Dental trauma: restorative procedures using composite resin and mouthguards for prevention.

J Contemp Dent Pract. 2007;8(6):89-95

Authors: Santos Filho PC, Quagliatto PS, Simamoto PC, Soares CJ

AIM: The aim of this article is to describe a step-by-step protocol for emergency care of a patient with a dentoalveolar injury in the anterior region of the mouth as well as the fabrication of a mouthguard to prevent future trauma. BACKGROUND: Dental trauma is one of the most serious oral health problems in active children and adolescents. Care of traumatized patients requires immediate initial emergency treatment followed by integrated procedures to restore damaged oral structures along with a subsequent trauma prevention strategy. Dentoalveolar injuries in the anterior region of the mouth are often characterized by tooth avulsion and coronal fracture. They are managed using procedures such as dental splinting, endodontic therapy with its unique characteristics, and restorative techniques to re-establish function and esthetics as well as protective mouthguards. REPORT: A 16-year-old male presented with avulsion of his maxillary central incisors as a result of a direct, unintentional impact with an opponent during a basketball game. The teeth had been stored in physiological serum immediately following the injury and the patient received immediate care. On clinical examination, the right central incisor was fractured at the incisal third of the crown but no bone fractures were found. The teeth were reimplanted and splinted. The fractured right central incisor was restored following endodontic treatment and a mouthguard was fabricated for the patient. SUMMARY: The dentist must be knowledgeable about the most efficient and suitable treatment for each traumatic scenario in order to provide appropriate care for dental injuries. Coordinated multi-disciplinary action is fundamental in the successful treatment of these injuries. The dental mouthguard is an effective device for protecting the teeth and supportive structures during physical activities and must be part of the protective equipment used by athletes. It is the responsibility of the dental professional to make parents, trainers, and athletic associations aware of the risks associated with physical activities without orofacial protection; this should encourage the proper use of all protective devices to prevent dentoalveolar injuries that compromise oral functions, esthetics, and increase the cost of healthcare.

PMID: 17846676 [PubMed - indexed for MEDLINE]

Study of the areas and thicknesses of mesiobucal root canals prepared by three endodontic techniques.

Braz Oral Res. 2007 Apr-Jun;21(2):118-26

Authors: Constante IG, Davidowicz H, Barletta FB, de Moura AA

The purpose of this study was to compare, in vitro, by means of computerized analysis of digital radiographic images, the anatomic alterations produced in the mandibular molar tooth dentinal walls of mesiobucal canals with severe curvature by three different endodontic techniques: Progressive Preparation, Staged and Serial Preparation. A selection was made of 45 extracted, human, mandibular molars, with root curvatures greater than 25 degrees. They were divided into three groups for every technique studied, which were then sub-divided into three sub-groups in accordance with the position of the curvature along the root: cervical, median or apical. After access surgery and tooth length determination, the canals were filled with 100% Barium Sulphate radiological contrast and the teeth were then radiographed with a direct digital radiography system, using a special apparatus capable of keeping the samples in the same spatial position during the different radiographic takes. After the above-mentioned endodontic techniques had been performed, the teeth were again filled with Barium sulphate and were also radiographed under the same previously mentioned conditions. The pre- and post-operative digital images were then analyzed in two computerized programs, AutoCAD 2004 and CorelDraw 10, to assess, respectively, the areas and the horizontal alterations which occurred in the internal and external walls of the root canals. The results indicated that although no significant differences among the techniques were shown in the statistical analysis, in a descriptive analysis the Progressive Preparation technique was shown to be more regular, uniform and effective.

PMID: 17589646 [PubMed - in process]

Restoration of a vertical tooth fracture and a badly mutilated tooth using canal projection.

Indian J Dent Res. 2007 Apr-Jun;18(2):87-9

Authors: Velmurugan N, Bhargavi N, Lakshmi N, Kandaswamy D

Management of vertically fractured tooth or a perforation frequently poses problem during endodontic management. Such teeth often need a pre-endodontic restoration prior to initiation of root canal therapy to aid in the placement of rubber dam clamp. This paper describes a simple method of placement of a pre-endodontic restoration using the canal projection technique using hollow metallic needles as sleeves.

PMID: 17502715 [PubMed - indexed for MEDLINE]

Effect of intracanal medication with calcium hydroxide and 1% chlorhexidine in endodontic retreatment cases with periapical lesions: an in vivo study.

J Formos Med Assoc. 2007 Mar;106(3):217-24

Authors: Ercan E, Dalli M, Duülgergil CT, Yaman F

BACKGROUND/PURPOSE: Calcium hydroxide (Ca(OH)(2)) has been widely used as an intracanal medicament for endodontic retreatment, but very few studies used both Ca(OH)(2) and 1% chlorhexidine (CHX) as intracanal medicaments. The purpose of this study was to assess the in vivo effectiveness of a combination of Ca(OH)(2) and 1% CHX as intracanal medicaments in endodontic retreatment cases with periapical lesions. METHODS: Previous cases of endodontically treated teeth with periapical pathosis in 70 patients (36 men and 34 women, age range 18-60 years) were included. Of these teeth, 59 had received root canal treatment and 11 had been subjected to previous apical surgery, indicating endodontic failure. Following the routine procedures, including canal reshaping and irrigation with 2% CHX, a canal medication material containing Ca(OH)(2) powder and a 1% CHX solution was placed into the root canals. Over a 6-week period, the intracanal medication was periodically changed until the teeth became asymptomatic. Patients were recalled at 3-month intervals for radiographic and clinical examination. RESULTS: Our clinical and radiographic assessment of retreatment cases showed complete healing in 41 (64%) teeth, incomplete healing in 9 (14%) teeth, and failure in 14 (22%) teeth. For complete healing teeth, the healing time varied from 6 to 36 months. The size of the periapical lesions and previous surgical treatment had no influence on the prognosis. CONCLUSION: Our results suggest that a combination of Ca(OH)(2) and 1% CHX can be successfully used as intracanal medicament for disinfection in endodontic retreatment cases with periapical lesions.

