ABSTRACT There are various factors that affect the success and outcome of root canal treatment.  The aim of the study is to thoroughly investigate the prognosis of endodontic treated by general dental practitioners in the region of Västerbotten, Sweden, and try to identify factors that are related to an unsuccessful root canal treatment. Our hypothesis is about prognosis for teeth, which are treated by a general dentist, is worse than the teeth, which are treated by specialists, and dental students.  Total 210 patients were included in our study. Of those 100 were excluded due to lack of documentation. We analysed these factors, aseptic treatment e.g. rubber dam, quality of root filling length, coronal restoration, and radiograph after 4 years.  In our study, rubber dam was used only in 64 teeth (58 %) throughout whole treatment and only in 27 teeth (22 %) have seen that root filling follow the standard criteria. Twenty-two teeth (20 %) have received coronal restoration and only 21 teeth (19 %) had radiograph after 4 years, six teeth (5 %) had retreatment and 5 teeth (4 %) have been extracted. Lack of documentation was another striking finding which made it difficult for our study to extract complete information.  In conclusion, we identified some factors, which can be improved.   Inadequate documentation.   Deficiencies in pre-treatment diagnostics.   Aseptic treatment e.g. rubber dam   Failure in follow-up documentation of treated teeth   Quality of root filing. / Enodontics

No description available.

avaliar a efetividade da terapia fotodinâmica (PDT) com fibra óptica ou peça de mão em canais radiculares de dentes decíduos com polpa morta, depois do preparo químico-cirúrgico, pela quantificação de microrganismos viáveis. Método: foram selecionados trinta dentes decíduos, de crianças na faixa etária entre quatro e sete anos com boa saúde geral que apresentavam um ou mais dentes com polpa morta e fístula visível clinicamente. Os dentes foram divididos em três grupos: G1- (n=10) que recebeu instrumentação com creme Endo-PTC e líquido de Dakin, G2- (n=10) que recebeu instrumentação com creme Endo-PTC e líquido de Dakin acrescida do PDT com fibra óptica e G3- (n=10) que recebeu instrumentação com creme Endo-PTC e líquido de Dakin acrescida do PDT com peça de mão. Após a obturação do canal e restauração do dente foi realizada uma tomada radiográfica. O material do interior do canal foi coletado com cones de papel esterilizados, imediatamente após a cirurgia de acesso aos canais, depois do preparo químico-cirúrgico e depois do PDT, e foram colocados em flaconetes com solução salina tamponada com fosfato (PBS) e levado ao laboratório para processamento Cada amostra foi agitada, diluída, semeada, incubada e as unidades formadoras de colônia (UFC) contadas e calculado o número de UFC/mL. Resultados: em todos os grupos experimentais houve redução do número de UFC/mL de forma significativa no interior do canal radicular. Houve redução significativa do G1 para G2 e de G1 para G3 quando comparado o log de UFC/mL da última coleta (coleta após instrumentação para G1 e após tratamento com PDT para G2 e G3), mas não houve diferença quando comparadas as últimas coletas de G2 e G3. Conclusão: a incorporação da terapia fotodinâmica, ao final do preparo químico-cirúrgico no tratamento endodôntico de dentes decíduos com polpa necrosada, potencializou a redução microbiana no interior dos canais radiculares. / to evaluate the effectiveness of photodynamic therapy (PDT) with optical fiber or handpiece in root canals of deciduous teeth with necrotic pulp, after chemical-surgical preparation, by the quantification of viable microorganisms. Method: thirty deciduous teeth were selected, of children aged between four and seven years in good general health who had one or more teeth with necrotic pulp and clinically visible fistulae. The teeth were divided into three groups: G1 (n=10) instrumentation with Endo-PTC cream and 0,5% sodium hypochlorite, G2 (n=10) instrumentation with Endo-PTC cream and 0,5% sodium hypochlorite added PDT by optical fiber, and G3 (n=10) instrumentation with Endo-PTC cream and 0,5% sodium hypochlorite added PDT with handpiece. After filling the canal and tooth restoration was performed radiography The samples were taken with sterile paper points immediately after the surgery to access the canals, after the chemical-surgical preparation, and after the PDT, and were placed in vials with saline solution buffered with phosphate (PBS) and taken to the laboratory for processing. Each sample was agitated, diluted, plated, and incubated, and the colony-forming units (CFU) were counted and the number of CFU/mL was calculated. Results: all the experimental groups showed a significant reduction in the number of CFU/mL in the root canal. There was a significant reduction from G1 to G2 and from G1 to G3, when comparing the logarithm of CFU/mL from the last sample (after instrumentation for G1 and after treatment with PDT for G2 and G3), but there was no difference when comparing the final samples of G2 and G3. Conclusion: the incorporation of photodynamic therapy at the end of the chemical-surgical preparation in the endodontic treatment of deciduous teeth with necrotic pulp increased the microbial reduction of root canals.

