Charles S. Solomon

Cost-effectiveness of Endodontic Molar Retreatment Compared with Fixed Partial Dentures and Single-tooth Implant Alternatives

INTRODUCTION One of the most challenging situations in dentistry is a failed root canal treatment case. Should a failed root canal-treated tooth be retreated nonsurgically or surgically, or should the tooth be extracted and replaced with an implant-supported restoration or fixed partial denture? These four treatment alternatives were compared from the perspective of cost-effectiveness on the basis of the current best available evidence. METHODS The costs of the four major treatment modalities were calculated using the national fee averages from the 2009 American Dental Association survey of dental fees. The outcome data of all treatment modalities were retrieved from meta-analyses after electronic and manual searches were undertaken in the database from MEDLINE, Cochrane, ISI Web of Knowledge, and Scopus up to April 2010. The treatment strategy model was built and run with TreeAge decision analysis software (TreeAge Software, Inc, Williamstown, MA). RESULTS Endodontic microsurgery was the most cost-effective approach followed by nonsurgical retreatment and crown, then extraction and fixed partial denture, and finally extraction and single implant-supported restoration. CONCLUSIONS The cost-effectiveness analysis showed that endodontic microsurgery was the most cost-effective among all the treatment modalities for a failed endodontically treated first molar. A single implant-supported restoration, despite its high survival rate, was shown to be the least cost-effective treatment option based on current fees.

Herpes zoster revisited: Implicated in root resorption

Previous reports in the literature have linked cases of herpes zoster to various forms of dental pathosis. Morphological anomalies, periodontal disease, and pulpal necrosis have been among the sequela documented. A case is presented here which implicates the varicella-zoster virus in cases of idiopathic internal root resorption. The possibility that subclinical episodes of herpes zoster may occur and ultimately result in pulpal pathosis is also presented.

Prevalence of Middle Mesial Canals in Mandibular Molars after Guided Troughing under High Magnification: An In Vivo Investigation

INTRODUCTION A limited number of in vivo studies have discussed the prevalence of middle mesial canals in root canal systems of mandibular molars. The reported results have varied between 1% and 25%, with no detailed description of the depth and direction of troughing needed to identify such small canal orifices. The objective of the present study was to determine (1) the prevalence of a middle mesial canal before and after troughing by using a standardized troughing technique, (2) the pathway of the middle mesial canal in relation to the mesiobuccal (MB) and mesiolingual (ML) canals, and (3) its correlation with the patients age. METHODS Ninety-one mandibular molars from 87 patients were included in this study. The patients age and tooth number were recorded. After access cavity preparation, a standardized troughing technique was performed between MB and ML canals to search for a middle mesial canal by using a dental operating microscope. If a middle mesial canal was located, it was recorded as separate or as joining the MB or the ML canals. Results were statistically analyzed by using Z test and logistic regression. RESULTS A middle mesial canal was found in 42 of 91 mandibular molars (46.2%). Six middle mesial canals were located after conventional access preparation (6.6%). The other 36 were located after standardized troughing (39.6%). The results were statistically significant (P < .001). There was a higher tendency to locate the middle mesial canal in second molars (60%) versus first molars (37.5%). Younger patients had a significantly higher incidence of a middle mesial canal (P = .004). CONCLUSIONS The middle mesial canal was present in 46.2% of mandibular molars. High magnification, troughing, and patients age appeared to be determining factors in accessing the middle mesial canal.

External root resorption—fact or fancy

A review of external resorption is presented with an emphasis on a wide range of etiological factors. This case report details the possible pitfalls in basing the diagnosis solely on radiographic interpretation.

Guided tissue regeneration in endodontic surgery by using a bioactive resorbable membrane.

INTRODUCTION Guided tissue regeneration is a valuable technique available to the endodontist because the quality, quantity, or extent of bone loss cannot be visualized by the surgeon until the tissue is reflected and the surgical site is exposed. METHODS After repeated attempts at nonsurgical treatment, a patient with a recurring sinus tract over the distobuccal root of an upper molar ultimately had the distobuccal root resected, leaving a 10 × 10 mm bony defect. This dehiscence was filled with freeze-dried bone and covered with a flexible and absorbable bioactive membrane that was new to endodontics. RESULTS Healing was uneventful, and bone regeneration was rapid and extensive as observed at the time of a second surgery just 5 months later. This can be attributed at least in part to the use of the bioactive membrane that contains an array of growth factors that enhance cell proliferation, inflammation, recruitment of progenitor cells, and metalloproteinase activity. CONCLUSIONS The use of the bioactive membrane in endodontic surgery should be considered to best restore the attachment apparatus to the tooth and prevent the downgrowth of a long junctional epithelium. The endodontists attention must not be limited to the apical region alone.

A nonsurgical approach to re-treatment: Report of a case

E ndodontic surgical techniques today have been so refined and the results are so predictable that they form an essential part of comprehensive endodontic therapy. There are many endodontic problems for which this surgical approach is the treatment of choice and may, in fact, be the only therapeutic approach. There are other situations, however, in which the nonsurgical method is the indicated treatment plan. It is wrong in these situations to first perform surgery because the particular operator happens to be more comfortable with a scalpel than with a root canal file.