PMID: 17389166 [PubMed - indexed for MEDLINE]

Endodontic or dental implant therapy: the factors affecting treatment planning.

J Am Dent Assoc. 2006 Jul;137(7):973-7; quiz 1027-8

Authors: Torabinejad M, Goodacre CJ

BACKGROUND: Clinicians are confronted with difficult choices regarding whether a tooth with pulpal and/or periapical disease should be saved through endodontic treatment or be extracted and replaced with an implant. METHODS: The authors examined publications (research, literature reviews and systematic reviews) related to the factors affecting decision making for patients who have oral diseases or traumatic injuries. RESULTS: The factors to be considered included patient-related issues (systemic and oral health, as well as comfort and treatment perceptions), tooth- and periodontium-related factors (pulpal and periodontal conditions, color characteristics of the teeth, quantity and quality of bone, and soft-tissue anatomy) and treatment-related factors (the potential for procedural complications, required adjunctive procedures and treatment outcomes). CONCLUSIONS: On the basis of survival rates, it appears that more than 95 percent of dental implants and teeth that have undergone endodontic treatment remain functional over time. CLINICAL IMPLICATIONS: Clinicians need to consider carefully several factors before choosing whether to perform endodontic therapy or extract a tooth and place an implant. The result should be high levels of comfort, function, longevity and esthetics for patients.

PMID: 16803823 [PubMed - indexed for MEDLINE]

Endodontic therapy.

J Am Dent Assoc. 2006 Jun;137(6):722, 724; author reply 724, 726

Authors: Kolzet DJ

PMID: 16803799 [PubMed - indexed for MEDLINE]

Complicated crown fracture: a case report.

Braz Dent J. 2006;17(1):83-6

Authors: Fidel RA, Carvalho RG, Varela CH, Letra A, Fidel SR

This case report describes the treatment of a severe crown fracture of an immature mandibular permanent incisor in a 12 year-old boy referred to the Dental Traumatology Center of UNIGRANRIO University. After conventional endodontic procedures and dressing with calcium hydroxide, an apical plug was made with mineral trioxide aggregate in order to avoid an overflow of gutta-percha and endodontic sealer into the periapical tissues. Two years later, the tooth was clinically asymptomatic and radiographs showed total repair of the apical lesion.

PMID: 16721473 [PubMed - indexed for MEDLINE]

Root canal therapy of a maxillary first molar with five root canals: case report.

Braz Dent J. 2006;17(1):75-8

Authors: Favieri A, Barros FG, Campos LC

This paper reports the case of a maxillary left first molar that presented three root canals in the mesiobuccal root. Root canal therapy and case management are described. Features like wide crown access, adequate illumination and use of exploring files where important for successful completion of the endodontic treatment.

PMID: 16721471 [PubMed - indexed for MEDLINE]

The importance of apical patency and cleaning of the apical foramen on root canal preparation.

Braz Dent J. 2006;17(1):6-9

Authors: Souza RA

The apical limit of root canal instrumentation has always been a matter of great controversy. Despite the large number of published studies on this subject, a consensus has not yet been reached. In fact, the recent discussion on apical patency and cleaning of the apical foramen, as well as the incorporation of these procedures to the endodontic treatment, seem to have raised even more polemics. It is likely that all this polemics has its roots in the lack of interrelation between the theoretical knowledge of pulp stump and periapical tissues and the real clinical practice. By addressing the most important aspects of this theme, this paper aims to present news concepts about the importance of apical patency and cleaning of the apical foramen during root canal preparation.

PMID: 16721456 [PubMed - indexed for MEDLINE]

Scope of practice comparison: a tool for curriculum decision making.

J Dent Educ. 2006 Mar;70(3):231-45

Authors: Solomon E, Murray J, Dodge WW, Redding SW, Valenza JA, Flaitz CM, Cole JS, Kalkwarf KL

The proportion of claims filed for specific dental procedures (ADA codes # 05110, 05120, 03320, 03330, 04260, 02150) between January 1, 2000 and June 30, 2004 by Texas general practitioners participating in a preferred provider network was compared to the proportion of these procedures performed by students graduating from the three Texas dental schools during the same period. Analysis of the data revealed that Texas dental students provide class two amalgam restorations in permanent teeth (02150) at approximately the same frequency as Texas general practitioners. Both groups provide periodontal osseous surgery (04260) at an extremely low frequency (<0.02% of total procedures). Bicuspid endodontic procedures (03320) were performed at a slightly higher frequency by students (0.43% of all procedures) than by general practitioners (0.36% of all procedures), and molar endodontic procedures (03330) were performed at a slightly higher frequency by general practitioners (0.65%) than by students (0.36%). Significant discrepancies between the groups were noted for the two complete denture procedures (05110, 05120). Students provided these procedures at frequencies fifteen times (05110) and twenty-five times (05120) greater than general practitioners. Dental schools should use data provided by scope of practice analyses to help determine an appropriate breadth and depth for their educational programs.

PMID: 16522752 [PubMed - indexed for MEDLINE]

Periapical surgery of maxillary posterior teeth. A review of the literature.

Med Oral Patol Oral Cir Bucal. 2006 Mar;11(2):E146-50

Authors: Garc&#xED;a B, Martorell L, Martí E, Peñarrocha M

In recent years, periapical surgery has evolved thanks to new diagnostic and technical advances. A review is made of the literature on periapical surgery of the antral teeth, based on a Medline search and on the revision of Spanish dental journals in the period between 1974 and 2003. The anatomy of the maxillary sinus is discussed, along with the diagnosis of periapical lesions and the relation of the maxillary sinus to the antral teeth. The surgical technique, special considerations and prognosis of periapical surgery in these teeth are also addressed. Recent studies postulate that the proximity of the antral teeth to the maxillary sinus should not be viewed as a contraindication to periapical surgery, and recommend such surgery in teeth with chronic periapical disease that are refractory to conventional endodontic management, despite the proximity of the maxillary sinus.

