Symptomatic apical periodontitis (SAP) is indicative of inflammation of the periodontal ligament. It may or may not be accompanied by radiographic changes and may occur with vital or necrotic pulpal diagnosis. Purpose of this study was to analyze clinical and radiographic presentations of SAP in a retrospective electronic dental chart and digital radiograph review utilizing the endodontic diagnostic template note of predoctoral dental school patients presenting with SAP. The aim was to determine prevalence of periapical radiolucencies (PARLs) in SAP, association of SAP to pulpal diagnosis, and define associated radiographic changes. Most prevalent pulpal diagnosis with SAP was symptomatic irreversible pulpitis (44%). A tooth presenting with SAP was more likely to have an intact lamina dura, but presented with a PARL 38% of the time. When a PARL was present the most common pulpal diagnosis was pulp necrosis however, 24.5% of teeth presented with a vital pulp diagnosis and lesions <2mm.

O objetivo deste estudo ex vivo foi avaliar o preparo biomecânico e a obturação de canais radiculares ovais utilizando os sistemas ProTaper, WaveOne, Reciproc e Self-Adjusting File. Com esta finalidade avaliou-se: 1) área, perímetro, circularidade, diâmetro maior, diâmetro menor, área de superfície, volume e SMI após o preparo biomecânico, por meio de microtomografia computadorizada (&mu;TC); 2) percentual volumétrico de espaços vazios após a obturação do canal, por meio de &mu;TC; 3) resistência de união (RU) e tipo de falha ocorrida após teste de push-out; e 4) a interface dentina/material obturador em microscopia eletrônica de varredura (MEV). Cem caninos inferiores humanos foram escaneados no microtomógrafo SkyScan 1174v.2. Após o preparo do terço cervical dos canais, os dentes foram distribuídos em 4 grupos (n=25), de acordo com o sistema usado no preparo biomecânico: ProTaper; WaveOne; Reciproc; Self-Adjusting File (SAF). Após a segunda &mu;TC, 18 espécimes de cada grupo foram redistribuídos em dois grupos (n=9), de acordo com a técnica de obturação: Técnica Modificada da Onda Contínua de Condensação e técnica recomendada pelo fabricante. Os sete espécimes restantes de cada grupo constituíram os grupos controle negativo e positivo. Após a TC dos espécimes obturados, as raízes foram seccionadas transversalmente em fatias de 1 mm de espessura correspondentes às regiões cervical, média e apical. A RU foi avaliada pelo teste de push-out e as falhas após desunião observadas em microscópio digital. Após preparo para MEV, avaliou-se a interface adesiva de forma qualitativa nominal e ordinal pelo estabelecimento e determinação de escores. No conjunto, a análise dos parâmetros avaliados no preparo biomecânico mostraram que as alterações mais significativas ocorreram nos grupos ProTaper e WaveOne. Os resultados no grupo Reciproc ficaram em um nível intermediário, enquanto as menores alterações foram observadas no grupo SAF (ANOVA, p<0,05). Em relação à obturação, a Técnica Modificada da Onda Contínua de Condensação apresentou menor percentual volumétrico de espaços vazios que a técnica recomendada pelo fabricante apenas no terço cervical (Kruskall-Wallis, p<0,05). Após o teste de push-out, a análise das médias indicou RU (MPa) significativamente maior nos espécimes obturados pela técnica do fabricante em comparação com a Técnica Modificada de Onda Contínua de Condensação (teste t para amostras independentes, p<0,05). Em todos os grupos foi verificado maior percentual de falhas adesivas, com predominância de falhas mistas na técnica do fabricante e de falhas adesiva na dentina na Técnica Modificada de Onda Contínua de Condensação. Em MEV, não houve tags na maioria dos espécimes obturados pela Técnica Modificada da Onda Contínua de Condensação e quando presentes, eram pequenos e irregularmente distribuídos. Nos espécimes obturados pela técnica recomendada pelo