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Long Beach VA Hospital

Karmali, Merchant, Davis
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Long Beach VA, Endodontic Section
Rahim Karmali DDS, Steven Merchant DDS, Stephen Davis DDS
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Author Date Subject Title Take Away
Chemically debrided 2800 teeth; introduced vulcanite via a vacuum. All teeth had apical ramifications and lateral canals. Showed the
complexity of root canal systems. Implies that it is impossible to clean the system purely mechanically. Teeth in 2nd decade were
Formation of root canals in relatively simple, 3rd decade were most complex as cementum entrapped blood vessels apically, 4th decade simplified slightly as cemental
Hess 1921 Morphology human teeth deposition continued.
First to state that the CDJ was the ideal place to terminate a filling. A great idea b/c the cementum is a protective barrier for the dentinal
The value of the tubules. Filling short leaves the tubules open to infection. Controversial b/c only 50-60% of teeth have a distinct CDJ at the apex. Also, if
dentinocemental junction in CDJ is uneven, where do you terminate the filling? Furthermore, the apical dentin is very sclerosed and not very permeable, so is it that
Grove 1931 Morphology pulp canal surgery important?
Looked at 268 apices and described their anatomy. Found that the center of the foramen deviates form the apex more during aging. The
diameter of the foramen inc w/ age due to cementum deposition. The foramen is uneven, esp in younger teeth and the cementum canal is
Microscopic investigations of divergent, making it impossible to seal. The minor diameter of the root is found mainly in dentin. Cementum thickness is .5mm in younger
Kuttler, Y 1955 Morphology root apexes and greater in older teeth.
Had very stringent guidelines for categorizing success and failure. For success, the PDL had to be WNL. Almost everything else was a
failure, including dec in size of PARL. His study addresses success and failure alone, w/o regard to tendency to heal. The decision was
The dependence of results of binary. Success has a clinical and RDX component. Took results out about 10 years. Teeth w/ PARL had a success rate of 82%, healing
Success/failur pulp therapy on certain stabilized at 3 years. Teeth w/o PARL, success 92%, stabilizing at 4 years. No mention of the irrigant used...if any. He did use intracanal
Strindberg 1956 e factors medicaments to attempt disinfection.
The effects of surgical The foundation of endodontic pathosis...landmark article. Pulpal exposures were made in germ-free and conventional rats. Jaws and
Kakahashi, exsposures of dental pulps in teeth sectioned at intervals. In conventional rats, all teeth showed pulpal necrosis and abscesses after day 8. In germ free rats, matrix
Stanley, Anachoresis / germ-free and conventional formation and dentinal bridging occurred. No inflammation was found and none of the pulps were necrotic at 28 days, dentin bridging was
Fitzgerald 1965 Bacteremia laboratory rats. complete at this time too. Therefore, pulpal infection is due to microbes.
Investigated the occurrence of bacteria in traumatically devitalized teeth with intact pulp chambers. Micro-orgs recovered from 64% of
Micro-organisms from teeth. May have appreared b/c of anachoresis (shown to be false by Moller 1981), patent dentinal tubules, cemental tears, exposed lateral
Anachoresis / necrotic pulp of traumatized canals, severe periodontal disease, or through traumatic ex-articulation. All teeth that had a PARL had bacteria, some teeth w/o a PARL
Bergenholtz 1974 Bacteremia teeth had bacteria. Implies that a sterile necrotic pulp will become infected w/ a PARL if given enough time via dentinal tubules.
Cleaning / Cleaning and Shaping of the
Schilder 1974 Shaping Root Canal
Cleaning / Instrumentation of Finely The first publication of the step-back technique. Step-back starting with a 25 file and constant re-introduction of the 25 between
Mullaney 1979 Shaping Curved Canals successively larger files resulted in less apical damage than traditional enlargement techinques.
Influence on periapical
Moller, tissues of indigenous oral Accessed and severed monkey pulps. Some sterile, some infected by oral bacteria. Sealed with temp for 6 mo. None of the sterile
Fabricius, Anachoresis / bacteria and necrotic pulp necrotic pulps showed PARL and remained sterile. Most of the infected necrotic pulps showed PARL. Argument against anachoresis.
Dahlen 1981 Bacteremia tissue in monkeys. Also shows effectiveness of 3mm temp seal.
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Cleaning /
The "Balanced Force"
Concept for Instrumentation
Karmali,
Describes new instr Merchant,
tech. As long Davis
as the Restoring Force of the file is less than the Dentinal Force of the canal, the instr will follow a curve.
The Restoring Force is affected by file mass, the radius of the canal, the arc of the curve, and arc to tip distance. Also intoduced the bi-
Roane 1985 Shaping of Curved Canals beveled transitional angle file-tip to minimize excessive cutting force at the leading edge
Apical periodontitis and Looked at SEMs of 100 teeth w/ apical granulomas and cysts. All teeth showed intracanal and apical resorption. Intra-canal resorption
resorption of the root canal occured in a gradient. Slight in cerv 1/3, mod in mid 1/3 and severe in apical 1/3. Gradient might be because the pulp dies corono-
Delzangles 1988 Morphology wall apically, therefore the apical pulp is infected longer. Additionally, the periapical tissues support destruction of the apex if infected.
Cleaning / Physician who used 0.5% NaOCl to disinfect war wounds. Great germicidal agent w/ minimal toxicity if used at this conc. "Valuable
Dakin 1915 Shaping property of assisting in the rapid dissolution of necrosed tissue."
Cleaning / A definite and dependable First to advocate NaOCl in endo. Strict adherence to asepsis during tx. Endorsed complete removal of debris and infected organic
Walker 1936 Shaping therapy of pulpless teeth material from the canals. Use double strength chlorinated soda to accomplish above.
Cleaning / Solution of pulp tisse by
Grossman 1941 Shaping chemical agents Showed how effective NaOCl is in the dissolution of pulp tissue
Did an initial study comparing the cytotoxicity vs the anti-microbial effect of NaOCl. Found that 0.5% NaOCl was just as effective at higher
conc w/o all the cytotox. This is a well quoted study against the usage of full strength NaOCl. This study did not look at secondary studies
or usage tests. It also does not address tissue dissolution, which is ineffective at the lower conc. Tissue dissolution must occur prior to
Cleaning / Biologic effects of dental antimicrobial effects b/c tissue inactivates NaOCl (Harrison and Hand 1981.) Also stated that CMCP has a cytotoxicity 48X grtr than
Spandberg 1973 Shaping materials antimicrobial effect.
Disputes the focal infection theory. PA lesions are well walled off by macrophages and lymphocytes and therefore can't spread to other
parts of the body. Understand Zones of Fish. Zone of infection is where the bacteria is present, surrounded by macrophages. Zone of
Anachoresis / contamination has bacterial by-products and has a high conc of lymphocytes, Zone of irritation has both norm cells and lymphocytes in
Fish 1939 Bacteremia Bone infection lower conc. Zone of stimulation has active osteoblasts/clasts and a high conc of active fibroblasts to wall of infection.
Studied bacterial content of necrotic, traumatized, asymptomatic intact teeth. 18/19 teeth w/ PARL had bacteria. All of the teeth w/o PARL
Anachoresis / Bacteriological studies of were sterile. 88 strains were isolated from all teeth, 83 of those were anaerobic. Additionally, 7 teeth had flare ups. All of these had
Sundqvist 1976 Bacteremia necrotic dental pulps bacteroides, a G- rod (now known porphrymonas, and prevotella.)
Bystrom, Cleaning / 30 necrotic teeth. 15 irrig w/ saline, 15 w/ 0.5% NaOCl. After 4 appts 8/15 of saline showed no growth, 12/15 of NaOCl showed no growth.
Sundqvist 1983 Shaping Not statistically sig b/c of small sample size. Does this conc. dissolve tissue???
Bystrom, Cleaning / 60 necrotic teeth irrig w/ 0.5% or 5% NaOCl. Showed about the same number w/o growth 12/20 & 14/20 respectively. How about tissue
Sundqvist 1985 Shaping dissolution?
Harrison, Cleaning / Organic material binds HOCl and decreases antimicrobial activity
Hand 1981 Shaping
Abou-Rass, Cleaning / Heated NaOCl to 140 deg. Dissolved vital tissue in 1/4 the time, necrotic tissue in 1/10 the time. Does the temp of NaOCl dec when
Oglesby 1981 Shaping placed in the canal??
Defined 4 categories of RDX healing in surgery and recommends f/u time periods. Complete healing is very stable after 1 yr and doesn't
change often (99%). Unsatisfactory healing does not often change after a year and addtl surg or EXT must be considered. Uncertain
Rud, healing should be f/u for 4 years, if no change then re-operation or EXT. Incomplete healing (scar tissue) is usu stable after 4 years, but
Andreason, A follow-up study of 1,000 should be followed up indef. Incomplete and uncertain healing can swing to complete healing in 52% and 60% respectively. For this
Moller, Success/failur cases treated by endodontic reason, in recent times, these two categories have been lumped as "uncertain healing." Also noted was the success rate for surg was
Jensen 1972 e surgery 81%.
Instr w/ step back and NaOCl irrig of M roots of Md molars. Then began exp. 1 group was irrig w/ US, another had CaOH for 7d, the other
had both. The main canal and the control were 97% free of debris 1 mm from apex. The isthmuses were 80-90% free of debris w/ all exp
Metzler, Cleaning / groups 1 mm back. The instrumented control was 28% free of debris at the isthmus. CaOH and US are effective in tissue debridement in
Montgomery 1989 Shaping the isthmus.
Cleaning / Actively irrig canals w/ 2 mm push-pull stroke and NaOCl.. With a #15, 50% had irrigant at the apex. With a #25, 100% had irrigant at the
Klinghofer 1990 Shaping apex.
Vander-Wall, Cleaning / Antibacterial efficacy of Formocresol was the only medicament effective as a vapor. CMCP was only effective when in contact w/ bacteria. No point placing a
Dowson 1972 Shaping intracanal medicaments CMCP pellet in the chamber. Cresatin totally ineffective.
Made experimental lesions in cadavers. Concluded that lesions show up radiographically only if coritcal bone is affected. Also, changes in
Roentgenographic and direct trabeculation patterns will be discernable only if the junction between the cortex is affected. The radiographic lesion always appears
Seltzer, observation of experimental smaller than the actual lesion. This study did not address the continuity of the PDL and its radiographic appearance of a disrupted lamina
Bender 1961 Diagnosis lesions in bone dura.
A histological and Tried to correlate RDX appearance w/ histology. Was very specific about what she termed a normal PA. Her findings show only 7% of the
reontgenological study of the RCT teeth returned to normal,w/ an additional 20% showing marginal healing. Was she too discerning and dependent upon RDx too
periapical region of human much. The RCT were done in the 40-60s. Obturations were well short, chloroform techniques used. Some of these teeth had severe
Brynolf 1967 Diagnosis upper incisors perio dz.
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Most frequent inKarmali,
adolescents. Merchant, Davis
Boys to girls almost 3:1. Max ant almost 75% of traumatized teeth. 50% were less than 10 yrs old. Don't
Etiology and pathogenesis of forget to check other teeth, even in the opposing arch. Check for soft tissue injuries as well. In the perm dentition, extrusions are most
Andreasen 1970 Trauma traumatic dental injuries common, followed by simple crown fx and then avulsions.
8% had pulpal healing (34% w/ incomplete root formation). Primary factor in pulpal healing was the length of the root (<17mm much better
px). Most of those that healed had calc met. 24% had complete PDL healing (36% if healed resorption inc). Most sig factor was
Replantation of 400 avulsed replantation time (73% healed if replanted w/in 5 min). Of those that did not heal: 61% replacement resorption, 30% Inflamm resorp, 5%
Andreasen 1995 Trauma permanent incisors. surface resorp.
The realtionship between
Simon, Glick, endodontic-periodontic First to offer current classification of both perio and endo lesions in combination. Primary endo and primary perio may have the same RDX
Frank 1972 Endo/Perio lesions appearance, pulp test to verify pulpal status. As per discussion, prim perio w/ sec endo is more rare than prim endo w/ sec perio.
Pulp
Physiology The hydrodynamics of
Brannstrom 1972 and Pathology dentine Describes the hydrodynamic theory.
Sealing ability of MTA when
Retrofilling used as a root end filling
Torabinejad 1993 Materials material Looked at amal, Super EBA and MTA. MTA showed no leakage. Amal showed the most (didn't use varnish).
Retrograde filling materials: A A large retrospective study. Showed a significant inc in success (91% and 95%) when using IRM or Super EBA vs. amal (75%). This is
Retrofillingretrospective success-failure only one of three long-term studies looking at a root end filling material other than amal. Discussion: This can potentially be extrapolated to
Dorn 1990 Materials study of amal, EBA and IRM mean that the success rate of SRCT using IRM and Super EBA is in the 90% range.
An initial investigation of the First to look at NiTi for endodontic instr. Compared #15 NiTi w/ #15 SS. Found that the NiTi is 2-3 more flexible than SS. Fx in NiTi
bending and torsional prop of occurred after about 2.5 turns CW and 1.75 turns CCW. SS fx at 1.5 and .5 revolutions respectively. Also showed that NiTi files could be
Walia 1988 Instruments nitinol root canal files bent permenently if they are over bent. Never patented idea.
Coronal
Leakage, An evaluaiton of coronal
Bleaching, microleakage in Began the current discussion about coronal microleakage. Instr and obt teeth, placed in artificial saliva, then in dye. All teeth leaked in 3-
and Cervical endodontically treated teeth. 56 days, at 3 days, the leakage was the same as at 56 days. All showed the same amount of leakage. Comments: dye studies are
Madison 1987 Resorp Part I: Time inaccurate. Bacteria is larger then dye molecules. Additionally, saliva has mucins and other agents that slow the ingress of bacteria.
Refuted the hollow tube theory. Implanted sterlie hollow tubes of different sizes in the backs of rats. Some were empty, some were filled
w/ sterile muscle, some w/ sterile musc inf w/ oral bacteria. The empty tubes showed very little inflamm. The shorter, wider tubes showed
Anachoresis / Rxn of rat CT to polyethylene CT ingrowth. The tubes filled w/ sterile musc showed mod inflamm. Is this the body's way of ridding itself of necrotic tissue? This is a
Torneck 1966 Bacteremia tube implants, Part I and II natural reparative process. Tubes w/ inf muscle showed severe inflamm and abscesses.
Anachoresis / The role of sepsis and
Hunter 1918 Bacteremia antisepsis in medicine Applied the Focal Infection Theory to dentistry.
Anachoresis / The controlling of root Describes the hollow tube theory. No microscopic study was presented in support of the irritation, an adequate control (solid tube) was not
Rickert, Dixon 1931 Bacteremia surgery used, and no other possiblity for irrtiation was given.
Two main factors influence healing: type of tissue wounded and type of wound (incisonal, dissectional and excisional). Mucoperiosteum
Harrison, Surgical Healing of surgical wounds in heals roughly in this order: 1. Clotting/inflamm 2. Eptih healing 3. CT healing 4. Maturation/remodeling. PMNs predominated by 24 hrs. At
Jurosky 1991 Endodontics oral mucoperiosteal tissues 48-72 hrs, macrophages kicked up. The macrophages are responsible for fibroblast activation.
Wound healing in the tissues Looked at incisional wound healing in monkeys. Eval'd 2 flap designs: sulcular triang and sub-marg rectang. At 14 and 28 days,
of the periodontium following essentially no difference in healing, though sub-marg might be less predictable in the very early stages. Vertical incisions showed an epith
Harrison, Surgical periradicular surgery. 1: The seal around 24-48 h and an epith barrier around 48-72h. Horiz incisions showed epith seal around 24-48h and an epith barrier at 72-96h.
Jurosky 1991 Endodontics incisional wound. Also stated that a sulcular incision leaves a layer of vital tissue on the exposed root surf. Maintain this to prevent loss of attachment.
Wound healing in the tissues

of the periodontium following Looked at the healing of dissectional wounds in monkeys. Found little difference in healing between the sulcular triang and the sub-marg
Harrison, Surgical periradicular surgery. 2: The rectang, though healing in the latter was less predictable. Healing is advanced by 4d and complete in 14d. The periosteum is destroyed
Jurosky 1991 Endodontics dissectional wound. during elevation. Remaining periosteal fragments on the cortical surface are protective and should be retained.
Wound healing in the tissues Looked at the healing of osseous excisional wounds in monkeys. Found that 28d S/P there is bone of advancing maturity and an intact
of the periodontium following periosteum (which is nec for cortical bone deposition). The periosteum does not develop until the bone defect is almost completely filled w/
Harrison, Surgical periradicular surgery. 3:The woven trabec bone. The endosteum plays a critical role by converting the coagulum into granulation tissue. There is no osteoclastic
Jurosky 1991 Endodontics osseous excisional wound. activity w/in the cavity, rather bone is deposited directly upon the devitalized surface of existing bone.
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432 teeth evaled after 1 and 5 yrs. 90% success w/ vital pulps, 89% success w/ pulpless. Complete or progressive repair of rarefaction
Success/failur Roentgenologic and clinical 85%. Found a direct relationship btwn age and PA repair. Poorly filled canals accounted for most of the failures. Comments: In actuality,
Grossman 1964 e eval of endo treated teeth age plays a role in rate of healing but not in ultimate healing. His numbers a bit high, could be due to the interval of recall.
Determination of success rates depend on the interpretation of rdx. Histo studies on the correlation of tissues and rdx are sparse. Personal
bias plays a role in interpretation. Change in angulation can change the appearance of the lesion making it look smaller or larger.
Differences in exposure and developing can also be sig. It has been determined that 50% of bone must be decalcified for it to be apparent
on the rdx. PARLs may be related to systemic dz (hyperparathyroidism, Pagets, mult myeloma, fibrous dysplasia). Endo tx will not resolve
these PARLs. Guidelines for clinical assessment of success are outlined. Failures become apparent 6 mo to 2 yrs after tx. Only 2% of the
Endodontic success- a teeth lookeed at histologically had scar tissue, so it is a pretty rare occurrence. Offers a great definition of clinical success: 1. Absence of
Seltzer, Success/failur reappraisal of criteria. Part 1 pain/swelling. 2. Disappearance of fistula. 3. No loss of function. 4. No evidence of tissue destruction. 5. Rdx evidence of an eliminated or
Bender 1966 e and 2. arrested area of rarefaction 6 mo to 2 yrs post-op.
Endo failures: an analysis
based on clinical,
roentgenographic and Combined clincal, histo and rdx to determine factors that induced failures of 146 teeth. Samples were either extracted teeth or tissue
Seltzer, Success/failur histologic findings, Part 1 and curetted from apex. Reduction in size of PARL is no guarantee of success, howver, most failures were noted w/in 24 mo. The culture test
Bender 1967 e 2. was not significant in predicting eventual success. Teeth w/ pre-existing PARLs failed 2.5X more freq.
Relationship of broken root
Natkin, Success/failur canal instruments to 53 teeth w/ sep instr were matched w/ appropriate controls. Found no significant difference in Px after 2 yrs. The size of the file and length
Crump 1970 e endodontic case prognosis of the seperation didn't seem to be relevant.
Success/failur Canals obt w/ sep instr, either accidently or intentionally, showed no difference in success rate when compared to conventional filling
Fox 1972 e Filling root canals w/ files materials. Of the 304 cases re-examined after 2 yrs, only 6% failed to heal.
Radiographic interpretation of
experimentally produced
Success/failur osseous lesions of the Were able to Rdx lesions created in cancellous bone. Also used a soft tissue imitation over the dried bone. Factors that influence visibilty
LeQuire 1977 e human mandible are higher amerpage and voltage, parallel rays and proper development. Found no sig diff w/ or w/o soft tissue barrier.
Success/failur Factors assoc w/ endodontic PosItive correlation btwn bacterial inf and PARL. The apical extent of the root canal fillings, whether underfilled, overfilled or flush had no
Lin 1992 e treatment failures correlation to failures.
Correlation of positive 306 teeth were txd until a neg bacteriological test was obtained. The teeth were obt at the following visit, with another bacteriological test
Engstrom, Success/failur cultures w/ the px for root taken just prior to obt. Followed for 4-5 yrs. Teeth that had neg cultures at obt had a success rate of 83%. Teeth w/ a pos culture had a
Segerstad 1964 e canal tx success rate of 70%. Stat sig.
Long-term results of
Kerekes, Success/failur endodontic tx performed w/ a
Tronstad 1979 e standardized technique The most important biologic factor is the pre-op dx (necrotic vs vital, WNL/AAP vs. CAP). 91% success after 2yrs.
Treated over 1100 teeth and evaluated healing at 1 yr. Overall failure rate was 5%. Multi-visit showed a failure rate of 3% while single-visit
showed a failure rate of 9%, approx equal. The highest failure rate was w/ re-treats (16%). Teeth that were sx at time of obt did not fail at
The incidence of failure a higher rate. Teeth that were prev opened for emergency tx had a failure rate of 3% while those not prev opened failed 9% of the time,
Success/failur following single-visit this was stat sig. Existing PARL had a higher failure rate. Teeth left open for drainage showed a similar failure rate than those not left
Pekruhn 1986 e endodontic therapy open.
Bystrom, Healing of periapical lesions
Happonen, of pulpless teeth after 79 teeth w/ PA lesions, followed for up to 5 yrs. 85% healed completely or lesion dec markedly in size after two yrs. More healed as time
Sjogren, Success/failur endodontic tx w/ controlled progressed. Showed that if the lesion is dec in size over time, it should not be considered a failure. Offered explanations for lesions not
Sundqvist 1987 e asepsis healing: remaining bact in tubules, bacteria in lesion (actino or arachnia), infected dentin being extruded into lesion.
Prospective study to eval the performance of AH26, Kloroperka and Procosol in 810 roots. 4 yr recall and evaluated w/ PAI. Kloroperka
Success/failur Clinical performance of 3 did poorer than the other two. The difference was stat sig at one year and became more pronounced after 2 and 3 yrs. Comments: It is
Orstavik 1987 e endodontic sealers assumed that the chloroform evaporates and leaves an irregular mass of GP in the tissues. This acts as a foreign body.
Eriksen, Healing of apical periodontitis

Orstavik, Success/failur after endodontic tx using 3 Looked at healing over 3 yrs of teeth tx w/ diff sealers ZOE based, epoxy resin based, and Kloroperca. Did not find a sig diff btwn the first
Kerekes 1988 e different root canal sealers two. The first two were better than Kloroperca.
Failure of endodontically Looked at 116 teeth that were endodontically tx and EXT for various reasons. Average time between RCT and EXT was 5 yrs. Found that
Success/failur treated teeth: classification 60% were pros failures (most were crn fx), 32% were perio failures, and 8% were endo failures. Endo failures were the quickest to appear
Vire 1991 e and evaluation (avg time was 21 mo. btwn RCT and EXT).
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Categoriezed theKarmali, Merchant,
pulpal and PA conditions and Davis
evaluated success w/ a 8-10 yr recall.. Found that the presence of PARL greatly reduced
Success/failur Factors affecting the long- the chance of success. W/o a PARL there was a 96% success rate. W/ a PARL the success dropped to 86%. Re-tx had a success of
Sjogren 1990 e term results of endodontic tx 62%. In cases w/ PARL, the success rate was inc if you could instr the full length of the canal (90% vs 69%).
Periapical status of
endodontically treated teeth
in relation to the technical
Success/failur quality of the root filling and The restoration is more sig than quality root canal tx in the success of the case. Good endo w/ good restoration has a success rate of 91%.
Trope 1995 e the coronal restoration This is a well cited study, but is very weak. Cross sectional study, which is just a snap shot. Know this article.
Time-course and risk
analyses of the development Looked at tx teeth w and w/o PARL and followed them for four years. 6% of teeth developed new PARL. In teeth w/ PARLs, 88% showed
Success/failur and healing of chronic apical signs of healing. These match w/ other studies. In this study, most of the changes, either towards healing or not healing, occured w/in 1 yr.
Orstavik 1996 e periodontitis in man This implies that a 1 yr f/u is all that is needed. Strindberg doesn't agree.
Influence of infection at the
time of root filling on the
Success/failur outcome of endodontic tx of 55 single visit one rooted txs. Cultured prior to obturation. 94% w/ neg cultures were successful after 5 yrs. 68% of pos cultures were
Sjogren 1997 e teeth w/ apical periodontitis successful after 5 yrs. Presence of cultivable bacteria sig affects the success rate. Big proponents of CaOH2 to kill remaining bacteria.
Assesment of the periapical Compared survivability of vital and root filled teeth over 25 years that are restored w/ cuspal covg. Found little difference btwn the two.
Success/failur and clinical status of crowned Most teeth failed due to caries. Survival 98% at five years and 83% after 25 yrs. Another important point is that preparation of a vital tooth
Valderhaug 1997 e teeth over 25 years for a crown does not condemn the pulp.
An argument against Brynolf's study. Enbloc resections of cadaver jaws after Rdx. Examined histologically for inflamm. 10/10 teeth w/
Radiographic and histologic PARLs had inflamm. 14/19 w/o PARLs did not have inflamm. Found Rdx to be a reliable indicator of tx failure, but not an accurate
Success/failur periapical findings of root indicator of histologic findings in healing/healed lesions. Also states that scar tissue repair doesn't happen. He only had 29 samples.
Walton 1997 e canal tx teeth in cadavers Bender and Seltzer show scars occur in 2% of cases, so Walton's statement doesn't hold water.
Block resections of 14 apices in juveniles. Overfilling w/ ZOE containing sealers caused a chronic inflamm rxn, GP overfilling caused epith
Long-term radiographic and proliferaton, and dentin filings can stimulate hard tissue formation both at and beyond the apex. Seltzer's big axe to grind is that nothing
Success/failur histological observations of should ever be place out of the apex. This was slanted towards that view. All these samples had PARL so of course they would have
Seltzer 1999 e endodontically treated histologic evidence of inflamm.
Endodontic tx of teeth w/ Blatant manipulation of statistics to prove his point. The study did not show a sig difference btwn the two. Power analyses was used
Success/failur periapical periodontitis: single backwrds to state that if the sample size was larger, then it would be significant. PAI was used to determine success, which has huge
Trope 1999 e vs. multivisit tx potential for error.
Influence of CaOH intracanal
dressings on the px of teeth
w/ endodontically induced Compared single w/ multi-visit in 73 pts. Found no sig difference in success. Did associate large PARL (>5mm) w/ grtr probability of
Weiger 2000 One-visit periapical lesions failure. The healing process started slower w/ the single visit, but caught up to the mulit-visit @ 4 yrs.
Periapical healing of
endodontically treated teeth No sig diff in healing btwn 1 visit and 2 w/ CaOH. All teeth had PARL. Single visit= healed 81%, healing 19%. Two-visit= healed 71%,
in one and two visits healing 23%. Results at 4.5 yrs. No sig diff whether there was cultivable bacteria or not prior to obturation. Cites Sjogren 1997 who
obturated in the presence or showed only 68% healing if there was cultivable bacteria and 94% if there wasn't. Makes the point that 0.5% NaOCl was used in that study
Peters, Success/failur absence of detectable while 2% was used in this, also the amount of bacteria found were not quantified...Sjogren may have had a ton of bacteria in his canals and
Wesselink 2002 e microorganisms that is why his results were so dramatic. This study had a small ample size of 39. Gives the important concept of entombing bacteria.
First study that looks at current tx methods. Compared success of .10 tapered prep/small MAF vs. less taper/large MAF. Found no sig diff.
Important prognostic indicators were size/presence of lesion and vitality of pulp. Important aspect was how they broke down their data to
Gulabivala, A retrospective comparison clinical and Rdx criteria. Both these protocols had 96.5% complete clinical success and 78% complete Rdx healing. This agrees that
Hoskinson, Success/failur of outcome or root canal tx healing is a long-term trend. 96.5% of these teeth are asymptomatic and functioning. Radiographically, these are prob heading towards
Ng 2002 e using two different protocols complete healing. Looking strictly at failures, which is a much more stable group, the rate is 2.5%.
199 teeth. No sig difference in success between the two. Only a 3 mo and 12 mo f/u. Showed a 78% success rate, again, this is at 1 yr.
This falls in line w/ other studies on success at the 1 yr mark. The important point is that it shows you can determine a trend towards
Healing of apical periodontitis healing in 3 mo. Used PAI averaging, which is an ordinal scale. It's like averaging A,B, C, or D...you just can't do that. Comments: You
after endo tx: A comparison really cannot establish an accurate trend towards healing in 3 mo. If you were to try, you would need to have a jig to insure that the rdx is
Success/failur btwn a silicone-based and taken at the same angle at recall. 3 mo is too short of a time frame. They are using PAI and doing math on it to quantify this tendancy to
Huumonen 2003 e ZOE based sealer heal.
Radiographic evaluation of
Hartwell, root canal anatomy of in vivo Found that in the 1st PM 6% w/ 1 canal, 91%/2, 3%/3. In 2nd PM, 40%/1, 59%/2, 1%/3. Looked at rdx of 1144 teeth in vivo. Not
Belliizzi 1985 Morphology endodontically treated Mx PM concerned if they exited from a common foramen or not.
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Carns, Configurations and deviations
Skidmore 1973 Morphology of root canals of Mx 1st PM Found that 85% of Mx 1st PM have two canals. 9% w/ 1 and 6% w/ 3. Looked at 100 ext teeth.
Kasahara, Root canal system of Mx Over 60% showed accessory canals that were impossible to clean mechanically. 80% of the foramena were < .5mm from the apex, 95%
Yasuda 1990 Morphology central incisor were w/in 1mm. Looked at 520 ext teeth w/ india ink.
Evidence and configuration of
canal systems in MB root of 95% of Mx molars had an MB2 in the coronal half of the root. 50/50 type 1/ type 2. 85% could be found if a bur was used to open the sub-
Kulild, Peters 1990 Morphology Mx 1st and 2nd Molars pulpal groove. 2 patent canals could be found at the apex in 71% of the cases. The MB2 was located 1.82 mm DP from MB1.
Vertucci, Root canal morphology of the
Seelig 1974 Morphology human Mx 2nd PM Describes 8 classes of morphology. I:1, II: 2/1, III: 1/2/1, IV:2, V: 1/2, VI: 2,1,2 VII: 1,2,1,2 VIII: 3
Vertucci, Root canal morphology of the
Gegauff 1979 Morphology Mx 1st PM Describes 5 classes of morphology. I: 1, II: 2/1 III: 2/2, IV: 1/2, V: 3
Canal config in the MB root of
Weine, Mx 1st M and its endo 48% had 1 a type 1 config, 38% had a type 2 config. Only 14% had a type 3 config. This means that 52% had 2 canals and that 86% had
Healey 1969 Morphology significance. 1 foramen. 208 roots were sectioned in a B-L direction.
A stereomicroscopic study of
the root apices of 400 Mx and
Green 1956 Morphology Md ant teeth Not a very scientific analysis. All Mx teeth had only one canal. 20% of Md teeth had 2 canals. 10% of the teeth had accessory foramena.
The relationship of the apical
formamen to the anatomic Deviation of the major foramen ranged from 78% in Mx incisors to 99% in D root of Md molars. The largest deviation was again in the D
Burch, Hulen 1972 Morphology apex of the tooth root of Md M. Deviations in the ant were usu to the Bu.
MD and BL roentgenographic Most teeth have curvatures that cannot be seen rdx. Most are in the BL plane and in the apical third. Only 3% of the canals were straight.
Kuttler, investigation of 7,257 root Most curvatures were found in the apical third. 83% of the foramena were not centered on the apex. Few deltas were visualized. The
Pineda 1972 Morphology canals canals shrink w/ age. Ramifications were present in the 35-45 year age group. Looked at BL and MD views of teeth divided by age.
Root canal morphology of Describes 8 classes of morphology. I:1, II: 2/1, III: 1/2/1, IV:2, V: 1/2, VI: 2,1,2 VII: 1,2,1,2 VIII: 3. Also found that the closer two orifices are
Vertucci 1984 Morphology human secondary teeth to each other, the greater the chance that the canals join. Looked at 2400 teeth which were stained and cleared.
Kulild, Root canal config of the Md
Baisden 1992 Morphology 1st PM 76% w/ 1 canal, 24% w/ 2. In type 4 canals, 74% split 6-9mm deep in the canal. Canals are predominantly round or oval.
