Prospective study of periapically infected teeth treated with periapical surgery including ultrasonic preparation and retrograde intermediate restorative material root-end fillings.

PURPOSE: The aim of this prospective study was to evaluate the current method of periapical surgery at the Maxillofacial Unit, Halmstad Hospital, which included ultrasonic root-end preparation and the use of intermediate restorative material as a root-end filling material. PATIENTS AND METHODS: Fifty-five consecutive patients with a total of 56 treated teeth, within the close vicinity of the hospital, were included in the study during a period of 10 months in 2002. Teeth with advanced periodontal bone loss or presence of root fractures were excluded from the study. RESULTS: All teeth but 1 were followed up after 1 year (12-19 months). Radiological evaluation (complete or incomplete healing) and clinical examination showed an 80% success rate. Twenty percent of the patients were stated as failures (uncertain healing and unsatisfactory healing). The success rate was highest among incisors (100%) and lowest among molars and premolars (78% and 69%, respectively). CONCLUSION: Compared with other studies, these findings seemed to be a bit inferior regarding success rate. However, our study population was not selected for the study purpose but rather represented the true clinical variety taken care of in our practice.     

Cytotoxicity of calcium enriched mixture cement compared with mineral trioxide aggregate and intermediate restorative material

Calcium enriched mixture (CEM) cement has been recently invented by the last author. It is composed of calcium oxide, calcium phosphate, calcium silicate and calcium sulphate; however, it has a different chemical composition to mineral trioxide aggregate (MTA). The purpose of this ex vivo study was to investigate the cytotoxicity of CEM cement, and compare it with intermediate restorative material (IRM) and MTA. The materials were tested in fresh and set states on L929 fibroblasts to assess their cytotoxicity. The cell viability responses were evaluated with methyl‐tetrazolium bromide assay and Elisa reader at 1, 24 and 168 h (7 days). The tested materials were eluted with L929 culture medium according to international standard organisation 109935 standard. Distilled water and culture medium served as positive and negative controls, respectively. Differences in cytotoxicity were evaluated by one‐way anova and t‐tests. The cytotoxicity of the materials was statistically different at the three time intervals (P < 0.01). The lowest cytotoxic values recorded were expressed by MTA subgroups followed by CEM cement; IRM subgroups were the most cytotoxic root‐end/dental material (P < 0.001). CEM cement and MTA are reasonable alternatives to IRM because of lower cytotoxicity. CEM cement also has good biocompatibility as well as lower estimated cost to MTA and seems to be a promising dental material.     

Tissue response to retrograde root fillings in the ferret canine: a comparison of a glass ionomer cement and gutta-percha with sealer

Tissue healing was compared after apicectomy and filling of ferret lower canines with glass ionomer (Ketacfil) or gutta-percha/sealer (Tubliseal). Both materials provoked an inflammatory response after 7 days, but the response to glass ionomer was less severe. The response after 28 days was different. Mild inflammation related to the gutta-percha was still present, but no inflammation was found in relation to the glass ionomer. Bone infill was quite advanced in all specimens at 28 days but was more complete in the glass ionomer specimens, with intimate contact between the bone and cement.     

Pulp-dentin biology in restorative dentistry. Part 2: initial reactions to preparation of teeth for restorative procedures.

Pulpal complications involving inflammation, degradation, and necrosis are the result of a series of traumatic injuries. The restorative dentist must minimize the trauma to dentin and pulp inflicted during clinical procedures, including that inflicted during tooth preparation. Part 11 of this series discusses the structural and physiologic changes in the pulp-dentin complex that result from crown and cavity preparation and the clinical implication of these changes.     

Modern restorative management of patients with congenitally missing teeth: 2. Orthodontic and restorative considerations

Managing edentulous spaces in patients with congenitally missing teeth demands careful planning and, often, a multidisciplinary approach. Orthodontic tooth movement can be considered to close spaces as well as improve the distribution of available teeth. In this second paper, the advantages of a collaborative approach are discussed.     

The comparison of a dentin adhesive with calcium hydroxide as a pulp-capping agent on the exposed pulps of human and sheep teeth.