PMID: 16505793 [PubMed - indexed for MEDLINE]

Inability of laser and rotary instrumentation to eliminate root canal infection.

J Am Dent Assoc. 2006 Jan;137(1):67-70

Authors: Jha D, Guerrero A, Ngo T, Helfer A, Hasselgren G

BACKGROUND: The authors evaluated the antibacterial effectiveness of laser instrumentation and rotary instrumentation of anterior, single-rooted teeth infected with Enterococcus faecalis. METHODS: The authors divided 35 infected samples into five groups: Group A: inoculation, laser, 17 percent ethylene-diamine-tetra-acetate (EDTA), 2.5 percent sodium hypochlorite (NaOCl) (n=10); Group B: inoculation, laser, 17 percent EDTA, sterile saline (n = 10); Group C: inoculation, rotary, 17 percent EDTA, 2.5 percent NaOCl (n=10); Group D: inoculation, no instrumentation (positive control) (n=5); Group E: no inoculation, no instrumentation (negative control) (n=5). They sampled and incubated dentin shavings from each canal for bacterial growth. RESULTS: In Group A, eight tubes were positive for bacterial growth. In Group B, 10 tubes were positive for bacterial growth. In Group C, six tube were positive for bacterial growth. In Group D, all of the tubes were positive for bacterial growth. In Group E, no tubes showed bacterial growth. The Fisher exact test showed no significant differences among groups A, E and C. CONCLUSION: Neither the laser nor the rotary instrumentation was able to eliminate endodontic infection. CLINICAL IMPLICATIONS: Although lasers have been presented as high-tech tools for disinfecting root canals, the laser was ineffective in this study.

PMID: 16457001 [PubMed - indexed for MEDLINE]

Osteosarcoma of mandible initially resembling lesion of dental periapex: a case report.

Rev Bras Otorrinolaringol (Engl Ed). 2005 Mar-Apr;71(2):242-5

Authors: Soares RC, Soares AF, Souza LB, Santos AL, Pinto LP

Osteosarcoma is a malignant mesenchymal tumor whose cancerous cells produce osteoid matrix. It is the most common primary malignant bone tumor, accounting for approximately 20% of the sarcomas, but only 5% of the osteosarcomas occur in the jaws. They present various clinical and histological aspects, as well as variable disease progression and outcome. This article shows a case report of a 20-year-old woman who presented swelling near the mandibular left premolar. After clinical diagnosis of lesion of the dental periapex, the patient initially underwent endodontic treatment of the tooth involved. Thereafter, in a period of eleven days, a significant increase of the lesion could be observed, resulting in visible facial asymmetry. The occlusal radiographic view showed an area of bone destruction and abnormal bone formation in the region. The external cortical portion showed clear radiopacity resembling sunrays, suggesting the diagnosis of osteosarcoma. The treatment comprised partial mandibulectomy and reconstruction of the area, using bone of the rib and skin graft from the buttock for the oral mucosa involved. Eight months after surgery, there was local recurrence of the lesion and the patient died approximately one year after relapse.

PMID: 16446924 [PubMed - indexed for MEDLINE]

Natural history of treatment outcomes of permanent first molars: a study of sealant effectiveness.

J Am Dent Assoc. 2005 Sep;136(9):1265-72

Authors: Bhuridej P, Damiano PC, Kuthy RA, Flach SD, Kanellis MJ, Heller KE, Dawson DV

BACKGROUND: Few studies have used insurance claims data to retrospectively assess the natural history--a natural process or flow of events without any special interventions--and treatment outcomes of teeth with dental sealants. METHODS: The authors constructed treatment outcome trees (TOTs) from the Iowa Medicaid claims and eligibility data (1996-2000) of continuously enrolled 6-year-old children who routinely used Medicaid dental services. The authors used the TOTs to compare the restorative treatments of sealed permanent first molars with those of nonsealed permanent first molars. RESULTS: Forty percent of routine utilizers received a sealant during the four-year period. Overall, 25 percent of molars received at least one restoration. Sealed molars were less likely to receive further restorative treatment than were nonsealed molars (13 versus 29 percent). Sealed molars had fewer extensive restorative treatments (crowns, endodontic therapy and extractions) than did nonsealed molars. The median time to restorative treatment of the sealed molars also was greater than that of the nonsealed molars. All four first molars had comparatively similar patterns of subsequent care. CONCLUSIONS: Permanent first molars with sealants received less subsequent restorative treatment than did those without sealants. TOTs are useful tools for identifying necessary outcome information needed for program evaluations. CLINICAL IMPLICATIONS: Greater use of sealants could reduce the need for subsequent treatment and prolong the time until treatment may be necessary for permanent first molars.

PMID: 16196231 [PubMed - indexed for MEDLINE]

Use of vitamin C in delayed tooth replantation.

Braz Dent J. 2005;16(1):17-22

Authors: Panzarini SR, Perri de Carvalho AC, Poi WR, Sonoda CK

This study evaluated microscopically the effects of root surface treatment with three different solutions in delayed rat teeth replantation. Central incisors from 30 rats (Rattus norvegicus, albinus Wistar) were extracted and left on a bench for 6 h. The pulps were extirpated and root canals were irrigated with 1% sodium hypochlorite. After endodontic treatment, the root surfaces of all teeth were submitted to a 10-min treatment with 1% sodium hypochlorite, changed every 5 min. The teeth were then rinsed with saline for 10 min and assigned to 3 groups with ten specimens each. Groups I, II and III were treated, respectively, with 2% acidulated-phosphate sodium fluoride, vitamin C solution and effervescent vitamin C (2 g, Redoxon. After root surface treatment, the teeth were filled with calcium hydroxide and replanted. The animals were sacrificed after 10 and 60 days. Group I (fluoride) presented the largest areas of replacement resorption and ankylosis. Comparing both vitamin C groups, Group III (effervescent vitamin C) yielded better results, showing more areas of ankylosis and replacement resorption than areas of inflammatory resorption.

