Abstracts - EndodonticsComparative outcome analysis of endodontic treatment and single implant restorationEndodontic failure: contributing factorsSuccess and Failure in EndodonticsHealing pattern and length of observation periodOne-visit apexification: techniqueMultifaceted use of ProRoot MTA root canal repair materialRoot perforation repair: surgical and nonsurgical managementObturation of a retained primary mandibular second molarProphylactic treatment of dens evaginatus using mineral trioxide aggregateMineral trioxide aggregate repair of lateral root perforationsMineral trioxide aggregate (MTA) as a root end filling materialMineral trioxide aggregate: a new material for endodonticsClinical applications of mineral trioxide aggregateRepairing iatrogenic root perforationsSpace maintenance--a review of treatment optionsMineral trioxide aggregate: a new material for the new millenniumPerforation repairs.Torabinejad, Repair of furcal perforations with mineral trioxide aggregate:Perforation during endodontic treatmentUse of mineral trioxide aggregate for repair of furcal perforations2587 Comparative outcome analysis of endodontic treatment and single implant restoration
J. CARTER, D. JONES, E. SOLOMON, and J. HE, Baylor College of Dentistry, Dallas, TX, USA
Endodontic treatment and implant-supported restoration are both viable treatment options to restore the functionality
and esthetics of the dentition. Both treatment modalities have high success rate and predictability. Clinical
decision making is often influenced by many factors in addition to success rate such as cost, time, function, and
esthetics. Patient perception and preference play an important role in the ultimate clinical decision making.
Objective: the purpose of this study was to compare endodontic treatment (Endo) and single implant restoration
(Implant) regarding time to function, cost, and patient satisfaction. Materials and methods: 254 patient satisfaction
surveys were sent to patients who received single implant restoration or endodontic treatment in the posterior
mandible at Baylor College of Dentistry. Survey questions included patient satisfaction towards the cost, duration of
the treatment, appearance and the ability to eat after the treatment. 53 responses from Endo patients and 36
responses from Implant patients were received. Treatment records of responded patients were reviewed to record the
duration of the treatment, number of visits, treatment protocol, post-op intervention, and cost. Patient survey
results were evaluated using Pearson chi square analysis to determine difference in the response to each question
between the groups. Overall satisfaction was analyzed by Student's t-test using a derived summative score. Results:
Time to function was significantly longer in Implant patients compared to Endo. Implant also required more post-op
interventions. Endo patients were significantly more likely to report satisfaction with treatment cost ( p<0.05) and
less likely to report dissatisfaction regarding treatment duration, as compared to Implant patients (p<0.05).
However, there is no statistical difference in overall satisfaction between the two groups. Conclusion: Implant
treatment requires more time and intervention to achieve function compared to Endo treatment. This delay causes
significant dissatisfaction among patients. However, Endo and Implant treatments have similar overall patient
654 Pulp Biology; IADR June 2001 , 1 018
Endodontic failure: contributing factors.
L. LIN*, N. CHUGAL, 0. T.-J. HUANG
(Section of Endodontics, UCLA School of Dentistry, Los Angeles, CA, USA)
Many factors have been suggested as the possible cause of root canal failures. The
purpose of this study was to examine clinically, radiographically, and
histobacteriologically the factors possibly related to root canal failures. The
study consisted of 70 cases of root canal failures obtained from biopsies of
periradicular lesions. Clinical signs and/or symptoms were recorded, and
preoperative and postoperative radiographs were taken of all teeth. Strindberg's
(1956) criteria of radiographic periapical status, completeness of root canal
fillings, and treatment failures are used. The biopsied specimens consisted of
resected root apexes and attached periapical tissues, and were processed for
histobacteriologic examination. Modified Brown and Brenn stain was used to
demonstrate bacteria in tissue. The results showed that among 70 cases of root canal
failures, 59 cases were diagnosed as inflammatory periapical granulomas and 11 cases
as inflammatory apical cysts. Thirty two cases were flush-filled, 14 cases
underfilled, and 24 cases overfilled Stainable bacteria were observed in 61(87%)
failure cases: among them 28(88%) cases flush-filled, 12(86%) cases underfilled, and
21 (88%) cases overfilled. Preoperative periradicular lesions were present in 55(76%)
cases in which 22(69%) cases were flush-filled, 11(79%) cases underfilled, and
22(92%) cases overfilled. Stainable bacteria were found in 52(95%) cases with
preoperative periapical lesions as compared to 9(60%) cases without preoperative
lesions. Stainable bacteria were further found in 20(91%) flush-filled, 10(91%)
underfilled, and 20(91%) overfilled cases with preoperative periapical lesions. In
inflammatory apical cysts, bacteria were observed in 9(82%) cases. In conclusion,
when root canal therapy has failed, completeness of root canal fillings is not an
important contributing factor. Rather persistent root canal infection, or presence of
preoperative periapical lesion.
