Comparison of efficacy of pulverization and sterile paper point techniques for sampling root canals.

INTRODUCTION: The purpose of this study was to compare the efficacy of the pulverization and sterile paper point techniques for sampling root canals using 5.25% NaOCl/17% EDTA and 1.3% NaOCl/MTAD (Dentsply, Tulsa, OK) as irrigation regimens. METHODS: Single-canal extracted human teeth were decoronated and infected with Enterococcus faecalis. Roots were randomly assigned to 2 irrigation regimens: group A with 5.25% NaOCl/17% EDTA (n = 30) and group B with 1.3% NaOCl/MTAD (n = 30). After chemomechanical debridement, bacterial samplings were taken using sterile paper points and pulverized powder of the apical 5 mm root ends. RESULTS: The sterile paper point technique did not show growth in any samples. The pulverization technique showed growth in 24 of the 60 samples. The Fisher exact test showed significant differences between sampling techniques (P < .001). The sterile paper point technique showed no difference between irrigation regimens. However, 17 of the 30 roots in group A and 7 of the 30 roots in group B resulted in growth as detected by pulverization technique. Data showed a significant difference between irrigation regimens (P = .03) in pulverization technique. CONCLUSIONS: The pulverization technique was more efficacious in detecting viable bacteria. Furthermore, this technique showed that 1.3% NaOCl/MTAD regimen was more effective in disinfecting root canals.

Apicoectomy using Er:YAG laser in association with microscope: a comparative retrospective investigation.

OBJECTIVE: This retrospective clinical investigation intends to examine the effectiveness of an Er:YAG laser used in conjunction with a dental operation microscope for apicoectomy, in comparison with the traditional surgical procedure. BACKGROUND DATA: The Er-YAG laser has shown great potential in application to periapical surgery; however, clinical data are rare. METHODS: To this end, 78 patients who had undergone apicoectomy in a private dental office were selected; 41 patients were treated by the traditional surgical technique for apicoectomy and 37 patients were treated using an Er:YAG laser under microscopic control. The five cardinal symptoms of inflammation were taken as clinical parameters/examination criteria and evaluated after postoperative days 1, 7, and 180, where days 7 and 180 after the operation can be regarded as the customary times for follow-up controls at the private dental office. RESULTS: Microscopically guided, laser-assisted treatment seems to favor a better healing process overall. After the first postoperative day, redness and swelling of the operation area were significantly reduced (p<0.001 and p=0.0048). Seven days after the operation, all inflammation parameters were statistically significantly lower in the laser-treated group (p<0.05). On day 180, 6 out of 41 patients in the control group still displayed a disturbed function of the treated teeth, whereas none of the patients in the laser group experienced further complaints. CONCLUSIONS: As a result, it can be ascertained that the use of an Er:YAG laser as an adjuvant tool in periapical surgery, with additional control by an operation microscope, displays significantly better results in terms of postoperative healing, in comparison with the conventional surgical treatment of apicoectomy.

Dentinal tubule infection as the cause of recurrent disease and late endodontic treatment failure: a case report.

INTRODUCTION: This article describes a case of recurrent post-treatment apical periodontitis and late failure after endodontic retreatment performed in a single visit. METHODS: The patient presented with a tooth exhibiting inadequate endodontic treatment and a large periradicular lesion that extended laterally to the root. Retreatment was performed in a single visit and involved chemomechanical preparation using 5.25% NaOCl as the irrigant and root canal obturation by Schilder's vertical compaction technique. A large lateral canal was radiographically revealed after obturation. After 2 years, the lesion was no longer radiographically discernible, a condition that was confirmed 9 years after retreatment procedures. Nonetheless, after 12 years, radiographs revealed recurrent disease. Apical surgery was performed, and the root apex, including the area of the large lateral canal, was resected with care to maintain the lesion attached to it. The biopsy specimen was subjected to histopathologic and histobacteriologic analyses. RESULTS: Longitudinal sections of the apical root specimen revealed a heavy dentinal tubule infection surrounding the area of the lateral canal. Bacteria were not found in any other area of the specimen. No other possible reason for the inflammatory periradicular lesion, such as root fracture, coronal leakage, or foreign-body reaction, was evident. CONCLUSIONS: A persistent intraradicular infection caused by bacteria located within dentinal tubules is the most reasonable explanation for resurgence of the apical periodontitis lesion. This case report stresses the importance of attaining proper disinfection of the root canal system for a predictable long-term outcome of the treatment.

Morphological features of the maxillary incisors roots and relationship with neighbouring anatomical structures: possible implications in endodontic surgery.