OBJECTIVE: This study evaluated the biocompatibility of a one-step dentin bonding agent (Prime&Bond 2.1) in pulp capping compared with calcium hydroxide [Ca(OH)2]. METHOD AND MATERIALS: Thirty sheep teeth and 20 intact human premolars were used. After cavity preparation, pulp exposure was achieved with a bur (#390). Adhesive pulp capping was performed in 25 teeth (15 sheep and 10 human). In the control group (12 sheep and 10 human teeth), pulps were capped with Ca(OH)2 and all of the cavities in both groups were sealed with resin composite. Three of the sheep teeth were used as intact controls. Teeth were extracted 7 or 90 days following treatment and prepared for histological examination and bacterial detection. RESULTS: At 7 days, severe inflammatory responses underlying the bonding agent and in the coronal pulp were observed with soft tissue disorganization in both human and sheep teeth capped with Prime&Bond 2.1. All of the teeth capped with Ca(OH)2 exhibited mild inflammatory reactions limited with the perforation area. After 90 days with the bonding agent, in 3 of 9 sheep teeth, chronic inflammatory reactions were significant, while slight pulpal reactions were observed in the others and dentin bridge formation in all of the sheep teeth was found. However, in human pulps, persistent, unresolved inflammation with the lack of dentin bridge formation was observed. In the Ca(OH)2 group, pulp repair with dentin bridging was found in all of the teeth, both sheep and human. No correlation was found between the presence of inflammation and bacterial staining using Spearman rank correlation test (P > .05). CONCLUSION: Prime&Bond 2.1 facilitates enhanced pulp healing and bridge formation in sheep teeth, but in human teeth it was not as successful as Ca(OH)2 as a pulp capping agent.     

Modern restorative management of patients with congenitally missing teeth: 3. Conventional restorative options and considerations

Restoration of spaces in hypodontia patients needs to take into account many factors including, the number of missing teeth, the distribution of space, the size of the teeth, and the age of the patient. This paper considers adhesive and conventional bridgework, as well as removal alternatives for the restoration of spaces. The various merits of each are discussed, together with treatment planning considerations for such cases.     

Fluoride uptake in human teeth from fluoride-releasing restorative material in vivo and in vitro: two-dimensional mapping by EPMA-WDX

Class V cavities were prepared in the upper and lower left second premolars from an individual under infiltration anesthesia. The cavities were filled with fluoride- releasing resin (TF). One month later, the teeth were extracted. As a control (in vitro), the upper and lower right second premolars were extracted at the time of the cavity preparation in vivo. Immediately after extraction, class V cavities were prepared and filled with TF, and immersed in normal saline solution for 1 month at 37 degrees C. All four premolars were bisected longitudinally and the fluoride uptake around the cavity wall on the cut surface was measured using an electron probe microanalyzer-wavelength dispersive X-ray method. The fluoride uptake was given in the form of a two-dimensional map. Comparison of the observed values of each corresponding part of the tooth in vivo and in vitro revealed no characteristic differences. The maps were quite analogous as a whole.     

Leakage of amalgam, composite, and Super-EBA, compared with a new retrofill material: bone cement

An in vitro leakage study was conducted to compare the root-end sealing ability of amalgam with cavity varnish, composite with dentin bonding agent, and Super-EBA with a new retrofill material: bone cement. Eighty single-rooted teeth were instrumented and obturated with gutta percha, resected and retroprepared. The teeth were then randomly divided into 4 groups of 20, with each group receiving one of the previously mentioned retrofill materials. The bone cement group was either etched or unetched. The teeth were immersed in silver nitrate and developer for leakage assessment. The teeth were grooved and split longitudinally to measure leakage. Statistical analysis showed that amalgam leaked significantly less than Super-EBA and unetched bone cement; composite leaked significantly less than Super-EBA. Amalgam was not statistically different from composite or etched bone cement. No significant difference between composite and both bone cements was noted, nor between both bone cements and Super-EBA.     

Leakage along apical root fillings with and without smear layer using two different leakage models: a two-month longitudinal ex vivo study

