A radiographic study of the prevalence of endodontically treated teeth and procedural errors of root canal filling.

The aim of this radiographic investigation was to study procedural errors encounterd in root canal treatment in a Jordanian population as evidenced using periapical radiographs A total of 2380 periapical radiographs including 3178 endodontically treated teeth were assessed in respect of the quality of endodontic treatment. The results indicated that the prevalence of endodontically treated teeth in the maxilla was higher than that in the mandible ( P < 0.001 ), the maxillary central incisors have the highest prevalence of endodontic treatment, and the maxillary second molars have the lowest prevalence of endodontic treatment. In respect of the quality of endodontic treatment, 30.2% of endodontically treated teeth exhibited an ideal length of root canal filling, 23.64% of the evaluated teeth were mummified, 37.45% of the teeth have short root canal fillings, 6.25% were overfilled, 1.35% were with preparations which deviated from the line of the root canal and 1.10% of the evaluated teeth have perforations of the root walls or the floor of the pulp chamber. It is concluded that the Maxillary teeth were found to be endodontically treated more frequently than the mandibular teeth, anterior teeth were found to be endodontically treated more than premolar and molar teeth, maxillary central incisors have the highest prevalence of endodontic treatment whilst the maxillary second molars have the lowest prevalence. The quality of endodontic treatment was disappointing. Therefore, emphasis on continuing education and post graduate courses in endodontics must be a priority in Jordan.     

Periapical status and prevalence of endodontic treatment in an adult Dutch population

This study examined the prevalence of endodontic treatment in a group of 184 Dutch adults, and determined the periapical status of all teeth using panoramic radiographs. The results indicate that in this group, 2.3% of the teeth were root-filled, and that 5.2% of all non-endodonticallv treated teeth showed signs of periapical pathology. Around the apices of 39.2% of the endodontically treated teeth in this survey, radiographic signs of periapical pathology were observed. Using the level of the root canal filling as a criterion for evaluating the quality of the root canal treatment, 50.6% of the endodontic treatments were qualified as inadequate. There was a significant correlation between the presence of periapical pathology and underfilling of the root canal(s). 44.6% of the patient sample had at least one tooth with radiographic signs of periapical pathology, indicating a substantial future need for endodontic treatment.     

Cytotoxicity, histopathological, microbiological and clinical aspects of an endodontic iodoform-based paste used in pediatric dentistry: a review

This review aims at describing and comparing materials commonly used in root canal therapy, the cytotoxicity, histopathological, microbiological and clinical aspects ofa iodoform-based paste (Guedes-Pinto Paste-GPP) used in endodontic treatment of primary teeth. GPP has shown excellent biocompatibility to pulp fibroblasts and mild inflammatory reactions, having been well-tolerated by the periapical and connective tissues. Moreover, GPP bactericidal and bacteriostatic effects against many oral microorganisms were also demonstrated. Regarding clinical trials, the GPP technique has achieved success rates when considering clinical and radiographic examinations. In the face of all the above mentioned results, this paper would like to propose the use of this endodontic material as a root canal filling for primary teeth.     

Periapical health related to the quality of root canal treatment in a Belgian population

AIM: The aim of this study was to collect data on the prevalence and technical standard of root canal treatment as well as the prevalence of apical periodontitis in Belgium. METHODOLOGY: The panoramic radiographs of 206 Belgian adults attending the Dental School of the University Hospital of Gent were examined for endodontic treatment, periapical conditions and coronal restorations. RESULTS: Of the 4617 teeth examined, 6.8% were endodontically treated. Periapical radiolucencies were found in 6.6% of all teeth and in 40.4% of the endodontically treated teeth. More than half of the root-filled teeth (56.7%) were scored inadequate on the basis of a criterion evaluating the level of the root canal filling. CONCLUSION: The endodontic treatment need of this Belgian subpopulation was great and the technical standard of root canal treatment disappointing. The findings indicate that there is still a substantial need for postgraduate endodontic education in Belgium and a need for specialists in endodontology.     

