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 Abstracts - 19

1. The radix entomolaris in mandibular first molars: an endodontic challenge.

2. Comparison of Laterally Condensed .06 and .02 Tapered Gutta-Percha and Sealer In Vitro

3. A preliminary study of the percentage of gutta-percha-filled area in the apical canal filled with
   vertically compacted warm gutta-percha.

4  Evaluation of Implants Placed Immediately or Delayed Into Extraction Sites   

5  Implant placement at the time of maxillary molar extraction: technique and report of preliminary
   results of 83 sites.

6  Clinical and radiographic performance of delayed-immediate single-tooth implant placement associated
   with peri-implant bone defects. A 2-year prospective, controlled, randomized follow-up report

7  Implant placement at the time of maxillary molar extraction: technique and report of preliminary
   results of 83 sites.

The radix entomolaris in mandibular first molars: an endodontic challenge.

De Moor RJ, Deroose CA, Calberson FL.

Department of Operative Dentistry and Endodontology, Dental School, Ghent University, Ghent University Hospital, B-9000 Gent, Belgium. roeland.demoor@ugent.be

AIM: To present cases of mandibular first molars with an additional distolingual root (radix entomolaris, RE) and to
survey the literature on the incidence of this anatomical feature. SUMMARY: A major anatomical variant of the two-rooted
mandibular first molar is a tooth with an additional distolingual and third root: the RE. The prevalence of these
three-rooted mandibular first molars appears to be less than 3% in African populations, not to exceed 4.2% in Caucasians,
to be less than 5% in Eurasian and Asian populations, and to be higher than 5% (even up to 40%) in populations with
Mongolian traits. A total of 18 cases (12 root filled and six extracted mandibular first molars) with an RE were
collected during the years 2000-2003 in patients of Caucasian origin. As far as the access was concerned, entering
the root canal in the RE required a modification of the opening in a distolingual direction resulting in a trapezoidal
opening cavity. None of the orifices was located midway between the mesial and distal root component. Based on the
anatomy of the extracted samples and the bending of ISO 10 files after scouting of the root canal in the RE, three
types of curvature were detected: (I) straight or no curvature (two cases); (II) coronal third curved and straight
continuation to the apex (five cases); and (III) curvature in the coronal third and buccal curvature from the middle
third or apical third of the root (11 cases). KEY LEARNING POINTS: Clinicians should be aware of this unusual root
morphology in mandibular first molars in Caucasian people. Radiographs exposed at two different horizontal angles are
needed to identify this additional root. The access cavity must be modified in a distolingual direction in order to
visualize and treat the RE, this results in a trapezoidal access cavity.

Comparison of Laterally Condensed .06 and .02 Tapered Gutta-Percha and Sealer In Vitro . 
Journal of Endodontics , Volume 27 , Issue 12 , Pages 786 - 788
A . Bal , M . Lamar Hicks , F . Barnett


The purpose of this in vitro study was to compare the quality of the seal in canals prepared in a standardized
manner and obturated with a .06 or a .02 tapered gutta-percha master cone using lateral condensation. Forty-four
extracted human anterior teeth with single, straight canals were divided into two experimental groups of 20 teeth
each and two control groups of 2 teeth each. The teeth were instrumented with Series 29 Profile .06 tapered rotary
nickel-titanium files to a master apical file of 0.46 mm. Teeth in group 1 were obturated with a .02 tapered master
gutta-percha cone and Roth 801 sealer using lateral condensation. Teeth in group 2 were obturated similarly,
except a .06 tapered master gutta-percha cone was used. The depth of spreader penetration was recorded in millimeters.
Positive control teeth were instrumented but not filled. Negative control teeth were instrumented, obturated, and
externally sealed. The teeth were placed into a coronal leakage apparatus that contained an upper and lower reservoir
of trypticase soy broth separated by the tooth. A 24-h growth of Proteus vulgaris in 0.25 ml of trypticase soy broth
was placed in the coronal reservoir every 7 days for 70 days and incubated at 37C. Student's t test was used to
determine whether there was a difference in spreader penetration between the groups, and a Fisher's exact test was
used to determine whether there was a difference in bacterial leakage. The positive and negative controls validated
the testing model. When a .02 tapered master cone was used, the spreader penetrated significantly closer to working
length than when a .06 tapered master cone was used (p < 0.05). The difference between the groups in the number of
samples that demonstrated complete bacterial penetration was not significant (p > 0.05).

