Análisis del tercio apical de un canino con infección endodóncica persistente / Analysis of the apical third of a canine with persistent endodontic infection

Una infección endodóncica persistente (IEP) representa un desafío en el tratamiento de conductos radiculares. La remoción de bacterias es complicada cuando una terapia de endodoncia convencional no es efectiva, por lo que estrategias adicionales de desinfección deben aplicarse para obtener un tratamiento exitoso. Este artículo reporta el caso de una IEP en un hombre de 58 años de edad que fue referido al posgrado de endodoncia de la Universidad Autónoma de Nuevo León. Aunque un retratamiento endodóncico fue iniciado, el paciente decidió extraerse el diente con un dentista general; un conducto recurrente y una ramificación apical fueron detectados en el diente extraído

A persistent endodontic infection (PEI) represents a challenge in root canal treatments. The bacterial removal is complicated when a conventional endodontic therapy is ineffective; therefore additional strategies of disinfection should be applied to obtain a successful treatment. This article describes a PEI case of a 58-years-old man who was referred to the Department of Endodontics of Nuevo Leon Autonomous University. Although an endodontic retreatment was initiated, the patient decided to remove his tooth with a general dentist; a recurrent canal and an apical ramification were detected in the extracted tooth

Adjunct Antimicrobial Therapy and Periodontal Surgery to Treat Generalized Aggressive Periodontitis: A Case Report.

Here we report a case of generalized aggressive periodontitis treated with periodontal therapy including adjunct antimicrobial therapy and periodontal surgery. The patient was a 22-year-old woman who presented with the chief complaint of gingival recession. Baseline examination revealed generalized plaque deposition and gingival inflammation. Thirty-nine percent of the sites had a probing depth (PD) of 4-6 mm and 2% a PD of ≥7 mm; 63% exhibited bleeding on probing (BOP). Radiographic examination revealed vertical bone loss in the molars and horizontal bone loss in other teeth. Microbiological examination of subgingival plaque revealed the presence of Aggregatibacter actinomycetemcomitans and Tannerella forsythia. Oral health-related quality of life was assessed as a measure of patient-reported outcome. Based on a clinical diagnosis of generalized aggressive periodontitis, initial periodontal therapy and adjunct antimicrobial therapy were implemented. After reducing inflammation and subgingival bacteria, open flap debridement was performed for teeth with a PD of ≥4 mm. Reevaluation showed no sites with a PD of ≥5 mm, a minimal level of BOP, and a marked reduction in the level of the targeted periodontal pathogens. The patient's oral health-related quality of life was slightly worsened during supportive periodontal therapy (SPT). Implementation of adjunct antimicrobial therapy targeting periodontal pathogens and subsequent periodontal surgery resulted in improvement in periodontal and microbiological parameters. This improvement has been adequately maintained over a 2-year period. However, additional care is necessary to further improve the patient's oral health-related quality of life during SPT.

Effect of single-dose low-level helium-neon laser irradiation on orthodontic pain: a split-mouth single-blind placebo-controlled randomized clinical trial.

BACKGROUND: Pain is the most common complication of orthodontic treatment. Low-level laser therapy (LLLT) has been suggested as a new analgesic treatment free of the adverse effects of analgesic medications. However, it is not studied thoroughly, and the available studies are quite controversial. Moreover, helium neon (He-Ne) laser has not been assessed before. METHODS: This split-mouth placebo-controlled randomized clinical trial was performed on 16 male and 14 female orthodontic patients requiring bilateral upper canine retraction. The study was performed at a private clinic in Sari, Iran, in 2014. It was single blind: patients, orthodontist, and personnel were blinded of the allocations, but the laser operator (periodontist) was not blinded. Once canine retractor was activated, a randomly selected maxillary quarter received a single dose of He-Ne laser irradiation (632.8 nm, 10 mw, 6 j/cm(2) density). The other quarter served as the placebo side, treated by the same device but powered off. In the first, second, fourth, and seventh days, blinded patients rated their pain sensed on each side at home using visual analog scale (VAS) questionnaires. There was no harm identified during or after the study. Pain changes were analyzed using two- and one-way repeated-measures ANOVA, Bonferroni, and t-test (α = 0.01, ß > 0.99). This trial was not registered. It was self-funded by the authors. RESULTS: Sixteen males and 11 females remained in the study (aged 12-21). Average pain scores sensed in all 4 intervals on control and laser sides were 4.06 ± 2.85 and 2.35 ± 1.77, respectively (t-test P < 0.0001). One-way ANOVA showed significant pain declines over time, in each group (P < 0.0001). Two-way ANOVA showed significant effects for LLLT (P < 0.0001) and time (P = <0.0001). CONCLUSIONS: Single-dose He-Ne laser therapy might reduce orthodontic pain caused by retracting maxillary canines.