CBCT在根管治疗后疾病诊治中的临床应用研究

目的：评估CBCT影像系统在根管治疗后疾病诊治中的应用。方法：对41颗完成根管治疗的牙齿进行回访,拍摄X线片,进行CBCT扫描重建,对比研究患牙根管治疗前以及回访时病变区域的变化,了解根管治疗后疾病的发生情况,评价根管治疗效果和预后。结果：17例临床术前诊断为根尖周病的病例在CBCT上均可见根尖周组织存在破坏,而X线上仅8例可见根尖区存在破坏。回访病例中根据X线片和CBCT影像诊断为根管治疗后疾病分别为17.03%和39.02%（P〈0.05）。结论：CBCT有利于评估根管治疗程序的可靠性,对根管治疗后疾病诊断及再治疗方案的选择具有重要的临床参考价值,值得在牙髓病诊治中推广应用。     

Periapical status and quality of root fillings and coronal restorations in a Danish population

AIM: The aim of this study was to investigate the quality of endodontic and coronal restorations and the association with periapical status in a Danish population. METHODOLOGY: A total of 614 randomly selected individuals (20-60+ years of age) from Aarhus County had a full-mouth radiographic examination. The quality of endodontic and coronal restorations and the periapical status of endodontically treated teeth were assessed by radiographic criteria. Root fillings were categorized as 'adequate' or 'inadequate' with regard to root filling length and lateral seal. Coronal restorations were categorized into 'adequate' and 'inadequate', defined by the absence or presence of radiographic signs of overhangs or open margins. Results were analysed statistically using the chi-squared test. RESULTS: The total number of endodontically treated teeth was 773, and 52.3% had apical periodontitis (AP). Root-filled teeth with an adequate lateral seal had a lower incidence of AP than teeth with an inadequate seal (44.3% vs. 57.8%), and teeth with an adequate root filling length were associated with a better periapical status than teeth with inadequate length of the root filling (42.0% vs. 67.6%). Similarly, adequate coronal restorations were associated with better periapical status than inadequate restorations (48.0% vs. 63.9%). When both root filling and coronal restoration quality were assessed, the incidence of AP ranged from 31.2% (optimal quality) to 78.3% (all parameters scored as inadequate). CONCLUSIONS: Inadequate root canal and coronal restorations were associated with an increased incidence of AP.     

Prevalence and quality of endodontic treatment in the Northern Manhattan elderly

Pulpitis results in significant morbidity among the elderly, particularly in underserved communities. We collected panoramic oral radiographs from 244 (mean age 67) participants of the Northern Manhattan Study, a prospective cohort study of stroke risk in a multiethnic urban population. Radiographs were evaluated for missing teeth, caries, restorations, periodontal bone loss, adequacy of endodontic treatment, and periapical radiolucencies. In the study 206 subjects were dentate (mean 17.1 teeth). 5.1% of teeth had periapical radiolucencies, and 4.8% had been endodontically treated; 37.5% of endodontically treated teeth had periapical radiolucencies. Teeth with restorations, periodontal bone loss, pulpotomy, and inadequate root canal filling had a significantly higher occurrence of periapical radiolucency (p < 0.05). Among all root filled teeth, only 26% were deemed satisfactory. We conclude that apical periodontitis is widely prevalent and the technical standard of root fillings is poor in this cohort. There is a substantial need for improved dental care among the northern Manhattan elderly.     

Factors affecting the long-term results of endodontic treatment

The influence of various factors that may affect the outcome of root canal therapy was evaluated in 356 patients 8 to 10 yr after the treatment. The results of treatment were directly dependent on the preoperative status of the pulp and periapical tissues. The rate of success for cases with vital or nonvital pulps but having no periapical radiolucency exceeded 96%, whereas only 86% of the cases with pulp necrosis and periapical radiolucency showed apical healing. The possibility of instrumenting the root canal to its full length and the level of root filling significantly affected the outcome of treatment. Of all of the periapical lesions present on previously root-filled teeth, only 62% healed after retreatment. The predictability from clinical and radiographic signs of the treatment-outcome in individual cases with preoperative periapical lesions cases was found to be low. Thus, factors which were not measured or identified may be critical to the outcome of endodontic treatment.     

Cross‐sectional study of endodontic treatment in an Australian population

The quality and technical standard of Australian endodontic treatment is generally unknown. Two hundred and forty‐three patients from a metropolitan dental hospital were radiographically assessed for quality of root canal therapy. Total teeth examined were 5647 with 499 teeth (8.84%) being root‐filled. Teeth were scored using Ørstavik's Periapical Index. Periapical Index scores indicating a healthy periapical state were found in 392 root‐filled teeth (78.56%) and those indicative of periapical disease in 107 root‐filled teeth (21.43%). Of the 499 root‐filled teeth, 149 (29.9%) were adequate in terms of length, with 120 teeth (80.5%) of these healthy. Three hundred and fifteen teeth (63.1%) were filled short with 271 (86.0%) classified as healthy. Thirty‐five teeth (7.0%) were filled long with only one tooth (2.9%) in this category deemed healthy. Four hundred and fifty‐nine teeth (92.0%) were adequate in density, with 365 teeth (79.5%) being healthy. Forty teeth (8.0%) showed inadequate density with 27 (67.5%) being healthy. One hundred and forty‐five teeth (29.1%) were adequate in length and density with 117 teeth (80.7%) deemed healthy. A significant statistical correlation between root filling quality and periapical status was not found. Factors, such as the coronal restoration quality, should be further investigated.     

