ABSTRACT
BACKGROUND: X-linked hypophosphatemia is associated with a range of dental problems, many of which may result in early loss of the dentition. Most patients, but especially young adults, are likely to desire fixed prosthodontic replacements, and dental implants may be the preferred solution in many cases. The use of dental implants to rehabilitate this patient group has not been widely studied with the literature limited to a small number of case reports with limited follow-up. CASE PRESENTATION: This case report describes the dental journey of a young adult with X-linked hypophosphatemia, his eventual tooth loss and rehabilitation with multiple dental implants. Over 10 years' follow-up of three of the fixtures is presented. CONCLUSIONS: This case report shows a common presentation and progression of a patient with X-linked hypophosphatemia and will hopefully provide further positive evidence for the clinician to rely on when considering dental implant based treatments for such patients.
ABSTRACT
Although the principles of endodontics have remained unchanged for many decades, root canal treatment has been subject to major changes in the past few years. This paper outlines the cutting-edge advances including the materials and techniques used. CPD/Clinical Relevance: This article provides an overview of bioactive materials and insight into regenerative endodontics, vital pulp therapy and intentional replantation.
Subject(s)
Root Canal Therapy/trends , Forecasting , Humans , Root Canal Therapy/methods , Root Canal Therapy/standardsABSTRACT
Clinicians are often faced with endodontic cases that are significantly more challenging than the primary root canal treatment of mature adult teeth. This paper outlines some of the common treatment modalities which can be employed in situations in which either primary treatment has failed, or there is iatrogenic damage or unusual anatomy. CPD/Clinical Relevance: This paper will provide the reader with advice and techniques for undertaking orthograde endodontic retreatment, hemisection, endodontic surgery and management of teeth with incompletely formed roots.
Subject(s)
Root Canal Therapy/methods , Humans , Practice Guidelines as Topic , Root Canal Therapy/instrumentationABSTRACT
Once cleaning and shaping is complete the clinician must obturate the canal. There are many different materials and techniques available each with their own discrete advantages and disadvantages. Whichever technique is used, the goal is to seal the entire prepared length of the root canal. This paper describes how best this may be achieved. CPD/Clinical Relevance: It is incumbent on the clinician to ensure that once the canal has been prepared it is sealed from bacterial re-entry.
Subject(s)
Root Canal Obturation/methods , Dental Cements/chemistry , Dental Pulp Cavity/pathology , Gutta-Percha/chemistry , Humans , Nylons/chemistry , Polyesters/chemistry , Polymers/chemistry , Root Canal Filling Materials/chemistry , Root Canal Obturation/instrumentation , Root Canal Therapy/methods , Surface Properties , TemperatureABSTRACT
The complex anatomy of the tooth limits the ability to eradicate pathogens by mechanical means alone. Irrigation is the key to solving this problem. This paper highlights the importance of irrigation, the key irrigants available and methods of improving the performance of irrigants within the canal. CPD/CLINICAL RELEVANCE: To provide advice on which irrigants to use, how to use them effectively and safely and what to do if irrigants are extruded beyond the apex.
Subject(s)
Root Canal Irrigants/therapeutic use , Root Canal Preparation/methods , Root Canal Therapy/methods , Therapeutic Irrigation/methods , Drug Combinations , Humans , Root Canal Irrigants/administration & dosage , Root Canal Preparation/instrumentation , Therapeutic Irrigation/instrumentation , Time Factors , UltrasonicsABSTRACT
The restoration of endodontically-treated teeth is a topic that has been extensively studied and yet remains controversial. The endodontically-treated tooth can be restored with a wide range of techniques of varying complexity. This article reviews the literature on this topic. Consideration is given to the ferrule and its importance in achieving success. Furthermore, consideration will be given to the use of endodontically-treated teeth as abutments for fixed and removable prostheses and the challenges this presents. Clinical recommendations are presented as guidelines to improve the predictability and outcome of treatment when restoring structurally compromised root-filled teeth. Clinical relevance: The prognosis of endodontically-treated teeth depends not only on the success of the endodontic treatment, but also on the type of reconstruction.
Subject(s)
Dental Restoration, Permanent/methods , Tooth, Nonvital/therapy , Dental Prosthesis Design , HumansABSTRACT
Poor access and iatrogenic damage can result in failed root canal treatment. Understanding tooth anatomy improves access and ensures that the clinician is cleaning and shaping the whole root canal system. If a canal is missed treatment usually fails. This paper revisits tooth anatomy and discusses how to ensure that access is optimized, but not at the expense of precious tooth structure. The concept of multi-visit root canal treatment is also addressed with emphasis on the, often overlooked, aspect of temporization. CPD/Clinical Relevance: Good anatomical knowledge of teeth is the cornerstone of endodontics. Once root treatment has begun the clinician must be logical about how many visits to take and how to temporize teeth between such visits.
