Mineral Trioxide Aggregate as Apical Plug in Teeth with Necrotic Pulp and Immature Apices: A 10-year Case Series

Introduction

This 10-year study evaluated the clinical and radiologic outcomes of teeth with necrotic pulp, immature apices, and periapical lesions treated with the mineral trioxide aggregate (MTA) apical plug technique.

Methods

Seventeen single-rooted immature teeth with necrotic pulp and periapical lesion from 17 patients treated between January 2001 and December 2001 were included in this study. Apical obturation on all teeth included in the study was completed in 2 visits: first using calcium hydroxide as an interappointment intracanal medication and a second visit for the creation of the artificial apical barrier with MTA. The outcome, based on clinical and radiographic criteria, was assessed by 2 calibrated investigators using the periapical index (PAI). The Friedman test was used to verify the differences between baseline and the 1-, 5-, and 10-year PAI scores.

Results

Of the 17 patients treated, 1 patient dropped out at 5 years. At the 10-year follow-up, 15 teeth were healed (PAI ≤2), and 1 tooth had been extracted because of the presence of a longitudinal root fracture. The PAI score exhibited a significant decrease between baseline and 1 year and between 1 and 5 years. The difference between 5 and 10 years was not significant.

Conclusions

The apical plug with MTA was a successful and effective technique for long-term management of this group of teeth with necrotic pulps with immature root development and periapical lesions.     

ASSOCIATION BETWEEN INTRA-RADICULAR POSTS AND PERIAPICAL LESIONS IN ENDODONTICALLY TREATED TEETH

Introduction:

A significant number of endodontically treated teeth restored with posts have associated periapical lesions, and several authors have discussed the probable causes of the development of these. Attention has been focused on restorative procedures performed after endodontic treatment and their association with the prognosis of endodontic therapy because a number of root-filled teeth will require post- and core-retained restorations.

Purpose:

The purpose of this study was to evaluate, by examination of periapical radiographs, whether the placement of intra-radicular posts in endodontically treated teeth may act as a risk factor for development of periapical lesions.

Material and Methods:

This case-control study analyzed periapical radiographs of 72 endodontically treated teeth with coronal restorations. All radiographs were obtained from a single private practice. Specimens were assigned to 2 groups: Group 1 (control) was composed of teeth without periapical lesions and Group 2 (case) was composed of teeth with periapical lesions. The number of teeth with and without posts in each group was recorded. Three calibrated examiners analyzed the radiographs visually under X4 magnification.

Results:

In Group 1, 28 (65.1%) out of 43 teeth were restored with posts. In Group 2, 24 (82.8%) out of 29 teeth had intra-radicular posts. The interpretation of chi-square test showed that these percentages were not significantly different (x²=2.687; p=0.101). Odds ratio was 2.571 (0.8158.118), which indicates that there was no statistically significant association between periapical lesions and posts.

Conclusion:

Intra-radicular posts placed in endodontically treated teeth were not a significant risk factor for development of periapical lesions in the practice where the cohort of patients was treated.     

Periapical Status Related to the Quality of Coronal Restorations and Root Fillings in a Korean Population

Introduction

The purpose of this study was to assess the prevalence of apical periodontitis in root canal–treated teeth from the Korean population and to evaluate the relationship between the quality of root canal fillings and coronal restorations and the periapical status of these teeth.

Methods

Full-mouth periapical radiographs at the Dental Hospital of Yonsei University, Seoul, South Korea, were examined. A total of 1030 endodontically treated teeth restored with full veneer crown–type restorations were evaluated by 2 independent examiners. Teeth were classified as healthy or diseased according to the periapical status. The quality of endodontic treatment and coronal restorations were also classified via radiographic and clinical evaluation. The data were analyzed using the chi-square test and logistic regression.

Results

Forty-one percent of all endodontically treated teeth were classified as diseased. Approximately 35.6% of the teeth had endodontic treatments that were rated as adequate. The diseased teeth rate for cases with adequate endodontic treatment was 24.5%, which was significantly lower when compared with teeth with inadequate endodontic treatment (49.9%). The number of teeth with adequate coronal restorations was 706 (68.5%). Teeth with adequate coronal restorations had a significantly decreased prevalence of diseased teeth (34.7%) compared with teeth with inadequate coronal restorations (54.3%). Teeth with both adequate root fillings and restorations showed a significantly better outcome (82.3%) than the others, and teeth with both inadequate root fillings and restorations showed a significantly worse outcome (41.2%) than the others.

