Therapeutic solution for a combined endo-periodontal lesion. Case report

The endo-periodontal lesion may lead to diagnostic and therapeutic difficulties in general dental practice. In the present case endo-periodontal inflammation of the lower left first molar caused the patient's complaints. The inflammation of periodontal and pulpal origin was separated although they simultaneously were present in the same time. Endo-periodontal lesion can be treated by endodontic and periodontal care and sometimes complemented by surgery. Scaling and polishing, as well as root planing were performed following the endodontic treatment of distal root, then the tooth was dissected and the mesial root was removed. Finally the remained distal part of molar was used as a bridge abutment. Combined endo-periodontal lesion can be cured with appropriate treatment as root filling, periodontal treatment, supplemented with tooth dissection.     

Discolouration potential of endodontic procedures and materials: a review

Ahmed HMA, Abbott PV. Discolouration potential of endodontic procedures and materials: a review. International Endodontic Journal,?45, 883-897, 2012. ABSTRACT: Advances in endodontic materials and techniques are at the forefront of endodontic research. Despite continuous improvements, tooth discolouration, especially in anterior teeth, is considered an undesirable consequence following endodontic treatment as it creates a range of aesthetic problems. This article aims to discuss the intrinsic and internalized tooth discolouration caused by endodontic procedures, and to address the discolouration potential of materials used during root canal treatment, including root canal irrigants, intra-canal medicaments, endodontic and post-endodontic filling materials. In addition, the discolouration patterns caused by combined endodontic and nonendodontic aetiological factors are discussed. The recommended guidelines that should be followed by dental practitioners to prevent and manage tooth discolouration are also outlined.     

Calcium hydroxide in the treatment of external root resorption

A case is presented in which calcium hydroxide was used in endodontic treatment of external root resorption in a tooth with a necrotic pulp, during active orthodontic movement. A calcified deposit formed, filling a defect, and the tooth was subsequently obturated with gutta-percha. Thus, both types of therapy--endodontic and orthodontic--were performed simultaneously.     

Endodontic treatment of immature tooth with dens invaginatus: a case report

The endodontic treatment of a dens invaginatus in an immature permanent upper lateral incisor of a 9-year-old boy is presented. Root canal treatment was performed using calcium hydroxide paste as a temporary root canal filling in order to achieve apexification. This was replaced after closure of the apex with a final root canal filling using gutta-percha and AH 26 as the sealer. The follow-up radiographic control demonstrated the effectiveness of nonsurgical treatment in a case of incomplete root formation in a tooth with dens invaginatus.     

Endodontic and orthodontic treatment of a cross-bite fused maxillary lateral incisor

AIM: To describe combined endodontic and orthodontic treatment of a maxillary lateral incisor fused with a supernumerary. SUMMARY: A rare case is presented in which combined endodontic and orthodontic treatment was performed on a cross-bite fused tooth. Clinical and radiographic examination showed the maxillary lateral incisor fused with a supernumerary and an impacted canine. The fused tooth required nonsurgical and surgical endodontic treatment for functional and aesthetic reasons. The root canals were dressed with calcium hydroxide for 2 months before they were obturated with thermoplasticized injectable gutta-percha. Then, the distal part of the fused tooth was removed and the mesial part of the tooth was replanted and fixed. Three months after the completion of orthodontic therapy, the impacted canine erupted between the remaining tooth and the first premolar. Recall examination, 3 years after completion of root canal treatment, showed clinical and radiographic evidence of healing. KEY LEARNING POINTS: Fusion has been described as a development anomaly characterized by the union of two adjacent teeth. Proper combined endodontic and orthodontic treatment resulted in maintaining one tooth half and solving the aesthetic and functional problem of a fused tooth.     