Clinical investigation of in
Hartwell, vivo endodontically tx Md ant
Belliizzi 1983 Morphology teeth About 20% of central and laterals had 2 canals. Only 4% of canines had 2. A retrospective study using rdx in 612 cases.
41% had 2 canals, only 1.3% of these exited by a separate foramen. So, even if you miss the 2nd canal, but do a great job of obt, then you
Benjamin, Incidence of 2 root canals in can seal off the missed canal. Discussion: The large variation in percentages btwn this study and Green's/Hartwell's is in how you define
Dawson 1974 Morphology the human Md incisor "separate canals." If you define 2 canals joined by an isthmus as one canal, you'll have lower numbers.
Anatomical study of the Wanted to define distances from cortical plated to M roots and nuerovascular bundle to assist in surg. Found distance btwn cortical plate
Frankle, position of the M roots of Md and M roots of 1st M to be 4.2 mm and 2nd M to be 7.4mm. These had a large range though. The nuerovascular bundle was located L to
Seibel 1990 Morphology molars. the apices 81% and 84% of the time respectively.
Ideal endodontic access in Determined that access needs to be F to the incisal edge 25% of the time for straight line access. 75% of the time, access is at the incisal
Mauger 1999 Morphology Md incisors edge. If there is incisal wear, access is at the incisal edge 98% of the time. Used 279 teeth and made measurements rdx.
Mental foramen, Part 1: Size,
orientation, and positional
relationship to the Md 2nd The mental is in line w/ the long axis of the 2nd PM 2/3 of the time. Remaining 1/3 evenly split ant and post to 2nd PM by an avg of 2 mm.
Kulild 1990 Morphology PM Avg vert position is 2/3 from the 2nd PM cusp tip to the inf border of the Md. Usu exits post-sup or sup.
Found divided canals about 40% of the time, w/ no diff btwn centrals and laterals. Teeth w/ long crowns and long roots usu had 1 canal,
Rankine, The bifurcated root canal in short blunt crowns usu had 2. When 2 canals, sep formamena 13% of the time. Access and instr (curving files) must be modifed to
Henry 1965 Morphology lower ant teeth negotiate L canal. Looked at 111 teeth rdx.
Skidmore, Root canal morphology of the Found 4 canals in almost 30% of teeth. 60% of M canals remained divided, 40% joined at the apex. 40% of D canals remained divided,
Bjorndal 1973 Morphology human Md 1st Molar 60% joined at the apex. Access should be more rectangular to locate the 4th canal.
Canal config of the Md 2nd M
Weine, using a clinically oriented in
Pasiewicz 1988 Morphology vitro method Four canals located only 11% of the time Canals in M root remained separate 60% of the time.
Dowson, Root canal morph of Md 1st
Zillich 1973 Morphology and 2nd PM 1st PM, almost 25% have two canals. 2nd PM, 12% have 2 canals. Used rdx and a large sample size.
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An SEM investigation of the
ML canal of human 1st and
90% of the 1st and 70% of the 2nd molars had an MB2. 1/3 were type 3, in type 2 systems, they joined about 5mm from the apex. 80% of
Reader 1990 Morphology 2nd molars 1st and 60% of 2nd had separate orifices. MB2 was located btwn 1.5-2.0 mm from the MB1 orifice.
C-shaped root canals in Md
2nd molars in the Chinese Looked at 581 extracted chinese 2nd molars. 1/3 had a c-shaped root. Of those, 2/3 had C-shaped orifices. Of those, 2/3 had C-shaped
Yang 1988 Morphology population canals. Grand total= 14% have C-shaped canals. Remember that it possible to have C-shaped orifices w/o have C-shaped canals.
The root canal morphology of

Md 2nd molars in a Southern
Walker 1988 Morphology Chinese population Found C-shaped roots in 50%. Looked at 100 ext molars
Roots appear conical, pulp chamber appears longer and is indistinct at the floor, PDL vanishes at the apex, no evid of a furcation. Upon
Simon 1993 Morphology C-shaped canals: Dx and Tx access, profuse bleeding. Rdx w/ instr looks like a perf. Use 5% NaOCl w/ sonic or U/S instr. Obt w/ thermoplasticized GP
Anatomical and histo features
of C-shaped canals in Md
Krell 1991 Morphology 2nd M A majority of resin cast replicas of the canal space showed broad fins and anastamoses.
Root canal anatomy of Md
2nd M, Part 2: C-shaped C-shaped orifices formed separate as well as C-shaped canals, Type 3 canals occurred most freq. Most had apical deltas and
Manning 1990 Morphology canals. anastamoses. The AF was positioned away from the apex most of the time.
Bilateral C-shaped config in
Friedman 1990 Morphology Mx 1st M C-shaped configs can also occur in Mx teeth. This case report shows that it occurred bilat.
Wanted to compare apicos on molars to other teeth. Looking at roots, 81% success, 6% uncertain @ 1-6 years. Found resecting 1/2 the
Surgical Follow-up study of root was more successful than resecting 1/3 (89% v. 75%). Also found that orthograde filling made along w/ surgery had a better success
Altonen 1976 Endodontics apicoectomized molars rate.
Modes of healing Biopsies of the apex were taken of prev tx teeth, a majority of which were not healing well. 3 conditions were observed. 1. 10 cases had
Surgical histologically after endodontic healing w/ PDL and/or ankylosis. 2. 35 cases had healing w/ fibrous scar w/ mild inflamm. 3. 25 cases had mod to severe inflamm w/o
Andreasen 1972 Endodontics surg in 70 cases scar. The freq of epith proliferation was found to be related to the extent of inflamm. 60% had a recall from 1-3 yrs.
Discussed a case were new cementum was deposited on dentin exposed by resection. Cementum was shown to cover the entire dentin
surface to the GP interface. Comments: Since cementum does not re-form over most obt materials, you can expect that the PDL will be
Surgical Root resection as a cure for widened over the material. With MTA and Geristor, you may not actually see widened PDL. This will also pan out histologically, fibrous CT
Coolidge 1930 Endodontics CAP: a histo report of a case over most obt materials, except MTA and Geristor.
Surgical Tx results of apical surgery in 44% success, 23% doubtful. F/u period was 6 mo to 8 yrs. Doubtful was considered incomplete or uncertain rdx healing w/o clinical
Friedman 1991 Endodontics PM and M teeth manifestations or complete rdx healing w/ perc +.
Healed 78% of the time, 15% uncertain/scar. Of the cases w/ curettage w/o retrofill, 4% failed. Cases w/ retrofill, 28% failed. Remember,
this is done by OS on a macroscopic level. Size of the PA lesion had an affect on success rate. A dehiscence doesn't affect the healing
PA surg in a Norwegian rate if they are treated appropriately. In opposition to Altonen and Matilla, they found no diff regardless of no resection, <2mm or >2mm
Surgical hospital: F/u findings if 477 resection. Comments: This was prob done by OS macroscopically, how good were their resections?? 545 sugeries, 1 to 8 yr f/u w/ avg of 2
Molven 1990 Endodontics teeth yrs.
The success rate of apicos. 90% success. Found no sig diff btwn quality of root fillings (silver points, poorly condensed GP). Teeth w/ PARLs had a lower success
Surgical A retrospective study of 1016 rate. F/u was at least 5 yrs. Discussion: Looked only at anterior teeth. The success rate is way off the charts considering the era this was
Harty 1970 Endodontics cases performed.
Oral mucosal soft tissue 3 case reports of pts who had flap necrosis following surg. In all cases, the pt had a sig hx of Ab use. Escherichia, Enterobacter, Klebsiella
Surgical necrosis caused by and penicillinase producing staph were found. These are common bugs in superinfections elsewhere in the body. Good idea to do a sens
Helavuo 1991 Endodontics superinfrection test w/ these kinds of pts. This is rare.
Lemon, Ferric sulfate hemostasis:
Steele, Surgical Effect on osseous wound Made osseous wounds bilaterally in rabbits. Filled one side w/ ferric sulfate, closed the other side immediately. Found that in the amts
Jeansonne 1993 Endodontics healing, Part 1. used and left in situ, ferric sulfate does damage bone and delays healing.
Lemon, Ferric sulfate hemostasis:
Steele, Surgical Effect on osseous wound Did roughly the same experiment, but this time curetted and irrigated the ferric sulfate out of the lesion. Ferric sulfate provided hemostasis
Jeansonne 1993 Endodontics healing, Part 2. in about 1 min, which lasted for about 5 min. If used in this manner, it did not effect healing.
Leubke, Surgical Indications and contra- Indications: drainage, failure of conventional tx, predictable failure w/ conventional tx, conv tx impractical, procuedural accidents.
Glick, Ingle 1964 Endodontics indications for endo surg Contraindications: promiscuous surg, health concerns, anatomic contraind (short root length, poor bony support, missing cort bone).
Relation of pre and intra-
Surgical operative factors to Px of No diff in Px of lesions bigger or smaller than 5mm. NSRCT failure cannot be treated by apico alone. Px is improved by retrofilling the
Friedman 1991 Endodontics post apical surg infected canal.
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Surgical
Incomplete healing (scar
tissue) after PA surg- rdx
Karmali,
24 cases that were Merchant,
dx as uncertain healing wereDavis
followed for 8-12 yrs. Found that gradual reformation of bone observed at 1 yr will almost
always continue for an extended period of time. Supports evid that if rdx healing is evident at 1 yr, f/u can be terminated. Discussion: This
Molven 1996 Endodontics findings 8-12 years after tx may be a bit too liberal, f/u should be carried longer if healing is uncertain.
A dentist's dilemma: NSRCT
or PA surg for teeth w/
Surgical apparent pulpal path and an Biopsy everything you pull out surgically. Comments: 6-9% of lesions are true cysts. If 1% of those convert to a malignancy, the probability
Morse 1990 Endodontics assoc PARL. is very low. Does this warrant doing biopsies if surg is not planned???
Surgical Treatment results of apical
Friedman 1991 Endodontics surgery in PM and M teeth 136 roots were f/u for 6mo-8yrs. Strict definition of healing. 44% success, 23% doubtful, 33% unsuccessful.
Pecora, Surgical Use of the dental operating
Andreana 1993 Endodontics microscope in endo surg
Short-term observation of the
results of endodontic surg w/
the use of a surg op
Rubinstein, Surgical microscope and Super-EBA
Kim 1999 Endodontics as a root end filling material
The two categories of completely healed or unsuccessful healing were stable, w/o changing categories, throughout the recall period. The
other two groups, uncertain and incomplete showed changes in category during the first post-op years. After 4 years, these two groups
Andreasen, Surgical A f/u study of 1000 cases tx also stabilized. So if a case shows healing or failure after 1 year, it will stay that way. Uncertain and incomplete should be followed for up
Rud 1972 Endodontics by endo surg to 4 years. Comments: with the drop out rate, this study is really based upon a group of 300.
Describes various ways in wich to obtain hemostasis during surgery. A good review article. Anesthesia: lido w/ epi 1:100K supplemented
Retrofilling Hemostasis in paeriradicular w/ 1:50 as local infiltration. Flap design: vert releasing to limit severed blood vessels, handle carefully. Surgicel: acts as a phys barrier in
Gutmann 1996 Materials surgery hemostasis, then acts as a sticky coagulum plug. Gelfoam: slows healing initially, but not in long term.
Apical leakage assoc w/ Apical dye penetration was much higher in the cold burnished GP group. The presence or absence of varnish in the amalgam prep
Retrofilling retrofilling techniques: a dye showed no sig diff in leakage. Leakage was sig less if the varnish coated both the prep and the bevel. Used 40 Mx canines. 45 degree
Vertucci 1986 Materials study bevel. Dye study over two weeks.
Sealing ability of dental amal
Tronstad, Retrofilling as retrograde fillings in endo Leakage was reduced by use of cavity varnish. Copper containing amal leaked the least, Zn free amal leaked the most. Placed amal as
Trope 1983 Materials therapy retrofills in 270 teeth, implanted them sub-q in rabbits. Observation periods of 7, 30 and 90 d.
Physical and chemical
Retrofilling properties of a new root end Main components of MTA are Ca oxide and Ca phosphate. pH is 10 when mixed, 12.5 when set. Setting time is about 3 hours. Low
Torabinejad 1995 Materials filling material. compressive strength, esp initially. Very low solubility.
Tissue rxn to implanted
Retrofilling Super-EBA and MTA in the Tissue rxn was slightly milder w/ MTA than w/ EBA. Used 7 guinea pigs so sample numbers were low. 1/5 MTA samples showed bone
Torabinejad 1995 Materials Md of guinea pigs. directly on the MTA. Both EBA and MTA are biocompatible.
A comparison of the marginal Cold burnished GP had the best marginal adaptation. Gaps were 90% smaller than w/ amal or heat burnished GP (which had the worst
Tanzilli, Retrofilling adaptation of retrograde adaptation). Possiblity: these samples were never placed in fluid for an extended period of time, so the sealer didn't dissovle. Results
Moodnick 1980 Materials techniques: an SEM study oppose Vertucci 1986 and King 1990.
In vitro evaluation of
biocompatibilty and marginal Retrofills using different materials were made. Retrofill area amputated and were exposed to rat fibroblasts. Cell density was then
Safavi, Retrofilling adaptation of root retrofilling
measured. Cell density sig less w/ composites than w/ amal. Therefore, comp not recommended for use as a retrofill material due to poor
Spangberg 1988 Materials materials biocompatibility.
The bond establshed by Retroplast with Gluma as a bonding agent remains stable over a period of 8-9 yrs. Looked at the first 33
Long-term evaluation of consecutive successes at 1 yr using this material . 32 cases had maintained complete bone healing and 9 showed a reformed PDL space.
retrograde rooot fillings w/ Andreason (89, 93) states that the presence of a PDL space rdx implies reformation of root cementum covering the retrofill material. Used
Retrofilling dentin-bonded resin Retroplast is a saucer shaped prep, so both the prep and exposed dentin were sealed. Be careful not to cover the remaining cementum as
Rud 1996 Materials composite that will inhibit the reformation of the cementum over the retrofill (Andreasen 93).
Oynick, Retrofilling A study of a new material for Describes the use of Super-EBA as a retrofill material. SEMs show better adaptation than amal. Fibers could be seen growing into the
Oynick 1978 Materials retrograde filliing cracks of the EBA surface. Small area of chronic inflamm. Much better material than amal.
Retrofilling Cytotoxicity of endodontic
Vertucci 1998 Materials materials MTA was the least cytotoxic retrofill material. CRCS was the least cytotoxic sealer.
Retrofilling Electrolytic precipitation of A case report. Found that a radio-opaque material around an amal retrofill to be zinc carbonate, deposited by an electrolytic process. A
Omnell 1959 Materials zinc carbonate in the jaw metal post was present in the canal. Don't use Zn containing amal if you use amal for retrofills.
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Retrofilling
A comparative retrofill
leakage study utilizing a
Composite w/ dentin bonding showed the least amount of apical leakage. If bonding agent is responsible for such a good seal, the author
Dumsha 1987 Materials dentin bonding material suggests that it may not be nec for a retroprep.
Histological study of PA
tissue healing in rat molars
Retrofilling after retrofilling w/ various
Maeda 1999 Materials materials
Super-EBA displayed the least amt of leakage. Ketac-silver showed the most. Amal w/ or w/o varnish were similar to each other , to Super
Retrofilling Longitudinal eval of the seal EBA, and to the negative control. Cold burnished GP provided an excellent seal for the first 3 weeks then began to breakdown (poss due
Pashley 1990 Materials of endodontic retrofillings to sealer dissolution). Might explain Tanzilli's (80) results. Used a fluid filtration apparatus.
Apical dentin permeability
and microleakage assoc w/ Resected apices at 0, 30 and 45 degree angles. Made retrofills of different depths w/ Ketac-silver. Found that apical leakage can be
Gilheany, Retrofilling root end resection and minimized by using a 0 degree resection. The depth of retrofill depends on the angle of the bevel: 1mm for 0 deg, 2mm for 30 deg and
Figdor 1994 Materials retrograde filling 2.5mm for 45 deg. Also pointed out that a rdx will over estimate the depth of the actual retrofill due to the bevel.
Looked at 104 teeth that had amal retrofills placed at least 10 yrs earlier. All had to have rdx evid of success at one point. At 15 yrs, 60%
were still successes, 40% had reversed from healed to not healed. Amal may show a short term success, but the healing trend may
Retrofilling Long-term evaluation of reverse in the long term. Quesitons: Do you stop your eval of successful amal at the first sign of success? Were these long term reversals
Frank, Glick 1992 Materials surgically placed amal fillings in healing specific to amal or all retrofill materials?
In vitro study of the sealing
Retrofilling ability of 4 retrograde filling
Beltes 1988 Materials materials All samples leaked. EBA leaked the least, then amal w/ varnish, then Ketac, then hot burnished GP.
Periodontal tissue
regeneration inducing
cementogenesis adjacent to Two case reports where cementogenesis occurred over composite retrofills. One case even had Sharpey fiber attachment. The bonding
Andreasen, Retrofilling dentin-bonded retrograde allowed a double seal- over the obt and on the resected surface. This means that composite must be biocompatible which opposes Safavi
Rud 1993 Materials compostie fillings 1988. Do not cover the PDL on the side of the root, this maybe the source of newly generated cementum.
Evaluation of endodontic
instruments as received from
Segall 1977 Instruments the manufacturer All instruments have debris and defects from the manufacturing process.
A comparison of the effect of
modified and non-modified
instr tips on apical canal Used modified and non-modified tips w/ 4 diff instr techniques in plastic blocks. Found that non-cutting tips allow a greater amount of
Simon 1986 Instruments configuration control during cleaning and shaping. Instr w/ modified tips removed material more evenly from canal walls.
A comparison of the effect of
modified and non-modified
instr tips on apical canal Used balanced force and step-back w/ flex and K files. Regardless of the technique used, the modified tip produced better results. The
Simon 1988 Instruments configuration. Part II. modified tips allowed better control of the prep and maintained the original canal shape better.
An in vitro eval of cnal prep This study wanted to eval the effects of adding orifice shapers and .06 taper to the simple .04 technique. Found that this addition
using Profile .04 and .06 improved canal shaping, but lengthened prep time. Duh. Early radicular access w/ the orifice shapers helped reduce apical canal
Lumley 1998 Instruments taper instruments transportation.
Morgan, An evaluation of the crown- 40 teeth were instr w/ either crown down pressureless or circumferential filing. Filled w/ impression material and cleared. Shapes were
Montgomery 1984 Instruments down pressureless technique subjectively evaluated. Crown down pressureless received sig more excellent ratings than conventional instrumentation.
Apical extrusion of debris
using 2 hand and 2 rotary
Hicks 1998 Instruments instr techniques Found that incorporating rotational movement w/ instr, whether rotary or balanced force, reduced the amt of apically extruded debris.
Orstavik, Bacterial reduction w/ NiTi An in-vivo, human, prospective study in which they wanted to compare bacterial reduction using rotary vs hand step-back. Found no
Trope, Dalton 1998 Instruments rotary instr difference w/ saline irrig. Did state that fewer bact remained w/ use of larger instr.
94% of the treated teeth had neg cultures at the end of the first visit. 76% of the teeth treated had neg cultures at the second visit. These
The importance of teeth were instr to a #50-60 w/ NaOCl irrig w/o inter-appt med. Small numbers of remaining bacteria may not be cultivable after initial
Cleaning / chemomechanical cleaning and shaping. If the canal is left empty btwn visits, the bacteria can multiply and give a positive culture at a subsequent appt.
Stewart 1955 Shaping preparation of the root canal Thorough chemomechanical cleansing of the canal system is important.
Cleaning / The biomechanics of
Heuer 1963 Shaping endodontic therapy Offers a historical perspective on cleaning and shaping. Defines chemomechanical preparation w/ NaOCl as the most important step.
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Cleaning /
The morphology of the
prepared root canal: A study
Cleaning and shaping were not able to produce smooth tapered canals. Nearly half of the canals wall were not touched by the instr. Irreg
Davis 1972 Shaping utilizing injectable silicone in canals are filled w/ tissue and bacteria.
The effect of preparation
procedures on orig canal
Cleaning / shape and on apical foramen Regardless of technique used, canals showed undesirable characteristics (elbows and zips). Introduced those two terms to the endo
Weine 1975 Shaping shape vocab. Came up with the plastic blocks w/ canals.
Moodnick, Cleaning / Efficacy of biomechanical The walls of the canals were irreg and were not clean. Describes the smear layer on all instr walls. Irrig w/ saline and NaOCl, but results
Dorn 1976 Shaping instr: an SEM study do not separate the two…why??? Used Hedstroms and K files.
The anti-curvature filing
Abou-Rass, Cleaning / method to prepare the curved
Frank, Glick 1980 Shaping root canal Describes various instr techniqes and introduces the anti-curvature method. This method reduces the possiblity of root perfs or stripping.
Cleaning / Clockwise or Looked at nearly 500 damaged/separated hand files. 92% were damaged during clockwise rotation. 66% separated during clockwise
Roane 1984 Shaping counterclockwise rotation. Less damage in CCW b/c the tip of the file wants to naturally disengage.
Endo retreatment: evaluation

Cleaning / of GP and sealer removal Used different methods to attempt removal of GP and Roth's or AH26. All methods left debris in the canals, AH26 consistently more diff to
Madison 1987 Shaping and canal reinstrumentation remove, esp at the apex.
Instrumentation of curved
Cleaning / canals w/ the Roane Found that curved canals can be reliably instr w/ straight files to a #45 while maintaining the shape of the canal. Great results even though
Natkin 1987 Shaping technique they were using cutting tips and placed a coronal flare late in the procedure.
Found that adding 30% EtOH to NaOCl decreases its surface tension. It also ties up active Chlorine shortening the working time of the
Effect of alcohol on the combination to 15 minutes. The most effective dilution was 1:1. So, you can get your NaOCl to the apex better, but it will be much less
Irrigation / spreading ability of NaOCl effective when it gets there. Discussion: Placing just 1 drop of EtOH in the chamber visibly improves flow of NaOCl. How does this 1 drop
Cunningham 1982 Medication endodontic irrigant effect the efficacy of NaOCl??
Irrigation / States that intracanal meds are generally ineffective (lit review). Did not include CaOH2. Does like steroids for pain management, either
Walton 1984 Medication Intracanal medicaments intracanal or IM. Great review of mechanism of action for halides and phenols.
Irrigation / Irrigation of the root canal Lit review that indicates that 5.25% NaOCl is the irrigant of choice. Describes factors that inc the efficacy: heat, energy, flushing. 1:1
Harrison 1984 Medication system dilution inc the exposure time nec for tissue solvency by a factor of 3.
Irrigation / Endodontic medicaments and
Osetek 1988 Medication irrigating solutions Text chapter that describes currently used intracanal medicaments.
An in vivo evaluation of the Found passive irrigation w/ hypaque reached the apex after instr w/ a 35 file and a GGD 2. In vital cases, hypaque only reached the depth
Salzgeber, Irrigation / penetration of an irrigating that tissue had been removed. In necrotic cases, the hypaque penetrated deeper faster b/c there was no tissue impediment. Did not
Brilliant 1977 Medication solution in root canals irrigate w/ NaOCl at all throughout procedure.
Analysis of the effect of Diluting NaOCl greatly reduces its ability to dissolve tissue. 5.25% NaOCl is a very effective tissue solvent. For some reason, he used rat
Harrison, Irrigation / dilution on the necrotic tissue CT w/ skin, which is very difficult to dissolve. Should have used tissue that more closely resembles human pulp tissue. H20, NaCl, H2O2
Hand 1978 Medication disolution property of NaOCl were all ineffective at dissolving tissue.
Reactions of guinea pig
subcutaneous connective Implanted tubes in the CT of guinea pigs containing diff conc of NaOCl. Found no sig diff in the inflammatory rxn of the various conc and
Irrigation / tissue following exposure to that of saline. Conc used were from 1-8% NaOCl. Discussion: realize that the solns were placed passively against the tissue. In a
The, Maltha 1980 Medication NaOCl hypochlorite accident, NaOCl is injected under pressure.
The effect of dilution and Paper points were contaminated w/ E. faecalis and exposed for various time periods in different concentrations of NaOCl and to 5.25%
organic matter on the NaOCl mixed w/ organic matter. After exposure to test solutions, the paper points were incubated. 5.25% NaOCl inhibited bacterial growth
Harrison, Irrigation / antibacterial property of w/in 45 sec. 2.5% NaOCl inhibited growth in 120 sec. Whole blood and albumin that was added to the test solution did not adversely
Hand 1981 Medication 5.25% NaOCl effect the action of NaOCl while the addition of yeast dramatically reduced the efficacy.
Effectiveness of selected
Irrigation / irrigants at eliminating B. 5.25% NaOCl is an effective method of removing B. melaninogenicus from the pulp space. Adding H2O2 to NaOCl is not more effective
Weine 1983 Medication melaninogenicus than NaOCl alone.
Irrigation / Analysis of clinical toxicity of
Harrison 1978 Medication endodontic irrigants Found that irrig w/ 5.25% NaOCl did not cause grtr interappt pain than irrig w/ saline.
NaOCl is very effective, but also very cytotoxic. The idea that diluted NaOCl will only affect necrotic tissue should be abandoned. Tested
Irrigation / Cytotoxic effects of NaOCl on diff conc w/ a control of saline in rabbits. All conc of NaOCl had cytotoxic effects. Cutting the NaOCl to 1:10 decreased, but did not
Pashley 1985 Medication vital tissue eliminate the cytotoxic effects. These effects were short lived.
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Irrigation /
The antimicrobial effect if
CaOH as a short-term
Found that CaOH2 eliminated all (18/18) bacteria when used for 7 days. Discussion: This is the only study w/ 100% of bacteria eliminated.
Sjogren 1991 Medication intracanal dressing Every other study shows reduction but not elimination of bacteria.
Tested NaOCl and CHX (liquid and gel) in killing E. faecalis. Found that all irrigants were effective, but higher conc worked faster. The 2%
In vitro antimicrobial activity CHX gel and the 2% CHX liquid were as effective as 5.25% NaOCl. All three solutions were effective w/in 30 seconds. CHX is not a tissue
of several conc of NaOCl and solvent. 2.5%, 1% and 0.5% NaOCl required 10, 20 and 30 minutes, respectively, to produce negative cultures. Discussion: This was done
Irrigation / CHX in elimination of E. in welll culture plates which gives the irrigant a big advantage over irrigating in a canal space w/ biofilms, smaller surface area contact, etc.
Gomes 2001 Medication faecalis Still the diluted NaOCl required significantly more time for disinfection than full strength. Good argument for 5.25% NaOCl.
The effectiveness of Evaluated the ability of CaOH and/or US to remove pulp tissue debris from isthmuses. M roots of extracted Md molars were hand instr.
ultrasonics and CaOH for the The US group was activated at full power using a Caviendo and a #15 file for 2 min under constant 2.6% NaOCl flow. The CaOH group
Irrigation / debridement of human had CaOH placed for a week and then irrig w/ 2.6% NaOCl. The Hand Instr group was just that. Root sectioned and stained. At the 3mm
Metzler 1989 Medication mandibular molars level, all groups were similar. At the 1 mm level, the US and CaOH groups were sig cleaner.
Used cylinders of bovine dentin to study various bacteria in regard to the speed and depth of infection, survival after removal of nutrient
medium and in their susceptibility to several root canal medicaments. Bacterial spp vary greatly in speed and depth of infection. E.
Disinfection by endodontic faecalis infected the entire depth of dentin w/in 48 hrs. It also showed survival after 7 days w/o any nutrients. IKI penetrated over 1000
irrigants and dressings of microns, NaOCl and CHX penetrated 100-300 microns. Smear layer did not stop the effect of medicaments but it did slow it down. CaOH
Irrigation / experimentally infected req at least 10 days to be effective. Several bacteria were used but E. faecalis proved to penetrate deeper and faster than any and was
Orstavik 1990 Medication dentinal tubules more difficult to kill.
The sequelae of accidently
Irrigation / injecting NaOCl beyond the Case report of NaOCl accident. Tx should be palliative and supportive. Analgesics, Ab for 1 wk should be considered. IV cortricosteroids
Cohen 1974 Medication root apex should be administered for 3 days. Cold compresses for 6 hrs followed by warm compresses and rinses for 1 wk.
Facial emphysema casued
Irrigation / by hydrigen peroxide
Kaufman 1981 Medication irrigation, a case report H2O2 may not be a good alternative irrigant.
Irrigation / A case report. Pt presented w/ a hypersensitvity to NaOCl. Confirmed by allergist. Solvidont was used uneventfully as an alternative
Kaufman 1989 Medication Hypersensitivity to NaOCl irrigant. Important to ask pt if they are allergic to household cleaning products prior to tx.
Irrigation / NaOCl injection into Tissue response is out of proportion w/ volume of irrigant. May be an allergic rxn. Tx should include analgesics, ice x 1 day , then heat.
Sabala 1989 Medication periapical tissues Ab should be used for 1 wk. Reassurance is big.
Effects of NaOCl on soft
tissues after its inadvertant
Irrigation / injection beyond the root
Gatot 1991 Medication apex Describes hypochlorite accident.
Solvent effect if various
Irrigation / dilutions of NaOCl on vital Vital and necrotic bovine pulp was exposed to 0, 1, 3, ahd 5% NaOCl for varying times. 3 and 5% had equal tissue dissolution properties
Gordon 1981 Medication and necrotic tissue (75% of pulp dissolved) after 2 min. 1,3, and 5% dissolved 90% of the tissue at 5 min.
Irrigation / Complications in the use of
Beckling 1991 Medication NaOCl Describes hypochlorite accident.
Sodium hypochlorite
accident: Inadvertant
Irrigation / injection into the maxillary Copious amounts were inadvertantly injected through a root into the sinus. Pt could taste and feel NaOCl in his throat. More was
Walker 1993 Medication sinus injected…just to make sure. No really big rxn was noted. Gives credence to the theory that hypochlorite accident is an allergic rxn.
Filling root canals in 3 Describes the warm vertical (multi-wave) technique. Produces dense, dimensionally stable obturations. Makes an important distinction
Schilder 1967 Obturation dimensions btwn overfilling (well sealed w/ a surplus of GP) vs overextension (going long w/o an adequate seal). Sees no problem w/ overfilling.
Gutta-percha root canal
Davis, fillings: An in vitro analysis. Did lateral condensation in Mx incisors and cleared them. Found many irregularities, inad sealer dispersion, lack of obturating canal
Brayton 1973 Obturation Part 1. variations and roughness/pitting.
SEM examination of root Found that no obturation material fully filled all the avialable canal space. Solid core materials (GP) don't have adhesion properties and req
Seltzer 1976 Obturation canal filling materials a cement. Shrinkage or poor compaction of GP was common. ZOE based cements adhered well.
Comparison of GP filling
techniques, compaction
(mech), vert (warm) and lat
condensation techniques, Warm vert placed a larger volume of GP into the canal space than lateral condensation. In regards to canal repilication:
Peters 1981 Obturation part 1 WV>compaction>LC.
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Comparison of GP filling
techniques: 3 chloroform-GP
No differences were shown in the replication abilites of chloropercha, Kloroperka NO and chloroform dip. Shrinkage at 2 weeks was 12%
Peters 1982 Obturation filling techniques, part 2. for chloropercha, 5% for Klorperka NO and 1% for chloroform dip. If a chloroform technique is used, the dip method should be used.
Comparison of
thermoplasticized injectable Both high and low temp injectable GP showed excellent obturation of the canal space, but length control was a big issue. Cold lateral
Kulild 1991 Obturation GP obturation techniques. failed to replicate internal canal morphology and did not demonstrate a homogenous mass of GP.
Effect of 3 obturation
techniques on the filling of
lateral canals and the main Compared WV, WL and CL obturation tech in epoxy blocks. WV had sig more GP in lateral canals. WL and CL showed no stat sig in the
Hoen 1993 Obturation canal. amt of sealer in lat canals. The main canal showed no diff in void to sealer/GP ratio for all three groups.
A comparison of
thermoplastic obturation
techniques: adaptation to the Found Obtura II had the best adaptation to the canal > ThermaFil plastic > ThermaFil NiTi > CL. The Obtura had very good length control
Weller 1997 Obturation canal walls. in this study. Split tooth model, instr to #60 in a step-back tech. Obtura tip placed to w/in 2mm of apex.
Analysis of forces developed
during obturations. Wedging
Machtou 1998 Obturation effect: Part 1 No sig diff in the wedging forces created by WV and CL. All methods have both vertical and lateral forces. Used a force analyzer.
