Dental Pulp Revascularization in a Replanted Avulsed Immature Maxillary Permanent Central Incisor.

An 8-year-old girl sustained an accidental traumatic avulsion of her right maxillary permanent central incisor. She arrived with her mother at a hospital dental clinic with the right maxillary central incisor tooth wrappe in a wet paper towel over 1 hour after the injury. Replantation was accomplished without root surface alteration or root canal intervention. Clinical and radiographic follow-up examinations for over 1 year revealed continued root growth and apical development of the replanted avulsed immature maxillary central incisor with no signs or symptoms of pulpal or periapical pathosis. Excellent outcomes were achieved for periodontal ligament reattachment without removal of the periodontal membrane and pulp revascularization without endodontic intervention.

An evaluation of setting time of mineral trioxide aggregate and EndoSequence root repair material in the presence of human blood and minimal essential media.

INTRODUCTION: The purpose of this study was to compare the ability of MTA (Dentsply Maillefer, Tulsa, OK) and EndoSequence Root Repair Material (ESRRM; Brasseler USA, Savannah, GA) to set in the presence of human blood and minimal essential media. METHODS: A model was created using polymethyl methacrylate blocks each prepared with 10 standardized wells (2-mm diameter × 3-mm depth). Prepared ProRoot MTA (Dentsply Maillefer) and ESRRM were each placed in 6 separate blocks. The samples were distributed among the 4 different media (ie, blood, minimal essential media, blood and minimal essential media, and sterile saline as the control). Each block was submerged for 4, 5, 6, 8, 24, 36, and 48 hours in an incubator at 37°C with 100% humidity. RESULTS: The results revealed that regardless of the type of media exposure, neither of the materials set at 4 or 6 hours. ESRRM was not set at 48 hours, whereas all of the MTA samples were set at 36 hours. CONCLUSIONS: This outcome draws into question the proposed setting time given by each respective manufacturer. Furthermore, despite ESRRM being marketed as a direct competitor to MTA with superior handling properties, MTA consistently set at a faster rate under the conditions of this study.

Comparison of sealing ability of MTA and EndoSequence Bioceramic Root Repair Material: a bacterial leakage study.

OBJECTIVE: To compare the sealing ability of ProRoot mineral trioxide aggregate (MTA) to the sealing ability of EndoSequence Bioceramic Root Repair Material (ES-BCRR) putty using a bacterial leakage model. METHOD AND MATERIALS: Root canals of 60 single-rooted extracted teeth were enlarged to an apical diameter of 0.5 mm using EndoSequence files. The apical 3 mm of each root was sectioned at 90 degrees to the long axis of the root. An ultrasonic surgical tip was used to prepare a 3-mm deep root-end preparation in all teeth. Teeth were equally divided into four groups: Group 1, MTA; Group 2, ES-BCRR putty; Group 3, positive control, gutta-percha without sealer; Group 4, negative control, sealed with wax and nail varnish. Prepared teeth were kept moist for 48 hours to allow for initial setting of the materials. After ethylene oxide sterilization, the teeth were suspended in sterilized vials containing 3% phenol lactose broth and inoculated with Enterococcus faecalis through the occlusal access openings. The samples were observed daily for leakage to a maximum of 28 days. Chi-square and Fisher exact tests were used to compare the experimental groups and an alpha level of significance was set at P = .05. RESULTS: In the ES-BCRR group 93% of samples leaked, compared to only 20% of samples in the MTA group. There was a significant difference in leakage between the experimental groups (P < .0001). Also there were no significant differences between the negative control group and MTA group and between the positive control group and ES-BCRR group (P = 1.00). CONCLUSION: Samples in the ES-BCRR group leaked significantly more than samples in the MTA group.

Endodontic clinical management of a dens invaginatus case by using a unique treatment approach: a case report.

INTRODUCTION: Dens invaginatus is a developmental anomaly that poses treatment challenges when nonsurgical root canal therapy is deemed necessary. Teeth with complex root canal morphology often require a comprehensive treatment approach to effectively clean, shape, and disinfect the pulp canal space before obturation. Endodontic clinical management of a tooth with dens invaginatus might include using cone-beam computed tomography (CBCT) to aid in the diagnosis and treatment-planning phase and use of the surgical operating microscope in performing the clinical phase of treatment. A novel approach could include using the revascularization technique as the final treatment step in the management of a dens invaginatus case in which the root apex has not completed formation. METHODS: This case report will provide both an overview of the feasibility of using CBCT scans in diagnosis and treatment planning and a step-by-step clinical technique, by using surgical operating microscope and the revascularization technique, in the successful endodontic management of a complex dens invaginatus case. CONCLUSIONS: Five-month and 12-month follow-up clinical and radiographic findings will provide a candid view of inherent advantages and challenges of this technique.