AIM: To compare two different experimental models when measuring leakage along root fillings with or without smear layer. METHODOLOGY: One hundred and twenty single-rooted teeth were prepared to size 50 and allocated to two groups: fluid transport model (n = 60) and glucose penetration model (n = 60). The roots in each group were divided into three subgroups of 20 teeth each. Smear layer was left in place in group 1 but removed in groups 2 and 3. In groups 1 and 2 canals were filled with laterally compacted gutta-percha cones and AH 26. Group 3 was laterally compacted with Resilon cones and Epiphany sealer. The coronal portion of the filling was removed to assure only 4 mm of filling remained in the canal. Leakage of glucose was evaluated by measuring its concentration once a week for a total period of 56 days using a glucose penetration model. Fluid transport was evaluated by measuring the movement of an air-bubble using a fluid transport model, 1 and 8 weeks after canal filling. Differences between the groups in glucose concentrations and fluid transport were statistically analysed with the Kruskal-Wallis and the Mann-Whitney tests. The level of significance was set at alpha = 0.05. RESULTS: Glucose penetration was significantly different between the three groups after the first 8 days (P < 0.05). Resilon leaked the most throughout the experiment period. No significant difference (P > 0.05) existed between the two gutta-percha groups at all time intervals (Mann-Whitney test). In the fluid transportation model, no statistically significant differences were observed between all three experimental groups (P > 0.05) at either 1 or 8 weeks after filling (Kruskal-Wallis test). CONCLUSIONS: Under the conditions of this study, the glucose penetration model was more sensitive in detecting leakage along root fillings. Removing the smear layer before filling did not improve the sealing of the apical 4 mm of filling. Resilon allowed more glucose penetration but the same amount of fluid transport as the gutta-percha root fillings.     

Supernumerary teeth associated with primary and permanent teeth: a case report

Concomitant presence of a supernumerary tooth in the primary dentition and another supernumerary tooth associated with permanent tooth in the same location is an uncommon condition. Presence of supernumerary tooth in the primary dentition itself is a rare phenomenon. Presented here, is the first such case of simultaneous presence of supernumerary tooth in primary and permanent maxillary lateral incisor region.     

Comparison of atraumatic restorative treatment and conventional restorative procedures in a hospital clinic: evaluation after 30 months.

OBJECTIVE: The purpose of this study was to evaluate two glass-ionomer cements placed in the occlusal surfaces of permanent molar teeth, using two cavity preparation methods. METHOD AND MATERIALS: Three dentists placed 149 restorations for 68 patients in a hospital clinic. Atraumatic restorative treatment or conventional cavity preparation methods were used for two encapsulated, high-strength conventional glass-ionomer cements: Fuji IX GP and Ketac-Molar. Non-gamma 2 amalgam alloy was used in conventional preparations for comparison. RESULTS: The restorative procedures were uneventful, but cavity preparations made with atraumatic restorative treatment hand instruments took approximately twice as long as did conventional rotary instrumentation. After 30 months, only one glass-ionomer cement restoration had failed. Both glass-ionomer cements showed high early losses of sealant material, but caries was not detected in the exposed fissures. Both glass-ionomer cements also showed relatively high restoration wear. At 30 months, the mean cumulative net occlusal wear was 119 +/- 12 mm for Fuji IX GP and 96 +/- 13 mm for Ketac-Molar; the difference was not statistically significant. Color matching improved significantly by 6 months; there was no significant difference in color match between the two glass-ionomer cements by 12 months. Minor surface tarnishing and marginal discrepancies were present in the amalgam restorations and increased with time. CONCLUSION: The occlusal restorations performed satisfactorily over periods of up to 30 months. However, the continued deterioration of the cements requires longer-term studies to be undertaken.     

Initiating restorative procedures at the first-stage implant surgery with a positional index: a case report.

With the use of a positional index, the restorative dentist and laboratory technician can be provided with an accurate record of implant fixture location after first-stage surgery. Thus it is possible to fabricate a master cast with implant analogs and initiate laboratory procedures immediately after first-stage surgery, and a provisional restoration can be processed and delivered at the time of second-stage surgery. A case report is presented to illustrate the technique.     

Autogenous tooth fragment reattachment--association of periodontal surgery and endodontic and restorative procedures: a case report.

The occurrence of dental traumas in adult patients is on the rise, according to the literature, and require correct and adequate treatment specific to each fracture in order to preserve the remaining tooth. In this article, two different fracture cases are reported. Based upon these cases, it may be concluded that there are situations that require the clinician to have a multidisciplinary vision of the different dental specializations in order to effectively treat the patient.     

Modern restorative management of patients with congenitally missing teeth: 1. Introduction, terminology and epidemiology

The management of patients with congenitally missing teeth can be a challenge and, in many cases, requires multidisciplinary care. In this four-part series, a contemporary approach to managing this group of patients is discussed. This first paper examines the terminology, epidemiology and restorative challenges that such patients can exhibit.