fabricante observou-se formação de tags longos e bem distribuídos, principalmente no terço apical (teste de Friedman, p<0,05). Concluiu-se que todos os sistemas resultaram em alterações nos parâmetros bidimensionais e tridimensionais do canal após o preparo biomecânico; a técnica recomendada pelo fabricante resultou em maior volume de espaços vazios no terço cervical e maior RU do material obturador do que a Técnica Modificada de Onda Contínua de Condensação. Obs: tese completa no site: https://rapidshare.com/files/963588082/Tese_Prof._Dr._Marco_Versiani_FORP_USP_2012.pdf (na pagina que abrir, clicar no botao \"download\"). / The purpose of this ex vivo study was to evaluate the biomechanical preparation and obturation of root canals using ProTaper, WaveOne, Reciproc and Self-Adjusting File systems. It was evaluated: 1) area, perimeter, roundness, major diameter, minor diameter, surface area, volume and SMI after biomechanical preparation, using microcomputed tomography (&mu;TC), 2) percentage volume of voids in the obturation material by means of &mu;TC, 3) bond strength (BS) and type of failure after the pushout test, and 4) the analysis of the interface dentin / filling material using scanning electron microscopy (SEM). One-hundred human mandibular canines were scanned in the SkyScan 1174v.2 device. After preparing the coronal third of the canals, the teeth were divided into 4 groups (n=25), according to the biomechanical preparation system used: ProTaper, WaveOne, Reciproc, and Self-Adjusting File (SAF). After the second TC, eigthteen specimens of each group were assigned to two groups (n=9), according to the obturation technique: the Modified Continuous Wave of Condensation Technique and the technique recommended by the manufacturer. The remaining seven specimens of each group were used as negative and positive controls. After scanning, the obturated specimens were sectioned perpendicularly to its long axis into 1-mm slice thickness of the coronal, middle and apical thirds. The bond strength (BS) was performed by the push-out test and, after dislodgments, the failures were observed in a digital microscope. The specimens were processed for SEM analysis to observe bonding interface formation and resin tag density using a four-step scale method. Overall, the analysis of the biomechanical parameters showed that the most significant changes in the root canal occurred in the ProTaper group and WaveOne groups. Reciproc results were in an intermediate level and smaller changes were observed in the SAF group (ANOVA, p<0.05). In the coronal third, the Modified Continuous Wave of Condensation Technique showed a lower percentage volume of voids than the technique recommended by the manufacturer (Kruskal-Wallis test, p<0.05). After the push-out test, the analysis indicated the mean BS (MPa) was significantly higher in specimens filled by the manufacturer\'s technical than the Modified Continuous Wave of Condensation Technique (t test for independent samples, p<0.05). The adhesive failures were frequent in all groups. The Modified Continuous Wave of Condensation Technique showed the highest percentage of adhesive failure in dentin while in the technique recommended by the manufacturer, mixed failure was predominant. Overall, in SEM analysis, no tags were observed in most of the specimens filled by the Modified Continuous Wave of Condensation Technique. When present, they were small and irregularly distributed. The specimens filled by the technique recommended by the manufacturer showed long and well-distributed tags, especially in the apical third (Friedman test, p<0.05). It was concluded that all systems promoted root canal changes after the biomechanical preparation, the obturation technique recommended by the manufacturer resulted in a higher volume of voids in the coronal third and BS of the Modified Continuous Wave of Condensation Technique group.