Effect of sodium fluorosilicate on the properties of Portland cement.

INTRODUCTION: Mineral trioxide aggregate (MTA) satisfies most of the ideal properties of a surgical root-end filling and perforation repair material. It has been found to be nontoxic, noncarcinogenic, nongenotoxic, biocompatible, insoluble in tissue fluids, and dimensionally stable and promotes cementogenesis. The major disadvantages are its long setting time and difficult handling characteristics during placement when performing endodontic procedures. MTA is similar to Portland cement (PC) in both composition and properties. The cement industry has used many additives to decrease the setting time of PC. Proprietary formulas of PC additives include fluorosilicates, which decrease setting time. The purpose of this pilot study was to determine whether sodium fluorosilicate (SF) could be used to decrease the setting time without adversely affecting the compressive strength of PC. METHODS: To determine the most appropriate amount of SF to add to PC to decrease its setting time, 1%, 2%, 3%, 4%, 5%, 10%, and 15% SF by weight were added to PC and compared with PC without SF. Setting times were measured by using a Gilmore needle, and compressive strengths were determined by using a materials testing system at 24 hours and 21 days. RESULTS: Statistical analysis was performed by using one-way analysis of variance with post hoc Games-Howell test. None of the percentages of SF were effective in changing the setting time of PC (P > .05), and the SF additives were found to decrease the compressive strength of PC (P < .001). CONCLUSIONS: On the basis of the conditions of this study, SF should not be used to decrease setting time and increase the compressive strength of PC and as such does not warrant further testing with MTA.

Bacterial leakage of provisional restorative materials used in endodontics.

OBJECTIVE: To test the bacterial sealing ability of commonly used provisional endodontic restorative materials. METHOD AND MATERIALS: This study investigated Cavit (3M ESPE), Ketac (3M ESPE), DuoTemp (Coltane/Whaledent), and a combination technique using Ketac and Cavit. One hundred molars were randomly selected and then mounted in an apparatus that isolated the crown portion of the tooth. Provisional restorative materials were placed in an open access following manufacturer guidelines. Streptococcus mutans was applied to the samples, and results were tabulated over the course of 4 weeks. RESULTS: Cavit and DuoTemp performed the best, and Ketac performed the worst. After 14 days, however, all materials leaked in over half of the samples. CONCLUSION: No material can be recommended as superior in providing a reliable seal after 14 days.

Identify and define all diagnostic terms for periapical/periradicular health and disease states.

INTRODUCTION: The purpose of this in-depth investigation was to identify, clarify, and substantiate clinical terminology relative to apical/periapical/periradicular diagnostic states, which is used routinely in the provision of endodontic care. Furthermore, the information gleaned from this investigation was used to link diagnostic categories to symptoms, pathogenesis, treatment, and prognosis wherever possible, along with establishing the basis for the metrics used in this diagnostic process. MATERIALS AND METHODS: Diagnostic terminologies and their relevance to clinical situations were procured from extensive historic and electronic searches and correlated with contemporary concepts in disease processes, clinical assessments, histologic findings (if appropriate), and standardized definitions that have been promulgated and promoted for use in the last 25 years in educational programs and test constructions and for third-party concerns. RESULTS: In general, clinical terminology that is used routinely in the practice of endodontics is not based on the findings of scientific investigations. The diagnostic terms are based on assumptions by correlating certain signs, symptoms, and radiographic findings with what is presumed (not proven) to be the underlying disease process of a given clinical state. There were no studies that specifically tried to assess the accuracy of the metrics used contemporarily for the classification of clinical disease states. CONCLUSION: A succinct diagnostic scheme that could be described thoroughly, agreed on unanimously, coded succinctly for easy electronic input, and ultimately used for follow-up analysis would not only drive treatment modalities more accurately, but would also allow for future outcomes assessment and validation.

Three canals in the mesiobuccal root of a maxillary first molar: a case report.

This article describes the identification and treatment of a maxillary first molar exhibiting three canals in the mesiobuccal root. An 18-yr-old male patient presented for nonsurgical root canal therapy of tooth #3. After accessing the pulp chamber, and probing with 2.5x magnification, only one canal was located in the mesiobuccal root initially. Subsequent to troughing the groove between the mesiobuccal and palatal canals with a #2 round bur, two additional canals were located. An electronic apex locator was utilized to ensure a perforation of the pulpal floor had not occurred. A working film confirmed the presence of three canals in the mesiobuccal root, and the canals were cleaned, shaped, and obturated.

The effect of endodontic solutions on resorcinol-formalin paste in teeth.