PMID: 16113928 [PubMed - indexed for MEDLINE]

Maxillofacial Fractures and Dental Trauma in a High School Soccer Goalkeeper: A Case Report.

J Athl Train. 2005 Jun;40(2):116-119

Authors: Mihalik JP, Myers JB, Sell TC, Anish EJ

Objective: To present the case of a 17-year-old male soccer goalkeeper who sustained maxillofacial fractures and dental trauma after being struck in the face by an opponent's knee.Background: Because of the nature of the sport and a lack of protective headgear, soccer players are at risk for sustaining maxillofacial trauma. Facial injuries can complicate the routine management of on-field medical emergencies often encountered by certified athletic trainers. The appropriate management of maxillofacial trauma on the playing field may help to reduce both the immediate and long-term morbidity and mortality associated with these injuries.Differential Diagnosis: Lacerated superior labial artery, lacerated upper lip, dental fractures, maxillofacial fractures, orbital blowout fracture, closed head injury, cervical spine injury, cerebrovascular accident.Treatment: The athlete received immediate on-field medical care and was subsequently transported to the hospital, where diagnostic testing was performed and further treatment was provided. Hospital inpatient management included dental and plastic surgery. After discharge from the hospital, the athlete underwent several additional dental procedures, including gingival surgery and nonsurgical endodontic treatments. The fractures were followed closely to assure that adequate healing had occurred. The athlete did not return to soccer.Uniqueness: Certified athletic trainers need to be prepared for on-field medical emergencies. Bleeding associated with maxillofacial trauma can complicate basic medical interventions such as airway maintenance. Inappropriate on-field management may result in unnecessary morbidity and mortality for the injured athlete. Therefore, immediate recognition of the severity of the injury is needed in order to institute appropriate airway-management strategies.Conclusions: It is sometimes necessary to consider nonstandard methods of airway management in order to first address heavy bleeding that may be associated with facial trauma. Achieving hemostasis is essential in order to prevent potentially life-threatening complications related to hemorrhage, such as airway obstruction and hypovolemic shock.

PMID: 15970958 [PubMed - as supplied by publisher]

Management of periodontitis associated with endodontically involved teeth: a case series.

J Contemp Dent Pract. 2005 May 15;6(2):118-29

Authors: Anand PS, Nandakumar K

The pulp and the periodontal attachment are the two components that enable a tooth to function in the oral cavity. Lesions of the periodontal ligament and adjacent alveolar bone may originate from infections of the periodontium or tissues of the dental pulp. The simultaneous existence of pulpal problems and inflammatory periodontal disease can complicate diagnosis and treatment planning. The function of the tooth is severely compromised when either one of these is involved in the disease process. Treatment of disease conditions involving both of these structures can be challenging and frequently requires combining both endodontic and periodontal treatment procedures. This article presents cases of periodontitis associated with endodontic lesions managed by both endodontic and periodontal therapy.

PMID: 15915211 [PubMed - indexed for MEDLINE]

A comparison of dental services received by Medicaid and privately insured adult populations.

J Am Dent Assoc. 2005 Jan;136(1):93-100

Authors: Sweet M, Damiano P, Rivera E, Kuthy R, Heller K

BACKGROUND: Few studies have compared differences in dental care utilization rates between a publicly and a privately insured adult population in the same geographic area. The authors conducted this study to compare the demographic characteristics and use of dental services for enrollees in the Iowa Medicaid program and in the Delta Dental Plan of Iowa. The focus was on the overall use of dental services, with an emphasis on the use of tertiary care services such as endodontic therapy and tooth extraction services. METHODS: The authors used insurance claims data for adults aged 21 to 64 years who were enrolled in Delta Dental of Iowa and the Iowa Medicaid program for fiscal year 1998. They calculated utilization of dental services rates by type of dental procedure. RESULTS: In fiscal year 1998, 69.3 percent of Delta Dental enrollees and 27.2 percent of Medicaid enrollees had a dental visit. More than 90 percent of those in both populations with a dental visit had used preventive dental services during the year. Medicaid users were nearly twice as likely as Delta Dental enrollees to receive endodontic therapy (9.9 percent versus 5.0 percent, respectively) and nearly four times as likely to have had a tooth extracted (27.4 percent versus 7.1 percent, respectively). CONCLUSIONS: Privately insured enrollees were more likely to use dental services that were Medicaid enrollees. The greater use of tertiary care services by the Medicaid population than by the privately insured population is indicative of a lower oral health status for this group at the time they sought care, even though it was a much younger group of adults. PRACTICE IMPLICATIONS: The oral health status of low-income adults enrolled in Medicaid could benefit greatly from higher use of routine preventive dental services and earlier treatment of oral diseases to prevent the substantial need for preventable tertiary care services.

PMID: 15693504 [PubMed - indexed for MEDLINE]

Treatment of endodontic perforations using guided tissue regeneration and demineralized freeze-dried bone allograft: two case reports with 2-4 year post-surgical evaluations.

J Contemp Dent Pract. 2004 Aug 15;5(3):131-41

Authors: Zenobio EG, Shibli JA

Clinicians often have difficulty with the diagnosis and treatment of root perforation. This paper reports two patients with root perforation treated with periodontal surgery associated with guided tissue regeneration (GTR) and demineralized freeze-dried bone allograft (DFDBA). This combined treatment resulted in minimal probing depths, minimal attachment loss, and radiographic evidence of bone gain after follow-up evaluations that ranged from 2 to 4 years. These case reports show a correct diagnosis and removal of etiologic factors can restore both periodontal and endodontic health.