Determined wedging forces during obt. Function of plugger size/GP cone size in relation to canal size and how conical the canal is. The
Analysis of forces developed closer the canal shape is to the cone shape, the greater wedging forces generated. WV produced the best wedging forces in relation to
during obturations. Wedging GP fluidity. Producing a conical preparation is the most important step in producing a 3-D obturation. Comments: Good argument for
Machtou 1998 Obturation effect: Part 2. larger tapered preps.
Intraorifice sealing of GP
obturated root canals to Cavit, IRM and Super EBA were used to seal the orifice of each canal. Bacterial leakage study showed that 15% of the cavit sealed teeth
prevent coronal leaked after 90 days. 35% of the IRM and EBA leaked after 90 days. The unsealed canals all leaked before 49 days. Sealing the orifice
McClanahan 1998 Obturation microleakage. might be a good idea to act as a secondary seal.
Endodontic obturation using Describes the technique which uses two different, more fluid types of GP. Condensor attached to slow speed run at mid range, no longer
Korzen 1997 Obturation the MicroSeal technique. than 6 seconds. How much heat does this produce??
Comparison of two devices
for root canal cleansing by
Irrigation / the noninstrumentation Describes new instr that uses cavitation and pressure changes w/ NaOCl in the canal for cleaning. Canals can be cleaned pretty well in 10
Lussi 1999 Medication technology min w/ 3% NaOCl. The continuous neg pressure prevents flow of NaOCl out of the apex.
Balanced force, crown-down
preperation and Inject-R fill Describes using a System B for the down pack in the traditional manner. Back fill is done w/ Inject R Fill, which is heated GP in a metal
Roane 1998 Obturation obturation tube. This is injected into the canal and compacted w/ pluggers.
An in vitro comparison of
thermoplasticized GP
obturation techniques with
Gulabivala 1998 Obturation cold lateral condensation Thermoplasticized methods produced more overfills. CL had the least leakage in straight canals. As the curvature inc, so did the leakage.
Effect of varying the depth of
heat application on the
adaptability of GP during Split tooth model again. All canals obt w/ thermo injectable and 85% of the warm vert heated to w/in 3mm of WL had excellent
Weller 2000 Obturation warm vertical compaction reproduction of the apical third. Down packing at 5, 7, 9 mm showed consistently worse results. CL was the worst.
Physical properties of root
McElroy 1955 Obturation canal filling materials Well condensed GP w/ sealer showed minimal volume change. Greatest change in volume was when chloroform was used.
The thermomechanical
properties of GP. Part 1: The Gp is basically incompressible on a molecluar level. Any reduction in volume is due to the obliteration of voids. You cannot expect to get a
Schilder 1974 Obturation compressibility of GP spring-back seal from GP. "Compaction" of GP is a more accurate term then condensing.
The thermomechanical
properties of GP. Part 2: The
histroy and molecular
Schilder 1974 Obturation chemistry of GP Describes structure of GP. Transpolyisoprene. Dental GP usually exists in the beta phase.
Gutta-percha root canal GP usu exists in the beta phase. Transforms to the alpha phase btwn 42-49 deg C. Transforms again from the alpha to the amorphous
fillings: An in vitro analysis. phase btwn 53-59 deg C. Did calorimetry studies. Numbers lower than other studies b/c this included industrial GP as well as dental
Schilder 1974 Obturation Part 1. grade.
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Reaction of rat connective
tissue to some GP
GP showed an initial acute response which lasted 15 days, and was quickly followed by a fibrous tissue encapsulation. A GP/CaOH
Seltzer 1975 Obturation formulations. formulation showed phagocytic activity. Kloroperka showed a severe inflamm rxn and abscess formation. Study carried out to 64 days.
Johnson 1978 Obturation A new GP technique Describes an early ThermaFil. Made chairside using a notched file as the carrier and heated GP.
A comparison between
ThermaFil and lateral
condensation in highly curved
Krell 1992 Obturation canals. ThermaFil showed similar results to LC in dye leakage studies in severley curved canals. No sig diff.
Evaluation of ThermaFil
obturation of curved canals
prepared by the Canal ThermaFil uses an alpha phase GPThermaFil had a grtr variability in the apical seal and grtr dye leakage than LC. There was no
Montgomery 1992 Obturation Master-U System. correlation between root curvature and dye penetration.
An evaluation of the
ThermaFil endodontic
Vire 1992 Obturation obturation technique. Showed no sig diff btwn dye penetration of ThermaFil and LC. Time req for obt was also not sig diff.
Apical sealing ability of
ThermaFil following
immediate and delayed post 4 groups of 15. 1. control w/ LC. 2. ThermaFil w/ immed post prep. 3. ThermaFil w/ delayed post prep. 4. ThermaFil w/o post prep. No
Zillich 1994 Obturation space preparations. sig diff in dye leakage.
ThermaFil obturation: A lit
Donnely 1997 Obturation review.
A SEM examination of silver
cones removed from Silver cones removed from teeth which had been treated 3mo-20yrs prior. The cones were moderately to serverely corroded. These
Seltzer 1972 Obturation endodontically treated teeth corrosion products were highly cytotoxic. Postulated to occur form contact w/ tissue fluids.
Corrosion of silver cones in Silver cones undergo mod to severe deterioration when used as root canal fillings. Biopsy showed that corrosion products were cytotoxic.
humans: A SEM and X-ray The corrosion occurred mostly apically, w/ dec amounts coronally. Consistent w/ the hypothesis that corrosion occurs in the presence of
del Rio 1975 Obturation microprobe analysis. apical fluids.
Silver cones undergo rapid corrosion in the bones of rats, but they are well tolerated by both hard and soft tissues. Over a period of 6 mo,
Corrosion of silver cones in bone actually formed over the cones and the cones became attached to the bone. Clinically, you might leave a fragment of an
bone: A SEM and microprobe overextended silver point b/c it has become attached to the PA bone. Also, when you remove a cone, there will be a corrosion layer in the
del Rio 1975 Obturation analysis. canal and the PA tissues.
Sliver points and GP and the Root canal fillings are not nec for healing. Fluids will not usu flow into empty canals. Both silver cones and GP fail to produce hermetic
Dubrow 1976 Obturation role of root canal fillings. seals. Therefore, success must depend on other factors…cleaning and shaping.
Spangberg 2002 Sealers Sealers/Cements (Pathways)

Root canal sealer cements
Heuer 1987 Sealers (Pathways) Describes ANSI standards of testing for dental materials.
Histopathologic study of rat Studied 10 materials used in root canals in rabbits. Kerr's sealer and Diaket had the mildest tissue response. N2, N2 Medical, Proco-Sol
CT responses to endodontic and Tubli-Seal produced the most severe responses, including necrosis and abscess formation. These should be confined to the canal
Guttuso 1963 Sealers materials system if used.
A comparitive study of
important physical properties
of various root canal sealers.
Schilder 1971 Sealers Part 1: eval of setting times.
A comparitive study of
important physical properties
of various root canal sealers.
Part 2: eval of dimensional ZOE sealers shrink upon setting. The faster the setting time, the greater the shrinkage. AH26 has an intial expansion followed by
Schilder 1971 Sealers changes. contraction. Therefore, you should maximize the central core material and minimize the amt of sealer used.
Evaluated sealers for various properties. Particle size: AH26 and Kerr had the smallest, Diaket and ZOE had the largest. Flow: AH26,
Roth 801 had exc flow, Kerr had mod flow, Diaket and ZOE had no flow (this was on a glass slab, no pressure from compaction).
Physical properties of root Adhesion (to glass): AH26 and Diaket were sig better. Setting time varied greatly w/ AH26 taking over 30 hours and Kerr taking about 1
Grossman 1976 Sealers canal cements hour. Dimensional change: all showed shrinkage. AH26 and ZOE were among the highest. Kerr and Diaket were among the lowest.
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Evaluation of the apical seal
produced by injected
thermoplasticized GP in the
absence of smear layer and Sealer is nec to effectively seal the apex regardless of tech used. Lack of sealer exhibited gross leakage. The presence or absence of the
Simon 1986 Sealers root canal sealer smear layer had no sig effect. Obturation method (CL or thermoplasticized) made no difference.
Study of the cytotoxicity of
Nakamura 1986 Sealers root canal filling materials AH26 showed severe cytotoxicity in tissue culture.
Sealapex caused partial calcific obliteration of the apex. Related to the CaOH and solubility of the sealer. Sealapex dissolves which is
desirable for the deposition of cementum. It is also considered undesirable b/c it affects the apical seal. The cementum barrier that forms
Periapical reactions to is incomplete and porous. CRCS showed a tissue response similar to ZOE based sealers. AH26 showed a severe inflamm rxn, though it
CaOH2 containing sealers does have a good clinical track record of success. Comments: Sealapex doesn't set so there is free CaOH2 to cause a cementoid barrier
Tagger 1989 Sealers and AH26 in monkeys (think apexification). If it doesn't set well, is it really sealing??
No evid of a CaOH containing sealer stimulating apical healing. Presence of extruded sealer inc the inflamm rxn and inhibited apical hard
tissue formation. In cases w/o overfilling, CRCS, Sealapex and ZOE showed CT ingrowth infiltrated w/ chronic inflamm cells and some
deposition of hard tissue along the canal walls. In the CRCS and Sealapex groups, particles of sealer were seen in macrophages some
distance from the apex. Chronic inflamm response in these CaOH containing sealers after 180 days. The ZOE group, after 180 days, had
Periapical tissue response to minimal inflamm cells and a fibrous capsule in contact with the filling material. 120 canals in dogs were used. Discussion: ZOE based
2 CaOH2 containing sealers also caused cemental deposition and partial apical closure, just like the CaOH containing sealers. The ZOE sealers were kinder to
Goldberg 1990 Sealers endodontic sealers the apical tissues.
Long-term sealing ability of Dye leakage study comparing Sealapex to Tubli-Seal (ZOE based). No difference btwn the sealers at 32 wks. Hypothesized that this is
Ludlow 1991 Sealers CaOH2 sealer. due to the limited surf area exposed to fluid if sealers are limited to the root canal system.
States that the "Endodontic Usage Test" may not be well suited for testing differences btwn endodontic materials. 1/3 of teeth showed
apical inflamm at 1 mo, 1/5 at 6 mo. Signs of persistent PA inflamm may be signs of infection vice material toxicity. All remaining pulp
Usage test of 4 endodontic stumps showed signs of necrosis. AH26, Endomethasone, Kloroperka and Proco-Sol were used. Discussion: bullshit about usage test not
sealers in Macaca being well suited. Maybe the results of this usage test shows that all the materials are comparable in vivo and just highlights the weakness
Orstavik 1992 Sealers fascicularis monkeys of other in vitro tests.
Efficacy of removing glass
ionomer cement, ZOE and Used hand and U/S to retreat ext teeth using three diff types of sealers. Roth's 801 had the least amt of remeaining debris and was the
epoxy resin sealers from fastest to remove. This was followed by AH26 and then Ketac-Endo. Using U/S were not more effective but were faster. In general, the
Trope 1992 Sealers retreated root canals better the adhesion, the more difficult to retreat.
Cytotoxicity of some modified Cytotoxicity study of four sealers used typically in Latin America. Found that Sealer 26 (similar to AH26 but with CaOH2) has low toxicity
root canal sealers and their and is biocompatible. Also state that eugenol, phenol and formaldehyde are unsuitable ingredients for a sealer…that's right...implying that
Spangberg 1993 Sealers leachable components AH26 is less cytotoxic than eugenol.
Used a gas chromatograph to evaluate the presence of formaldehyde in AH26. Found that when the powder and liquid are mixed,
formaldehyde forms. 200 fold increase over two days as it sets, then decreases over the next 7 days. Did not take study to the point
where no formaldehyde is released. At 7 days, a sig amt of formaldehyde is still being released. This study, unlike their other 1993 study,
Spangberg 1993 Sealers AH26 releases formaldehyde states that AH26 is cytotoxic. Hypothesize that irritation caused by AH26 might be due to release of formaldehyde.
Dimensional changes of Tested ZOE, Endomethasone, Endo-Fill and AH26 for dimensional change to 180 days. Endo-Fill and AH26 had the least amt of change
Spangberg 1993 Sealers endodontic sealers and were statistically similar. ZOE and endometh had the most and were statistically similar as well.
A comparison of sealer Regardless of technique used, 50-60% of the canal walls were coated w/ sealer after obturation. Compared lentulo, k-file, and GP cone.
placement techniques in The lentulo covered 90% of the walls prior to obturation, but the sealer was displaced during CL obturation. AH26, which has exc flow and
Walker 1996 Sealers curved canals adhesion, was used.
Sealing ability of the vertical Use of sealer is critical to the quality of the apical seal. Compared Pulp Canal Sealer, AH26 and Roth's 801. Kerr Pulp Canal Sealer
Yared, Bou condensation with different showed sig less leakage than AH26 and Roth's 801 at 24 weeks. All showed an increase in leakage as time progressed. Used a fluid
Dagher 1996 Sealers root canal sealers filtration model to 24 weeks. Allowed all sealers to set only 30 minutes prior to the study.
Eugenol based (Roth's and Tubliseal) and Ketac-Endo were effective against all bacteria. CaOH2 containing sealers were variable with
The antimicrobial activity of Sealapex and Apexit being the most efficacious. Apexit was the least cytotoxic. Recommend Apexit as the sealer of choice. Blood agar
Saunders, endodontic sealers to plates were used. Argue that CaOH2 needs time to work (10 d according to Orstavik, Haapasalo 1990). This experiment looked at results
Abdulkader 1996 Sealers anaerobic bacteria at 48h.
Dynamic torque and apical
forces of Profile .04 rotary Found that up to 10 curved canals could be safely prepared w/ ProFile .04. The larger the instr, the fewer rotations to failure. Also found
Peters, instruments during that cyclic fatigue does not occur when the file is not contacting the canal walls…the files generated torque only about 50% of the time it
Barbakow 2002 Instruments preparation of curved canals was rotated in the canals.
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Gulabivala,
External cervical resorption
associated w/ localized
Karmali,
Defined as a resorptive processMerchant,
that commencesDavis
in the zone of CT attachment. Rarely symptomatic. Contributory factors include trauma,
ortho, surg, perio dz, and internal bleaching. Usu vital w/o connection of the lesion w/ the pulp. Pulp space might be violated during
Patel 2002 Resorption gingival overgrowth removal of granulation tissue, in which case NSRCT is indicated at same visit as surgery.
Reduction in intracanal
bacteria during root canal
Saunders. Cleaning / preparation w/ and w/o apical Great article summarizing tapered preps. Found no sig differnce in the bacteria remaining in preps w/ apical enlargement vs ones w/o.
Coldero 2002 Shaping enlargement Used 4% NaOCl as irrigant. Tapered preps allow enough coronal flare to facilitate irrigation deep in the prep.
A preliminary study of the
percentage of GP filled area
in the apical canal filled w/ Used a Touch N Heat in a multiple wave 2 to 4 mm from the apex. Found that GP was better adapted (96% of the area filled) when heat
Wesselink, vertically compacted warm is applied to w/in 2 mm of the apex. 87% of the area was filled when heat applied to w/in 4mm. The size of the apical portion also played a
Wu 2002 Obturation GP role. The wider roots had poorer adaptation.
A study on the thickness of
radicular dentine and
Bellucci, cementum in anterior and Wall thickness varied greatly, the L wall was usu the thickest. The M and D walls were the thinnest. The walls in the apical third were very
Perrini 2002 Morphology premolar teeth thin as well.
Irrigation / Influence of CaOH intracanal CaOH2 medicated canals showed sig more dye leakage than non-medicated canals when a ZOE sealer was used. Diff to remove all of
Kim 2002 Medication medication on apical seal the CaOH2. When combined w/ a ZOE sealer, a calcium eugonolate is formed which weakens the sealer in the long-term.
Comparison btwn a
conventional technique and
two bone regeneration
Valencia, Surgical techniques in periradicular Using a GTR barrier alone or a GTR w/ hydroxylapatite showed more predictable healing at 12 mo when compared to conventional surgical
Tobon 2002 Endodontics surgery tx. Using both GTR and HA had the best results. Both a radiographic and histologic evaluation were done.
Inflammatory response to
Irrigation / different endodontic irrigating 0.5% NaOCl induced an inflamm response while 2% CHX did not. Irrigants were injected into the peritoneal cavity of mice. CHX
Tanomaru 2002 Medication solutions recommended as an alternative in hypochlorite allergic pts and in crestal perforations. CHX does not dissolve tissue.
Calcium sulfate as a bone
substitute for various Calcium sulfate was effective in assisting w/ bone regeneration of large osseous defects and through and through bony lesions. It was not
Surgical osseous defects in effective in osseous defects connecting w/ the ging sulcus. This material is resorbable, easy to place, biocompatible, osteogenic and cost-
Suda 2002 Endodontics conjunction w/ apicoectomy effective. Does not act as a barrier b/c it is resorbed w/in 8 wks.
Periapical changes following Extended a 10-17 yr F/U another 10 years and found that late PA changes favored success. 14/17 teeth that showed late healing had an
Molven, Success/failur root canal tx observed 20-27 over-extension of material. Small lucencies around surplus material should not be interpreted as failures. Of the 265 roots, 95% were
Halse 2002 e years postoperatively successful at 20-27 years. Success was defined as normal or slightly widened PDL.
Comparison of Diaket and
MTA when used as root-end
filling materials to support
Witherspoon, Retrofilling regeneration of the
Gutmann 2002 Materials periradicular tissues
Eval of 5000 endodontic txs:
Incidence of the opened Avoid leaving a tooth open unless nec. The longer a tooth is left open, the more attempts before a closed tooth remains asymptomatic.
Bence 1980 Emergencies tooth Almost half the teeth left open had to be re-opened.
Managing the abscessed Instrumenting and closing abscessed teeth that were left open for drainage at the same appt does not lead to a high incidence of acute
August 1982 Emergencies tooth: Instr and close - Part 2. exacerbations. Only about 5% had flare-ups. Teeth w/ PA lucencies were more likely to have flare-ups than teeth w/o PA lucencies.
Preoperative and operative
factors assoc w/ pain after The chance of post-op pain is strongly assoc w/ a few factors. 1. Pre-op pain in a non-vital tooth. 2. Large radiolucency (> 5mm). 3. The
Wesselink 1987 Emergencies the first endodontic visit number of root canals in the tooth. 4. Possibly females, although not consistent w/ other studies.
Emergency pulpotomy: pain 96% of pts reported satisfactory pain relief immed post-tx. After 1 d. post-op, none of the pts reported pain. Dressings had no effect on
relieving effect w/ and w/o the post-op pain. Cleaning of the root canal and placement of a temp seal was the major cause of pain relief. CMCP, Cresatin, Eugenol and
Hasselgren 1989 Emergencies use of sedative dressings saline were used as well as ZOE cement.
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Acute pulpal-alveolar cellulitis
syndrome Part I. Clinical
study of bacterial isolates
from pulps and exudates of
intact teeth, w/ description of Strep is the major group of microbes assoc w/ acute odontogenic infection. Anaerobes, primarily gram neg, also play a substantial role.
Matusow 1979 Emergencies a specific culture technique Comments: strep is responsible for pus production.
Describes a theory for Flare-ups. Facultative anaerobes can grow much more rapidly in the presence of O2. Opening a tooth, gives these
Endodontic flare-ups: bacteria the metabolic fuel to grow rapidly. Also describes the complement cascade and it's relation to inflamm. C3: histamine release.
Bacteriological and C5: chemotactic for granulocytes. C6: bone resorption. C9: cell lysis and and triggering of the cascade (self-perpetuates). With this in
Naidorff 1985 Emergencies immunological mechanisms mind, it may be a good idea to Rx antihistamine to pts experienceing flare-ups.
Describes methods that might be helpful in alleviating discomfort for the pt. Educate and inform pt of what is involved with the procedure.
Patient empowerment: a Distract the patient during the tx, monitors and explanations of what you are doing as you are doing it. Make sure pts understand what to
stratgy for pain management expect post-op and relay what is normal. Have pts call the next day to see how they are doing. Administer analgesics pre-op and/or post-
Selden 1993 Emergencies in endo op.
Leaving the pulp chamber
open for drainage has no Leaving a tooth open for drainange had no effect on the incidence of flare-ups or other complications. On the rare occasions that you have
effect on the complications of to leave a tooth open, does not necessarily cause problems. They did find an inc amt of gram neg bacteria in teeth that were left open.
Tjaderjane 1995 Emergencies root canal therapy Cite Trope 90: The most effective method to prevent flare-up is complete chemo-mechanincal debridement.
Treatment of the endodontic Compared trends btwn 1977 and 1988 on how diplomates treated emergencies. Found that fewer are leaving teeth open, more are
Dorn 1990 Emergencies emergency: a decade later treating single-visit for vital cases, more are instr to the apex, and CaOH2 use is inc.
Needle aspiration: An Needle aspiration allows you to re-direct the needle to locate purulence. Scarring is reduced. Purulent matter is contained, ready for
Simon 1995 Emergencies alternative to I&D culturing. The main disadvantage is that if the swelling is diffuse, only blood will be obtained.
Incidence of pain following 247 teeth had single-visit endo. 90% had no or little spontaneous pain. 82% had little or no AAP. Pulp vitality was not a sig predicting
Fox 1970 One-visit one-visit endo tx factor. Teeth w/o PARL did seem to have slightly more AAP than those with. Overinstr and over filled teeth also had more post-op pain.
A comparative study of the Sig more pain occurred after single-visit than multi-visit...but their data shows that in both categories 86% and 81% had little or mild pain
single-visit and the mult-visit after 3 d. The mulit-visit had more in the "no pain" category. They showed no diff in healing, and whether the canals were overfilled or
Soltanoff 1978 One-visit endo procedure underfilled. Irrigated w/ saline and obturated using Kloroperka.
Incidence of post-operative
pain after one-appt endo tx of
asymptomatic pulpal necrosis
Patterson 1982 One-visit in singel rooted teeth No diff in pain whether tx was single or multi-visit. The occurrence of pain proved to be unpredictable.
Single-vist endo- A clinical
Oliet 1983 One-visit study Single visit and multi-visit did not differ sig in post op pain or healing.
Incidence of post-op pain
after singel-visit and multi- Single visit methods resulted in 1/2 the pain experience of mulit-visit…the fewer times you go in, the less chance of post-op sens. Pulp
Roane 1983 One-visit visit endo procedures status was irrelevent, and tooth type didn't matter.
Effective one-visit therapy for 19 pts w/ fluctuant swellings. Tx'd w/ I&D, single visit RCT, and Ab. Pts experienced sig dec pain and swelling. They were asymptomatic
Southard 1984 One-visit the acute PA abscess and showed rdx signs of healing at 1 yr.
Relationship of intracanal
medicaments to endo flare-
Trope 1990 Flare-ups ups Incidence of flare-up was independent of intracanal med used (Formocresol, Ledermix, CaOH). Flare-ups did not occur in teeth w/o PARL.
Flare-up rate of single-visit Teeth w/ and w/o PARL can be tx in single visit safely (0% and 1.4% flare-up respectively). Teeth w/ PARL and prev RCT should not be tx
Trope 1991 Flare-ups endo in one visit (13.6% flare-up)
Endo interappt flare-ups: A

prospective study of 3% flare-up rate. Pt sx pre-op were strongly assoc. Pulp and PA status were also sig assoc, esp AAA (13%). Number of visits were not
Walton 1992 Flare-ups incidence and related factors sig. Flare-ups were roughly equal in groups that were partially debrided vs ones that were fully debrided.
Incidence of interappt
emergency associated w/
Friedman 1992 Flare-ups endodontic therapy Potential for flare-up grtr in non-vital teeth, roughly 2:1.
Flare-up rate in pulpally
necrotic molars in one-visit
Eleazer 1998 Flare-ups vs. two-visit endo tx Little or no diff in flare-up rate btwn single and mulit-visit.
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Karmali,
Histologically studied 85 perio Merchant, Davis
affected teeth. Found a profusion of accessory canals in the bi- and tri-furcation areas of molars. 1/4 of the
pulps were atrophic, 1/2 were inflammed, 1/5 were necrotic. Perio and rest compromised teeth had a grtr degree of pulpal dz than either
Seltzer, The interrelationship of pulp group alone. Pulp lesions had an effect on the severity of perio lesion b/c of the perculation through accessory canals along the root.
Bender 1963 Endo/Perio and perio dz Comments: are their findings much different than the other studies?? All these pulpal changes may not be due to just perio.
Simring, The pulpal pocket approach: Points out cases that have refractory perio that resists perio tx but resolved after RCT. Pointed out a success rate of 89% in these cases.
Goldberg 1964 Endo/Perio retrograde periodontitis Retrograde periodontitis occurs from the bacterial egress from an inflammed/nec pulp through various formena.
No relationship was found between severity of perio dz ( as measured by exposed root surface) and changes in the pulp. Paired control
Influence of periodontal dz on teeth from the same pt showed similar pulpal conditions regardless of perio status of tooth. This is one of the best controlled studies on
Massler 1964 Endo/Perio the dental pulp the subject.
Perio dz bacteria and pulpal 60 perio involved teeth were extracted and examined histologically. Effect of perio dz on pulp was inflamm, calcifications, resorption, and
Langeland 1974 Endo/Perio histology dentinal apposition. The pulp is likely to remain vital unless all major foramena are involved w/ bacterial plaque.
Effect of experimentally
induced marginal perio and Induced perio lesions in monkeys over 5-7 mo and evaluated effect on the pulp. Found that perio did not cause severe (only mild)
perio scaling in the dental alterations in the pulp. Alterations may have been more severe if a longer period of experimentation was used. Also, none of the perio
Bergenholtz 1978 Endo/Perio pulp lesions reached the apex. They did not find any lateral canals in the area of the perio lesions, which also could have had an effect.
A histological eval of the
human pulp in teeth w/
varying degrees of
Schilder 1979 Endo/Perio periodontal dz \
The perio-endo question: diff
Harrington 1979 Endo/Perio dx Defines different lesions, how they might occur and how to diagnose them. Great review.
Similarity of Wollinella recta
strains isolated from perio DNA homology btwn perio lesion bacteria and root canal isolates suggest that the perio pocket is a source of infectious strains for root
Sundqvist 1982 Endo/Perio pockets and root canals canal infections.
Gargiulo 1984 Endo/Perio Endo-perio interrelationships Describes how to diagnose and treat endo-perio lesions. Uses Simon's classifications.
Root planed rat molars and histologically looked at the pulps at intervals upto 12 mo. Found reparative dentin along the pulpal wall facing
Pulpal reaponse to root the instremented region. The pulp showed no inflamm. Contralateral, uninstr control teeth also showed a deposition of reparative dentin
Hattler 1984 Endo/Perio planing in a rat model indicating a possible central component to reparative dentin formation.
A histologic evaluation of
dental pulp tissue of a pt w/ Extracted perio involved teeth from single pt with differing levels of perio dz. No correlation was found btwn attachment loss and
Torabinejad 1985 Endo/Perio perio dz morphologic changes in the pulp.
Pulpal response to the topical Citric acid (pH 1.0) applied to root planed regions of roots in cats does not produce a pulpal response. Periodontists use citric acid to
application of citric acid demineralize roots so as to expose collagen to facilitate CT attachment. Citric acid is also antibacterial and removes endotoxin for the root
Johnson 1985 Endo/Perio following root planing in cats surface.
Controversy still exists over primary perio/secondary endo. Describes theoretical pathway for this to occur. A perio pocket forms which
Lombrianidis, Periodontally derived pulp exposes the root surface w/ dentinal tubules, resorptive defects and lateral canals to the oral environment. States that the pulp has a high
Dengari 1988 Endo/Perio lesions level of resistance to periodontally released toxic substances as long as the main apical foramen remains intact.
Stands the concept of root planing on its head. Root planing does not promote attachment of perio fibers. Furthermore, it removes
Endo effects of root planing cementum and exposes dentinal tubules. Localized pulpitis was found adjacent to root planed surface and in some samples, bacteria was
Wong, Clark 1989 Endo/Perio in humans found in the tubules. Study included only 10 human teeth.
Similarities in the microflora Points out the similarities in the micrflora assoc w/ both perio and endo infections. Supports the theory that infections can spread from one
of root canals and deep site to another. Bacteroides, fusobacteria, eubacteria, spirochetes, wolinella are the major players. Comments: The profile of endo
Kerekes 1990 Endo/Perio periodontal pockets pathogens looks very similar to the profile of perio pathogens.
The potential of perio pocket
formation associated w/
untreated accessory root Resected 6 roots from endo failures w/ deep perio pockets and bone loss around the root. All six roots had missed canals. The remaining
Stewart 1990 Endo/Perio canals necrotic tissue and bacteria caused the periradicular pathosis.
Two approaches to the tx of
Zubery, true combined perio-endo Two endo-perio lesions were present in the same pt. One was tx w/ apcial surg and root planing. Thee other had NSRCT and bone graft.
Kozlovsky 1993 Endo/Perio lesions Both healed equally well. Proper dx and removal of the etiological factors can restore health in cases of severe attachment loss.
Long-term eval of endo and Looked at 195 endo and perio tx teeth 8-9 yrs post-op. 91% were well maintained. 12 teeth w/ endo were lost….8 for perio reasons, 3
Machtou 1995 Endo/Perio perio tx were fx , and 1 was caries. The risk for endo failures in this group is very low.
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Glickman 1997 Endo/Perio
The influence of endo tx
upon perio wound healing
The influence of endo
Jansson, infection of perio status in Md
Ehnevid 1998 Endo/Perio molars Endo infection in perio involved Md molars was assoc w/ grtr PD and more attachment loss in the furcation area.
Presurgical crown contouring
Kirchoff, for root amputation
Gerstein 1969 Endo/Perio procedures Describes how to do a root amp.
Langer, An eval of root restection: A 38 of 100 cases failed. 16% of those failures occurred w/in the first 5 yrs. Md molars failed twice as often as Mx molars. Md molars failed
Wagenberg 1981 Endo/Perio ten year study mostly due to fx.
Hemisection and root
Green 1986 Endo/Perio amputation Gives definitions of hemisection and root amputation. Describes technique and tx planning considerations.
Eval of root resected teeth- 32% failure rate at 10 yrs. Similar to Langer. Few failures occurred before 5 yrs. Reason for failure was different than Langer. Here, endo
Buhler 1988 Endo/Perio results after 10 years failures were more predominant. Only 28 cases studied and most of the endo failures occurred in two patients (host susuceptibility).
Barrier membranes can enhance the quality and quantity of bone regeneration. The size of the lesion is the most important factor in
determining the typw of healing that occurs. Barriers work by slowing the infiltration of CT components into the wound site and giving time
for osteogenesis to occur. Membranes and Ca Sulfate are discussed. Ca Sulfate is easier, more cost effective and may give better
Barrier membrane techniques results. Indications and techniques for each are given. Comments: Ca Sulfate resorbs w/in 3-4 weeks. Not quite long enough for
Pecora, Kim 1997 Endo/Perio in endodontic microsurgery osteogenesis to occur. Good to use as a space filler or as a hemostatic agent.
Guided tissue regeneration in
Danesh- the management of severe
Meyer 1999 Endo/Perio perio-endo lesions Reviews the management of perio-endo lesions w/ GTR.
Coronal
Leakage, A root canal can be sealed effectively by the use of GP and an adequate sealer. Only minor differences could be found btwn the different
Bleaching, sealers used. Obvious microleakage occurred when the coronal portion of the root canal was exposed to isotopes. Kerr w/ GP showed the
and Cervical The sealing of pulpless teeth least marginal leakage. Good study to cite as to why we use Kerr. Weaknessess of study: radioisotopes were used and the results were
Massler 1961 Resorp evaluated w/ radioisotopes obtained only after 24 hrs, meaning that the sealers did not fully set.
Coronal
Leakage, An evaluation of coronal Used AH26, Sealapex and Roth's w/ laterally condensed GP. Exposed to artificial saliva for 7 d, then in dye. AH26 showed sig more
Bleaching, microleakage in leakage than the other two. Sealapex showed the least but is not sig different than Roth's. Comments: Sealers were allowed to set for
and Cervical endodontically treated teeth. only 48 hours, is this enough time for the sealers to set?? The standard deviation on these, esp Sealapex, were huge. Means that
Madison 1987 Resorp Part II: Sealer types technique must play a large role. Take this to mean that sealers leak, don't take amount of leakage too seriously.