This study determined if any of six endodontic solutions would have a softening effect on resorcinol-formalin paste in extracted teeth, and if there were any differences in the solvent action between these solutions. Forty-nine single-rooted extracted teeth were decoronated 2 mm coronal to the CEJ, and the roots sectioned apically to a standard length of 15 mm. Canals were prepared to a 12 mm WL and a uniform size with a #7 Parapost drill. Teeth were then mounted in a cylinder ring with acrylic. The resorcinol-formalin mixture was placed into the canals and was allowed to set for 60 days in a humidor. The solutions tested were 0.9% sodium chloride, 5.25% sodium hypochlorite, chloroform, Endosolv R (Endosolv R), 3% hydrogen peroxide, and 70% isopropyl alcohol. Seven samples per solution were tested and seven samples using water served as controls. One drop of the solution was placed over the set mixture in the canal, and the depth of penetration of a 1.5-mm probe was measured at 2, 5, 10, and 20 min using a dial micrometer gauge. A repeated-measures ANOVA showed a difference in penetration between the solutions at 10 min (p = 0.04) and at 20 min (p = 0.0004). At 20 min, Endosolv R, had significantly greater penetration than 5.25% sodium hypochlorite (p = 0.0033) and chloroform (p = 0.0018); however, it was not significantly better than the control (p = 0.0812). Although Endosolv R, had statistically superior probe penetration at 20 min, the softening effect could not be detected clinically at this time.

K3 Endo, ProTaper, and ProFile systems: breakage and distortion in severely curved roots of molars.

It was the aim of this study to investigate the incidence of file breakage and distortion when the ProTaper, K3 Endo, and ProFile systems were used to instrument canals in the severely curved roots of extracted molars. Forty-five roots of extracted mandibular and maxillary molars with curvatures between 40 and 75 degrees were chosen for this study. The canals in group 1 were instrumented with the ProFile system. Roots in group 2 were instrumented with the ProTaper system, and those in group 3 were instrumented with the K3 Endo system. The three systems were used according to the manufacturers' instructions. The proportion of files distorted was 15.3% for the ProFile group, 2.4% for the ProTaper group, and 8.3% for the K3 Endo group. There was a statistically significant difference between the ProFile and ProTaper groups (p=0.0079). The percentage of broken files was 1.7% for the ProFile group, 6.0% for the ProTaper group, and 2.1% for the K3 Endo group. No statistically significant differences were found between these three groups (p=0.4243). The results of this study showed that these three rotary tapered systems were not significantly different with regard to breakage. There were significantly more distorted files in the ProFile group when compared with the ProTaper group. With regard to distortion, there was no significant difference between the ProTaper and K3 Endo and the ProFile and K3 Endo groups.

Placement of mineral trioxide aggregate using two different techniques.

The purpose of this study was to determine if the adaptation of mineral trioxide aggregate (MTA) would differ when placed into simulated root canals of varying length when using two different placement and condensation methods. Hand condensation was compared to ultrasonic condensation. Eighty polyethylene tubes were divided into four groups of 20 tubes each. The tubes in the four groups were prepared to receive 3-, 5-, 7-, and 10-mm lengths of MTA respectively. Each group of 20 tubes was subdivided; 10 samples of each length had MTA placed and condensed by the hand method and the other 10 by the ultrasonic method. After condensation the samples were evaluated with a light microscope and radiographs for the degree of adaptation of the MTA to the tube walls and for the presence of voids within the MTA material itself. The results demonstrated an 80% agreement for findings between the light microscopy and radiographic evaluation. Hand condensation resulted in better adaptation to the tube walls and less voids than the ultrasonic method. There was no significant difference in the results for any of the four lengths of MTA placed by the hand method (p > 0.9). At this time hand condensation should be considered the preferred method for placement of MTA.

Cleaning efficiency of nickel-titanium GT and .04 rotary files when used in a torque-controlled rotary handpiece.

This study determined if the cleaning efficiency of nickel-titanium rotary files in an endodontic electric handpiece using a no-torque control setting was superior to that obtained when using the torque-control feature. Fifty extracted human anterior teeth with straight canals were divided into two groups of 20 and two control groups of 5. Canals were instrumented with GT and .04 ProFile nickel-titanium files until a size 35 advanced to working length. Samples were sectioned and the apical 6 mm of the canal was photographed (x20) and projected onto a 3- x 4-foot grid with squares measuring 0.5 inches each. Total debris was the percentage of the number of squares containing debris versus the total number of squares. The teeth in the torque-controlled group showed an average of 24.99% debris versus 15.55% for the teeth in the no-torque group. The difference was not statistically significant; therefore, no difference can be said to exist between the two torque settings in terms of cleaning efficiency.

The effect of chlorhexidine gluconate as an endodontic irrigant on the apical seal: long-term results.