PMID: 15318264 [PubMed - in process]

A comparison of retreatment decisions among general dental practitioners and endodontists.

J Dent Educ. 2004 Aug;68(8):872-9

Authors: Balto HA, Al-Madi EM

This study compared the difference in decision making regarding retreatment of endodontically treated teeth by general dental practitioners and endodontists. Thirty radiographs of endodontically treated teeth taken from undergraduate records with their respective case descriptions were submitted to fifteen endodontists and fifteen general dental practitioners. Seven treatment alternatives were given as choices; reasons for retreatment, if chosen, were also requested and presented as choices. The results showed statistically different decisions among these two groups regarding retreatment cases. More endodontists opted for retreatment of cases, while higher percentages of general dentists decided to observe, not treat or extract. To prevent misdiagnosis and eventually mistreatment, endodontic decision making should be taught. Currently, there are no specific guidelines for management of failed root canal retreatment. It is suggested that guidelines generated by evidence-based dentistry may produce less variation in clinical decision making.

PMID: 15286111 [PubMed - indexed for MEDLINE]

Considerations and differences in the treatment of a fused tooth.

Med Oral. 2004 May-Jul;9(3):224-8

Authors: Olivan-Rosas G, L&#xF3;pez-Jiménez J, Giménez-Prats MJ, Piqueras-Hernández M

Dental malformations relating to bigeminism, fused teeth, etc., have a prevalence of 0.5-5%, depending on geographic, racial or genetic factors. This in turn may influence the treatment to be provided in each case. Anomalies in the shape, size and number of teeth are more common in the so-called pediatric genetic syndromes, many of which are associated to mental retardation. The present study describes two clinical cases of similar dental fusion involving a central incisor and comprising different and individualized treatment plans due to the important differences in the characteristics of each patient. The first case corresponded to a healthy 9-year-old boy with a fused upper central incisor and a supernumerary incisor in the second quadrant. The fused tooth presented two independent and converging roots with a single pulp chamber. Endodontic treatment was provided, with dental sectioning and composite reconstruction of the crown. Orthodontic management was reserved for a second stage. The second patient was a 27-year-old male with severe mental retardation of uncertain origin, gingival hyperplasia, a large bilobular upper central incisor, and a total lack of oral hygiene. Treatment in this case was limited to surgical resolution of the periodontal problem and the introduction of an exhaustive prevention program involving instructions for oral hygiene (with implication of the parents and care takers). In conclusion, the development of a management plan in these two cases of fused teeth required due consideration of the degree of patient cooperation, which was severely limited in one case -- thereby causing treatment to differ greatly from one individual to another.

PMID: 15122124 [PubMed - indexed for MEDLINE]

Cemento-ossifying mandibular fibroma: a presentation of two cases and review of the literature.

Med Oral. 2004 Jan-Feb;9(1):69-73

Authors: Sanchis JM, Peñarrocha M, Balaguer JM, Camacho F

We present two clinical cases of radiolucent mandibular lesions in young women that simulated chronic periapical infectious pathology. The detection of both cases was fortuitous since they were totally asymptomatic. Diagnosis was reached in one case (upon periapical surgery and anatomo-pathologic study) after endodontic treatment and after verifying non-resolution of affected periapical area. The other case was an extensive lesion, which involved the periapices of the four inferior incisors in which surgery was directly performed upon verifying pulp vitality of these teeth. After surgery endodontic treatment was performed on the teeth that had lost their vitality. In both cases the histopathologic tests revealed the presence of a cemento-ossifying fibroma, the initial clinical and radiographic diagnosis of which could easily be overlooked.

PMID: 14704620 [PubMed - indexed for MEDLINE]

Cytotoxic effects of cyanoacrylates used as retrograde filling materials: an in vitro analysis.

Pesqui Odontol Bras. 2003 Apr-Jun;17(2):113-8

Authors: de Azevedo CL, Marques MM, Bombana AC

Cyanoacrylate has been used in medicine and dentistry for many years. It has been used as a postextraction dressing and retrograde filling material in endodontic surgery. The aim of this study was to evaluate the cytotoxic effects of Histoacryl and other two homologue ethyl cyanoacrylates, Super Bonder and Ultrabond, on cultured fibroblasts, using the Trypan blue dye exclusion assay. The cyanoacrylates were applied to round glass coverslips, which were placed in contact with NIH 3T3 cells. After 0, 6, 12 and 24 h (short-term assay; viability) and 1, 3, 5 and 7 days (long-term assay; survival), the cells were examined under phase light microscopy and counted. The data were compared by the Kruskal-Wallis test. In the short-term experiments, only the cultures of the Ultrabond group (GIV) presented significant smaller percentages of cell viability than the cultures of the other groups (GI: control; GII: Super Bonder; GIII: Histoacryl). Although the cultures of the Super Bonder group (GII) presented smaller percentages of cell viability than cultures of the other groups (GI, GIII, GIV) at the long-term assay, this group was the only experimental group presenting a continuous and progressive cell growth. Our results have shown an in vitro biocompatibility of Histoacryl and ethyl cyanoacrylate homologues. These cyanoacrylates could therefore be of importance for endodontic purposes.

PMID: 14569351 [PubMed - indexed for MEDLINE]

Mandibular nerve paresthesia caused by endodontic treatment.

