The opinions within this web page are not ours. Authors have been given due credit|
Roots Digest 2
Sent: Monday, July 06, 2009 3:32 AM
Subject: [roots] Uh oh.........the smell of napalm Part 2
Continued from Page 1
|Fig 4a Panel of anatomic preparations from the classic work by
Professor Walter Hess of Zurich The Anatomy of the root canals of teeth of the permanent dentition, London, 1925,
John Bale, Sons & Danielsson.|
|Fig 4b - Vertucci FJ 1984.Two thousand four hundred human permanent
teeth were decalcified, injected with dye, and cleared in order to determine the number of root canals and their
different morphology, the ramifications of the main root canals, the location of apical foramena and transverse
anastomoses, and the frequency of apical deltas|
|Table I and II derived from Antibiotics and the Treatment of
Endodontic Infections Summer 2006 American Association of Endodontics Colleagues for Excellence |
|Figs 5a, 5b Flat field sensors provide a sense of the extent of
osseous pathology; however, the periapical radiographic image corresponds to a two-dimensional aspect of a three
dimensional structure. Periapical lesions confined within the cancellous bone are usually not detected.
Thus a lesion of a certain size can be detected in a region covered by a thin cortex, whereas the same size lesion
cannot be detected in a region covered by thicker cortex |
|Fig 6 All cone beam tomography units provide correlated axial,
coronal and sagittal multiplanar volume reformations. Basic enhancements include zoom or magnification and visual
adjustments to narrow the range of grey-scale, in addition to the capability to add annotation and cursor-driven
|Fig 7 Strategic extension of the access perimeter is too often
undervalued in terms of successful endodontic treatment outcomes. The shape of the chamber must be regressed to
its native state to ensure that axial interference is negated as an instrument traverses the length of the root
|Fig 8a Dystrophic calcification confounds even the most experienced
clinician. The key to identification of the orifices is to regress the inner space using the continuum, cusp tip,
pulp horn, canal orifice. In lieu of an ultrasonic tip which tends to chop the stone and scatter debris, gross removal
is best done with a diamond bur in a high speed handpiece. The fine removal of residue can be done with a multi-fluted
carbide bur to trace the fusion lines |
|Fig 8b Keeping the chamber wet with alcohol improves optics and
highlights colour differential. The most important tool for orifice identification in addition to dyes is a micro-etcher.
The satin finish produced highlights the disparity between the natural tooth structure of the floor and the secondary and
tertiary dentin of the calcified orifice.|
|Fig 9 Micro-etching ensures the removal of oils and debris as well as
eliminating the residue in fusion lines and fissures. Routine dentin bonding is then performed. The composite chosen
in this instance is Permaflo® Purple (UPI, South Jordan, UT) which enables differentiation of restoration and tooth
structure should re-entry be necessary.|
|Fig 10 A vast array of equipment exists in the marketplace to optimize
irrigation protocols. Radical change may well be in the offing, however, R&D on bio-active obturating materials may prove
to be the defining variable in total asepsis.|
|Fig 11 Numerous investigators have shown that the concept of keeping
the apical foramen foramen as small as practical does not mean a size 20 or 25 file. This Schilderian concept should
read as small as the apical morphology permits in order to ensure that the free flow of irrigant to the apical terminus
enables more definitive cleaning of the apical segment of the root canal space.|
|Fig 12 The artist/clinician recognizes that negative space surrounding
an object is equally important as the object itself. In the case of root canal therapy, the positive space is alterable,
but must be created in balance with the encompassing negative space to ensure morphologic integrity.|
1. Farzaneh M, Abitbol S, Lawrence H, Friedman S. Treatment Outcome in Endodontics
The Toronto Study. Phase II: Initial Treatment. J Endod 2004 May;30(5):302-309
2. Bero L, Rennie D. The Cochrane Collaboration. Preparing, maintaining, and disseminating systematic reviews of
the effects of health care. JAMA 1995 Dec;274(24): 1935-1938
3. Salehrabi R, Rotstein I. Endodontic treatment outcomes in a large patient population in the USA: an epidemiological
study. J Endod 2004 Dec;30(12):846-50
4. Cagidiaco MC, García-Godoy F, et al. Placement of fiber prefabricated or custom made posts affects the 3-year survival
of endodontically treated premolars. Am J Dent 2008 Jun;21(3):179-84
5. Dietschi D, Duc O, Krejci I, Sadan A. Biomechanical considerations for the restoration of endodontically treated teeth:
a systematic review of the literature, Part II (Evaluation of fatigue behavior, interfaces, and in vivo studies).