Conclusions

Data from this Korean population showed a relatively high prevalence of apical periodontitis. The quality of endodontic treatment and coronal restorations were of equal importance and were strong independent predictors of the periapical status.     

Impact of Three Radiographic Methods in the Outcome of Nonsurgical Endodontic Treatment: A Five-Year Follow-up

Introduction

The periapical film radiograph (PFR) and digital periapical radiograph (DPR) techniques have some limitations in the visualization of small periapical lesions (PLs) when compared with cone-beam computed tomography (CBCT). However, the evidence supporting their effectiveness is very limited. This retrospective longitudinal cohort study evaluated the outcome of endodontic treatments measured/monitored by PFR, DPR, and CBCT during a 5-year follow-up and also determined the prognostic factors that influenced treatment success.

Methods

A total of 132 teeth (208 roots) with vital pulps received endodontic treatment. The periapical indexes with scores ≥2 for PFR and DPR and ≥1 for CBCT indicated the presence of PLs. Prognostic factors were determined by bivariate and multivariate analyses. Statistical significance was defined at a P level <.05.

Results

CBCT detected a higher number of PLs (18.7%, n = 39 roots), followed by DPR (7.7%, n = 16 roots) and PFR (5.7%, n = 12 roots). Likewise, CBCT was more sensitive than PFR and DPR in detecting deficiencies in extension and density of the root canal filling (P ≤ .001). Of the 17 prognostic factors evaluated, 4 were significantly associated with poor outcome to the treatment (P < .05): root canal curvature, disinfection of gutta-percha, presence of missed canals, and the quality of definitive coronal restoration.

Conclusions

The success outcome of endodontic treatment after 5 years in teeth with vital pulps varied with each radiographic method: 94.3%/PFR, 92.3%/DPR, and 81.3%/CBCT.     

Area and 3-dimensional Volumetric Changes of Periapical Lesions after Root Canal Treatments

Introduction

This study compared the changes in size of periapical lesions after root canal treatment as revealed by periapical radiography (PA) and cone-beam computed tomography (CBCT) imaging using area and 3-dimensional volumetric measurements and assessed the outcome of the treatments based on these parameters.

Methods

Both PA and CBCT scans were taken preoperatively and at recall. In total, 50 teeth (71 roots) with evidence of periapical bone loss on both PA and CBCT images were endodontically treated and followed for 10–37 months. The area and volume of periapical lesions were measured, and changes were presented in the following 4 categories: lesion undetected, lesion reduced in size, lesion unchanged, or lesion enlarged. The McNemar and chi-square tests were used to compare the lesion changes determined by CBCT imaging and PA.

Results

The 4-category diagnosis made using both methods were in agreement in 39 of 71 (54.9%) roots, whereas disagreement was observed in 32 of 71 (45.1%) roots (P < .001). At recall, lesion was absent in 11 of 71 (15.5%) roots on CBCT scans and 32 of 71 (45.1%) roots on PA (P < .001). When success was defined as the absence of a lesion or a reduction in size of a lesion, 55 (77.5%) roots on CBCT imaging showed success and 63 (88.7%) roots on PA (P = .073).

Conclusions

Changes in lesion size after root canal treatment determined with 3-dimensional volumetric CBCT data and 2-dimensional PA data are different. The outcome of root canal treatments determined with PA could be untrue.     

An assessment of orofacial clefts in Tanzania

Background

To determine the prevalence of periapical lesions in root canal-treated teeth in a rural, male adult, Turkish population and to investigate the influence of the quality of root canal fillings on prevalence of periapical lesions.

Methods

The sample for this cross-sectional study consisted of 552 adult male patients, 18-32 years of age, presenting consecutively as new patients seeking routine dental care at the Dental Sciences of Gulhane Military Medicine, Ankara. The radiographs of the 1014 root canal-treated teeth were evaluated. The teeth were grouped according to the radiographic quality of the root canal filling and the coronal restoration. The criteria used for the examination were slightly modified from those described by De Moor. Periapical status was assessed by the Periapical Index scores (PAI) proposed by Orstavik.