Long-term survival of teeth in the posterior region after apical surgery

Oftentimes the discussion of long-term success rates and treatment modalities becomes a central issue in consultations with patients. The aim of this study was to retrospectively evaluate survival rates of teeth after apicoectomy in an established private practice for Oral and Maxillofacial Surgery in Kiel, Germany.All teeth treated with apicoectomy between 2001 and 2006 were included. Treatment success was previously defined as preservation of the tooth. Putative influence factors on success as kind and quality of endodontic treatment, additional intraoperative endodontic filling, inflammatory status, tooth mobility, and pre- and postoperative X-rays were further evaluated.A total of 149 teeth could be included. The mean observation period was 6.3 (SD: 4.4) years. In all, 48.3% of these teeth could be retained after a 10-year period. Teeth that received an additional retrograde root canal filling during surgery resulted in a significantly higher success rate (p = 0.0237) compared to those with orthograde root canal fillings or without additional endodontic treatment. The quality of endodontic treatment had no impact (p = 0.125).Our results suggest that apical surgery is a reliable procedure to treat and ensure the survival of symptomatic teeth in the posterior region for several years. A significant improvement was further determined for a retrograde filling.     

根管治疗期间急症发生的多因素分析

目的：通过对根管治疗病例进行多因素综合分析，探讨根管治疗期间急症（EIAE）发生的主要原因及其预防方法。方法：收集159例根管治疗病例，对病人的年龄、性别、牙位、病因、治疗史、窦道、冲洗总药量、消毒药物、根充方法、根充情况和术后反应进行详细记录，对结果进行logistic回归分析。结果：通过回归分析选人的4个因素分别为根管冲洗总药量（P〈0．01）、患牙是否为再治疗（P〈0.05）、是否存在窦道（P〈0.05）及根充情况（P〈0.05），亦即上述4因素与EIAE的发生存在相关关系。年龄、性别、牙位、病因、消毒药物、根充方法（P〉0．05）可能与EIAE的发生无相关关系。结论：足量的根管冲洗，初次治疗的患牙，存在窦道和恰当充填不易发生EIAE。     

Treatment of injuries to the inferior alveolar nerve after endodontic procedures

Overextension of filling material into the mandibular canal after root treatment in the lower jaw is a rare but serious complication. Mechanical compression, chemical neurotoxicity and local infection may cause irreversible nerve damage. A report on 11 patients with neurological complaints of the inferior alveolar nerve after endodontic treatment is summarised. The neurological findings are dominated by hypaesthesia and dysaesthesia. Half of the patients reported pain. Hyperaesthesia is found much more rarely. Nearly all the patients had a combination of one or more symptoms. Initial X-rays showed root filling material in the area of the mandibular canal. Nine cases were treated with apicectomy and decompression of the nerve; in two cases, extraction of the tooth was necessary. Only one patient reported persistent pain after surgery. If neurological complaints appear after root filling in the lower jaw, a nerve injury due to root filling material should be ruled out. In cases of overfilling, immediate apicectomy and decompression of the nerve with conservation of the tooth is often the treatment of choice; the tooth may be preserved and the best chance of avoiding permanent nerve damage is provided.     

Endodontic therapy of traumatised teeth in children.

One of the most difficult problems met with in endodontic therapy for children is the traumatized anterior tooth whose root is still incomplete. In cases where the pulp is vital, treatment by pulp capping or pulpotomy is directed to preserving the vitality of the radicular pulp to ensure completion of root formation. Calcium hydroxide remains the material of choice in both forms of treatment. Once root formation is complete, removal of the pulp residue and filling of the root canal may be performed as a preliminary to restoration by means of a post retained crown. Where the pulp is non vital, attempts to fill the funnel shaped apical part of the canal, whether from a coronal approach or by open operation for retrograde filling, have proved unsatisfactory. Many workers have shown however that a number of root filling materials and root dressings are capable of inducing either continued root growth or a closure of the apical region by a calcific scar. A detailed survey of 34 teeth treated by this method has been made and the important principles which appear to influence the success of the technique are enumerated.     

