Clinical Testing of Walking Bleach, In-Office, and Combined Bleaching of Endodontically Treated Teeth.

Objective. The causes of internal posteruptive discoloration of teeth are bleeding, necroses, infections, and endodontic filling materials. The aim of this study was to establish the results of bleaching endodontically treated teeth using walking bleach, in-office, and combined techniques, using 30% carbamide peroxide and 35% hydrogen peroxide, as well as the effect of etiological factors, and the time elapsed after endodontic treatment on the success of bleaching. Materials and Methods. The research involved 30 endodontically treated teeth in healthy patients. Retroalveolar X-rays were taken to check the quality of root canal obturation. Endodontic treatment and obturation were carried out on the discolored non-vital teeth without any previous endodontic treatment. Before bleaching, two millimeters of the filling were removed from the root canal and the very entry into the canal was protected with glass ionomer cement. The teeth were divided into three groups, depending on the bleaching technique: walking bleach technique (10 patients), in-office technique (10 patients), and combined technique (10 patients). The teeth were bleached with 30% carbamide peroxide and 35% hydrogen peroxide. The bleaching procedure was repeated in all the patients three times. The color of all teeth was determined based on the Vita Classic guide before and after bleaching. The Χ2 square and Kruskal−Wallis tests were used to identify differences in teeth bleaching results. Results. A statistically significant difference (p < 0.05) was established between bleaching success and the time elapsed after endodontic treatment. There were no statistically significant differences observed between the bleaching success and etiological factors, bleaching techniques, or bleaching agents. Conclusions. The effectiveness of non-vital tooth bleaching is affected by the time elapsed after endodontic treatment.

Endodontic Periapical Lesion: An Overview on the Etiology, Diagnosis and Current Treatment Modalities.

Nonsurgical and surgical endodontic treatments have a high success rate in the treatment and prevention of apical periodontitis when carried out according to standard and accepted clinical principles. Nevertheless, endodontic periapical lesions remain in some cases, and further treatment should be considered when apical periodontitis persists. Although several treatment modalities have been proposed for endodontically treated teeth with persistent apical periodontitis, there is a need for less invasive methods with more predictable outcomes. The advantages and shortcomings of existing approaches for the diagnosis and treatment of endodontic periradicular lesions are discussed in this review.

Devitalization of adjacent teeth following maxillary sinus floor augmentation: A retrospective radiographic study.

BACKGROUND: Elevation of the schneiderian membrane, during maxillary sinus floor augmentation (MSFA) may theoretically result in devitalization of adjacent teeth, which are in a close spatial relationship to the sinus floor. PURPOSE: To assess retrospectively the probability of devitalization of teeth adjacent to the osteotomy site after MSFA in a relatively large number of patients. MATERIALS AND METHODS: All MSFA procedures, performed at a university oral surgery clinic within a time period of 10 years, were assessed on the following eligibility criteria: (1) presence of vital teeth (ie, not root canal treated and no periapical radiolucency on a panoramic radiograph taken just after MSFA), (2) presence of a 3 to 12 months postoperative radiograph of the teeth adjacent to the osteotomy site displaying the root apices, and (3) complete medical records up to at least 12 months postoperatively. The radiographs of the different time points were compared and any changes in the radiographic status of the adjacent teeth (eg, development of a periapical lesion, root canal treatment, etc.) were recorded and the spatial relationship of the adjacent teeth to the maxillary sinus classified. RESULTS: Out of 684 MSFAs, 257 fulfilled the inclusion criteria and involved 357 adjacent teeth, of which 221 presented close to and/or intimate relationship to the sinus. In only a single case, tooth vitality might have been lost due to the procedure. Thus, the probability for tooth devitalization for teeth with close to and/or intimate spatial relationship to the sinus floor ranged from 0.45% to 0.7%. CONCLUSIONS: Even for teeth with apices very close to and/or intimately related to the sinus tooth devitalization after MSFA is an extremely rare complication; that is, the probability of tooth devitalization after MSFA is ≤0.7%.

Prevalence of Periapical Rarefying Osteitis in Patients with Rheumatoid Arthritis.