Results

The overall success rate of root canal treatment was 32.1%. The success rates of adequately root canal treatment were significantly higher than inadequately root canal treatment, regardless of the quality or presence of the coronal restoration (P < .001). In addition, the success rate of inadequate root canal treatment was also significantly affected by the quality of coronal restorations.

Conclusions

Our results revealed a high prevalence of periapical lesions in root canal treatment, which is comparable to that reported in other methodologically compatible studies from diverse geographical locations. In addition, the results from the present study confirm the findings of other studies that found the quality of the root canal treatment to be a key factor for prognosis with or without adequate coronal restoration.     

Impact of the quality of coronal restoration versus the quality of root canal fillings on success of root canal treatment: a systematic review and meta-analysis

Introduction

Thorough cleaning and shaping of root canals are essential for periapical healing. Restoration of endodontically treated teeth is also required for them to function and prevent coronal leakage. This study compared the impact of the quality of root canal treatment versus the quality of coronal restoration in treatment outcomes.

Methods

Literature search was conducted using the search terms “coronal restoration,” “root canal,” “periapical status,” and “quality.” Articles that evaluated the effect of the quality of root filling and coronal restoration or both on the success of root canal treatment were selected. Nine articles were identified and were reviewed by 3 investigators. Data were collected based on predetermined criteria. Percentages of teeth without apical periodontitis were recorded for each category: adequate root canal treatment (AE), inadequate root canal treatment (IE), adequate restoration (AR), and inadequate restoration (IR). Data were analyzed using meta-analysis for odds ratios (ORs).

Results

After adjusting for significant covariates to reduce heterogeneity, the results were combined to obtain pooled estimates of the common OR for the comparison of AR/AE versus AR/IE (OR = 2.734; 95% confidence interval [CI], 2.61-2.88; P < .001) and AR/AE versus IR/AE (OR = 2.808; 95% CI, 2.64−2.97; P < .001).

Conclusions

On the basis of the current best available evidence, the odds for healing of apical periodontitis increase with both adequate root canal treatment and adequate restorative treatment. Although poorer clinical outcomes may be expected with adequate root filling-inadequate coronal restoration and inadequate root filling-adequate coronal restoration, there is no significant difference in the odds of healing between these 2 combinations.     

Histologic Evaluation of the Effects of Emdogain Gel on Injured Root Apex in Rats

Introduction

This study investigated the effects of Emdogain gel (EMD) on the injured open apex within periapical lesions.

Methods

Periapical lesions were induced in rats by opening the pulp chambers of the mandibular first molars and filing the apical foramen through the distal root canal with #25 K-files to make an open apex. The teeth were exposed to the oral environment for 7 days. Then we irrigated the distal root canals and divided them into EMD-treated and propylene glycol alginate–treated groups. The rats were killed 7, 14, and 28 days after treatment and examined histochemically.

Results

In the EMD-treated rats, more cells expressed transforming growth factor-β1 or bone morphogenetic protein-2 at 7 days after treatment, and the regeneration of cementum and bone was observed around the root apex at 14 days after treatment. Conversely, in the propylene glycol alginate–treated group, few cells expressed transforming growth factor-β1 or bone morphogenetic protein-2, and apical periodontal tissue recovery was rarely seen within the periapical lesions throughout the experiment.

Conclusions

These results suggest that EMD does not irritate injured periapical tissue and may create a favorable environment that promotes the healing of destroyed periapical tissues.     

Radiographic Healing after a Root Canal Treatment Performed in Single-rooted Teeth with and without Ultrasonic Activation of the Irrigant: A Randomized Controlled Trial

Introduction

The aim of this study was to compare the outcome of a root canal treatment with and without additional ultrasonic activation of the irrigant.