O objetivo deste estudo ex vivo foi avaliar o preparo biomecânico e a obturação de canais radiculares ovais utilizando os sistemas ProTaper, WaveOne, Reciproc e Self-Adjusting File. Com esta finalidade avaliou-se: 1) área, perímetro, circularidade, diâmetro maior, diâmetro menor, área de superfície, volume e SMI após o preparo biomecânico, por meio de microtomografia computadorizada (&mu;TC); 2) percentual volumétrico de espaços vazios após a obturação do canal, por meio de &mu;TC; 3) resistência de união (RU) e tipo de falha ocorrida após teste de push-out; e 4) a interface dentina/material obturador em microscopia eletrônica de varredura (MEV). Cem caninos inferiores humanos foram escaneados no microtomógrafo SkyScan 1174v.2. Após o preparo do terço cervical dos canais, os dentes foram distribuídos em 4 grupos (n=25), de acordo com o sistema usado no preparo biomecânico: ProTaper; WaveOne; Reciproc; Self-Adjusting File (SAF). Após a segunda &mu;TC, 18 espécimes de cada grupo foram redistribuídos em dois grupos (n=9), de acordo com a técnica de obturação: Técnica Modificada da Onda Contínua de Condensação e técnica recomendada pelo fabricante. Os sete espécimes restantes de cada grupo constituíram os grupos controle negativo e positivo. Após a TC dos espécimes obturados, as raízes foram seccionadas transversalmente em fatias de 1 mm de espessura correspondentes às regiões cervical, média e apical. A RU foi avaliada pelo teste de push-out e as falhas após desunião observadas em microscópio digital. Após preparo para MEV, avaliou-se a interface adesiva de forma qualitativa nominal e ordinal pelo estabelecimento e determinação de escores. No conjunto, a análise dos parâmetros avaliados no preparo biomecânico mostraram que as alterações mais significativas ocorreram nos grupos ProTaper e WaveOne. Os resultados no grupo Reciproc ficaram em um nível intermediário, enquanto as menores alterações foram observadas no grupo SAF (ANOVA, p<0,05). Em relação à obturação, a Técnica Modificada da Onda Contínua de Condensação apresentou menor percentual volumétrico de espaços vazios que a técnica recomendada pelo fabricante apenas no terço cervical (Kruskall-Wallis, p<0,05). Após o teste de push-out, a análise das médias indicou RU (MPa) significativamente maior nos espécimes obturados pela técnica do fabricante em comparação com a Técnica Modificada de Onda Contínua de Condensação (teste t para amostras independentes, p<0,05). Em todos os grupos foi verificado maior percentual de falhas adesivas, com predominância de falhas mistas na técnica do fabricante e de falhas adesiva na dentina na Técnica Modificada de Onda Contínua de Condensação. Em MEV, não houve tags na maioria dos espécimes obturados pela Técnica Modificada da Onda Contínua de Condensação e quando presentes, eram pequenos e irregularmente distribuídos. Nos espécimes obturados pela técnica recomendada pelo fabricante observou-se formação de tags longos e bem distribuídos, principalmente no terço apical (teste de Friedman, p<0,05). Concluiu-se que todos os sistemas resultaram em alterações nos parâmetros bidimensionais e tridimensionais do canal após o preparo biomecânico; a técnica recomendada pelo fabricante resultou em maior volume de espaços vazios no terço cervical e maior RU do material obturador do que a Técnica Modificada de Onda Contínua de Condensação. Obs: tese completa no site: https://rapidshare.com/files/963588082/Tese_Prof._Dr._Marco_Versiani_FORP_USP_2012.pdf (na pagina que abrir, clicar no botao \"download\"). / The purpose of this ex vivo study was to evaluate the biomechanical preparation and obturation of root canals using ProTaper, WaveOne, Reciproc and Self-Adjusting File systems. It was evaluated: 1) area, perimeter, roundness, major diameter, minor diameter, surface area, volume and SMI after biomechanical preparation, using microcomputed tomography (&mu;TC), 2) percentage volume of voids in the obturation material by means of &mu;TC, 3) bond strength (BS) and type of failure after the pushout test, and 4) the analysis of the interface dentin / filling material using scanning electron microscopy (SEM). One-hundred human mandibular canines were scanned in the SkyScan 1174v.2 device. After preparing the coronal third of the canals, the teeth were divided into 4 groups (n=25), according to the biomechanical preparation system used: ProTaper, WaveOne, Reciproc, and Self-Adjusting File (SAF). After the second TC, eigthteen specimens of each group were assigned to two groups (n=9), according to the obturation technique: the Modified Continuous Wave of Condensation Technique and the technique recommended by the manufacturer. The remaining seven specimens of each group were used as negative and positive controls. After scanning, the obturated specimens were sectioned perpendicularly to its long axis into 1-mm slice thickness of the coronal, middle and apical thirds. The bond