INTRODUCTION: The effect of rheumatoid arthritis (RA) on the healing and pathophyisiology of apical periodontitis is unknown because there is no study in the literature evaluating the association of RA with the prevalence of periapical rarefying osteitis (PAR) and endodontic treatment. Therefore, the goal of this cross-sectional study was to evaluate the prevalence of PAR and root canal treatment in RA patients when compared with controlled individuals. METHODS: Full-mouth radiographs of 131 individuals with RA were examined and compared with 131 controls that were sex and age matched exactly with the diseased group. The total number of teeth, presence or absence of root canal filling, quality of root canal filling, quality of restoration, and periapical status were recorded. RESULTS: Overall, the prevalence of teeth with PAR was 4.0% in the diseased group and 3.5% in the control group (P > .05). The prevalence of root canal-treated teeth was 6.2% in the RA group and 5.6% in the control group (P > .05). Controls have significantly more teeth than those with RA (P = .027). CONCLUSIONS: The prevalence of PAR and endodontic treatment was not significantly different in individuals with RA compared with control patients.

Implant-associated Vertical Root Fracture in Adjacent Endodontically Treated Teeth: A Case Series and Systematic Review.

INTRODUCTION: This study aimed to report a possible effect of the presence of an adjacent implant on the development of a vertical root fracture (VRF) in endodontically treated teeth. METHODS: A series of 8 cases in 7 patients with teeth diagnosed with VRF after the placement of implants in the adjacent area is described and analyzed. In addition, a comprehensive literature search with strict inclusion and exclusion criteria was undertaken to identify additional clinical studies that assessed this clinical scenario. RESULTS: The case series analysis revealed that the time from implant placement to the diagnosis of VRF was between 5 and 28 months (average = 11 months). The majority of cases occurred in female patients who received 2 or more implants. Six of the 7 patients were older than 40 years, with an average age of 54 years. The majority of teeth with VRF were premolar or mandibular molar teeth (6/8 teeth). All fractured teeth had been restored with a crown and had a post present, and the quality of the root canal filling was determined to be adequate. The systematic review revealed that implant-associated VRF has not been investigated or reported in the literature yet. CONCLUSIONS: Based on a systematic review of the literature, this case series, although limited in its extent, is the first clinical report of a possible serious adverse event of implant-associated VRF in adjacent endodontically treated teeth. Additional clinical studies are indicated to shed light on this potential phenomenon.

A retrospective analysis of factors influencing the success of autotransplanted posterior teeth.

BACKGROUND: Survival and success rates of tooth transplantations even after long follow-up periods have been shown to be very high. Nevertheless, it is important to analyse factors potentially influencing these rates. The aim of this study was to assess the influence on success of potential factors. METHODS: The research was based on a retrospective analysis of clinical and radiological data from a sample of 59 subjects (75 transplanted teeth). The follow-up period varied from 0.44 to 12.28 years (mean 3.95 years). Success rates were calculated and depicted with Kaplan-Meier plots. Log-rank tests were used to analyse the effect of root development stage, apex width, the use of enamel matrix proteins or the surgeon on success of transplantations. RESULTS: Results for success of premolar transplantations were comparable with already published data, while molars performed worse than shown in other studies. The surgeon performing the transplantation (p = 0.001) and tooth type (p ≤ 0.001) were significantly associated with transplantation success. Use of enamel matrix proteins (p = 0.10), root development stage (p = 0.13), the recipient area (p = 0.48) and apex width (p = 0.59) were not significantly associated with success. CONCLUSIONS: Molar transplantations were not as successful as premolar transplantations; however, success rates varied greatly depending on the surgeon's experience. The use of enamel matrix proteins as well as root development stage, the recipient area and apex width did not show significant associations with success of tooth transplantations.

[Vitality loss: influence of orthodontic process]. / Perte de vitalité : influence des procédures orthodontiques.

Vitality loss is an unusual event that can occur before, during or after an orthodontic treatment. It can lead to loss of sensitivity, color change or necrosis of the pulp tissue. Before starting the orthodontic treatment, we have to identify the tooth's risk (injured tooth, included occlusal trauma...). Knowing that, if an endodontic treatment has to be done, it is better to do it before starting orthodontic forces. Lamps do not provide problems except high intensity halogen ones. RPE on children, Le Fort I and mandibular osteotomies, corticotomies, genioplasties are responsible of a transitory ischemia without reaching a pathogen level. Mini-screws or mini-plates may be iatrogenic, if they impact the root. The repair options depend on the delay before removing the miniscrew and the nature of injured tissue.

Substantial bone loss in the mandibular central incisors area as a complication of tongue piercing: a case report.