Success and Failure in Endodontics: Ulf Sjogren, 1996....excerpts.Criteria for evaluation of treatment outcome:
Histological evaluation of the periapical tissues is the most stringent assessment of
post-treatment healing. Brynolf (1967) investigated post-mortem specimens in an extensive
histological evaluation of periapical healing. Comparing radiographs and histological sections,
Brynolf (1967) tested the reliability of X-ray records to distinguish between healthy and
diseased periapical tissue. The results showed that 98% of the cases with periapical lesions
that were histologically identifiable could be detected by examining the continuity of the
lamina dura and the shape and width of the periodontal ligament. The accuracy of
interpretation of the periapical conditions can be increased by looking at detailed
radiographic features (Brynolf 1967, Kaffe & Graft 1988). Brynolf’s (1967) findings
provide a strong histological confirmation of the radiographic criteria developed by
Strindberg (1956) for evaluating the outcome of conventional endodontic treatment.
Strindberg (1956) used the normal contour and width of the periodontal ligament as
radiographic signs that the treatment outcome was successful.
Healing pattern and length of observation period:
The healing of periapical lesions is a dynamic process, the duration of which can vary from
case to case. A clinically relevant assessment of endodontically treated teeth cannot be
conducted until the periapical tissue response and remodelling have stabilised. A healing
tendency is a sign that the balance between the irritants and the host defense is tipped
positively in favour of the latter. This process can, however, be transient and a reduction
in the radiographic size of an apical lesion is no guarantee for eventual complete healing
(Strindberg 1956, Seltzer et al. 1967, Bystrom et al. 1987). Studies on healing patterns
indicate that most lesions resolve within 4-5 years after therapy (Strindberg 1956, Bystrom
et al. 1987), but some cases may take as long as 10 years to heal (Strindberg 1956).
Teeth with no periapical radiolucency before root canal treatment may sometimes develop
radiographically detectable lesions after treatment. This periapical breakdown is usually
due to chemical and/or mechanical irritation resulting from the root canal treatment and
will usually revert to normal conditions within a span of 3-4 years (Strindberg 1956,
Adenubi & Rule 1976). Studies based on observation periods of less than 4 years may include
cases which have not attained a stable periapical condition, and the conclusions reached may
therefore be erroneous. Because of this, the observation period following treatment is
recommended to be at least 4 years.
1. Witherspoon, D.E. and K. Ham,
One-visit apexification: technique for inducing root-end barrier formation in apical closures.
Pract Proced Aesthet Dent, 2001. 13(6): p. 455-60; quiz 462.
Numerous procedures and materials have been utilized to induce
root-end barrier formation. Mineral trioxide aggregate (MTA) was
introduced to dentistry as a root-end filling material. It has been
advocated for filling root canals, repairing perforations, pulp
capping, and root-end induction. Mineral trioxide aggregate reacts
with tissue fluids to form a hard tissue apical barrier. As a result,
MTA shows promise as a valuable material for use in one-visit
apexification treatment, primarily for treating immature teeth with
2. Schmitt, D., J. Lee, and G. Bogen,
Multifaceted use of ProRoot MTA root canal repair material.
Pediatr Dent, 2001. 23(4): p. 326-30.
Mineral Trioxide Aggregate (MTA) is a new material recently approved
by the FDA for use in pulpal therapy. MTA has been reported to have
superior biocompatibility and sealing ability and is less cytotoxic
than other materials currently used in pulpal therapy. This report is
a review of MTA's physical and biological properties and the clinical
techniques of direct pulp capping, apexification, and repair of failed
calcium hydroxide therapy.
3. Roda, R.S.,
Root perforation repair: surgical and nonsurgical management.
Pract Proced Aesthet Dent, 2001. 13(6): p.467-72; quiz 474.
Root perforation repair has historically been an unpredictable
treatment modality with an unacceptably high rate of clinical failure.
Recent developments in the techniques and materials utilized in root
perforation repair have dramatically enhanced the prognosis of both
surgical and nonsurgical procedures. This article presents a review of
the literature pertaining to root perforation repair and illustrates,
through clinical case presentations, the principles of extraradicular
surgical repair and non-surgical internal repair of root perforation
using mineral trioxide aggregate (MTA).