Methods

Single-rooted teeth with radiographic evidence of periapical bone loss were randomly assigned to 2 treatment groups. In both groups syringe irrigation was performed, and in one group the irrigant was also activated by ultrasound. Ten to 19 months after treatment, the teeth were examined by using periapical radiography (PA) and cone-beam computed tomography (CBCT). Area and volume of the periapical lesions were measured, and the outcome was presented in 4 categories: absence, reduction or enlargement of the radiolucency, or uncertain. Lesions were classified as reduced or enlarged when the change in size of the radiolucency was 20% or more.

Results

The recall rate was 82%, and 84 teeth were analyzed. CBCT detected significantly more post-treatment lesions than PA (P = .038), but the percentages of absence and reduction of the radiolucency together revealed by CBCT and PA were similar (P = .383). The CBCT results showed that absence of the radiolucency was observed in 16 of 84 teeth (19%) and reduction of the radiolucency in 61 of 84 teeth (72.6%), but there was no significant difference between the results of the 2 groups (P = .470). Absence and reduction of the radiolucency together were observed in the ultrasonic group in 39 of 41 teeth (95.1%) and in the syringe group in 38 of 43 teeth (88.4%).

Conclusions

Root canal treatments with and without additional ultrasonic activation of the irrigant contributed equally to periapical healing.     

Volumetric Changes in Apical Radiolucencies of Endodontically Treated Teeth Assessed by Cone-beam Computed Tomography 1 Year after Orthograde Retreatment

Introduction

Cone-beam computed tomography (CBCT) allows us to assess in 3 dimensions the location and size of periapical radiolucencies. We aimed to assess by CBCT scans the volumetric changes of periapical radiolucencies in endodontically treated teeth 1 year after orthograde retreatment.

Methods

Forty-five root-filled teeth with persistent apical periodontitis requiring endodontic orthograde retreatment from 37 individuals were included in the study. The research protocol was approved by the VU University Medical Center Amsterdam ethics committee (2007/265), and the participants signed a letter of consent. We made 2 CBCT scans for every patient, the first one before retreatment and the second one a year later. Two observers measured independently the volume of radiolucencies on CBCT images by using the AMIRA software. The intraclass correlation coefficient was used to evaluate interobserver agreement, and the Wilcoxon signed rank test was used to assess pretreatment and post-treatment volume size.

Results

The intraclass correlation coefficients were 0.994 and 0.998 for the scans before retreatment and 1 year after, respectively. The recall rate was 78% for the teeth and 73% for the patients. The volumetric change in periapical radiolucencies 1 year after retreatment was statistically significant (z = −3.112, P < .005). The volume of periapical radiolucencies reduced in 20 teeth (57%), remained unchanged in 8 (23%), and increased in 7 (20%).

Conclusions

One year after endodontic orthograde retreatment, the volume of periapical radiolucencies reduced significantly in 57% of the teeth.     

Detection of Vertical Root Fractures in the Presence of Intracanal Metallic Post: A Comparison between Periapical Radiography and Cone-beam Computed Tomography

Introduction

This in vitro study compared cone-beam computed tomography (CBCT) exam with different voxel sizes with digital periapical radiography in the detection of vertical root fractures in teeth with and without intracanal metallic posts.

Methods

Eighteen single-rooted human teeth were endodontically treated, prepared for cast metal posts, and artificially fractured. After positioning the teeth in dry mandibular sockets, the samples were subjected twice (with and without posts) to digital periapical radiography at 3 different angles and to CBCT examinations with 2 voxel sizes, 0.125 and 0.25 mm. The images were evaluated by 3 oral radiologists. Indices of sensitivity, specificity, and positive and negative predictive values, in addition to the areas under the receiver operating characteristic curves (accuracy), were calculated. Comparison of the accuracy of the imaging methods was assessed by using the χ² test. Comparison of the accuracy between teeth with and without posts was determined by using the Fisher exact test.

Results

The accuracy of the imaging methods showed no significant differences (P = .08). The comparison between teeth with and without posts in each examination revealed significant differences for CBCT with a voxel of 0.125 mm (P = .04) and for periapical radiography (P = .04).

Conclusions

No significant differences were observed between CBCT and periapical radiography in the detection of vertical root fractures, except for teeth with metallic posts in images from CBCT with a voxel of 0.125 mm and in digital periapical radiography. Furthermore, voxel size did not significantly influence the diagnosis of vertical root fractures.     