strength (BS) was performed by the push-out test and, after dislodgments, the failures were observed in a digital microscope. The specimens were processed for SEM analysis to observe bonding interface formation and resin tag density using a four-step scale method. Overall, the analysis of the biomechanical parameters showed that the most significant changes in the root canal occurred in the ProTaper group and WaveOne groups. Reciproc results were in an intermediate level and smaller changes were observed in the SAF group (ANOVA, p<0.05). In the coronal third, the Modified Continuous Wave of Condensation Technique showed a lower percentage volume of voids than the technique recommended by the manufacturer (Kruskal-Wallis test, p<0.05). After the push-out test, the analysis indicated the mean BS (MPa) was significantly higher in specimens filled by the manufacturer\'s technical than the Modified Continuous Wave of Condensation Technique (t test for independent samples, p<0.05). The adhesive failures were frequent in all groups. The Modified Continuous Wave of Condensation Technique showed the highest percentage of adhesive failure in dentin while in the technique recommended by the manufacturer, mixed failure was predominant. Overall, in SEM analysis, no tags were observed in most of the specimens filled by the Modified Continuous Wave of Condensation Technique. When present, they were small and irregularly distributed. The specimens filled by the technique recommended by the manufacturer showed long and well-distributed tags, especially in the apical third (Friedman test, p<0.05). It was concluded that all systems promoted root canal changes after the biomechanical preparation, the obturation technique recommended by the manufacturer resulted in a higher volume of voids in the coronal third and BS of the Modified Continuous Wave of Condensation Technique group.

POTENTIAL ANTIMICROBIAL METHODS FOR PROVISIONALIZING TEETH AFTER ENDODONTIC TREATMENT By Laura T. Garden, DDS A thesis submitted in partial fulfillment of the requirements for the degree of Master of Science in Dentistry at Virginia Commonwealth University. Virginia Commonwealth University, 2018 Thesis Advisor: Garry Myers, DDS Department of Endodontics Objective:To evaluate the effectiveness of a Chlorhexidine soaked cotton pellet on bacterial leakage. Methods: Fifty-one extracted teeth, including six controls, were instrumented, obturated, and sealed with either a cotton pellet (CP), 2% Chlorhexidine soaked cotton pellet (CHX), or a Permaflo orifice barrier (OB). Each root was suspended between two chambers: the coronal chamber inoculated with brain heart infusion broth and colony-forming units of Enterococcus faecalis, the apical chamber with brain heart infusion broth and phenol red. The latter was checked daily for turbidity, indicating bacterial leakage. Results: All open and closed control groups had leaked by day 7. The average CP tooth survived for 13.1 days whereas the CHX and OB teeth leaked by an average of 5.8 days. Conclusion:There is insufficient evidence to support the use of a Chlorhexidine soaked cotton pellet. The results were not as expected and the study design should be re-evaluated.

The aim of this study was to determine the change in working length (∆WL) before and after coronal flaring and after complete rotary instrumentation as a function of canal curvature. One mesiobuccal or mesiolingual canal from each of 43 extracted molars had coronal standardization and access performed. Once the access was completed, canal preparation was accomplished using Gates Glidden drills for coronal flaring and EndoSequence files for rotary instrumentation. WLs were obtained at 3 time points: pre-instrumentation (unflared), mid-instrumentation (flared) and post-instrumentation (concluded). Measurements were made via direct visualization (DV) and the CanalPro apex locator (EM) in triplicate by a single operator with blinding across the time points. Root curvature was measured using Schneider’s technique. The change in working length was assessed using repeated-measures ANCOVA. The direct visualization measurements were statistically larger than the electronic measurements (paired t-test difference = 0.20 mm, SE = 0.037, P < .0001), although a difference this large may not be clinically important. Overall, a greater change in working length was observed in straight canals than in curved canals. This unexpected finding was attributed to the limitations of the study, specifically the confounding factor of root length. This trend was more pronounced when measured electronically than via direct visualization, especially after complete instrumentation than after coronal flaring. The overall change in working length after complete instrumentation was found to be clinically insignificant in this study. A limited amount of change in working length may be expected prior to obturation.

