Leaving the pulp chamber open for drainage has no effect on the complications of root canal therapy.

In this retrospective study the effects of different kinds of emergency treatments on flare-ups and other complications were examined. A total of 197 teeth received emergency treatment after diagnosis at the beginning of the root canal therapy; in 103 the pulp chamber was left open for drainage of pus, 35 were treated with dexamethasone sodium phosphate, and 59 with various other medicaments, followed by routine root canal treatment. In all, 404 teeth received root canal treatment without emergency treatment. If symptoms occurred during treatment, flare-up was said to be present. If a periapical radiolucency was found, long-term calcium hydroxide treatment was used: no sign of periapical healing radiographically after 6 months was described as a complication. The percentage of teeth with no complications varied from 72.2% (dexamethasone) to 78.9% (other modification) and the results showed no differences between the groups in the teeth with no complications, flare-ups or other complications. The number of bacteria detected with Gram's staining was higher in the teeth which were left open. In conclusion, leaving the pulp chamber open for drainage had no effect on the incidence of flare-ups or other complications.     

Influence of calcium hydroxide intracanal dressings on the prognosis of teeth with endodontically induced periapical lesions

AIM: This prospective clinical study explored the influence of calcium hydroxide as an interappointment dressing on the healing of periapical lesions associated with pulpless teeth that had not been endodontically treated previously. This was achieved by comparing the prognosis after a two-visit root canal treatment with that following a one-visit treatment. METHODOLOGY: Seventy-three patients were recruited having one tooth with an endodontically induced lesion. Of these patients, 67 could be re-examined. Calcium hydroxide was placed in the instrumented root canals of 31 teeth for at least one week and the treatment finished at the second visit. Thirty-six teeth were root canal treated at one visit. The criteria for success were the absence of signs and symptoms indicating an acute phase of periapical periodontitis and radiographically a periodontal ligament space of normal width. Methods for event time analysis were used to evaluate and compare the prognosis of both treatment approaches. RESULTS: The probability that complete periapical healing will take place increased continuously with the length of the observation period. In both treatment groups the likelihood that the root canal treatment yields a success within an observation time of five years exceeded 90%. A statistically significant difference between the two treatment groups could not be detected. CONCLUSIONS: From a microbiological perspective, one-visit root canal treatment created favourable environmental conditions for periapical repair similar to the two-visit therapy when calcium hydroxide was used as antimicrobial dressing. One-visit root canal treatment is an acceptable alternative to two-visit treatment for pulpless teeth associated with an endodontically induced lesion.     

Endodontic Outcomes in Mandibular Second Premolars with Complex Apical Branching

Introduction

Mandibular premolars that have rare and complex anatomies may have the highest failure rate in nonsurgical endodontic treatment. Awareness of rare and complex anatomies of mandibular second premolars would aid in better outcomes of the treatment. This study aimed to evaluate the success of nonsurgical root canal treatment of mandibular second premolar teeth with complex apical branching.

Limitations of previously published systematic reviews evaluating the outcome of endodontic treatment

The aim of this work was to identify the limitations of previously published systematic reviews evaluating the outcome of root canal treatment. Traditionally, periapical radiography has been used to assess the outcome of root canal treatment with the absence of a periapical radiolucency being considered a confirmation of a healthy periapex. However, a high percentage of cases confirmed as healthy by radiographs revealed apical periodontitis on cone beam computed tomography (CBCT) and by histology. In teeth, where reduced size of the existing radiolucency was diagnosed by radiographs and considered to represent periapical healing, enlargement of the lesion was frequently confirmed by CBCT. In clinical studies, two additional factors may have further contributed to the overestimation of successful outcomes after root canal treatment: (i) extractions and re-treatments were rarely recorded as failures; and (ii) the recall rate was often lower than 50%. The periapical index (PAI), frequently used for determination of success, was based on radiographic and histological findings in the periapical region of maxillary incisors. The validity of using PAI for all tooth positions might be questionable, as the thickness of the cortical bone and the position of the root tip in relation with the cortex vary with tooth position. In conclusion, the serious limitations of longitudinal clinical studies restrict the correct interpretation of root canal treatment outcomes. Systematic reviews reporting the success rates of root canal treatment without referring to these limitations may mislead readers. The outcomes of root canal treatment should be re-evaluated in long-term longitudinal studies using CBCT and stricter evaluation criteria.     