Coronal Sealer study repeated in monkeys using AH26, Sealapex and Roth's. Exposed to oral environment for 7 d. Dye penetration occurred in all
Leakage, An evaluation of coronal groups w/ considerable variability w/in each group. AH26 showed the most leakage and Sealapex showed the least, but differences were
Bleaching, microleakage in not significant. Shows the differences that can be obtained between in vitro and in vivo studies. Comments: This shows that dye studies
and Cervical endodontically treated teeth. may not accurately depict the actual biologic situation. Dye leakage studies only tell you if you have a perfect seal or not. It tells you
Madison 1988 Resorp Part III: An in vivo study nothing else.
Coronal
Leakage, Bacterial leakage to the apex occurred w/in 10-51 days. The average for the non-motile S. epidermis was 24 d. while the average for the
Bleaching, In vitro bacterial penetration very motile P vulgaris was 49 d. Motility may not play a role in rate of leakage. Bacterial leakage studies paint a different picture than dye
and Cervical of coronally unsealed endo tx and isotope studies. Comments: Torabinejad and Khayat did a f/u study w/ the same model but used whole human saliva and found an
Torabinejad 1990 Resorp teeth avg of about a month before leakage reached the apex.
Coronal
Leakage,
Bleaching, Human saliva coronal Study suggests re-tx for canals which have been exposed to saliva for grtr than 3 mo. The time intervals for this study were 2,7,14,28 and
and Cervical microleakage in obturated 90 d. Sig diff was noted btwn 90 d and the rest. Possible that leakage could have occurred btwn 28 and 90 d, so the 3 mo suggestion is at
Magura 1991 Resorp canals, an in vitro study the top end of the range.
Coronal
Leakage, All 30 teeth showed leakage at the gingival crown margin which extended to the pulp. Crown margin design does not seem to play a
Bleaching, significant role. Cemented w/ Zn PO4 cement. The unimpeded lethal highways of freshly cut, open dentinal tubules are the cultprit.
and Cervical Microleakage- full crowns and Comments: could cite this study along w/ Valderhag as to why a tooth w/ a handsome crown could become necrotic. Also keep in mind
Goldman 1992 Resorp the dental pulp that these are EXT teeth so you don't have intra-pulpal pressure and immunoglobulins preventing ingress.
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Coronal
Leakage,
Bleaching, An evaluation of 3 materials GI leaked the most when compared to Barrier Seal and TERM. Barrier Seal was the best but not stat different from TERM. The GI and the
and Cervical as barriers to coronal TERM were only placed 2 mm thick. Barrier seal can be placed in a minimal thickness and does not affect amal or comp, so it might be
Beckham 1993 Resorp microleakage in endo tx teeth worth a try.
Coronal
Leakage,
Bleaching,
and Cervical Coronal leakage as a cause
Saunders 1994 Resorp of failure in root canal therapy Coronal leakage is a major cause of root canal failure. Proper regard must be paid to minimizing this during and after RCT.
Coronal
Leakage, Clinical evaluation of
Bleaching, bacterial leakage of
and Cervical endodontic temporary filling Cavit, IRM and TERM were used in vitro to evaluate leakage at three weeks. 0/19 of the Cavit temps leaked. 1/18 IRM leaked, not stat
Hutter 1996 Resorp materials sig. 4/14 TERM samples leaked. Cavit and IRM are superior to TERM. 4mm increments of each were placed. 50/51 temps were class 1.
Coronal Microleakage of human
Leakage, saliva through dentinal
Bleaching, tubules exposed as the
and Cervical cervical level in teeth treated Demonstrates in vitro that the root canal fill can be contaminated via patent dentinal tubules exposed to saliva. The longer the exposure,
Berutti 1996 Resorp endodontically the greater the leakage. Root planing and acidic diet can be the main culprits in exposing dentinal tubules.
Coronal Leakage associated w/ load
Leakage, fatigue induced preliminary
Bleaching, failure of full crowns placed
and Cervical over different post and core Para-Post, Flexi-post and custom cast P&C were evaluated for failure and leakage in vitro. No stat sig diff in leakage or failure in the three
Harrington 1998 Resorp systems post systems. All restorations leaked to some extent. Comments: the main point of this article is that clinically intact crowns still leak.
Coronal
Leakage,
Bleaching, Intra-orifice sealing of GP Looked at leakage of Cavit, IRM and Super-EBA using human saliva and scintillation tubes. Temp materials were placed as intra -orifice
and Cervical obturated root canals to seals 3.5mm thick. At 90 days, 85% of Cavit group were leak free, 35% of the IRM and Super EBA groups were leak free. The orifice
Mclanahan 1998 Resorp prevent coronal microleakage might be the logical place to initiate a coronal seal, but is it convenient to remove?
Coronal
Leakage, Periapical status of root filled Looked at 55 matched pairs a minimum of 3 yrs post op for signs of PA infections and its correlation to coronal seal. Found PARL in both
Bleaching, teeth exposed to the oral sealed and open teeth. Open teeth healed and sealed teeth failed. Nothing was stat sig. Poses the question that may be the coronal seal
Bergenholtz, and Cervical environment by loss of is not as important as people think. This study was underpowered. Odds ratios show that an open tooth is 3X as likely to fail, not stat sig
Ricucci 2000 Resorp restoration or caries b/c of small numbers.
Coronal
Leakage,
Bleaching, Correlation between clinical
and Cervical success and apical dye Apical dye leakage study in 116 extracted teeth w/ RCT. They were clinically and rdx deemed success or failures. 95.5% of these teeth,
Oliver, Abbot 2001 Resorp penetration regardless of clinical dx showed dye leakage through the apex. Penetration of dye is not a reliable indicator of clinical success or failure.
Coronal
Leakage,
Bleaching, External resorption Presents the theory that Superoxol can cause inflammation by leaching through patent cervical dentinal tubules into the periodontium.
Harrington, and Cervical associated w/ bleaching of Case reports of cervical resorption. Similarities btwn cases included young age, traumatic devitalization, heat and caustic agent used for
Natkin 1979 Resorp pulpless teeth bleaching and resorptions were limited to the cervical third.
Coronal
Leakage,
Bleaching,
and Cervical Postbleaching cervical Presents a case report where cervical resorption occurred w/o the application of heat, just bleaching agent. Comments: In general 3 things
Latcham 1986 Resorp resorption that can cause resorption are a young pt w/ hx of trauma, use of superoxol and the application of heat.
Coronal
Leakage,
Bleaching, Diffusion of bleaching agents alone through patent dentinal tubules alone may be sufficient to cause resorption. Pt must be made aware of
and Cervical External cervical root the possible risks and should be followed carefully. Addition of heat or acid etching to speed the results of internal bleaching may be
Cohen, Goon 1986 Resorp resorption following bleaching considered over treatment and increase the risk of resorption unnecessarily.
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Coronal
Leakage,
Bleaching, Case report. Base should be placed to protect cervical tubules. Suggest that CaOH be placed in the chamber for 2 d after bleaching to
Schindler, and Cervical Management of post possibly prevent resorption. Carefully follow pts. Should resorption occur, initiate CaOH therapy. Extrusion and crown lengthening may be
Gimilin 1990 Resorp bleaching cervical resorption indicated to repair defect.
Coronal
Leakage,
Bleaching, Cervical root resorption
and Cervical following bleaching of Used various bleaching methods in dog teeth. Found that 30% H2O2 in combination w/ heat was more assoc w/ resorption than any other
Walton 1990 Resorp endodontically treated teeth method. No single reason could be isolated for the cause of resorption.
Coronal
Leakage,
Bleaching, Effect of cementum defects Teeth w/ cemental defects at the CEJ were significantly more permeable to 30% H2O2 than teeth w/o defects. When defects were placed
and Cervical on radicular penetration of in the middle third leakage was also observed but to a lesser degree than the CEJ defects. GP does not prevent the penetration of H2O2
Rotstein 1991 Resorp 30% H2O2 during bleaching deeper into the canal. Another reason to use a base.
Coronal
Leakage,
Bleaching, Incidence of invasive cervical 2% of 204 teeth tx showed cervical resorption after bleaching. All of the resorptive cases were assoc w/ hx of trauma, though 75% of the
and Cervical resorption in bleached root entire sample had hx of trauma. No base was placed. Canals were obt w/ GP and AH26. The AH26 may have a sealing ability superior to
Heithersay 1994 Resorp filled teeth other sealers.
Coronal
Leakage,
Bleaching, Cementoenamel junction: Microscopy shows an irregular and sinuous length of the CEJ in almost all specimens. The most frequent pattern was enamel overlapped
Neuvold, and Cervical Microscopic analysis and by cementum, followed by edge to edge and gap patterns. The occurrence of dentin exposure at the CEJ can cause a focal inflamm
Consolaro 2000 Resorp external cervical resorption process.
Coronal
Leakage, Effect of fatigue testing on
Bleaching, core integrity and post
and Cervical microleakage if teeth restored Regardless of post system, all leaked after fatigue testing. The more cycles of fatigue --> the more leakage. Some even leaked prior to
Kazemi 2003 Resorp w/ different post systems fatigue loading. No real difference in post systems. Comments: everything leaks all the time!!!!
Pulp Histopathological study of EMD group showed an inc in tertiary dentin deposition. Implies that EMD has a substantial effect on odontoblasts. This tertiary dentin
Physiology dental pulp tissue capped w/ deposition seemed to occur all along the dentin walls. Comments: not necessarily a good thing to form dentin all along the walls because
Ishizaki 2003 and Pathology enamel matrix derivative canals will calcify making RCT more difficult.
Antimicrobial activity of Used agar plates and paper disks containing AH26, Sealapex, Kerr EWT and Roth's 801. Zones of inhibition were measured. ZOE based
endodontic sealers on E. sealers did well with Roth's the best, and Kerr EWT. Sealapex was third and AH26 had no antimicrobial activity. Comments: Roth's has
Mickel 2003 Sealers faecalis the longest setting time and therefore has more free eugenol for a longer time.
The comparative sealing
ability of hydroxyapatite
Retrofilling cement, MTA, and Super-
Stevens 2003 Materials EBA as root end fillings No sig difference in the sealing ability of any of these.
Effect of intraosseous
injection of Depo-Medrol in
pulpal conc of PGE2 and IL-8
in untreated irreversible Gave intraosseous injections of steroid to pts w/ IP. Teeth were ext and amts of PGE2 and IL-8 were looked at. Steroid decreased amts
Reader 2003 Flare-ups pulpitis for about 24 hours then conc matched placebo. Comments: is it worth it for just a 24 hour decrease??? Probably not.
Effectiveness of stannous
Irrigation / fluoride and CaOH against E. Used agar plates and paper disks containing Stanimax, CaOH, or a combination of both. Zones of inhibition were measured. Stannous
Mickel 2003 Medication faecalis fluoride showed the largest zone of inhibition, then the combination, then finally CaOH. CaOH is not effective against E. faecalis.
Does an experiment on cats to show that a pulpitis can occur if the pulp is irritated and there is a subsequent systemic transient
bacteremia. Made cavity preps in cats and placed an irritant on the dentin. The cats were then injected in the leg w/ bacteria. At different
The anachoretic effect of time intervals, the cats were sacrificed and the pulps were cultured. 72% of the irritated pulps were infected while only 6% of the control
Robinson, Anachoresis / pulpitis. I. Bacteriological teeth showed infection. The control teeth had not been prepped. 1 of the 3 teeth prepped but not irritated showed an infection. All the
Boling 1941 Bacteremia studies experimental teeth were left open to the oral environment.
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The incidence ofKarmali, Merchant,
bacteremia following endo w/inDavis
the confines of the canal is 0%. If filing is done vigorously for 10 minutes beyond the
apex, the incidence is 25%. This was done w/o a RD, so as to purposefully attempt to induce a bacteremia. All bacteremias that were
Seltzer, Anachoresis / The incidence of bacteremia caused were transient in nature and only lasted < 10 min. The more trauma induced, the grtr chance of bacteremia. Endo is the least
Bender 1960 Bacteremia in endodontic manipulation traumatic when compared to EXT and perio.
The incidence of bacteremias
related to endodontic When RCT is confined to w/in the root canal, bacteremias do not occur. 1/30 (3%) chance of bacteremia if canal is over instrumented.
Anachoresis / procedures. I. Non-surgical Took blood samples from 30 pts and sought to compare the bacteremia, if present, to the bacteria in the pulp. The only bacteremia
Baumgartner 1976 Bacteremia endodontics occurred in a necrotic case that was over instrumented. Done under strict asceptic conditions.
Inflammatory reaction in the Did pulpectomies in dogs to the level of the apical delta. 3 mo later, they injected colloidal carbon to map any vascular changes assoc w/
Allard, Anachoresis / apical area of pulpectomized these teeth. Colloidal carbon was noticed around the apical deltas and the periodontium of pulpectomized teeth. Increased vascular
Stromberg 1979 Bacteremia and sterile root canals. leakage or changes occur in the area.
Localization of blood borne Showed that treated but unfilled root canals would not get re-infected by a percolation of tissue fluids into the canal because the pulpless
Anachoresis / bacteria in instrumented canal has no blood flow. Did pulpectomies on cats, violated the apical foramen and left the canals empty and coronally sealed. Artificial
Delivanis 1981 Bacteremia unfilled root canals bacteremia was induced. Exudate in the canals 4 days later showed neg cultures for the bacteria used.
During a bacteremia, pulp irritated by CaOH will attract bacteria from the bloodstream. This bacteria will be more localized around the area
Experimental bacterial of irritation. The more irritated the tissue, the more bacteria is attracted. Also, more bacteria is attracted early on in the inflammation rxn.
Anachoresis / anachoresis in dog dental Did pulp caps in dogs w/ CaOH and Teflon. Injected bacteria into their leg. Teeth were extracted and evaluated histologically. Control
Tziafas 1989 Bacteremia pulps capped w/ CaOH teeth and most of the Teflon teeth did not show an ingress of bacteria...implies that this is due to the lack of inflammation.
A bacterial study of human

Winkler, Anachoresis / periapical pathosis employing Bacteria usu exist w/in a chronic PA granuloma. 15 teeth were extracted w/ intact granulomas to rule out other sources of contamination
Healey 1972 Bacteremia a modified gram tissue stain. and bacterial staining was carried out.
Pulpal and pericapical tissues

responses in conventional
Korzen, Anachoresis / and monoinfected gnotobiotic The severity of pulpal and PA inflammation can be related to the quantity of microorganisms in the root canal and the length of time that the
Green 1974 Bacteremia rats tisssues were exposed to them.
Histological evaluation of the Argument against anachoresis. Monkey pulps were exposed to the oral environment for 7 days then sealed w/ amal. 7 mo later, en bloc
Anachoresis / presence of bacteria induced resections were made. Bacterial staining shows bacterial presence in the canals, but no bacteria was noted in the apical granulomas.
Walton 1992 Bacteremia periapical lesions in monkeys Bacteria in monkey canals seem to remain w/in the canal and infection of the PA lesion via a hematogenous route does not seem to occur.
Root canal cover-up
exposed. The resurgence of
Anachoresis / the refuted focal infection
Glassman 1998 Bacteremia theory Describes Meinigs ideas about focal infection theory.
Anaerobic bacteremia and
fungemia in patients Used phenotyping and genetic tests to verify the presence of oral bacteria in the general circulation during and 10 minutes after RCT. Two
Anachoresis / undergoing endodontic groups, one instr long and the other w/in the canal. The group instr long had more oral bact circulating, but it was not statistically sig.
Tronstad 1998 Bacteremia therapy: an overview Found bacteremias present 31-54% of the time, though no data was offered in support.
Endodontics 1776-1976: A
bicentennial history against
Anachoresis / the background of general
Grossman 1976 Bacteremia dentistry A history of dentistry. Very interesting stuff.
A preliminary investigation of
the "Hollow Tube" theory in Found that there is an interchange of fluids in and out of the tube. No inflamm was found at the open end of the tube. Used hollow teflon
Anachoresis / endodontics" Studies w/ tubes sealed at one end w/ cavit. Tubes were filled w/ substance that turns blue when in contact w/ tissue fluids. Implanted into rat's
Goldman 1965 Bacteremia neotetrazolium backs. Blue coloring was noted in a fibrous capsule surrounding the open end of the tube. Refutes hollow tube theory.
A bacteriological and Histologically examined and cultured samples of PA tissues from 58 non-healing PA lesions. 29 of the lesions communicated w/ the oral
Anachoresis / histological evaluation of 58 cavity (vert fx, sinus tract, perio pockets) and 29 did not. Found that close to 90% of the lesions contained bacteria. Most of the bacteria
Wayman 1992 Bacteremia periapical lesions were anaerobes.
Predominant indigenous oral
Moller, bacteria isolated from Found a predominance of obligate anaerobes (85-98%), mainly Bacteroideds and gram pos rods. Facultative anaerobes were found in
Fabricius, Anachoresis / infected root canals after smaller quantities. The proportion of obligate anaerobes inc w/ time. 24 root canals were examined in 3 monkey over 3mo, 6mo, and 3yrs.
Dahlen 1982 Bacteremia varied times of closure Teeth were accessed, exposed to oral environment and sealed.
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Karmali,
Indigenous oral bacteria Merchant,
isolated Davis
from their previous monkey study were inoculated into monkey teeth in equal proportions and sealed for 6
mo. It was found that the bacteria were capable of re-establishing themselves and surviving. Also, even though the different bacteria were
placed into the canal in equal proportion, the original proportion from the previous study was restored. Confirms that some bacteria are
Moller, Influence of combinations of more capable of surviving than others. Bacteroides was the most prominent bacteria isolated. When bacteroides was inoculated
Fabricius, Anachoresis / oral bacteria on periapical sperately, it was unable to survive. Bottom line: indigenous bacteria are capable of inducing apical periodontitis and combinations of bact
Dahlen 1982 Bacteremia tissues of monkeys are more capable than single strains.
Root canal flora were isolated from 65 human teeth w/ apical perio. Relatively low number of species that were found indicate that there
are strong environmental pressures w/in the root canal. A strong inter-relationship was also found between different microbes and their
Associations between interactions are correlated to their respective concentrations. Environmental factors which play a role are available nutrients, oxygen
Anachoresis / microbial species in dental tension, and bacterial interactions. F. nucleatum was the most commonly found bacteria followed by P. intermedia, P. micros,
Sundqvist 1992 Bacteremia root canal infections Peptostreptococcus anerobius...
An investigation into the
Anachoresis / residual periapical infection 68% had bacteria in both the canal and the PA lesion. 23% had no bacteria in the canal or the PA lesion. 8% had bacteria in the canal,
Hedman 1951 Bacteremia after pulp canal therapy but not the PA lesion. Samples were taken through the canal in single rooted teeth using a cannula and a wire.
Pulp
Physiology Pain is comprised of perception and reaction. Dz of teeth are usu localized until pulp is affected, then referred pain becomes more
Glick 1962 and Pathology Locating referred pulpal pains prominent. Referred pain does not cross the midline.
Pulp
Physiology Calcific metamorphosis of the Should be regarded as a pathological condition and as a potential source of periapical infection. Should be treated orthograde as soon as
Patterson 1965 and Pathology pulp dx is made. If canal cannot be found, than retrograde approach should be attempted. Not a scientific study, an opinion paper.
Pulp Calcific metamorphosis of the Found an incidence of 4% of teeth undergo calc metamorph (sample size of 881). Even though this is a pathologic condition, very few
Physiology pulp: it's incidence and develop PA lesions. No correlation btwn diagnostic tests, discoloration, and EPT. Often times, the tooth will be negative to cold testing.
Holcomb 1967 and Pathology treatment The only definite criterion for endo intervention is the appearance of a PA lesion.
Pulp An experimental investigation Used custom arch plates w/ electrodes to EPT multiple teeth in 20 subjects and determine the freq of referred pain. Found that pulpal pain
Physiology into the localization of pain is not easy to localize, esp the more post you go. Pulpal pain can usu be localized to w/in one tooth on either side. Found 3% of the time,
Friend 1968 and Pathology from the dental pulp pain was referred to the other arch, and 1.5% referred across the midline, though most of these were Md centrals.
Pulp Describes possible systemic dz that have a pulpal consequence. Not much research has been done in this area, so the article is based
Physiology The effect of systemic upon case reports. Comments: In general, systemic dz that effect the pulp are infections (leprosy, actinomycosis, EBV etc.). They can all
Stanley 1972 and Pathology diseases on the human pulp infect the pulp.
Pulp To prevent damage to the pulp, tx should be focused towards reducing the permeability of dentin, not in causing the formation of secondary
Physiology Human coronal dentine: dentin. Secondary dentin is less mineralized so it is more permeable. Preserving as much primary dentin and reducing its permeability will
Mjor 1972 and Pathology Structure and reactions protect the pulp better.
Ischemic infarction of the Describes ischemic infarction of the pulp after trauma. If the main blood vessels are occluded most of the blood supply to the pulp is
Pulp pulp: Sequential compromised, although some accessiry canals will still provide some bood flow. This infarction prevents the inflamm rxn to cause repair.
Physiology degenerative changes of the The pulp changes into a granulomatous, hyperemic state. Many times, these teeth will remain in a period of limbo, w/o change until
Stanley 1978 and Pathology pulp after traumatic injury infected. Then they will progress to the classic necrotic pulp.
Can CAP occur before a pulp is totally necrotic?? Histologically examined 75 pulps from cariously involoved teeth w/ PARL. The size of
Pulp Pulp biopsies from the teeth the PARL was related to the amt of pulpal destruction. Teeth w/ small PARL may respond to sensitivity testing and usu reveal only coronal
Physiology associated w/ periapical necrosis. PA inflamm changes often develop before total inflamm of the pulp occurs. Intact nerve fibers can persist in pulps having severe
Langeland 1984 and Pathology radiolucency inflamm and partial necrosis. Comments: if you see a PARL but the tooth tests pos to cold, keep this article in mind.
Pulp Neurovascular interactions in Two key components in pulpal inflamm are microcirculation and nerve activity. Are they inter-related?. Excitation of A-deltas do not sig
Physiology the dental pulp in health and alter blood flow. C fiber activation causes an inc in blood flow, b/c Sub P released from nerve terminals. This inc in blood flow further
Kim 1990 and Pathology inflammation stimulates A and C fibers b/c of the inc in pressure. C fibers are more durable in a low blood flow environment.
Discusses the sensory neurpeptides in the pulp. All 3 originate in the Trigem Gan, are localized around the blood vessels in the pulp and
Pulp Neuropeptides in the dental have vasodilator effects. Sub P: causes vasodilation and plasma extravasation. CGRP: extends into the predentin and denitn, is sensory in
Physiology pulp: distribution, origins, and nature. Nerokinin A: belongs to the same family as SP and has the same precursors. Also discusses Catecholamine from the sympathetic
Wakisaka 1990 and Pathology correlation system, action is vasoconstrictive.
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Pulp
Karmali,
All dental materials Merchant,
leak. The more Davis
dentin exposed and the thinner the remaining dentin, the more leakage occurs. Smear layers and
smear plugs reduce permeability, but its presence reduces bind strength of dentin bonding agents. There is a balance btwn the rate of
Physiology Clinical considerations of bacterial diffusion and the rate that they are removed by pulpal circulation. Dec in circulation causes an inc in bacterial by-products leading
Pashley 1990 and Pathology microleakage to inflamm.
Made shallow, moderate and exposures in rat molars. 4 days later, used immunocytochemistry to look for CGRP. In all three, she found
significant CGRP nerve sprouting. The nerve sprouting lasted about 4 days. In exposed pulps, PA lesions developed in about 1 wk, even
Pulp Effects of injury and though much of the pulp was still vital. CGRP fibers continued to sprout around the PA abscesses. This nerve sprouting may explain
Physiology inflammation on pulpal and dentinal hypersens, episodic toothache (sprouting fluctuates w/ cycles of abscess formation and healing) and diff obtaining anesth in
Byers 1990 and Pathology periapical nerves inflammed teeth. Inc levels of CGRP was also found in the nerve trunks, some distance from the inflammed tooth.
Pulp SEM of the blood vessels of

Physiology dog pulp using corrosion Used low-viscosity resin to map out pulp vasculature in the dog. Found numerous AV anastamoses, VV anastomoses and U-shaped
Takahashi 1982 and Pathology resin casts arterioles.
Pulp Did cavity preps w/o water on dogs. Made resin casts of microvasculature 4 hours and 1 week post op. The acute (4hr) group showed
Physiology Pulpal vascular changes in localized increase in vascular permeability, but was otherwise normal. The chronic (1wk) group showed localized ulceration surrounded by
Takahashi 1992 and Pathology inflammation normal looking vessels. Numerous AV shunts could be seen in this area. May play a role in protection against chronic inflamm.
Pulp
Physiology Odontoblast response under A review of tertiary dentinogenesis. Odontoblasts may be regulated locally by factors, like TGF-b, that is stored in dentin and released
Magloire 1992 and Pathology carious lesions upon demineralization. TGF-b is highly relevant to the inflamm process and is closely related to BMP and Cartilage inducing factors.
Pulp Discusses the dental/pulp complex in response to injury. Macrophages are responsible for stimulating the differentiation of odontoblast-like
Physiology Dentin/pulp complex cells. In the absence of infection, these new cells differntiate and elaborate reparative dentin in a short period of time. The role of
Ten Cate 1992 and Pathology reactions: A reaction odontoblasts (which are really just fibroblasts) are to deposit collagen and mineralize it.
Sprouting of CGRP releasing fibers were closely assoc w/ sites of reparative dentin synthesis. Sprouting subsided as reparative dentin
forms. These fibers affect blood flow and vascular dilation by releasing neuropeptides (CGRP, SP…). Also directly stimulate inflamm cells
Pulp Effects of inflammation on (macrophages, mast cells...). Sprouting enhances delivery of neuropeptides to the injured pulp. Inc pain sens from sprouting also
Physiology dental sensory nerves and promotes guarding behavior of injured tooth. Innervated teeth had better pulp survival than dennervated ones, but the amount of
Byers 1992 and Pathology vice versa reparative dentin was the same in both.
Aging of the dental pulp involves both structural and neurochemical regressive changes. Main affects are hemoregulation of the pulp and
Pulp as a result, it may influence the viability of the pulp. It also may explain the age related reduction in sensitivty to pulpal stimulation. Loss of
Physiology Changes in pulpal nerves w/ neurochemical action may be due to either the loss of nerve fibers or a loss of nueropeptide expression. Reason for age related down
Fried 1992 and Pathology aging regulation of neuropeptides is unclear.
Correlation btwn thermal Found that the type of microflora in a deep carious lesion may play a role in thermally stimulated pulpal pain. Postitive correlation btwn
Pulp sensitivity and Bacteroides and heat sensitivity. The more lactobacilli present, the shorter the temp sens. Plausible explanation is that the bacterial
Physiology microorganisms isolated from metabolites from certain bacteria effect the nerves in the pulp differently. Pulp tested 29 cariously involved teeth before EXT and cultured
Hahn 1993 and Pathology deep carious lesions the bacteria present.
401 pulp caps done by students on carious pulp exposures. RD was used. No mention of hemostasis. Hard CaOH and base was placed.
Pulp capping of carious Followed up for 5 and 10 yrs. 31% follow-up rate. Almost half had failed at 5 yrs and 80% at 10 yrs. Placement of definitive restoration
Pulp exposures: Treatment w/in 2 days after exposure resulted in sig better results. Comments: This might be a good look at traditional pulp capping procedures.
Physiology outcome after 5 and 10 Today, however, materials and methods practiced by endodontists are different. A consesus is forming that CaOH might not be the best
Roulet 2000 and Pathology years: A retrospective. material to use. MTA or possibly a bonded resin might a better choice b/c it seals better.
Case report. Pulse granuloma is a foreign body rxn caused by legumes. Can occur if the pulp chamber is exposed due to caries or if the
Periapical Clinical significance of thetooth is left open during tx. Clinical implications: 1. Do not leave the tooth open. If you have to, do so for the shortest amt of time poss. 2.
Simon 1982 Pathology pulse granuloma If the chamber is exposed for an extended amt of time, possibiliyt of a pulse granuloma should be considered in refractory cases.
Stained 20 PA lesions for antibodies to establish the proportions of immunoglobulin positve B lymphocytes and plasma cells and their
distribution in endo tx vs non tx teeth. 81% of the inflamm cells did not stain for immunoglobulins, meaning that they were T cell or null
cells. Of the 19% that did stain positive, 74% stained for IgG, 20% for IgA, 4% IgE and 2% IgM. There was no stat sig difference in teeth
Antibody producing cells in that were endo tx vs non-tx. Indicates that NSRCT does not alter the humoral immune responses in PA lesions. Comments: These are the
Periapical human periapical granulomas normal proportions found in the body, so this is nothing extraordinary. This may not seem like a big deal today, but this stuff was only
Stern, Levy 1982 Pathology and cysts described only 20 years ago. This is realatively new stuff.
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Role of oral microorganisms Karmali, Merchant, Davis
in the pathogenesis of
pericapical pathosis. I. Effect
of S. mutans and its cellular
constituents on the dental Exposed cat canines to S. Mutans, either whole or fragments. Found that both induced severe PA dz. Even cell wall fragments of some
Periapical pulp and periapical tissue of bacteria may cause PA dz. Comments: Even if you kill the bacteria w/ intracanal meds, have you removed all the cell components?? Will
Stabholz 1983 Pathology cats these have a negative effect upon healing??
Case report of SOT-like epith proliferation in an odontogenic cyst. This looks similar histologically to a Squamous Odontogenic Tumor but
Squamous odontogenic the clinical and radiographic features are different. The SOT-like cyst has an epith proliferation that will not fill the cyst, otherwise it
Periapical tumor-like proliferations in behaves just like an ordinary cyst. The SOT is a benign odontogenic tumor, causes mobility, has mulitple radiographic lesions, and has a
Simon 1985 Pathology periapical cysts triangular or semi-circular lucencies assoc w/ the alveolar crest.
Cellulose fibers from
endodontic paper points as
an etiological factor in post Post endodontic lesions frequently display foreign body reactions. Looked histologically at 8 lesions dx as having foreign bodies. Found
Periapical endodontic periapical cellulose fibers in the lesions, probably from paper points. Cellulose, even in minute amts, can cause vivid inflamm reactions and cellulose
Koppang 1989 Pathology granulomas and cysts is not broken down by the body. Extreme caution should be used w/ paper points.
T cells, more so than B cells, are responsible for PA lesion pathogenesis. Futhermore, T helper cells predominate in actively growing
Kinetics of immune cell and lesions while T supressor cells predominate in chronic lesions. Temporally, tissue destruction is not linear but happens in bursts of activity.
Stashenko, Periapical bone resorptive responses to Induced PA lesions in rats and histologically examined lesions at different time points. Comments: Stashenko and Nair are the go-to guys
Wang 1992 Pathology endodontic infections for mechanisms of PA pathosis .
PA lesions contain low but significant amts of bone resorptive activity. This was unaffected by Polymixin B which nuetralizes LPS. This
discounts the direct affect of LPS in forming PA lesions, suggesting the presence of protein mediators causing resorption. Action of LPS
is probably to stimulate the production of cytokines from macrophages and lymphocytes. IL-1B and TNF-B are also elevated in sites of
Characterizations of bone resorption. TNF-B is produced by T cells (see Stashenko 1992.) Comments: In the old days, literature mentioned Osteoclast Activating
Stashenko, Periapical resorbing activity in human Factor (OAF) that somehow activated resorption. Today, it is found that OAF is really a combination of IL-1b, and TNF-b. These factors are
Wang 1993 Pathology periapical lesions host produced but stimulated by some foreign substance.
Induced PA lesions in ferrets and histologically examined them up to 12 wks out. All the RCT teeth showed a tendency towards healing, in
contrast to the non-treated controls. There was a deposition of new cellular cementum around the PA. An abundance of vascular
elements, fibroblasts and osteoblasts were also assoc w/ the treated teeth. There were fewer lymphocytes in the treated group as well.
Periapical Healing of induced periapical Expressed sealer showed signs of phagocytosis. Comments: The big deal is that they found the deposition of new cementum...at least in
Fouad 1993 Pathology lesions in ferret canines the ferret. So in healing, we are assuming that cementum regenerates around the apex.
