Balloon-occluded retrograde transvenous obliteration of varices: focusing on the portal hemodynamics and the recent techniques.

PURPOSE: To evaluate the recent topics of Ballloon-occluded retrograde trasnvenous obliteration(B-RTO). METHOD: We overviewed the recent scientific papers regarding B-RTO. RESULT: B-RTO is a treatment method for occluding varices retrogradely using a sclerosing agent under balloon occlusion of a major draining vein. It has been recognized as an effective treatment method for gastric varices. Hepatic function reserve is improved and liver volume is increased after B-RTO. In recent years, various technical options, such as plug-assisted retrograde transvenous obliteration, coil-assisted retrograde transvenous obliteration, or foam B-RTO, have also been reported. In performing B-RTO, portal hemodynamics must be thoroughly examined radiologically. Judging the classification of the grade of collateral venous hemodynamics is important to select the appropriate embolization technique of B-RTO and to successfully occlude varices. Finally, the word "portosystemic shunt syndrome" has been proposed and the condition should be considered while selecting a treatment for gastric varices. CONCLUSION: B-RTO is effective for gastrointestinal varices and portosystemic shunts.

Apical adaptation, sealing ability and push-out bond strength of five root-end filling materials.

This study compared the fluid filtration, adaptation to the root canal walls, and the push-out bond strength of two resin-based sealers and three calcium silicate-based retrograde filling materials. Fifty maxillary canines were shaped using manual instruments and the apical portion was sectioned. Retrograde cavities of 3-mm depth were prepared. The specimens were divided into five groups (n = 10): Sealer 26 (S26); MBPc (experimental); MTA; Portland cement with 20% zirconium oxide (PC/ZO), and Portland cement with 20% calcium tungstate (PC/CT). The fluid filtration was measured at 7 and 15 days. To evaluate the interfacial adaptation, sections of the teeth, 1 and 2 mm from the apex, were prepared and the percentage of gaps was calculated. The push-out bond strength at 2 mm from the apex was evaluated. Statistical analysis was performed using the ANOVA/Tukey's test (p < 0.05). At 7 and 15 days (p = 0.0048, p = 0.006), the PC/CT group showed higher fluid filtration values when compared to other groups. At 1 mm from the apex, no statistical differences in the adaptation were found among the cements (p = 0.44). At 2 mm from the apex, the PC/ZO group presented statistically lower percentage of gaps than S26, MBPc, and MTA (p = 0.0007). The MBPc group showed higher push-out bond strength than other cements evaluated (p = 0.0008). The fluid filtration and interfacial adaptation of the calcium silicate-based cements were similar to those of the resin-based cements. The resinous cement MBPc showed superior push-out bond strength.

Traditional endodontic surgery versus modern technique: a 5-year controlled clinical trial.

In this study, we compared outcomes of traditional apicoectomy versus modern apicoectomy, by means of a controlled clinical trial with a 5-year follow-up. The study investigated 938 teeth in 843 patients. On the basis of the procedure performed, the teeth were grouped in 3 groups. Differences between the groups were the method of osteotomy (type of instruments used), type of preparation of retrograde cavity (different apicoectomy angles and instruments used for root-end preparation), and root-end filling material used (gray mineral trioxide aggregate or silver amalgam). Outcome (tooth healing) was estimated after 1 and 5 years, postoperatively. Clinical success rates after 1 year were 67% (306 teeth), 90% (186 teeth), and 94% (256 teeth) according to traditional apicoectomy (group 1), modern microsurgical apicoectomy using burns for osteotomy (group 2) or using piezo-osteotomy (group 3), respectively. After 1 year, group comparison results were statistically significant (P < 0.0001). Linear trend test was also statistically significant (P < 0.0001), pointing out larger healing from group 1 to group 3. After 5 years, teeth were classified into 2 groups on the basis of root-end filling material used. Clinical success was 90.8% (197 teeth) in the silver amalgam group versus 96% (309 teeth) in the mineral trioxide aggregate group (P < 0.00214). Multiple logistic regression analysis found that surgical technique was independently associated to tooth healing. In conclusion, modern apicoectomy resulted in a probability of success more than 5 times higher (odds ratio, 5.20 [95% confidence interval, 3.94-6.92]; P < 0.001) compared with the traditional technique.

