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Title: Increased width of the apical periodontal membrane space in endodontically treated teeth may present favourable healing Author: Halse, A, & Molven, O. Journal: International Endodontic Journal, Vol. 37(8)552, August 2004. Reviewer: Aaron Doms, D.D.S. Purpose: To determine whether a wider periodontal space than the typical appearance might represent a radiographically stable healing pattern and thereby be interpreted as a successful treatment result. Material &Methods: A series of periapical x-rays were taken of 131 patients (265 roots) 20-27 years after root canal treatment. The same individuals had been examined 10 years earlier, and radiographs taken immediately after treatment were also available. Fourteen roots (5.6%) demonstrated increased width of the apical periodontal space at the end of the study period. These were subjected to further analysis in an attempt to disclose possible explanatory factors. Results: Two of the fourteen cases had reduced marginal bone levels interpreted as the origin of the increased width of the periodontal space (IW). In three cases, overextended root filling material present 10 years earlier had disappeared and the persistent IW was interpreted as representing a remodeling process. In six cases the findings were explained as being caused by physical and anatomical factors that represented healing without re-formation of the apical periodontal structures, or both. And, three cases were classified as unfavourable on the basis of lacking progress in healing, unsatisfactory obturation of the apical portion of the root canal or dentine resorption close to the apical end of the root filling. Conclusion: Most of the fourteen IW cases examined after 20-27 years could be explained by reduced marginal bone support, or by physical and anatomical factors or they might represent incomplete reformation of the typical apical morphology and were thereby recorded as favourable outcomes.
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Title: Cultivable microbial flora associated with persistent periapical disease and coronal leakage after root canal treatment: a preliminary study Author: Adib et al. Journal: International Endodontic Journal, Vol. 37(8)542, 2004 Reviewer: Hung Do, DDS Purpose: To identify bacterial flora in root filled teeth with persistent periapical (PA) lesions and to locate their distribution within the root canal system Materials &Methods: · 8 freshly extracted root filled teeth with persistent PA lesions were used · 7 of these had evidence of coronal leakage · teeth were transported to an anaerobic chamber after extraction · each tooth was sectioned transversely into 3 parts (crown, coronal root, apical root) · sections were then split and samples were taken in canal area using paper points · samples were placed into reduced transport medium, diluted, and cultured both aerobically and anaerobically · bacterial strains were identified using microbiological techniques and commercial enzyme tests. Results: · 252 strains were isolated from all the teeth · 75% were Gram + facultative anaerobes a. 19% were staphylococci b. 17% were streptococci c. 8% were enterococci d. 8% were Actinomyces · 17% were obligate anaerobes a. 7% were peptostreptococcus · 5.6% were aerobes · due to small sample size, a statistical association between sample site and bacterial flora could not be shown Conclusion: Failed root canals with persistent PA lesions are mostly due to Gram+ facultative anaerobes. |
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Title: A clinical report of 85 fractured metallic post-retained crowns Author: Fox et al. Journal: International Endodontic Journal, Vol. 37, 561-573, 2004 Reviewer: Sahrip Kim, DDS Purpose: A longitudinal case study was undertaken to determine any patient, technique or material factors that were significantly associated with post fracture in metallic post systems. Methods &Materials: Eighty-five fractured posts were obtained from 84 patients. The posts were removed using ultrasonic vibration and/or Masserann trepan instrumentation. Clinical information were recorded including date of removal, tooth number, history of trauma, length of time since the post placement, number of teeth in dentition, excursive occlusal scheme, type of post, and evidence of root fracture. Radiographic examination was performed preoperatively for each tooth and the length of each post was measured. Results:
Conclusion:
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Title: The efficacy of pain control following non-surgical root canal treatment using ibuprofen or a combination of ibuprofen and acetaminophen in a randomized, double-blind, placebo-controlled study. Author: K. A. Menhinick, et al Journal: International Endodontic Journal Vol 37; 531-541, 2004 Reviewer: Vahid Atabakhsh, DDS Purpose: To compare ibuprofen against a combination of ibuprofen and acetaminophen or a placebo. Methods and Materials: Patients presenting at the Texas A&M Baylor College of Dentistry’s graduate endodontic clinic, experiencing moderate to severe pain, where considered potential candidates. Fifty-seven patients were included based on established criteria. Following administration of local anesthesia, a pulpectomy was performed. No intra-canal medicament was placed. The patients were administered a single dose of either (i) placebo; (ii) 600 mg ibuprofen; or (iii) 600 mg ibuprofen and 1000 mg of acetaminophen (in a double blind manner). Patients recorded pain intensity following treatment on a visual analog scale and a baseline four-point category pain scale s well as pain relief every hour for the first 4 hour then