Med Oral. 2003 Aug-Oct;8(4):299-303

Authors: Gallas-Torreira MM, Reboiras-López MD, García-García A, Gándara-Rey J

The paresthesias of the inferior dental nerve consists of a complication that can occur after performing various dental procedures such as cystectomies, extraction of impacted teeth, apicoectomies, endodontic treatments, local anesthetic deposition, preprosthetic or implantologic surgery. The possible mechanisms of nervous lesions are mechanical, chemical and thermal. Mechanical injury includes compression, stretching, partial or total resection and laceration. The lesion can cause a discontinuity to the nerve with Wallerian degeneration of the distal and integrated fibers of the covering (axonotmesis) or can cause the total sectioning of the nerve (neurotmesis). Chemical trauma can be due to certain toxic components of the endodontic filling materials (paraformaldehyde, corticoids or eugenol) and irrigating solutions (sodium hypochlorite) or local anesthetics. Thermal injury is a consequence of bone overheating during the execution of surgical techniques. We present a clinical case of paresthesia of the inferior dental nerve after the introduction of a gutta-percha point in the mandibular canal during the performance of a root canal therapy of the inferior first molar. The etiology and the treatment of this endodontic complication are described.

PMID: 12937392 [PubMed - indexed for MEDLINE]

Do regular dental visits affect the oral health care provided to people with HIV?

J Am Dent Assoc. 2002 Oct;133(10):1343-50

Authors: Hastreiter RJ, Jiang P

BACKGROUND: Financial factors related to income and insurance coverage have been found to limit access to, and influence use of, oral health care services by people with human immunodeficiency virus, or HIV. METHODS: The authors determined if visiting a dentist regularly affected the oral health services provided to people with HIV when financial barriers were eliminated as an impediment to access. They analyzed dental claims data for services submitted for payment to the Minnesota Access to Dental Care Program. The analyses focused on comparisons of dental utilization patterns among 273 people classified as regular patients, or RPs, and 222 people classified as nonregular patients, or NRPs. RESULTS: RPs were found to have been provided more diagnostic and preventive care, and less restorative, endodontic, periodontic, removable prosthodontic and oral surgical treatment than were NRPs. Although the mean submitted cost per patient visit was much higher for NRPs, total mean submitted costs per patient for RPs and NRPs were not significantly different. Even though NRPs underwent fewer procedures and had fewer clinic visits than did RPs, the procedures provided to NRPs were more complex and costly. As indicated by differences in the mix of dental care services provided to RPs vs. NRPs, continuity of primary oral health care for RPs led to a better oral health result at no increase in cost over that for NRPs. CONCLUSIONS: The study findings provide substantial evidence regarding the value of regular oral health care for people with HIV. CLINICAL IMPLICATIONS: This study reinforces the need for dentists to educate and encourage people with HIV to integrate regular oral health care into the ongoing maintenance of their overall health and well-being.

PMID: 12403536 [PubMed - indexed for MEDLINE]

Endodontic perforation repair with resin-ionomer: a case report.

J Contemp Dent Pract. 2000 Nov 15;1(4):48-59

Authors: Breault LG, Fowler EB, Primack PD

Root perforations are significant complications of endodontic treatment. However, when teeth are of strategic value, perforation repair is clearly indicated. The successful utilization and placement of a subgingival resin-ionomer restoration to repair an endodontic root perforation is demonstrated. Sustained tissue health and minimal probing depths at the surgical site demonstrate clinical success.

PMID: 12167950 [PubMed - indexed for MEDLINE]

Using a Hedström endodontic file to retrieve a root tip.

J Am Dent Assoc. 2002 Apr;133(4):473

Authors: Stoner KE

PMID: 11991465 [PubMed - indexed for MEDLINE]

A systematic review of complication risks for HIV-positive patients undergoing invasive dental procedures.

J Am Dent Assoc. 2002 Feb;133(2):195-203

Authors: Patton LL, Shugars DA, Bonito AJ

BACKGROUND: This systematic literature review determined the strength of evidence regarding whether patients with human immunodeficiency virus, or HIV, are at higher risk of developing complications from invasive oral procedures than similar patients without HIV. TYPES OF STUDIES REVIEWED: MEDLINE and EMBASE searches of the English literature from the early 1980s through April 2000 yielded five articles meeting the inclusion and exclusion criteria: original research, concurrent treatment of HIV-positive and HIV-negative subjects, presence of complications (for example, local or systemic infection, bleeding, alveolitis, delayed healing) resulting from extractions, orthognathic surgery, periodontal therapy, endodontic therapy, placement of dental implants, prophylaxis, or scaling and root planing. RESULTS: The authors found no studies involving orthognathic surgery, periodontal therapy, dental implants, prophylaxis, or scaling and root planing, and only one study reporting few immediate endodontic therapeutic complications. Thus, the evidence is insufficient with respect to any additional risk associated with these procedures among people with HIV/AIDS. Because of the few studies, low overall complication rates and variability in results from different analytic approaches, the authors consider the evidence to be too poor to rule in or out a meaningful relationship between HIV status and complications from tooth extractions. CLINICAL IMPLICATIONS: Limited published scientific evidence is available to guide clinicians in regard to possible increased risks of invasive oral procedures associated with the HIV status of the patient.

PMID: 11868838 [PubMed - indexed for MEDLINE]

Use of dental services: an analysis of visits, procedures and providers, 1996.

J Am Dent Assoc. 2002 Feb;133(2):167-75

Authors: Manski RJ, Moeller JF

BACKGROUND: While many studies have provided data on Americans' access to dental care, few have provided a detailed understanding of what specific treatments patients receive. This article provides detailed information about the types of dental services that Americans receive and the types of providers who render them. METHODS: The authors provide national estimates for the U.S. civilian noninstitutionalized population in several socioeconomic and demographic categories regarding dental visits, procedures performed and the types of providers who performed them, using household data from the 1996 Medical Expenditure Panel Survey, or MEPS. RESULTS: Data show that while the combination of diagnostic and preventive services adds up to 65 percent of all dental procedures, the combination of periodontal and endodontic procedures represents only 3 percent. Additionally, while 81 percent of all dental visits were reported as visits to general dentists, approximately 7 percent and 5 percent of respondents who had had a dental visit reported having visited orthodontists or oral surgeons, respectively. CONCLUSION: MEPS data show the magnitude and nature of dental visits in aggregate and for each of several demographic and socioeconomic categories. This information establishes a nationally representative baseline for the U.S. population in terms of rates of utilization, number and types of procedures and variations in types of providers performing the procedures. These nationally representative estimates include data elements that describe specific dental visits, dental procedures and type of provider, and they offer details that are useful, important and not found elsewhere. PRACTICE IMPLICATIONS: By understanding these analyses, U.S. dentists will be better positioned to provide care and better meet the dental care needs of all Americans.