BACKGROUND: Along with the increasing popularity of oral piercings, the number of reported complications and side effects increases, too. CASE REPORT: The aim of this report is to present a case of substantial bone loss in the area of the mandibular central incisors caused by lingual piercing and persistent bad habits. Dentist should be aware of potential complications associated with oral piercings and warn patients about them.

Loss of pulp vitality after maxillary sinus augmentation: a surgical and endodontic approach.

BACKGROUND: Maxillary sinus augmentation is a routine procedure performed in implant dentistry in cases with sinus pneumatization. This study presents a series of clinical cases in which tooth devitalization occurred in conjunction with sinus augmentation. METHODS: In the three cases presented, a sinus-lift procedure was performed that resulted in devitalization of the adjacent teeth. Patients were referred to an endodontist for evaluation and treatment. Vitality of the teeth was determined by the use of a cold test, electric pulp test, and cavity test. The pulp was considered to be necrotic if the tests were negative. RESULTS: In this case series, loss of pulp vitality of two maxillary left second premolars and one maxillary left first molar occurs after sinus-augmentation procedures. The devitalized teeth were free of caries. In one case, two amalgam restorations were present. CONCLUSION: Pulp necrosis may occur in conjunction with a sinus-lift procedure in cases when an adjacent root is in close proximity to the sinus floor and the sinus membrane is elevated over the root apex.

A retrospective comparative 8-year study of cumulative complications in teeth adjacent to both natural and implant-supported fixed partial dentures.

PURPOSE: To compare the complication rate of natural teeth adjacent to implant supported dentures (IFDs) with that of teeth serving as abutments for fixed partial dentures (FPDs). The second goal was to assess the risk factors for complications in teeth adjacent to bounded edentulous spaces. MATERIALS AND METHODS: The study subjects were selected from patients who received prosthodontic treatment for their bounded edentulous space not exceeding two missing teeth between February 1990 and March 2007. Sixty-one patients were included in the IFD group and 66 patients were included in the FPD group. Tooth complications were defined as tooth extraction, periodontal lesion, periapical lesion, and loss of prosthesis and were assessed by one examiner based on dental records. RESULTS: The 8-year cumulative complication rate for the IFD group (7.9%) was significantly lower than for the FPD group (40.7%). Additionally, the 8-year cumulative complication rate of vital teeth (6%) was significantly lower than that of nonvital teeth (45.9%). A cox proportional hazard analysis revealed that nonvitality of dental pulp was a significant risk factor for tooth complications, whereas treatment modality was not. CONCLUSIONS: Teeth adjacent to IFD-treated edentulous spaces presented fewer complications than natural teeth serving as abutments for FPDs. Conservation of teeth adjacent to edentulous spaces as vital teeth was the key finding to limit further tooth loss.

Long-term effect on tooth vitality of regenerative therapy in deep periodontal bony defects: a retrospective study.

Over the last few decades, many authors have investigated the effect of periodontal disease and treatment on pulpal status with controversial results. This study was conducted to verify whether periodontal disease in a deep intrabony defect and complex therapy, including aggressive root planing such as in periodontal regeneration, have an influence on tooth vitality. One hundred thirty-seven patients who fulfilled the requirements were included. The collected data did not support the need for "preventive" root canal treatment in severely compromised teeth that are planned to undergo periodontal regenerative surgery.

Root fractures: the influence of type of healing and location of fracture on tooth survival rates - an analysis of 492 cases.

AIM: The purpose of this study was to analyze tooth loss after root fractures and to assess the influence of the type of healing and the location of the root fracture. Furthermore, the actual cause of tooth loss was analyzed. MATERIAL AND METHODS: Long-term survival rates were calculated using data from 492 root-fractured teeth in 432 patients. The cause of tooth loss was assessed as being the result of either pulp necrosis (including endodontic failures), new traumas or excessive mobility. The statistics used were Kaplan-Meier and the log rank method. RESULTS AND CONCLUSIONS: The location of the root fracture had a strong significant effect on tooth survival (P = 0.0001). The 10-year tooth survival of apical root fractures was 89% [95% confidence interval (CI), 78-99%], of mid-root fractures 78% (CI, 64-92%), of cervical-mid-root fractures 67% (CI, 50-85%), and of cervical fractures 33% (CI, 17-49%). The fracture-healing type offered further prognostic information. No tooth loss was observed in teeth with hard tissue fracture healing regardless of the position of the fracture. For teeth with interposition of connective tissue, the location of the fracture had a significant influence on tooth loss (P = 0.0001). For teeth with connective tissue healing, the estimated 8-year survival of apical, mid-root, and cervical-mid-root fractures were all more than 80%, whereas the estimated 8-year survival of cervical fractures was 25% (CI, 7-43%). For teeth with non-healing with interposition of granulation tissue, the location of the fracture showed a significant influence on tooth loss (P = 0.0001). The cause of tooth loss was found to be very dependent upon the location of the fracture. In conclusion, the long-term tooth survival of root fractures was strongly influenced by the type of healing and the location of the fracture.