Exposed rat molar pulps to the oral environment and measured the histometrical changes in the pulp and the PA tissues. Necrosis
Pulpal and periapical tissue increased from 1-28 days, with full necrosis at 28 days. Inflamm was already present at the PA in 3 days. Abscesses formed around the
Periapical reactions after experimental PA at 21 days. As soon as bacteria and their by-products leak past the apex, regardless of pulp vitality, they cause PA inflamm. This is
Yamasaki 1994 Pathology pulal exposures in rats. why it is possible to have a PA lucency w/ a partially vital pulp.
Periapical Squamous odontogenic Presents case reports. Rare, benign, arise from Rests of Malassez. Triangular, uni-locular expansile lucency in the alveolar process btwn
Baden 1993 Pathology tumor the roots of teeth. Mult sites 25% of the time.
Surgically excised 10 sinus tracts to evaluate them for the presence of epith lining. Found only one that was lined w/ eptih. Showed that it
Periapical The epithelized oral sinus is poss for tracts to be lined w/ epith, but that it is uncommon. These are clinically indistinguishable from tracts lined w/ granulation tissue
Harrison 1976 Pathology tract there was no correlation found w/ time lesion was present and the development of epith.
Microscopic examination of
oral sinus tracts and their
Periapical associated pericapical Microscopic examination of 30 sinus tracts. 100% were lined w/ squamous epith at the oral interface. 67% did not exhibit epith deeper
Baumgartner 1984 Pathology lesions than this. 33% showed epith extending the length of the canal. Sinus tracts were usu assoc w/ lesions grtr than 5mm.
Pulpal-periradicular pathosis
causing sinus tract formation
Periapical through the periodontal Case reports. Contibuting factors are root proximity, dilacerations, size/location of the lesion, virulence, preexisting perio, and host
Kelly, Ellinger 1988 Pathology ligament of adjacent teeth defense. Proper sensitivity testing is essential for proper dx. Comments: Always trace a sinus tract!!!
Comparison of cellular
cementum in normal and Diseased cellular cementum showed more projections, more lacunae and fewer fibers when compared to healthy cementum. This
Periapical diseased teeth- an SEM indicates increased calcification in the area. Resorption was also a present in diseased teeth. An amorphous layer was found on the
Simon 1981 Pathology study cemental surface corresponding to the outline of the lesion, but its significance is unknown.
35% of infected root canals have "pathological granules" in areas near the CDJ. These areas are rich in unineralized collagen suggesting
Cemental changes in teeth that microbial products dentaure this collagen and give rise to the granules. Uninfected root canals did not display this change. Pathologic
Periapical with heavily infected root granules are known to occur in exposed cementum due to perio dz, now it has been shown to occur in unexposed cementum, the bacterial
Armitage 1983 Pathology canals source being the root canal.
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Garre's osteomyelitis of the
mandible: The role of
Periapical endodontic therapy in patient Bony, hard swelling of the mandible adjacent to a non-vital posterior tooth, showing sx of PA pathosis. Usu in children or young adults. DD
Mattison, Neb 1981 Pathology management includes Ewing's sarcoma, syphilis, and leukemia. The swelling should resolve after NSRCT, if not consider a biopsy.
Periapical Periapical condensing osteitis Retrospective study looking at over 1,000 roots found an incidence of 2%. 85% of these showed complete or partial resolutionof the
Eliasson 1984 Pathology and endodontic treatment osteitis after NSRCT. None showed an inc in size. Condensing osteitis is the deposition of sclerotic bone in response to infection.
Garre's osteomyelitis of the Case report where Garre's Osteomyelitis was resolved w/ NSRCT vs EXT. Bony expansion had onion skin appearance and was assoc w/
McWalter, Periapical mandible resolved by a carious, necrotic Md molar w/ a PARL. Biopsy to rule out Ewing's sarcoma, syphilis and leukemia was not taken b/c of the appearance of
Schaberg 1984 Pathology endodontic treatment association w/ a necrotic tooth. The expansion showed rapid improvement and was resolved w/in a year.
Periapical Squamous carcinoma arising Squamous cell carcinoma can occur in the stratified squamous epith of dental cyst. Rare. Usu a residual cyst is assoc w/ malignant
Lavery 1987 Pathology in a dental cyst change. Md is affected 5X more. Illustrates the importance of submiting all cysts for biopsy.
CGCG is a local but destructive rxn due to trauma or hemorrhage. Contains multi-nucleated giant cells. Usu in young female and
Central giant cell granuloma predominantly in the Md. It is a well defined uni or multi locular lucency. Causes expansion and tooth displacement. Rarely assoc w/ the
Periapical associated with a non-vital apex of a tooth. Illustrates a case of a necrotic Md PM w/ a large PARL and resorptive lesion. Did not respond to NSRCT, developed a
Glickman 1988 Pathology tooth: A case report. sinus tract. Long term CaOH therapy was unsuccessful. Surg and biopsy revealed CGCG.
Microroganisms from canals Isolated bacteria from canals assoc w/ long standing unhealed lesions. 83% of the bacteria cultured were gram +, E. faecalis was the most
of root-filled teeth with PA commonly isolated single organism. 57% were facultative anaerobes, 43% were obligate. Most teeth had only 1 or 2 strains isolated from
Gomes 2003 Microbiology lesions each canal. Polymicrobial infections tended to be more assoc w/ pain. Strep and candida were assoc w/ teeth w/ poor coronal seal.
DNA samples were taken from 32 infected human teeth (22 had CAP, 10 had AAP). About 80% had T. denticola, 40% had T. socranskii,
Oral treponemes in primary 15% had T. vincentii, 10% had T. pectinovorum. Trepomona are involved in endodontic infections. Comments: Few bacteria cause
root canal infections as infections. Treponema is a common cause of infection in perio dz, so finding them in root canals suggest that they might be assoc w/ endo
Siqueira 2003 Microbiology detected by nested PCR dz. These bacteria cannot be cultured.
Varying dentin thicknesses were left in CL V preps. Restored w/ amal or amal/CaOH or amal/ZOE. EXT for ortho reasons 3-89 days later.
Remaining Dentin Thickness plays an important role in pulp vitality, but has little effect on reparative dentin secretion or on inflamm rxn. An
RDT of 0.5mm is req to prevent pulp injury. Comments: CaOH does not permeate through coronal dentin that is .5 mm or more from the
Pulp pulp. The tubules here are large and numerous. Think about the tubules in the root canal, they are narrower and fewer. Are we
Physiology Remaining dentine thickness disinfecting radicular dentin effectively w/ CaOH?? Probably not. Dentin infection is not the big deal though, our failures in disinfection are
Mjor 2003 and Pathology and human pulp responses of a grosser nature.
Short-term periradicular Root resections and retrofills w/ MTA and IRM were done on RCT teeth of dogs. The PA tissues were evaluated histologically from 1-5
Tziafas, Retrofilling tissue response to MTA as a wks. The MTA group commonly had CT and little to no inflamm. As time progressed, hard tissue formed peripherally from the dentin
Economides 2003 Materials root-end filling material towards the center of the MTA. The IRM group showed no hard tissue formation.
A preliminary analysis of the Looked at 30 canals in Mx molars. Instr, irrig w/ 5.25% NaOCl and used RC prep. Canals obt w/ warm vert using Pulp Canal Sealer and
morphology of lateral canals AH-Plus. The teeth were cleared and the lateral canals were evaluated. All roots had accessory canals. GP filled most of the wider
after root canal filling using a coronal lateral canals while the narrower apical canals were often partly filled w/ sealer. Overall, AH-Plus demonstrated better flow into
Venturi, Prati 2003 Morphology tooth-clearing technique lateral canals than Pulp Canal Sealer.
Histological evaluation of
Pulp teeth with hyperplastic Histologically evaluated 5 hyperplastic pulps. All showed changes in the pulp ie fibrosis and calcifications. In the mid to apical radicular
Physiology pulpitis caused by trauma or pulp, there was an absence of inflamm cells. Hyperplastic pulpitis is an irrev chronic open pulpitis. It is caused by trauma or caries. The
Calskan 2003 and Pathology caries: Case reports young pulp has a great capacity to heal.
ProTaper rotary root canal
preparation: Effects of canal
Peters, anatomy on final shape Canals of Mx molars were prepared in vitro. No major procedural errors were found, though some apical transportation was found. These
Barbakow 2003 Instruments analysed by micro CT instr maybe more effective in shaping narrow canals than wide canals.
ProTaper rotary root canal
preparation: Assessment of
Peters, torque and force in relation to These instr showed lower torque scores than other U shaped rotary instr. Even in constricted canals, when the torque scores raised sig,
Barbakow 2003 Instruments canal anatomy none of the instr fx when a patent glide path was present.
Chemical and antimicrobial
properties of calcium CaOH was mixed w/ CHX, NaOCl, Iodine and saline. Placed in EXT human teeth. pH and antimicrbial effect against E. faecalis was
Irrigation / hydroxide mixed with measured out to 5 wks. There was no sig change in the pH of CaOH or in the antimicrobial effect regardless of what liquid it was mixed
Zehnder 2003 Medication irrigating solutions with.
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Histomorphometric analysis
of odontoblast-like cell
The numbers and secretory activity of odontoblast-like cells were measured in 161 non-human primate pulps from 7days to 2 yrs. The
Pulp numbers and dentine bridge reparative dentin thickness was mediated by the number and secretory activity of these odontoblastic-like cells over time. Bacterial
Physiology secretory activity following microleakage was found to impede bridge formation. Comments: The magic bullet is the elimination and control of bacteria. If you want a
Murray, Cox 2003 and Pathology pulp exposure purist statement of this look at Kakahashi. The germ free rats formed a dentin bridge w/o anything being placed on the exposure.
Endodontic and orthodontic
Tsurumachi, treatment of cross-bite fused Case report of fusion where both segments were treated w/ NSRCT. They were then EXT and seperated. One was replanted and otho tx
Kuno 2003 maxillary lateral incisor was carried out. After three years, there were no sx, the tooth fit the esthetic demands. There was evid of replacement resorption.
Good review of what is out there and has good citations. GP is biocompatidble unless it is dispersed in small particles. Eugenol is the
cytotoxic component in ZOE sealers. Inhibits macrophage function, has slow release through dentin that can last for months. CaOH
sealers (Sealpex) are antimicrobial but require dissociation to work and this affects the seal. Formaledehyde containing sealers (N2,
Endomethsasone) are highly cytotoxic, cause necrosis of the tissues, which are then perfused w/ formald makng repair difficult. Also
mutagenic and carcinogenic. Chloroform based selaers (Kloroperka) contain chloroform and rosins which are cytotoxic. Polymers (AH26,
Biocompatibilty of dental +) are very toxic when mixed but exerts little toxic effects when set, due to the release of formaldehyde. Hard tissue formation can occur
materials used in around it. Diaket is highly toxic at first but more biocompatible after 2 wks. GI cements cause minor tissue irritation, have good
contemporary endodontic biocompatibility and are antibacterial. It inhibits the growth of PDL cells and has been found to leak when used as a retrofill material.
Hauman, therapy: a review. Part 2: Composite resin as a retrofill looks promising, shows Sharpey fiber attachment, success depends on maintaining a controlled field during
Love 2003 Obturation Root canal filling materials. placement. MTA-good.
Periapical lesions associated Evaluation of 501 PA lesions. 84% were granulomas, 14% were cysts and 2% were other pathologic conditions. Diagnosing a cyst
Patterson, w/ endodontically treated depended upon the presence of a layer of stratified epith along one surface of the tissue to indicate that epith actually lined the cavity.
Healey 1964 Cysts teeth Suspect a cyst if: 1 The canal continues to exude a serous exudate. 2. Impossible to obtain a negative culture. 3. Lesion emits a foul odor.
42% of the lesions studied were cysts. The diagnoses of cyst was made only when there was a definite epithelium lined cavity. Varying
degrees of eptih proliferation w/o cavitation was dx as a granuloma. 48% were granulomas. The other lesions that were found were
Periapical lesions- type, residual cysts, apical scars, cementomas, abscesses, foreign body rxns, cholesteatoma and giant cell lesions. 3 times as many cysts were
incidence, and clinical found in the Mx. Postulated that since the Mx has more epith fragments remaining from fusion, that it is more likely for granulomas to
Bhaskar 1966 Cysts features convert to cysts in the Mx. Study included over 2,300 cases.
The frequency and
Luebke, distribution of PA cysts and Closely parallels Bhaskar's study. 44% were cysts and 45% were granulomas. Freq of both was 1.5X grtr in the Mx. Study was based
LaLonde 1968 Cysts granulomas upon 800 cases.
A histopathologic,
histobacteriologic and
radiographic study of PA
Langeland, endodontic surgical 230 specimens were studied. Only one had bacteria in the PA tissues. Epith occurred in 26% of the cases, a cyst occurred on 6%. No
Block 1977 Cysts specimens correlation btwn presence of inflamm cells and clinical signs/sx. Radiographs did not correlate w/ dx of cyst or granuloma.
A histopathologic and
Langeland, histobacteriologic study of 35 35 biopsy specimens. 60% had epith fragments. 26% had true cysts. Both chronic and acute inflamm cells were present. Bacteria was
Block, PA endodontic surgical found in the PA tissues of only one specimen. B/c the exact incidence of cysts is unknown, cannot condone overinstrumentation
Grossman 1977 Cysts specimens contributing to non-surgical resolution.
Defines the Bay Cyst. Evaluated 35 cysts that were still attached to the apex upon extraction. He found 9% were true cysts, 9% were bay
cysts and 23% were epithelial granulomas. All previous studies used curetted samples, so histologically, they could have easily mistaken a
strip of epith as lining a cavity when it may not have. If you add true cysts together w/ bay cysts and epith granulomas, you get 41%, which
is in the ball park of Bhaskar and Luebke/LaLonde. Also consider that true cysts do not heal unless surgically excised. If success iof
NSRCT is in the 90% range, then the incidence of cysts cannot be higher than 10% or so. since bay cysts are still attached to the apex,
changing the environment in the root canal will also change the environment in the bay cyst and result in healing. Since true cysts are
Incidence of PA cysts in independent of the canal system, NSRCT will have no effect. Comments: A small sample number, but the methodology is awesome. He
Simon 1980 Cysts relation to the root canal looked only at cysts that were attached to the apex...in toto
Provides theory for the development of apical cysts. A granuloma occurs in an area where there are many epith rests. These rests
become associated w/ the granuloma and proliferate in attempt to cover the "raw" surface of the granuloma. As the epith isolates the core
of the granulation tissue, it becomes ischemic and breaks down. As fluid enters the area to equilibrate the osmotic pressure caused by
Origin and growth of cysts of these smaller molecules, the cyst expands. This increased internal pressure causes the collapse of capillaries w/in the cyst, which leads to
Toller 1966 Cysts the jaws more ischemia. Thus, the process continues. If you find a way to open the epith surface and keep it patent, then the cyst should resolve.
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Karmali,
Epith proliferation Merchant,
is relatively common Davis
in PA tissues. NSRCT in 72 teeth w/o PA pathosis. Bloc resections of PA tissues were examined
histologically 6-360 days after tx. 26% showed proliferation of the Rests of Malassez. 46% of the cases that were instr and obt long had
epith proliferation. Epith proliferation occurred in 25% of the cases that were instr short and unfilled and in 17% of the cases that were instr
Seltzer, Epithelial proliferation of PAshort and filled short. Confirms previous reports that Rests of Malassez can proliferate in the presence of inflamm and possibly form a cyst.
Bender 1969 Cysts lesions Anything that inflames the PA tissues can be a trigger.
Backs up Toller's theory about how cysts form i.e cell death w/in a core surrounded by proliferating epith. All granulomas do not form cysts
b/c the inflamm reaction in some cases maybe too great for the rests of Malassez to survive or the inflamm rxn might not be great enough
Thhe epithelial cell rests of to alter the PA tissue environment enough to stimulate the rests. The rests of Malassez behave in the same manner as other epith cells.
Malassez and the genesis of Other epithelia surround CT while the rests of Malassez are surrounded by CT. This might be why they act differently and are prone to cyst
Ten Cate 1972 Cysts the dental cyst formation.
Induced cysts in monkeys by performing pulpectomies and leaving the canal exposed to the oral environment to study the temporal and
histologic dynamics of cyst formation. No cysts developed before day 200. Up to that point, there was granulation tissue w/ a progression
of epith proliferation. Cysts developed in 11/16 teeth that had been exposed for more than 200 days. Did not find evidence to support Ten
A histologic study of Cate's theory of cyst formation (central necrosis w/in a wall of eptih). A very common observation was the apical granuloma being
experimentally induced surrounded by proliferating epith. The complete encirclement by eptih seemed to be related to the maturity of the cyst and the degree of
Valderhaug 1972 Cysts radicular cysts inflamm. If the inflamm was too great, it could cause necrosis of the surrounding epith.
Pathways of inflammatory
cellular exudate through Only acute inflamm cells (PMNs) infiltrate radicular cysts, whereas chronic cells do not. SEM study shows the presence of numerous
radicular cyst epithelium: A interepithelial channels through which PMNs reach the cyst cavity. The chemotactic stimulus being the degeneration of superficial epith
Cohen 1979 Cysts light and SEM study cells.
Search for evidence of three

viral agents in radicular cysts 20 cysts were immunostained to search for HSV and HPV. All of the specimens were negative. Either there are no HSV and HPV or more
Rider, Chen 1995 Cysts w/ immunohistochemistry sensitive tests are needed.
The stimulus for radicular cysts is thought to be endotoxins from a necrotic pulp, but for OKC and folliculcar cysts, such a stimulus is not
The role of endotoxin and present. All three types of cysts were examined to determine a cause for epith proliferation. A sig higher amt of endotoxins were found in
cytokines in the pathogenesis radicular cysts. There were no bacteria isolated from any of the cysts. All cysts contained IL-1a and IL-6. Only the radicular cyst contained
Meghji, Harris 1996 Cysts of odontogenic cysts IL-1b. Endotoxin enhances the ability of fibroblasts in CT to form epith.
Electrophoretic differentiation The albumin pattern found in cysts was consistently much more intense and larger than the pattern found in granulomas. Fluids were
of radicular cysts and aspirated from 41 root canals w/ PA pathosis. They were examined by electrophoresis. The PA lesions were biopsied and the histology
Morse 1973 Cysts granulomas was compared to the electrophoretic patterns. This might be a possible way of making a non-invasive dx although there are some pitfalls.
Dispels some commonly held assumptions about cysts. First, the accuracy of radiographs in dx cysts is suspect. Although, the larger the
lucency, the more likely the lesion is a cyst. Secondly, the issue of nonsurgical healing of cysts is brought up. All the incidence of cyst
Relationship of lesion size to studies naturally select for larger lesions, which are more likely to be cystic. Possible that many of the smaller lesions are cysts too, and
Natkin, diagnosis, incidence and that they heal equally well as granulomas...we just don't know it. Another possiblility, is that the appearance that cyst have a lower healing
Oswald, treatment of PA cysts and rate might not be due to the fact that they are cystic,but are do to the fact that they tend to be larger lesions. Maybe larger cysts and
Carnes 1984 Cysts granulomas granulomas both heal less frequently than their smaller counterparts.
Differentiation of PA
granulomas and radicular Determined that you can radiometrically discriminate cysts from granulomas. Lesions were daignosed histologically and their radiographs
Shrout, cysts by digital radiometric were scanned. The gray scale of the radiographs were examined for any correlation to cysts vs granulomas. None of the films were
Hildebolt 1993 Cysts analysis standardized and they were all from the Md post. Still, they were able to differentiate btwn the two radiometrically, but not visually.
Non-surgical resolution of Suggests that in cases in which a cyst is suspected, instrumentation carefully beyond the apex will cause a transitory acute inflammation.
Bhaskar 1972 Cysts radicular cysts This will be sufficient to destroy or disrupt the epith lining of the cyst and therfore, it will convert ot a granuloma and resolve.
Points out that careful serial sectioning of lesions in toto reveal an incidence of apical cysts to be 15%. 9% are true cysts and 6% are
pocket cysts (aka bay cysts). The pocket cyst may heal after NSRCT. Radicular cysts are the most common cyst of the jaw. Highest
New perspective on radicular incidence in the third decade, favors men. More freq in the Mx. In the Mx. most common in the anterior, in the Md most common in the PM
Nair 1998 Cysts cysts: Do they heal? area.
The calcifying odontogenic
cyst- a possible analogue of
Gorlin, the cutaneous calcifying Describes a new lesion, the calcifying odontogenic cyst. It is a true cyst lined w/ stratified epith. There is a basal layer of amelobastic cells,
Pindborg 1962 Cysts epithelioma of Malherbe it produces or induces dentinoid formation and it occurs close to dental structures. There is no predeliction for age, sex or location.
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Aggressive growth and
Usu odontogenic cysts are inocuous. Under certain conditions, which are nebulous, they can transform into a keratinizing cyst w/ a more
Eversole, neoplastic potential of aggressive growth pattern and a high tendency towards recurrence. Ordinary odontogenic cysts may transform into a neoplasms such as
Rovin 1975 Cysts odontogenic cysts epidermoid or mucoepidermoid carcinomas. This cannot be dx from RDX and so all odontogenic cysts should be removed and biopsied.
Form as solitary or multiple lesions of the jaws. 2:1 in the Md, usu third molar or ramus area. 5% are assoc w/ basal cell nevus syndrome.
Usu develop early in life, 2nd or 3rd decade. Freq mis-dx as ameloblastoma. Can masquerade as any radiolucent lesion of the jaw,
Brannon 1976 Cysts The odontogenic keratocyst though most commonly assoc w/ impacted teeth. High recurrence rate so pt should be followed indefinitely.
This variant is histopathologically and clinically distinct from the traditionally parakeratinized OKC. Make up 13% of all OKC. Low
The odontogenic keratocyst: recurrence rate. 2:1 in the Md, favors post Md. Usu occurs in 2nd to 5th decade. 72% were assoc w/ what was thought to be a
Wright 1981 Cysts Orthokeratinized variant dentigerous cyst. 40% were asymptomatic, the rest presented w/ pain, swelling or infection.
Squamous cell carcinoma
Schwimmer, arising in residual Neoplastic transformation in the epith lining of cysts is rare. Neplasms assoc w/ cyst linings include SCC, ameloblastoma and
Morrison 1991 Cysts odontogenic cyst mucoepidermoid carcinoma. More freq in the 5-8th decades, 4:1 Md:Mx, 2:1 M:F
The anterior teeth are relatively straight-forward w/ few apical complexities. In Mx 1st molars, 75% have a P and DB that are fused, leading
to complex anastomosing of pulp tissue. Fusing present in almost 60% of Mx 2nd molars. In Md molars, the furcation is usu just below the
crown, though almost 10% exhibit partial taurodontism. Apical ramifications are common. 2nd Md molars have grtr divergence than 1st.
Anatomy of root canals. IV. Resorbable paste material must be used if obturating these teeth. Roots have very thin walls. Comments: If you are instr these teeth, do
Barker 1975 Pedo-Endo Deciduous teeth. not over instr. Rely more on chemical cleaning. The shape will naturally be there.
19 teeth were pulpotomized using formo. These teeth were considered successfully treated (no PA path, no resorption, no pian). EXT 3-
24 mo after tx and pulp examined histologically. Pulpal changers were evident in all teeth. Some portion of vitality was preserved in 78%
of the cases. Inflammation and dentinal resorption were the most common reactions taking place. Complete in vivo fixation was not seen
as previous studies have reported. The formo method should only be considered as a means to keep primary teeth functioning for a
Pulp condition of successfully limited time. Comments: Formo is not a good pulp capping agent if you are going for apexogenesis. The only reason he can think of for
formocresol treated primary using formocresol is a perm tooth w/ IP and you know the pt will disappear for a long time...and you have very limited time. The majority of
Rolling 1978 Pedo-Endo molars endodontisits don't even have this in their office b/c of limited indications for usage.
Contraindications for formo pulpotomy are pain, perc+, suppuration, hyperemic, necrotic, PA/furcal path. These should have NSRCT or
EXT. Contraindications for NSRCT are furcal caries/perf, resorption of grtr than 1/3 of the root and a non-restorable tooth. Primary teeth
Root canal treatment in are smaller in all dimensions, so perforations occur easily. Roots are divergent and curved. Instr should be 1-2 mm short of rdx apex...2-
Camp 1985 Pedo-Endo primary teeth: A review. 3mm short if excessive resorption. Filling material of choice is ZOE, though length control is difficult. Success rate is 95%+.
A retrospective radiographic
evaluation of primary molar 62 primary molars w/ one-step formo pulpectomies, canals irrig w/ water and filled w/ a paste containing ZOE and formo. Avg recall was 40
Hicks, Barr 1991 Pedo-Endo pulpectomies months. Healing rate was 82%. Pulpectomies offer an alternative to EXT, have a high healing rate. Periodic rdx eval is necessary.
Histopathology of the pulp in Removed deep caries in 53 teeth. 2/3 of the cases w/ carious exposures had inflammation limited to the coronal pulp. 2/3 of the teeth w/o
primary incisors with deep exposures had normal or almost normal pulps. Absence of pulp exposure is a good indicator of normal pulp histology. Since inflamm is
Eidelman 1992 Pedo-Endo dentinal caries limited to the coronal pulp in cariously exposed teeth, they are good candidates for pulpotomies.
Root canal filling materials for ZOE: most commonly used, length control difficult, resorbs slower than the root. CaOH: usu not used b/c of inc ocurrence of internal root
primary teeth: A review of the resorption. Vitapex (CaOH and iodoform) has a similar resorption rate to root, mixture easily applied, no toxic effects on perm teeth. GP:
Kubota 1992 Pedo-Endo literature non-resorbable, nevertheless still used. There is no ideal material, but Vitapex is the closest.
The rational treatment of
putrescent pulps and their
Buckley 1906 Pedo-Endo sequela. First describes the use of formocresol.
Evaluation of deciduous 103 pulpectomized primary molars tx w/ CaOH were evaluated for an avg of 24 months. Almost 70% failed…showed internal resorption.
molars treated by pulpectomy Study states that it is not in line w/ other studies. Comments: A reason for the high failure rate is that these teeth were not restored. Over
Via 1955 Pedo-Endo and CaOH two years the CaOH probably washed out.
Comaprison of CaOH and
formocresol pulpotomies in Both CaOH and formocresol pulpectomies were done on 28 lamb teeth. Both groups showed reparative dentin formation, the onset being
Ozata 1987 Pedo-Endo primary teeth in lambs faster w/ CaOH. Formocresol did not prevent healing, just slowed it.
Retrospective analysis of 108 traumatized, pulpotomized permanent incisors. 97% were PARL neg if tx w/in 24 hrs. 86% were PARL neg
Traumatized incisors treated if tx after 24 hrs. Incidence of internal resorption was 1/175. Pulpotomy considered to be temporary due to complications like necrosis and
by vital pulpotomy: A canal calcification. This did not bear out in this study. Elective NSRCT can be postponed until late adolescence or early adulthood to
Gelbier 1988 Pedo-Endo retrospective study maximize maturity of the root.
Electrosurgical pulpotomy- a Formocresol and electrosurg pulpotomies were done on 20 primary monkey teeth. Both produced comparable results. Formation of
Morton, Shaw 1987 Pedo-Endo 6 month study in primates reparative dentin as a bridge and along canal walls were a common finding. When a failure occurred, it happened quickly…w/in 6 months.
Morton, Electrosurgical pulpotomy- a A pilot study of 11 non-carious human primary canines. Canines were EXT 1 hr to 13 wks post-opThe results were not promising.
Sheller 1987 Pedo-Endo pilot study in humans Electrosurgery cannot be recommended as superior to formocresol.
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Mack, Dean 1993
Electrosurgical pulpotomy: A
Pedo-Endo retrospective human study
Karmali,
Retrospective study Merchant,
of 164 electrosurg Davis
pulpotomies on carious primary molars over ten years shows a 99.4% success rate.
defined as maintenance of tooth until normal exfoliation and/or no RDX pathology.
Success
Pulp capping of carious 123 pulp caps were recalled after 5 and 10 years, this was 31% of the original material. 45% in the 5 yr group and 80% in the 10 yr group
exposures: Treatment failed. These were CaOH pulp caps placed on CARIOUS exposures. All successful cases showed calcific metamorphosis. Points out that
Barthel, outcome after 5 and 10 it might be better to treat w/ NSRCT while the canals are still accessible and the pulp is still vital. The success rate was much higher in the
Roulet 2000 Pedo-Endo years: A retrospective. cases were a permanent restoration was placed w/in 2 days.
Proposes methods and materials to treat pulpitis by diffusion through the dentinal tubules. Materials could include local, antibacterials,
Medication of the dental pulp: anitmicrobials, and non-steroidal anti-inflamm agents. Diffusion surface area, smear layer, and dentinal thickness are the main barriers to
Pashley 1992 Pedo-Endo A review and proposal success. He proposes that more research be done in this area.
Eugenol can be both beneficial or harmful based upon its concentration. When E is mixed w/ ZO, zinc eugenolate forms. In the presence
of moisture, eugenol is released. As a base, the diffusion through dentin is a good controlled release system to keep the dose at a
therapeutic level. Never apply directly to vital tissue...very cytotoxic. Eugenol's anit-inflamm effects may be due to its ability to inhibit nerve
activity by slowing the release of mediators. At higher doses, ZOE has an anti-bacterial effect, this higher dose is often manifested in the
Irrigation / Biologic properties of eugenol immediately adjacent dentin. Common ingredient in sealers. Too much expressed out of the apex is cytotoxic, but sx are masked by its
Kim 1992 Medication and ZOE anodyne affects. Despite its cytotoxicity, it has a great clinical track record.
31 primary molars received a formocresol pulpotomy, 17 received a ZOE pulpotomy. Histologically, the formocresol group showed
necrosis as early as 3 wks w/ replacement by granulation tissue migrating from the apex. There was also evidence of slight internal
resorption, osteoid development and narrowing of the canals. In the ZOE group, there was an active inflamm rxn and internal resorption
Pulp tissue reaction to consistently. Radiographically, the formocresol group was deemed successful 97% of the time compared to 58% w/ the ZOE group.
Berger 1965 Pedo-Endo formocresol and ZOE Clinically, neither had signs/sx of failure. Histologic, radiographic and clinical criteria are not consistent.
Cresatin and saline pulpopotomies were performed on 64 non-carious or incipeintly carious primary molars. EXT from 118 to 133 days and
evaluated histologically. Cresatin applied to freshly cut dentin had no effect on the pulp. Saline pulpotomies caused eventual necrosis.
The histologic response of Cavit will not prevent ingress of bacteria past 27 days. Clinically and radiographically successful pulpotomies can be performed using
Sandler 1971 Pedo-Endo the dental pulp to cresatin cresatin.
The destructive nature of cresol was eaxamined on bovine pulps. Cresol, formocresol, a standard tissue solvent and saline were
The effect of formocresol on compared. Lipid solubilty followed the same order. The pulp cautery that is observed clinically is due to the ability of cresol to effectively
Ranly 1987 Pedo-Endo lipids of bovine pulp dissolve the lipids in pulp.
Pulpal and pericapical
reactions to gluteraldehyde Pulpotomies were performed on 23 permanent monkey teeth. Two dressing were made by mixing ZOE w/ either paraformaldehyde or
and paraformaldehyde gluteraldehyde. Teeth were examined 3 and 9 months post-op. Paraformaldehyde induced total pulpal necrosis and chronic apical
Tagger, pulpotomy dressing in inflamm. The gluteraldehyde pulp remained mostly vital w/o PA rxn. None of the groups showed complete pulp healing. Calcifications
Tagger 1984 Pedo-Endo monkeys were present in all cases.
Kopczyk, Periodontal implications of Describes a case were a squeezed formocresol pellet was ineffectively sealed in a temp of a RCT tooth. The cotton fibers got imbedded in
Abrams 1986 Pedo-Endo formocresol medication the soft tissue and bone causing severe necrosis. Bone was sequestras formed and the tooth was lost. Be careful w/ this stuff.
Distribution of C-
Formaldehyde after This study demonstrates that materials placed in vital pulp may be absorbed into the systemic circulation. Labelled formaldehyde
Myers 1978 Pedo-Endo pulpotomies with formocresol pulpotomies were performed on monkeys. 1% of the dose placed into the tooth was observed in the systemic circulation.
