An evaluation of tricalcium phosphate as a treatment for endodontic perforations.

In the rat, perforations of maxillary molars were created and treated with either tricalcium phosphate (Synthograft) or Cavit. At four time intervals (1 day, 1 wk, 2 wk, and 1 month), four evaluative factors (inflammation, bone resorption, cementum and dentin resorption, and epithelial proliferation) were analyzed and compared for the two materials. For the individual time periods, there were no statistically significant differences between the two materials. However, when all four time periods were combined, there was a statistically significant better result for tricalcium phosphate than for Cavit with respect to decreased inflammation (p less than 0.05).

A prospective randomized trial on efficacy of antibiotic prophylaxis in asymptomatic teeth with pulpal necrosis and associated periapical pathosis.

A recent study from a private endodontic practice compared "prophylactic" antibiotic (high-dose, 1-day) regimens of penicillin V and erythromycin (base or stearate) for patients who had asymptomatic teeth with pulpal necrosis and associated periapical radiolucent lesions (PN/PL). A 2.2% flare-up incidence was found, with no statistically significant differences for penicillin (0.0%), base (2.9%), and stearate (3.8%). No hypersensitivity responses occurred, and gastrointestinal side effects were found primarily with the erythromycins (12.4%). To ascertain whether or not similar results would occur with student operators in a dental school clinic population, the current study was undertaken. One-hundred ninety-five patients with quiescent PN/PL were randomly given either penicillin V or erythromycin (base or stearate). A 2.6% flare-up incidence was found, with no statistically significant differences for penicillin (3.1%), base (1.5%), and stearate (3.1%). No hypersensitivity responses occurred, and GI side effects were found primarily with the erythromycins (17.7%). As can be seen, the results were very similar to those of the recent endodontic practice study. Hence, it can be concluded that the results of the previous endodontic practice study were not unique to any one clinician or method. A comparison was also made between the "prophylactic" penicillin group of the current study and the placebo control group of our previous dental school clinic, student operator study (in which the methods, population, and regimen were almost identical to those of the current study). The results showed that the "prophylactic" penicillin group had significant fewer flare-ups and non-flare-up-associated swelling and pain than did the placebo group. In view of these findings and those from studies from the literature in which "prophylactic" antibiotics were not used, it is our opinion that the antibiotic regimens used in the current study should be a component of clinical endodontic therapy for quiescent PN/PL.

A detailed analysis of four long-term silver cone root canal fillings.

Because many failures in root canal therapy have been attributed to the use of silver cones as a filling material, it was decided to examine four roots of three teeth, each of which had been successfully treated endodontically with silver cones ranging from 24 to 34 years previously. These roots, which were resected for periodontal reasons, were examined both under the scanning electron microscope and histologically. Examination with the scanning electron microscope revealed that all four cones were moderately to severely corroded. Histologic examination of two teeth disclosed corrosion products along the entire wall and, in one instance, within the dentinal tubules and apical tissue. The corrosion products, however, were most extensive in the cone that appeared to be loose fitting within the canal. The results indicated that corrosion products occurred in all of the teeth examined. Therefore, corrosion may not be the primary factor accounting for failure in teeth endodontically treated with silver cones.

Prophylactic use of penicillin V in teeth with necrotic pulps and asymptomatic periapical radiolucencies.

As a result of (1) clinical experience with flare-ups occurring in teeth with necrotic pulps and asymptomatic periapical radiolucencies and (2) on apparent reduction to the incidence of such flare-ups by the administration of penicillin V at the first sign of swelling, this study on the prophylactic administration of penicillin V in similar cases was undertaken. The subjects were 100 consecutive clinic patients whose teeth had necrotic pulps and asymptomatic periapical radiolucencies. At the initial visit, all teeth were instrumented completely to the radiographic apex, with 0.5% to 2.54% sodium hypochlorite as the irrigant. Sterile, dry cotton pellets and ZOE restorations were used. Alternate patients were given 250 mg of penicillin V and an identical-appearing placebo with instructions to take two tablets every 6 hours for the first 24 hours, followed by one tablet every 6 hours until all tablets were taken. Pain and swelling were graded by the patients on five-point scales, and flare-ups were scored when either pain and/or swelling necessitated an unscheduled emergency visit. Fifteen patients developed flare-ups, with significantly more flare-ups in the placebo group (p less than 0.05). The findings indicate that, in selected cases, prophylactic penicillin can be used to prevent flare-ups.

Endodontic perforations: their prognosis and treatment.

Causes of tooth perforation include resorption, caries, and operator performance. The prognosis for a tooth with a perforation is related to the location of the perforation, negotiability of the canal, contamination, and treatment. Alternative treatment approaches include routine endodontic treatment, correction via the chamber, surgical correction, and stimulation of calcification. In most instances, a perforation can be treated so that satisfactory healing will occur.