4. O'Sullivan, S.M. and G.R. Hartwell,
Obturation of a retained primary mandibular second molar using mineral trioxide aggregate: a case report.
J Endod, 2001. 27(11): p. 703-5.
This case report demonstrates Mineral Trioxide Aggregate obturation of
the root canal system of a retained primary mandibular second molar
where no succedaneous permanent tooth was present. The technique
seemed to provide a biocompatible seal of the root canal system in
this case. It is not recommended for obturation of primary teeth that
are expected to exfoliate since it is anticipated that Mineral
Trioxide Aggregate would be absorbed slowly, if at all.
5. Koh, E.T., et al.,
Prophylactic treatment of dens evaginatus using mineral trioxide aggregate.
J Endod, 2001. 27(8): p. 540-2.
Two case reports with dens evaginatus are presented. Each patient had
one tooth affected. There was a prominent tubercle on the occlusal
surface of the mandibular second premolar. Under local anesthesia and
rubber dam isolation a partial pulpotomy was conducted and mineral
trioxide aggregate was placed. After 6 months the teeth were removed
as part of planned orthodontic treatment. Histological examination of
these teeth showed an apparent continuous dentin bridge formation in
both teeth, and the pulps were free of inflammation. These cases show
that mineral trioxide aggregate can be used as an alternative to
existing materials in the proplylactic treatment of dens evaginatus.
6.Holland, R., et al.,
Mineral trioxide aggregate repair of lateral root perforations.
J Endod, 2001. 27(4): p. 281-4.
This study was conducted to observe the healing process of intentional
lateral root perforation repaired with mineral trioxide aggregate
(MTA). Forty-eight root canals of dogs' teeth were instrumented and
filled. After partial removal of the filling, an intentional
perforation was made with a bur in the lateral area of the root. The
perforations were repaired with MTA or Sealapex (control group).
Histological analysis occurred 30 and 180 days after treatment.
Results showed no inflammation and deposition of cementum over MTA in
the majority of the specimens. In the 180-day period, Sealapex
exhibited chronic inflammation in all the specimens and slight
deposition of cementum over the material in only three cases. In
conclusion, MTA exhibited better results than the control group.
7. Koh, E.T.,
Mineral trioxide aggregate (MTA) as a root end filling
material in apical surgery--a case report.
Singapore Dent J, 2000.23(1 Suppl): p. 72-8.
Many root end filling materials for apical surgeries have been
identified either for scientific evaluation or clinical usage but none
meets the requirements of an ideal root end filling material. Recently
a new cement, Mineral Trioxide Aggregate (MTA) was researched as a
potential root end filling material and showed promising results. This
paper reports the significant findings of research done on MTA as a
root end filling material and presents a clinical case where apical
surgery was performed using MTA as retrograde filling.
8. Schwartz, R.S., et al.,
Mineral trioxide aggregate: a new material for endodontics.
J Am Dent Assoc, 1999. 130(7): p. 967-75.
BACKGROUND: Mineral trioxide aggregate, or MTA, is a new material
developed for endodontics that appears to be a significant improvement
over other materials for procedures in bone. It is the first
restorative material that consistently allows for the overgrowth of
cementum, and it may facilitate the regeneration of the periodontal
CASE DESCRIPTION: The authors present five cases in which MTA was used
to manage clinical problems. These included vertical root fracture,
apexification, perforation repair and repair of a resorptive defect.
In each case, MTA allowed bone healing and elimination of clinical
CLINICAL IMPLICATIONS: Materials such as zinc oxide-eugenol cement and
resin composite have been used in the past to repair root defects, but
their use resulted in the formation of fibrous connective tissue
adjacent to the bone. Because it allows the overgrowth of cementum and
periodontal ligament, MTA may be an ideal material for certain
9. Torabinejad, M. and N. Chivian,
Clinical applications of mineral trioxide aggregate.
J Endod, 1999. 25(3): p. 197-205.
An experimental material, mineral trioxide aggregate (MTA), has
recently been investigated as a potential alternative restorative
material to the presently used materials in endodontics. Several in
vitro and in vivo studies have shown that MTA prevents microleakage,
is biocompatible, and promotes regeneration of the original tissues
when it is placed in contact with the dental pulp or periradicular
tissues. This article describes the clinical procedures for
application of MTA in capping of pulps with reversible pulpitis,
apexification, repair of root perforations nonsurgically and
surgically, as well as its use as a root-end filling material.
10. Behnia, A., H.E. Strassler, and R. Campbell,
Repairing iatrogenic root perforations.
J Am Dent Assoc, 2000. 131(2): p. 196-201.