Pulp Revascularization of Immature Dens Invaginatus with Periapical Periodontitis

IntroductionDens invaginatus is a rare developmental malformation of a tooth caused by the invagination of the tooth crown before biological mineralization occurs. The complex anatomy of these teeth makes nonsurgical endodontic treatment difficult and more so when there is presence of periapical periodontitis with open apex. The endodontic treatment of dens invaginatus is a challenge, especially in the case of periapical periodontitis with open apex. Pulp revascularization is a conservative endodontic treatment that has been introduced in recent years. Presented here is a variant approach for the treatment of immature dens invaginatus type II with periapical periodontitis, which combines filling of the invagination and pulp revascularization.MethodsAfter accessing the pulp chamber, the main canal and the invagination were explored. The root was thoroughly disinfected by irrigating and medication, invagination was filled, and the main canal was revascularized. Then the coronal sealing was made by glass ionomer cement and composite resin. Radiograph taken regularly and computed tomography scan were used to investigate the healing of the periapical lesion and development of the root.ResultsIn the subsequent follow-up, the periapical lesion was completely eliminated, the open apex was closed, and the wall of the root was thickened.ConclusionsFor type II immature dens invaginatus with large periapical lesion, conservative endodontic treatment should be considered before periapical surgery. With sufficient infection control, pulp revascularization can be an effective alternative method.     

Quality of root canal treatment performed by undergraduate dental students at the University of Khartoum, Sudan

The aim of the present study was to evaluate the quality of root canal treatment performed by undergraduate dental students at the University of Khartoum. Assessment was by examination of periapical radiographs of completed endodontically treated teeth, performed by undergraduate dental students. A total of 166 postoperative periapical radiographs compromising 265 roots were included. The quality of endodontic treatment was examined in relation to the length of the root filling in relation to the radiographic apex, the density of the obturation according to presence of voids and the taper of root canal fillings. Adequate length of the root filling was found in 34.7% of the maxillary teeth and in 10.9% of mandibular teeth in this study. Adequate density was found in 38.87% of maxillary and 16.98% of mandibular teeth and appropriate taper was found in 40% of maxillary and 16.6% of mandibular teeth. Overall 24.2% in all evaluated teeth were found to have a root filling of an acceptable quality. This result may be because of insufficient preclinical endodontic training of the students' operators or because of the introduction of students to endodontic clinical practice late in their program.     

Outcome of endodontic treatment of teeth filled using lateral condensation versus vertical compaction (Schilder's technique)

The purpose of this prospective clinical and radiographic investigation was to assess the treatment results following endodontic therapy of teeth filled with lateral condensation versus teeth filled with vertical compaction of warm gutta-percha. A total of 290 patients were treated using the standardized step-back technique for canal preparation, which were filled with either lateral condensation or vertical compaction in one single session. Five years later, the treatment results were assessed clinically and radiographically and related to the type of the obturation technique using Chi-square analysis. Of the 340 teeth that were reexamined, 160 teeth were filled with lateral condensation, and 180 teeth were filled with vertical condensation. The results showed a significantly higher success rate for the vertical compaction versus the lateral condensation technique of teeth presented with preoperative periapical lesions P<0.04. Regardless of the preoperative periapical status of the teeth, no statistically significant difference was found between the two techniques. The overall success rate of both filling techniques was 80.3%.     

Nonsurgical endodontic treatments in molar teeth with large periapical lesions in children: 2-year follow-up

Profound caries lesions may lead to invasion of microorganisms to the dental pulp, and periapical areas can promote the development of dentoalveolar abscess and periapical bone loss. Treatment options to manage large periapical lesions range from nonsurgical root canal treatment and/or apical surgical procedure to extraction. Young molar teeth with pulp necrosis and large periapical lesions in children are frequently treated with root canal treatment because the therapy is more difficult in multirooted teeth. In these case reports, nonsurgical endodontic treatments performed on 6 molar teeth with large periapical lesions, by repeated intracanal dressing with calcium hydroxide, are presented. Radiographs displayed significant bony healing at the end of the second year. In conclusion, large periapical lesions can respond favorably to nonsurgical treatment, and complex and difficult endodontic treatments in children might not be required.     