A preliminary study of the percentage of gutta-percha-filled area in the apical canal filled with
   vertically compacted warm gutta-percha.
Wu MK,
van der Sluis LW,
Wesselink PR.
Department of Cariology Endodontology Pedodontology, Academic Centre for Dentistry Amsterdam (ACTA), Amsterdam,
the Netherlands. m.wu@acta.nl

AIM: The aim of this study was to determine the influence of the width of apical root canals and the depth of heat
application during warm vertical compaction on the percentage of gutta-percha-filled area (PGFA) in the apical
root canal.

METHODOLOGY: Two groups of extracted human canines (total 60) were instrumented and filled with
vertically compacted warm gutta-percha up to the apical foramen (AF). Using the Touch 'n Heat device heat was
applied 4 mm from the AP in one group and 2 mm in the other. The number of teeth with gutta-percha extrusion was
recorded. A horizontal section was cut 1.5 mm from the AF of each tooth. The cross-sectional area of the canal
and the gutta-percha was measured using an image-analysis programme. The PGFA was then calculated. Multiple linear
regression was performed to investigate the association between the experimental variables and the PGFA, and the
occurrence of gutta-percha extrusion.

RESULTS: A significant association was seen between the depth of heat
application and the PGFA (P= 0.000), and between the canal area and the PGFA (P= 0.038). The average PGFA reached
96.1% when heated to 2 mm, as compared with 87.0% when heated to 4 mm. PGFAs were lower in wide apical canals
than in small canals. Gutta-percha extruded in seven teeth (12%) and was independent of experimental variables.

CONCLUSIONS: After warm vertical compaction, the quality of adaptation of gutta-percha to the wall of the apical
root canal varies; the influencing factors in this study were the depth of heat application and the width of the
apical root canal.

Evaluation of Implants Placed Immediately or Delayed Into Extraction Sites

This study is currently recruiting patients.
Verified by National Institute of Dental and Craniofacial Research (NIDCR) February 2006
Sponsors and Collaborators: National Institute of Dental and Craniofacial Research (NIDCR)
Implant Innovations
Information provided by:  National Institute of Dental and Craniofacial Research (NIDCR)
ClinicalTrials.gov Identifier:  NCT00067392

The purpose of this study is to determine the difference in success when placing implants immediately into
an extraction site compared to delaying the implant placement until the extraction site has healed. In addition,
the level of bone around the implants will be compared to determine if one method leads to better results
over time.


Dental Caries
Procedure: Dental Implant
Phase III

MedlinePlus related topics:  Tooth Disorders
Genetics Home Reference related topics:  Tooth Disorders

Study Type: Interventional
Study Design: Educational/Counseling/Training, Randomized, Single Blind, Active Control, Parallel Assignment,
Safety/Efficacy Study

Official Title: Prospective Evaluation of Immediate Temporized Implants

Further study details as provided by National Institute of Dental and Craniofacial Research (NIDCR):

Primary Outcomes: Crestal bone levels adjacent to the implants
Secondary Outcomes: Position of the papillary complex and facial gingival margin, and indicator of the
inflammatory state of the perimplant tissues.

Expected Total Enrollment:  90

Study start: November 2003;  Expected completion: May 2008
Last follow-up: May 2008;  Data entry closure: May 2008

This revised application is a clinical trial designed to evaluate crestal bone level changes when implants are
placed into extraction sites and immediately provisionalized. Extraction of maxillary incisor teeth is a common
procedure as documented in our school clinics. Traditional treatment when a tooth is extracted includes a period
of healing followed by placement of an implant. Our preliminary data indicates that the delayed approach results
in labial bone loss with resultant horizontal deficiency in over 50% of cases, requiring hard and soft tissue
grafting to achieve a functional result. Additional preliminary data indicates that grafting the extraction site
and/or immediate implant placement and provisionalization results in a functional restoration, without the need
for additional adjunctive grafting procedures. It is unclear how the crestal bone levels change during healing of
the extraction site prior to implant placement, in contrast to immediate implant placement, with immediate
provisionalization with a crown. We hypothesize that there will be differences in the crestal bone levels
(primary endpoint), and differences in soft tissue levels and indices (secondary endpoints) between implants
immediately temporized, placed either delayed or immediately after tooth extraction, with more bone loss in the
immediate placement group (experimental) compared to the delayed placement group (control). The long-term goal
is to determine if the crestal bone remodeling after tooth extraction or the apical position of the implant
determines the final level of the crestal bone. Two groups of 45 patients will be evaluated. All subjects will
have a single rooted maxillary tooth extracted. One group will have the socket grafted with mineralized bone and
allowed four months prior to implant placement. The crestal bone in this group will have remodeled during the
four months of healing prior to implant placement. The second group will have the implant placed immediately
after tooth extraction, thus the crestal bone will remodel in the presence of the implant and the immediately
placed temporary restoration, as a one-stage procedure. For both groups, the implants will be immediately
temporized with a crown after implant placement. Standardized hard and soft tissue data will be collected
pre-extraction as baseline, and then prospectively for at least two years in this trial, to compare the methods
and contrast the effectiveness of the proposed immediate restoration therapy.