El traumatismo dental trae consigo afecciones pulpares irreversibles que pueden desencadenar una necrosis del tejido pulpar. Debido a la ausencia de sintomatología en algunos casos, el proceso necrótico puede generar una lesión apical que a largo plazo puede alcanzar grandes extensiones. Para tratar este tipo de lesiones apicales de gran tamaño, es necesario un adecuado diagnóstico clínico, complementado con la evaluación tomográfica, para la localización los dientes afectados. Es posible tratar estas afecciones con un abordaje no quirúrgico, obteniendo resultados favorables. El presente reporte de caso tiene como objetivo presentar la resolución no quirúrgica de una lesión periapical extensa de origen endodóntico. / Dental trauma brings irreversible pulpal conditions that can trigger pulp tissue necrosis. Due to the absence of symptomatology in some cases, the necrotic process can generate an apical lesion that in the long term can reach large extensions. To treat this type of large apical lesions, an adequate clinical diagnosis, complemented with tomographic evaluation, are necessary to locate the affected teeth. Is possible to treat these conditions with a non-surgical approach, obtaining favorable results. This case report aims to present the non-surgical resolution of an extensive periapical lesion of endodontic origin. / Trabajo académico

Indiana University-Purdue University Indianapolis (IUPUI) / Introduction: Endodontic treatment in teeth with pulp canal obliteration (PCO) is challenging. Guided Endodontic Access (GEA) combines information from a cone-beam computed tomography (CBCT) scan with an intra-oral scan to create a stent that can be used as a guide to treat teeth with PCO. GEA stents designed with traditional palatal accesses were shown to be successful in accurately negotiating these 3D printed teeth with simulated PCO, however, the difference in accuracy between the traditional palatal access compared to a conservative incisal access is not yet known. Objective: This in vitro study compares GEA stents designed with an incisal access approach to GEA stents designed with a traditional palatal access approach. The effect on the overall degree of deviation of the designed access path from the prepared path is evaluated by measuring the degree of angle of deviation and amount of deviation in millimeters. Materials and Methods: A 3-D printed maxillary model of an anonymous patient was used. PCO was simulated in a 3D printed natural #8 using the coDiagnostiX software tooth at two levels: coronal and mid-root. A GEA stent that extended from tooth #3 to tooth #14 with a guide sleeve over the simulated tooth #8 was accessed with a dedicated 1.0 mm diameter and 20 mm length drill that is designed to fit the access sleeve. 15 GEA stents had guides utilized for the incisal access approach, and 15 GEA stents had guides utilized for the traditional palatal access approach. Results: Angle, mesio-distal (base), and mesio-distal (tip) deviations were significantly lower for the incisal access compared to the traditional access. Inciso-apical (base) deviation was significantly more negative for incisal access compared to the traditional access. Bucco-lingual (base) deviation was significantly more negative for traditional access compared to the incisal access, while incisal and traditional accesses were not significantly different for bucco-lingual (tip) deviation. Coronal 1/3 calcification groups had significantly more mesio-distal (base) deviation than the middle 1/3 and no PCO groups. The no PCO group had significantly more negative inciso--apical (base) deviation than the coronal 1/3 calcification and middle 1/3 calcification groups, and the coronal 1/3 calcification group was significantly more negative than the middle 1/3 calcification group. The coronal 1/3 calcification group had significantly more mesio-distal (tip) deviation than the no PCO group. PCO level did not have a significant effect on angle, bucco-lingual (base), or bucco-lingual (tip) deviations. Conclusion: The utilization GEA via incisal access resulted in less degree and amount of drill deviation compared to the traditional access at all levels of calcification, however, the level of PCO did not influence the degree and amount of drill deviation between the incisal and traditional access approaches. It can be concluded that the use of a GEA stent that utilizes an incisal access approach in teeth with PCO will result in a more predictable outcome.