Quintessence Int 2008 Feb;39(2):117-29
6. Aquilino SA, Caplan DJ. Relationship between crown placement and the survival of endodontically treated teeth.
J Prosthet Dent 2002 Mar;87(3):256-63
7. Dorn SO, Moodnik RM, Feldman MJ, Borden BG. Treatment of the endodontic emergencies: A report on a questionnaire.
Part I. J Endod 1977;3:94 100
8. Gatewood RS, Himel VT, Dorn SO. Treatment of the endodontic emergency: A decade later. J Endod 1990;16:284 91
9. Siqueira, J F. Endodontic infections: Concepts, paradigms, and perspectives.
OS, OM, OP, OR & Endo Sept 2002;94(3):281-293
10.Siqueira JF Jr, Guimarães-Pinto T, Rôças IN. Effects of chemomechanical preparation with 2.5% sodium hypochlorite and
intracanal medication with calcium hydroxide on cultivable bacteria in infected root canals.
J Endod. 2007 Jul;33(7):800-5
11.Baumgartner JC, Hutter JW, Siqueira JF. Endodontic Microbiology and Treatment of Infections.
In: Cohen S, Hargreaves KM, editors. Pathways of the Pulp. Ninth ed. St. Louis: Mosby; 2006
12.Baumgartner JC, Xia T. Antibiotic susceptibility of bacteria associated with endodontic abscesses.
J Endod 2003;29(1):44-47
13.Khemaleelakul S, Baumgartner JC, Pruksakorn S. Identification of bacteria in acute endodontic infections and their
antimicrobial susceptibility. Oral Surg Oral Med Oral Pathol 2002;94(6):746-55
14.Grondahl H-G, Huumonen S. Radiographic manifestation of periapical inflammatory lesions.
Endodontic Topics 2004;8:55-67
15.Scarfe WC, Farman AG, Sukovic P. Clinical applications of cone-beam computed tomography in dental practice.
16.Pinksy HM et al. Accuracy of three-dimensional measurements using cone-beam CT.
Dentomaxillofacial Radiology 2006;35:410-6
17.Iwai et al. Estimation of effective dose from limited cone beam x-ray CT examination.
Dental Radiology (Japanese) 2001;50:251-9
18.Patel S, Dawood A, Whaites E, Pitt Ford T. The potential applications of cone beam computed tomography in the
management of endodontic problems. Int EndoJournal 2007;40:818-30
19.Estrela C. Accuracy of Cone Beam Computed Tomography and Panoramic and Periapical Radiography for Detection of
Apical Periodontitis. J Endo 2008;34(3):273-279
20.Simon JHS, Enciso R, Malfaz JM, Rogers R, Bailey-Perry M, Patel A. Differential diagnosis of large periapical
lesions using cone-beam computed tomography measurements and biopsy. J Endod 2006;32:833 7
21.Iqbal MK, Johansson AA, Akeel RF, Bergenholtz A, Omar R. A retrospective analysis
of factors associated with the periapical status of restored, endodontically treated
teeth. Int J Prosthodont 2003;16:31 8
22.Siqueira JF Jr, Rocas IN, Favieri A, Abad EC, Castro AJ, Gahyva SM. Bacterial leakage
in coronally unsealed root canals obturated with 3 different techniques. Oral Surg
Oral Med Oral Pathol Oral Radiol Endod 2000;90:647 50
23.Schwartz RS, Fransman R. Adhesive Dentistry and Endodontics: Materials, Clinical Strategies and Procedures for
Restoration of Access Cavities: A Review. J Endod March 2005;(31)3:151-165
24.Zehnder M, Kosicki D, et al. Tissue-dissolving capacity and antibacterial effect of buffered and unbuffered
hypochlorite solutions. Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology & Endodontics;(94):756-762
25.Sjogren U, Figdor D, Persson S, Sundqvist G. Influence of Infection at the time of root filling on the outcome of
endodontic treatment of teeth with apical periodontitis. Int Endo Journal Sept 1997;(30)5:297-306
26.Siqueira JF, Rôças IN, et al. Chemomechanical Reduction of the Bacterial Population in the Root Canal after
Instrumentation and Irrigation with 1%, 2.5%, and 5.25% Sodium Hypochlorite. J EndodonJune 2000;(26)6:331-334
27.Torabinejad M, Cho Y, Khademi AA, Bakland LK, Shabahang S. The effect of various concentrations of sodium
hypochlorite on the ability of MTAD to remove the smear layer. J Endod 2003;(29):233 239
28.Siqueira JF Jr, Rocas IN, Santos SR, Lima KC, Magalhaes FA, de Uzeda M. Efficacy of instrumentation techniques and
irrigation regimens in reducing the bacterial population within root canals. J Endod 2002;28:181 184
29.Niu W, Yoshioka T, Kobayashi C, Suda H. A scanning electron microscopic study of dentinal erosion by final irrigation
with EDTA and NaOCl solutions. Int Endod J 2002;35:934–939
30.Lin LM, Rosenberg PA, Lin J. Do procedural errors cause endodontic treatment failure? JADA 2005;(136) 2:187-193
31.De-Deus G et al. Dye extraction results on bacterial leakproof root fillings. J Endo Sept 2008;(34)9:1093-5
32.Barthel CR, Moshonov J, Shuping G, Orstavik D. Bacterial leakage versus dye leakage in obturated root canals.
