The relation between apical periodontitis and root-filled teeth in patients with periodontal treatment need.

AIM: To investigate a number of clinical and treatment variables that might have influenced the prevalence of apical periodontitis in root-filled teeth in a population of periodontally compromised patients. METHODOLOGY: This investigation was a retrospective cross-sectional study on data collected from periodontal charts in addition to intra-oral full-mouth radiographs from patients attending the Department of Periodontology of the Dental School of the Ghent University Hospital. Periodontal parameters (clinical attachment loss and the lowest marginal bone level, the history of periodontal treatment), endodontic treatment (length, homogeneity and overall quality of the root filling) and the quality of coronal restorations were related to the prevalence of apical periodontitis. A total of 272 root-filled teeth in 94 patients were evaluated. RESULTS: The periapical condition was significantly influenced by the quality of the root filling and the coronal filling (P < 0.05). More apical periodontitis was seen when the coronal level of the root filling exceeded the marginal bone level (P < 0.005). The marginal periodontal condition seemed to influence the periapical status. Teeth with apical periodontitis were associated with significantly more extended marginal bone loss (P < 0.001). Significantly less apical periodontitis was seen in patients that had received marginal periodontal treatment (P < 0.005), compared with untreated periodontal patients. CONCLUSIONS: Signs of periodontal disease, as reflected by marginal bone loss, are of importance for the periapical condition of root-filled teeth. Efforts should be taken in preventing spread of infection through the periodontal-endodontic pathway by periodontal infection control and a high quality of root filling and coronal filling. Care should also be taken to seal the coronal cavity up to the level of the root filling, where it is advisable to reduce the coronal level of the root filling below or at least at the level of the surrounding marginal bone.

Dental and oral complications of lip and tongue piercings.

Piercing of the tongue and perioral regions is an increasingly popular expression of body art, with more patients coming in for a routine check-up with tongue and/or lip piercings. Several complications of oral piercing have been reported, some of which are life-threatening. In the present clinical survey the prevalence of both tongue and lip piercing complications in oral health was assessed in a group of 50 patients. The most common dental problem registered was chipping of the teeth, especially in association with tongue piercing. Gingival recession was seen as a result of lip piercing with studs. Post-procedural complications included oedema, haemorrhage and infection. Therefore, dentists and oral and maxillofacial surgeons should be given more authority to advise patients with oral and facial piercings or those who plan to acquire this type of body art.

Investigation of the effect of the coronal restoration quality on the composition of the root canal microflora in teeth with apical periodontitis by means of T-RFLP analysis.

AIM: To investigate the effect of the radiographic and clinical quality of coronal restorations on the composition of the root canal flora of teeth with necrotic pulps and teeth with root fillings associated with apical periodontitis. METHODOLOGY: Twenty-eight necrotic pulps and 35 root filled canals with signs of apical periodontitis were studied. Both the coronal filling (presence of radiographically or clinically deficient margins and/or secondary caries) and the root filling (homogeneity and length) were scored. Bacterial root canal samples were taken with sterile paper points under rubber dam and using measures to prevent contamination. A DNA-based nonculture bacterial identification technique was used, namely terminal restriction fragment length polymorphism (T-RFLP) analysis. RESULTS: Twelve samples were negative for bacterial DNA. A total of 33 different terminal restriction fragments (TRFs) were detected. The Fusobacterium nucleatum/Streptococcus mitis group was the most frequently encountered TRF. The mean number of TRFs per necrotic pulp was 6.2 and 5.8 for the groups with acceptable and unacceptable coronal restorations, respectively. This difference was not significant. In the root filled group, these values (respectively, 5.2 and 8.6) were statistically significantly different (P < 0.05). The following parameters in root filled teeth had no significant influence on the mean numbers of TRFs detected: the length and homogeneity of the root filling and the type of tooth (anterior-premolar-molar). CONCLUSION: T-RFLP allowed the rapid assessment of bacterial biodiversity in root canal samples. The technique revealed the presence of bacteria that have rarely been described in the root canals of teeth with apical periodontitis. Biodiversity in the root filled group was high, as compared with culture-dependent studies where monoinfections were more frequently reported. Only in root filled teeth did defective coronal restorations have a statistically significant influence on the mean numbers of detected TRFs per sample.

Shaping ability of ProTaper nickel-titanium files in simulated resin root canals.