Purpose: The purpose of this study was to assess the radiographic changes in periapical status and analysis of healing determined using periapical radiographs (PA) versus cone beam computed tomography (CBCT) pre-operatively and at 3-64 months following endodontic treatment. Methods: Pre/post treatment radiograph and CBCT scans of patients who had NSRCT, NSReTx, or SRCT from July 2011-December 2018 at VCU Graduate Endodontic clinic were included in this study. Volumetric and linear measurements of periapical lesions on initial and recall PA and CBCT images were performed using three calibrated examiners. Changes and differences in the estimated area from PA to CBCT were compared using the Wilcoxon signed-rank test. McNemar’s chi-squared test was used to determine agreement in the proportion of lesions that were absent (0x0) between the PA and corresponding view of CBCT. This data was used to calculate the sensitivity, specificity, positive predictive value (PPV), and negative predicative value (NPV). Results: A total of 51 patients with a median healing time of 13 months were included in the analysis. Significant healing was observed on both PA and CBCT images (p-value Conclusion: Assessment using CBCT revealed a lower healing rate for all treatment categories compared with periapical radiographs. CBCT was more likely to detect the presence of a PARL, whereas a periapical radiograph would be less sensitive to detection of a PARL. Significant healing cannot be detected at an earlier point in time with PA radiographs or CBCT.

Introduction: Skeletal expansion has been a treatment modality in orthodontics and orthopedics to correct skeletal transverse discrepancies with maxillary constriction. The utilization of microimplants in conjunction with these palatal expanders offers a higher degree of pure skeletal expansion and minimizes the dental side effects. The purpose of this study is to evaluate the changes of the hard and soft tissues of the face after skeletal expansion for orthodontics. Methods: 36 patients who had received successful expansion with a microimplant assisted rapid palatal expander were compared to their pre-expansion records. All patients received CBCTs from which a 3-D analysis configuration was created to trace hard and soft tissue landmarks of the midface and nasal cavity regions. 3 judges analyzed each set of records and the average was used to calculate the amount of expansion experienced at each anatomical region. A paired T-test and Wilcoxon signed-rank test were used for statistical comparison between time points. Results: Expansion can affect all of the midfacial hard tissues that support the overlying soft tissues. Increases in skeletal width from the Frontozygomatic suture down to the maxillary alveolar bone were all significant. The nasal cavity increased in width in all locations measured. Soft tissue changes were significant at the base of the ala suggesting a widening of the nose with expansion therapy. Conclusion: Maxillary expansion with microimplant assisted expanders can have skeletal changes throughout the entire midface and may affect the width of the nasal cavity. Soft tissue changes were less pronounced, and though a widening of the base of the nose may be expected this may not be noticed by the patient.

Introduction: The aim of this study was to evaluate the frequency and amount of Ca(OH)2 extrusion in relation to the intracanal delivery technique, apical foramen size, and depth of placement. Methods: Standardized training blocks with j-shaped canals were used (n=64); half of the simulated canals were shaped to apical size #35(.06 taper) and the remaining 32 to #45(.06). The frequency and extent of Ca(OH)2 extrusion were measured relative to apical taper, the depth of insertion, and whether syringe or spiral filler was used. Blocks were immersed in pH-sensitive gel and observed for color change. The visible extent of extrusion, indicated by color change, was determined as area and expressed in mm2. Results: Extrusion of Ca(OH)2 occurred in 48/64 of the samples. At 3mm from the canal terminus, the device type had a significant effect on the frequency of extrusion, with syringe placement causing extrusion significantly (p<0.01) more frequently, irrespective of device size. Amounts of extrusion were significantly larger at 2mm short of the canal terminus (median 27.44mm2, IQR 10.02), compared to 3mm distance (median 19.69mm2, IQR 25.07; p<0.0001). Analyzed separately at 2 and 3mm distance, respectively, there was significantly more extrusion with placement using a syringe size #35 compared to spiral filler size #45. Conclusions: Considering the limits of the in vitro experimental design, a spiral filler at 500rpm, placed 3mm short of the apex found to minimize extrusion of Ca(OH)2 placed in root canals.

