Calculus-like deposit on the apical external root surface of teeth with post-treatment apical periodontitis: report of two cases

AIM: To report two cases in which calculus-like material was found on external root surfaces of (i) an extracted root and (ii) an apicected part of a root, both of which were removed due to post-treatment refractory apical periodontitis. SUMMARY: In each case, there was a fistulous tract, which did not heal after conventional root canal treatment. The first case did not heal even after apical surgery, and subsequent tooth extraction revealed calculus-like material on a root surface of complex anatomy. The second case showed radiographic signs of healing after apicectomy. Histology of the apical biopsy revealed a calculus-like material on the external surface of the root apex. It is suggested that the presence of calculus on the root surfaces of teeth with periapical lesions may contribute towards the aetiology of failure. KEY LEARNING POINTS: Biofilm on the external root surface has been implicated in the failure of apical periodontitis to heal, despite adequate root canal treatment. Calculus-like material was found, in two cases, on the root surface of teeth with post-treatment apical periodontitis, where the only communication externally was a sinus tract.     

Calculus-like deposit at apex of tooth with refractory apical periodontitis

Abstract— It is generally accepted that bacteria in or outside the root canal are the reason for apical periodontitis and endodontic failures. This case report presents a 60-year-old woman with a periapical lesion and a fistulous tract which did not respond to conventional root canal treatment. During periapical surgery, granulomatous tissue was removed and a calculus-like deposit was observed on the root surface. A radicular cyst was diagnosed. Nine months after this calculus-like deposit had been removed and the cyst enucleated, complete recovery of the bone had occurred. It is suggested that the presence of the calculus-like deposit at the apex of the tooth or its effects may in part have delayed the healing of the periapical inflammation in spite of apparently adequate endodontic treatment.     

Deposition of calcified tissue around an overextended gutta-percha cone: case report

CASE REPORT: Root canal treatment was performed in a mandibular right second premolar with a periapical lesion and apical resorption. The root canal was prepared with K-files using the step-back technique and 3% NaOCl as an irrigant; during obturation gross overfilling of gutta-percha occurred. The tooth was permanently restored with a post and core along with a crown. Although healing of the periapical lesion occurred and the patient reported that he was symptom-free, the tooth was extracted after 4 years because of a subgingival root fracture. Following extraction the tooth was examined with SEM. The examination revealed the presence of newly formed calcified tissue at resorption sites on the root apex. This newly formed tissue extended from the surface of the root around the apex to the extruded gutta-percha cone to which it was well adapted, forming a bridge between the cone and the root.     

Post-treatment apical periodontitis associated with a missed root canal in a maxillary lateral incisor with two roots: A case report

Missed canals can be a common cause of persistent intraradicular infection and post-treatment apical periodontitis. This article reports on a rare case of a maxillary lateral incisor with two roots exhibiting symptomatic post-treatment apical periodontitis regardless of a radiographically adequate root canal treatment. The second root, which was only revealed by cone-beam computed tomography, had passed unnoticed during the first treatment, and its missed canal was the most likely cause of symptoms and treatment failure. Reintervention including the proper management of the extra root canal and retreatment of the main canal resulted in the resolution of symptoms and periradicular tissue healing. This case report reinforces the need for three-dimensional radiographic diagnosis to search for the cause of post-treatment disease and guide the decision-making process for proper management.     

Anatomic and microbiologic challenges to achieving success with endodontic treatment: a case report

This article describes a case of persistent apical periodontitis that required several nonsurgical and surgical approaches for resolution. A 28-year-old woman presented with a large symptomatic apical periodontitis lesion associated with the maxillary left lateral incisor that persisted in spite of previous nonsurgical and surgical endodontic treatment. Root canal retreatment was accomplished, but the lesion only showed a slight decrease in size after 18 months. Forty-six months after retreatment, the patient returned because of reemergence of symptoms. Radiographically, the lesion remained relatively unaltered. Periradicular resurgery was performed, and a biopsy specimen consisting of the lesion and the apical part of the root was collected for analysis. Radiographic and clinical reevaluation after 4 years revealed complete healing. Histopathologic and histobacteriologic observations demonstrated that the lesion was a cyst, and that the probable reason for failure was the occurrence of bacteria within dentinal tubules and in a lateral canal slightly coronal to the amalgam root-end filling. This case report clearly illustrates the difficulties imposed by anatomic complexities in attaining a disinfection level that is compatible with periradicular tissue healing.     

Effect of root canal filling material and level of surgical injury on periodontal healing in dogs

Abstract— Some divergencies in the literature about periodontal healing after surgical injury stimulated the development of this experiment. The root canals of dogs' teeth were negotiated and filled by the lateral condensation technique with two kinds of sealers: Sealapex and zinc oxide-eugenol cement. In the second session, the bone tissue was exposed and one cabity was made at the apical third of the root and another at the border between the coronal and middle thirds, both penetrating into the root canal. Six months later the animals were sacrificed and the specimens prepared for histopathologic analysis. The results showed that the kind of filling material and the level of the periodontal wound exposing the root canal can influence the healing process ( P <.01).     