Ages Eligible for Study:  21 Years   -   65 Years,
Genders Eligible for Study:  Both
Accepts Healthy Volunteers


Inclusion Criteria:

All patients will be willing to be present for examination two times a year for at least three years, as well as
maintenance cleanings twice a year 3 months prior to the data collection visit.

All patients will be free of uncontrolled diabetes (any type), existing malignancy, and will not be receiving
any therapy that suppresses their immune system, such as radiation, chemotherapy, or chronic steroid usage

Need for extraction of a single rooted maxillary central or lateral incisor, canine, or premolar, with no signs
of acute infection (purulent exudate, erythema, pain, and swelling).

Patients will have bone present on all surfaces of the tooth within 3 mm of the gingival margin of the planned
restoration, in order to provide sufficient bone to circumferentially cover the implant.

All patients will have adequate space for satisfactory restoration of the edentulous space.

Each patient's dentition will be free of active periodontal disease or exhibit controllable periodontal disease
such that their teeth will clinically be non-mobile and have probing depths less than 3 mm.

All prospective sites will have at least 2mm of attached or keratinized gingiva.

The crestal bone width should be enough to accommodate either a 3.75 diameter implant for the central incisor,
canine, and premolar sites, or a 3.25 mm diameter implant for the lateral incisor tooth sites. Bone height
should be at least 14 mm for accommodation of the implant.

Exclusion Criteria:

Patients with labial dehiscence defects greater than 3 mm from the proposed gingival margin of the planned
restoration will be excluded from this study.

Patients who cannot come for follow up due to conflicts of schedules will not be accepted into the study.

Patients with advanced cardiovascular, pulmonary, renal, liver disease that place them in an ASA III or IV
rating will be excluded. Post-menopausal women with known osteoporosis as determined by their medical internist,
will be excluded. Patients with known alcohol abuse will be excluded.

Location and Contact Information

Please refer to this study by ClinicalTrials.gov identifier  NCT00067392
Michael S Block, DMD      504-619-8565    mblock@lsuhsc.edu
      LSU School of Dentistry, New Orleans,  Louisiana,  70119,  United States; Recruiting
Michael S Block, DMD  504-619-8565    mblock@lsuhsc.edu
Michael S Block, DMD,  Principal Investigator

Study chairs or principal investigators
Michael S Block, DMD, Ph.D,  Principal Investigator,  LSU School of Dentistry

