Thomas Connert

Guided Endodontics: a novel treatment approach for teeth with pulp canal calcification and apical pathology

AIM To present a new treatment approach for teeth with pulp canal calcification (PCC) which require root canal treatment. CASE A 15-year-old male patient presented with pain of his upper right central incisor. The tooth showed signs of apical periodontitis. Due to PCC, location of the root canal was judged to be difficult and associated with a high risk of perforation. A cone beam computed tomography (CBCT) and an intra-oral surface scan were performed and matched using software for virtual implant planning. After planning the position of the drill for root canal location, a virtual template was designed, and the data were exported as an STL file and sent to a 3D printer for template fabrication. The template was positioned on the anterior maxillary teeth. A specific drill was used to penetrate through the obliterated part of the root canal and obtain minimally invasive access to the apical part. The root canal was accessible at 9 mm distance from the apex. Further root canal preparation was carried out using an endodontic rotary instrumentation system. After an interappointment dressing for 4 weeks, the root canal was filled with vertically condensed gutta-percha using an epoxy sealer. The access cavity was restored with a composite material. After 15 months, the patient was clinically asymptomatic with no pain on percussion. The radiograph showed no apical pathology. CONCLUSIONS The presented guided endodontic approach seems to be a safe, clinically feasible method to locate root canals and prevent root perforation in teeth with PCC.

Microguided Endodontics: Accuracy of a Miniaturized Technique for Apically Extended Access Cavity Preparation in Anterior Teeth

Introduction: The aim of this study was to assess the accuracy of guided endodontics in mandibular anterior teeth by using miniaturized instruments. This technique is designed to treat teeth with pulp canal calcifications and narrow roots by using a printed template that guides a bur to the calcified root canal. Methods: Sixty sound mandibular anterior teeth were used in 10 mandibular models. Preoperative surface and cone‐beam computed tomography scans were matched by using the coDiagnostix software. Virtual planning was performed for the access cavities, and templates were used for guidance. The templates were produced by a three‐dimensional printer. Two operators performed the access cavities. A postoperative cone‐beam computed tomography scan was superimposed on the virtual plan, and the deviation was measured in 3 dimensions and angles. Descriptive statistical analyses were performed, and 95% confidence intervals were calculated for both operators and each measured aspect. Results: The deviations between the planned‐ and prepared‐access cavities were low, with means ranging from 0.12 to 0.13 mm for different aspects at the base of the bur and 0.12 to 0.34 mm at the tip of the bur. The mean of angle deviation was 1.59°. A considerable overlap of the 95% confidence intervals indicated no significant difference between the operators. The mean treatment time, including planning and preparation, was approximately 10 minutes per tooth. Conclusions: Microguided endodontics provides an accurate, fast, and operator‐independent technique for the preparation of apically extended access cavities in teeth with narrow roots such as mandibular incisors. HIGHLIGHTSDescription of a novel treatment approach for teeth with pulp canal calcification.Microguided endodontics is accurate and operator independent.Mean treatment time, including planning, was approximately 10 minutes per tooth.

Treatment of calcified root canals in elderly people: a clinical study about the accessibility, the time needed and the outcome with a three-year follow-up

OBJECTIVE Determination of accessibility, time needed and outcome of endodontic treatment of teeth with calcified root canals in a sample of elderly participants in a private practice limited to endodontics. BACKGROUND Due to demographic changes, gerodontology is becoming more and more important, also in the field of endodontology. Elderly patients can show up with severe calcifications of root canals. Root canal treatment, when needed, can be very challenging in these cases. Only few data exist about the treatment of calcified root canals and its outcome, especially in an elderly population. MATERIALS AND METHODS Forty-one participants (median age: 72 years) needing a root canal treatment were included. The total number of treated teeth was 41 with 114 negotiated root canals. A specialist limited to endodontics performed the treatment in a private practice. Outcome was assessed by applying the periapical index score on the basis of recall radiographs provided by the referring dentists. Likewise, time required to localise the root canals was measured. RESULTS All root canals have been detected using the operating microscope, and full working length could be established in 90% of the cases. Success rate was 80% after an observation time of 3 years. In three of five teeth, root canals could be localised within 15 min. CONCLUSION Calcified root canals of older people treated in this study were all accessible within a maximum of 60 min. The success rate after a follow-up of 3 years was 80%.

Dental trauma in showjumping - A trinational study between Switzerland, France and Germany.

AIM Showjumping is one of the sporting activities with a high injury risk. Unpredictable behaviour of the horse, considerable speed and the height of the rider in the saddle make this sport to one of the most dangerous, with the highest risk of injury and the highest mortality rate per competitor. The aim of this study was to determine the frequency of dental trauma, the wearing of protective gear such as helmet, back protector and mouthguard as well as the knowledge of primary care after dental trauma. MATERIAL AND METHODS Within the framework of this study, 608 female and male showjumpers from Switzerland, France and Germany were questioned in a personal interview consisting of 14 questions about general injuries, dental injuries and the usage of protective gear. The competitors were subdivided into different categories according to amateur or professional level, gender and age. RESULTS Of the 608 competitors, 189 (31.1%) had witnessed an accident involving tooth injury and 91 (15.0%) had suffered one themselves. The prevalence of dental trauma rose with increasing age and more riding experience. A total of 436 (71.1%) of the competitors were familiar with mouthguards, of which only three owned one. The main reasons for not wearing a mouthguard were both doubtful necessity (22.5%) and a generally low acceptance among the riders (26.3%). Less than half of the competitors (44.4%) knew that an avulsed tooth can be replanted and only 4.1% had knowledge about the existence of a tooth rescue box. CONCLUSION The results of this study show that in equestrian sports still little is known about dental trauma and protective measures.

Surgical extrusion with an atraumatic extraction system: A clinical study

Statement of problem. Clinical studies evaluating the feasibility of a novel technique for the surgical extrusion of nonrestorable teeth with subgingival caries are lacking. Purpose. The purpose of this clinical study was to investigate the success rate and incidence of biological and technical complications after tooth extrusion with an atraumatic extraction system (AES). Material and methods. Participants were recruited from 61 consecutive patients initially referred to a specialist oral surgery practice. Fifty‐one participants who underwent surgical extrusion with an AES followed by endodontic treatment and coronal restoration could be re‐evaluated clinically and radiographically. Results. The mean observation period was 3.1 years (range: 0.8 to 6.5 years). The participants varied in age between 24.8 and 86.3 years. The amount of extrusion was between 2.5 and 5.0 mm (mean 3.2 mm). At recall, 92.2% (47 of 51) of the extruded teeth were considered successful. All extruded teeth were asymptomatic, without clinical signs of inflammation. Percussion appeared normal and did not differ from that of the adjacent teeth, indicating absence of ankylosis. Transient resorption with a slightly altered root contour was detected in 5 of the 51 teeth. Minor reduction of the bone level (less than 10%) was detected in 8 of the 51. In a further 2 teeth, bone loss amounted to 25% and 30%. Periapical periodontitis at recall was seen in 4 of the 51 teeth, and a preexisting periapical lesion healed in 10 of 13. Root perforation was identified in 3 of the 51, and a further 3 of 11 were not available for recall. Thus, the technical complication rate was 9.7% (6 of 62). Conclusions. The AES may be successfully used for surgical extrusion to save apparently nonrestorable teeth, irrespective of patient age.