A new minimally invasive guided endodontic microsurgery by cone beam computed tomography and 3-dimensional printing technology

Endodontic microsurgery is defined as the treatment performed on the root apices of an infected tooth, which was unresolved with conventional root canal therapy. Recently, the advanced technology in 3-dimensional model reconstruction based on computed tomography such as cone beam computed tomography has opened a new avenue in application of personalized, accurate diagnosis and has been increasingly used in the field of dentistry. Nevertheless, direct intra-oral localization of root apex based on the 3-dimensional information is extremely difficult and significant amount of bone removal is inevitable when freehand surgical procedure was employed. Moreover, gingival flap and alveolar bone fenestration are usually required, which leads to prolonged time of surgery, thereby increasing the chance of trauma as well as the risk of infection. The purpose of this case report is to present endodontic microsurgery using the guide template that can accurately target the position of apex for the treatment of an anterior tooth with calcified canal which was untreatable with conventional root canal therapy and unable to track the position of the apex due to the absence of fistula.

Study on the incidence of lateral canals and sealing quality in the apical third roots of permanent teeth with failed endodontic treatments / 中华口腔医学杂志

Objective@#To investigate the association between the frequency and filling rate of lateral canals and the sealing quality in the apical third roots of the permanent teeth with failed endodontic treatments, so as to explore the failure factors of root canal therapy.@*Methods@#Clinical records of the permanent teeth with failed endodontic treatments were collected from the Department of Endodontics, Capital Medical University School of Stomatology during a period of 2 years. The teeth were diagnosed as chronic apical periodontitis and then undergone endodontic microsurgery. The sealing quality of the apical root canal was observed by means of periapical radiographs. The surgical treatments were performed and the resected root apices were collected. The samples were scanned by micro-computed tomography and the 3D volume rendered images of the resected root apices were reconstructed. Moreover, the frequency and the filling rate of lateral canals in the apical third roots were calculated. The potential relationship between tooth position and the presence of lateral canals was evaluated.@*Results@#Totally 89 teeth with 89 root apices met the inclusion criteria and were included in the present study. The rate of correct-filling, underfilling and overfilling was 40% (36/89), 32% (28/89), and 28% (25/89), respectively, examined by periapical radiographs. Amongst all of the 89 samples, lateral canals were found in 44 samples. The incidence of apices with lateral canals was 49% (44/89). Furthermore, 3 out of 44 samples were fully filled with material in the lateral canals, and the rest 41 samples showed no filling materials. The filling rate of the lateral canals was 7% (3/44). However, no significant difference was detected between the tooth position and the presence of lateral canals (P>0.05).@*Conclusions@#The sealing quality of the apical third roots in permanent teeth with failed endodontic treatments was not good enough. The incidence of apices with lateral canals was high, but the filling rate of the canals was low. Further studies are needed to explore the relationship between lateral canals and the failure of endodontic treatment.

Research progress in applications used for guided tissue regeneration in endodontic surgery / 口腔疾病防治

@#Conventional root canal therapy can not completely treat all periradicular lesions, especially combined endodontic-periodontic diseases, large periapical lesions and bone defect lesions. Guided tissue regeneration greatly improves the success rate of endodontic surgery in treating these lesions. This article focuses on the application of various grafting materials, guided bone regeneration membranes and regulatory factors in endodontic surgery.

The effects of different ultrasonic retroprep tips on the root-end preparation in cadavers / 实用口腔医学杂志

Objective:To evaluate the effects of different ultrasonic retroprep tips on the root-end preparation in cadavers.Methods:34 anterior teeth in situ in maxillary and mandibular jaws in cadavers were chosen and the root-end of 3 mm of all teeth was exposed. Root canal was prepared and filled with gutta-purcha in all teeth,3 mm of the root end was cut off.The teeth were divided into 2 treat-ment groups(n=1 5),and 1 control group(n=4).The root-end preparation was made using ultrasonic diamond tip and stainless steel tip respectively to 3 mm depth.The teeth in control group were not treated.Microcracks,marginal integrity and gutta-percha clearance were observated under SEM.Results:Diamond ultrasonic tips provoked a smaller number of cracks(P=0.059)and destroy of margin-al integrity(P=0.269)than stainless steel tips.Less gutta-percha clearance was produced by stainless steel tip than that by diamond ultrasonic tip(P=0.006).Conclusion:Diamond ultrasonic tip is more suitable for root-end preparation.