BACKGROUND: Post preparation is an integral part of restoring
endodontically treated teeth in indicated cases. Iatrogenic
perforation of the root can result from preparing post space and can
severely compromise the prognosis of the tooth.
CASE DESCRIPTION: Two years after a patient's maxillary lateral
incisor was restored with a post-retained composite resin, he went to
a dental school emergency clinic with a chief complaint of soft-tissue
swelling adjacent to the tooth. The authors took a periapical
radiograph that revealed evidence of a circumscribed radiolucent
lesion associated with the distal midroot area and a periapical
radiolucency. Based on the radiograph, the authors suspected that the
canal preparation for the post and the post placement had perforated
the root at the base of the post.
CLINICAL IMPLICATIONS: The authors used a combined surgical and
orthograde approach with a biocompatible restorative material and a
clear, plastic light-transmitting post to repair the iatrogenic
11. Blackler, S.M.,
Space maintenance--a review of treatment options to repair the iatrogenic perforation.
Ann R Australas Coll Dent Surg, 2000. 15: p. 252-3.
Management of intra-canal and furcation perforations can pose a
significant clinical challenge. In such cases a biological matrix can
provide the framework for healing of injured periodontal tissues and
will facilitate placement of the perforation repair material. As a
consequence the long-term prognosis for treatment of the iatrogenic
perforation can be significantly improved and the need for surgical
intervention can often be eliminated.
12. Germain, L.P.,
Mineral trioxide aggregate: a new material for the new millennium.
Dent Today, 1999. 18(1): p. 66-7, 70-1.
A midroot strip perforation can be a difficult problem to treat.
Surgical treatment is arduous and has a poor prognosis. Variable
success has been seen with the classic repair materials for
nonsurgical treatment. Mineral trioxide aggregate seems to have
incredible promise for sealing these defects with a good long-term
13.Bruder, G.A., 3rd, et al.,
N Y State Dent J, 1999. 65(5): p. 26-7.
Management of instrument perforations in the periodontal ligament
space during endodontic or restorative procedures is an ongoing
problem in dentistry. The introduction of microscopes, new instruments
and materials has resulted in more controllable and predictable
surgical and nonsurgical outcomes. This paper discusses some of the
newer techniques and materials used to manage perforations effectively.
14.Arens, D.E. and M.
Torabinejad, Repair of furcal perforations with mineral trioxide aggregate:
two case reports.
Oral Surg Oral Med Oral Pathol Oral Radiol Endod, 1996. 82(1): p. 84-8.
Furcal perforation is an unfortunate incident that can occur during
root canal therapy or post preparation of multirooted teeth. Studies
have shown that the materials currently used to repair these
iatrogenic accidents are inadequate. The poor prognosis of furcation
perforations is probably due to bacterial leakage or lack of
biocompatibility of repair materials. On the basis of the recent
physical and biologic property studies of the newly introduced mineral
trioxide aggregate, this material may be suitable for closing the
communication between the pulp chamber and the underlying periodontal
tissues. These case reports support this hypothesis.
15. Valavanis, D.K. and G.N. Spyropoulos,
[Perforation during endodontic treatment].
Hell Stomatol Chron, 1989. 33(1): p. 57-65.
Perforations of the pulp chamber wall and area of root may occur
during access opening of the pulp chamber and during root canal
instrumentation. The authors in this paper describe in details the
factors that can lead to perforations of pulp chamber or area of the
root, the treatment and factors that affecting the repair and the
prognosis of the perforations.
16.Ford, T.R., et al.,
Use of mineral trioxide aggregate for repair of furcal perforations.
Oral Surg Oral Med Oral Pathol Oral Radiol Endod, 1995. 79(6): p. 756-63.
The histologic response to intentional perforation in the furcations
of 28 mandibular premolars in seven dogs was investigated. In half the
teeth, the perforations were repaired immediately with either amalgam
or mineral trioxide aggregate; in the rest the perforations were left
open to salivary contamination before repair. All repaired
perforations were left for 4 months before histologic examination of
vertical sections through the site. In the immediately repaired group,
all the amalgam specimens were associated with inflammation, whereas
only one of six with mineral trioxide aggregate was; further, the five
noninflamed mineral trioxide aggregate specimens had some cementum
over the repair material. In the delayed group, all the amalgam
specimens were associated with inflammation; in contrast only four of
seven filled with the aggregate were inflamed. On the basis of these
results, it appears that mineral trioxide aggregate is a far more
suitable material than amalgam for perforation repair, particularly
when used immediately after perforation.