every 2 hours thereafter for a total of 8 hours. A general linear model (GLM) analysis was used to analyze the outcome. Results: Based upon the GLM analysis, there was a significant difference between the ibuprofen and the combination drug groups. There was no significant difference between the placebo and ibuprofen. Conclusion: The results demonstrate that the combination of ibuprofen with acetaminophen may be more effective than ibuprofen alone for the management of postoperative endodontic pain. The original estimation of a statistically significant sample size was calculated to be 60. Only 57 patients were included due to time constraints. The insignificant result between the placebo and 600 mg of ibuprofen may be due to this issue. Also, since the study did not include an acetaminophen only group, one can only infer a positive interaction when the drugs are combined (can not say that combination therapy was better than acetaminophen treatment alone). |
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Title: Infected immature teeth treated with surgical endodontic treatment and root-reinforcing technique with glass ionomer. Author: Duprez, JP, et. al. Journal: Dental Traumatology 2004; 20: 233-240 Reviewer: Aaron Doms, D.D.S. Purpose: To propose an endodontic surgery protocol for necrotic and infected immature teeth using condensable autoploymerizable glass ionomer cement (GIC) as root-end filling material. Materials & Methods: Three patients were used as case studies and the following procedure were performed:
Initial Appt: RDI, access cavity, mechanical prep of canals with large files with 2.5% NaOCl irrigation, dried with paper points, and filled with a combination of Ca(OH)2 powder and sterile distilled water via pluggers. One week later: Soft tissues disinfected with antiseptic rinse, LA, full-thickness mucoperiostal flap elevated and osteotomy with subsequent removal of PA lesion; canal cleaned from apex with ultrasonic tips and 2.5% NaOCl, RC rinsed with distilled water and dried from apex and crown with paper points; large GP cone fit to 3mm from apex, then pulled back 3 more mm to create 6mm vacuum. Fuji IX (GIC) was injected into apical and then the GP was pushed back down 3mm, excess GIC removed from apex, root end was finished and polished, flap sutured up, GP removed from canal and then canal filled with Ca(OH)2 and incisal access is filled with GIC.
One week later: RDI, root canal filled with GP with more GIC placed under GP cone to fill apical area under GP 3-dimmensionally. Patients were recalled at 1 month and 6 months to assess bone healing. Results: Patients:
Conclusion: Apexification is the preferred treatment of immature teeth with pulpal necrosis but sometimes unsuccessful for many reasons: length of treatment, large fibrous lesions, risk of fracture, fragility and porosity of calcific barrier resulting in apical extrusion of GP during fill. Surgical endodontic treatment is therefore recommended when: large chronic PA lesion or failure of apexification. The advantages: rapidity of treatment with fewer appointments, reduction of risk of fracture by reinforcing with GIC, immediate suppression of PA lesions, and efficient/reliable GIC apical barrier. GIC is less expensive and easier to handle than MTA |
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Title: Successful treatment of a radicular groove by intentional replantation and Emdogain® therapy Author: Al-Hazaimi, et al. Journal: Dental Traumatology, 20:226-228, 2004. Reviewer: Jonathan Lee, D.D.S. Introduction: The radicular groove is a developmental anomaly on lingual surface of maxillary lateral incisors starting from the level of the cingulum to varying lengths of the root. This defect may harbor bacteria leading to inflammatory process with attachment lost and eventual periodontal defect and possible secondary pulpal involvement. Treatment involves curettage of the affected area with mechanical elimination of the groove or by sealing with filling material. If the periodontal defect extends beyond middle 1/3 of root, surgical intervention is required including barrier techniques and osseous grafts. Recent reports suggest use of enamel matrix protein - Emdogain® as alternatives to barrier techniques to
periodontal defects. Emdogain® consists of hydrophobic enamel matrix proteins
extracted from porcine developing embryonic enamel. Studies have reported use of Emdogain® enhance healing of the periodontal ligament (pdl), promote healing of root resorption,
and prevent ankylosis on transplanted and replanted teeth. Case Report: A 15 year old Hispanic female presented because of purulent discharge and mouth odor. Clinical examination revealed a draining sinus tract along with a 13mm periodontal defect on a maxillary lateral incisor. Thermal tests were negative and a large, periradicular radiolucency was present radiographally. The diagnosis was necrosis with suppurative apical periodontitis. Two visit endodontic therapy was performed with 5.25% NaOCl as irrigant and 8wk Ca(OH)2 intracanal medicament. Three months later the tooth was extracted and soaked in Hank’s Balanced Salt Solution. The radicular groove was removed with a bur and coated with Emdogain® prior to replantation. A semi-rigid splint was placed for 8wks. At the three months recall, the patient was asymptomatic and there was closure of the sinus tract. At one year recall the periodontal pocket showed re-attachment with 3mm pocket depths and radiographic healing was noted. Discussion: The exact mechanism of periodontal repair with Emdogain® has not been elucidated. It is reported Emdogain® may promote acellular cementum, which is essential in pdl repair. It may also have regulatory effects during enamel formation and maturation and during root development. There is evidence of enamel matrix proteins secretion by Hertwig’s epithelial root sheaths. |