Endodontic retreatment of maxillary incisors previously treated with a conventional apexification protocol: a case report

This case reports on the treatment of an immature tooth initially treated with calcium hydroxide apexification techniques. When the patient subsequently sought treatment for aesthetic concerns, the presence of apical periodontitis required revision of the endodontic procedure. Resolution of the periapical radiolucency was evident at a 12-month review. The use of mineral trioxide aggregate as an apical filling material and restoration with chemically cured composite resin extending into the coronal third of the root may prevent further contamination of the root canal system and strengthen the tooth.     

Treatment of inflammatory external root resorption resulting from dental avulsion and pulp necrosis: clinical case report

The aim of this case report was to present a treatment for severe inflammatory external root resorption. The condition developed due to the patient's neglect to seek adequate treatment following replantation of an avulsed maxillary left central incisor. Following diagnosis, treatment consisted of conventional endodontic therapy with calcium hydroxide dressings and definitive filling of the root canal after the resorption was controlled radiographically. A 24-month follow-up showed that the resorption process had stabilized and the patient was free of symptoms. Successful tooth replantation requires following the indicated therapy effectively. Nevertheless, when an inflammatory external root resorption occurs, adequate endodontic treatment to remove the necrotic content and bacteria is required, as is the use of calcium hydroxide dressings.     

Microsurgical endodontic retreatment of a maxillary molar with a separated file: a case report

Background: A separated instrument complicated orthograde endodontic retreatment of a maxillary molar tooth with apical periodontitis. Methods: The tooth was treated utilizing microsurgical techniques that employed an operating microscope, ultrasonics, micro‐instrumentation and mineral trioxide aggregate as a root‐end filling material. Results: Healing was evident at a 12‐month review appointment. Conclusions: 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.     

Resolution of persistent periapical infection by endodontic surgery

AIM: To examine the surfaces of a root tip removed during surgical endodontic treatment for the presence of microorganisms. SUMMARY: The present clinical case illustrates an endodontic retreatment of a maxillary premolar tooth with a fistula and periapical reaction. The case was under treatment for 1 year, during which an intracanal medicament was replaced several times. As the lesion did not decrease and exudate was persistent through the fistula and root canal, root end resection with root end filling was performed. Microbiological samples were collected from the fistula, where Propionibacterium acnes, a species associated with endodontic failures, was detected by appropriate anaerobic technique. The resected root apex was observed by scanning electron microscopy (SEM), which revealed cocci and fungal forms surrounding one of the foramina. After 12 months, the periapical lesion had reduced.     

Repair of a large furcation perforation: a four-year follow-up

This case report describes the management of a large furcation perforation in a maxillary first molar. Although the majority of the pulpal floor was destroyed and the mesiobuccal root was damaged, an attempt was made to repair the defect and restore the tooth. An absorbable gelatin sponge matrix was placed, and the defect was repaired with gray ProRoot mineral trioxide aggregate. Subsequently the endodontic treatment was completed; the tooth was restored and was later used as a fixed partial denture abutment. A 55-month recall showed no evidence of periodontal breakdown, no symptoms, and complete healing of all periradicular lesions.     

Regenerative endodontic procedure combined with non-surgical root canal treatment in an immature permanent maxillary molar: A 7-year follow-up case report

The aim of this report is to present the results of a personalised endodontic treatment for an immature molar, using regenerative endodontic procedure (REP) combined with non-surgical root canal treatment (NSRCT), with 7 years of follow-up. The tooth#3 presented combined endodontic pathologies in each root, with different pulpal and periapical status. A REP in the palatal (P) canal and a NSCRT in the mesio-buccal (MB) and disto-buccal (DB) canals were performed. Absence of clinical signs/symptoms and continuous palatal root development with apical closure were observed over 4-years. After 5-years an apical lesion in the MB root was observed. Both MB canals were selectively retreated by completely filling them with TotalFill BC RRM Fast Set putty. After 7-years, the tooth remained functional and the apical lesion was resolving. The palatal root was completely mature. This case report reveals the potential for use of combined treatment approaches for immature multirooted teeth.     