Antimicrobial Effects of Novel Triple Antibiotic Paste-Mimic Scaffolds on Actinomyces naeslundii Biofilm.

INTRODUCTION: Actinomyces naeslundii has been recovered from traumatized permanent teeth diagnosed with necrotic pulps. In this work, a triple antibiotic paste (TAP)-mimic scaffold is proposed as a drug-delivery strategy to eliminate A. naeslundii dentin biofilm. METHODS: Metronidazole, ciprofloxacin, and minocycline were added to a polydioxanone (PDS) polymer solution and spun into fibrous scaffolds. Fiber morphology, mechanical properties, and drug release were investigated by using scanning electron microscopy, microtensile testing, and high-performance liquid chromatography, respectively. Human dentin specimens (4 × 4 × 1 mm(3), n = 4/group) were inoculated with A. naeslundii (ATCC 43146) for 7 days for biofilm formation. The infected dentin specimens were exposed to TAP-mimic scaffolds, TAP solution (positive control), and pure PDS (drug-free scaffold). Dentin infected (7-day biofilm) specimens were used for comparison (negative control). Confocal laser scanning microscopy was done to determine bacterial viability. RESULTS: Scaffolds displayed a submicron mean fiber diameter (PDS = 689 ± 312 nm and TAP-mimic = 718 ± 125 nm). Overall, TAP-mimic scaffolds showed significantly (P ≤ .040) lower mechanical properties than PDS. Within the first 24 hours, a burst release for all drugs was seen. A sustained maintenance of metronidazole and ciprofloxacin was observed over 4 weeks, but not for minocycline. Confocal laser scanning microscopy demonstrated complete elimination of all viable bacteria exposed to the TAP solution. Meanwhile, TAP-mimic scaffolds led to a significant (P < .05) reduction in the percentage of viable bacteria compared with the negative control and PDS. CONCLUSIONS: Our findings suggest that TAP-mimic scaffolds hold significant potential in the eradication/elimination of bacterial biofilm, a critical step in regenerative endodontics.

Brief Communication: An enigmatic enamel alteration on the anterior maxillary teeth in a prehistoric North Italian population.

In this paper we describe a hitherto undocumented modification of the dental enamel surface observed in an Early Bronze Age population from northern Italy. The defect, which can be described as a curvilinear groove, is located on the lingual surface of incisors and canines in the upper jaw. This groove, documented both in the permanent and deciduous dentition, is located at approximately 1 mm from the cervix and extends from the mesiolingual to the distolingual surface. The occurrence of the groove is not related to the sex of the affected individuals, but its degree of expression is related to age at death. Because of its morphology, the groove cannot be considered as a result of disruptions in the process of enamel deposition. At the present stage of research we suggest that the groove might have been the result of some kind of dental erosion caused by as yet unidentified chemical factors.

The influence of four dual-cure resin cements and surface treatment selection to bond strength of fiber post.

In this study, we evaluate the influence of post surface pre-treatments on the bond strength of four different cements to glass fiber posts. Eighty extracted human maxillary central incisors and canines were endodontically treated and standardized post spaces were prepared. Four post pre-treatments were tested: (i) no pre-treatment (NS, control), (ii) sandblasting (SA), (iii) silanization (SI) and (iv) sandblasting followed by silanization (SS). Per pre-treatment, four dual-cure resin cements were used for luting posts: DMG LUXACORE Smartmix Dual, Multilink Automix, RelyX Unicem and Panavia F2.0. All the specimens were subjected to micro push-out test. Two-way analysis of variance and Tukey post hoc tests were performed (α=0.05) to analyze the data. Bond strength was significantly affected by the type of resin cement, and bond strengths of RelyX Unicem and Panavia F2.0 to the fiber posts were significantly higher than the other cement groups. Sandblasting significantly increased the bond strength of DMG group to the fiber posts.