The purpose of this study was to determine whether chlorhexidine gluconate (0.12%), used as an endodontic irrigating solution, would affect the apical seal of three root canal cements. One hundred, extracted, human, single-canal teeth were divided into 9 experimental groups of 10 teeth each, in addition to a positive and negative control group of 5 teeth each. The teeth were decoronated at the level of the CEJ, accessed, instrumented to a Master apical file #50, irrigated with either sterile saline, 5.25% NaOCl, or 0.12% chlorhexidine gluconate, and dried using paper points. Obturation was accomplished using lateral condensation and one of three endodontic sealers: Roth's 811, AH 26, or Sealapex. Postobturation apical leakage was measured at 270- and 360-day observation periods using the fluid filtration method. Using the mixed-model repeated-measures ANOVA test with Tukey's honest significance difference multiple comparison procedure, the results showed the saline-Sealapex combination had significantly more leakage (p < 0.05) than either the Peridex-Sealapex or saline-Roth's combinations at 270 days. No other significant differences were noted between any sealer-irrigant combination at 270 days. The saline-Sealapex combination had significantly more leakage than the saline-Roth's combination at 360 days. No other significant differences were noted at 360 days. Under the conditions of this study, chlorhexidine gluconate irrigant did not adversely affect the apical seal of three root canal cements at 270 and 360 days.

Working length determination in palatal roots of maxillary molars.

The purpose of this study was to determine if a buccal curvature in the palatal roots of maxillary molars affected the clinician's ability to accurately determine working length. Twenty-seven extracted, human maxillary molars were sorted by palatal root curvatures as J- and C-type, and the angle of curvature was determined. Straight-line access was made and a #20 file was placed into the canal until the tip was visible at the apical foramen then withdrawn. The file, tooth, and calibration wire were radiographed on one image using the RadioVisioGraphy system. Actual (file) and radiographic (tooth) lengths were determined using the RadioVisioGraphy ruler. Radiographic length appeared shorter on average than the actual length. Canal curvatures larger than 25 degrees had differences greater than 0.5 mm. This represents a statistically significant difference between the actual and radiographic lengths as the degree of curvature increases. There was no significant difference between the J- and C- types.

The effect of endodontic solutions on resorcinol-formalin paste.

This study determined if any of four endodontic solutions would have a softening effect on resorcinol-formalin paste and if there were any differences in the solvent action between these solutions. Resorcinol, formalin, and zinc oxide were mixed and allowed to set for 30 days. The solutions tested were 0.9% sodium chloride, 5.25% sodium hypochlorite, chloroform, and Endosolv R. Seven samples per solution were tested and an additional seven samples served as controls. Each sample was saturated with one of the solutions and the depth of penetration was tested at 1, 2, 5, 10, and 20 min using a dial strain gauge. At 2 min, sodium hypochlorite and sodium chloride had significantly greater penetration than the other groups (p < 0.0010). Sodium hypochlorite was superior to all other groups after 5 min. This study showed that both sodium chloride and sodium hypochlorite exhibited a significant softening effect within 2 min.

Antibiotic use by members of the American Association of Endodontists in the year 2000: report of a national survey.

The purpose of this study was to determine the prescribing habits of active members of the American Association of Endodontists (AAE) with regard to antibiotics. A one-page, double-sided questionnaire was sent to the active members of the AAE living in the United States. The 1999 mailing list of 3203 members was obtained from the AAE, and the return rate was 50.1% (1606 surveys). With a sample size over 1000, the study was able to distinguish differences to within 0.5% with power = 80% (at alpha = 5%). The data were analyzed using descriptive statistics and chi-square tests of independence. Penicillin VK, 500 mg, 4 times a day, was the first choice antibiotic prescribed by 61.48% of respondents. Clindamycin (Cleocin), 150 mg, 4 times a day, was selected by 29.59%. For those patients with a penicillin allergy, 57.03% prescribed clindamycin and various erythromycin preparations were prescribed by 26.65%. A loading dose was used by 85.14%. The average duration of antibiotic therapy was 7.58 days. Those respondents involved in academics, either part-time or full-time, were significantly more likely to prescribe penicillin VK, 500 mg, 4 times a day at a rate of 85% versus those in part-time or full-time private practice at a rate of 67%. For cases of irreversible pulpitis, 16.76% of responding endodontists prescribed antibiotics. For the scenario of a necrotic pulp, acute apical periodontitis, and no swelling, 53.93% prescribed antibiotics. Almost 12% prescribed antibiotics for necrotic pulps with chronic apical periodontitis and a sinus tract. For the most part, the majority of the members of the AAE were selecting the appropriate antibiotic for use in orofacial infections, but there are still many who are prescribing antibiotics inappropriately. Although there were trends of improvement in some areas with regards to prescribing antibiotics, there were other areas where there had been no improvement in 25 years. Unless these trends change, our generation and those to come may not have effective antibiotics for use in the management of true orofacial infections.