A Comparative Investigation of Cone-beam Computed Tomography and Periapical Radiography in the Diagnosis of a Healthy Periapex

Introduction

This research aimed to compare the appearance of healthy periapical tissues on cone-beam computed tomography (CBCT) with periapical radiography and to measure the periodontal ligament (PDL) space on CBCT for teeth with healthy and necrotic pulps.

Methods

Patient records from specialist endodontic practices were examined for teeth that had a high-resolution (0.08-mm voxel) and small field-of-view CBCT scan, a periapical radiograph, and clinical pulp tests (CO₂ and electric pulp testing). The periapical regions of the CBCT scans and radiographs were scored individually by 2 calibrated, blinded examiners by using a modified CBCT-periapical index (CBCT-PAI) for both and represented as CBCT-PAI and PAI, respectively. The Fisher exact and χ² statistics tested the relationships between CBCT-PAI, PAI, and pulp status.

Results

Of 200 teeth included in the study, 166 showed clinical signs of pulpal health, and the CBCT-PAI score was greater than the PAI in 72% (119 of 166), with a vital pulp likely to have a radiographic PDL space widening of 0–1 mm (P < .001). Although 2 healthy teeth showed radiolucencies 2–4 mm on CBCT scan when the periapical radiograph showed none, a PDL space of greater than 1–2 mm was indicative of a necrotic pulp (P < .001).

Conclusions

Teeth with necrotic pulps were more likely to have PDL widening, but the PDL space of a healthy tooth demonstrated significant variation when examined by CBCT. The radiographic interpretation of health and disease on CBCT must be further investigated before usage in outcome or epidemiologic investigations. This research questions the traditional radiographic interpretation of the PDL space.     

Rubber Dam Use during Post Placement Influences the Success of Root Canal–treated Teeth

Introduction

Salivary leakage after root canal therapy is of great concern and can lead to failure of the endodontic therapy. The aim of this study was to investigate whether the use of a rubber dam (RD) during post placement impacts the success of root canal–treated teeth.

Methods

Retrospective chart reviews of 185 patients with an average recall of 2.7 years were assessed for the incidence of a new periapical lesion (periapical index score >2) after root canal therapy and post placement. The patients were divided into 2 groups based on the presence or absence of an RD clamp in the verification radiograph during post placement.

Results

Twenty-six patients (30 teeth) had a post placed with the use of an RD, and 159 patients (174 teeth) had a post placed without an RD. In the non-RD group, 128 (73.6%) teeth were considered successful at follow-up. In the RD group, 28 (93.3%) teeth were considered successful at follow-up. Based on the bivariate GEE model, the difference in success between these 2 groups was statistically significant (P = .035).

Conclusions

The use of an RD during prefabricated post placement provides a significantly higher success rate of root canal–treated teeth. Using an RD is already considered a standard of care for nonsurgical root canal therapy; in addition, using an RD during restorative procedures that involve open teeth should also become a standard of care.     

Intracanal Delivery of Resolvin E1 Controls Inflammation in Necrotic Immature Rat Teeth

Introduction

Pulp necrosis in immature teeth and the resulting periodontal apical inflammation negatively affect root formation. Resolvin E1 (RvE1) is a lipid-derived endogenous pro-resolution molecule that controls inflammation. The aim of this investigation was to evaluate the impact of RvE1 applied as an intracanal medication on root formation in nonvital immature teeth.

Methods

To arrest root development, pulpectomy was performed in the lower first molars of 4-week-old Wistar rats. After 3 weeks, irrigation with 2.5% sodium hypochlorite and 0.9% sterile saline was performed, and either a triple antibiotic paste (TAP) or RvE1 in saline was applied into the root canals. In the control group, access openings drilled into molars were left exposed to the oral environment. Root development and periapical repair were evaluated radiographically and histologically at 3 and 6 weeks after treatment.

Results

RvE1 reduced periapical lesion size compared with the control at 3 weeks, which was similar to TAP. Inflammatory response in the RvE1-treated group was markedly reduced compared with both TAP and control specimens. At 6 weeks, root development was observed in both groups, but RvE1 treatment produced less cellularity with more regular calcified tissue deposition.

