Richard S. Schwartz

Post Placement and Restoration of Endodontically Treated Teeth: A Literature Review

The restoration of endodontically treated teeth is a topic that is extensively studied and yet remains controversial from many perspectives. This article reviews the major pertinent literature on this topic, with an emphasis on major decision-making elements in post placement and restoration of endodontically treated teeth. Recommendations are made for treatment planning, materials, and clinical practices from restorative and endodontic perspectives.

Ultrastructural Examination of Failed Molar Retreatment with Secondary Apical Periodontitis: An Examination of Endodontic Biofilms in an Endodontic Retreatment Failure

A light and electron microscope examination of the resected root tip of a failing endodontically re-treated lower molar was examined. The tooth had been initially treated 10 years ago and then re-treated 2 years ago. The resected root tip was sectioned axially, and thin sections were examined through the entire length of the specimen. Thin sections were examined with a transmission electron microscope. The thin sections were randomly chosen along the isthmus areas between the mesiobuccal and mesiolingual canals. Our findings suggest that a complex, variable, multispecies biofilm was present the entire length of the specimen.

Effects of eugenol and noneugenol endodontic sealer cements on post retention.

Resin cements are sometimes recommended to enhance the retention of posts in endodontically treated teeth. Many sealer cements used in endodontics contain eugenol, however, which has been shown to inhibit the polymerization of resins. The purpose of this study was to evaluate the effects of a eugenol and a noneugenol sealer cement on the retention of posts. Sixty extracted canines were divided equally into four groups. Each tooth received conventional endodontic therapy and was prepared to receive a post. Two sealer cements were used in obturation: one contained eugenol and one was eugenol-free. The posts were cemented with either zinc phosphate cement or resin cement. Each combination of sealer and post cement was tested for retention on an Instron testing machine. The type of sealer used had no effect on post retention with either cement. Post retention was significantly greater with the zinc phosphate cement than the resin cement.

Cutting effectiveness of diamond instruments subjected to cyclic sterilization methods

The effect of repeated sterilization on the cutting effectiveness of one brand of rotary dental diamond cutting instruments was measured. Four groups of five diamond burs were sterilized by four methods: (1) sterilization with a chemical agent (Sporicidin); (2) steam under pressure (autoclave); (3) dry heat (Dri-Clave); or (4) chemical vapor (Chemiclave). Each group of diamond instruments made a timed cut in a ceramic block. This cut and all subsequent cuts were measured and were used to determine a baseline cutting effectiveness. Each group of diamond burs was then ultrasonically cleaned, sterilized, and another cut was made. At the end of 10 cycles there was no difference in cutting efficiency of the dental diamond instruments. However, there are differences in the cutting efficiency of individual diamond instruments. The SEM evaluation made prior to cutting and at the end of the 10 cycles of sterilization demonstrated that diamond wear was similar in all groups and that little diamond particle loss occurred in any group.

Management of invasive cervical resorption: observations from three private practices and a report of three cases.

Invasive cervical resorption (ICR) is a type of external resorption that is not well understood or well known in the dental community. It is often misdiagnosed, leading to improper treatment or unnecessary loss of the tooth. Treatment may involve the periodontium as well as the tooth and pulp, and management can be complex. Early diagnosis and appropriate treatment are the keys to a successful outcome. This article discusses the decision-making process and management of ICR, with emphasis on the restorative aspects of treatment. Three treatment cases are presented that include nonsurgical and surgical approaches, with recalls of 4, 8, and 9.5 years.

Management of perforations: four cases from two private practices with medium- to long-term recalls.

INTRODUCTION Perforation repair is a fairly common endodontic procedure, but most of the recall data in the endodontic literature are short-term (ie, 1-2 years). The purpose of this article was to present 4 clinical cases of perforation repair with medium- to long-term recalls. METHODS Four cases were selected with different clinical scenarios. Three nonsurgical cases were retreated, repaired with mineral trioxide aggregate, and restored. The fourth case was strictly a surgical repair. Recalls up to 13 years are presented. RESULTS Perforation repair was shown to be successful in this case series, the teeth were preserved, and extraction was avoided. CONCLUSIONS If managed properly, perforation repairs can result in long-term clinical success.

Clinical evaluation of two desensitizing agents for use under Class 5 silver amalgam restorations

STATEMENT OF PROBLEM Postoperative sensitivity is sometimes reported to be a clinical problem after placement of silver amalgam restorations. PURPOSE This study compared postoperative sensitivity of Class 5 caries restored with amalgam restorations and Copalite or DentinBloc cavity liners. MATERIAL AND METHODS At least 1 pair of amalgam restorations were placed in each of 16 patients and tested for sensitivity at 5 time periods. RESULTS Sensitivity was significantly less with DentinBloc cavity liner (P < .05) at 24 hours, and 2 and 4 weeks. There was a directional but nonsignificant effect (P > .05) in favor of DentinBloc cavity liner at 1 and 16 weeks. CONCLUSION DentinBloc cavity liner was more effective than Copalite cavity liner in reducing sort term postoperative sensitivity for amalgam restorations.

Safe storage times for sterile dental packs

Safe storage times were evaluated for three sterile packaging materials that are commonly used in dentistry. No significant differences were found among packaging materials. Only three packs of 300 produced positive cultures during the 1-year test period. There were no time-related trends. The contamination levels found were within the range that has been reported to occur as a result of inadvertent contamination during unpackaging and transfer of sterile instruments. The findings of this study support the proposal that contamination is event related, not time related; that is, sterile instrument packs remain sterile for at least 1 year unless a specific event causes contamination.

Long-term Success of Nonvital, Immature Permanent Incisors Treated With a Mineral Trioxide Aggregate Plug and Adhesive Restorations: A Case Series from a Private Endodontic Practice

Abstract This case series evaluated the long‐term clinical outcome of nonvital immature teeth treated with mineral trioxide aggregate (MTA) as an apical barrier and an adhesive restoration with or without a fiber post. Eighty‐three teeth in 72 patients were treated by the first author with an apical MTA plug and an adhesive restoration of composite resin and in 45 of the 83 teeth 1 or more fiber posts. All of the patients had been referred to the first authors private endodontic practice with at least 1 immature tooth with signs of pulpal necrosis and subsequent apical periodontitis that had been caused by a variety of traumatic dental injuries. Three teeth presented had dens invaginatus. Of 83 teeth, 69 teeth in 60 patients were available for follow‐up after 5 to 15 years (recall rate = 83%). The mean follow‐up time was 8.29 years. No teeth were lost because of a root fracture. Ninety‐six percent (66/69) of the recalled teeth were characterized as healed. Based on periapical radiographs and clinical examination, 96% of teeth treated with the MTA barrier technique and adhesive restorations were characterized as “healed” and were in function after 5 to 15 years (mean = 8.29 years). These results indicate that this is a viable and predictable treatment approach for the long‐term success of nonvital immature teeth.

Biokeramieken (2): Nieuwe vulmaterialen in de endodontie

SamenvattingIn de vorige TP werden twee casussen getoond waarin voorgemengde biokeramische vulmaterialen zijn gebruikt voor een endodontische herbehandeling. Followup van 1 tot 2 jaar werden getoond. Conclusies: deze gevalsbeschrijvingen laten zien dat biokeramische materialen succesvol gebruikt kunnen worden in uiteenlopende klinische situaties en een aantal voordelen bieden ten opzichte van traditionele materialen. In alle beschreven gevallen leidde de behandeling tot verdwijnen van de klinische symptomen en genezing van parodontitis apicalis. Tot slot volgen hierna nog drie casussen en een discussie waarin de voordelen van deze materialen worden samengevat.