Ilan Rotstein

Epidemiologic evaluation of the outcomes of orthograde endodontic retreatment.

INTRODUCTION Teeth undergoing initial endodontic therapy have a very high survival rate. Some teeth that continue to show signs of pathosis after the initial therapy will require nonsurgical (orthograde) retreatment. Outcome assessment of endodontic retreatment is crucial for appropriate case selection and treatment planning. However, reports on outcomes of orthograde endodontic retreatment performed by endodontists are limited in number, and the reported data vary. In this study, outcomes of orthograde endodontic retreatment performed on 4744 teeth were assessed during a period of 5 years. METHODS Data were obtained from retreatments that were performed by endodontists participating in the Delta Dental Insurance plan that insures approximately 15 million individuals in the USA. RESULTS Overall, 89% of teeth were retained in the oral cavity 5 years after the endodontic retreatment. Four percent of all teeth underwent apical surgery that occurred mostly within 2 years from completion of orthograde retreatment. Eleven percent of teeth were extracted at the end of the 5-year observation period. CONCLUSIONS It appears that orthograde endodontic retreatment yields high incidence of tooth retention after 5 years.

Extraoral Sinus Tract Misdiagnosed as an Endodontic Lesion

The extraoral sinus tract may occur as a result of an inflammatory process associated with a necrotic pulp. However, several non-odontogenic disorders may also produce an extraoral sinus tract. Thus, the differential diagnosis of this clinical finding is of paramount importance in providing appropriate clinical care because misdiagnosis of this condition may result in healing failure or unnecessary treatment. This case report of a 19-yr-old male patient describes an extraoral cutaneous sinus tract misdiagnosed as an endodontic lesion. Consequently, the patient underwent unnecessary exploratory procedures and antibiotic therapy. Identification of the inflammatory source of the lesion and removal of the affected tissue led to tissue healing.

MTA preparations from different origins may vary in their antimicrobial activity.

OBJECTIVE The antimicrobial effects of 4 mineral trioxide aggregate (MTA) preparations, 2 white-colored (WMTA-1, WMTA-2) and 2 gray-colored (GMTA-1, GMTA-2), against C. albicans and E. faecalis were assessed in vitro. METHODOLOGY Minimal inhibitory concentration (MIC) for each preparation was determined using the tube dilution test and Sabouraud agar media for C. albicans and brain heart infusion media for E. faecalis. Broth tubes were prepared and divided into experimental and control groups. Aliquots of each of the tested microorganisms were taken from a stock culture and added to each experimental and positive control group. All groups were incubated at 37 degrees C and evaluated for turbidity at 24-, 48-, and 72-hour time periods. Samples of 0.1 mL from each of the experimental and control tubes were subcultured on agar or brain heart infusion plates to confirm visible signs of bacterial or fungal growth. RESULTS MIC of MTA against the 2 microorganisms tested varied among the 4 preparations tested. WMTA-1 and WMTA-2 inhibited C. albicans growth at concentrations of 3.125 mg/10 mL and 25 mg/10 mL, respectively, and statistically significant differences were found between WMTA-1 and WMTA-2 (P < .001). WMTA-1 and WMTA-2 inhibited E. faecalis growth at concentrations of 12.5 mg/10 mL and 50 mg/10 mL, respectively, and statistically significant differences were found between WMTA-1 and WMTA-2 (P < .001). GMTA-1 and GMTA-2 inhibited E. faecalis growth at concentrations of 12.5 mg/10 mL and 3.125 mg/10 mL, respectively, and statistically significant differences were found between GMTA-1 and GMTA-2 (P < .001). Both GMTA-1 and GMTA-2 inhibited C. albicans growth at a concentration of 3.125 mg/10 mL and no statistical differences were found between the preparations. Subculture of the broth tubes in agar or brain heart infusion plates confirmed the turbidity test result. CONCLUSION The origin of MTA as well as the type of preparation may affect its antimicrobial characteristics. Clinicians should be aware of variations that may exist among such MTA preparations.

Successful treatment of a radicular groove by intentional replantation and Emdogain therapy: four years follow-up.

Radicular groove is an anatomical malformation that often causes severe periodontal defects. Treatments of such an anomaly present a clinical challenge to the operator. Presented is a case of successful treatment of radicular groove associated with a maxillary lateral incisor of a 15-year-old girl. A combination of endodontics, intentional replantation, and Emdogain therapy was used. At 4-year follow-up, the patient was comfortable and complete resolution of the periapical pathology was evident.