Prognostic factors of clinical outcomes in endodontic microsurgery: a prospective study.

INTRODUCTION: This prospective study examined the potential prognostic factors of endodontic microsurgery and compared the predictors of an isolated endodontic lesion with those of both an isolated endodontic lesion and an endodontic-periodontal lesion. METHODS: Data were collected from the Microscope Center of the Department of Conservative Dentistry at the Dental College of Yonsei University, Seoul, Korea, between March 2001 and March 2011. A total number of 584 teeth were included, and all clinical procedures were performed by a single operator (E.K.). The evaluation was performed at least 1 year after surgery. For statistical analysis of the predisposing factors, the chi-square test and logistic regression were performed. RESULTS: Of the 584 cases treated, 431 cases came for recall after a period of at least 12 months. Sex (female), tooth position (anterior), arch type (maxilla), and lesion type (isolated endodontic lesion) were found to have a positive effect on surgical outcome. With regards to isolated endodontic lesions, the tooth position (anterior), arch type (maxilla), and type of restoration (single/splinted crown, short bridge, and removable partial denture abutment) were found to be pure positive predictors. CONCLUSIONS: In endodontic microsurgery, it is likely that preoperative factors, particularly the tooth position and arch type, have a greater influence on the healing outcome than intra- and post-operative factors.

Effect of guided tissue regeneration on the outcome of surgical endodontic treatment of through-and-through lesions: a retrospective study at 4-year follow-up.

PURPOSE: The main purpose of this retrospective cohort study was to evaluate the 4-year success rate of endodontic surgery in combination with a collagen resorbable membrane for the treatment of through-and-through periradicular lesions. MATERIALS AND METHODS: Patients with one or more teeth with a through-and-through periradicular lesion in need of endodontic surgery were treated. A clinical and radiographic evaluation was performed at 3, 6, 12, 24, 36, and 48 months. The outcome was categorized at 1 and 4-year follow-up as success, failure, and doubtful depending on clinical signs and symptoms and radiographic evaluation. Fisher's exact test was used to evaluate differences between successful and failed cases (P < 0.05). RESULTS: Forty-three teeth in 33 patients were radiographically and clinically evaluated after 4 years. Thirty-eight teeth were classified as success, 4 teeth as failure, and 1 tooth as doubtful. No statistically significant differences were found in results related to tooth type, tooth location, and presence of post. CONCLUSIONS: The association of endodontic surgery and guided tissue regeneration for the treatment of through-and-through periapical lesions leads to excellent outcomes up to 4 years. Standardized criteria are needed to determine the treatment outcome.

Sealing ability of MTA and amalgam in different root-end preparations and resection bevel angles: an in vitro evaluation using marginal dye leakage.

This in vitro study evaluated the effect of different apicoectomy angles, instruments used in root-end preparation, and dental materials used in retrofilling on apical sealing. Root ends were resected at 45 or 90 degrees in 80 single-rooted teeth. For each type of apicoectomy, root-end cavities were prepared with either a round carbide #2 bur or an S12/90D ultrasonic tip. The root-end cavities in each subgroup (apicoectomy + root-end preparation) were filled with silver amalgam without zinc (Am) or with gray mineral trioxide aggregate -Angelus (MTA), and the specimens were immediately immersed in 0.2% rhodamine B for 24 h. Sealing was evaluated based on the dyed cross-sectional dentin area. Data were analyzed statistically by the Kruskal-Wallis test at 5% significance level. No group showed complete sealing of root-end areas. The only significant factor affecting microleakage was dental material, with MTA exhibiting less leakage.

Microsurgical endodontic retreatment of post restored posterior teeth: a case series.

Post-treatment apical periodontitis may persist due to biological factors as outlined by Nair or when treatment procedures have been ineffective in eliminating the intraradicular infection. This case series reports on the management of five posterior teeth restored with posts where microsurgical techniques were employed utilising the operating microscope, ultrasonics, micro-instrumentation and mineral trioxide aggregate as a root-end filling material. Healing was evident at 12-month review appointments. Microsurgical techniques have significantly improved the outcomes for healing of periapical lesions when compared to traditional approaches to endodontic surgery. Success rates have been shown to be comparable with conventional orthograde treatment.

Apical surgery of a maxillary molar creating a maxillary sinus window using ultrasonics: a clinical case.