AIM: To determine the shaping ability of ProTaper instruments in simulated root canals. METHODOLOGY: Forty canals with four different shapes in terms of angle (20 degrees and 40 degrees) and position of curvature (straight section before curve: 8 and 12 mm) were enlarged according to the recommendations of the manufacturer with the finishing files F1, F2 and F3 to full working length. Preoperative and postoperative pictures, recorded using a digital camera, were superimposed and aberrations recorded. Measurements were carried out at five different points: at the canal orifice (O); half-way to the orifice in the straight section (HO); beginning of the curve (BC); apex of the curve (AC); end-point (EP). RESULTS: Ten instruments deformed (nine F3 and one S1, all in canals with straight section of 8 mm), one instrument fractured. There were significant differences between the various canal shapes for the amount of resin removed from the inner curve at all points (O: P < 0.05; HO: P = 0.001; BC, AC and EP: P < 0.001); and for the resin removed on the outer curve at points HO, AC and EP (P < 0.001). Mean transportation was towards the inner aspect of the curve in all canal types at points BC, towards the outer aspect at the end-point of preparation (EP) in all canals with 12 mm straight section. In 8 mm straight section canals, four danger zones were found; in 12 mm straight section canals three zips were present. The canal aberrations were produced following the use of the F2 and F3 instruments. There were no aberrations following the use of the F1 instrument. CONCLUSIONS: Under the conditions of this study, ProTaper instruments performed acceptable tapered preparations in all canal types. When using F2 and F3 in curved canals, care should be taken to avoid excessive removal at the inner curve, leading to danger zones. In addition, care should also be taken to avoid deformation of the F3 instrument.

Endodontic treatment performed by Flemish dentists. Part 2. Canal filling and decision making for referrals and treatment of apical periodontitis.

AIM: To gather information on root-canal treatment carried out by dentists working in Flanders (Belgium). METHODOLOGY: A questionnaire reported in a previous study was also used to gather information on canal medicaments, canal filling, and in decision making for referrals and treatment of apical periodontitis. RESULTS: Calcium hydroxide as an interappointment dressing was used by 69.7% of the respondents. Approximately one-third of the respondents did not use any intracanal medicament. Caustic products used for pulp tissue fixation were used by 66.8% of the respondents. Cavit (48.2%) and glass-ionomer (31.3%) were the temporary coronal-filling materials used most often, followed by zinc oxide-eugenol and IRM(R). Cold lateral condensation of gutta-percha was the filling technique most used by the respondents (65.8%). Single-cone gutta-percha placement (16%), paste techniques (4.9%) and silver points (3.9%) were still used. Resin-based sealers were used most often (88.6%). Paraformaldehyde containing sealers such as Endomethasone and N2 were used infrequently. Approximately half of the practitioners were satisfied with their canal-filling technique, others felt that they could do better (43.0%); 0.7% were not satisfied. In cases with apical periodontitis, the size of periapical lesions and/or the presence of a root filling influenced the choice of endodontic treatment. The most common reasons for referral of endodontic cases were: retrieval of silver points, surgery, and post removal. CONCLUSIONS: The results of this study indicate that techniques and methods used for canal medication and canal filling were acceptable for the majority of the respondents. Re-treatment was underestimated as a treatment option.

Root canal treatment performed by Flemish dentists. Part 1. Cleaning and shaping.

AIM: To gather information on root canal treatment carried out by dentists working in Flanders (Belgium). METHODOLOGY: A questionnaire was handed to 312 dentists attending peer review sessions organized by the Flemish Universities. Basic information (age, gender, year of graduation, practice profile) and information on various issues relating to the cleaning and shaping of root canals was collected. RESULTS: A total of 310 questionnaires were returned. The majority (85.7%) of respondents categorized themselves as general practitioners; 25.7% mentioned a clinical interest or speciality in practice. Most practitioners (64.5%) did not use rubber dam routinely during root canal treatment and performed treatment over two visits irrespective of the number of root canals. The majority of respondents (82.4%) used sodium hypochlorite as an irrigant, but 10.6% did not know the concentration they used; EDTA was used by 61.6%. The vast majority exposed a radiograph with an instrument of known length in situ to gauge the working length; only 3.6% relied on tactile sense; electronic root canal length determination was seldom used. Amongst the root canal instruments, K-files were used solely or in combination with other instruments by 60.3% of the respondents, reamers were used solely or in combination with other instruments by 55.4%. The stepback technique was used by 31.2% of the participants, a combination of stepdown and stepback by 26.4%, a reaming technique by 26.1% and the step-down technique by 14.7%. The majority were familiar with mechanical root canal Instruments. Almost half of the practitioners believed their preparation technique could be improved: only 1.3% felt that their procedures were poor. CONCLUSIONS: The results of this study indicate that the theoretical knowledge of dentists working in Flanders is good. However, the use of rubber dam remained low, half believed their preparation technique could be improved.

Periapical health related to the quality of coronal restorations and root fillings.

