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.     

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.     

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%.     

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.     

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提要：产黑色素类杆菌是感染根管内的优势菌,与自发性疼痛、脓肿、根管内恶臭等牙髓病和根尖周病的临床症状关系密切。有效地去除产黑色素类杆菌对治疗牙髓病和根尖周病具有重要意义。本文从几种临床根管消毒方法对产黑色素类杆菌抑菌作用方面进行综述。     

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??Chronic periapical periodontitis??CAP??is a common kind of chronic inflammation of periapical tissue. Under the conditions of failure of root canal treatment or retreatment??serious variation of root canal anatomy and definite diagnosis after exploratory operation??endodontic microsurgery has its unique application value. This paper summarized the current situation of clinical application and development trend of microscopic endodontic microsurgery in the treatment of chronic periapical periodontitis??providing references to the diagnosis and treatment of chronic periapical periodontitis in clinical work.     

根尖显微外科手术治疗慢性根尖周炎研究进展

慢性根尖周炎（CAP）是一类常见的根尖周围组织慢性炎症反应,在根管治疗或再治疗失败、根管解剖严重变异或需通过探查手术明确诊断等情况下,显微根管外科有其独特的应用价值。本文综述了CAP治疗中根尖显微外科手术的临床应用现状及发展趋势,为临床工作中对CAP的诊断和治疗提供参考。     

A suggested role for polymorphonuclear leukocytes in the perpetuation of periapical disease

During the course of an investigation of endodontic materials using subcutaneously implanted human roots in rats and guinea pigs, it was noted that in areas of the root canal which had not been reamed polymorphonuclear leukocytes had migrated into the dentinal tubules. It is suggested that irritation of the periapical tissues may be mediated by these polymorphonuclear leukocytes. Therefore, the occlusion of dentinal tubules which may be exposed to periapical exudate may be of prime importance in endodontic treatment.     

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.     

Endodontic therapy in a 3-rooted mandibular first molar: importance of a thorough radiographic examination

This case report describes endodontic therapy on a mandibular first molar with unusual root morphology. In the initial treatment the working length had been determined with only an apex locator; no periapical radiographs had been obtained because the patient was pregnant. The root canal into an additional distolingual root had not been found and was therefore left untreated, which led to treatment failure after 11 months. The radiographic examination performed in a subsequent endodontic treatment allowed detection of the anomalous root and completion of the root canal treatment. The distolingual root canal would have been identified during the initial endodontic therapy if a thorough radiographic examination had been carried out. This report highlights the importance of radiographic examination and points out the need to look for additional canals and unusual canal morphology associated with a mandibular first molar. Radiographic examination during pregnancy is also discussed.     

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.     

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提要：根管治疗是牙髓病和根尖周病最有效的治疗方法，但是在根管治疗的开髓、根管预备和充填等步骤中的操作失误时有发生。本文包括4个部分：（1）开髓不当；（2）根管遗漏；（3）根管预备中操作失误；（4）根管充填中操作失误。第一部分主要介绍开髓过程中的操作失误，旨在为临床医生提供理论和实践参考。     

Case of mistaken identity: periapical cemental dysplasia in an endodontically treated tooth

A case of a patient with a history of root canal treatment and re-treatment and a persistent periapical radiolucency is reviewed. Following surgery, biopsy material was submitted and diagnosed as periapical cemental dysplasia (PCD). With careful diagnosis, PCD should be readily differentiated from endodontic pathosis, thus avoiding unnecessary root canal treatment. In this case, surgery was necessary to rule out other inflammatory disease or benign odontogenic entities.     

A case of mistaken identity: periapical cemental dysplasia in an endodontically treated tooth

Abstract A case of a patient with a history of root canal treatment and re-treatment and a persistent periapical radiolucency is reviewed. Following surgery, biopsy material was submitted and diagnosed as periapical cemental dysplasia (PCD). With careful diagnosis, PCD should be readily differentiated from endodontic pathosis, thus avoiding unnecessary root canal treatment. In this case, surgery was necessary to rule out other inflammatory disease or benign odontogenic entities.     

The outcome of teeth with periapical periodontitis treated with nonsurgical endodontic treatment: a computerized morphometric study.

OBJECTIVES: This study investigated the prognosis for successful endodontic treatment and the correlation between the size of the periapical lesion, the quality of the root canal treatment, and the type of coronal restoration. METHOD AND MATERIALS: Periapical radiographs of 319 teeth with periapical periodontitis were studied. The area of each lesion was measured before treatment and 1 to 12 years after completion of the endodontic treatment. The measurements were performed using computerized morphometry. RESULTS: In 65.2% of the teeth, the size of the lesion decreased, while in 34.8% of teeth, there was an increase. Lesions larger than 10 mm2 had a greater tendency for healing. CONCLUSION: No significant correlation was found between the quality of root canal treatment, the type of the coronal restoration, and the success rate of the endodontic treatment.     

Nonsurgical endodontic management using MTA for perforative defect of internal root resorption: report of a long term follow-up

Internal root resorption is an uncommon lesion following a dental injury. The use of mineral trioxide aggregate (MTA) is a conservative approach to repair lesions with periodontal communication. This case report presents a long-term follow-up of a nonsurgical endodontic management using MTA for perforative defect of internal root resorption. During the endodontic treatment, the granulation tissue was removed and the root canal prepared. Calcium hydroxide was placed as a temporary dressing for 30 days. After this period, the root canal space and the perforation defect were filled with MTA. The clinical findings and periapical radiographs indicated success of treatment until 2 years of follow-up. However, the radiograph after 8 years showed an extensive radiolucent area in the middle third of the root with separation of the apical and coronal root segments. These findings were observed more accurately by using cone-beam computerized tomography.     

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.     

尖周刮治术和根管逆行充填术10例

目的：通过根管外科手术，治疗一些常规根管治疗疗效不佳，根管内有不能取出的充填物而不能进行常规根管治疗的患牙。方法：收集临床病例10例，除1例根充完整患牙仅行根尖周刮治术外，其余9例均在根尖周刮治术的基础上行根管倒充术。结果：治疗后观察1年10例均无不适。8例根尖病灶缩小，2例根尖病变区有新生骨小梁形成，密度较正常稍低。结论：对于由于各种原因所致的根管堵塞无法进行常规根管治疗的患牙，可通过根管外科手术予以解决。     

Healing of periapical lesions of pulpless teeth after endodontic treatment with controlled asepsis

Abstract Using a careful anaerobic bacteriological technique, bacteria were shown to be eliminated from infected root canals before the endodontic treatment was finished by root filling. Healing of the periapical lesions of the teeth was followed for 2–5 yr. The majority of the 79 lesions healed completely or decreased in size in such a way that they could be expected to heal. In 5 cases there was no or only an insignificant decrease in the size of the lesions. Two of these lesions were shown to contain bacteria of the species Actinomyces or Arachnid. In another case there were dentin chips in the periapical tissue. Periapical lesions which fail to heal in spite of careful bacteriological monitoring of the endodontic treatment may in some cases be due to an establishment of the bacteria outside the root canal in the periapical tissue. In these sites, the bacteria are inaccessible to conventional endodontic treatment.