Reparative Endodontic Treatment of a Perforating Internal Inflammatory Root Resorption: A Case Report

The aim of this case report was to present a reparative treatment approach of an extensive internal inflammatory resorption with a lateral perforation and apical and lateral inflammatory lesions. Only the necrotic coronal part of the pulp was removed, and the vital pulp tissue within the resorption cavity and the apical part of the root canal was left uninstrumented. Bleeding was induced, and the blood clot was covered with mineral trioxide aggregate. Hard tissue repair and healing of the apical lesion could be observed in the 3-year recall.     

Cone-beam Computed Tomographic and Micro–computed Tomographic Evaluations of the Root Apexes of Teeth with Posttreatment Apical Periodontitis

IntroductionThis study evaluated the association of different variables that may influence the outcome of root canal treatment through cone-beam computed tomographic (CBCT) and micro–computed tomography (micro-CT) assessments of root apexes obtained by endodontic microsurgery of teeth with posttreatment apical periodontitis (AP), the agreement between CBCT and micro-CT findings, and the association of these variables with symptoms or lesion size.MethodsClinical and CBCT records and root apexes obtained by endodontic microsurgery from 11 cases of symptomatic AP and 22 cases of asymptomatic AP were available. Apical root specimens were further scanned using micro-CT imaging. CBCT parameters included periapical radiolucency size, apical extent/density of root canal filling, and occurrence of procedural errors. Micro-CT images evaluated the same parameters plus the presence of filling material in lateral canals and ramifications, the volume of the filled/nonfilled apical root canal, and the percentage of the nonfilled canal space. The agreement between CBCT/micro-CT observations was evaluated.ResultsMandibular teeth, a lesion size <5 mm, a nonfilled volume <0.04 mm³, and the decreased percentage of the nonfilled canal volume were significantly associated with symptomatic AP. Maxillary teeth and inadequate apical filling density were significantly associated with larger lesions. Agreement between CBCT/micro-CT scores varied from fair (procedural errors) to satisfactory (extent/density of filling).ConclusionsTooth location, lesion size, the nonfilled apical canal volume, and the percentage of the nonfilled apical canal volume were associated with symptomatic AP. In addition, lesion size was significantly associated with tooth location and apical root canal filling density. CBCT imaging may not provide a reliable evaluation of procedural errors associated with posttreatment disease.     

Repair of Extensive Apical Root Resorption Associated with Apical Periodontitis: Radiographic and Histologic Observations after 25 Years

Introduction

Root resorption is a frequent finding in teeth with apical periodontitis. In cases of severe apical periodontitis, root resorption may involve not only cementum but also dentin. Resorbed tooth structures can only be repaired with cementum because stem cells in the periradicular tissues are not capable of differentiating into odontoblasts. This article reports the repair of extensive apical root resorption associated with apical periodontitis 25 years after treatment.

Methods

A 51-year-old man presented with pulp necrosis and symptomatic apical periodontitis in tooth #7. The periapical radiograph showed a large radiolucent periradicular lesion and severe root resorption. Nonsurgical root canal therapy was performed. Twenty-five years after treatment, a crown fracture developed, and the tooth could not be restored. The periapical radiograph revealed complete healing of the previous apical periodontitis lesion and restoration of the resorbed root structure. The tooth was removed and examined histologically.

Results

The apical canal was almost completely filled with a cementumlike tissue with some strands of entrapped vital uninflamed connective tissue. Areas of cementum and dentin resorption in the apical third were repaired by a combination of cellular and acellular cementum to which periodontal ligament fibers were attached.

Conclusions

Root resorption caused by apical periodontitis can be restored almost to its normal structure after adequate nonsurgical root canal treatment that succeeded in controlling infection. The mechanisms behind this process are not clear but probably involve signaling pathways regulating root development, cell-cell and cell-matrix interaction, and morphogens.     