Periapical status, quality of root canal fillings and estimated endodontic treatment needs in an urban German population

Abstract The objective of this study was to determine the periapical status and the quality of root canal fillings and to estimate the endodontic treatment needs in a German population. Clinical and radiographic data and the operative procedures performed were evaluated on 323 patients coming to a dental surgery in Stuttgart, Germany, in 1993. In 182 individuals at least one tooth exhibited a root canal filling, a necrotic pulp or an irreversible pulpitis. Out of the 7897 teeth examined, 215 (2.7%) had a root canal treatment (category A), 122 being nonendodontically treated (1.5%) did not respond to the sensitivity test (category B) and 53 (0.7%) were diagnosed as having irreversible inflamed pulp tissue (category C). The prevalence of teeth associated with radiographic signs of periapical pathosis was 61 % in the group of root canal filled teeth and 88% in the group of pulpless and non-endodontically treated teeth. Using the level and the density of the root canal filling as criteria for evaluating the technical standard, only 14% of the endodontic treatments of non-apicectomized teeth were qualified as adequate. The minimal endodontic treatment need is 2.3% related to all examined teeth when the root canal filled teeth with clinical symptoms of periapical periodontitis (category A) and those of categories B and C are included. The real endodontic treatment need is suggested to be larger when considering that the technical quality of the obturation is poor in most symptomless endodontically treated teeth associated with a periapical lesion. In the case of retreatment of these teeth, the endodontic treatment need would then be calculated at 3.7%.     

Root end filling materials: a review

Abstract When non-surgical attempts prove unsuccessful or are contraindicated, surgical endodontic therapy is needed to save the tooth. The procedure usually consists of exposure of the involved area, root end resection, root end preparation and insertion of a root end filling material. Numerous materials have been suggested as root end filling materials. This article is a review of the literature on the suitability of various root end filling materials based on their leakage assessment, marginal adaptation, cytotoxicity, and usage test in experimental animals and humans.     

Contemporary treatment of class II dens invaginatus

AIM: To present the nonsurgical management of a tooth with class II dens invaginatus with an open apex utilizing contemporary techniques. SUMMARY: Root canal treatment of teeth with complex root canal anatomy such as dens invaginatus can be problematic because infected pulpal tissues may remain in inaccessible areas of the canal system. The cleaning and debridement of such root canal systems are therefore challenging and may sometimes be considered impossible. An immature apical root-end development is another challenge in root canal treatment especially in controlling the apical extent of the filling material and achieving an apical seal. When difficulties in cleaning and filling combine, management options may include surgical intervention or extraction. This article reports the nonsurgical endodontic treatment of a case of an open apex and dens invaginatus utilizing the operating microscope, endodontic ultrasonic instruments and mineral trioxide aggregate. KEY LEARNING POINT: Teeth with class II dens evaginatus and an open apex may be managed successfully with contemporary nonsurgical materials and techniques.     

Reattachment of subgingivally fractured central incisor with an open apex

Abstract –  A case report of a 6-year-old girl with a fractured maxillary left central incisor with an open apex is presented. The procedure used to repair the fracture included flap surgery with an intrasulcular incision and endodontic treatment. The patient was called for 3 months regular follow-up to check the root formation. At the end of 32 months just before the root was obturated by guttaperka, she fractured the same tooth. Flap surgery was repeated and the tooth was restored. The root canal was obturated with a root filling paste and guttaperka as the apex was closed. Examination 10 months after treatment revealed good periodontal health, aesthetics and normal function.     

Retrograde treatment in an extensive implant-tooth-supported reconstruction

Diagnosis and treatment of chronic apical periodontitis associated with an abutment tooth in an extensive tooth-implant-supported fixed prosthesis is reported. Careful, complete interpretation of clinical data was imperative because the periapical radiolucency presented around the apex of a vital tooth. A retrograde endodontic approach was used to prevent an adverse outcome to the complex rehabilitative treatment that had been performed over many years.