PMID: 11868835 [PubMed - indexed for MEDLINE]

Periapical surgery of 29 teeth. A comparison of conventional technique, microsaw and ultrasound.

Med Oral. 2002 Jan-Feb;7(1):46-9, 50-3

Authors: Vallecillo Capilla M, Mu&#xF1;oz Soto E, Reyes Botella C, Prados Sáchez E, Olmedo Gaya MV

OBJECTIVES: A clinical and radiological study is made of the results obtained with different periapical surgical techniques. MATERIAL AND METHODS: Twenty-nine single-root teeth from 29 patients with periapical pathology following correct endodontic treatment were divided into three groups: (A) 10 patients in which rotary instruments were used to perform osteotomy, apicoectomy and cavity preparation; (B) 10 patients in which rotary instruments were used to perform osteotomy and apical resection, with ultrasound root-end cavity preparation; and (C) 9 patients in which microsaws were used for osteotomy, and ultrasound for cavity preparation. All teeth were filled with IRM. Clinical and radiological controls were made after 10 days, one and 6 months, and one year. RESULTS: Clinical success with the absence of symptoms was achieved in 17 cases (58.6%), while in 16 patients (55.2%) the X-ray images showed complete bony regeneration (complete healing). The clinical success rate after one year was 40%, 70% and 66.7% in groups A, B and C, respectively, while complete radiographic healing was recorded in 30%, 60% and 77.8%. There were three failures in group A, two in group C, and none in group B. CONCLUSION: In conclusion, the best results were obtained when ultrasound was used for root-end cavity preparation.

PMID: 11788808 [PubMed - indexed for MEDLINE]

21st-century endodontics.

J Am Dent Assoc. 2000 Jun;131 Suppl:39S-46S

Authors: Glickman GN, Koch KA

BACKGROUND: Endodontics as a discipline has offered patients the opportunity to maintain their natural teeth. As the population expands and ages, the demand for endodontic therapy can be expected to increase as patients seek dental options to keep their teeth for a lifetime. CLINICAL IMPLICATIONS: New materials, techniques and instruments are entering the market-place to assist dentists in providing patients with more predictable and reliable endodontic treatment. In addition, these new systems make the delivery of endodontic services more efficient. This article describes these advances in endodontic treatment for dentists interested in incorporating these advances into their clinical practice.

PMID: 10860344 [PubMed - indexed for MEDLINE]

Formation of a facial hematoma during endodontic therapy.

J Am Dent Assoc. 2000 Jan;131(1):67-71

Authors: Mehra P, Clancy C, Wu J

BACKGROUND: Sodium hypochlorite, or NaOCl, is one of the most commonly used irrigating solutions in endodontic practice. Its clinically proven antibacterial, solvent and lubricating properties make it a very appealing choice as an intracanal medicament. CASE DESCRIPTION: The authors present a case of facial hematoma formation after an inadvertent injection of NaOCl into the periapical tissues. The NaOCl solution caused extensive tissue destruction. Management of the condition required the hospitalization, intravenous antibiotic therapy and multiple intraoral surgical incisions to facilitate drainage. CLINICAL IMPLICATIONS: Use of NaOCl must be confined to the root canal system. This report reviews this intracanal medicament's potential toxicity and emphasizes the need for clinicians to remain cognizant of possible problems while using the solution.

PMID: 10649874 [PubMed - indexed for MEDLINE]

Bronchoscopic removal of foreign bodies in adults: experience with 62 patients from 1974-1998.

Eur Respir J. 1999 Oct;14(4):792-5

Authors: Debeljak A, Sorli J, Music E, Kecelj P

The authors reviewed their experience with therapeutic bronchoscopy for removal of tracheobronchial foreign bodies in the adult. Bronchoscopy records and collection of foreign bodies in the endoscopic department were retrospectively examined. Among 37,466 bronchoscopies performed between 1974-1998, 62 (0.2%) were performed for the removal of tracheobronchial foreign bodies. Medical history was suggestive of foreign body aspiration in 33 patients and the chest radiograph was suggestive in 10 patients. The procedure was performed with the flexible bronchoscope in 42 patients (68%), rigid bronchoscope in 4 (6%), and with both in 16 (26%) patients. Foreign bodies were found in the right bronchial tree on 42 occasions, in the left on 20 and in the trachea once. In 39 patients, inflammatory granulations were found around the foreign body. The origins of the foreign bodies included: bone fragments (n=31), vegetable (n=10), broncholith (n=8), a part of dental prosthesis (n=7), endodontic needle (n=2), a metallic (n=2), or plastic (n=1) particle, a tracheostomy tube (n=1) and a match (n=1). In one patient, 2 foreign bodies were found. The foreign bodies were successfully removed in all but 2 patients (3%). The most useful instruments for removal were alligator forceps and the wire basket. Foreign bodies in the tracheobronchial system are rare in adults. They can be successfully removed in the majority of patients under either flexible or rigid bronchoscopy.

PMID: 10573222 [PubMed - indexed for MEDLINE]

Forceps extraction of teeth with severe internal root resorption.