Tissue changes induced by To determine the potential cellular damage caused by systemic uptake of formocresol, pulpotomies were perfomed on dogs. The first dog
the absorption of formocresol had 16 pulpotomies, the second had 3 and the third had 1. Six hours later, lung, heart, liver and kidney samples were taken. The dog w/
Pashley 1983 Pedo-Endo from pulpotomy sites in dogs 16 pulpotomies showed early signs of liver and kidney damage.
Assessment of the systemic Systemically administered formaldehyde into rats to determine the toxic load and compare it to the dose of a single formocresol pulpotomy.
distribution and toxicity of Urine values for lactate dehydrogenase and protein were the limiting factor, requiring 125X the single pulpotomy dose to see a significant
formaldehyde following difference. The rats showed clinical signs of toxicity (respiratory distress, lacrimation, death) prior to these values being reached. This
Ranly 1987 Pedo-Endo pulpotomy treatment: part 2 study also fails to address the cresol component which may have a lower toxicity than formaldehyde.
Assessment of the systemic Labelled glutaraldehyde was used for pulpotomies, IV, and metabolic studies in rats. Systemic distribution from a pulpotomy was 25% of
distribution and toxicity of the appllied dose. More than 90% of the GA accumulated in the body was eliminated in 3 days. Even with a bolus IV at a considerably
gluteraldehyde as a higher dose than assoc w/ a pulpotomy was given, no toxic effects were noticed. GA as a pulptomy agent would be free of any systemic
Ranly 1989 Pedo-Endo pulpotomy agent toxicity
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Karmali,
Monkey incisor teeth Merchant,
were pulpotomized Davis
and different medicaments were placed on the exposures. Monkeys were sacrificed at 12 weeks.
Hard tissue barrier formation Group 1- cyanoacrylate for 12 wks: 7/10 showed a hard tissue barrier, 6 were discontinuous. Group 2- CaOH for 10 min: 8/10 had a hard
in pulpotomized monkey tissue barrier, 5 were discontinuous. Group 3: CaOH for 60 min: 10/10 hard tissue, 7 discontinuous. Group 4: CaOH for 12 wks: 10/10
teeth capped with hard tissue, 1 discontinuous. Supports theory that a low-grade irritation is responsible for the formation of a hard barrier over exposed
cyanoacrylate or CaOH for pulp tissue. The less bacteria present in the pulp, the less inflammed the pulp was, the more continuous the hard barrier was. Long-term
Cvek 1987 Pedo-Endo 10 and 60 minutes application of CaOH not nec, but may be valuable in its anti-bacterial properties.
Tricalcium phosphate/Hydoxyapatite showed thicker, faster and more homogenous reparative dentin bridge than CaOH. Tricalcium
Effects of various phosphate phosphate/magnesium and ostocalcium showed dystrphic dentin formation. The CaOH group showed 2 zones, the first zone, which was in
biomaterials on reparative contact w/ the material was hypermineralized and irregular. The 2nd zone was more regular and continuous but still had numerous
Jean, Hamel 1988 Pedo-Endo dentin bridge formation lacunae. 24 pig teeth were used w/ 1/2mm exposures.
Tricalcium Phosphate, CaOH, and CaOH/TCP mixtures were used as pulp caps on dogs. TCP showed the presence in a reparative dentin
bridge in 86% of the cases, it also showed the highest infamm response. CaOH showed RD in 50%, and had less inflamm. TCP/CaOH
Chohayeb, Pulpal response to tricalcium showed the least RD (38%) and the least inflamm. The degree if inflamm relates to the amt of RD formation. How much inflamm is too
Salamat 1991 Pedo-Endo phophate as a capping agent. much inflamm?
84 rat teeth were pulp capped w/ HA or CaOH. Evaluated at 7,14 and 28 days. Almost every tooth showed hard tissue formation, but
Jaber, Reaction of the dental pulp to more complete bridging was evident in the CaOH group. The HA group showed a thicker bridge, but it was less organized and could
Donahue 1992 Pedo-Endo hydroxyapatite render future RCT difficult.
Human pulpal response to
hydroxyapatite and a CaOH 44 human teeth were pulp capped w/ HA and Dycal. Ext at 2, 30 and 60 days. No dentin bridge formation was seen in the HA group,
material as direct capping these pulps also showed moderate inflamm throughout the experimental procedure. Could be caused by the particulate nature of HA.
Subay 1993 Pedo-Endo agents This study confirms that Dycal will cause hard tissue formation in human pulps.
12 monkey teeth were pulp cappled w/ MTA or Dycal and examined at 5 mo. MTA group: 6/6 had complete dentin bridge formation, 5/6
Using MTA as a pulp capping were free of inflamm. Dycal group: 2/6 had bridge formation and all were inflammed. MTA has the potential to be used as a pulp capping
Torabinejad 1996 Pedo-Endo material agent.
Describes techniques and indications for both. Apexogenesis is the physiological root end development assoc w/ a vital pulp. 3 types. 1.
Indirect pulp cap: potential carious exposure approximates the pulp, zone of demineralization. 2. CaOH pulpotomy: carious exposure,
traumatic exsosures of more than 24 hours duration, and traumatic exposures grtr than 1mm. 3. Direct pulp cap: traumatic exposure of
only a few hours duration and < 1mm. Apexification is the induction of apical closure by the formation of hard tissue when the pulp is no
longer vital. CaOH is the material of choice. Goal is to get CaOH to contact vital PA tissues, care must be taken not to traumatize these
Apexogenesis vs tissues. CaOH should be changed after 6 weeks, then as often as nec, usu q 2-3 mo. Determined RDX and clinically, if the apical CaOH
Webber 1984 Open Apex apexification is wet, then change. Can take 1-2 years for barrier to form.
Describes his method for apexification, popularized it in the USA. 1st appt: canal is biomechanically enlarged and dried. CaOH w/ CMCP
is condensed into the canal. Tooth is temporized. Recall: q 3-6 mo. Procedures of the 1st appt are repeated until closure is evident either
clinically or RDX. Obturation then done w/ GP. Comments: CMCP was used b/c at the time, CMCP was used for everything including
Therapy for the divergent canal irrig. Since it was around, they just threw it in w/ the CaOH. We know that CMCP is very toxic, yet clinically, when CMCP is mixed in,
pulpless tooth by continued apexification carries forward. So somehow, when mixed, the effects of CMCP are mitigated. CaOH/CMCP is still used by the Brazillians
Frank, Glick 1966 Open Apex apical formation b/c CMCP seems to be detoxified when mixed w/ CaOH.
21 necrotic, immature teeth were treated w/ CaOH apexification. PA repair was complete or progressing in all teeth for the observation
Stimulation of root formation period. 14 showed complete root formation, 5 partial and 2 none. 1 tooth was EXT b/c of root fx and examined histologically. Showed
in incompletely developed new tissue formation both apically and w/in the canal. Consisted of pulp, interglogular dentin, cementum and PDL fibers. Study supports
Hiethersay 1970 Open Apex pulpless teeth the tx of necrotic immature teeth w/ CaOH apexification procedures.
Treatment of non-vital 55 immature, necrotic incisors were filled w/ CaOH after bacertiologic studies of the canals no longer revealed infection. Radiographically
permanent incisors with demonstrable complete bone healing in association w/ apical closure by hard tissue was noted in 50 cases. In all cases, apical closure
Cvek 1972 Open Apex CaOH occurred at the level of pre-op root development. The larger the pre-op PARL, the longer it took for healing. How long was the f/u period?
Biologic effects of
endondontic procedures on Pulpectomies and pulpotomies were performed on partially developed incisors of monkeys. Irrig w/ sterile saline, no CaOH was placed.
developing incisor teeth. I. Evaluated 1 year later RDX and histologically. Root formation was retarded and irregular, assoc w/ ingrowth of cancellous bone into the
Torneck, Effect of partial and total pulp open root end. An attempt to retain pulp vitality in the apical third resulted in necrosis and PA path. The calcific bridging that occurs is
Smith 1970 Open Apex removal. more related to the ingrowth of bone into the open apex than the development of dental hard tissues.
Biologic effects of
endondontic procedures on Pulp injuries were induced in 14 incompletely formed monkey incisors, followed for up to 95 days. The more prolonged the f/u period was,
developing incisor teeth. II. the more pronounced the RDX changes were. Despite the presence of severe inflammation, the developing incisor still had viable
Torneck, Effect of pulp injury and oral odontogenic tissue in the apical third and apical formation continued to some extent. These viable odontoblasts were present until the Day
Smith 1973 Open Apex contamination. 88 specimen. The pattern of deposition was irregular and involved only a portion of the root.
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Biologic effects of endodontic
procedures on developing
incisor teeth. III. Effect of Pulp injuries were induced in 8 immature incisor teeth of monkeys and were left exposed to the oral environment for 14-92 days. They
debridement and disinfection were then re-instrumented, irrig w/ saline, and medicated w/ CMCP. Access was sealed w/ amal. Sacrificed at intervals up to 63 days.
procedures and CMCP paste Like part II, there was evidence of residual pulp tissue and inflammed CT at the apex. There was also hard tissue deposition. Compared
in the treatment of to part II, there was less hard tissue depostion, less foramenal closure, and a grtr degree of PA pathology. Appears that additional
Torneck, experimentally induced pulp instrumentation/medication impedes the apexification process by removing remaining CT cells and exposing the apex to more inflamm.
Smith 1973 Open Apex and periapical disease. Comments: Is it the remaining bacteria in the canal or the toxicity of CMCP that are destroying the CT cells??
Pulp injuries were induced in 13 immature incisor teeth of monkeys and were left exposed to the oral environment from 39-196 days. They
Biologic effects of endodontic were then re-instrumented, irrig w/ saline, and medicated w/ CaOH/CMCP. Access was sealed w/ amal. Sacrificed from 49-196 days.
procedures on developing Displayed a higher and more rapid incidence of apical closure than the prior studies. This was attributed to the CaOH. The barrier formed
incisor teeth. IV. Effect of was irregular dental hard tissues and bone. There was mod to severe PA inflamm present regardless of the presence of an apical barrier.
debridement procedures and Atrributed to remaining necrotic tissue around the apical bridge. Comments: Summarizing these 4 articles what is absolutely necessary for
CaOH/CMCP paste in the apexification to occur?? The most important thing is the elimination of bacteria, via an adeq coronal seal and proper debridement and
Torneck, treatment of experimentally disinfection of the canal. Is it nec to place CaOH and bring the kid back every 3 mo for a couple of years?? Not really. Furthermore,
Smith 1973 Open Apex induced pulp and PA disease Balkland says that long term CaOH can weaken tooth structure.
Histologic evaluation of
induced apical closure of a
Klein 1974 Open Apex human pulpless tooth. Great summary article of how to dx and manage open apex cases.
A clinical report on partial 60 permanent incisors w/ complicated crown fx were tx w/ pulpotomy and CaOH. The tx was 96% successful. Success was determined by
pulpotomy and capping with no clinical sx, no rdx path, conitnued development of the immature root and pos sensitivty tests. The size of the exposure and the length of
CaOH in permanent incisors time before tx did not seem to influence results. Freq of healing should be judged on the presence of vital, proliferative tissue in the
with complicated crown chamber before tx. Possible that openly exposed pulp tissue is continuously rinsed w/ saliva and does not involve the impaction of food or
Cvek 1978 Open Apex fracture debris into the chamber. Discussion: The pulp can be exposed for weeks and the pulpotomy can still be succesful.
Necrosis was initiated in monkey incisors. Some were filled w/ CaOH. Teeth were EXT 4 wks after endo tx and pH paper was used to get
a generalized look at pH changes. Non-CaOH teeth had a pH range 0f 6.4-7.0. The CaOH teeth had a pH of 10-12 in the canal. The pH
dropped to 7.4 as you progressed towards the exterior of the root. The cementum had no change in pH. In areas of resorption an alkaline
pH was observed at the exposed dentinal surfaces. Rationale for CaOH is that the inc in pH is unfavorable for osteoclastic acid hydrolase
pH changes in dental tissues activity. The alkaline pH might also induce alkaline phosphatase activity. Comments: Does CaOH work primarily by the chemistry??
Tronstad, after root canal filling with Nope...it is the ability to kill bacteria. Most bacteria is killed at pH of 9.5, E. faecalis at pH of 11.5. So the CaOH is not that effective as you
Andreasen 1981 Open Apex CaOH. move deeper into the dentin.
Pulpectomies in monkey teeth, instr long to destroy the epith around the apex, and infected w/ E. faecalis. 3 mo later, instr, irrig w/ 1%
NaOCl. One group filled w/ CaOH, the other w/ BaOH. Followed for 9 mo. The CaOH group showed bridging and minimal inflamm. The
A comparison of CaOH and BaOH group showed marked inflamm and no bridging at all. The major difference btwn the two materials is their cations. Seems that Ca is
barium hydroxide as agents necessary to induce a positive apical response. It is possible though, that Ba ions are not biocompatible. Comments: Turns out that Ca is
Smith, Leeb 1984 Open Apex for inducing apical closure. not nec for hard tissue formation. See Torabinejad, Javalet.
Induced PA path in 28 immature monkey incisors. Filled one group w/ CaOH (pH 11.8) and the other w/ CaCl (pH 4.4)., the final group was
Comparison of 2 pH levels for left empty. Followed for 6 months. PA repair and apical barrier formation occurred more readily in the CaOH group than in the other two.
the induction of apical In teeth that exhibited complete apical closure, there was no evidence of communication of the PA tissues and the canals...not seen in any
barriers in immature teeth of of the serial sections. pH of CaOH seems to play a more sig role in the induciton of apical closure than the presence of exogenous Ca.
Torabinejad 1985 Open Apex monkeys Comments: Not only the pH that causes this, see Smith, Leeb. It is the antimicrobial effect of CaOH.
Compared the leakage of root canal fillings placed in human teeth w/ artificially enlarged apices that were plugged or not plugged w/ CaOH.
46 teeth were used. Canals were obt w/ GP and Tubliseal. Evaluated by dye leakage. A better seal was obtained w/ a CaOH plug.
Weisenseel, Provided a better matrix on which to condense the GP, and prevented overextension of GP. Length control was diff w/ CaOH though.
Hicks 1987 Open Apex CaOH as an apical barrier Might be a good material to consider w/ open apices, although might be diff to place in curved canals.
Apical closure of mature
Rotstein, molar roots with the use of Describes 2 cases where CaOH was used for apexification of mature teeth that had wide open apices due to CAP. Recommends this
Friedman 1990 Open Apex CaOH technique if apical diameter is grtr than a #80. Disadvantages are mult visits over a long period of time.
One-step apexification w/o Case report of Tricalcium Phospate as an apical plug in an open apex. 7yr f/u shows a calcified dome around the apex and a normal PDL.
Harbert 1996 Open Apex CaOH Remained free from resorption, ankylosis or sx.
Clinical management of the
Polendo 1998 Open Apex open apex Great summary article of how to dx and manage open apex cases.
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A comparative study of root- PA lesions wereKarmali,
induced in 64 Merchant, Davis
dog roots. Instr w/ 5.25% NaOCl and treated w/ CaOH for 1 week. Canals were then filled w/ CaOH, MTA
end induction using or Osteogenic protein-1. PA tissues were studied histologically 12 wks later. Hard tissue formation w/ MTA and OP-1 was about twice that
Shabahang, osteogenic protein 1, CaOH, of CaOH, but not statistically sig. The degree of inflamm was also less w/ MTA. Placement of an apical MTA barrier is an alternative to
Torabinejad 1999 Open Apex and MTA in dogs CaOH apexification.
Katebzadeh, Strengthening immature teeth Immature teeth are strengthened w/ composite and with posts. A post does not strengthen mature teeth b/c placement req removal of lots
Trope 1998 Open Apex during and after apexification of tooth structure. In immature teeth, you are not removing too much dentin to place the post. So the post is good for immature teeth.
Evaluation of fiber-composite 26 mature mx incisors were hogged out to simulate immature teeth. These were either left unfilled, filled w/ composite, or filled w/ ribbon
laminate in the restoration of reinforced composite. An Instron was then used to measure the force to fx. The composite alone group did much better than the ribbon
Pene, immature, nonvital maxillary reinforced composite. The empty one did the worst. The ribbon reinforced composite did not do as well becuase the resin fibers act as
Harrington 2001 Open Apex central incisors voids in the composite, therby weakening it.
External root resorption: Its Describes the 3 types of external root resorption. Surface resorption is caused by injury to the PDL. If injury is not repeated, the formation
implication in dental of new cementum and PDL will take place. Inflamm resorption is a combined injury to the PDL/Cementum and there is bacteria present in
traumatology paedodontics, the canal. Replacement resorption occurs if the damage to the PDL is extensive and the osteogenic healing process out paces the PDL
periodontics, orthodontics repair process. Progressive and transient forms are determined by the size of the lesion and the presence of other functional stimuli.
Andreasen 1985 Resorption and endodontics Sometimes, the cause of resorption is unknown.
Good description of internal, external, invasive, pressure and idiopathic resorption. Internal: rare, can be transient or progressive, req vital
tissue, external perforation may occur. Diagnosis by angled rdx, absence of canal outline, and sharp outline of lesion. External: Three
types. Surface: not clinically sig, not detectable, usu heals spontaneously. Inflammatory: 4 factors need to be present: injured PDL,
surface resorption, bacteria and patency of tubules. Tx is the removal of the source of the infection (RCT). After traumatic injury, f/u q 4-6
wks for 6 mo, then q year. Replacement: tooth structure is replaced by bone, occurs when PDL loses vitality, lack of mobility and metallic
sound on percussion are diagnostic. No treatement nec, just observe. Invasive: involves cervical area, small opeining into dentin where it
burrows, pulp protected by pre-dentin layer. Caused by trauma, bleaching, perio tx. Tx is restoring lost tooth structure and disrupting the
Bakland 1992 Resorption Root resorption resorptive process. RCT may or may not be nec.
Presents ideas why roots are not usu resorbed by osteoclasts. Collagen fibers in the PDL make the root surface less available to the
Factors regulating and resorbing cells. Cementobalsts do not respond to parathyroid stimulation like osteoblasts. Finally, cementoid, which is present under the
Hammarstro modifying dental root cememtobalst layer covers the mineralized cemenum. Root resorption induced by succedaneous tooth eruption and tumors are not fully
m, Lindskog 1992 Resorption resorption understood.
Clinical endodontic and
surgical management of tooth
and associated bone
Heithersay 1985 Resorption resorption Describes indications for when orthograde and surgical approaches maybe appropriate. Lots of good info.
Internal resorption in both primary and permanent (13) were extracted and studied histologically and microscopically. No differences btwn
prim and perm either clinically or morphologically. Resorption progressed more rapidly in the primary teeth. Bacteria were also detectable
Internal resorption in human in the teeth showing the most rapid resorption. Normal pulp tissue was replaced w/ a periodontal-like CT. Comments: The perio-like CT is
teeth- a histological, SEM very unique, with varying degrees of inflamm w/in the vital pulp. Since this is such a highly unique situation, this is rare. This situation req
Wedenberg, and enzyme histochemical a vital pulp to support the clastic cells and a source of inflamm like caries or infected necrotic coronal pulp. Don't immediately interpret a
Zetterquist 1987 Resorption study roundish, sharply defined resorptive lesion as internal, as was done in the past.
Looked at the relationship of periodontal fiber attachment to root location in 10 teeth from monkeys. Found that the density and the
Auyeung, Periodontal fiber attachment numbers of fibers dec as you moved apically. The thickness of the fibers inc as you moved apically. Gives credence to the theory that
Polson 1988 Resorption and apical root resorption apical resorption is more freq than cervcal or mid-root b/c the apical root surface is less protected from osteoclasts by periodontal fibers.
Retrospective study of 151 pts w/ avulsed teeth, replanted after a minimum of 1 hr of extra-oral dry time. Followed for an average of 5 yrs.
Progression of root resorption Replacement resorption increased in freq w/ time for all pts. If RCT w/in 3 wks of replantation, there was a minimum of inflamm resorption.
following replantation of Rate of resorption was higher in younger pts. Replanted teeth w/ a necrotic PDL will become ankylosed and resorbed w/in 3-7 yrs in young
Andersson, human teeth after extended pts, and longer in older pts. Comments: The bottom line here is that RCT has to occur quickly. The standard has been changed from 3
Sorensen 1989 Resorption extra-oral storage wks to 1-2 wks.
Teeth were EXT from monkeys. Some were replanted after 15 minutes. RCT was completed in the others, and they were replanted after 1
hour. Half of the entire material were given antibiotics. Followed from 2 days to 40 wks. All teeth showed initiation of ankylosis after 1
Dynamics of dentoalveolar week. In the 15 minute subjects, the ankylosis halted and normal PDL was established. In the 1 hour group, ankylosis increased w/ time.
Hammarstro ankylosis and associated root After 8 wks, most of the PDL was replaced w/ bone. Antibiotics given at the time of replantation reduced the inflamm root resorption over
m, Lindskog 1989 Resorption resorption all time periods.
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Karmali,
Describes the similarities btwnMerchant,
bone and dentin Davis
resorption. The use of Ledermix as an intial treatment for inflamm root resoprtion is a good
idea b/c it is less toxic to barrier forming cells than CaOH while eliminating the source of inflammation. CaOH can be used later in tx if hard
tissue repair is delayed. Frequent changes of CaOH are not advocated b/c fresh CaOH always causes a superficial layer of tissue
Experimental basis for the necrosis, this may damage hard tissue forming cells. Prompt replantation in combination w/ early pulp removal and the use of Ledermix
management of dental should provide an excellent preventive measure against inflamm resorption. Comments: Keep in mind that any of the articles written
Pierce 1989 Resorption resorption before 1995, the concept en vogue was long-term CaOH. This is not what we do today.
This study examined the healing of intentionally damaged root surfaces of replanted teeth w/ either infected or uninfected root canals.
Some were treated w/ short term and others w/ long term CaOH. Group 1: uninfected obturated incisors were extracted, grooved and
replanted w/in 2 min. Group 2: artificially infected, extracted and grooved. 2 wks later. instr and CaOH. 1 wk after that, canals were obt w/
GP. Group 3: same as group 2, but instead of GP obt, they were re-packed w/ CaOH. Group 4 were positive controls, treated like group 2
but no endo performed. None of the teeth in group 4 showed cemental repair and all had inflamm resorption. Most of the teeth in the rest
of the groups showed complete cemental repair. The remaining ones had partial cemental repair. Is long-term CaOH therapy necessary
Effects of different for these teeth as advocated by the AAE?? If you remove the infection w/ pulpectomy and 1 wk of CaOH, that should be sufficient to
endodontic treatment prevent inflamm resorption. Also, if an endo treated tooth is avulsed, is there a need to remove the GP and replace w/ long term CaOH?
protocols on periodontal According to this, frequent recall seems to be all that is necessary. Comments: Andreasen a couple of years ago gave us another reason
Trope, repair and root resorption of to avoid long-term CaOH therapy...higher incidence of fx. This is missing a group, avulsed, replanted and immed endo w/o CaOH. What
Friedman 1992 Resorption replanted dog teeth are the expected results of this group in relation to inflamm root resorption?? You would expect no inflamm resorption.
Effects of dental trauma on
Love 1997 Resorption the pulp A great review of the literature on trauma. Hits all the major implications and treatment alternatives. Too much good stuff to summarize.
EXT immature first molars in conventional and germ-free rats and immediately replanted them. Rats sacrificed at 3d, 1,2,4,&8 wks.
Compared w/ the conventional rats, the germ-free rats had an almost complete absence of neutrophil infiltration of the pulp. The pulpal
calcification w/ the ingrowth of bone was a common finding. There was a lack of typical inflamm root resorption, though ankylosis was very
common. Supports the concept that bacterial infiltration causes healing complications like pulpal necrosis and inflamm resorption.
Tooth replantation in germ- Although ankylosis did develop under asceptic conditions, this could have occured b/c of the trauma to the PDL during EXT. Comments:
Suda 1998 Resorption free and conventional rats Ankylosis occurred in germ-free rats, but inflamm root resorption did not. You do not need bacteria for ankylosis to occur.
Periapical replacement Review of case hx involving endo and Periapical Replacement Resorption (PARR) due to orthodontic movement. PARR is a
resorption of permanent, cementoblastic activity while replacement resorption due to trauma is an osteoclastic activity. Endodontically treated teeth seem to be less
vital, endodontically treated frequently involved w/ orthodontic resorption, and when they are, it is usually less severe. Possible reasons are that in the vital pulp. there
incisors after orthodontic is higher conc of neuropeptides (SP,CGRP,NKY) that play a role in bone resorption. PARR is also decreased when CaOH is introduced at
movement: A report of two the apex. Describes a case of ortho movement during a CaOH apexification without any ill effects. Comments: most other reports find the
Bender 1997 Resorption cases opposite, that endo tx teeth resorb more, but it is more self-limiting.
Describes dx and tx w/ case reports. 1. Determine the type of resorption by rdx. Look for continuity in the outline if the canal/chamber. Off
angle rdx, the lesion should move. 2. Clinically, the pulp should test vital. Look for a pink discoloration at the gingival level, maybe able to
probe. 3. Surgically expose the lesion and develop a sound dentinal margin. Remove the soft tissue in the defect w/o disturbing the
predentin layer protecting the pulp. 4. Place Dycal and restorative material. 5. Replace flap. Dx can be tricky...rule out internal resorption
Nonendodontic therapy for b/c the can present similarly. Be careful not to expose the pulp during curettage. Ensure that you remove all the granulation tissue and
Frank, supraosseous extracanal that you seal the POE. Supraosseous is tx diiferently from intraosseous where NSRCT is indicated, followed by debridement and
Bakland 1987 Resorption invasive resorption restoration from an intracanal approach...a lot more difficult to tx.
Clinical findings: asymtomatic, maybe assoc w/ discoloration or perio defects depending on location, palp and perc wnl. Radiographically,
outline of the canal should be visualized, off angle rdx will move lesion. Important to differentiate from internal resorption. If tx
endodontically, GP would remain symetrically w/in the confines of the canal. Histologically there are irregular resorptive defects of the
cementum and dentin, there are no inflammatory cells. Resorption takes place w/in the dentin and does not involve the pulp. Breakdown
does not occur at the POE, which makes it diff to locate surgically. Treamtent is debridement and obliteration of the POE and the defect. If
Frank, Diagnosis and treatment of supraosseous, vitality of the pulp can be maintained. If crestal, NSRCT is indicated w/ tx of defect rendered from w/in the canal. If
Torabinejad 1998 Resorption extracanal invasive resorption intraosseous, tx should be rendered form w/in the canal as well. A last ditch effort may include intentional replantation.
Clinical presentation may involve a pink discoloration of the crown. Usu painless, pulp remains protected by the predentin, pulp is vital
unless superceded by secondary infection. Outline of the canal space is evident, lesion moves w/ angled rdx. Usu confined to one tooth,
but can be in mult teeth, esp if hx of ortho. Can be found in RCT teeth if hx of trauma or bleaching. Histo: mass of fibrous tissue w/ clastic
cells. As process continues, channels are created and can burrow deeply into the dentin. This can develop an osseous component.
Clinical, radiologic, and Cavitation into oral cavity can occur later in the process introducing an inflamm component. For invasion to occur, there must be a defect
histopathologic features of in the cementum , the tissues involved arise from the periodontium. Early tx is best. Tx includes complete removal of active tissue of
Heithersay 1999 Resorption invasive cervical resorption removal of its blood supply. Can be done surgically or chemically.
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Karmali,
189 luxated perm Merchant,
teeth followed Davis
for an avg of 3.4 yrs. Necrosis was found in 52% of the time.It was related type of luxation (sublux best,
intrusion worst) and root development (open apex better than closed apex). Pulp obliteration happened 22% of the time. Related to root
development, type of luxation and crown fx. For obliteration to occur, the pulp has to remain vital, so this was more common in open apex,
sublux and/or no crown fx. Progressive external resorption occurred in 11%. Type of luxation, time to tx, and reduction were related.
Luxation of permanent teeth Reduction surprisingly caused more resorption, thought to be the trauma to the PDL assoc w/ reduction. Loss of marginal ridge support
Andreasen 1970 Trauma due to trauma was 10%. Type of luxation, time to tx and alveolar fx were related. Rigid splinting was used for an avg of 6 wks.
84 single-rooted teeth w/ intact crowns. 64% showed growth. Most were mixed flora w/ a single strain dominating, avg of 4 isolated
strains. Predominance of anaerobes. Bacteroides, Corynebacterium, Peptostrep, and Fusobacterium were common. Length of time btwn
Microorganisms from necrotic trauma and tx did not influence composition of microflora. PARL 71%, external resorption 28%. Specimens that were PARL- showed no
Bergenholtz 1974 Trauma pulp of traumatized teeth growth of baceria, so if no sx, endo can be postponed.
Long-term prognosis of 122 traumatized teeth were followed form 10-23 years (16 yr avg). 64% had complete pulpal obliteration, 21% of the severely traumatized
traumatized permanent necrosed and only 4% of the moderately traumatized necrosed. None of the 36% w/ partial obliteration showed necrosis. The more
anterior teeth showing severe the injury, the more likely it was to have complete obliteration and necroses w/ PARL. Conclusions: extended observation periods
calcifying processes in the are needed to predict outcome. Only teeth w/ complete obliteration are susceptible to necrosis. Also, it is possible to predict in which
Kerekes 1977 Trauma pulp cavity cases total pulpal obliteration will occur in. Even if 21% of the totally obliterated canals necrosed, routine endo is not prudent.
Pulpal prognosis following After observing 52 teeth after extrusive luxation from 4wks to 1.5yrs, 98% showed necrosis. Higher percentage than reported w/
extrusive luxation injuries in Andreasen and Eklund's separate studies, but this one had an older pt population (mean 20yrs) which meant a grtr poss of complete apical
permanent teeth with closed closure. Also, the severity of these injuries are prob grtr than those in the other two studies. So, teeth with fully developed apices that are
Dumsha 1982 Trauma apexes. forcefully seperated from their blood supply are likely to necrose.
Prognosis of luxated non-vital

maxillary incisors treated with 60 incisors w/ complex crown fx was treated w/ shallow pulpotomy and CaOH. Exposures prior to tx were from 1 day to 90 days.
CaOH and filled with GP. A Pulpotomy was done w/ a diamond bur and exposed pulp was irrig w/ saline. Followed for 1-5 yrs. 96% healed. Comments: Today we
Cvek 1992 Trauma retrospective clinical study would irrig w/ NaOCl and place MTA as the pulp capping agent.
29 pts w/ alveolar fx involving 71 teeth. Mean observation time was 6.5 yrs. 75% showed necrosis. Related to how quickly tooth was
splinted, thereby limiting further trauma to microvasculature. 15% showed pulp obliteration. Time to tx was also sig related. Since vitality
Fractures of the alveolar is necessary for pulp obliteration to occur, it happened to teeth that were splinted w/in 60 minutes. Root resorption 11%. Loss of marginal
Andreasen 1970 Trauma process of the jaw bone support 13%
132 pts involving 185 teeth, observation period from 1-3 yrs. 59% of the teeth completely recovered. Inciidence and degree of pulpal and
Prognosis of teeth involved in perio complications was closely related to the location of the fx line (at the apex or down the PDL) and the amt of displacement of the
Kahnberg, the line of mandibular fragments. How well the fx could be reduced and stabilized also played a role. 23% of the teeth that tested - at initial exam showed +
Ridell 1979 Trauma fractures sensibility at follow up, thus a long -term follow up is nec.
Pulpal and radicular Maxillary osteotomies were done on 4 monkeys. Killed 150 days post op. The pulp of a majority of teeth showed pathological pulpal
response to maxillary changes, even in the presence of collateral circulation. NSRCT will not save teeth involved in external resorption caused by any cut,
Langeland 1982 Trauma osteotomy in monkeys longitudinal or cross. Apices cut during the osteotomies caused necrosis in every case.
A radioigraphic evaluation of
the response of previously
avulsed teeth and partially
avulsed teeth to orthodontic Ortho tx can be accomplished successfully in teeth that have been avulsed and reimplanted. They respond normally to movement forces.
Hines 1970 Trauma movement Apical resorption does occur more often in these teeth. How long do you stabilize the avulsed tooth prior to initiating movement forces????