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Title: Re-eruption of traumatically intruded mature permanent incisor: case report. Author: Faria et al Journal: Dental Traumatology 2004; 20:229-232 Reviewer: Rahul Gupta, D.D.S. Introduction: Intrusive luxations are relatively uncommon, corresponding to only 3% of all traumatic injuries in permanent teeth, and 5-12% of dental luxations. Serious damage to the pulp and support structures occurs because of the dislocation of the tooth into the alveolar process. Thus, the repair process after intrusion is complex. There is no agreement in the literature for the ideal treatment for permanent intruded teeth after trauma. Depending on the stage of root development, waiting for spontaneous re-eruption, surgical or orthodontic repositioning is recommended. Waiting for spontaneous re-eruption is indicated for immature permanent teeth, because of their high potential for eruption, and pulp/periodontal repair. For mature teeth, it is recommended to reposition the intruded tooth with light orthodontic force, allowing adequate bone remodeling and periodontal fiber re-insertion. Case report: The case
describes the treatment of a mature permanent central incisor in which
spontaneous re-eruption after severe traumatic intrusion occurred. A 10-year-old patient presented to the
dental clinic 3 days after trauma. Clinical examination showed complete
intrusion of tooth # 8 with crown
fracture and tooth # 9 with crown fracture only. Also, extensive gingival inflammation and
purulent exudates drainage was observed at the gingival sulcus
of the tooth # 8. Radiographs show
fully formed roots for # 8 and #9. Antiseptic procedures with 0.12% chlorhexidine gluconate were carried out, antibiotic therapy was started and maintained for 7 days, and the patient was followed up clinically and radiographically. After 20 days, radiographic examination showed external inflammatory radicular resorption of tooth #8, #9. On tooth #8 palatal gingivectomy was performed so that access could be made. The root canals of #8, #9 were instrumented and calcium hydroxide paste placed. The calcium hydroxide dressing was changed every 30 days for 4 months until control of resorption was confirmed radiographically. Fifteen days after biomechanical preparation and the placement of calcium hydroxide, the beginning of spontaneous re-eruption was observed. After 6 months, the tooth returned spontaneously to its normal position. Tooth #8, #9 were then obturated and restored with composite. Discussion: The main
objective in the treatment of dental luxation is
the periodontal repair. The intruded
teeth should be let to re-erupt spontaneously rather than re-positioning them
surgically or orthodontically. This process occurs between 2 and 4 months,
and endodontic treatment of these teeth must be
performed before this period to prevent external radicular
inflammatory resorption, because pulp necrosis
occurs in 100% of mature teeth. |
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Title: Management of a complex dentoalveolar trauma with multiple avulsions: a case report Authors: Sheroan M, and Roberts M. Journal: Dental Traumatology. 2004 Vol. 20 (4) pp 222-5. Purpose: To describe diagnostic considerations, the immediate treatment, short term follow-up, and transitional esthetic goals for an adolescent with multiple avulsions. Reviewer: Omar Porras, D.M.D. Case report: 9-year-old Caucasian male presented with severe dentoalveolar trauma with soft tissue involvement. Patient presented for treatment 6 h after the accident. No loss of consciousness or bleeding from the nose or ears was reported. Intraoral evaluation reveal avulsion of teeth no. 3, A, B, 7, 8, 9,10, I, J, 12, 13 and 14, extensive intraoral soft tissue damage and multiple minor fractures of alveolar bone (teeth were transported in a bag with no storage media). Panoramic radiograph confirmed no maxillary or mandibular fractures. In the O.R. under general anesthesia lacerations were sutured teeth no. 7 and 10 were reimplanted with the long-term goal of ankylosis to preserve the bone in the anterior maxilla. Permanent molars and premolars could not be reimplanted due to alveolar damage. Patient was admitted to the hospital for observation due to development of immediate postoperative fever and discharged after 2 days; amoxicillin 500 mg t.i.d. and acetaminophen with codeine were prescribed. At 1 and 2 weeks post-op teeth 7 and 10 exhibited class III mobility no inflammatory or replacement resorption was observed. At 3 weeks No. 7 was accessed, instrumented and filled with Ca (OH)2. After 1 month decision to extract No. 10 was made. In 6 wks impressions taken tooth #7 was decoronated and re-packed with Ca (OH)2 long term and composite. A denture was delivered in 3 months and is periodically modified to accommodate eruption of tooth No.4 and 5. After 9 months no signs of resorption observed. Discussion: Long-term treatment requires a multidisciplinary approach focusing in esthetics and alveolar bone maintenance. Bone graft will be needed. Call for more research for the treatment of dental avulsions with extensive extra oral time. Discussed research for maintaining vitality of PDL cells using different media, HBSS and ViaSpan®, as well as the use of Emdogain® to promote healing and decrease incidence of replacement resorption. The benefit of preserving the height and width of the alveolar bone must be considered. |
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