More Information

Study ID Numbers:  NIDCR-14185
Last Updated:  February 14, 2006
Record first received:  August 15, 2003
ClinicalTrials.gov Identifier:  NCT00067392
Health Authority: United States: Federal Government
ClinicalTrials.gov processed this record on 2006-09-05
Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2006 Jun;101(6):705-10. Epub 2006 Mar 22. Links Immediate placement of implants in periapical infected sites: a prospective randomized study in 50 patients. Lindeboom JA, Tjiook Y, Kroon FH. Department of Oral and Maxillofacial Surgery, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands. j.a.lindeboom@amc.uva.nl OBJECTIVE: To determine clinical success when implants are placed in chronic periapical infected sites. STUDY DESIGN: Fifty patients (25 females, 25 males, mean age 39.7 +/- 14.5 years) were included in this prospective controlled study. After randomization, 25 Frialit-2 Synchro implants were immediately placed (IP) after extraction, and 25 Frialit-2 Synchro implants were placed after a 3-month healing period (DP). Thirty-two implants were placed in the anterior maxilla and 18 implants were placed in the premolar region. Implant survival, mean Implant Stability Quotient (ISQ) values, gingival aesthetics, radiographic bone loss, and microbiologic characteristics of periapical lesions were evaluated for both groups. RESULTS: Overall, 2 implants belonging to the IP group were lost, resulting in a survival rate of 92% for IP implants versus 100% for DP implants. Mean ISQ, gingival aesthetics and radiographic bone resorption, and periapical cultures were not significantly different with the IP and DP implants. CONCLUSIONS: Immediate implant placement in chronic periapical lesions may be indicated. J Clin Periodontol. 2005 May;32(5):480-7. Links Clinical and radiographic performance of delayed-immediate single-tooth implant placement associated with peri-implant bone defects. A 2-year prospective, controlled, randomized follow-up report. Schropp L, Kostopoulos L, Wenzel A, Isidor F. Department of Prosthetic Dentistry, University of Aarhus, Aarhus C, Denmark. lschropp@odont.au.dk OBJECTIVES: The aim of the present study was to compare the delayed-immediate (Im) and the delayed (De) protocols for placement of single-tooth implants. MATERIAL AND METHODS: After allocation to the Im and De groups by random, 46 patients were treated with a single-tooth implant with acid etched surfaces (Osseotite) in the anterior or pre-molar region of the maxilla or the mandible on average 10 days (Im) or 3 months (De) following tooth extraction, respectively. Forty-one patients attended a follow-up visit 2 years after implant placement corresponding to 1(1/2) years of loading of the implant restorations. Peri-implant and prosthetic parameters were evaluated clinically and marginal bone levels measured on radiographs. RESULTS: Three implants were lost, all before mounting of the crown. None of the implant restorations had failed after 1(1/2) years of function. Probing pocket depths were reduced by up to 1.4 mm on average from the time of loading to the 2-year follow-up and at that time, no significant difference between the Im and De groups was found (4.2 versus 4.1 mm). A statistically significant radiographic marginal bone loss had occurred in the Im group (mean=0.8 mm) as well as in the De group (mean=0.7 mm) in the follow-up period. However, a mean marginal bone level of approx. 1.5 mm in both groups measured from the implant-abutment junction was found to be acceptable. It was demonstrated that probing pocket depths and marginal bone levels after 1(1/2) years of loading of the implant-retained crowns were not influenced by the presence of peri-implant bone defects immediately after implant placement. Furthermore, no severe prosthodontic complications, such as screw loosening or porcelain fractures, arose in this study material. CONCLUSION: High success rates of single-tooth implants after 1(1/2) years of function were achieved using the delayed-immediate and delayed implant placement techniques. Block MS, Finger I, Lytle R. Department of Oral and Maxillofacial Surgery, Louisiana State University Health Sciences Center, School of Dentistry, New Orleans 70119, USA. BACKGROUND: Bone loss after tooth extraction may prevent dental implant placement. Human mineralized bone grafts can be used to restore bone volume and allow for tooth replacement with dental implants. METHODS: The authors grafted 22 sites in 18 patients with human mineralized bone after tooth extraction. They allowed molar sites 16 weeks for graft healing, placed the implants and restored them with a final crown after a four-month integration period. Single-rooted maxillary sites received implants and immediate placement of provisional crowns or underwent a delayed two-stage restoration approach. The authors used radiographs and clinical examinations to evaluate the results. RESULTS: All of the sites were restored successfully with a single-tooth implant restoration. Periapical radiographs indicated that the crestal bone levels were limited to the first thread of the implants or slightly coronal to the first thread of the implant. Clinical evaluation indicated excellent gingival health around the provisional and final restorations, without obvious gingival migration. CONCLUSIONS: The use of human mineralized bone may have significant potential to reconstruct missing bone resulting from tooth extraction and to preserve bone after tooth extraction. In addition, healed bone graft sites seem to be able to support immediate placement of a provisional crown and implant restorations. CLINICAL IMPLICATIONS: Patients who are having teeth extracted may become candidates for implant restorations when the sites are appropriately grafted to preserve and reconstruct bone volume, thus allowing for more options for reconstructing the missing tooth site. J Periodontol. 2006 Feb;77(2):302-9. Implant placement at the time of maxillary molar extraction: technique and report of preliminary results of 83 sites. Fugazzotto PA. BACKGROUND: The purpose of this study was to evaluate the predictability of implant placement at the time of maxillary molar extraction using a modified insertion technique and implant design. METHODS: At the time of maxillary molar extraction, 83 tapered-end implants with an apical diameter of 4.1 mm and a neck diameter of 6.5 mm were placed in maxillary first or second molar sites, following manipulation of the remaining interradicular bone with osteotomes. Regenerative materials, consisting of demineralized freeze-dried bone allograft (DFDBA) and/or osseous coagulum, and bioabsorbable or non-resorbable membranes were placed, and passive soft-tissue primary closure was attained in all cases. RESULTS: Soft-tissue closure was maintained until the time of clinical reentry 6 months after implant insertion in 81 of 83 sites. Loss of primary soft-tissue closure in the other two areas did not result in complete uncovering of the cover screw and implant top. All implants were clinically immobile at the time of implant uncovery 6 months after insertion and were restored with single crowns. All implants were functioning successfully for up to 18 months (mean: 12.4 months). CONCLUSION: The combination of atraumatic removal of hopeless maxillary molars, controlled manipulation of the residual interradicular bone, insertion of implants of the aforementioned design, and use of appropriate regenerative materials at the time of implant insertion predictably afforded a stable implant for restoration with a single crown
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