Regenerative endodontic treatment of an immature permanent canine following infant oral mutilation.

Extracting primary canine tooth buds is a ritual ceremony that prevails in some African countries. This procedure is considered infant oral mutilation (IOM) and may damage the permanent successor and adjacent primary and permanent teeth, resulting in dysplastic or deformed teeth. The purpose of this report was to describe regenerative endodontic treatment of a permanent mandibular canine with extensive coronal hypoplasia, immature root, and a periapical radiolucency following damage to the permanent canine that was probably a result of infant oral mutilation. Regenerative endodontic treatment was initiated by irrigating the root canal, followed by applying triple antibiotic paste dressing over three weeks and creating a blood clot scaffold covered with mineral trioxide aggregate. A 4-year clinical and radiographic follow-up demonstrated healing of the periapical radiolucency. This treatment may serve as a substitute for traditional apexification with calcium hydroxide or creation of an artificial apical barrier with mineral trioxide aggregate.

Prevalence of dental erosion in adolescent competitive swimmers exposed to gas-chlorinated swimming pool water.

OBJECTIVES: The purpose of this study was to analyze the prevalence of dental erosion among competitive swimmers of the local swimming club in Szczecin, Poland, who train in closely monitored gas-chlorinated swimming pool water. MATERIALS AND METHODS: The population for this survey consisted of a group of junior competitive swimmers who had been training for an average of 7 years, a group of senior competitive swimmers who had been training for an average of 10 years, and a group of recreational swimmers. All subjects underwent a clinical dental examination and responded to a questionnaire regarding aspects of dental erosion. In pool water samples, the concentration of calcium, magnesium, phosphate, sodium, and potassium ions and pH were determined. The degree of hydroxyapatite saturation was also calculated. RESULTS: Dental erosion was found in more than 26 % of the competitive swimmers and 10 % of the recreational swimmers. The lesions in competitive swimmers were on both the labial and palatal surfaces of the anterior teeth, whereas erosions in recreational swimmers developed exclusively on the palatal surfaces. Although the pH of the pool water was neutral, it was undersaturated with respect to hydroxyapatite. CONCLUSION: The factors that increase the risk of dental erosion include the duration of swimming and the amount of training. An increased risk of erosion may be related to undersaturation of pool water with hydroxyapatite components. CLINICAL RELEVANCE: To decrease the risk of erosion in competitive swimmers, the degree of dental hydroxyapatite saturation should be a controlled parameter in pool water.

Detection of artificial demineralization bordering different types of laminate veneers using visual inspection and storage phosphor radiography.

OBJECTIVE: The objective of this study is to compare the diagnostic accuracy of visual inspection (VI) and storage phosphor plate (SPP) radiography for the detection of artificial demineralization bordering different laminate veneers. MATERIALS AND METHODS: Twenty human maxillary canine teeth were prepared. All-ceramic (A) and hybrid ceramic (H) laminate veneers were fabricated and luted. Veneered teeth were covered except for a circular window on the proximal surface bordering restorations. Teeth were kept in acetic acid buffer to create demineralization and imaged with a SPP system. Ten observers evaluated all teeth first visually then with SPP images for the presence/absence of demineralization. Teeth were examined using scanning electron microscopy (SEM) as well. The accuracy was expressed as the area under the ROC curves (A(z)). Pair-wise comparisons were performed using two-way ANOVA and post hoc t test (p = 0.05). Fleiss kappa (κ) was used for agreement. RESULTS: SPP radiography was better than the VI for both veneers (p = 0.004). The A(z)s of two veneers were different for both VI (p < 0.005) and SPP (p < 0.005). SEM evaluation revealed lesions confined to enamel. κ was fair for H, and fair to moderate for A. Agreement was higher for the radiographic evaluation for both veneers. CONCLUSION: Enamel demineralizations bordering hybrid and ceramic laminate veneers can be detected better with SPP radiography than VI and detectability was better for all-ceramic veneers than the hybrid ceramic ones. CLINICAL RELEVANCE: Early detection of enamel demineralizations bordering laminate veneers would result in time-saving and less-invasive treatment methods; therefore, SPP radiography may be recommended in clinically suspicious cases since it provides better diagnostic accuracy.

