using ultrasonic device and mineral trioxide aggregate.

The purpose of this case report is to present a root fracture repair procedure for non devitalized injured tooth. One injured, non-endodontically treated maxillary anterior tooth in which an incomplete vertical root fracture involving only the buccal side was suspected, underwent an exploratory flap to visualize the pattern of bone loss and assess the type of root fracture. The pre-operative diagnosis was confirmed. A groove following fracture line was prepared using retro-tips driven by an ultrasonic device and sealed with Mineral Trioxide Aggregate (MTA), following filling of the bone defect with Calcium Sulphate. At 24 months follow up the case showed clinical and radiographic success. The present surgical approach showed preservation of function and vitality of tooth with a shallow incomplete vertical root fracture.

Revisión de una fractura radicular con tratamiento atípico durante 23 años / Review of root fracture with atypical treatment for 23 years

Presentamos el caso de un incisivo central superior derecho, con fractura del tercio medio radicular, que fue tratado de forma atípica y se revisó durante 23 años de evolución. La fractura del tercio medio, conminuta en su área central, se produjo por un traumatismo contuso, acudiendo el paciente de urgencia por dolor agudo y movilidad del cliente. Con el diagnóstico de pulpitis aguda y fractura radicular media con subluxación, se decidió tratarlo en toda su longitud después de su ferulización. Practicado el tratamiento se dejó hidróxido de calcio en el conducto y a las dos semanas, con un diente asintomático desde el primer día, se selló definitivamente con hidróxido de calcio en suero fisiológico y gutapercha en condensación lateral. Tres meses después se retiró la ferulización y el diente esta asintomático, funcional y con una movilidad semejante a la de los incisivos vecinos. Radiológicamente, el área de fractura presento distintos aspectos diagnósticos a lo largo de 23 años de seguimiento. Actualmente, el incisivo sigue asintomático, firme, funcional y con un remodelado de su contorno bien definido (AU)

We are herewith presenting a case based on a maxillary right superior central incisor, which suffered a middle third fracture of the root. This fracture has been atypically treated and has been checked up throughout 23 years. The middle third fracture, which is comminuted in its central area, was caused by a contusion trauma. The patient came with urgency due to tooth mobility as well as an acute pain. After being diagnosed acute pulpitis and mid radicular fracture with subluxation, it was agreed to treat it throughout the whole process after its ferulization. Once treated, calcium hydroxide was left in the canal and two weeks after, with an asymptomatic tooth since the first day, it was sealed with calcium hydroxide with physiological saline solution and lateral condensation with gutta-percha. Three months after, ferulization was removed and the incisor was asymptomatic, functional and with mobility similar to the neighboring incisive. Radiograph examinations proved that the fracture presented different diagnosis throughout its 23 years. Nowadays, this incisor keeps being asymptomatic, firm and functional with a well done reshape (AU)

Root perforations treatment using mineral trioxide aggregate and Portland cements.

PURPOSE: Clinical, radiological and histological evaluation of root perforations treated with mineral trioxide aggregate (MTA) or Portland cements, and calcium sulfate barrier. METHODS: One molar and 11 premolar teeth of a male mongrel dog received endodontic treatment and furcations were perforated with a high-speed round bur and treated with a calcium sulfate barrier. MTA, Portland cement type II (PCII) and type V (PCV), and white Portland cement (WPC) were used as obturation materials. The teeth were restored with composite resin and periapical radiographs were taken. The animal was euthanized 120 days post-surgery for treatment evaluation. RESULTS: Right lower first premolar (MTA), right lower third premolar (PCV), left lower second premolar (MTA), and right lower second premolar (WPC): clinically normal, slightly radio-transparent area on the furcation, little inflammatory infiltrate, and new-bone formation. Left lower third premolar (PCII), right upper first premolar (WPC), right upper third premolar (PCII), and left upper first molar (PCV): clinically normal, radiopaque area on the furcation, and new-bone formation. Right upper second premolar (MTA), left upper second premolar (WPC), left upper third premolar (PCII): presence of furcation lesion, large radiolucent area, and intense inflammatory infiltrate. CONCLUSION: All obturation materials used in this study induced new-bone formation.

Root perforations treatment using mineral trioxide aggregate and Portland cements / Cimentos de agregado trióxido mineral e Portland no tratamento de perfurações radiculares

PURPOSE: Clinical, radiological and histological evaluation of root perforations treated with mineral trioxide aggregate (MTA) or Portland cements, and calcium sulfate barrier. METHODS: One molar and 11 premolar teeth of a male mongrel dog received endodontic treatment and furcations were perforated with a high-speed round bur and treated with a calcium sulfate barrier. MTA, Portland cement type II (PCII) and type V (PCV), and white Portland cement (WPC) were used as obturation materials. The teeth were restored with composite resin and periapical radiographs were taken. The animal was euthanized 120 days post-surgery for treatment evaluation. RESULTS: Right lower first premolar (MTA), right lower third premolar (PCV), left lower second premolar (MTA), and right lower second premolar (WPC): clinically normal, slightly radio-transparent area on the furcation, little inflammatory infiltrate, and new-bone formation. Left lower third premolar (PCII), right upper first premolar (WPC), right upper third premolar (PCII), and left upper first molar (PCV): clinically normal, radiopaque area on the furcation, and new-bone formation. Right upper second premolar (MTA), left upper second premolar (WPC), left upper third premolar (PCII): presence of furcation lesion, large radiolucent area, and intense inflammatory infiltrate. CONCLUSION: All obturation materials used in this study induced new-bone formation.

