ABSTRACT
INTRODUCTION: Outcomes assessment of retreatment and endodontic microsurgery (EMS) are traditionally based on clinical findings and radiographs. The purpose of this study was to assess the volumetric change of periapical radiolucencies (PARLs) by cone-beam computed tomographic (CBCT)-based analysis in retreatment and EMS cases. METHODS: For 68 retreatment and 57 EMS cases, preoperative and recall clinical data, periapical (PA) radiographs, and CBCT imaging were retrospectively obtained. Specialized software was used by 2 board-certified endodontists for volumetric analysis of PARLs. For EMS and retreatment, clinical outcomes were determined by combining clinical data with CBCT-generated volumetric analysis (PA radiographs not used). Additionally, comparisons of percent volume reduction for EMS and retreatment were performed. Examiner interpretations of outcomes assessment using PA radiography and CBCT imaging were compared. RESULTS: In teeth with or without a preoperative PARL, EMS resulted in a statistically significant difference in complete healing (49/57 [86.0%]) versus retreatment (28/68 [41.2%], P < .0001). EMS resulted in a statistically significant difference in combined complete healing and reductive healing (54/57 [94.7%]) versus retreatment (56/68 [82.4%], P < .05). Of 46 recalls in which CBCT imaging detected a PARL, PA radiography detected 30 (a 35% false-negative rate). Of the 79 recall studies in which CBCT imaging did not detect a PARL, PA radiography did detect PARL in 13 (a 16.5% false-positive rate). CONCLUSIONS: In this CBCT and clinical data-based outcomes assessment, EMS resulted in a greater mean volumetric reduction and a higher healing rate compared with retreatment. Postoperative CBCT imaging is more sensitive and specific than PA radiography in assessing PARL and has demonstrable usefulness in outcomes assessment.
Subject(s)
Cone-Beam Computed Tomography/methods , Microsurgery/methods , Outcome Assessment, Health Care , Periapical Diseases/surgery , Adult , Aged , Aged, 80 and over , Endodontics/methods , Female , Humans , Male , Middle Aged , Periapical Diseases/diagnostic imaging , Retreatment , Retrospective Studies , Wound Healing , Young AdultABSTRACT
The mechanical properties of pulp-capping materials may affect their resistance to fracture during placement of a final restorative material or while supporting an overlying restoration over time. The purpose of this study was to compare the compressive strength, flexural strength, and flexural modulus of 2 new pulp-capping materials (TheraCal LC and Biodentine), mineral trioxide aggregate (MTA), and calcium hydroxide over time. Specimens were created in molds and tested to failure in a universal testing machine after 15 minutes, 3 hours, and 24 hours. The MTA specimens did not set at 15 minutes. At all time periods, TheraCal LC had the greatest compressive and flexural strengths. After 3 and 24 hours, Biodentine had the greatest flexural modulus. TheraCal LC had greater early strength to potentially resist fracture during immediate placement of a final restorative material. Biodentine had greater stiffness after 3 hours to potentially provide better support of an overlying restoration under function over time.
Subject(s)
Pulp Capping and Pulpectomy Agents/chemistry , Aluminum Compounds/chemistry , Aluminum Compounds/therapeutic use , Calcium Compounds/chemistry , Calcium Compounds/therapeutic use , Compressive Strength , Dental Stress Analysis , Drug Combinations , Humans , Oxides/chemistry , Oxides/therapeutic use , Pulp Capping and Pulpectomy Agents/therapeutic use , Silicates/chemistry , Silicates/therapeutic use , Tensile StrengthABSTRACT
Simulated furcation perforations were repaired with and without blood contamination utilizing tooth-colored mineral trioxide aggregrate (MTA) mixed with either MTA liquid (sterile water), lidocaine, or saline. Samples underwent Instron testing at either 24 or 72 hours and at 7 days. Data were analyzed using a 3-way ANOVA and post-hoc testing using Turkey's true test for significance. All of the 72-hour samples displayed significantly greater resistance to displacement than the 24-hour samples. All of the 7-day samples displayed significantly greater resistance to displacement than the 24-hour and 72-hour samples. Non-contaminated samples displayed significantly greater resistance to displacement than their blood-contaminated counterparts at 7 days. Non-contaminated samples mixed with sterile water, lidocaine, or saline performed similarly at all time periods. Allowing tooth-colored MTA to set undisturbed for 72 hours or longer prior to placement of a coronal restoration may decrease the chance of MTA displacement in furcation perforation repairs.