Indiana University-Purdue University Indianapolis (IUPUI) Endodontic Regeneration Graduate Endodontic Department / Introduction: Regenerative endodontic procedures are used to treat immature teeth with pulpal necrosis in order to control infection, enable continued root development and enhance formation of a pulp like tissue in the canal. Canal disinfection is an integral part the regenerative endodontic process. Double antibiotic paste (DAP; i.e., equal parts of ciprofloxacin and metronidazole) has been successfully used for canal disinfection in regenerative endodontics. A comparison of the residual antibacterial effect of dentin treated with various dilutions of DAP pastes on biofilm formation has not yet been investigated thoroughly. Objectives: The aims of this in-vitro study were to investigate how concentration and time of treatment affect the residual antibacterial properties of DAP in preventing E. faecalis biofilm formation on human dentin. Materials and Methods: Extracted human teeth were used to obtain 4x4mm radicular dentin specimens. Each specimen was pretreated for 1 or 4 weeks with the 77 clinically used concentration of DAP (500 mg/mL), low concentrations of DAP (1, 5 or 50 mg/mL) loaded into a methylcellulose system, calcium hydroxide (Ca(OH)2), or placebo paste. After treatment, samples were rinsed and placed in sterile phosphate buffered saline (PBS) for three weeks. Samples were then inoculated with cultured E. faecalis and incubated in anaerobic conditions for three weeks to allow mature biofilm formation. The dentin samples were rinsed and biofilms detached. The detached biofilm cells were then diluted and spirally plated for enumeration on blood agar plates. The plates were then incubated for 24 h and the number of CFUs/mL was determined using an automated colony counter. Data was analyzed using Fisher’s Exact and Wilcoxon rank sum tests were used for statistical comparisons (α=0.05). Results: Dentin pretreatment for 4 weeks with 5, 50 or 500 mg/mL of DAP demonstrated significantly higher residual antibacterial effects and complete eradication of E. faecalis biofilms in comparison to a 1 week pretreatment with similar concentrations. However, dentin pretreated with 1 mg/mL of DAP or Ca(OH)2 did not provide a substantial residual antibacterial effect regardless of the application time. Conclusion: Dentin treated with 500, 50, or 5 mg/mL of DAP for 4 weeks was able to completely prevent the colonization of bacterial biofilm. Four-week treatment of dentin with DAP offers superior residual antibacterial effect in comparison to a one-week treatment. Intracanal application of DAP for 4 weeks during endodontic regeneration may offer an extended residual antibacterial effect.