23 EXT monkey teeth were place in milk, saliva and saline. Histochemically analyzed at 1,2,&3 hrs. Stained for two enzymes to determine
Blomlof, vitality of the PDL and pulp. At 1 hr, milk showed a slightly better staining. At 2 &3 hrs, milk was sig better at maintaining vitality. There
Lindskog, Vitality of PDL cells after was a slow degeneration of the pulp suggesting a low content of autolytic enzymes in the pulp. Comments: Blomlof is the milk man!!! Milk
Hammarstro storage of monkey teeth in can maintain PDL vitality for about 6hrs, HBSS is about 24-48 hrs, Viaspan is about 48 hrs. Tap water sucks, but it is better than dry.
m 1980 Trauma milk or saliva Wrapping in plastic wrap is better than dry as well.
Various areas of PDL were dried or removed from the roots of monkey teeth and replanted. Histo study after 2,4,& 8 wks. In the drying
experiment, ankylosis was established after 2 wks corresponding to the dried area of root. This was removed by a resorptive process in a
majority of the cases after 8 wks. When 1 or 4 mm squared of the PDL was removed, a transient ankylosis which resolved after 8 wks was
The effect of limited drying or also noted. The 9 & 16mm squared removal of PDL resulted in a persistent ankylosis at 8wks. If the damaged PDL is next to vital PDL,
Andreasen 1981 Trauma removal of the PDL ankylosis can be reversed by a resorptive process, the extent of this process is estimated to be 1-1.5mm.
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Teeth were EXTKarmali, Merchant,
from monkeys. Davis
Extra-oral NSRCT. One group was kept moist and replanted in in 18 min. The other was allowed to dry
for 120 min. 1/2 the monkeys in each group had their labial plate removed. Sacrificed and eval'd after 8 wks. In the 18 min group,
resorption was independent of the presence of the cortical plate. Bone level was sig more coronally placed than in the 120 min group. In
the 120 min group, no sig diff in the freq of root resorption, in most cases the labial plate was only partly reformed or not reformed at all.
Interrelation between alveolar Conclusion: a sig relationship exists btwn PDL vitality (extra-oral dry time) and labial plate repair. Supports theory that cells in and around
bone and PDL repair after the PDL are capable of bone induction. Also, removal of the bone socket did not prevent root resorption, so CT facing a damaged root
replantation of mature surface can induce root resorption. Comments: This can be used to justify the surgical principle of locating the root first, then moving to
permanent incisors in find the apex. If you can do this with reasonable skill, there will be limited effect on the PDL. It will not effect healing of the bone, nor will
Andreasen 1981 Trauma monkeys there be permanent replacement resorption.
Teeth were EXT from monkeys. Pulp extirpation was performed on all teeth and one half of the material was obt w/ GP. Some were
The effect of pulp extirpation replanted after being kept moist for 18 min. The others were allowed to dry for 120 min. Sacrificed after 8 wks. Extra-oral filling lead to
or root canal treatment on more ankylosis and surf resorption, but less inflamm resorption. In root filled teeth, the resorption occurred close to the apical foramen,
periodontal healing after indicating that the filling procudure or the materials used (Kerr sealer) further damages the PDL. Extra-oral pulp extirpation did not change
replantation of permanent the extent of resorption. Conclusion: The avulsed tooth should be replanted immediately, prior to extirpation or full NSRCT. This may inc
Andreasen 1981 Trauma incisors in monkeys the extent of inflamm root resorption, but CaOH tx later offers a predictable result.
EXT in monkeys and replanted them w/ or w/o completing extra-oral RCT. EXT atraumatically and PDL kept moist. Reimplanted from 18
to 120 min. Followed for 2-8 weeks and studied histologically. Inflamm root resorption, in contrast to surface resorption, was always linked
to the presence of a luekocyte zone or necrotic pulp tissue. Teeth w/o bacteria in the necrotic pulp had fewer inflamm resorption cavities.
Inflamm resorption was strongly linked to the "corner" surfaces of the root. The theory of why this all happens is that damaged PDL is
Relationship between surface removed by a resorption process, leading to the resorption of cementum and dentin and these "corners" are more likely to have damged
and inflammatory resoption PDL from the EXT or trauma. Now either surface resorption or infalmm resorption can take place depending on the the extent of exposed
and changes in pulp after dentinal tubules and the status of the pulp. If the initial resorption is deep, and the pulp is infected, then toxins will leak through the tubules
replantation of permanent and inflamm resorption will occur. If the cavity is shallow, even an infected pulp may cause only surface resorption. Finally, when the pulp
Andreasen 1981 Trauma incisors in monkeys is vital, inflamed or not, or NSRCT has been performed, then surface resorption occurs regardless of the depth of the cavity.
Avulsed human teeth 21 human avulsed teeth were replanted w/in 15 minutes and followed for an average of five years. 15/21 ( approx 75) showed no sign of
Andersson, replanted within 15 minutes- resorption or shallow non-progressive resorption. 6 teeth showed signs of progressive resorption, 5 of these did not have NSRCT w/in
Bodin 1990 Trauma long term clinical follow up three weeks. Teeth replanted w/in 15 min have a favorable long-term prognosis.
Epithelial rests' function in Teeth from mongrel dogs were EXT, Cavit retroseal placed, and replanted w/in 3 min. Followed from 24-48 days. Where there were Rests
Wallace, replantation: is splinting of Mallesez, resorption was absent. Splinting is not nec to prevent replacement resorption. Splinting too long will result in more
Vergona 1990 Trauma necessary in replantation replacement resorption.
29 aulsed teeth were replanted. In most cases, extra-oral NSRCT was completed before replantation and splinting. Followed for 8 yrs.
Replantation: analysis of 29 The incidence of root resorption was higher in teeth that had been replanted after an hour. When resorption occurred, it was w/in a year.
Gonda 1990 Trauma teeth Some teeth that had long extra-oral times showed no signs of resorption...so you never know.
The effect of citric acid 95 dog teeth were EXT, root planed, replanted and followed up to 56 days. Half of the teeth were soaked w/ citric acid for 3 min prior to
treatment on periodontal replantation. At 3 and 14 days, the citric acid group showed better healing. At 56 days though, the citric acid group had much more
healing after replantation of replacement resorption and inflamm resorption. Hypothesis that the citric acid acts as a chemotactic agent for resorptive cells or that it
Zervas 1991 Trauma permanent teeth makes the root surface more prone to resorption and ankylosis. Do not treat teeth to be replanted w/ citric acid.
72 dog teeth were treated endodontically, extractracted and placed in Viaspan or milk for 6-36 hrs and Viaspan or HBSS for 36-96 hrs.
Histologically examined after 2 mo. Milk had good results upto 6 hrs of storage. Viaspan proved ot be superior to milk and similar to
Periodontal healing of HBSS. Interesting to note that from 24-48 hrs of storage, there was an inc incidence of replacement and inflamm resorption. The
replanted dog teeth stored in incidence dropped to lower levels after 48 hrs of storage. Hypothesized that from 24-48 hrs, there is a host inflamm rxn in the socket which
Trope, Viaspan, milk, and Hank's dissapates after 48 hrs. If the PDL vitality can be maintained for this time period w/ Viaspan or HBSS, and replanted after 48 hrs, then
Friedman 1992 Trauma balanced salt solution good results can be expected.
Report of 31 teeth treated w/ intentional replantation. Contraindications: perio dz, mobility, furcal involvement, gingivitis, long curved roots,
divergent roots. Ab given 1 hr prior to procedure and given for 4 days later. Root end resected and amal retrofill placed. Splinting was
Intentional replantation of not nec, tooth placed in socket and pt instructed to bite down. Perio pack placed and removed after 3-4 wks. Overall success rate of 80%
Bender 1993 Trauma endodontically treated teeth (78% in molars).
Kratchman 1997 Trauma Intentional replantation Great review of the replantation procedure. Step-by-step.
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Karmali,
400 replanted perm Merchant,
incisors were Davis
followed for up to 20 yrs (5 yr avg). Stored and rinsed in saline once pt arrived at clinic. Tooth was
replanted and splinted. RCT depended upon level of root formation and rdx evidence of infection. Moorees classification was described.
1-4 represent 1/4 to 4/4 root development. 5 is a half-open apex. 6 is a fully developed apex. In root formation stages 2-5, pulpal
revascularization occured in 34% of the cases. The trend was the less developed roots showed a grtr chance of revascularization (2=60%,
Replantation of 400 avulsed 5=24%). Perio healing w/o any signs of resorption occurred in 24% of the cases, 36% adding in teeth w/ arrested resorption. The less
permanent incisors. 1. mature roots did better. Replacement resorption was the most common form of non-healing, followed by inflamm resorption and surf
Diagnosis of healing resorption. Tooth survival was much better for mature teeth b/c rate of resorption was slower and there was more tooth structure available
Andreasen 1995 Trauma complications to resorb. For a mature tooth, survival was about 70% @ 10 yrs.
Treatment of the avulsed
tooth. Recommended
AAE 1995 Trauma guidelines of the AAE
Hargreaves, Endodontic Pharmacology,

Hutter 2002 Pharmacology Pathways of the Pulp, 8th ed. Good review to read.
Management of pain and
anxiety, Pathways of the
Malamed 2002 Pharmacology Pulp, 8th ed. Good review to read.
Penicillins and cephalosporins interfere w/ bacterial cell wall synthesis. It prevents the cross-linking of the murein in the inner-portion of the
wall. Murein is responsible for cell wall strength, w/o murein the cell bursts in a hypotonic environment. Penicllin works specifically on the
transpeptidase enzyme by irreversibly binding to it and blocking its action. PCN is non-toxic b/c mammal cells do not have cell walls. Since
all bacteria have cell walls, why isn't PCN effective against evrything?? Some bacteria have penicillinase, others have a cell wall that
Smith 1976 Pharmacology How penicillin works prevents the diffusion of PCN so that it doesn't have access to the transpeptidase. Bactericidal.
Tetracycline, Erythromycin and Clindamycin interfere w/ bacterial protein synthesis by binding to bacterial ribosomal sub-units.
Tetracyclines interfere w/ the 30S sub-unit, while Erythromycin and Clindamycin interfere w/ the 50S sub-unit. These are not effective on
Antibiotics that interfere with all bacteria b/c some bacteria have cell walls that prevent access to the ribosomes. Furthermore, these antibiotics are not comaptible w/
Smith 1976 Pharmacology bacterial protein synthesis some bacterial ribosomes. Bacteriostatic.
Antibiotic sensitivity patterns
of facultative and obligate Bacterial samples were obtained from 55 infected root canals and in vitro sensitvity tests were performed. Clindamycin was the most
Ernest, anaerobic bacteria from pulp effective against strict anaerobes (both G+ and G-), while Erythromycin was the least effective. Ampicillin was the most effective Ab against
Kuedell 1977 Pharmacology canals facultative organisms while clindamycin and Pen G were the least effective
Goldstein, Extrachromosomal control of Mulitple Ab resistance is related to an extrachromosomal particle called a plasmid or a resistance plasmid (R-plasmid). This plasmid
Macrina 1977 Pharmacology antibiotic resistance spreads among a population of bacteria making them multi-resistant. E. Faecalis is one of these.
Glucocoritcosteroids in
Bahn 1982 Pharmacology dentistry
Epinepherine is a sympathomimetic amine. In conventional doses, it inc cardiac output. Vasoconstictors enhance the effect of LA. Most
local anesthetics are vasodilators except mepivacaine. Lidocaine is an incompetent pulpal anesthetic w/o epi. Vasoconstictors reduce
peak plasma conc by retarding the rate of absorption. Vasoconstrictors control local hemorrhage. Most studies have found no diff in
Vasoconstrictors and local toxicity btwn LA w/ and w/o vasoconstrictors. Vasoconstrictors can interact w/ TCA b/c TCAs inhibit uptake of epi around neuronal
Jastak, anesthesia: A review and terminals. Epi not potentiated by MAOIs b/c they are metabolized thru a different system. Phenothiazines (anti-psychotic) interacts w/ epi.
Yagiela 1983 Pharmacology rationale for use Do not use in uncontrolled hyperthyroid pts.
The effect of IM injection of Controlled double blind study of 50 pts. IM injection of 4 mg of dexameth showed a sig amount of pain reduction at 4 h vs placebo. At 24
steroid on post-treatment hrs, there was a trend towards pain reduction in the steroid group. Things were about equal at 24 hrs. Pretreatment pain was the best
Walton 1984 Pharmacology endodontic pain indicator of posttreatment pain.
Case report where only anaerobes were isolated after a course of Erythromycin. Erythro levels reaching the mucosa are minimal and may
be sufficient to attack some facultative bact but not others. A combination w/ Metronidazole, which targets anaerobes, would be advisable,
Microbiological though it has an antabuse effect. Clindamycin, which is great against anaerobes may cause colitis, so it should be used w/ more caution.
considerations in selecting a No drug can replace the effectiveness of removing the infected substrate in which anaerobes grow. Comments: Colitis is not specific to
drug for endodontic just clindamycin...it happens to w/ every antibiotic. Colitis is caused by Clostridium difficile, tx w/ vancomycin or metronidazole. Niether are
Schein 1986 Pharmacology abscesses absorbed in the gut.
People react differently to different NSAIDs. Tough to know why. It may be due more to pharmacodynamics than to pharmacokinetics.
Proper dosing also plays a role. The mech of action is mainly due to the inhibition of PGs. There is also an effect on PMNs. NSAIDs
Variability in response to effect their aggregation and lysosomal release. It takes short half life NSAIDs (Ibuprofen) about 3 days to hit a maximal effect. In medium
Day, Brooks 1988 Pharmacology NSAIDs, fact or fiction half life NSAIDs (Naproxen), it can take up to a week.
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NSAIDs work byKarmali, Merchant,
inhibiting PG synthesis via the Davis
COX pathway, blocks the accumulation of proinflamm PGs. Also has an effect on
Clinical differences among nuetrophils and the immune system. All the NSAIDs possess antipyretic, anit-inflamm and analgesic to varying degrees. Can have imp
NSAIDs: implications for platelet inhibition properties (ASA is most prolonged in effect). Inhibiting PG production can have both positive and negative effects. PGs
therapuetic substitution in modulate pain, mediate inflamm, cytpoprotect GI tract, stimulate platelet aggregation, and maintain blood flow to kidneys. Dose related. GI
Smtih, Levy 1989 Pharmacology ambulatory patients sx most common. Can inc lithium conc to toxic levels for those on lithium meds. Use cautiously on pts on oral anticoags.
Reviews drugs by class. Not that great. Important to know b/c so many pts are on this stuff. Look for another source. It does state briefly
Anonymous 1989 Pharmacology Drugs for hypertension that NSAIDs can decrease the effectiveness of these drugs.
Angina Pectoris has two types. Stable angina has a consistent pain pattern, usu upon exertion, responds to rest and nitro. Unstable
angina occurs at rest and may not respond to nitro. When treating these pts, monitor vitals, keep appts short and minimize epi. If sx occur,
100% O2, if no response to three doses nitro in 30 min, then transfer to hospital. Myocardial infact is ischemia leading to tissue death. Sx
are pain more severe than angina and not relieved by nitro, cyanosis, cold sweat, N&V, dyspnea. If it occurs, 100% O2, EMS and CPR if
nec. Hypertension is BP grtr than 140/90. Make sure it is controlled prior to elective dental care, reasonable control is acceptable for
emerg tx. Avoid IV injection of epi...duh. Also avoid drug interactions w/ their meds (NSAIDs). CHF is the inability of the heart to pump
sufficient blood to meet metabolic demands. Signs/sx are dyspnea, fatigue, jugular distention, rales. Well compensated pts can be tx w/o
Managing pateints with med consult. Anticoag therapy (coumadin or asa): consult w/ MD prior to surg. meticulous use of local hemorrhage control measures,
Anonymous 1989 Pharmacology cardiovascular disease determine INH/PT, no ASA 1 wk prior to surg. Pacemakers: avoid apex locators, cavitrons and electrosurg.
The essential features of
microorganisms and the
rationale for antimicrobial There are inherent differences btwn various types of microorgs so the proper choice of an antimicrobial drug must be chosen carefully.
Douglas 1992 Pharmacology therapy Describes viruses, procaryotic cells and eukaryotic cells. Brief description of the appropriate types antimicrobials to use and why.
Pharmacokinetics and
Greenblatt 1990 Pharmacology pharmacodynamics Discusses diazepam drugs and their absorption, clerance, etc. Not very good.
Discusses the absolute contraindications. Many of them involve heart conditions, such as, unstable angina, recent MI (3-6 mo), recent
bypass surg (3 mo), refractory arrhythmias, uncontrolled/sever HTN, and severe/uncontrolled CHF. Furthermore, the use of
intraligamentary and intraosseous anesthesia greatly inc the risk. Epi may potentiate the efftects of thyroid hormone in hyperthyroid pts.
Epi is considered a hyperglycemic hormone and directly opposes the actions of insulin, therefore, it should not be used in uncontrolled
Contraindications to diabetics. It should also be avoided in pts w/ sulfite allergies. Although this allergy is rare, it seems to be mreo prevelant in steroid-
Perusse, vasoconstrictors in dentistry; dependent asthmatics, so it should be avoided in this group. Pheocromocytoma is rare and is characterized by the presence of a
Goulet 1992 Pharmacology Part I and Part II catecholamine producing hormone. Epi should not be used in these pts.
Site of action is the nerve membrane, displaces the Ca on receptors therby decreasing the Na conductance which decreases the
depolarization of the nerve. RN form diffuses across the membrane, RNH+ form binds to the receptor site. The lower the pKa, the more
RN is available for diffusion. As the pH decreases, the amt of RN also decreaes, making the anesth less effective. The amides are
metabolized in the liver and excretion is in the kidneys. Max safe doses of epi are 0.2mg in a healthy adult and .04mg in a cardiac pt.
Ayoub, Levonordeferin is an epi substitute that is 15-50% as effective, found in 1:20K conc, 1.0mg in a healthy adult and 0.2 mg in a cardiac pt are
Coleman 1992 Pharmacology A review of local anesthetics the max doses.
PCN and Cephalosporins: Food delays absorption, hypersensitivity is a rare but major adverse effect, impairs oral contraceptives. Pen
VK is the drug of choice for mild-mod odontogenic infections. Works against G+/G- anaerobes and some strep. Amox has little value for
odontogenic infections but is very effective for endocarditis proph. Erythromcyin: Safe, common choice for pts allergic to PCN, not as
good as PCN, but still effective. May inc toxicity of anticoags. Tetracyclines: limited use in dentistry, widespread resistance, GI
disturbance and hypersens can occur. Clindamycin: very effective against most anaerobes and G+ facultative orgs like staph and strep.
A review of commonly Hx of GI disturbances (PMC is causes by Clostridium difficile, tx w/ vancomycin or metronidazole). Good choice for severe odontogenic
Karlowsky, prescribed oral antibiotics in infecitons. Metronidazole: ineffective against aerobes but very effective against anaerobes, great in combination w/ PCN. Antabuse
Zhanel 1993 Pharmacology general dentistry effects, inhibits metab of anticoags, impairs oral contracptives.
Local anesthetics and
vasoconstrictors in patients Vasoconstrictors inc the intensity and duration of LA, decrease toxicity by dec rate of absorption and they reduce local hemorrhage. Effect
Anderson, w/ compromised on heart is inc rate and cardiac output. Also causes autonomic vasoconstriction and skeletal mm vasodilation (results in inc systolic, dec
Reagan 1993 Pharmacology cardiovascular systems diastolic BP). Intraligamental injection inc amt absorbed in bloodstream.
To avoid Adverse Drug Rxns, a throrough med hx, including and medication hx, must be taken. Should include dosage schedules. Drug
interactions can be categorized as antagonistic: dec of effect of one drug when a 2nd is added. Potentiation: combination of 2 drugs that
do not share a common action resulting in a response grtr than normal. Unexpected: adverse response when drugs are combined that do
not occuyre when drugs are given seperately. Summation: inc effects when similar drugs are given together (1+1=2). Synergism:
Combination results in exaggerated response (1+1=4). Risk factors that contribute to ADR: Drugs that are highly bound to plasma proteins.
If one is highly bound, and another is added, it cannot bind, so there is an inc in blood conc. Drugs that rely upon a first pass effect to
Adverse drug interactions in become bioavailable are effected by drugs that impair enzymes in the gut of the liver. Drugs that have a small margin of safety. Drugs that
Moore, Haas 1999 Pharmacology dental practice; Part I are used in the elderly or the medically compromised.
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Karmali,
Bacteriocidals w/ Merchant,
bacteriostatics: Cidals workDavis
best when microbes are growing. Adding statics antagonizes the cidals. TCN w/ di and
trivalent cations: Tetracycline chelates cations impairing Ab absorption (milk, cheese, iron supplements). Also, antacids raise the gastric
pH, impairing absorption. Metronidazole w/ EtOH: antabuse (disulfiram) effect. Metronidazole w/ Lithium: inhibits renal excretion
leading to elevated blood lithium levels. Erythro or TCN w/ Digoxin: reduces the gut flora which metabolizes a lot of the digoxin, leads to
inc blood levels, Digoxin has a low therapuetic index. Manifested as salivation, visual disturbances and arrhythmias. Erythro or Metro w/
Warfarin or anisinidione: Dec metabolism and sig inc PT times, look for bleeding and bruising. Erythro and -azoles w/ Cyclosporin,
Prednisone, Theophylline, Lovastatin, Triazolam: block metabolism of these drugs and inc blood levels and effects. Severity depends
Adverse drug interaction in upon therapuetic index. Comments: there is no reason to ever use Erythromycin. The new macrolides have less Erythro-like effects.
dental practice: Interactions Azythromycin has the least Erythro-like effects. These are more expensive than even Clindamycin, so these are never first or even second
Hersh 1999 Pharmacology involving antibiotics; Part II choice antibiotics.
NSAIDS and Antihypertensives (ACEI, Diuretics, Beta-blockers): Hazardous for long-term tx. May be Rx'd for up to 4 days, unless
severe CHF. Ca+ channel blockers not affected. NSAIDs and Lithium: combination should be avoided or kept short term, evidence is
inconclusive. NSAIDs and Anticoags: GI bleeding may result, esp w/ ASA. NSAIDS w/ Methotrexate: Avoid if high dose methotrexate
for cancer tx, little concern w/ low dose methotrexate used for arthritis. NSAIDs w/ EtOH: Poss GI bleeding. NSAIDs w/ Digoxin: NSAIDs
reduce PG production in the kidney which is responsible for metabolism, results in a higher blood conc. Digoxin has a narrow therapuetic
index. ASA w/ Hypoglycemics: ASA enhances insulin secretion and reduces glucose blood levels, so it can inc the hypoglycemic effect.
Adverse drug interactions in APAP w/ EtOH: Esp dangerous after cessation of EtOH ingestion after chronic intake. Stopping chronic intake frees up excess enzymes
dental practice: Interactions in the P-450 system which can form more toxic metabolites from the APAP. In alcoholics, lower dose to less than 4g/day. Opiods w/
associated w/ analgesics; EtOH: additive rxn. Meperidine w/ MAOIs: mechanism unclear but may be result of accumulation of seratonin from MAOI, avoid if pt has
Haas 1999 Pharmacology Part III taken MAOI w/in 14 days. Davis: Safe to say that there is no reason to Rx oral Meperidine.
Adverse drug interactions in
dental practice; Interactions
associated w/ local
anesthetics, sedatives, and
Moore 1999 Pharmacology anxiolytics; Part IV
Adverse drug interactions in
dental practice: Interactions
associated w/
Yagiela 1999 Pharmacology vasoconstrictors; Part V
The capability of these solutions of solubilize necrotic bovine pulp and dentin were examined. Nectrotic pulp: 5.25% and 2.6% NaOCl
Quantitative analysis of the were about equal in their ability to dissolve (>90%). 1.3% dissolved about 80% of the tissue. 17% EDTA and MTAD were able to dissolve
solubilizing action of MTAD, approx 50-60% of the necrotic pulp. Dentin: 17% EDTA dissloved about 70% of the dentin while MTAD showed a 60% gain in tissue
Irrigation / NaOCL, and EDTA on bovine mass...hypothesized that this was due to the binding of doxycycline to the dentin. 5.25% NaOCl dissolved the organic portion of dentin,
Torabinejad 2003 Medication dental pulps reducing its total mass by about 20%....decreasing conc showed dec dissolution properties.
610 randomly selected pts, aged from 25-40 yo, from two communities w/ different saturation of endodontists were looked at in a cross-
sectional study. All RDX were viewed by one investigator under similar conditions, PAI scores were used to compare the prevalence of AP
w/in the two populations and btwn teeth tx by generalists vs specialists. PAI of 1 and 2 were considered healthy. The prevalence of AP
was 45%!!!! Finding is consistent w/ other studies using the same methodology. Mediocre outcome was related to mediocre quality of
NSRCT...less than 40% of the root fillings were adeq when length and density were combined, less than 20% having both adeq NSRCT
and coronal restorations. Results clearly implicate the quality of the root filling in the outcome of tx. The quality of the restoration also had
Periapical health and an impact...teeth w/ adeq NSRCT but inadeq rests were 3X more likely to fail. So when the root filling appeared to be sound, the rest had a
treatment quality assessment more decisive impact, still the root filling was more decisive than the rest. The outcome of tx did not sig vary btwn the generalist and the
Success/failur of root filled teeth in 2 endodontist. This study had a large % of immigrants, were some of these endos done abroad?? Also, since this was a cross-sectional
Friedman 2003 e Canadian populations study, many of these NSRCT were done w/in 2 yrs (13%) and how many of these may be put in the "healing" category???
Periapical endodontic 120 teeth were tx surgically and followed for 3 yrs. The surgery was done using magnification, u/s, and Super EBA. RDX were analyzed
Maddalone, Success/failur surgery: A 3 year follow-up seperately twice by two investigators on two different occasions. Worst score was recorded. Overall, there was a 93% RDX success rate,
Gagliani 2003 e study did not mention clinical sx. 66% healed RDX w/in 12 months.
Efficiency of rotary nickel-
titanium K3 instruments
compared with stainless steel
hand K-Flexofile. Part 1. K3 were compared w/ Flexofiles used in a reaming motion on curved canals in plastic blocks. K3's were faster and prduced less canal
Schafer, Shaping ability in simulated aberrations than reaming by hand. 11 seperations occurred in 96 canals, they were all K3's. No glide path and a funky sequence of files,
Florek 2003 Instruments curved canals no surprise that they had instr seperate. Kind of a worthless study.
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Efficiency of rotary nickel- Karmali, Merchant, Davis
titanium K3 instruments
compared with stainless steel
hand K-Flexofile. Part 2.
Cleaning effectiveness and
Schafer, shaping ability in severely Flexofiles removed more debris than K3 files. K3s remained more centered though they were more prone to separate. No glide path was
Schlingeman curved root canals of created and they used a funky sequence of files. A bullshit sequel to a bullshit article. Comments: The low quality of these studies are
n 2003 Instruments extracted teeth surprising b/c Schafer is a smart guy when it comes to rotary instr. May be he'll kick it up a notch.
30 Md incisors w/ a single ovoid canal were instr using 2 techniques: balanced force and circumferential filing. Photos were taken before
The capability of 2 hand and after instr. These were compared and the amount of the canal that was mechanically altered was measured. Balanced force instr
instrumentation techniques to near 40% of the wall while circumferential instr near 60% of the wall. This was not statistically sig. With either method, 40-60% of the
Wesselink, Cleaning / remove the inner layer of dentin is untouched!! Since we have a high success rate for NSRCT, the theory that mechanical removal of infected dentin is vital to
Wu 2003 Shaping dentine in oval canals success is being challenged.
MTA and CaOH as pulp
Aeinehchi, capping agents in human 11 pairs of third molars were mechanically exposed and capped w/ MTA or CaOH. EXT and evaluated at intervals to 6 mo. MTA showed
Eslami 2003 Pedo-Endo teeth: A preliminary report less inflamm, hyperemia, and necrosis. It also showed formation of a thicker dentinal bridge.
Ch 7 from Problem solving in
endodontics: Problems in
Gutmann, nonsurgical root canal
Lovdahl 1997 Retreatment retreatment. Review of different techniquest that could be used to treat canal obstructions.
Relationship of broken root
Natkin, canal instruments to 53 teeth w/ sep instr were matched w/ appropriate controls. Found no significant difference in Px after 2 yrs. The size of the file and length
Crump 1970 Retreatment endodontic case prognosis of the seperation didn't seem to be relevant.
The dilemma of the fractured Guest editorial. Describes Grossman's guidelines for the prevention of seperating instruments. 1. Frequent inspection of instruments. 2.
Frank 1983 Retreatment instrument Discard them frequently. 3. Use instruments in sequence of size. If an instrument is seperated, the pt must be informed of what took place.
Endodontic retreatment- Criteria and considerations that are important in the selection of retreatment cases are discussed. A good chart in decision making is in
Friedman 1986 Retreatment Case selection and technique here. A systematic approach is suggested in making treatment planning is suggested.
Investigated the possibilty of removing seperated instr w/ U/S. A file was attached to the U/S and activated in an attempt to work along side
Ultrasonic removal of broken the file. Clinical sample size of 39. In 26 cases the file was removed. In 6 cases, the file was able to be by-passed. So in 80% of the
Nagai, Osada 1986 Retreatment instruments in root canals cases, access to the apex was acheived. The time required ranged from 3-40 minutes.
Review of success and failure in 1300 pt who had undergone retreatment. Success is 66%, Healing is 18% (84% combined). Many
A statistical analysis of variables can affect the success rate of each individual case such as reason for retx, original filling material, how it was retx'd (orthograde
surgical and nonsurgical vs apico alone), the tooth.... Mx ant comprised almost 50% of the Max retxs!!!!! A failure due to a short fill was the most common reason
Brown, Allen 1989 Retreatment endodontic retreatment cases for retx.
Machtou, Post removal prior to
Cohen G 1989 Retreatment retreatment Describes the use of the Gonon post removal system….that's it.
Endodontic retreatment- 40 single rooted extracted teeth were instr and obt w/ GP and Roth's or AH26. Allowed to set for 3 mo. GP removed w/ heat and
ultrasonics and chloroform as chloroform. 2 min of U/S activation w/ using either 1.25% NaOCl or chloroform. Teeth split and evaluated for remaining obt materials. All
the final step in teeth had sealer remaining, accounting for 10-20% of the total canal wall area, tended to be located in the bu and li areas. Both types of
Wilcox 1989 Retreatment reinstrumentation sealers were equally well removed.
Endodontic retreatment- a
rational approach to root
Friedman 1992 Retreatment canal instrumentation Offers a technique for removing GP and instrumenting.
Thermafil retreatment with
Wilcox 1993 Retreatment and without chloroform Technique for retreating Thermafils
Endodontic retreatment. 1:
Pitt Ford, Indications and case
Chong 1996 Retreatment selection Good summary.
Pitt Ford, Endodontic retreatment. 2:
Chong 1996 Retreatment Methods Good summary.
Clinical management of Prospective randomized study. 38 pts with PARL were reandomly divided into 2 groups. Retreatment group had GP removed, instr 1-2
nonhealing periradicular mm from apex, irrig w/ 0.5% NaOCl and obt w/ resin chloroform and GP. The surgical group had a 45 degree resection, a 2mm retroprep
Danin, pathosis. Surgery vs and were filled w/ GI. 1 yr recall. There were no statistically sig differences btwn the groups. 56% in retx group and 58% in surgery group.
Stromberg 1996 Retreatment endodontic retreatment The conclusion makes it sound like the surg group faired much better than the retx one.
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Evidence based dentistry: A review article. Karmali,
Conventional Merchant, Davis
NSRCT is usually successful, though some will fail. Good evidence that NSRCRT is usually associated w/ a
Endodontic failure- how successful outcome. SRCT appears to be assoc w/ an inc success rate if a satisfactory orthograde filling has been placed. Teeth that are
Briggs, Scott 1997 Retreatment should it be managed? permanently restored soon after tx appear to be assoc w/ a higher rate of success.
Presents a case report where he uses a CollaCote as a matrix to repair a perf. Describes the 4 dimensions of a perforation. 1. Level:
Endodontic perforation repair: coronal, middle or apical. In general, the more apical the perf, the better the px. Location: Circumferentially, bu vs li. Important for surgical
Utilizing the operating access. Size: never round, usu elliptical. The smaller the surface area the better. Time: the longer the perf is present, the more damage
Ruddle 1997 Retreatment microscope occurs to the periodontium. Best to repair at same appt as it occurs.