AIM: To describe a method of carrying out apical surgery of a maxillary molar using ultrasonics to create a lateral sinus window into the maxillary sinus and an endoscope to enhance visibility during surgery. SUMMARY: A 37-year-old female patient presented with tenderness to percussion of the maxillary second right molar. Root canal treatment had been undertaken, and the tooth restored with a metal-ceramic crown. Radiological examination revealed an apical radiolucency in close proximity to the maxillary sinus. Apical surgery of the molar was performed through the maxillary sinus, using ultrasonics for the osteotomy, creating a window in the lateral wall of the maxillary sinus. During surgery, the lining of the sinus was exposed and elevated without perforation. The root-end was resected using a round tungsten carbide drill, and the root-end cavity was prepared with ultrasonic retrotips. Root-end filling was accomplished with MTA(®) . An endoscope was used to examine the cut root face, the prepared cavity and the root-end filling. No intraoperative or postoperative complications were observed. At the 12-month follow-up, the tooth had no clinical signs or symptoms, and the radiograph demonstrated progressing resolution of the radiolucency. KEY LEARNING POINTS: When conventional root canal retreatment cannot be performed or has failed, apical surgery may be considered, even in maxillary molars with roots in close proximity to the maxillary sinus. Ultrasonic sinus window preparation allows more control and can minimize perforation of the sinus membrane when compared with conventional rotary drilling techniques. The endoscope enhances visibility during endodontic surgery, thus improving the quality of the case.

Clinical results with two different methods of root-end preparation and filling in apical surgery: mineral trioxide aggregate and adhesive resin composite.

INTRODUCTION: The aim of apical surgery is to hermetically seal the root canal system after root-end resection, thereby enabling periradicular healing. The objective of this nonrandomized prospective clinical study was to report results of 2 different root-end preparation and filling methods, ie, mineral trioxide aggregate (MTA) and an adhesive resin composite (Retroplast). METHODS: The study included 353 consecutive cases with endodontic lesions limited to the periapical area. Root-end cavities were prepared with sonic microtips and filled with MTA (n = 178), or alternatively, a shallow concavity was prepared in the cut root face, with subsequent placement of an adhesive resin composite (Retroplast) (n = 175). Patients were recalled after 1 year. Cases were defined as healed when no clinical signs or symptoms were present and radiographs demonstrated complete or incomplete (scar tissue) healing of previous radiolucencies. RESULTS: The overall rate of healed cases was 85.5%. MTA-treated teeth demonstrated a significantly (P = .003) higher rate of healed cases (91.3%) compared with Retroplast-treated teeth (79.5%). Within the MTA group, 89.5%-100% of cases were classified as healed, depending on the type of treated tooth. In contrast, more variable rates ranging from 66.7%-100% were found in the Retroplast group. In particular, mandibular premolars and molars demonstrated considerably lower rates of healed cases when treated with Retroplast. CONCLUSIONS: MTA can be recommended for root-end filling in apical surgery, irrespective of the type of treated tooth. Retroplast should be used with caution for root-end sealing in apical surgery of mandibular premolars and molars.

Effect of smear layer and root-end cavity thickness on apical sealing ability of MTA as a root-end filling material: a bacterial leakage study.

OBJECTIVE: The aim of this study was to investigate the effect of the cavity thickness and smear layer on apical sealing ability of mineral trioxide aggregate (MTA) as a root-end filling material. STUDY DESIGN: Seventy single-rooted maxillary central teeth were used in this study. All teeth were instrumented to size 50 using a step-back technique. The selected teeth were randomly divided into 4 groups, each containing 15 experimental samples and 5 positive and 5 negative control samples. In the first and second groups (smear+), the teeth were irrigated with only 5.25% NaOCl. In the third and fourth groups (smear-), the teeth were irrigated with 17% EDTA and 5.25% NaOCl to remove the smear layer. Also, in the first and third groups, cavities were prepared as 3 mm. In the second and fourth groups, cavities were prepared as 5 mm. All the root-end cavities were then filled with MTA. Nail varnish was applied to all external root surfaces to the level of the resected root-ends to prevent lateral microleakage. Samples were sterilized in an ethylene oxide sterilizer for 12 hours. The apical 3-4 mm of the roots were immersed in brain heart infusion culture medium with phenol red indicator within culture chambers. The coronal access of each specimen was inoculated every 48 hours with a suspension of Enterococcus faecalis. Bacterial leakage was monitored every 24 hours for 4 weeks. The data obtained were analyzed using a chi-squared test, with alpha = .05 as the level for statistical significance. RESULTS: There were no statistically significant differences in rate of bacterial leakage among the experimental groups at 1-4 weeks (P > .05). Also, there was no difference between the groups when the 2 thickness groups were combined (P > .05). However, there was statistically significant differences when the 2 smear groups were combined for 4-week observation periods (P < .05). Removal of the smear layer caused significantly more apical microleakage than when the smear layer was left intact for 4 weeks. CONCLUSION: The thickness of root-end cavity (3 or 5 mm) had no influence in the bacterial leakage of the root end filled with MTA. Removing the smear layer may not be necessary in root-end cavities filled with MTA.

