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1.
J Endod ; 39(1): 20-6, 2013 Jan.
Article in English | MEDLINE | ID: mdl-23228252

ABSTRACT

INTRODUCTION: This cohort study is the second phase of a previously reported trial. The primary aim was to assess the outcome of the treatment of teeth with open apices managed by the orthograde placement of mineral trioxide aggregate (MTA) apical plugs. The secondary goal was to identify potential outcome factors for this kind of treatment with a larger sample size and longer follow-up periods than in the first phase of the project. METHODS: Two hundred twenty-one patients who had been treated between 2000 and 2010 were contacted for follow-up examination 12-128 months after treatment (median, 21 months). At the time of treatment, these patients presented a total of 252 teeth with open apices caused by apical root resorption or excessive apical enlargement or with immature apices. Treatment was performed by supervised undergraduate students (12% of teeth), general dentists (49%), and dentists whose practice was limited to endodontics (39%). The investigated outcome relied on clinical and radiographic criteria and was dichotomized as healed or diseased. RESULTS: Of 252 examined teeth (88% recall rate), 90% were healed. Teeth with and without preoperative periapical radiolucencies demonstrated healed rates of 85% and 96%, respectively. Forty-five percent of the teeth (113/252) were followed up at least 2 years later and 21% (53/252) at least 4 years later. Univariate survival analyses identified 4 prognostic factors: preoperative apical periodontitis, the experience of the treatment providers, the number of treatment sessions, and the apical extrusion of MTA. Multiple regression analyses confirmed an increased risk of disease for teeth with preoperative apical periodontitis (hazard ratio = 4.59; 95% confidence interval, 1.57-13.4; P = .005). In addition, the experience of the treatment provider was found to influence the outcome (hazard ratio = 0.25; 95% confidence interval, 0.09-0.75; P = .03). CONCLUSIONS: Orthograde placement of MTA apical plugs appears to be a promising treatment option for teeth with open apices. The healed rates for such teeth were high in this study, even after follow-up periods of more than 4 years. The presence of preoperative apical periodontitis was identified as an important prognostic factor.


Subject(s)
Aluminum Compounds/therapeutic use , Apexification/methods , Calcium Compounds/therapeutic use , Oxides/therapeutic use , Root Canal Filling Materials/therapeutic use , Silicates/therapeutic use , Tooth Apex/drug effects , Adolescent , Adult , Aged , Aged, 80 and over , Child , Clinical Competence , Cohort Studies , Drug Combinations , Female , Follow-Up Studies , Foreign Bodies/complications , Humans , Longitudinal Studies , Male , Middle Aged , Odontogenesis/physiology , Periapical Periodontitis/complications , Periapical Tissue/pathology , Prognosis , Retrospective Studies , Root Canal Preparation/methods , Root Resorption/therapy , Tooth Apex/growth & development , Treatment Outcome , Wound Healing/physiology , Young Adult
2.
J Endod ; 36(5): 806-13, 2010 May.
Article in English | MEDLINE | ID: mdl-20416424

ABSTRACT

INTRODUCTION: The use of mineral trioxide aggregate (MTA) might improve the prognosis of teeth after pulp exposure. The treatment outcome of teeth after direct pulp capping, either with mineral trioxide aggregate (MTA) or calcium hydroxide (controls), was investigated, taking into account possible confounding factors. METHODS: One hundred forty-nine patients treated between 2001 and 2006 who received direct pulp capping treatment in 167 teeth met the inclusion criteria. Treatment was performed by supervised undergraduate students (72%) and dentists (28%). Assessment of clinical and radiographic outcomes was performed by calibrated examiners 12-80 months after treatment (median, 27 months). RESULTS: One hundred eight patients (122 treated teeth) were available for follow-up (72.5% recall rate). A successful outcome was recorded for 78% of teeth (54 of 69) in the MTA group and for 60% of teeth (32 of 53) in the the calcium hydroxide group. The univariate analysis (generalized estimation equations model [GEE model] showed a significant difference in the success rate (odds ratio [OR], 2.36; 95% confidence interval [CI], 1.05-5.32; P = .04). In the multiple analysis (GEE model), the OR is marginally inside the nonsignificant range (OR, 0.43; 95% CI, 0.19-1.02; P = .05) when conspicuous confounding factors are stabilized (univariate analysis). Multiple analysis showed that teeth that were permanently restored >or=2 days after capping had a significantly worse prognosis in both groups (OR, 0.24; 95% CI, 0.09-0.66; P = .01). CONCLUSIONS: MTA appears to be more effective than calcium hydroxide for maintaining long-term pulp vitality after direct pulp capping. The immediate and definitive restoration of teeth after direct pulp capping should always be aimed for.


Subject(s)
Aluminum Compounds/therapeutic use , Calcium Compounds/therapeutic use , Calcium Hydroxide/therapeutic use , Dental Pulp Capping/methods , Oxides/therapeutic use , Root Canal Filling Materials/therapeutic use , Silicates/therapeutic use , Adolescent , Adult , Aged , Analysis of Variance , Child , Drug Combinations , Female , Follow-Up Studies , Humans , Linear Models , Male , Middle Aged , Retrospective Studies , Treatment Outcome , Young Adult
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