The purpose of this study was to investigate the relationship between the root apex of the upper incisors and neighbouring anatomical structures as well as the morphology of the root-end foramen after apicoectomy. Fifty-seven patients requiring endodontic surgical treatment for a maxillary anterior root were enrolled. A preoperative diagnostic computed tomography (CT) scan was analysed to determine: the distance between the anterior wall of the nasopalatine duct and the central (CI-ND) incisor root 4mm from the apex; and the distance between the floor of the nasal cavity and the tip of either the central (CI-NF) or the lateral (LI-NF) incisor root. After apicoectomy, root-end foramen endoscopic pictures were taken in order to characterize their morphology. Fifty-nine central and 26 lateral incisors were evaluated. The average CI-ND was 4.71 ± 1.26 (SD) mm. The average CI-NF was 10.62 ± 2.25 mm. The average LI-NF was 13.05 ± 2.43 mm. The foramen shape after apicoectomy was ovoid to circular in about 90% of cases in both central and lateral incisors. A sound knowledge of the anatomical relationships at the surgical site is essential for the clinician to perform a safe endodontic surgical procedure.

Hemostasis control in endodontic surgery: a comparative study of calcium sulfate versus gauzes and versus ferric sulfate.

INTRODUCTION: Calcium sulfate (CaS) is a simple, biocompatible material with a long history of safe use in different fields of medicine. CaS is a rapidly resorbing material that leaves behind a calcium phosphate lattice, which promotes bone regeneration and hemostasis. The aim of this study was a clinical evaluation of the hemostatic effect of CaS hemi-hydrate (CaSO4), commonly known as plaster of Paris, in endodontic surgery. METHODS: Twenty-four patients with 31 periradicular lesions were enrolled in this study. The apical roots were exposed, and the bleeding would have made it difficult to correctly fill the root-end cavities. To avoid such an inconvenience, the teeth were divided into 3 groups. Hemostasis was attempted by using CaS in 11 teeth (group I), gauze tamponade in another 10 teeth (group II), or 20% ferric sulfate in the last 10 teeth (group III). RESULTS: Control of the bleeding was achieved in all teeth of group I, whereas in group II adequate hemostasis was achieved in 3 of 10 cases and in group III in 6 of 10 cases. CONCLUSIONS: The use of CaS completely eliminated the bleeding, with a very good level of hemostasis.

Apicoectomies with the erbium laser: a complementary technique for retrograde endodontic treatment.

OBJECTIVE: The purpose of this study was to evaluate the efficacy of erbium lasers for retrograde endodontic treatment, in terms of clinical outcome and therapeutic success. BACKGROUND DATA: Apicoectomy with retrograde filling is a well-established surgical procedure to treat teeth affected by persistent periapical lesions. The apical root end is generally removed with burs, and the adjacent periapical tissue curetted, or alternatively treated with ultrasound or laser. METHODS: Between 2000 and 2010, 65 apicoectomies were performed on necrotic teeth that presented apical lesions (29 men, 36 women). The lasers used in the study were the erbium:yttrium-aluminum-garnet (Er:YAG) laser, wavelength 2940 nm, and the erbium,chromium-doped:yttrium-scandium-gallium-garnet (Er,Cr:YSGG) laser, wavelength 2780 nm. RESULTS: Of the 65 teeth in the study, failure only occurred in 9 CASES, MANIFESTING AFTER DIFFERENT TIMES. THE REMAINING PATIENTS, 86.15%, experienced no complications, and their treatment followed a positive course. CONCLUSIONS: Laser-assisted surgery increases the range of therapeutic approaches in the sphere of retrograde endodontic treatment. The results of this study show that the erbium laser, used for apicoectomy, results in a high success rate with considerable benefit in terms of clinical outcome and therapeutic success.

Effect of guided tissue regeneration on the outcome of surgical endodontic treatment of through-and-through lesions: a retrospective study at 4-year follow-up.

PURPOSE: The main purpose of this retrospective cohort study was to evaluate the 4-year success rate of endodontic surgery in combination with a collagen resorbable membrane for the treatment of through-and-through periradicular lesions. MATERIALS AND METHODS: Patients with one or more teeth with a through-and-through periradicular lesion in need of endodontic surgery were treated. A clinical and radiographic evaluation was performed at 3, 6, 12, 24, 36, and 48 months. The outcome was categorized at 1 and 4-year follow-up as success, failure, and doubtful depending on clinical signs and symptoms and radiographic evaluation. Fisher's exact test was used to evaluate differences between successful and failed cases (P < 0.05). RESULTS: Forty-three teeth in 33 patients were radiographically and clinically evaluated after 4 years. Thirty-eight teeth were classified as success, 4 teeth as failure, and 1 tooth as doubtful. No statistically significant differences were found in results related to tooth type, tooth location, and presence of post. CONCLUSIONS: The association of endodontic surgery and guided tissue regeneration for the treatment of through-and-through periapical lesions leads to excellent outcomes up to 4 years. Standardized criteria are needed to determine the treatment outcome.

Morphological assessment of dentine and cementum following apicectomy with Zekrya burs and Er:YAG laser associated with direct and indirect Nd:YAG laser irradiation.

