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Title: Root resorption-diagnosis, classification and treatment choices based on stimulation factors. Author: Fuss Z., et al. Journal: Dental Traumatology 2003; 19: 175-82 Reviewer: Allyson Byrne, D.M.D. Purpose: To suggest a clinical-related
classification of root resorption that will assist
clinicians in diagnosis and treatment of this pathological process. Background: Root resorption requires two phases in order to take place - an injury (mechanical or chemical ie. Trauma or bleach) to the protective tissues covering the root (precementum or predentin) which initiates the resorption process, and a continued stimulation of the resorptive process by either infection or pressure. The author suggests that the various types of root resorption be classified according to the stimulating factors. Suggested classification:
Treatment: For internal resorption, the treatment is a pulpectomy since the resorbing cells are pulpal in origin. For external resorption, the treatment is placement of Ca(OH)2 for 6-24 months.
Treatment: Surgically expose the resorptive area and remove the granulation tissue, followed by restoration with composite or amalgam. Endo tx. is necessary only if canal is perforated.
Treatment: Discontinue orthodontic tx. Endo is not necessary.
Treatment: Surgery.
Treatment: There is no tx. for ankylosis. The goal with severe traumas such as avulsions is to minimize damage to PDL cells by either immediately reimplanting the tooth into the socket, or placing the tooth into a suitable storage media until the tooth can be reimplanted.
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Author:
Fred W. Benenati Journal: Dental Traumatology 2003; 19 233-236. Reviewer: Fernando Meza, D.M.D. Purpose: To provide a 16-year follow-up case report of a mandibular second molar that underwent non-surgical endodontic treatment and intentional replantation to relieve subsequent symptoms. Definition: Intentional replantation is the purposeful removal of a tooth and its reinsertion into the socket immediately following extra-oral examination, diagnosis, and treatment. Case
Report: Tooth #19 had conventional root canal treatment several
years ago and restored with a full metal crown. The patient presented
initially with swelling and sensitivity to cold in the lower left quadrant.
Widened PDL space was noted on the mesial root
apex. #18 was diagnosed as irreversible pulpitis. Pulpectomy, and obturation using warm vertical
technique was performed on #18. Retreatment of #19 was performed due to symptoms and inadequate
obturation. The MB canal was unable to be
negotiated. Pt returned with swelling on #19 1 month post-op. Root end
resections of both roots were performed and amalgam retrofillings
were placed. Pt returned 3 months post-op with swelling on #18. Intentional replantation was performed 1 month later following
prescription for Vibramycin for swelling. Pt
returned asymptomatic for both #18 and #19 for 3 month recall. Patient missed
the 6 month recall appointment, but returned 16 years later asymptomatic with
evidence of healing. Discussion: The success and ease of intentional replantation is based on case selection. Fused, conical roots are preferentially selected. Contra-indications include active periodontal disease, non-restorable teeth, curved roots, and missing interseptal bone. Advantages include access, an alternative to apical surgery in cases with close proximity to vital structures, and patient refusal of surgery. Disadvantages include unpredictable extraction, and risk of replacement resorption in the long term.
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Title:
An in vivo comparison of two frequency-based electronic apex
locators Author:
Welk, Baumgartner, and Marshall Journal:
JOE Vol. 29, No.8 August 2003 Reviewer: Michael Moreno, D.M.D. Purpose: To compare the accuracy of a
two-frequency (Root ZX) and a five frequency (Endo Analyzer Model 8005)
electronic apex locator under clinical conditions. Methods
and Materials: 32 teeth (incisors,
canines, and premolars) slated for extraction were accessed. The orifices were flared with Gates Glidden
drills and orifice openers. The canals
were irrigated with 2.6% NaOCl. Both electronic apex locators were used in
each canal to make working length readings with a single K-type file. All working length recordings were made
with he largest instrument that would pass to the
minor diameter. For the Root ZX, the
file was advanced until the flashing bar was reached on the display. For the Endo Analyzer, the file was
advanced until the numeric display read 0.0 and flashed, indicating the
location of the foramen. The files
were cemented in place according to the last working length measurement. The teeth were extracted and radiographed. The
apical 4mm of the root was shaved using a carbide finishing bur along the
long axis of the tooth. Each specimen
was photographed at 15x and 30x original
magnification, and projected onto a large viewing screen. Two investigators marked the distance of
the file position in relation to the minor diameter microscopically for each
specimen. The distance from the end of
the file to the minor diameter was measured and recorded. Results: The mean distance between the
electronic apex locator (EAL) working length and minor diameter was 1.03 mm
with a range of +0.21 to +4.58mm for the Endo Analyzer Model 8005, and 0.19
mm for the Root ZX, with a range of –0.5 to +1.73mm. In no case was the file short of the minor
diameter using the Endo Analyzer. The
minor diameter (± 0.5mm)
was located 90.7% of the times for the Root ZX an 34.4% of the
times for the Endo Analyzer Model 8005.
The Endo Analyzer had significantly longer readings beyond the minor
diameter than the Root ZX. Four EALs of both models were tested on each tooth for
consistency. Each brand of EAL
consistently measured the same length with no deviation in values between
similar devices. The file length of 6/32 (18.7%) appeared to be radiographically at or within 0.5mm of the radiographic
apex, when in fact the tip was beyond the foramen. Conclusion: The use of EALs is a reliable method for determining root canal length. The Root ZX was able to locate the minor diameter more frequently than the Endo Analyzer.
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