OBJETIVO: Avaliar clínica, radiológica e histologicamente perfurações radiculares tratadas com MTA e cimentos Portland, com barreira de sulfato de cálcio. MÉTODOS: A amostra foi constituída por 11 dentes pré-molares e um molar de cão macho, sem raça definida. Após tratamento endodôntico realizaram-se perfurações nas furcas com broca esférica de alta rotação e barreira de sulfato de cálcio. Foram utiliados os cimentos MTA, Portland tipo II (CPII), Portland tipo V (CPV) e Portland branco estrutural (CPB). Os dentes foram restaurados com resina composta e submetidos a radiografias periapicais. O animal foi confinado por 120 dias e submetido à eutanásia para avaliações. RESULTADOS: Primeiro pré-molar inferior direito (MTA), terceiro pré-molar inferior direito (CPV), segundo pré-molar inferior esquerdo (MTA) e segundo pré-molar inferior direito (CPB): clinicamente normal; leve área radiotransparente na furca; pequeno infiltrado inflamatório e neoformação óssea. Terceiro pré-molar inferior esquerdo (CPII), primeiro pré-molar superior direito (CPB), terceiro pré-molar superior direito (CPII) e primeiro molar superior esquerdo (CPV): clinicamente normal; área radiopaca na furca; neoformação óssea. Segundo pré-molar superior direito (MTA), segundo pré-molar superior esquerdo (CPB) e terceiro pré-molar superior esquerdo (CPII): clinicamente com lesão na furca; intensa área radiolucida; infiltrado inflamatório intenso. CONCLUSÃO: Todos os cimentos induziram a neoformação óssea.

Effects of root canal irrigants on the push-out strength and hydration behavior of accelerated mineral trioxide aggregate in its early setting phase.

INTRODUCTION: The purpose of this study was to evaluate the effects of endodontic irrigants on the push-out strength and hydration behavior of accelerated mineral trioxide aggregate (MTA) in its early setting phase. METHODS: In an in vitro perforation model, MTA with or without 10% CaCl(2) was condensed and allowed to initial set for 10 minutes. The samples were divided into four groups (n = 10) to be immersed into either 3.5% sodium hypochlorite (NaOCl) or 2% chlorhexidine gluconate (CHX) for 30 minutes and then allowed to set for 48 hours. In the control group, a wet cotton pellet was placed over MTA. The maximum force applied to the set MTA mixture before dislodgement was recorded. Irrigant-treated surfaces were examined using a scanning electron microscope (SEM). Chemical elements of these surfaces were also analyzed by energy dispersive x-ray spectroscope (EDS). RESULTS: The push-out strength of group A1 (NaOCl-treated accelerated MTA) was the highest of all groups. When compared with nonaccelerated MTA, CaCl(2)-accelerated MTA showed significantly higher push-out strength (p < 0.05). NaOCl-treated groups showed significantly higher push-out strength than CHX-treated groups (p < 0.05). Scanning electron microscopic examination and EDS analysis showed that the formation of calcium hydroxide crystals on accelerated MTA exposed to NaOCl was increased compared with those of the control group. CONCLUSION: These findings imply that the use of accelerated MTA under the NaOCl irrigation was effective in perforation repair without altering its hydration behavior even in the early setting phase.

Evaluation of fracture resistance in simulated immature teeth using Resilon and Ribbond as root reinforcements--an in vitro study.

BACKGROUND/AIM: To compare the reinforcement and strengthening ability of resilon, gutta-percha, and ribbond in endodontically treated roots of immature teeth. MATERIAL AND METHODS: Sixty five freshly extracted human maxillary anterior teeth were prepared with a Peeso no. 6 to simulate immature teeth (Cvek's stage 3 root development). After instrumentation, each root was irrigated with sodium hypochlorite and with ethylene diamino tetra acetic acid to remove the smear layer. To simulate single visit apexification technique a 4-5 mm white Pro Root mineral trioxide aggregate plug was placed apically using schilder carrier. The teeth were divided into three experimental groups and one control group. Group I--control group (root canals instrumented but not filled); Group II--backfilled with thermoplastisized gutta-percha using AH plus sealer; Group III--reinforced with Resilon using epiphany sealer; Group IV--reinforced with Ribbond fibers using Panavia F luting cement. A Universal Testing Machine was used to apply a load, at the level of the lingual cementoenamel junction with a chisel-shaped tip The peak load to fracture was recorded and statistical analysis was completed using student's t-test. RESULTS: Values of peak load to fracture were 1320.8, 1604.88, 1620, and 1851 newtons for Group I to Group IV respectively. The results of student's t-test, revealed no significant difference (P > 0.05,) between Group II and Group III. Comparison between Group IV and Group III and between Group IV and Group II revealed highly significant difference (P > 0.001). CONCLUSIONS: Teeth reinforced with Ribbond fibers using Panavia F luting cement showed the highest resistance to fracture. Resilon could not strengthen the roots and showed no statistically significant difference when compared with thermoplastisized gutta-percha in reinforcing immature tooth when tested with universal testing machine in an experimental model of immature tooth.