根管系统封闭性的影响因素及其检测方法

根管治疗术是牙髓病和根尖周病常见的治疗方法,术后严密封闭根管系统可以切断根尖周组织再感染途径,确保根管治疗的远期疗效。如果根管封闭性欠佳则容易引起病原微生物及其代谢产物经过封闭材料与根管壁之间的微渗漏(包括冠方和根尖区)使根尖周组织再感染导致根管治疗失败。可见严密封闭根管系统至关重要。目前检测根管封闭性的方法较多,但关于根管系统封闭性的影响因素和检测根管封闭性的方法尚缺乏较系统的阐述。本文将影响根管封闭性的因素及检测和评价根管封闭性的方法进行综述,为检测根管充填质量和评估远期疗效提供借鉴和参考。     

Periapical Microsurgery: Do Root Canal–retreated Teeth Have More Dentinal Defects?

Introduction

This microsurgical clinical study evaluated if teeth that have undergone endodontic retreatment are associated with more dentinal defects than primary root canal–treated teeth.

改良截根术治疗上颌第一磨牙根管侧穿及根管外断针1例

根管侧穿和器械分离是根管治疗术中常见的并发症。随着显微根管治疗术的发展,可以有效地进行侧穿修补和分离器械的取出,但仍有部分病例难以进行常规根管治疗,必要时需行根尖切除术、截根术等,促进根尖周病的愈合。该文报导1例采用改良截根术治疗根管侧穿及根管外断针的病例,取得较好疗效。     

前牙髓腔完全钙化的临床研究

目的：探讨完全钙化根管行根管治疗术的可行性。方法：对26例完全钙化前牙根管行根管治疗术，进行术前术后X线片对比研究。结果：24例顺利完成根管治疗术，2例因根管口完全钙化行根尖手术。结论：完全钙化的前牙根管X线片上显示为根管闭锁，临床上可通过寻找根管口，逐步扩大根管完成根管治疗术，以避免根尖手术或牙拔除术。     

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目的探讨Vitapex糊剂在根尖周囊肿非手术治疗中的疗效。方法选择2011年6月至2012年3月在开滦总医院康复医院确诊为根尖周囊肿10例患者,共计19颗患牙,经充分根管引流、根管预备及根管消毒后,封入Vitapex糊剂并超出根尖孔至囊肿内,待囊肿范围减小或病变区骨密度增高后,行严密根管充填。术后定期拍摄X线牙片观察6～12个月。结果10例中1例患者（1颗患牙）因自身原因退出,失败1例（2颗患牙）,其余8例（16颗惠牙）有效,有效率达88．9％。结论Vitapex糊剂根管封药加根管充填可应用于根尖周囊肿的非手术治疗。     

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目的探讨前牙钙化根管治疗的可行性。方法2003年1月至2005年12月,对郑州市中医院口腔科收集的前牙钙化根管患者22例,通过寻找根管口,行根管治疗术,进行术前、术后X线片观察研究。结果20例患者顺利完成根管治疗术,2例因根管完全钙化行根尖手术。结论前牙钙化根管的治疗关键在于根管口的寻找,并进行常规根管治疗术,避免根尖手术或牙拔除术。     

Management of Large Radicular Lesions Using Decompression: A Case Series and Review of the Literature

The purpose of this study was to report the clinical efficacy of decompression for 3 cases with large periapical lesions and to review technique details. Three cases with large periapical cystic lesions were treated with decompression after root canal treatment. A traditional decompression technique was used for the first case. After aspiration, mucogingival incision, irrigation, and incisional biopsy, a pediatric endotracheal tube was sutured in place and kept for 3 weeks for lesion debridement. An aspiration/irrigation technique was adopted for the second case. An 18-G needle with a syringe was used to aspirate the cystic lesion. Two needles were then inserted into the lesion; copious saline irrigation was delivered from 1 needle and until clear saline was expressed from the other. For the third case, decompression was accomplished with a surgical catheter that was subsequently replaced with a gutta-percha plug after 1 month. None of the 3 cases underwent complete enucleation and root-end surgery. Healed lesions or lesions in healing were observed after 1 to 2 years. Based on the presented cases and published case reports on decompression, a literature review was provided covering indications, technique details, modification, and prognosis of decompression in endodontics. For large periapical cystic lesions, conservative decompression may be used for certain cases before or in lieu of apical surgery. Decompression enables healing of large, persistent periapical lesions after root canal 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.     