Subject(s)
Root Canal Preparation/methods , HumansABSTRACT
Following a diagnosis of irreversible pulpal disease, periapical disease or failed endodontic therapy, the options for the tooth are extraction or root canal treatment. There is increasing evidence that certain factors may allow the clinician to predict the likely outcome of root canal therapy (RCT) and thus better inform the patient of the possible success rates. Should the patient choose root canal treatment, the clinician must also be able to gauge the potential difficulties that may be encountered and consequently determine whether it is within their competency. CPD/CLINICAL RELEVANCE: Assessing outcomes and complexity of care is an essential part of informed consent. Knowing when to refer is an essential component of best clinical practice.
Subject(s)
Patient Care Planning , Root Canal Therapy/methods , Clinical Competence , Decision Making , Dental Caries/complications , Dental Implants, Single-Tooth , Dental Pulp Diseases/diagnosis , Dental Pulp Diseases/therapy , Denture, Partial , Forecasting , Humans , Informed Consent , Periapical Diseases/diagnosis , Periapical Diseases/therapy , Periodontal Diseases/complications , Referral and Consultation , Retreatment , Root Canal Preparation/instrumentation , Root Canal Preparation/methods , Rubber Dams , Tooth Extraction , Tooth, Nonvital/therapy , Treatment OutcomeABSTRACT
The purpose of instrumentation is to facilitate irrigation and allow controlled obturation. This article will revisit methods of instrumentation of the root canal system with consideration given to length determination, apical preparation and the concept of patency filing. It will discuss hand instrumentation and rotary preparation looking at emerging technology such as reciprocating systems and the self-adjusting file. CPD/CLINICAL RELEVANCE: Mechanical preparation of the root canal system is of fundamental importance in achieving success, creating a more easily managed environment from a biological perspective.
Subject(s)
Root Canal Preparation/methods , Dental Alloys/chemistry , Dental Pulp Cavity/anatomy & histology , Electrical Equipment and Supplies , Equipment Design , Humans , Nickel/chemistry , Odontometry/instrumentation , Odontometry/methods , Radiography, Bitewing , Root Canal Irrigants/therapeutic use , Root Canal Obturation/methods , Root Canal Preparation/instrumentation , Rotation , Smear Layer/pathology , Therapeutic Irrigation/methods , Titanium/chemistry , Tooth Apex/anatomy & histologyABSTRACT
STATEMENT OF PROBLEM: Several factors exist which result in crown preparations that are less than ideal. In these situations, the clinician should find a practical way to overcome the lack of resistance of the compromised tooth preparation. PURPOSE: The purpose of this study was to evaluate the effect of different auxiliary features on the resistance form of crowns with reduced axial wall height and increased total occlusal convergence. MATERIAL AND METHODS: An Ivorine tooth was prepared on a milling machine with 22 degrees of total occlusal convergence (TOC), 3.0 mm of occlusocervical height, and a chamfer finish line (Group Ctrl). The crown preparation was subsequently modified to include proximal grooves (Group Grv), and reduced TOC from 22 to 4 degrees in the cervical 1.5 mm (Group Rdc). Ten standardized metal dies were fabricated for each group. Cobalt-chromium copings were fabricated for all specimens. The metal copings were cemented onto their corresponding metal dies with zinc phosphate cement. The resistance of each specimen was evaluated when force was applied at a 45-degree angle to the long axis of the die with a universal testing machine in a buccal to lingual direction. The maximum force (newtons) was applied before coping dislodgment was measured. Data from the 3 groups were compared with a 1-way ANOVA (α=.05) and a Post Hoc Bonferroni test. RESULTS: The mean (SD) force needed to dislodge crowns with proximal grooves was 156.75 (30.96) N and for those with reduced TOC, it was 221.06 (27.02) N, Both were effective in increasing the resistance form of the original shape (P=.002 and P<.001 respectively). The reduced TOC increased the resistance significantly more than the proximal grooves (P<.001). CONCLUSIONS: Within the limitations of this in vitro study, crown preparation modifications enhanced the resistance form; however, the reduction in cervical TOC proved to be more effective than proximal grooves.