Sealing ability of MTA and amalgam in different root-end preparations and resection bevel angles: an in vitro evaluation using marginal dye leakage

This in vitro study evaluated the effect of different apicoectomy angles, instruments used in root-end preparation, and dental materials used in retrofilling on apical sealing. Root ends were resected at 45 or 90 degrees in 80 single-rooted teeth. For each type of apicoectomy, root-end cavities were prepared with either a round carbide #2 bur or an S12/90D ultrasonic tip. The root-end cavities in each subgroup (apicoectomy + root-end preparation) were filled with silver amalgam without zinc (Am) or with gray mineral trioxide aggregate -Angelus (MTA), and the specimens were immediately immersed in 0.2 percent rhodamine B for 24 h. Sealing was evaluated based on the dyed cross-sectional dentin area. Data were analyzed statistically by the Kruskal-Wallis test at 5 percent significance level. No group showed complete sealing of root-end areas. The only significant factor affecting microleakage was dental material, with MTA exhibiting less leakage.

Este estudo in vitro avaliou o efeito de diferentes ângulos de apicectomia, instrumentos utilizados na retrocavitação e materiais odontológicos usados na retrobturação sobre selamento apical. Oitenta dentes unirradiculares, tratados endodonticamente, foram apicectomizados. Quarenta raízes tiveram seu ápice radicular seccionado com angulação de 45º e a outra metade com angulação de 90º. Para cada tipo de apicectomia realizou-se retrocavidades com broca esférica carbide nº 2 ou com retroponta ultra-sônica S12/90D. Cada subgrupo (apicectomia/retrocavidade) foi retrobturado com MTA ou amálgama, sendo os espécimes imediatamente imersos no corante Rodamina B a 0,2 por cento por 24 h. O selamento apical foi avaliado com base na área transversal de dentina corada ao redor da retrobturação. Os dados foram submetidos á análise estatística utilizando os testes de Kruskal-Wallis e Mann-Whitney. Nenhum grupo foi capaz de selar totalmente a região apical. O tipo de material utilizado na retrobturação foi o único fator que mostrou significativa diferença no selamento apical em relação à infiltração de corante.

A clinical guide to endodontics - update part 1.

This is the first of two opinion papers that aim to provide a review of changes and developments that have occurred within the field of root canal treatment for both permanent and primary teeth since the publication in 2004 of the BDJ's textbook A clinical guide to endodontics. This, the first part, considers the changes in thinking and practice that have occurred with regard to the treatment of permanent teeth, in particular the continued significant move toward the use of nickel titanium rotary instruments. Knowledge of the changes discussed in this paper is essential both for the best possible prognosis of treatment, and when obtaining informed or valid consent to treatment.

Comparison between the use of an ultrasonic tip and a microhead handpiece in periradicular surgery: a prospective randomised trial.

Innovations in periradicular surgery for failed treatment of orthograde root canal disease have been well-documented. We know of no prospective studies that have compared success rates of conventional methods with these presumed advances. In this prospective randomised trial we compare the use of an ultrasonic retrotip with a microhead bur in the preparation of a retrograde cavity. Outcome was estimated clinically by estimation of pain, swelling, and sinus, and radiographically by looking at infill of bone and retrograde root filling 2 weeks and 6 months postoperatively. Both methods used other surgical techniques including microinstruments to place the retrograde root filling. The success rate of the ultrasonic method was higher (all patients, n=26) than that of the microhead method (n=19 of 21). A larger study with longer follow up is required to consolidate this evidence.