无机三氧化聚合物修补根管穿孔的疗效观察

目的:评价采用非手术方法以无机三氧化聚合物(mineral trioxide aggregate,MTA)修补根管侧壁穿孔的临床疗效。方法:选取因病理性或医源性因素造成的根管侧壁穿孔患牙18颗,彻底清理根管并预备根管,在手术显微镜下以MTA修补根管侧壁穿孔,完成根管充填及冠部修复。结果:仅1颗患牙因穿孔范围过大治疗失败,其余患牙术后X线片显示充填物致密,10颗有少量材料超充,但未引起临床症状;治疗后1～2a复查,16颗患牙无不适,X线片示根尖周或根侧暗影明显缩小或消失。结论:MTA治疗根管侧壁穿孔患牙临床疗效好,少量超充不影响其疗效。     

上颌侧切牙腭根遗漏、钙化伴侧壁穿孔显微根管外科手术一例

目的 报道一例上颌侧切牙根管治疗术后腭根遗漏、钙化伴侧壁穿孔病例,探讨根管治疗规范及侧壁穿孔显微根管外科手术治疗方法.方法 患者,女,40岁,主诉左上前牙唇侧脓包1周,查体见22牙颊侧黏膜见瘘管口,舌窝见树脂补体,影像学检查示22牙单根双根管,颊根充填达尖,腭根遗漏且根尖1/3段无明显根管影像,根中1/3段远中根面处高...     

左上侧切牙Ⅲ型牙内陷牙髓及牙周联合治疗1例

本文报告1例因牙齿根面畸形导致严重根尖病变及牙周破坏的牙周牙髓联合病变的左上侧切牙,瘘道长期不愈,腭侧窄而深牙周袋,严重根尖病变及牙槽骨垂直吸收。通过显微根管治疗、根尖手术、引导牙周组织再生术治疗,实现了控制根尖及牙周感染,达到了保留患牙的目的。     

Resorption and mineralization processes following root fracture of permanent incisors

Abstract The records of 85 patients treated for 95 root fractures of permanent incisors and followed regularly for up to 11 years were studied with respect to healing events after injury. The radiographic exposure best suited for disclosing root fractures in the apical third of the root was a steep occlusal exposure, while a conventional bisecting angle periapical exposure was optimal for revealing fractures in the cervical third. It is concluded that both exposures should, therefore, be used at the initial examination at the time of injury. Root resorption processes were observed in 60% of the material and could usually be detected within one year after injury. These preceded fracture healing and obliteration of the apical and/or coronal root canals. The changes observed represented one or more of four resorption entities: 1) external surface resorption, characterized by the rounding of the fracture edges mesially and/or distally; 2) internal surface resorption, manifested as rounding of the fracture edges centrally, in the apical and coronal root canals, at the intersection between the pulp canal and fracture line; 3) internal tunneling resorption, going behind the predentin layer and burrowing along the root canal walls of the coronal fragment; and 4) transient apical breakdown of the apical lamina dura. While the resorption processes were self-limiting and required no treatment, the pattern of resorption and pulp canal obliteration appeared to be decisive for the type of fracture healing. Thus, all resorption entities collectively and internal tunneling resorption particularly were significantly related to healing at the fracture site by interposition of connective tissue. However, when seen alone, internal surface resorption was significantly related to fracture healing by hard tissue union. The different root resorption entities may represent osteoclastic activity connected with the ingrowth of new vascularized connective tissue into the fracture site or the coronal part of the root canal.     

Assessment of a contrast medium as an adjunct to endodontic radiography

AIM: To assess if a contrast medium improved diagnostic yield of endodontic radiographs. METHODOLOGY: Forty-five extracted mandibular premolar teeth were radiographed in bucco-lingual and mesio-distal planes. Access cavities were prepared, pulpal tissue extirpated and Ultravist contrast medium introduced under pressure. Radiographs were retaken and the teeth cleared following perfusion with India ink. Three examiners assessed all the films for: number of roots, number of root canals, curvature of root and/or root canal, presence of lateral canals, presence of a single foramen or apical delta and the presence or absence of canal obstructions. The examiners' interpretations were compared with the anatomy revealed by clearing. RESULTS: Kappa scores were calculated for each of the examiners, for each set of radiographs, to assess the level of intra- and inter-examiner agreement. Only moderate agreement was found throughout (kappa = 0.40-0.61). For multiple root canals a false-positive result was significantly more likely with contrast (P < 0.05). The use of contrast did not significantly improve the sensitivity of diagnosis of lateral canals or a single apical foramen. Contrast significantly increased the risk of falsely perceiving lateral canals (P < 0.002). Overall there was no statistically significant difference in the overall assessment of the anatomy of the root canals using contrast or plain radiographs (P > 0.2). CONCLUSIONS: Plain film radiographs confidently predict the presence of root or canal curvature but apical anatomy was assessed accurately in only 46% of cases. Plain radiographs were insensitive in assessing the number of root canals present, the presence of lateral canals and the occurrence of canal obstructions. The use of Ultravist contrast medium to improve diagnosis of root canal morphology of premolars is not supported.     