Efficacy of low-intensity laser therapy in reducing treatment time and orthodontic pain: a clinical investigation.

INTRODUCTION: The long duration of orthodontic treatment is a major concern for patients. A noninvasive method of accelerating tooth movement in a physiologic manner is needed. The aim of this study was to evaluate of the efficacy of low-intensity laser therapy in reducing orthodontic treatment duration and pain. METHODS: Twenty patients requiring extraction of first premolars were selected for this study. We used a randomly assigned incomplete block split-mouth design. Individual canine retraction by a nickel-titanium closed-coil spring was studied. The experimental side received infrared radiation from a semiconductor (aluminium gallium arsenide) diode laser with a wavelength of 810 nm. The laser regimen was applied on days 0, 3, 7, and 14 in the first month, and thereafter on every 15th day until complete canine retraction was achieved on the experimental side. Tooth movement was measured on progress models. Each patient's pain response was ranked according to a visual analog scale. RESULTS: An average increase of 30% in the rate of tooth movement was observed with the low-intensity laser therapy. Pain scores on the experimental sides were significantly lower compared with the control sides. CONCLUSIONS: Low-intensity laser therapy is a good option to reduce treatment duration and pain.

Brief communication: two-rooted lower canines--a European trait and sensitive indicator of admixture across Eurasia.

With the exception of Carabelli's trait, the European dentition is better known for the morphological traits that it does not exhibit rather than the ones that it does. One root trait, however, runs counter to the characterization of reduced and simplified European crowns and roots. Although a rare trait in general, two-rooted lower canines are much more common in Europeans than in any other regional grouping and, given adequate sample sizes, can be useful in evaluating gene flow between Europeans and neighboring groups. In European samples, two-rooted lower canines consistently exhibit frequencies of 5-8%. In our sample from northern Spain, the trait attains a frequency of almost 10%. In contrast, in Sub-Saharan Africans the trait is virtually unknown while in Asian and Asian-derived populations, it varies between 0.0 and 1.0%. Here we show that two-rooted canine frequencies for new migrants along the western frontiers of China and Mongolia ranged from 0-4%. These data suggest European-derived populations migrated into western China (Xinjiang Province) and Mongolia (Bayan Olgii Aimag) sometime during the late Bronze age (1000-400 BCE).

Anterior discolored teeth restored with procera all-ceramic restorations: a clinical evaluation of the esthetic outcome based on the thickness of the core selected.

UNLABELLED: The most common esthetic challenge associated with endodontics is the discoloration of natural tooth structure. Also in fixed prosthesis, discolorations represent an esthetic limit, particularly in the case of all-ceramic restorations. In fact, the final esthetic result can be compromised by the grey radiated through the coping and soft tissue. PURPOSE: The aim of the study was to evaluate the masking ability of Procera alumina restorations. MATERIALS AND METHODS: Clinical evaluation was investigated by using tests of discolored teeth. Each abutment, classified with Natural Die Material (Ivoclar Vivadent), were manufactured three alumina copings with thickness of 0.4, 0.6, and 0.8 mm, respectively. Masking ability for each coping was evaluated in relation to the degree of discoloration. On the basis of the results obtained, seventeen discolored teeth, treated with Procera alumina restorations, were evaluated. Color match, porcelain surface, marginal discoloration, and marginal integrity were clinically examined following modified CDA/Ryge criteria. CONCLUSION: The Procera AllCeram alumina system seems to be a reliable and excellent technology for the prosthetic treatment of moderate and serious discolored anterior teeth with an exceptionally natural look.