Introduction: Lymphoepithelial carcinoma (LEC) in the oropharynx is rare. Current understanding of the disease is derived mainly from case reports and small case series, prompting further elucidation of its epidemiology and prognostic factors that affect outcome. The aim of this retrospective cohort study was to examine demographic characteristics, clinicopathologic features, and prognostic factors in patients with oropharyngeal LEC. Methods: The U.S. National Cancer Institute’s SEER registry was queried to obtain data on patients with primary oropharyngeal LEC from 1975 to 2016. Variables examined include age at diagnosis, sex, race, year of diagnosis, primary site of tumor origin, tumor size, extent, nodal status, overall stage, tumor grade, surgical treatment, and county socioeconomic status (SES). Kaplan-Meier univariable and Cox regression model multivariable analyses were conducted to identify independent predictors of survival. Results: In total, 199 cases of primary LEC in the oropharynx were found. Overall survival rates at 2-, 5-, and 10-years were 81.0%, 74.0%, and 56.0%, respectively. Disease-specific survival rates at 2-, 5-, and 10-years were 85.0%, 80.0%, and 77.0%, respectively. Multivariable analysis identified older age at diagnosis, Black race, and tonsil primary site to be independent predictors of worse survival. Contrarily, a more recent year of diagnosis, surgical resection, and higher county SES were identified to be associated with an improved prognosis. Conclusion: Oropharyngeal LEC is a rare malignancy that is diagnosed mostly in White males in the fifth decade of life. Patient age, race, year of diagnosis, primary site of tumor origin, surgical treatment, and county SES were found to significantly affect survival. Although oropharyngeal LEC is associated with a relatively favorable prognosis, detecting disease early and including surgical resection in treatment may aid in further improving survival.

Aims Preservation of peri-cervical dentin during the preparation of endodontic access is important to prevent fractures and improve the long-term prognosis. The purpose of this study was to evaluate the impact of rotary file instrumentation (TruNatomy and XP-Endo Shaper) on peri-cervical dentin removal, depending on access size. Materials and Methods Forty 3D printed mandibular first molars, with either a small or large access design, were instrumented using TruNatomy or XP-endo Shaper file systems. Canal volumes were calculated based on micro-computed tomography data obtained pre- and post-operatively. Digital sectioning of each reconstructed volume was performed 90-degrees to the long axis at the floor of the pulp chamber at 5 levels, at the pulp chamber floor (Level 0) as well as 1 and 2mm coronally and apically of Level 0. Linear measurements were taken from the inner wall of the access cavity or canal to the outer surface of the tooth for both instrumentation techniques and compared to the unprepared control dataset. These measurements served as an approximation of remaining peri-cervical dentin after root canal instrumentation. Results Some of the coronal measurements were not reportable for the control group due to incomplete capture of the crown during the microCT scan. The remaining peri-cervical dentin thickness at the level of the pulpal floor and coronally were significantly (p<0.01) affected by the access cavity size, with the smaller access preserving more dentin in all samples. Apical to the pulpal floor, there was no significant difference between instrumentation groups at the data points evaluated. Remaining dentin thickness was largest at coronal section 1 and smallest at apical section 6 with 3.81mm (p = 0.05) and 1.84mm (p = 0.06), respectively. Conclusion Access cavity size had a significant impact on remaining dentin thickness at the level of the pulpal floor and coronally, with more remaining dentin in the conservative access group, irrespective of instrumentation technique. Future studies will evaluate dentin thickness in the furcation and mid root level, as well as apical canal transportation, and procedural errors.