Cvek pulpotomy – revisited

BACKGROUND/AIM While some studies support the notion that the time elapsed from coronal fracture and treatment with Cvek pulpotomy in permanent teeth plays an important role in minimizing the possibility of pain and discomfort, microbial pulp invasion, and ensuring pulp and periodontal healing, others consider that neither time between the accident and treatment nor size of exposure is critical if the inflamed superficial pulp tissue is amputated to the level of a healthy pulp. This study compares published data in an attempt to assess whether the outcome of Cvek pulpotomies is affected by these factors. RESULTS AND CONCLUSIONS Evidence in the literature suggests to treat a permanent tooth with a complicated crown fracture as soon as possible to diminish the possibility of pain and prevent necrosis and infection of the pulp. Delay of treatment by 9 days or less may have minimal effect on the outcome of Cvek pulpotomies. While the literature indicates that pulp exposures of 4 mm or less may have a good prognosis after a Cvek pulpotomy, the prognosis in teeth with pulp exposures of more than 4 mm has not yet been clarified. Although the literature is not conclusive regarding a difference in the outcomes of Cvek pulpotomies in teeth with open or closed apices, it appears that teeth with open apices have a better prognosis. The outcome of a Cvek pulpotomy may be compromised by a luxation injury that diminishes the tooths blood supply and innervation. A good restoration that prevents bacterial penetration into the tooth is essential for the success of a Cvek pulpotomy.

Efficacy of the enamel matrix derivative to induce cementogenesis in vital and endodontically treated teeth with osseous dehiscence defects

This experiment assessed the efficacy of the enamel matrix derivative (EMD) to regenerate cementum in vital and endodontically treated teeth with osseous dehiscence defects. Five adult female beagle dogs were used. Thirty maxillary teeth (bilateral maxillary canines and second and fourth premolars) were randomly divided into two experimental groups (groups A and B, containing 12 teeth each) and one control group (group C). Endodontic treatment was only performed on teeth in group A compared with teeth in groups B and C. Buccal osseous dehiscence defects were surgically created in teeth from all groups. Teeth in the experimental group were treated with the EMD, whereas the controls were not. After 5 months, the animals were sacrificed and block sections of the teeth in experimental and control groups were processed for histological analysis. Newly regenerated cementum was observed in all teeth in groups A and B. No cementum regeneration was observed in group C. There was a significant difference in cementum generation between the experimental and control groups (P < 0.001). EMD therapy induces cementogenesis in vital and endodontically treated teeth with osseous dehiscence defects.

Interaction between endodontics and periodontics

Endodontic-periodontal lesions present challenges to the clinician regarding diagnosis, treatment planning and prognosis. Etiologic factors, such as bacteria and viruses, as well as contributing factors, such as trauma, root resorptions, perforations, cracks and dental malformations, play an important role in the development and progression of such lesions. Treatment and prognosis of endodontic-periodontal lesions vary, depending on the etiology, pathogenesis and correct diagnosis of each specific condition. This chapter will appraise the interrelationship between endodontic and periodontal lesions and provide biological and clinical evidence for diagnosis, prognosis and decision-making in the treatment of these conditions.

Endodontic retreatment of unusually long maxillary central incisors

Anatomical and morphological variations in teeth may affect the success and prognosis of endodontic therapy. The reported data regarding such variations in the maxillary central incisors are limited. This article presents a case of endodontic retreatment in unusually long maxillary central incisors.

Histological Examination of Furcal Perforation Repair Using Geristore?: A Preliminary Report

Objective: The aim of the present study was to examine the efficacy of a resin-modified glass ionomer (Geristore ® syringeable) to repair accidental furcal perforations occurring during root canal treatment in dogs. Materials and methods: Two beagle dogs (mean age and weight: 15 months and 13.8 kg respectively) with furcal perforations (2 mm x 3 mm) in the mandibular second premolars (P2) were included. Under general anesthesia, supragingival scaling was performed, performation sites were irrigated with 0.9% sodium hypochlorite and haemorrhage was controlled. Geristore® syringeable was delivered to the perforation site using intra-oral tips. The material was left over the perforation defect for ten seconds and then light-cured according to the manufacturers’ instructions. After 4 months, a periodontal examination was performed following which the animals were sacrificed. Jaw segments were prepared and histologically assessed for the presence or absence of hard tissue apposition in the furcal sites where Geristore ® was placed. Results: Upon clinical examination, teeth with furcal perforations repaired with Geristore ® presented with bleeding on probing, pus discharge and bone resorption. Histological results displayed severe gingival inflammation with chronic inflammatory infiltrate around the defect and absence of cementum repair. Conclusion: Within the limits of the present histological experiment, it is concluded that Geristore® is not