Radiographic features and outcome of root canal treatment carried out in the Łódź region of Poland

AIM: The aim of this study was to assess the radiographic features and factors affecting the long-term results of root canal treatment in the Lód? region of Poland. METHODOLOGY: Three hundred and fifty-five periapical radiographs of previously endodontically treated teeth (282 root-filled teeth and 73 teeth with pulpotomy) from 236 patients were evaluated in the study. The patients were aged from 15 to 76 years and randomly selected amongst subjects referred to the Institute of Dentistry. Medical University of Lód? and two private dental practices. The radiographs were examined by the authors according to criteria proposed by De Cleen et al. (1993) using an illuminated viewbox in a dark room. The Fisher's exact test was used to compare the frequencies in teeth groups. RESULTS: Amongst root-filled teeth, 49% were adequately filled within 0-2 mm of the radiographic apex. Periapical radiolucencies were observed in 25% of root-filled teeth. Teeth without periapical pathosis were more often filled within 0-2 mm of the apex (59%) than teeth with pathosis (17%). Teeth were most often adequately filled (64%) in patients attending the Institute of Dentistry. In patients attending the dental outpatients' departments, 71% of teeth were inadequately filled. Amongst the teeth treated with pulpotomy, 67% had a periapical radiolucency. CONCLUSION: The radiographic technical quality of the root canal treatment was associated with the outcome that root fillings of adequate standard were associated with health more often than inadequate root fillings. Pulpotomy was associated with periapical disease in the majority of cases.     

下前牙根管再治疗的临床研究

目的:经切缘开髓路径对下颌前牙根管治疗失败的病例进行再治疗,探讨下颌前牙开髓路径提高根管治疗的成功率。方法:临床收集79例下前牙因根管治疗失败后需要再治疗的患牙共计94颗,去除原根充材料,探查是否遗漏根管,采用经切缘开髓路径对患牙进行根管再治疗,治疗前后拍摄X线片,观察对比治疗前后根管的充填情况及下颌前牙根尖病变的愈合情况。结果:94颗患牙中共发现72例下前牙为双根管,其中下颌中切牙为双根管33例,下颌侧切牙为双根管19例,下颌尖牙双根管20例。所有患牙经根管再治疗后根管充填结果满意,患牙根尖病变明显好转。结论:下颌前牙切缘开髓根管路径趋于直线不仅视野良好,且能有效提高复杂根管的发现率及治疗成功率。     

Regenerative Endodontic Procedures for Traumatized Immature Permanent Teeth with Severe External Root Resorption and Root Perforation

External root resorption (ERR) is often a complication of traumatic injury to the teeth. Traditionally, external inflammatory root resorption is treated with calcium hydroxide. The outcome of ERR, especially replacement resorption, is unpredictable. The purpose of the present case report was to describe regenerative endodontic procedures (REPs) for 1 replanted avulsed tooth with severe external root resorption and root perforation (tooth #9) and 1 extruded tooth (tooth #8). A 9-year-old girl was referred for the treatment of teeth #8 and #9 4 months after the initial trauma. Clinical examination showed that tooth #9 had a sinus tract present near the periapical area, was tender to percussion and palpation, and did not respond to pulp sensibility tests. Tooth #8 responded to pulp sensibility tests. Periapical radiographic and cone-beam computed tomographic examination showed that tooth #9 had a periapical radiolucent lesion and severe ERRs with a root perforation. Tooth #9 was diagnosed with a necrotic pulp and symptomatic apical periodontitis. Regenerative endodontic procedures (REPs) were initiated. Tooth #8 became nonresponsive to pulp sensibility tests and developed a periapical lesion 12 months after REPs of tooth #9 and was also treated with REPs. The clinical symptoms and apical lesions resolved for both teeth after REPs. The severe ERRs were arrested, and root perforation was repaired for tooth #9. Teeth #8 and #9 underwent canal obliteration by hard tissue formation after REPs and were in function at 18 months and 30 months, respectively. REPs may be used to manage traumatized immature permanent teeth with a necrotic pulp and apical periodontitis associated with severe ERR and root perforation.     