Apical capping as a new technique for retrograde treatment of an infected root apex: introduction and first results.

INTRODUCTION: The success rate of surgical retrograde treatment of an infected root apex is limited by the existence of infected side canals which are not treatable by conventional retrograde preparation and filling techniques. This experimental study introduces a new technique of retrograde apex preparation followed by covering the apex with a titanium cap. MATERIAL AND METHODS: In 10 extracted canines, retrograde circular preparation of the root apex was performed using a new ultrasonic preparation tip and a high-power ultrasound machine. The prepared stump was covered by a titanium cap fixed with glass ionomer cement. The teeth were examined clinically and radiologically for unevenness, steps or clefts in the border between the titanium cap and root surface. Furthermore, a histological work-up was performed to register the existence and number of side canals, as well as their covering by the titanium cap and the width of the cement layer. RESULTS: The clinical and radiological examinations revealed only a small degree of unevenness in one case. In all other teeth the border was without any unevenness. There were 0 - 4 side canals as noted in the histological cross sections, all of which were covered by the titanium cap. The mean width of the cement layer was 27.2microm. From a technical point of view there were no difficulties or complications. CLINICAL CASE REPORT: For demonstration of the clinical use, a case of a 32-old-patient with an apical cyst on an upper lateral incisor is reported. The patient was treated successfully by apical capping. CONCLUSIONS: Apical capping is a new technique for retrograde treatment of an infected root apex which seals all side canals effectively. The technique is easy to perform and can be carried out quickly without complications. The technique is suitable for clinical testing.

Actividad antimicrobiana de cementos a base de trióxidos minerales agregados / Antimicrobial activity of mineral trioxide aggregates-based cements

El objetivo del presente estudio fue comparar in vitro la actividad antimicrobiana de dos cementos a base de trióxidos minerales agregados MTA Pro-Root Gray (Dentsply, Tulsa Dental, EE.UU.) y CPM (Cemento Portland Mejorado, Egeo, Argentina) en obturaciones retrógradas. Se utilizaron 32 dientes humanos unirradiculares extraídos y mantenidos en solución salina. El ápice fue resecado previa limpieza y conformación de los conductos. Se realizaron cavidades retrógradas de 3mm de profundidad que fueron obturadas con cada uno de los materiales. Las muestras se dividieron en dos grupos de doce dientes cada una y los ocho dientes restantes fueron considerados grupo control. Mediante curvas de sobrevivientes, a intervalos de 0,2, 4 y 24 horas se evaluó la actividad microbicida o inhibitoria frente a cuatro cepas de microoganismos. Los resultados obtenidos por curvas de desarrollo no mostraron diferencias estadísticamente significativas entre los grupos. (AU)

Actividad antimicrobiana de cementos a base de trióxidos minerales agregados / Antimicrobial activity of mineral trioxide aggregates-based cements

El objetivo del presente estudio fue comparar in vitro la actividad antimicrobiana de dos cementos a base de trióxidos minerales agregados MTA Pro-Root Gray (Dentsply, Tulsa Dental, EE.UU.) y CPM (Cemento Portland Mejorado, Egeo, Argentina) en obturaciones retrógradas. Se utilizaron 32 dientes humanos unirradiculares extraídos y mantenidos en solución salina. El ápice fue resecado previa limpieza y conformación de los conductos. Se realizaron cavidades retrógradas de 3mm de profundidad que fueron obturadas con cada uno de los materiales. Las muestras se dividieron en dos grupos de doce dientes cada una y los ocho dientes restantes fueron considerados grupo control. Mediante curvas de sobrevivientes, a intervalos de 0,2, 4 y 24 horas se evaluó la actividad microbicida o inhibitoria frente a cuatro cepas de microoganismos. Los resultados obtenidos por curvas de desarrollo no mostraron diferencias estadísticamente significativas entre los grupos.

Endodontic reoperation using an endoscope and microsurgical instruments: One year follow-up.

Endodontic reoperation was required for 30 teeth with periapical lesions in 18 patients, using microsurgical instruments and a 6cm long and 3mm wide endoscope for magnification. Reoperation was successful in 14 patients after 1 year.