Evaluation of treatment for functional posterior crossbite of the deciduous dentition using Planas' direct tracks.

BACKGROUND: Functional posterior crossbites are a common finding in children with deciduous teeth and must be treated as soon as they are diagnosed in order to avoid unwanted changes in normal growth and development patterns. OBJECTIVE: This study objective was to evaluate the changes caused by Planas' direct tracks treatment on the arch dimensions of patients with functional posterior crossbite in first dentition. MATERIALS AND METHODS: The sample consisted of 20 children, 4 to 6 years old, divided into two groups, paired up according to age and gender. Group test was composed of 10 patients with functional posterior crossbite treated with PDT. Group control consisted of 10 children with normal occlusion. The evaluation criteria were intercanine and intermolar distances and Carrea's analysis (arch perimeter). All data were collected by a pre-calibrated examiner on study casts obtained at baseline and after 4 months of treatment. The statistical analysis of the data was achieved using GraphPad InStat software, version 3.05 for Windows, with the level of significance set at 0.05. For the comparison between intercanine and intermolar distances, the Tukey-Kramer Multiple Comparisons test was used. When Carrea's analysis was considered, the Mann-Whitney test was used. RESULTS: At the beginning of the study, all the evaluated criteria showed lower mean values in patients with posterior crossbites, and significant differences between test and control groups were noticed (P<0.05). After the end of follow-up period, these differences could not be verified (P>0.05). CONCLUSIONS: Within the limits of the present study, it is possible to conclude that the treatment with Planas' direct tracks was able to give back the normal dimensions of deciduous arch in patients with unilateral functional posterior crossbites, thus making it possible a better growth pattern.

Effect on dental stain occurrence by chewing gum containing sodium tripolyphosphate--a double-blind six-week trial.

OBJECTIVE: A six-week controlled double-blind clinical study was conducted to assess and to measure the efficacy of a sugar-free chewing gum containing sodium tripolyphosphate (1%) on dental stain occurrence versus a placebo sugar-free chewing gum. METHODS: One-hundred and eleven subjects who had a Lobene Modified Index for stain extent score between 0.33 and 1.5 in their frontal teeth joined this study. Each subject entered in the test or the control group using a random table which allowed for an equal distribution of smokers and habitual tea users. Participants agreed to chew two gums (two grams each) three times per day, after meals, for ten minutes over six weeks. All received the same dentifrice containing only fluoride as the active agent. After six weeks, participants were scored for dental stain with the Lobene Modified Index. Data were scored by the same blinded operator for all measurements. Comparisons between the groups with respect to baseline scores were performed using an unpaired t-test, and inside the groups with a paired t-test (alpha = 0.05). RESULTS: One-hundred and eight subjects completed the trial; three left, but none reported problems linked to sodium tripolyphosphate. The mean difference for stain extent index after the six-week trial was 0.04 (+/- 0.08) in the control group, and -0.05 (+/- 0.08) in the test group (p < 0.001). A statistically significant reduction was also reported for intensity and composite indexes. The initial mean for stain extent index in the test group was 0.8 (+/- 0.34), and at six weeks was 0.74 (+/- 0.33; p < 0.001). The initial mean for extent index in the control group was 0.78 (+/- 0.3), and at six weeks was 0.81 (+/- 0.32; p < 0.005). CONCLUSION: This trial showed a reduction in dental stain by a chewing gum containing sodium tripolyphosphate after six weeks.

The effect of pulsed electromagnetic fields on the acceleration of tooth movement.

AIM: Accelerating the speed of orthodontic tooth movement should contribute to the shortening of the treatment period. This study was designed to determine whether a pulsed electromagnetic field (PEMF) affects orthodontic tooth movement. METHODS: The canines of one side of 10 patients (mean age 23.0 ± 3.3 years) who needed canine retraction were exposed to a PEMF; the canines on the contralateral sides of the same patients were not similarly exposed. After extraction of the maxillary first premolars, both canines were retracted with coil springs. A circuit and a watch battery were used to generate a PEMF (1 Hz). The generator was embedded in a removable appliance. Foil was used to obstruct the contol group from PEMF exposure. Patients were instructed to use the device from the commencement of canine retraction, and it was removed when Class I canine relationship was achieved in either of the canines after 5.0 ± 0.6 months. The changes in the space between the maxillary canine and first molar were measured to indicate the amount of tooth movement. The canine retraction distances were compared by paired t test. Afterward, the treatment plan was continued. RESULTS: With exposure to a PEMF, canine retraction was 1.57 ± 0.83 mm more than the control group (P<.001). CONCLUSION: These findings suggest that application of a PEMF can accelerate orthodontic tooth movement.