左上侧切牙Ⅲ型牙内陷牙髓及牙周联合治疗1例

本文报告1例因牙齿根面畸形导致严重根尖病变及牙周破坏的牙周牙髓联合病变的左上侧切牙,瘘道长期不愈,腭侧窄而深牙周袋,严重根尖病变及牙槽骨垂直吸收。通过显微根管治疗、根尖手术、引导牙周组织再生术治疗,实现了控制根尖及牙周感染,达到了保留患牙的目的。     

Endodontic treatment of an immature maxillary lateral incisor with type II dens invaginatus in an orthodontic patient: A case report

This paper presents a case report of an immature maxillary lateral incisor with type II dens invaginatus, with a periapical lesion. The tooth was treated with MTA apical barrier followed by root filling with thermoplasticised GP and restoration with resin composite. Three-year radiographic follow-up showed healing of the apical lesion and normal clinical parameters.     

Complete Healing of a Large Cystic Lesion Following Root Canal Treatment with Concurrent Surgical Drainage: A Case Report with 14-Year Follow-Up

We describe complete healing of an extensive cystic lesion by using a conservative approach: root canal treatment with concurrent surgical drainage. A silicone Foley catheter drain was modified into a surgical drainage stent, which was then used for 4 weeks. Disinfection of the root canal was achieved by the use of hand files and irrigation with 5.25% NaOCl for a minimum of 30 minutes. The irrigant changes were performed at 5-minute intervals, and no intracanal dressing was used. At subsequent follow-up examinations, cone-beam computed tomography and periapical radiographs confirmed that complete healing had occurred around the periapical and lateral areas of affected teeth. This case report indicates the potential for healing of large cystic lesions by nonsurgical root canal treatment.     

Root form and canal morphology of mandibular premolars in a Jordanian population

AIM: To investigate the root canal anatomy of mandibular premolars in a Jordanian population. METHODOLOGY: Nine hundred extracted mandibular premolars were examined. After the length of the teeth was measured, the presence of developmental grooves and furcated roots was noted. Following the preparation of access cavities, pulp tissue was removed and the canal systems were stained. The teeth were then rendered clear by demineralization and immersion in methyl salicylate. Cleared teeth were examined and the following features were evaluated: (i) type of root canals; (ii) presence and location of lateral canals; transverse anastomosis; (iii) location of apical foramina; and (iv) frequency of apical deltas. RESULTS: The mean lengths of first and second mandibular premolars were 22.6 mm (18-27.5 mm) and 22.2 mm (16-26.5 mm), respectively. Although the majority of the specimens corresponded to Vertucci's classification scheme, analysis of this large data set revealed four additional root canal morphologies. Variable root canal morphologies were found in the mandibular first premolars; two separate apical foramina were found in 33% of the teeth with two canals, compared to 6.2% with one apical foramen. Teeth with three separate apical foramina were scarce (2.2%). The majority of the mandibular second premolars had a single canal; 72% of teeth possessed type I canal systems, whilst 22.8% of the roots had two canals with two separate apical foramina. CONCLUSIONS: The prevalence of multiple canals in the investigated Jordanian mandibular premolars was high, especially for the second mandibular premolar, in comparison with previous studies performed on populations of different racial origin.     

即刻桩腔预备对三种根管预备方法预备的直根管根尖封闭性的影响

目的 研究三种不同根管预备方法根管预备、根管充填后即刺桩腔预备对直根管根尖封闭性的影响.方法 离体直单根管上前牙124个,其中120个随机平均分为3组(n=40),A组:不锈钢根管锉常规法;B组:G 型钻根管冠部预处理 不锈钢根管锉常规法;C组:手用Pr01raper镍钛根管锉冠向下法,刺余4个随机平均分为阴性对照组和阳性对照组.所有根管均用侧方加压法充填,即刻手持垂直加压器去除部分充填材料,然后P型钻桩腔预备.用染料渗透法评价各组根尖封闭能力.结果 B组G型钻根管冠部预处理 不锈钢根管锉常规法预备的根管和C组手用ProTaper镍钛根管锉冠向下法预备的根管即刻桩腔预备后,其根尖微渗漏较A组常规法预备的轻(P<0.05).结论 大锥度根管预备,根管充填后即刻桩腔预备的根尖封闭性较好.     

不同根充糊剂根尖封闭性的比较研究

目的　比较不同根充糊剂根管充填后的根尖封闭性。方法　 79颗离体单根牙随机分为阳性对照 (2颗 )、阴性对照 (2颗 )及 5个实验组 (各 15颗 ) ,分别用不同的根充糊剂加牙胶尖以冷侧压法充填根管 ,通过染料渗入法检查根尖微渗漏。结果　所有根充糊剂充填后根尖部位均有微渗漏 ,Vitapex组的微渗漏值低于其他各组 ,差异有显著性 (P <0 .0 5 ) ,而其余各组结果差异无显著性 (P >0 .0 5 )。结论　各种根充糊剂充填后都不能完全封闭根尖孔 ,Vitapex的根尖封闭性优于其他各组。