Indiana University-Purdue University Indianapolis (IUPUI) Indiana University School of Dentistry Indiana University Endodontic Department / The residual antibacterial effects of antimicrobials used in endodontic regeneration against biofilm bacteria obtained from immature and mature teeth Jordon C. Jacobs DDS, Richard L Gregory PhD, Ygal Ehrlich DMD, Kenneth Spolnik DDS, MS, Josef S. Bringas DMD, DDS, MS, and Ghaeth Yassen BDS, MSD, PhD We explored the residual antibacterial properties of dentin pretreated with low concentrations of double antibiotic paste (DAP) against biofilm bacteria obtained from different clinical sources. Dentin blocks were sterilized and randomized into 4 treatment groups and 2 control groups (n=20). Blocks from treatment groups were pretreated with DAP (1 or 5 mg/ml) loaded into methylcellulose, calcium hydroxide (Ca(OH)2), or methylcellulose paste. After one week, the treatment pastes were removed and all blocks were immersed in PBS. The dentin blocks from treatment groups and one of the control groups were then inoculated with bacterial isolates obtained from immature or mature teeth with pulpal necrosis(n=10). The remaining control group received no bacteria and was used as a sterile control. Blocks were then incubated anaerobically for 3 weeks. Biofilm disruption assays were conducted for all samples. Two-way ANOVA and pair-wise comparisons were used for statistical analyses. The residual antibacterial effect of dentin pretreated with 5 mg/ml of DAP was significantly higher than all other groups regardless of the source of biofilm. Dentin pretreated with 1 mg/ml of DAP demonstrated significantly higher residual antibacterial effects in comparison to dentin pretreated with placebo paste and Ca(OH)2 only in bacterial isolates obtained from mature teeth with pulpal necrosis. Dentin pretreated with Ca(OH)2 did not demonstrate any residual antibacterial effects. Dentin pretreated with 1 or 5 mg/ml of DAP demonstrated significantly better residual antibacterial effects against biofilm bacteria obtained from mature teeth with pulpal necrosis in comparison to bacterial isolates obtained from immature teeth with pulpal necrosis.

Daktaro disertacijos „Kūginio pluošto kompiuterinės tomografijos diagnostinių galimybių endodontijoje tyrimai” tikslas - įvertinti kūginio pluošto kompiuterinės tomografijos (KPKT) galimybes tiriant viršūninio apydančio būklę ir danties šaknies kanalo gydymo rezultatus klinikinėmis sąlygomis bei ex vivo modelyje. Uždaviniai: 1) palyginti skaitmeninės intraoralinės rentgenografijos (SPR) ir KPKT metodų efektyvumą, diagnozuojant danties šaknies kanalo perforacijas žmogaus apatinio žandikaulio ex vivo modelyje bei nustatyti optimalų tūrinio vaizdo elemento dydį; 2) palyginti dantų šaknų perforacijų vietos ir dydžio įtaką KPKT diagnostinėms savybėms žmogaus apatinio žandikaulio ex vivo modelyje; 3) palyginti dantų šaknų perforacijų diagnozavimą skirtingose KPKT rekonstrukcinėse projekcijose žmogaus apatinio žandikaulio ex vivo modelyje; 4) palyginti SPR ir KPKT metodų tikslumą, vertinant endodontiškai gydytų pacientų dantų šaknų viršūninio apydančio (VA) būklę; 5) Sukurti pacientų VA būklės ir endodontinio gydymo kokybės įvertinimo sistemą (PESS), pagrįstą KPKT metodo tyrimo rezultatais; 6) Pagal kompleksinį viršūninio apydančio būklės įvertinimo indeksą, (COPI) ištirti pacientų VA būklę, naudojant KPKT ir skaitmeninę ortopantomografiją (SOR) bei palyginti abiem metodais gautus rezultatus; 7) Pagal endodontiškai gydytų dantų indeksą (ETTI), įvertinti pacientų endodontinio gydymo kokybę, naudojant KPKT ir SOR bei palyginti abiem metodais gautus rezultatus. / The aim of doctoral dissertation "Evaluation of diagnostic abilities of cone-beam computed tomography in endodontics” are to evaluate the cone-beam computed tomography (CBCT) diagnostic ability in assessment of periapical bone lesions and tooth root canal treatment outcome clinically and in ex vivo model. Objectives: 1) to compare the diagnostic abilities of CBCT and digital periapical radiogram (DPR) methods in the detection of root perforations ex vivo and to assess the use of different voxel sizes of a CBCT unit; 2) to assess the influence of root perforations sizes and locations on diagnostic performance of CBCT ex vivo; 3) to assess the influence of different reconstruction planes of CBCT in diagnosing root perforations ex vivo; 4) to compare the accuracy of DPR and CBCT in the detection of periapical radiolucencies in endodontically treated teeth; 5) to develop new patients Periapical and Endodontic Status Scale (PESS) by means of CBCT analysis; 6) to investigate periapical status of the patient using Complex Periapical Index (COPI) with two radiological methods (CBCT and digital orthopantomogram (DOR)) and to compare their results; 7) to investigate endodontic treatment quality using Endodontically Treated Tooth Index (ETTI) with two radiological methods (CBCT and DOR) and to compare their results.