Treatment of a horizontal open bite with an invisible multiloop appliance in a girl with tooth trauma.

This case report presents the treatment of a girl with a Class II horizontal open bite and severe crowding with an invisible appliance. She had been in a severe traffic accident at 5 years 10 months of age. Her teeth, especially the mandibular right lateral incisor, canine, and first premolar had ankylosed, and their roots were severely resorbed and fused to the alveolar bone. Orthodontic treatment started at the age of 12 years. The mandibular left first premolar and both maxillary first premolars were extracted to reduce overjet and crowding. The left first premolar was extracted and transplanted to the extracted position of the right first premolar. Because the patient wanted an invisible appliance, we selected the Fujita lingual bracket system for her treatment. During the final stage of treatment, a multiloop mushroom archwire was placed to correct the open bite in the maxillary arch with vertical elastics. Six years after retention, her occlusion remained stable, and the transplanted premolar was functioning normally.

Retreatment of a resected tooth associated with a large periradicular lesion by using a triple antibiotic paste and mineral trioxide aggregate: a case report with a thirty-month follow-up.

INTRODUCTION: Trauma to the teeth and supporting structures is a frequent problem among children. Endodontic treatment is necessary for 41.3% of traumatized teeth. Two of the most important criteria for successful endodontic treatment are the elimination of microorganisms and apical sealing. A combination of antibiotic drugs (metranidozole, ciprofloxacin, and minocycline) is used to eliminate target bacteria, which are possible sources of endodontic lesions. For cases in which apical sealing is difficult, specific materials to plug the apical region have been advocated. Mineral trioxide aggregate (MTA) has become the material of choice because it is biocompatible and has bacteriostatic action. METHODS: This case report describes the nonsurgical retreatment of a traumatized tooth that had already undergone unsuccessful apical resection associated with a large periradicular lesion. A combination of antibiotic drugs was used as an intracanal medicament, and MTA was used to obtain a hermetic seal of the lateral tooth that had undergone unsuccessful apical resection. RESULTS: On follow up, the tooth was clinically and radiographically asymptomatic for 30 months. CONCLUSIONS: The results of this case show that MTA and triple antibiotic paste can be used clinically in the treatment of an unsuccessfully resected tooth associated with a large periradicular lesion.

Evaluation of several protocols for the application of ultrasound during the removal of cast intraradicular posts cemented with zinc phosphate cement.

AIM: To evaluate several protocols for the application of ultrasound during removal of cast posts with varying core configurations cemented with zinc phosphate. METHODOLOGY: Sixty maxillary canines were distributed into three groups (n = 20): group 1 - core with 5 mm diameter/height and post diameter of 1.3 mm; groups 2 and 3 - core with the same diameter as the post (1.3 mm) and heights of 5 mm and 3 mm, respectively. Posts/cores were cemented using a standard technique with zinc phosphate cement. Each group was divided into two subgroups according to the ultrasonic vibration mode: point vibration - ultrasonic vibration applied to the core surface for 5 s, on each face totalling 25 s; alternate vibration - intermittent application of ultrasonic vibration for 10 s to the labial and lingual surfaces, 10 s to the mesial and distal surfaces and 5 s to the incisal surface, totalling 25 s. The specimens were submitted to the tensile test using an Instron machine (1 mm min(-1)) and results were analysed by anova and t-test. The failure type was also analysed. RESULTS: Statistical analysis showed significant differences between groups relating to the core preparations (P < 0.05). The lowest mean values of traction force were obtained for group 3 (46.1 +/- 7.7 N), followed by group 2 (89.0 +/- 2.7 N) and group 1 (160.4 +/- 7.5 N). Regarding ultrasonic vibration, the lowest mean was observed with alternate vibration (81.1 +/- 10.1 N), which was significantly lower than the point vibration (115.9 +/- 9.5 N) (P < 0.05). Cohesive failure occurred in all cases. CONCLUSION: A reduction in core diameter/height and intermittent ultrasonic application improved the removal of cast posts cemented with zinc phosphate.