Endodontic management in a patient with vitamin D-resistant Rickets.

INTRODUCTION: Hypophosphatemic vitamin D-resistant rickets (VDRRs) is a metabolic bone disease caused by abnormalities in the vitamin D receptive system or in phosphate and calcium metabolism. This condition occurs in growing skeleton affecting bone and dentin mineralization, resulting in systemic and oral manifestations. METHODS: A 15-year-old boy was referred to the private clinic for endodontic treatment in #9. His medical history revealed VDRR disease. The dental findings were multiple periapical lesions in several teeth without obvious reason such as caries or trauma. The radiographic examination showed short roots, enlarged pulp chambers with longer pulp horns, thin dentin and enamel, missing or poorly defined lamina dura, and abnormalities in the cementoenamel junction, all pathognomonic features of the disorder. Conservative endodontic treatment was completed in all teeth with pulp necrosis and rarefactions. RESULTS: A 6-month, 1-year, and 2-year follow-up radiographic examination revealed progressive improvement with bone reconstruction without any clinical symptoms. CONCLUSIONS: Early diagnosis, conventional treatment, and continuous radiographic examination are important factors in improving dental alterations in patients with VDRRs.

Can traumatic occlusion cause endodontic problems? A case report.

Radicular cysts are commonly found odontogenic cysts in the jaws. The lesion is diagnosed mainly in young patients during the second decade of life. In the majority of cases, it is asymptomatic. This paper reports a rare case in which traumatic occlusion was identified as the etiology of a radicular cyst. Endodontic treatment was performed and the traumatic occlusion also was corrected. A six-month follow-up appointment found good healing of the periapical region.

Treatment of severe inflammatory root resorption in a young permanent incisor with mineral trioxide aggregate.

Inflammatory root resorption is a pathologic condition caused by several etiologic factors including traumatic dental injury. In this case report, we describe treatment of a maxillary lateral incisor affected by severe, perforating inflammatory root resorption. An 11-year-old patient presented with a previously traumatized, root-filled maxillary lateral incisor associated with pain, mobility and a sinus tract. Radiographic examination revealed a large periradicular lesion involving pathologic resorption of the apical region of the root. After removal of the root canal filling, the tooth was treated with intracanal calcium hydroxide for 2 weeks. The calcium hydroxide dressing was then removed and the entire root canal was filled with mineral trioxide aggregate. The endodontic access cavity was restored with composite resin. After 1 year, advanced osseous healing of the periradicular region had occurred and no clinical symptoms were apparent.

Surgical complications of segmental Le Fort I osteotomy.

Segmental maxillary osteotomy is a useful adjunct in orthognathic surgery for the correction of vertical and transverse maxillary deformities, but we know of few published reports that document complications. We evaluated the complication rates associated with segmental maxillary surgery in our unit by retrospective review of medical records, radiographs, and study models of 85 consecutive patients (mean age 23.3 years, range 14-51; male:female ratio 1:2) treated from 1995 to 2009. Types of deformity were anterior open bite (n=30, 35%), transverse maxillary deficiency (n=24, 28%), anterior open bite with transverse maxillary deficiency (n=28, 33%), and anterior vertical maxillary excess (n=3, 4%). There were 70 tripartite (82%), 13 bipartite (15%), and two quadripartite (2%) maxillas. Twenty-one patients (25%) had bone grafts. Fixation was done using titanium miniplates in 80 patients (94%), and titanium miniplates and resorbable plates in five (6%). The overall complication rate was 27%. Three patients (4%) had devitalisation of teeth, three (4%) developed minor periodontal defects, and one had tooth loss. Eight patients (9%) had plates removed, and two patients developed persistent postoperative palatal fistula. There was no segmental loss of bone or teeth. Our results show that complications in this cohort were relatively low, and that segmental maxillary surgery is safe as an adjunct in carefully selected cases.