Treatment of horizontal root fractures using a triple antibiotic paste and mineral trioxide aggregate: a case report.

This case report describes the treatment of a horizontal root fracture in a maxillary central incisor (tooth #8) using a triple antibiotic paste and mineral trioxide aggregate. A nonsurgical endodontic treatment was performed to a coronal root canal fragment of tooth #8. During the treatment procedure, 1% sodium hypochlorite solution was used for irrigation and a triple antibiotic paste was used as an intracanal medicament. The coronal part of the canal was obturated with mineral trioxide aggregate totally. At follow-up examination after 12 months, the tooth was asymptomatic and radiographically showed repair of the fracture region. Healing was achieved without any need for further interventions.

Intrasocket reactive soft tissue for primary closure after augmentation of extraction sites with severe bone loss before implant placement.

PURPOSE: The normal bone resorption after tooth extraction can be significantly aggravated in the case of pre-existing severe bone loss and chronic infection. Bone augmentation procedures have been proposed, but they require adequate closure of soft tissues. We propose the use of intrasocket reactive tissue to cover extraction sites augmented by bovine bone mineral graft to promote the success of the graft procedure. PATIENTS AND METHODS: The study included 24 patients with severe bone loss and chronic pathology in 27 sites. The intrasocket reactive soft tissue was elevated from the bony walls in a subperiosteal plane. Porous bovine or allograft bone mineral was placed in the extraction site without membranes, and the intrasocket reactive soft tissue was sutured over the grafting material to seal the coronal portion of the socket. Twenty-seven implants were placed 6 months after bone augmentation. RESULTS: Healing progressed uneventfully. Postoperative morbidity was minimal. There was no leakage or infection of the grafting material. The mean time to implant placement was 7.8 months. Supplemental augmentation was not needed. There were no implant failures. Follow-up ranged from 6 to 36 months (mean, 15 months). All implants were rehabilitated with fixed prostheses. CONCLUSIONS: Intrasocket reactive soft tissue can be used predictably to obtain primary closure of augmented extraction sites with severe bone loss with minimal postoperative morbidity.

Effects of different irrigation regimens on the sealing properties of repaired furcal perforations.

OBJECTIVE: The pulp chamber is inevitably exposed to irrigants during endodontic therapy. This study aimed to investigate whether different irrigation regimens would alter the sealing ability of repaired furcal perforations. STUDY DESIGN: Pulp chambers of 90 extracted human molars were accessed, after which standardized diamond bur-cut perforations were created in the center of the pulp chamber floor. The canal orifices and the apical end of roots were sealed with acid-etch composite resin. Eighty teeth were randomly divided into 2 groups (n = 40/group) according to the material used for repairing the perforation defects: (1) Mineral trioxide aggregate (MTA), (2) Super-EBA. The remaining teeth (n = 10) served as controls. The specimens were further subgrouped according to the irrigation regimens applied over the repair site (n = 10/group): (a) 5.25% NaOCl, (b) 5.25% NaOCl + EDTA, (c) 5.25% NaOCl + MTAD, and (d) No irrigation. Coronal leakage was measured by the fluid-filtration method at 1 day and 1 week. RESULTS: Fluid conductance was not affected by the type of repair material (P = .964) or time (P = .726), but was affected significantly by the irrigation regimens in the following ranking: (P < .001): NaOCl < or = No Irrigation < NaOCl + MTAD < or = NaOCl + EDTA. CONCLUSION: The sealing ability of furcal perforations repaired with MTA or Super-EBA were differentially affected by exposure to the tested irrigation regimens.

Mineral trioxide aggregate as repair material for furcal perforation: case series.

The purpose of treating furcal perforation is to seal the artificial communication between the endodontic space and the periradicular tissue to prevent alveolar bone resorption and damage to the periodontal ligament. These complications are not infrequent in cases of furcal and/or old perforations, which show a worse prognosis than fresh, small, coronal, and apical perforations. Mineral trioxide aggregate (MTA) is widely used to seal perforations because of its biocompatibility and sealability. Ten cases of furcal perforation were selected at the department of Endodontics, University of Florence. All the perforations were cleaned with NaOCl, EDTA, and ultrasonic tips and sealed with MTA without internal matrix. Finally, the teeth were endodontically treated and coronally restored. Clinical and radiographic follow-ups were done at 6 months, 1 year, 2 years, and 5 years. After 5 years, the absence of periradicular radiolucent lesions, pain. and swelling along with functional tooth stability indicated a successful outcome of sealing perforations in 9 out of 10 teeth. One patient dropped out of the study after the 1-year follow-up and could not be contacted for further recalls. The results confirm that MTA without matrix provides an effective seal of root perforations and clinical healing of the surrounding periodontal tissue.