Int Endod J 1999;32:370 5
33.Kersten HW, Moorer WR. Particles and molecules in endodontic leakage. Int Endod J 1989;22:118-24
34.Oliver CM, Abbott PV. Correlation between clinical success and apical dye penetration.
Int Endod J 2001;34:637-44
35.Paqué F, Sirtes G. Apical sealing ability of Resilon/Epiphany versus gutta-percha/AHPlus: immediate and 16-months
leakage. Int Endod J. 2007 Sep;40(9):722-9
36.Cruse WP, Bellizzi R. A historic review of endodontics 1689-1963, Part I. J Endod,1980; 6:495-499
37.Blaney JR. The biologic aspect of root canal therapy. Dental Items of Interest 1927;49:681-708
38.Schilder H. Filling root canals in three dimensions. Dental Clinics of North America 1967;723-44
39.Ingle H: Endodontics, ed 5, Hamilton, London, 2002 BC Decker
40.Wu MK, Fan B, Wesselink PF. Leakage along apical root fillings in curved root canals. I.
Effects of apical transportation on seal of root fillings J Endodon 2000;(26):210
41.Siqueira JF Jr. Aetiology of the endodontic failure: why well-treated teeth can fail. Int Endod J 2001;34:110
42.Roggendorf et al. Bacterial leakage in filled root canals using four root canal sealers. IEJ Dec 2007;40(2):
43.Roedl et al. Bond strength to root canal dentine following different irrigation protocols using a new testing method.
IEJ Dec 2007;(40)12:Abstract R3.66
44.Raina R et al. Evaluation of the Quality of the Apical Seal in Resilon/Epiphany and Gutta-Percha/AH Plus filled
Root Canals by Using a Fluid Filtration Approach J Endod;(33)8:944-47
45.Teixeira FB, et al. Fracture resistance of roots endodontically treated with a new resin filling material.
46.Sly MM, Moore BK, Platt JA, Brown CE. Push-out bond strength of a new endodontic obturation system
(Resilon/Epiphany). J Endod. 2007 Feb;33(2):160-2
47.Williams C, Loushine R et al. A Comparison of Cohesive Strength and Stiffness of Resilon and Gutta-Percha.
J Endod 2006;(32)6:553-5
48.Tay F, Loushine R et al. Ultrastructural Evaluation of the Apical Seal in Roots Filled with a Polycaprolactone-Based
Root Canal Filling Material. J Endod 2005;(31)7:514-19
49.Kapalas A, Lambrianidis T. Factors associated with root canal ledging during instrumentation.
Endod Dent Traumatol 2000;16:220–231
50.Souza, RA. Clinical and radiographic evaluation of the relation between the apical limit of root canal filling and
success in Endodontics. Part 1 Braz Endod J 1998;3:43-48
51.AL-Omari MAO, Dummer PM. Canal blockage and debris extrusion with eight preparation techniques.
J Endod 1995;21:154-158
52.McKendry DJ. Comparison of balanced forces, endosonic, and step-back filing instrumentation techniques:
quantification of extruded apical debris. J Endod Jan 1990;16(1):24-7
53.Mullaney TP. Instrumentation of finely curved canals. Dent Clin North Am 1979;23:575 92
54.Morgan LF, Montgomery S. An evaluation of the crown-down pressureless technique. J Endod 1984;10:491 8
55.M. Al-Omari, P. Dummer. Canal blockage and debris extrusion with eight preparation techniques.
J Endod 2006;21(3):154-158
56.P. Hankins, M. ElDeeb/ An evaluation of the canal master, balanced-force, and step-back techniques.
J Endod 1996;22(3):123-130
57.Siqueira J, Araújo M, Garcia P, Fraga R, Dantas C. Histological evaluation of the effectiveness of five
instrumentation techniques for cleaning the apical third of root canals. J Endod 1997;23(8): 499-502
58.Serota KS et al. Predictable endodontic success: The apical control zone. Dentistry Today May 2003;(22)5:90-7
59.Peters OA, Peters C, et al. ProTaper rotary root canal preparation: effects of canal anatomy on final shape
analysed by micro CT. Int Endo J February 2003;(36)2:86-92
60.Becker W. Immediate implant placement: Diagnosis, treatment planning and treatment steps for successful outcomes.
J Calif Dent Assoc 2002;33:303-310