Conclusions

RvE1 and TAP had a positive impact on reducing inflammation and promoting root formation. RvE1 was more effective in reducing inflammation at earlier stages. RvE1 has potential to be used as root canal dressing to control inflammation in endodontically compromised teeth before complete root formation. Stability of RvE1 within the root canal and its delivery are issues to be addressed before its clinical use.     

Endodontic outcome predictors identified with periapical radiographs and cone-beam computed tomography scans

Introduction

The outcome predictors identified with data from periapical radiographs (PA) and cone-beam computed tomography (CBCT) scans might not be the same. This retrospective study evaluated various factors that might affect the outcome of root canal therapy.

Methods

In total, 115 teeth (143 roots) with vital pulps were endodontically treated and followed up 2 years after treatment. Multivariate logistic regression was performed on the data from PA or CBCT to analyze outcome predictors.

Results

At recall, PA detected periapical lesions in 18 roots (12.6%), as compared with 37 on CBCT images (25.9%). The length and density of root filling determined by PA and CBCT were often different (p < .001). Overall, 20 of the 25 short root fillings (80%) diagnosed by PA appeared as flush fillings on CBCT images. PA revealed 23 root fillings (16.1%) with voids, as compared with 66 on CBCT images (46.2%). When findings from PA were analyzed, density and apical extent of root filling were identified as predictors (p < .05). When findings from CBCT were analyzed, density of root filling and quality of coronal restoration influenced the outcome significantly (p ≤ .001), whereas gender, tooth type, root curvature, number of visits, CBCT-determined apical extent of root filling, and use as abutment did not (p > .1).

Conclusions

Treatment outcome, length and density of root fillings, and outcome predictors as determined with CBCT scans might not be the same as corresponding values determined with PA.     

Evaluation of technical quality and periapical health of root-filled teeth by using cone-beam CT

Objective

This study aimed to assess the quality of root fillings, coronal restorations, complications of all root-filled teeth and their association with apical periodontitis (AP) detected by cone-beam computed tomography (CBCT) images from an adult Turkish subpopulation.

Material and Methods

The sample for this study consisted of 242 patients (aging from 15 to 72 years) with 522 endodontically treated teeth that were assessed for technical quality of the root canal filling and periapical status of the teeth. Additionally, the apical status of each root-filled tooth was assessed according to the gender, dental arch, tooth type and age classification, undetected canals, instrument fracture, root fracture, apical resorption, apical lesion, furcation lesion and type and quality of the coronal structure. Statistical analysis was performed using percentages and chi-square test.

Results

The success rate of the root canal treatment was of 54.4%. The success rates of adequate and inadequate root canal treatment were not significantly different (p>0.05). Apical periodontitis was found in 228 (45.6%) teeth treated for root canals. Higher prevalence of AP was found in patients aging from 20 to 29 years [64 (27%) teeth] and in anterior (canines and incisors) teeth [97 (41%) teeth].

Conclusions

The technical quality of root canal filling performed by dental practitioners in a Turkish subpopulation was consistent with a high prevalence of AP. The probable reasons for this failure are multifactorial, and there may be a need for improved undergraduate education and postgraduate courses to improve the clinical skills of dental practitioners in endodontics.     

A Standardized Novel Method to Measure Radiographic Root Changes after Endodontic Therapy in Immature Teeth

Introduction

Outcome studies of endodontic treatment of necrotic immature permanent teeth rely on radiographic measures as surrogates of whether the treatment achieved regeneration/revascularization/revitalization. An increase in radiographic root length and/or width is thought to result in a better long-term prognosis for the tooth. In this study, a method to measure radiographic outcomes of endodontic therapies on immature teeth was developed and validated.

Methods

A standardized protocol was developed for measuring the entire area of the root of immature teeth. The radiographic root area (RRA) measurement accounts for the entire surface area of the root as observed on a periapical radiograph. Reviewers were given instructions on how to measure RRA, and they completed measurements on a set of standardized radiographs.