J Am Dent Assoc. 1997 Jun;128(6):751-4

Authors: Javaheri DS, Garibaldi JA

Many treatment plans require a dental practitioner to maintain the entire labial cortical plate of bone when removing an anterior maxillary tooth. A tooth with an undermined root secondary to an endodontic perforation or internal (Idiopathic) resorption can present a surgical challenge to the general practitioner. This article describes a new technique for extracting a severely undermined anterior maxillary tooth while maintaining the entire labial cortex of bone.

PMID: 9188233 [PubMed - indexed for MEDLINE]

A review of root resective therapy as a treatment option for maxillary molars.

J Am Dent Assoc. 1997 Apr;128(4):449-55

Authors: Hempton T, Leone C

Restorative treatment planning is often confounded when periodontal attachment loss, caries or tooth fracture involves the furcation area of the tri-rooted maxillary molars. Although such involvement invariably diminishes the long-term prognosis of the affected teeth, extraction is not always an option. Root resective therapy, which removes the involved root plus its associated crown portion (trisection), is one of several treatment modalities that can be used in such cases. This article reviews the indications and contraindications for root resective therapy, describes the techniques of surgical trisection and presents a case in which combined resective, endodontic and prosthetic management resulted in a successful outcome.

PMID: 9103795 [PubMed - indexed for MEDLINE]

Preventing after-hours endodontic emergencies.

J Am Dent Assoc. 1997 Mar;128(3):350

Authors: Oppenheimer RE

PMID: 9066220 [PubMed - indexed for MEDLINE]

Identifying acute pulpalgia as a factor in TMD pain.

J Am Dent Assoc. 1996 Jun;127(6):773-80

Authors: Wright EF, Gullickson DC

An acute pulpalgia and temporomandibular disorders can produce many of the same symptoms. To illustrate identification of an acute pulpalgia as a component in TMD, the authors review the evaluation of 11 patients at a clinic that specializes in TMD treatment. During the evaluation, thermal testing and periodontal ligament anesthesia were used to identify the offending tooth. After receiving endodontic treatment or having the tooth extracted, patients reported either complete or partial relief of TMD symptoms. The authors provide questions that may help practitioners identify a tooth with an acute pulpalgia as a contributing factor to TMD symptoms and suggest a technique to confirm this diagnosis.

PMID: 8708279 [PubMed - indexed for MEDLINE]

Surgically treating a benign cementoblastoma while retaining the involved tooth.

J Am Dent Assoc. 1995 Sep;126(9):1288-90

Authors: Biggs JT, Benenati FW

The authors describe the case of a patient who had tenderness when biting and mild sensitivity to palpation as well as a radiopaque lesion attached to the mesial root of a mandibular first molar. Evidence pointed to a benign cementoblastoma. The dentist redid the original endodontic treatment and surgically removed the lesion, leaving the involved tooth intact. The authors suggest that in certain cases, it may be possible to remove benign cementoblastomas affecting molars without extracting the involved teeth.

PMID: 7560589 [PubMed - indexed for MEDLINE]

Detection and quantitation by lysis-filtration of bacteremia after different oral surgical procedures.

J Clin Microbiol. 1990 Oct;28(10):2205-9

Authors: Heimdahl A, Hall G, Hedberg M, Sandberg H, S&#xF6;der PO, Tunér K, Nord CE

Patients with bacteremia after dental extraction, third-molar surgery, dental scaling, endodontic treatment, and bilateral tonsillectomy were studied by means of lysis-filtration of blood samples with subsequent aerobic and anaerobic incubation. Samples were obtained before, during, and 10 min after treatment. Bacteremia was observed in 100% of patients after dental extraction, 55% of patients after third-molar surgery, 70% of patients after dental scaling, 20% of patients after endodontic treatment, and 55% of patients after bilateral tonsillectomy. Anaerobic microorganisms were isolated more frequently than aerobic microorganisms were, and viridans group streptococci were the most commonly isolated bacteria. Ten minutes after treatment, the frequency as well as the magnitude of bacteremia showed pronounced reduction.

PMID: 2229342 [PubMed - indexed for MEDLINE]

Effects of dental root posts on human gingival fibroblasts in vitro.

J Dent Res. 1980 Mar;59(3):651-6

Authors: Arvidson K, Cottler-Fox M, Friberg U

Dental root posts of gold-plated brass and German silver caused injury of human gingival fibroblasts in vitro. Posts made of stainless steel, titanium and gold alloys showed no discernible effects of cell morphology of apparent metabolic activity during the two-week period of observation.

PMID: 6937497 [PubMed - indexed for MEDLINE]

The effect of desalivation upon pulpal function and dental caries in rats.

J Dent Res. 1980 Feb;59(2):176-85

Authors: Steinman RR, Leonora J, Singh RJ

The role of pulp and saliva in caries susceptibility and resistance was evaluated using a combination of endodontic treatment and desalivation. Evidence was presented that the pulp plays a major role in caries susceptibility. It is suggested that pulpal function is modified by hormonal factor(s) originating from salivary glands. In the rat, saliva appears to play a minor role in resistance to caries.

PMID: 6928003 [PubMed - indexed for MEDLINE]

Replantation of mature teeth without endodontics in monkeys.

J Dent Res. 1978 Apr;57(4):650-8

Authors: Nasjleti CE, Caffesse RG, Castelli WA

The purpose of this study was to evaluate the histologic response after replantation of mature, developed teeth without endodontic treatment in monkeys. To serve as experimental controls, the other replanted teeth received endodontic treatment. No significant differences were noted in the rate and quality of periodontal tissues healing between the endodontically and the nonendodontically treated teeth in monkeys sacrificed at 5, 7, and 14 days, and at 1, 2, and 3 months after replantation. However, specimens obtained at 4, 6, 9, and 12 months showed that teeth replanted without endodontics developed periapical complications, whereas endodontically treated teeth did not.

PMID: 101567 [PubMed - indexed for MEDLINE]