AIMS: To evaluate the impact of the quality of coronal restorations scored on a clinical and radiographic basis and the quality of root fillings on periapical health. METHODOLOGY: Periapical radiographs were taken of 745 root-filled teeth, randomly selected from patients attending the Ghent University Dental School. The teeth had not received restorative treatment in the previous year. The coronal status was scored both clinically according to modified Ryge's criteria, and radiographically by evaluating the presence of signs of marginal leakage or decay. The quality of the root filling was scored according to criteria of length and homogeneity and the periapical status was categorized on the basis of presence or absence of radiographic signs of apical periodontitis. The relationship between coronal status, quality of root filling and periapical health was determined. The data were analyzed using Chi2 test, Odds ratio, Spearman's r(S) and logistic regression. RESULTS: Thirty-three percent of the teeth had apical periodontitis as diagnosed radiographically. Teeth with good and poor coronal restorations scored clinically had apical periodontitis in 31.1 and 36.8%, respectively; this difference was not statistically significant. The quality of the coronal restorations scored radiographically had a statistically significant influence on the periapical condition (P<0.001) with apical periodontitis in 23.8 and 49.1%, respectively, for acceptable and unacceptable restorations. Marginal decay did not influence the periapical status. Teeth restored without a base under the coronal filling had apical periodontitis in 41.3%, whereas teeth with a base had significantly less (P<0.005) apical periodontitis (25.9%). Composite-restored teeth exhibited apical periodontitis in 40.5% of cases whilst amalgam-restored teeth had apical periodontitis in 28.4% of cases; this difference was statistically significant (P<0.01). Root-canal posts had no influence on periapical health. The length and homogeneity of the root-canal fillings had a significant influence (P<0.01 and P<0.001, respectively) on the presence of apical periodontitis, as well as the quality of the coronal restoration scored radiographically (P<0.001). CONCLUSION: The importance of a good coronal restoration, as well as of a good root filling should be emphasized as the technical quality of both influencing the periapical status.

Shaping ability of GTTM Rotary Files in simulated resin root canals.

AIM: The aim of this study was to determine the shaping ability of GT Rotary Files in simulated root canals. METHODOLOGY: Forty canals with four different shapes in terms of angle (40 degrees and 60 degrees) and position of curvature (straight section before curve: 8 and 12 mm) were prepared using a crown-down/stepback technique. Pre-operative and post-operative pictures, recorded using an image analysis system, were super-imposed and aberrations recorded. Measurements were carried out at 5 different points: at the canal orifice (0): half-way to the orifice in the straight section (HO); the beginning of the curve (BC); the apex of the curve (AC): the endpoint (EP). RESULTS: Two instrument fractures occurred and 9 instruments were deformed. Overall, eight zips and one ledge were created. There were significant differences (P < 0.001) for the total width of the canals between the various canal shapes at AC, BC and HO. There were significant differences (P < 0.001) for the amount of resin removed from the outer aspect of the curve at AC, BC and HO; and for the amount of resin removed from the inner aspect of the curve at all five measuring points (0, AC and EP (P < 0.05) and HO and BC (P < 0.001)). Mean transportation was towards the inner aspect of the canal in canals with straight sections of 12 mm regardless the curve angle; towards the outer aspect in canals with straight sections of 8 mm and 40 degrees curves at all the five measuring points, and at AC, BC and HO when the curve was 60 degrees. CONCLUSIONS: Under the conditions of this study, GT Rotary Files produced acceptable canal shapes. In narrow and curved canals, the length of the straight section of the canal determines the direction of transportation more than the angle of the curve. In the 60 degrees curves, a high incidence of instrument deformation was found when using the 0.04 tapered instruments.

The long-term sealing ability of an epoxy resin root canal sealer used with five gutta percha obturation techniques.

AIM: The aim of the present study was to evaluate the long-term sealing ability (both apical and coronal) of an epoxy resin root canal sealer (AH26) when used with different gutta-percha obturation techniques. METHODOLOGY: Straight single-rooted teeth with mature apices were divided into 10 groups of 75 teeth and one group of 40 control teeth. Root canals were prepared according to the crown-down/step-back technique and using both 2.5% sodium hypochlorite and an EDTA paste. Root canals were obturated using cold lateral condensation, warm vertical condensation and hybrid condensation of gutta-percha; and with Thermafil and Soft-Core obturators. AH26 was used as the sealer in all cases. After root canal filling, each group was divided into five individual groups of 15 teeth. The first group of 15 teeth was kept for 1 day, the second for 1 week, the third for 4 months, the fourth for 6 months and the fifth for 12 months at 37 degrees C in vacutainers in 80% relative humidity. The teeth were immersed in India ink for 90 h, each root was split and sectioned longitudinally, and the maximum extent of leakage was measured using a stereomicroscope at x6 magnification. RESULTS: Leakage occurred whatever filling technique was combined with AH26. The number of teeth with gross leakage increased with time up to 4 months, but did not appear to increase between 6 and 12 months storage. The degree of apical leakage and the number of leaking teeth in the Soft-Core obturator groups was significantly higher than all four other gutta-percha obturation techniques. Up to 4 months the degree of coronal leakage and the number of leaking teeth in the Thermafil groups was significantly higher than the other gutta-percha obturation techniques, except for Soft-Core. In the Soft-Core obturator groups the degree of coronal leakage and the number of leaking teeth was significantly higher than the other gutta-percha obturation techniques, except for Thermafil at all evaluation times. CONCLUSION: The hybrid gutta-percha condensation technique was superior to the other four obturation techniques in respect of apical leakage. Coronal leakage was significantly greater during the first 4 months for the Thermafil system as compared to the three condensation techniques; coronal leakage was significantly greater at all time periods for the Soft-Core system. There were no significant differences between the Thermafil and the Soft-core system.