Identification and antibiotic sensitivity of bacteria isolated from periapical lesions.

Periradicular tissues from 28 refractory endodontic cases requiring surgical intervention were submitted for histological diagnosis and microbiological culture. Bacteria isolated from these lesions were identified and then tested for their antibiotic sensitivity to a panel of common antibiotics. The periapical tissue specimens of 22 out of 28 lesions (79%) contained microorganisms. Of the 22 cases showing positive growth cultures, 15 were polymicrobial and 7 were single species isolates. Fifty-three different species were recovered: 29 anaerobes, 19 facultative anaerobes, and 5 aerobes. Microbes were observed under light microscopy in only one case. The most common organisms isolated were Propionibacterium acnes, Staphylococcus epidermidis, Streptococcus intermedius, Wolinella recta, Fusobacterium species, and Clostridium species. Antibiotic susceptibility results showed no clear cut evidence of significant antibiotic resistance among the species tested. The results of this study seem to corroborate earlier studies regarding the microbial population of periapical lesions refractory to nonsurgical endodontics.

Distribution of injected dexamethasone from the buccal vestibule of the rat mandible.

Thirty-six Sprague-Dawley rats were divided into three groups of 12. Group 1 was a control, whereas group 2 had the dental pulp of the first mandibular molar acutely exposed, and group 3 had dental pulp exposure for 10 days. All animals were injected with 125I-labeled dexamethasone phosphate into the right mandibular vestibule. Each group of 12 was divided into subgroups of 4 and sacrificed at 1, 2, or 4 h. The soft tissue on the buccal side and the mandible with the molars were collected and the radioactivity determined. Dexamethasone was absorbed from the injection site and distributed to the ipsilateral mandible and to the contralateral muscle and bone similarly, regardless of the treatment. Results also indicate a possible osseous affinity for this steroid, which could be beneficial in relieving the pain of intraosseous endodontic flare-ups.

Relative frequency of teeth needing endodontic treatment in 3350 consecutive endodontic patients.

A survey covering 8 years and 3350 consecutive endodontic patients (1958 men (58%) and 1392 women (42%)) was conducted to determine the frequency of endodontic treatment for each tooth. At the time of initial examination, 3672 teeth required root canal therapy. Three hundred twenty-two patients needed endodontic therapy on multiple teeth. Posterior teeth were most frequently treated, 80.1% of the total with molars requiring 52.6% of the needed endodontic treatment. The mandibular first molar was treated most often, 18.8% of the time, followed by the maxillary first molar (13.5%) and the mandibular second molar (12.0%). The number of endodontically treated maxillary and mandibular teeth was similar, 50.8% and 49.2%, respectively.

An in vitro comparison of incomplete root fractures associated with three obturation techniques.

This study compared the incidence of incomplete root fractures among five groups of mandibular incisors (20/group). The groups were: (a) no canal preparation, (b) canal preparation, (c) canal preparation and obturation with laterally condensed gutta-percha, (d) canal preparation and obturation with thermoplasticized gutta-percha on a central carrier (Thermafil), and (e) canal preparation and obturation with thermoplasticized injectable gutta-percha (Ultrafil). Following experimental manipulation, all teeth were stained, transversely sectioned, and evaluated for the presence of root fracture. No complete root fractures were noted. The lowest incidence of stained incomplete fracture was found in the no canal preparation group. The canal preparation, lateral condensation, Ultrafil, and Thermafil groups had more incomplete fractures than the no canal preparation group. The incidence of stained fracture in the three obturation groups was not significantly different from the incidence in the group which had only canal preparation.

A bacteriological and histological evaluation of 58 periapical lesions.

Periapical tissue from 58 cases requiring periapical surgery was examined histologically and cultured for the presence of microbes. Twenty-nine had a possible oral cavity communication and 29 did not. Approximately one-half of each biopsy was submitted for culture while the other portion was examined histologically. Cultures were positive for the presence of bacteria in 51 of 58 cases while bacteria were seen histologically in only 8 of 58 cases. A total of 50 different species of bacteria were isolated from the 58 cultures of periapical tissue. Of 133 isolates, 87 were strict anaerobes, 37 were facultative anaerobes, and 9 were aerobes. Bacteroides species were found in 17 cultures, always with additional bacteria. Seventeen of 58 biopsies contained foreign particulate matter thought to be root canal sealer. Bacteria were found in periapical granulomas, radicular cysts, and a periapical abscess. According to our data, bacteria, foreign material, missed canals, vertical root fractures, and periodontal disease may all contribute to the chronic, non-healing periradicular lesion.

Duration of anesthesia using the periodontal ligament injection: a comparison of bupivacaine to lidocaine.

The purpose of this study was to compare the duration of pulpal anesthesia obtained with 0.5% bupivacaine HCl with 1:200,000 epinephrine to 2% lidocaine HCl with 1:100,000 epinephrine, using the periodontal ligament (PDL) injection. Twenty-four subjects received bilateral PDL injections using mandibular premolar teeth and a double-blind research design. Anesthesia was defined as no response to maximum output of an electric pulp tester. An overall success rate of 35.4% was achieved. Duration of anesthesia obtained with bupivacaine HCl ranged from 4 minutes 59 seconds to 16 minutes 37 seconds with a mean duration of 10 minutes 24 seconds. Excluding one instance in which the duration was three orders of magnitude beyond the norm, duration of anesthesia obtained with lidocaine HCl ranged from 1 minute 43 seconds to 16 minutes 16 seconds with a mean duration of 7 minutes 10 seconds. Postoperatively, all experimental teeth tested vital with no clinically apparent pulpal or periodontal damage. Some postoperative discomfort was experienced at 16.6% of the injection sites.

Endodontic endosseous implants: case reports and update of material.

Two cases are presented with 5-yr follow-ups in which Vitallium endodontic implants were used successfully to improve the crown-root ratio of central incisors compromised by trauma. A review of recent developments in endodontic implant materials and designs indicates that new materials should provide greater biocompatibility and retention.

Endodontic flap design: analysis and recommendations for current usage.

An endodontic flap design, which may be used as an alternative to the presently described endodontic flaps, is presented. This flap involves a full-thickness dissection with easily recognizable landmarks and straight-line incisions. A beveled horizontal incision is designed to incorporate the maximum amount of facial keratinized tissue into the body of the flap, while leaving the interproximal tissues untouched. The resultant flap is easily replaced with interrupted sutures to the stable interproximal papillae. Healing is rapid, with excellent esthetic results.