Results

The intraclass correlation between the 4 reviewers was 0.9945, suggesting a high concordance among reviewers. There was no effect of the reviewer on the measured RRA values. High concordance was also observed when 1 rater repeated the measurements, with an intraclass correlation value of 0.9995. There was no significant difference in RRA values measured at the 2 sessions by the same rater. Furthermore, significant differences in RRA were detectable between clinical cases that showed obvious continued root development and cases that did not demonstrate discernible root development.

Conclusions

These results suggest that RRA is a valid measure to assess radiographic outcomes in endodontically treated immature teeth, and RRA should be useful in future clinical studies of regenerative endodontic outcomes.     

Histologic Study of a Human Immature Permanent Premolar with Chronic Apical Abscess after Revascularization/Revitalization

Introduction

Histologic studies of teeth from animal models of revascularization/revitalization are available; however, specimens from human studies are lacking. The nature of tissues formed in the canal of human revascularized/revitalized teeth was not well established.

Methods

An immature mandibular premolar with infected necrotic pulp and a chronic apical abscess was treated with revascularization/revitalization procedures. At both the 18-month and 2-year follow-up visits, radiographic examination showed complete resolution of the periapical lesion, narrowing of the root apex without root lengthening, and minimal thickening of the canal walls. The revascularized/revitalized tooth was removed because of orthodontic treatment and processed for histologic examination.

Results

The large canal space of revascularized/revitalized tooth was not empty and filled with fibrous connective tissue. The apical closure was caused by cementum deposition without dentin. Some cementum-like tissue was formed on the canal dentin walls. Inflammatory cells were observed in the coronal and middle third of revascularized/revitalized tissue.

Conclusions

In the present case, the tissue formed in the canal of a human revascularized/revitalized tooth was soft connective tissue similar to that in the periodontal ligament and cementum-like or bone-like hard tissue, which is comparable with the histology observed in the canals of teeth from animal models of revascularization/revitalization.     

Endodontically treated teeth and periapical findings in the elderly

The radiographic quality of root-canal fillings, the prevalence of periapical findings and their associations with gender and age and were investigated in 133 dentate old people living at home (45 males and 88 females, aged 76, 81, and 86 years and who had endodontically treated teeth or periapical lesions. Sixteen per cent of the endodontically treated teeth (n= 507) exhibited periapical lesions, compared with 4% for the teeth not endodontically treated (P < 0.0001) (χ² test). Lesions were least prevalent in association with radiographically adequate root canal fillings (10%), and most prevalent in teeth with root canal post perforation (100%). Overfilled root canals and multi-rooted teeth with one or more unfilled roots also showed a high percentage of lesions (19% and 22%, respectively). Men had more periapical lesions than women in endodontically treated teeth (P < 0.0001, Mann-Whitney U-test), a finding contrary to previous studies in younger subjects. There were no other statistically significant differences between the sexes or age groups, although the percentage of root-filled teeth increased with age.     

Cast metal vs. glass fibre posts: A randomized controlled trial with up to 3 years of follow up

Objective

This randomized controlled trial compared the survival of glass fibre and cast metal dental posts used to restore endodontically treated teeth with no remaining coronal wall.

Methods

Fifty-four participants (45 women) and 72 teeth were evaluated during a follow-up period of up to 3 years. Teeth were randomly allocated to the glass-fibre and cast-metal post groups. All teeth were restored with single metal-ceramic crowns. Survival probabilities were analyzed using Kaplan–Meier statistics (p ≤ 0.05).

Results

The 3-year recall rate was 92.3% and the survival rates of glass fibre and cast metal posts were similar (97.1% and 91.9%, respectively; p = 0.682). Four failures were observed: two glass fibre posts in a premolar and anterior tooth debonded, one glass fibre post in a premolar debonded in association with root fracture, and one root fracture occurred in a molar with a cast metal post.

Conclusions

Glass fibre and cast metal posts showed similar clinical performance in teeth with no remaining coronal wall after 3 years.

Clinical Significance

Posts are used to restore most endodontically treated teeth with no remaining coronal wall. This randomized controlled trial, one of few to compare glass fibre and cast metal posts in such teeth, showed that post type did not significantly influence the survival of restorations. These results can help dentists respond to the important question of how best to rehabilitate endodontically treated teeth with no remaining coronal wall.