No description available.

Esta pesquisa teve por objetivo avaliar a reabsorção radicular externa em dentes tratados endodonticamente após tratamento ortodôntico, por meio de análise das imagens das radiografias panorâmica final digitalizada, convencional periapical digitalizada e digital direta, como também comparar os métodos radiográficos empregados. Foram selecionados, após uma avaliação de 2.130 documentações ortodônticas 20 dentes de pacientes com documentação ortodôntica completa, boas condições de saúde, faixa etária entre 25 a 50 anos de ambos os sexos e com dentes anteriores (incisivo central ou lateral) tratados endodonticamente antes da realização do tratamento ortodôntico. De cada documentação ortodôntica completa foi selecionada a radiografia panorâmica inicial e final e, posteriormente, foram obtidas duas radiografias periapicais atuais de cada dente, uma pela técnica convencional e outra digital direta. Após a obtenção e identificação das radiografias, as imagens da panorâmica final digitalizada, radiografia periapical convencional digitalizada e digital direta foram analisadas na tela do computador por três especialistas (endodontista, ortodontista e radiologista). Estes avaliaram se a reabsorção radicular externa estava presente ou ausente no dente tratado endodonticamente após tratamento ortodôntico, bem como compararam os métodos empregados verificando sua confiabilidade. Os seguintes parâmetros foram observados: a) lesão periapical, b) espaço pericementário e c) limite do tratamento endodôntico. As observações foram submetidas à análise estatística chegando-se às seguintes conclusões: 1) A maioria dos ortodontistas não utiliza radiografias periapicais para avaliar os dentes tratados endodonticamente antes do tratamento ortodôntico, o que pode comprometer o andamento e o resultado final do tratamento, visto que a reabsorção radicular não apresenta um caráter sintomatológico no seu diagnóstico; 2) Quanto à reabsorção radicular externa, os examinadores apontaram que houve um incremento desta, na maioria do tipo suave e localizada na região apical, e que a radiografia digital direta foi o método radiográfico mais eficiente na determinação deste diagnóstico. / In this research, the assessment of the external root resorption was carried out in endodontically treated teeth after orthodontic treatment, through the analysis of the image of the digital panoramic radiography, the digital periapical conventional and direct digital; as well as the employed methods were comparatively appraised. It was selected, after an evaluation of 2,130 orthodontic records from two centres of orthodontic studies, 20 teeth of patients with complete orthodontic records, good health conditions, age group between 25 and 50 years-old of both sexes and with front teeth (central or lateral incisor) endodontically treated before the accomplishment of the orthodontic treatment. An initial and final panoramic radiography were selected from each orthodontic record, and, later two current radiographies were obtained from each patient, one by conventional technique and the other by direct digital. After the obtaining and identification of the radiographies, the images of the digital panoramic of the digital conventional and of the direct digital were analyzed on the computer screen by three experts (an endodontist, an orthodontist and a radiologist) who evaluated whether the external root resorption was present or absent in the endodontically treated tooth after the orthodontic treatment and comparatively assessed the employed methods, verifying their reliability; they also observed the following parameters: a) periapical lesion, b) pericemental space, and c) limits of the endodontical treatment. The observations were submitted to a statistical analysis, reaching the following conclusions: 1) most of the orthodontists don\'t use periapical radiographies to evaluate endodontically treated teeth. Before the orthodontic treatment, what can compromise its course and its final results, once the root resorption doesn\'t present a symptomatology in its diagnosis; 2) as for the external root resorption, examiners claimed that there was an increment in it, most in the soft type and located in the apical area, and that the evaluation of the effectiveness of the resorption diagnosis, as well as of the other appraised parameters, indicated that the direct digital radiography obtained better outcomes regarding its identification and its classification.