Longitudinal study of periapical and endodontic status in a Danish population

AIM: To describe and discuss changes in periapical and endodontic status in a general Danish population. METHODOLOGY: In 1997, 616 randomly selected individuals had a full-mouth radiographic survey taken. In 2003, 77% of the participants attended for a new full-mouth radiographic examination. Information on endodontic treatment and periapical status was obtained. The periapical index (PAI) was used to assess apical periodontitis (AP). RESULTS: More participants had root filling(s) and AP in 2003 than in 1997. More teeth had AP and/or root fillings in 2003. Fewer of the root-filled teeth (RFT) had AP in 2003. Less than 3% of the teeth without root fillings (NRFT) that in 1997 had no AP, developed AP and/or received a root filling. Of the NRFT which in 1997 had AP, more than 35% still had AP and no root filling in 2003. Approximately, 30% of the NRFT with AP in 1997 received a root filling. Of the teeth that received a root filling, 40% had healed, whereas 60% had not. Approximately, 25% of the NRFT that in 1997 had AP had been extracted. In 1997 there were 618 RFT, 314 of the RFT had no AP in 1997. Almost 20% of the RFT that in 1997 were periapically sound, developed AP. Of the 304 RFT with AP in 1997, approximately 30% had healed, in 60% AP persisted, and 10% were extracted. CONCLUSIONS: The present study indicates that caution must be exercised when statements on the outcome of root canal treatment are made based on the cross-sectional studies.     

Influence of apical patency and filling material on healing process of dogs' teeth with vital pulp after root canal therapy

The purpose of this study was to investigate the periapical healing process of dogs' teeth with or without apical patency and after root canal filling with two types of sealers. Forty roots of premolars and incisors were utilized. The root canals were over-instrumented and dressed with a corticosteroid-antibiotic solution for 7 days to obtain ingrowth of periapical connective tissue into the canals. After this period, the tissue was removed in half of the specimens (groups with patency) and preserved in the other half (groups without patency). Canals were filled by lateral condensation technique with gutta-percha points and either a calcium hydroxide-based sealer (Sealer Plus) or a Grossman's cement (Fill Canal). The animals were killed by anesthetic overdose 60 days after the endodontic treatment and anatomic pieces were obtained and prepared for histologic examination. Data were evaluated in a blind analysis on the basis of several histomorphologic parameters. The groups without patency had better results (p=0.01) than those in which the ingrown connective tissue was removed. Comparing the sealers, Sealer Plus had significantly better results (p=0.01) than Fill Canal. In conclusion, both the apical patency (presence or absence) and the type of root canal filling material influenced the periapical healing process in dogs' teeth with vital pulp after root canal treatment. The use of a calcium hydroxide-based sealer in teeth without apical patency yielded the best results among the experimental conditions proposed.     

Effect of irrigating solution and calcium hydroxide root canal dressing on the repair of apical and periapical tissues of teeth with periapical lesion

The objective of this study was to evaluate the apical and periapical repair after endodontic treatment of teeth with pulp necrosis and a chronic periapical lesion in dogs. Seventy-two root canals from four mongrel dogs were submitted to biomechanical preparation, using 5.25% sodium hypochlorite or 2% chlorhexidine digluconate as the irrigating solution. The root canals were subsequently either filled immediately with Sealapex, using active lateral gutta-percha condensation, or a calcium hydroxide root canal dressing was applied for 15 days before filling with Sealapex. After 210 days, the animals were killed by anesthetic overdose, and the obtained histological sections were stained with hematoxylin and eosin for optical microscopic analysis of apical and periapical repair. There was better histological repair in the groups with the root canal dressing (p < 0.05) than the groups with immediate obturation. Comparing the immediate obturation groups, irrigation with chlorhexidine solution resulted in better repair than sodium hypochlorite.     

Prevalence and quality of endodontic treatment in an elderly urban population of Switzerland.

Little oral health data on the elderly are available in Switzerland. This study assessed endodontic findings in 66-yr-old residents of the city of Zurich using intraoral radiographs. Of the 143 volunteers having a total of 2004 natural teeth, 78% had at least one endodontically treated tooth. Twenty percent of all teeth were root filled, two thirds of them being in the upper jaw. Sixty-four percent of the root fillings were judged insufficient and 8.5% of all teeth showed periapical radiolucencies, most of the latter (73%) being associated with insufficient root canal treatments. Ninety-eight percent of the root-filled teeth had intracanal retentive devices. Fifty-two percent of the teeth with insufficient root fillings were judged not to need revision, 37% needed revision, 9% needed apicectomy, and 2% were ready for extraction. The considerable endodontic treatment needs of the elderly can only be reduced by an improvement of quality of initial endodontic treatment.