OBJECTIVES: This study aimed to assess the apical surface morphology of maxillary central incisors resected 3.0 mm from the tooth apex using Zekrya burs or Er:YAG laser, with or without subsequent direct Nd:YAG laser irradiation (apical and buccal surfaces) and indirect irradiation (palatal surface). STUDY DESIGN: Forty maxillary central incisors were instrumented and obturated. The roots were divided into 4 groups according to the root resection method (Zekrya bur or Er:YAG laser - 1.8 W, 450 mJ, 4 Hz, 113 J/cm(2)) and further surface treatment (none or Nd:YAG laser - 2.0 W, 100 mJ, 20 Hz, 124 J/cm(2)). The teeth were prepared for SEM analysis. Scores ranging from 1 to 4 were attributed to cut quality and morphological changes. The data were analyzed by the Kruskal-Wallis test and by Dunn's test. RESULTS: SEM images showed irregular surfaces on the apical portions resected with Zekrya burs, with smear layer and grooves in the resected dentine and slight gutta-percha displacement and plasticization. On the other hand, apicectomies carried out with Er:YAG laser showed morphological changes compatible with ablated dentine, with rough surfaces and craters. In spite of the presence of plasticized gutta-percha, with the presence of bubbles, an irregular adaptation of the filling material to the root walls was also observed. Direct Nd:YAG laser irradiation of the apical and buccal surfaces of the resected roots resulted in areas of resolidification and fusion in the dentine and cementum, with a vitrified aspect; indirect Nd:YAG laser irradiation of the palatal surfaces yielded a lower number of changes in the cementum, with irregular resolidification areas. CONCLUSIONS: There were no differences in terms of cut quality between the use of burs and Er:YAG laser or between the 2 surfaces (apical and buccal) treated with Nd:YAG laser with direct irradiation. However, morphological changes were significantly less frequent on surfaces submitted to indirect irradiation (palatal) when compared with those directly irradiated.

Laser applications in endodontics: an update review.

The search for new devices and technologies for endodontic procedures always has been challenging. Since the development of the ruby laser by Maiman in 1960 and the application of the laser for endodontics by Weichman in 1971, a variety of potential applications for lasers in endodontics have been proposed. With the development of thinner, more flexible and durable laser fibres, laser applications in endodontics have increased. Since laser devices are still relatively costly, access to them is limited. The purpose of this paper is to summarise laser applications in endodontics, including their use in pulp diagnosis, dentinal hypersensitivity, pulp capping and pulpotomy, sterilisation of root canals, root canal shaping and obturation and apicectomy. The effects of lasers on root canal walls and periodontal tissues are also reviewed.

Tooth root abscesses in llamas and alpacas: 123 cases (1994-2005).

OBJECTIVE: To determine features, outcome, and complications of surgical treatment of camelid tooth root abscesses. DESIGN: Retrospective case series. ANIMALS: 123 camelids with tooth root abscesses. PROCEDURES: Signalment, history, teeth involved, surgery performed, ancillary diagnostic tests, and short-term complications were recorded from each medical record. An owner questionnaire was used to obtain long-term (> 1 year) follow-up information. RESULTS: The most common surgical treatments included tooth extraction (n = 106) and apicoectomy (13). Owners provided follow-up information on 84 animals. Postoperative complications were reported in 42 of 84 animals. The most common complications included reinfection (n = 15), chronic draining tract (14), and osteomyelitis (14). Significantly more camelids that were in good or obese body condition at the time of surgery were alive at the time of follow-up, compared with those with thin body condition at the time of surgery. Camelids with 2 teeth extracted had significantly more complications than those with 1 tooth extracted. Thirty-four of 47 owners reported that they were completely satisfied with the outcome. CONCLUSIONS AND CLINICAL RELEVANCE: Owners of camelids in poor body condition should be forewarned that such animals are at greater risk for complications following dental surgery. Clinicians should recognize that the number of teeth affected was not associated with a poorer outcome.

A new method of tooth replantation and autotransplantation: aluminum oxide ceramic for extraoral retrograde root filling.

After an initial clinical test phase, the new method of replantation and transplantation with the use of aluminum oxide ceramic for retrograde root filling may be viewed as possible differential indications to other methods, even to apicectomy in the molar region. Twenty-three of the twenty-five replantations and eight of the nine transplantations may be regarded as having been successful. Contraindications are cases of wide apical foramina and oval or octagonal root canal cross sections.

[The use of biocompatible materials in apicoectomy]. / Het gebruik van biocompatibele materialen voor de apicotomie.

The use of more biocompatible materials in comparison with silver, gutta-percha and amalgam was introduced a decade ago. First titanium was used, later followed by alumina. Both clinical as well as radiological results favor their use. Yet it appears that the system is mainly confined to the maxillary front teeth and mandibular canines.