Enucleação de cisto radicular maxilar associado à apicectomia: relato de caso / Enucleation root of jaw cyst associated apicectomy: Report of case

Os cistos radiculares são as lesões císticas mais comuns dos maxilares, e apresentam como local de predileção a região anterior da maxila. Seu tratamento pode ser realizado cirurgicamente associado ao tratamento endodôntico da unidade envolvida. O objetivo do presente artigo é relatar um caso clínico de um cisto radicular maxilar, através de associação do tratamento endodôntico e cirúrgico, utilizando o agregado trióxido mineral (MTA) na obturação retrógrada das unidades envolvidas... (AU)

Radicular cysts are the most common cystic lesions of the jaws, and present as a place of predilection to previous region of the maxilla. Your treatment may be accomplished surgically associated the endodontic treatment of the unit involved. The goal of this article is to report a case of a radicular cyst jaw, through association of surgical and endodontic treatment, using mineral trioxide aggregate (MTA) in retrograde obturation of the units involved... (AU)

Management of Type III Dens Invaginatus in a Mandibular Premolar: A Case Report

Dens invaginatus is a well-known malformation of teeth, which probably results from an invagination of enamel organ into dental papilla during tooth development. The endodontic treatment of invaginated teeth may be challenging due to difficulties in accessing the root canals and also due to complex variations of internal morphology. This article presents the endodontic management and follow-up in a rare case of right mandibular second premolar with Oehlers' type III dens invaginatus. The result of cold pulp testing was positive for this tooth but it was associated to a sinus tract and periapical lesion. Herein, it is described the root canal therapy of this tooth combined with periapical surgery, emphasizing the importance of proper diagnosis and planning by using cone beam computed tomography (CBCT). This case report presents the proper periapical healing 6 months after the combination of nonsurgical and surgical treatments. It also shows that CBCT is an important auxiliary examination to avoid errors in diagnosis and subsequent treatment of dental anomalies.

Dens invaginatus é uma malformação dentária já bem reconhecida, que provavelmente resulta de uma invaginação do órgão do esmalte para dentro da papila dentária durante o desenvolvimento do dente em questão. O tratamento endodôntico de dentes invaginados pode ser um desafio devido às dificuldades de acesso aos canais radiculares e também devido à complexidade da morfologia interna. Este artigo apresenta o manejo endodôntico e o acompanhamento de um caso raro de segundo pré-molar inferior direito com dens invaginatus Tipo III de Oehlers. O resultado do teste de sensibilidade pulpar ao frio foi positivo para este dente, mas o mesmo estava associado a uma fístula e lesão periapical. Relata-se o tratamento de canal deste dente associado à cirurgia periapical, enfatizando a importância de um correto diagnóstico e plano de tratamento, utilizando a tomografia computadorizada de feixe cônico (TCFC). Este relato de caso mostra reparo periapical adequado 6 meses após a combinação dos tratamentos não-cirúrgico e cirúrgico. Mostra também que a TCFC é um importante exame auxiliar para evitar erros no diagnóstico e posterior tratamento de anomalias dentárias.

Endodontic Management of Cutaneously Draining Odontogenic Sinus using Shoe Lace Technique.

Odontogenic cutaneous sinus tract is a rare but well-documented condition. It is usually misdiagnosed as a local skin lesion and maltreated by systemic antibiotics and/or surgical intervention. This is because the primary etiology is incorrectly determined. We came across a 30-year-old patient who presented with a cutaneous lesion of dental etiology in the submental region with frequent purulent discharge which was not responding to systemic antibiotics. The case history, diagnosis and management of this condition using surgical endodontics are presented here.

Root - End Filling Materials - A Review.

When non-surgical root canal treatment fails to resolve periradicular lesions of endodontic origin or if retreatment is not feasible surgical intervention is recommended. Management of root end during endodontic surgery involves apical resection,retropreparation and retrofilling to seal the root canal. Numerous materials have been suggested and the newer ones like MTA, Castor Oil Polymer and calcium phosphate have shown promising results . This article is a review of literature on the suitability of various root end filling materials based on their leakage assessment, marginal adaptation, cytotoxicity and usage tests in experimental animals and humans.

Materiais retrobturadores utilizados na cirurgia paraendodôntica / Root - end filling materials used in endodontics surgery

A cirurgia paraendodôntica é o tratamento de lesões perirradiculares através de um conjunto de procedimentos por meio cirúrgico, cujo objetivo entre outros visa resolver complicações decorrentes do tratamento endodôntico mal sucedido. A obturação retrógrada, uma das modalidades da cirurgia paraendodôntica, cnsiste na remoção do ápice da raiz, seguida de um preparo de uma cavidade e obturação desse espaço com material adequado. Vários materiais tem sido propostos, com o objetivo de promover o selamento do canal radicular por via retrógrada, dentre os quais podemos citar o Super EBA, o amálgama de prata e o MTA. Este trabalho se propõe através de uma revisão de literatura determinar entre os materiais retrobturadores, aquele que apresenta propriedades aceitáveis para a sua utilização na prática cirúrgica.

Endodontic surgery is the treatment of periradicular lesions by any surgical procedure to solve complications of unsucccessful the endodontic treatment. Retrograde filling, one of the surgery modalities, consists in removing the apex of the root, followed by the preparation of the cavity and its filling with appropriate materials such as Super-EBA, amalgam and MTA. The purpose of this literature review is determinate among the root-end filling materials witch one presents acceptable properties for it uses in surgical practice.