根管治疗慢性根尖周炎5年预后及影响因素分析

目的:探讨慢性根尖周炎经根管治疗后的牙生存率、拔除原因、根尖愈合率及预后影响因素.方法:回顾性队列研究纳入由同一名医师完成根管治疗的102例根尖周炎患者.主要预测变量为根管治疗难度系数(difficulty assessment of root canal therapy,DARCT),即根据牙根长度、牙根弯曲度、根管...     

根管初步预备器械的研究现状

根管治疗是牙髓病和根尖周病的主要治疗手段,而根管治疗成功与否很大程度上取决于根管预备的质量。在根管预备之前,首先要设计良好的髓腔入口并建立连续光滑的根管疏通通道,这个过程即为根管的初步预备。根管初步预备使清洁和成形根管的器械能够顺畅进入根管,可避免器械分离,为此专门用于建立根管光滑通道的器械应运而生。当下,根管初步预备器械凭借其独特的作用和良好的成形能力发展较为迅速,本文就根管初步预备器械的发展现状作一综述,旨在给牙髓病和根尖周病的治疗提供一些建设性的建议。     

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提要：根管充填的目的是用根充材料将根管系统三维严密封闭,防止微渗漏,促进牙髓病和根尖周病的愈合。本文主要介绍根管充填中的操作失误,旨在为临床医生提供理论和实践参考。     

Healing of Apical Periodontitis after Nonsurgical Root Canal Treatment: The Role of Statin Intake

Introduction

Numerous previously undocumented factors may influence the healing of apical periodontitis (AP). The aim of this cohort study was to analyze the association between statin medication intake during the follow-up period and healing of AP.

根管治疗术中的疼痛原因分析及疼痛控制

根管治疗是牙髓病及根尖周病的一种有效治疗方法,已在临床上广泛使用,然而在治疗过程中及治疗完成后患者可能会出现各种原因的疼痛。本文对根管治疗术中疼痛发生的原因进行分析,从而为临床医生采取相应的有效措施和治疗手段缓解患者痛苦提供参考。     

老年人磨牙根管治疗变异法的临床疗效分析

目的 :研究老年人变异根管治疗法治疗慢性根尖周炎的疗效。方法 :对 83例慢性根尖周炎的老年病例在接受常规根管治疗、变异法根管治疗或牙髓塑化治疗 2年后的 85个磨牙进行复查 ;并以同期治疗的 79例青年病例 82个同类牙作对照。采用根尖周指数 (periapicalindex ,PAI)评定X线片并结合临床检查 ,对疗效进行评价。结果 :变异根管治疗法组与常规根管治疗组疗效差异无显著性 (P >0 .0 5 ) ,牙髓塑化治疗组与常规根管治疗组疗效差异有显著性 (P <0 .0 5 )。结论 :变异根管治疗法治疗老年人慢性根尖周炎的远期疗效是肯定的。对老年人磨牙按照不同的根管形态采用不同的方法充填是合理的。     

CBCT在疑难根管治疗中的应用分析

目的探讨CBCT在疑难根管治疗中的临床应用价值。方法对我院2014年7月至2015年3月数字根尖片不能确诊后拍摄CBCT的45例患者的临床资料进行回顾性分析。结果疑似根折20例,经CBCT诊断为根折且拔除后证实根折13例,诊断无根折且根管治疗后无异常7例;辅助查找钙化根管8例;判断牙根吸收7例;判断根尖周炎症范围及严重程度10例。结论 CBCT成像精度高,可三维立体观察病灶,在疑难根管治疗中较数字根尖片有明显优势。     

Garrè's osteomyelitis managed by root canal treatment of a mandibular second molar: incorporation of computed tomography with 3D reconstruction in the diagnosis and monitoring of the disease

AIM: To report the healing of Garrè's osteomyelitis involving a mandibular second molar following root canal treatment. SUMMARY: To describe the endodontic management of Garrè's osteomyelitis involving a mandibular second molar. In this case, computed tomography (CT) was used to evaluate the status of the periapical lesion. Five years after root canal treatment, the tooth and supporting tissues appeared healthy both clinically and radiographically and were functioning well. KEY LEARNING POINTS: Garrè's osteomyelitis of an adult can be managed by root canal treatment. Computed tomography could be used for diagnosis and treatment planning in endodontics.