Surgically assisted palatine expansion in adult patients: evaluation of a conservative technique.

PURPOSE: This study was conducted to assess a conservative technique for surgically assisted palatine expansion (SAPE) done under local anesthesia and conscious sedation in adults. Dental inclination, uniformity of expansion, and satisfaction of orthodontist were evaluated. PATIENTS AND METHODS: Twenty-seven consecutive patients, ranging in age from 25 to 42 years, underwent SAPE under local anesthesia. The surgical procedure involved osteotomy of the lateral wall of the maxilla, from the maxillary tuberosity to the nasal cavity, with the nasal septum and the ptyerigoid plates left intact. Cast models were obtained before surgery and 1 year after surgery. Cuspid inclinations were assessed, with intercanine distance in 2 points, the incisal and cervical borders, measured before and after surgery. Molar inclination was obtained by measuring intermolar distance at the cervical margin and occlusal table. The results were statistically analyzed by analysis of variance. A questionnaire with 4 questions was addressed to the orthodontists to evaluate the level of satisfaction with the procedure. RESULTS: Cuspid and molar inclination occurred, but there was no statistically significant difference (P < .05) in dental inclination before and after surgery. The expansion was greater at the molar level than at the canine level, but this difference also was not statistically significant (P > .05). According to the questionnaire, 100% of the procedures allowed the expansion, 100% of the orthodontists were satisfied, and 68.75% observed dental inclination, but this inclination was not excessive in 100% of the cases. CONCLUSIONS: The proposed technique is a safe, predictable, and reliable method for SAPE in adult patients. Although ptyerigoid plate and nasal septum fractures were not performed, the maxillary bone exhibited uniform expansion. Dental inclination was not significant, either clinically or during cast model analysis. Orthodontists could achieve treatment objectives with this surgical procedure.

Root canal morphology of permanent maxillary teeth in the Han nationality in Chinese Guanzhong area: a new modified root canal staining technique.

INTRODUCTION: The purpose of this study was to investigate the canal morphology of 504 maxillary permanent teeth of subjects of Han nationality in Chinese Guanzhong area. METHODS: Maxillary permanent teeth were randomly collected in Guanzhong area. After regular preparation, the teeth were immersed into ink without preparing access cavities and then put into hyperbaric oxygen chamber (0.6 Mpa) for 2 hours to let the ink penetrate into root canal from apical foramen, apical deltas and foramen of lateral canals under stable positive pressure. After demineralization and clearing, the following observations were made: (1) number of root canals, (2) root canal configuration by using Vertucci's classification, (3) presence of lateral canals, and (4) frequency of apical deltas. RESULTS: All the teeth were well-stained, and the fine details were well-revealed. Apical deltas (12.2%-83.3%) and lateral canals (13.7%-68.8%) could be frequently found in all types of maxillary teeth. Most of central incisors (95.8%), lateral incisors (91.4%), and canines (75.4%) displayed type I canal configuration, whereas most of first premolars (87.3%) and second premolars (72.3%) possessed 2 canals with type II, IV, or VI canal configuration. The majority of distobuccal roots and palatal roots of first molars (88.9%, 97.8%), second molars (92.0%, 94.0%), and third molars (87.5%, 91.6%) possessed type I canal configuration. The prevalence of mesiobuccal roots with type I configuration was 66.7% in maxillary first molars, 82% in second molars, and 62.5% in third molars. CONCLUSIONS: The modified technique of canal staining can effectively reveal detailed root canal system. The canal configuration of maxillary teeth in subjects of Han nationality in Chinese Guanzhong area is consistent with previous reports in other races.