Late failure of root canal
therapy: a diagnostic and
Hayes, treatment planning challenge. Case report that highlights the need for determining the cause of failure and addressing it in re-tx. Not doing so may offer a short term fix,
Drummer 1997 Retreatment Case report. but in the long-term, it is doomed to fail again.
Meta-analysis of various studies using weighted averages regarding re-tx and surgery. For orthograde re-tx: 82% success, 6% uncertain.
This can be further be categorized as re-tx for technical reasons (95% success) and re-tx for pathological reasons (66% success, 11%
Treatment outcome of uncertain). Apical surgery: 66% success, 20% uncertain. If orthograde re-tx done first: 81% success, 12% uncertain. If surgery w/o
surgical and nonsurgical orthograde re-tx: 59% success and 22% uncertain. It is difficult to make direct correlations btwn these studies b/c of different definitions of
Friendman, management of endodontic success, different observation times, quality of coronal seal, and type of techniques used. Most of these studies are older, so scopes, U/S,
Hepworth 1997 Retreatment failures. and modern materials were not used. This should inc the success rates.
Stresses the importance of orthograde re-tx prior to surgery. A good, although topical, review of lit concerning surgery and success/failure
Koton 1997 Retreatment Endodontic retreatment in general.
When RCT has failed, re-tx should always be considered prior to suergery. Apical surgery alone seals only the apex w/o addressing the
possible causes of failure. Long-term success of re-tx is higher than surgery and re-tx is more conservative. Indications for surgery are to
Endodontic retreatment: establish drainage, when re-tx has failed, when re-tx is impracticable and the need for biopsy. Indications for re-tx are poor canal prep,
van der Vyver 1997 Retreatment indications and techniques failure to locate a canal, procedural errors, symptoms, and coronal leakage.
Total endodontic treatment
and retreatment: A case
Marais 1997 Retreatment report A case report of a pt suffering pain from 21 of her teeth, most were necrotic. Tx w/ CaOH is encouraged.
Non-surgical endodontic
Ruddle 1997 Retreatment retreatment A good review. Too many points to summarize.
Microbiologic analysis of 54 asymptomatic teeth were re-tx'd in mult visits w/ the use of CaOH. Cultures were taken at each visit. Followed for 5 yrs. Success rate
teeth with failed endodontic of 75%. For teeth w/ E. faecalis, success was 66%. Teeth that had no recoverable bacteria at the time of obt, the success rate was 80%.
treatment and the outcome of Bacteria and size of the lesion were the only two factors that seemed to affect healing. These two factors were mutually exclusive...the
Sundqvist 1998 Retreatment conservative re-treatment amount of bacteria did not have an affect on the size of the lesion.
The palato-gingival groove.
A cause of failure in root Case reoort. Incidence from 5-8% of Max anteriors. Sometimes difficult to dx, often seen as a narrow, deep PD. Confused as primary
Santa Cecilia 1998 Retreatment canal treatment endo/secondary perio.
Risk assessment of the
toxicity of solvents of gutta Retreated extracted single canal teeth in test tubes to determine how much solvent is expressed through the apex. Took the difference
Chutich, percha used in endodontic btwn the pre-op and post-op weights of the test tubes. Used chloroform, halothane and xylene. The amounts expressed out the apex and
Kaminski 1998 Retreatment retreatment into the tissues were miniscule and were several orders of magnitude lower than the Threshold Limit Value.
In vitro study of a Nd:YAP Determined that the laser, incombination with hand instruments, is an effective way of retreating root canals. There is superficial melting of
laser in endodontic the dentinal walls. The root also heats up 5-7 degrees celsius for about 2 min. The heat necessary for damaging the PDL is 10 degrees C
Farge, Bonin 1998 Retreatment retreatment for about 5 min.
A new method for retrieving The coronal portion of the SP of SI is exposed. 1-2mm trough. 21 guage or smaller section of a need is placed over the exposed tip. A
silver points and seperated Hedstrom of appropriate size is wound down in a clockwise motion to tightly bind the obstruction. All three pieces can now be removed in
Suter 1998 Retreatment instruments from root canals one motion.
Results of endodontic
retreatment: A randomized
clinical study comparing Randomly assigned 95 failing incisors and canines to either an orthograde re-tx goup or to a surgical re-tx group. Follwed for 4 yrs. At 12
surgical and non-surgical mo, the surg group showed a statistically higher healing rate. At 4yrs, however, both groups equalized. The surgery group had more "late
Kvist, Reit 1999 Retreatment procedures failures". The orthograde group took longer to show radiographic signs of healing.
Investigated the occurrence of bacteria in traumatically devitalized teeth with intact pulp chambers. Micro-orgs recovered from 64% of
teeth. May have appreared b/c of anachoresis (shown to be false by Moller 1981), patent dentinal tubules, cemental tears, exposed lateral
Micro-organisms from canals, severe periodontal disease, or through traumatic ex-articulation. 85% of teeth that had a PARL had bacteria, some teeth w/o a
necrotic pulp of traumatized PARL had bacteria. Implies that a sterile necrotic pulp will become infected w/ a PARL if given enough time via dentinal tubules.
Bergenholtz 1974 Microbiology teeth Comments: culturing has its limitations, especially in the 70's...culturing has gotten better since.
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Isolation and classification of Karmali, Merchant, Davis
anaerobic bacteria from intact New method for the isolation and identification of strict anaerobes from w/in a canal. A stream of nitrogen is blown across the tooth during
pulp chambers of non-vital access and sampling. The culturing fluid is drawn into a syrnige from its vial. Injected into canal. Instrumented. Fluid is then drawn back
Kantz, Henry 1974 Microbiology teeth in man into the syringe and injected back into the vial.
35 mono-infected and conventional rats had molars intentionally overinstrumented. Half were sealed w/ amal and the other half were left
Pulpal and periapical tissue open. Sacrificed up to 30 days later. The severity of pulpal and PA inflammation can be related to the quantity of microorganisms in the
Korzen, responses in conventional root canal and the length of time that the tisssues were exposed to them. The degree of mineralized tissues in the canals were inversely
Green 1974 Microbiology and gnotobiotic rats proportional to the presence of microorganisms. No microorganisms were found in the PA tissues of any group. Are PA lesions sterile??
Studied bacterial content of necrotic, traumatized, asymptomatic intact teeth. 18/19 teeth w/ PARL had bacteria. All of the teeth w/o PARL
Bacteriological studies of were sterile. 88 strains were isolated from all teeth, 83 of those were anaerobic (over 90%). Additionally, 7 teeth had flare ups. All of
Sundqvist 1976 Microbiology necrotic dental pulps these, and the teeth which were symptomatic, had bacteroides (now known as bacteroides, porphymonas, and prevotella.)
The oxygen tolerance of 36 strains of anaerobes from necrotic, intact human teeth was studied. Cultured on different media. All strains
Oxygen tolerance of survived for at least 2 hours on the media supplemented w/ blood. 26/79 survived for more than 7 days!!. It is thought that the lysed
anaerobic bacteria isolated RBC's, and not the serum, had the protective effect. The use of a blood containing media might be more important than trying to minimize
Sundqvist 1977 Microbiology from necrotic dental pulps air exposure.
The relationship of 33 necrosed teeth were evaluated to elucidate the relationship of BM to signs and symptoms. BM was isolated from 36% of the cases.
Bacteroides melaninogenicus Strong relationships were found with foul odor, pain and sinus tract formation. Pain and sinus tracts together seem to be exclusive b/c you
Griffee, to symptoms associated w/ don't often have them both together, but consider them part of the same process (production of exudate). No relationship was found with
Patterson 1980 Microbiology pulpal necrosis PARL or exudate in the canal. BM requires Vit K, produced from other microorgs, to survive.
16 surgical cases where Actino or Arachnia were found. All pts had a long, complicated endo hx w/ several infections and fistulations
before surgery. PA Actino is considered rare. A. isrealii was found most often, as well as A. naeslundii and A. propionica. Prolonged
Periapical actinomycosis: A anitbiotic treatment is generally recommended for actino infections (30 days w/ Pen VK). Comments: Arachnia is a genus that used to be
follow up study of 16 categorized w/ Actino. Now it is known to be different...though very similar. Actinomycosis is a good boards topic...yellowish color, sulfur
Happonen 1986 Microbiology surgically treated cases granule, histologically has a hyphae like effect.
8 pts w/ teeth that had refractory PARL were examined for PA bacteria. Bacterial growth was evident in all PA lesions. Anaerobic bacteria
Extraradicular endodontic dominated. Presence of B. gingivalis, B. endodontalis, Eubacterium, Peptostrep and Actino were all demonstrated. PA tissues are not
Tronstad 1987 Microbiology infections sterile, anaerobic bateria can survive in them.
Healing of periapical lesions 79 teeth w/ PA lesions, obturated once bacterial testing was negative. Followed for up to 5 yrs. 94% healed completely (85%) or lesion
of pulpless teeth after dec markedly in size after two yrs (9%) showing a tendency towards healing. More healed as time progressed. Showed that if the lesion
endodontic tx w/ controlled is dec in size over time, it should not be considered a failure. Offered explanations for lesions not healing: remaining bact in tubules,
Sundqvist 1987 Microbiology asepsis bacteria in lesion (actino or arachnia), infected dentin being extruded into lesion.
Infectious flare-ups and
serious sequelae following
endodontic treatment: A
prospective randomized trial 315 consecutive pts w/ Nec/CAP were tx'd single visit. Were assigned a regimen of Pen VK, Erythro stearate, or Erythro base. A dose
on efficacy of antibiotic was given 1 hr prior to tx and another 6 hrs post-op. The pt had to return to the office in pain w/ evidence of infection to be considered a
prophylaxis in cases of flare-up. Their flare-up rate was 2.2%. They compared this with the 19.6% flare up rate they found in 3 retrospective studies they had
asymptomatic pulpal- already completed. Found that teeth w/ very large PARL have a marked tendency towards flare-ups. Short term, high dose antibiotic
Morse 1987 Microbiology periapical lesions prophylaxis reduce flare-ups, swelling and pain. Comments: How much debris was this dude pumping out there???
31 tissue specimens from extracted untreated teeth w/ PARL were taken and examined by light and TE microscopy. All root canals
revealed presence of a mixed bacterial flora. In most cases, the bacteria was restricted to the canal, but in 4 granulomas and 1 cyst,
bacteria was found in the lesion. There was a distinct bacterial plaque adhering to the dentinal wall at the apical foramen. Spirochetes
Light and electron formed a significant component of bacteria seen. Branching, hyphal structures were also seen, suggesting fungi. Actino was also
microscopic studies of root endcountered. The interface btwn the bacterial front and the lesion were seperated by a dense PMN wall or by an eptihelial plug at the
canal flora and periapical apical foramen. All lesions were intact upon extraction. So, all canals of PA affected teeth contain bacteria, and a small percentage of
Nair 1987 Microbiology lesions those reveal bacteria in the PA lesion. Those lesions are usu symptomatic and painful.
Proposal for reclassification
of B. asaccharolyticus, B.
ginigvalis, and B.
endodontalis in a new genus,
Shah, Collins 1988 Microbiology Porphymonas The title says it all.
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Karmali,
Bacteriology of 62 Merchant,
root canal infections Davis
were studied. 61/62 infections were mixed and dominated by anaerobes. B. buccae, B.
intermedius, B. denticola and B. gingivalis were all common species. 35/62 teeth were symptomatic, B. ginigivalis and B. endodontalis
were common in these. Black pigmented bacteroides inc the probability of post op sx. CaOH was an effective antimiocrobial. There was
Bacteroides spp. In dental no difference in long term healing w/ the use of Pen G. 50 cases showed complete healing, 11 showed partial healing and 1 case of no
Haapasalo 1989 Microbiology root canal infections healing was found at 1 yr.
Prevalence of black
pigmented Bacteroides Bacteria from 72 teeth w/ PARL were cultured. All 72 canals contained bacteria. 91% were anaerobes. Bacteroides were recovered from
species in root canal 30% of the canals. B. intermedius and B. endodontalis were the most common. 16/22 canals containing Bacteroides were assoc w/
Sundqvist 1989 Microbiology infections abscess and purulence.
16 granulomas were collected asceptically via surgical curettage from RCT'd anterior teeth. Teeth w/ external sources of bacteria were
excluded (sinus tracts). Clinical precautions were taken to reduce contamination during sampling. Samples were rinsed in a series of
bottles. After six rinses, the granulomas were ground. 85% (14) gave a postive culture after the washing procedures. The rinse water of
the final washing showed a positive culture in 13% (2) of the samples. 55% were facultative anaerobes 45% were strict. Veillonella, strep,
Iwu, Microbiology of periapical actino were commonly isolated. Supports the view that viable organisms from necrotic pulp tissue spread into and colonize part of the PA
Stenhouse 1990 Microbiology granulomas lesions an in so doing, elicit a chronic inflamm response.
Apicoectomies were performed on 10 pts w/ refractory CAP. 5 had sinus tracts. Examined w/ SEM and culture. Microorganisms were
recovered from all specimens. Dominated by anaerobic bacteria. Under the SEM, much of the cementum was covered w/ an amorphous
bacterial plaque that was continuous w/ the apical foramen. Many bacterial forms were recognizable as colonies which were also covered
w/ this plaque. The plaque was probably extracellular polysaccharide which provides a reserve of substrate and acts as a diffusion barrier
Periapical bacterial plaque in making it more difficult to treat wtih antibiotics. Many of these colonies were associated w/ accessory formina making it likely that the
teeth refractory to endodontic source was the root canal. Comments: Tronstad is the PA plaque guy...along w/ Nair. We're talking about bacteria just around the very
Tronstad 1990 Microbiology treatment end of the apex, not free floating in the PA lesions.
Microbiological monitoring Case report of a refractory endo infection that was treated, re-treated w/ long term CaOH, then formocresol, and then an ammonium
and results of treatment of compound. Systemic anitbiotics were also tried w/ the addition of metronidazole after initial failure. The infection persisted. Apico was
extraradicular endodontic performed and root tip was examined in the SEM. The root was covered by a bacterial plaque. Clearly, the presence of this plaque may
Tronstad 1990 Microbiology infection have been one reason the local and systemic anitbiotic treatment were ineffectve.
Analysis of positive cultures 12,150 endodontically treated teeth were sampled for bacteria prior to obturation. 10% had bacteria. Strep was found in 60% of the pure
Stern, from endodontically treated cultures and 98% of the mixed cultures. Ampicillin, cephalothin, erythro and PCN were all effective against strep. Only 17% of the
Dreizen 1990 Microbiology teeth: a retrospective study samples had anaerobes. Instr w/ step-back using 0.5% NaOCl.
Localization and identification
of root canal bacteria in 21 teeth that were dx as pulpless/CAP and were asymptomatic were EXT. The bacteria in the root apex was cultured and the apex was
asymptomatic periapical studied under the SEM. Poylmicrobial colonies were isolated from 60% of the teeth. The bacteria were all isolated from w/in the canal.
Fukushima 1990 Microbiology pathosis Means anachoresis didn't happen. Could also mean that bacteria are not found in the PA lesion in asymptomatic CAP.
Intraradicular bacteria and
fungi in root-filled,
asymptomatic human teeth
and therapy resistant
Nair, periapical lesions: A long- 9 teeth w/ therapy resistant PA lesions were treated w/ block resections. Investigated w/ light and TE microscopy. Microorgs were found In
Sundqvist, term light and electron 6 of the root canals. 4 canals had bacteria, 2 canals had fungi. The light microscope was ineffective in visualizing the bacteria. One lesion
Sjogren 1990 Microbiology microscope follow-up study exhibited a foriegn body reaction. Bacteria and fungi play a significant role in persistent PA lesions,
Therapy resistant foreign
Nair, body giant cell granuloma at Biopsy was taken of an asymptomatic refractory PA lesion that had persisted for more than a decade. A vast number of foreign body giant
Sundqvist, the periapex of a root filled cells were found. Strongly suggests that in the absence of microbial causes, foreign bodies can elicit an inflammatory response at the
Sjogren 1990 Microbiology human tooth apex.
10 pts w/ Nec/CAP and pain as the CC had EXT. All teeth had carious exposures. The apical 5mm was sectioned from the root and
Bacteria in the apical 5mm of cultured both aerobically and anaerobically. 70% of the bacteria isolated were anaerobes. Actino, Lacto, Bacteroides, and E. Faecalis
Baumgartner 1991 Microbiology infected root canals were common.
Immunobiological activities of Bacteria were assayed from RCT'd teeth w/ CAP. Cellular components of the pathogens were obtained by sonic extraction. Investigated
bacteria isolated from root the ability to induce monocyte migration, IL-1 production, mitogenic response and activation of B lymphocytes. A wide range of responses
canals of postendodontic were found. All species enhanced migration of monocytes and induced B lymphocyte mitogenesis. G- anaerobes were stronger activators
teeth with persistent of IL-1 and B lymphocyte activation. As a polymicrobial infection, they can hit different aspects of the immune response leading to the
Tani 1992 Microbiology periapical lesions formation of a persistent PA lesion.
Darkfield microscopic
spirochete count in the Uses a darkfield microscopic count of spirochetes in a perio pocket to determine if the lesion is primary endo or primary perio. If the
differentiation of endodontic spirochete count is less than 10%, it is endo. If the count is grtr than 30%, then it is perio. These counts can be obtained chairside in a few
Trope 1992 Microbiology and periodontal abscesses minutes. Presents 2 cases where this technique was successful.
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A bacteriological and
Karmali,
Histologically examined Merchant,
and cultured samples ofDavis
PA tissues from 58 non-healing PA lesions. 29 of the lesions communicated w/ the oral
cavity (vert fx, sinus tract, perio pockets) and 29 did not. Found that close to 90% of the lesions contained bacteria. Most of the bacteria
Wayman, histological evaluation of 58 were anaerobes. Those that did not communicate w/ the oral cavity had bacteria present in the lesion 83% of the time. Lesions can be
Fowler 1992 Microbiology periapical lesions contaminated.
Argument against anachoresis and against the infection of PA lesions. Monkey pulps were exposed to the oral environment for 7 days
Histological evaluation of the then sealed w/ amal. 7 mo later, en bloc resections were made. Bacterial staining shows bacterial presence in the canals, but no bacteria
presence of bacteria induced was noted in the apical granulomas. Bacteria in monkey canals seem to remain w/in the canal and infection of the PA lesion via a
Walton 1992 Microbiology periapical lesions in monkeys hematogenous route does not seem to occur.
A lit review. The root canal respresents a special environment in which selective pressures result in the establishment of a restricted group
of oral flora. Population shifts occur over time favoring obligate anaerobes. Bacterial interrelationships and available nutritional supply are
Sundqvist 1992 Microbiology Ecology of the root canal flora key factors that affect the mix of microbes. Endodontic treatment can completely disrupt this delicate balance.
van P. endodontalis: Its role in Review article. P. endodontalis is a black-pigmented Gram - rod. Correlated w/ sx of acute infections. It plays an essential role in mixed
Winkelhoff 1992 Microbiology endodontal infections infections. Susceptible to a wide range of antibiotics.
Endotoxin and gram-negative Induced PA lesions in 45 rats. Measured the presence of endotoxin in the PA lesion at varying times to 70 days. Found that the amt of
bacteria in the rat periapical endotoxin increased as time progressed. They also found Gram - bacteria in the PA lesions. There was no correlation btwn the amt of
Yamasaki 1992 Microbiology lesion endotoxin and the number of bacteria. Vague description of how they removed the PA lesion...was it contaminated during removal?
The relationship between
clinical symptoms and
anaerobic bactera from Bacteria from 28 Nec/CAP teeth were cultured. Eubacterium was were found to be significantly related to acute and chronic clinical
Yamasaki 1992 Microbiology infected root canals symptoms. Peptococcus, Peptostrep and P. ginigvalis were associated w/ subacute clinical sx (percussion, swelling, fistula).
Characterizations of total
membrane proteins of P. Uses gel electrophoresis to identify major and minor surface proteins on different strains of P. endodontalis. All strains showed similarity in
Herweijer 1992 Microbiology endodontalis certain major proteins and variation in several minor ones. Some membrane proteins are improtant targets of the immune response.
Root canal infections are polymicrobial (4-7 species). Most frequent isolates are (Gram-): Prevotella, Fusobacterium, Wolinella,
Black pigmented gram- Porphyromanas, (Gram+): Eubacterium, and Strep. Pr. Intermedia, follwed by Pr. Denticola, P. ginigvalis and P. endodontalis are the most
negative anaerobes in common pigmented spp. The latter two are related to acute sx. These Gram- bacteria do not affect Px b/c they are easily eliminated.
Haapasalo 1993 Microbiology endodontic infections Gram+ bacteria are the ones that usu affect the Px (Actino, Arachnia, E. faecalis)
Relationship between clinical
symptoms and enzyme- 28 Nec/CAP teeth were examined for the relationship btwn clinical sx and the presence of the enzymes collagenase, chondroitinase, and
producing bacterai isolated hyaluroidase. Bacteria that produced these enzymes were found to be assoc w/ the presence of sx. The bacteria that produced
Hashioka 1994 Microbiology from infected root canals collagenase were assoc w/ larger PARL. Davis: These are known as spreading factors , Hyaluronidase is the most common.
Ten molars whose root canals were exposed to the oral envirnment and had PARL were used. EXT, largest canal was split and examined
Observation of bacteria and under the SEM. Canals were heavily infected w/ the bulk of the necrotic material in the apical third. There was no bacterial penetration
fungi in infected root canals into the tubules in the coronal third, about 50 microns in the middle third and about 65 microns in the apical third. 4/10 canals had yeast,
Sen 1995 Microbiology and dentinal tubules by SEM supporting the view that we should be adding antifungals to our armamentarium.
Review article. Failure of RCT appears to be unrelated to the relatively small numbers of bacteria left in the tubules. Obturation w/ GP and
sealer during the first appt, after proper chemomechanical cleansing deprives the remaining bacteria access to nutrition and leaves them
Peters, The fate and role of bacteria no space to mulitply, therefore, their effect is inconsequential. There is not enough evidence to support the use of intracanal, interappt
Wesselink 1995 Microbiology left in root dentinal tubules. medicaments to eradicate the bacteria left in the tubules.
70 root canals (both treated and untreated) were cultured for bacteria to find as association with symptoms. 64% were anaerobes. Pain:
Prevotella spp (G-), P. Melaninogenicus (G-), Peptostrep spp. (esp micros) (G+). Swelling: Prevotella, Eubacterium (G+). Percussion:
Prevotella, P. Melaninogenicus. Exudate: Prevotella, Eubacterium, Fusobacterium, Bacteroides. PARL: Peptostrep. RCT'd:
Propionobacterium. This study shows that certain clinical features are assoc w/ certain bacteria in a polymicrobial environment. Postulated
Clinical significance of dental that the most common pathway for yeast to enter the canal is via the tubules. Also can happen thru caries and cracks. Has also been
Gomes 1996 Microbiology root canal microflora found in intact, non-carious teeth. Antibiotics are ineffective against yeast and may even facilitate its growth.
Fungi in therapy resistant Samples were taken from 967 refractory cases. Yeast was isolated in 7% of these. All yeast samples, except one, were Candida.
Haapasalo 1997 Microbiology apical periodontitis C.albicans was the most common. The accompanying bacteria were almost always G+.
54 asymptomatic teeth were re-tx'd in mult visits w/ the use of CaOH. Cultures were taken at each visit. Followed for 5 yrs. Success rate
Microbiologic analysis of of 75%. For teeth w/ E. faecalis, success was 66%. Teeth that had no recoverable bacteria at the time of obt, the success rate was 80%.
teeth with failed endodontic Bacteria and size of the lesion were the only two factors that seemed to affect healing. These two factors were mutually exclusive...the
treatment and the outcome of amount of bacteria did not have an affect on the size of the lesion. In previoulsly root filled teeth, mononinfections are more common and
Sundqvist 1998 Microbiology conservative re-treatment G+ bacteria seem to predominate.
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Karmali,
98 strains of bacteria Merchant,
were isolated DavisAnbitbiotic susceptibility tests were performed. 85% were susceptible to Pen VK,
from 12 abscesses.
91% to Amox, 100% to amox/clavulanic acid, 96% to Clinda, and 45% to Metro. If Metro is used in combo w/ Pen VK or Amox,
Antibiotic susceptibility of effectiveness inc to 93% and 99% respectively. Ab are indicated when infection is systemic, pts w/ progressive infections or in
bacterai associated with immunocompromised pts. Pen VK is still the Ab of choice. If a pt has recently taken Pen or other beta-lactam ring Ab, then
Baumgartner 2003 Pharmacology endodontic absecesses Amox/Clavulanic acid is recommended. Clindamycin is an excellent alternative to Pen allergic pts.
Anatomic consideration in
diagnosis and treatment of Great article to review. Describes muscle attachments, bony landmarks and fascia that are responsible for the localization of infection for
Laskin 1964 Microbiology odontogenic infections each tooth type. Too much to summarize.
Orofacial odontogenic
Chow, Brady 1978 Microbiology infections Describes some of the complications that may arise from odontogenic infections.
Bacteriology and treatment of Cultures from 61 cases of abscesses were obtained by needle aspiration and cultured. 74% had anaerobes. 20/25 cases were effectively
Kannangara 1980 Microbiology dental infections tx'd w/ PCN, the 5 that failed had Md fxs!! 10/10 pts tx'd w/ Clinda healed.
Secondary
Liewehr, hyperparathyroidism: A case
Loushine 2003 report
Cytomegalovirus and
Epstein-Barr virus active Apicoectomies were performed on 5 teeth (NEC/CAP w/ calcified canals). Pts had acute pain, teeth had intact crowns w/o restorations,
infection in periapical lesions cracks, etc. No perio involvement. Tissue samples were collected virological examination was done using PCR. All samples showed
Simon 2003 Microbiology of teeth with intact crowns evidence of active CMV and EBV. None had HSV. How did it get there?? Argument for anachoresis??
Histological and scanning
Witherspoon, Pulp electron microscopy
Gutmann, Physiology assessment of various pulp- Pulp caps and pulpectomies were performed on dogs using MTA, CaOH2 and bonding agents. Sacrificed and evaluated at 50 and 150
Dominguez 2003 and Pathology therapy materials days via light and SE microscopy. MTA gave the best pulpal response and had the fewest cases of necrosis.
Pulp tissue and dentin were isolated from bovine teeth. Placed in test solutions of saline, EDTA, MTAD and varying conc on NaOCl.
Quantitative analysis of the Incubated for 2 hrs under circular rotation. Difference in pre-experiment weight and post experiment weight was calculated. Both 5.25%
solubilizing action of MTAD, and 2.6% NaOCl dissolved >90% of the pulp and approx 20% of the dentin. The most effective solubilizer of dentin was 17% EDTA (70%).
Irrigation / NaOCl, and EDTA on bovine MTAD showed an inc in weight by nearly 60% due to the dinding of Doxicycline to the dentin. Assumed that it was just as effective at
Torabinejad 2003 Medication pulp and dentin demineralizing dentin as EDTA but it was masked by the binding. Looks like full and half strength NaOCl are equally effective.
Efficacy of calcium 24 bovine dentin cylinders were infected w/ E. faecalis and incubated. Two test solutions were places in the cylinders (CaOH w/ water and
hydroxide:chlorhexidine paste CaOH w/ 2% CHX) for 1 week. Shavings of dentin were taken at different depths and incubated. The CaOH/CHX group was significantly
Irrigation / as an intracanal medication better at eliminating E. faecalis (20 CFU vs 1000 CFU). We know that CaOH is ineffective against E. faecalis, what would have happened
Baumgartner 2003 Medication in bovine dentin if a different bacteria was used??
Evaluates the oral manifestations of DM. Disorder of carb and fat metabolism due to the impaired function or secretion of insulin.
Important changes occur in the vascular system. Thickened BM which impairs leukocyte chemotaxis and reduced oxygen diffusion across
the membrane. Lack of insulin also produces fluid flow from cells due to a higher extracellular glucose concentration. Causes less
vascular leaks and cellular dehydration. Detailed human pulp studies are not available. Pulps in DM pts show premature aging and are at
an inc risk for necrosis. Long-term, uncontrolled diabetics exhibit teeth w/ more PARLs of RCT. Can occur b/c of decreased immune
Diabetes mellitus and the response of the pulp to bacteria or b/c of anachoresis. Diabetic odontalgia is described, multiple necrotic teeth w/ CAP w/ no apperant
Bender 2003 dental pulp cause.
Used two methods to compare the antimicrobial effect of MTAD vs NaOCl and EDTA. MTAD was similar to undiluted NaOCl in a zone of
The antimicrobial effect of inhibition test. EDTA was about half as effective. In a Minimum Inhibitory Conc test, MTAD was effective when diluted 200X. NaOCl was
Irrigation / MTAD: An in vitro effective at a 32X dilution. At the end, this study mentions that MTAD can kill E. faecalis in 2 or 5 min which was not observed w/ NaOCl.
Torabinejad 2003 Medication investigation This is not backed up in the study. Is this true??
In vitro infrared Thermafil retreatment was performed on 20 single canal extracted premolars. Group 1: fine System B plugger was inserted on the buccal
thermographic assessment of and lingual of the carrier for 5 sec each. Group 2: same but for 8 sec. Temps were measured w/ a thermal imaging camera. The temp
root surface temperature increase ranged from 27-46 degrees C. It is generally accepted that a 10 degree C increase in temp is enough to cause damage to the
Lipski, rises during Thermafil periodontium. This exceeds it by far. This was also done on the bench top at room temp. Davis: The 10 degree increase is misleading.
Wozniak 2003 Retreatment retreatment using System B The study that this was cited from says the temp of 10 degrees needs to be held for 1 minute for damage to occur.
27 bovine dentin cylinders were sterilized and innoculated w/ E. faecalis. 9 were irrigated w/ 0.2% CHX for 7 minutes. 9 had an Activ Point
Antibacterial efficacy of a (CHX containing GP point) placed and 9 served as positive controls. Incubated for 7 days. The Activ Point group showed no CFUs at any
new chlorhexidine slow depth. The CHX irrigation group showed CFUs slightly better...but not much...from the postive controls (no meds). Activ Points are ISO
Irrigation / release device to disinfect sized GP points that are easy to place accurately to length and are easy to retrieve. They are readiopaque...might be confused as a
Lin, Fuss 2003 Medication dentinal tubules completed RCT.
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Russian Red is aKarmali, Merchant,
paste consisting Davis
of formaldehyde, resorcinol powder and NaOH as a catalyst or hardener. This combination kills the
Resorcinol-formaldehyde bacteria and fixes the remaining pulp tissue. Toxic and causes teeth to turn red. Canals are often underinstrumented. This is a quick and
Gound, resin "Russian Red" cheap way of doing endo. Success rates are equivicle. Soem studies say about an 80% success rate, others say complications arise 90%
Schwandt 2003 Obturation endodontic therapy of the time. Retreatment can be difficult if it has been full polymerized into the canal to length.
Periapical inflammation
affecting coronally-inoculated Premolars of dogs were RCT'd. Half the roots had a 2mm orifice plug of white MTA which was allowed to set for 1 wk. Chambers were
dog teeth with root fillings then inoculated w/ bacteria and sealed. Block resections taken 10 mo later and evaluated. Both groups had no to mild inflammation. No
Periapical augmented by White MTA real difference. This study shows that a traditional GP seal may be effective against leakage if exposed up to 10 mo. Long term
Friedman 2003 Pathology orifice plugs effectiveness of an MTA plug cannot be projected from this study.
132 extracted teeth were instr and autoclaved. Contaminated with saliva and incubated. After controls were used two groups of 60. One
group was rinsed w/ either 1 ml of MTAD or 5.25% NaOCl. Soaked in saline for 2 minutes then transferred to a vial containing culture
Irrigation / In vitro antimicrobial efficacy medium. Incubated and evaluated for turbidity after 96 hours. 1/60 in the MTAD group showed turbidity. 23/60 in the NaOCl group
Torabinejad 2003 Medication of MTAD and NaOCl showed turbidity. MTAD is therefore a more effective disinfectant.
Cultured Human Periodontal Fibrobalsts w/ Canals (a ZOE based sealer) and KT-308 (an experimental GI sealer) for up to 7 days. The
In vitro evaluation of the ZOE sealer was severely cytotoxic at all time intervals. The fibroblasts in the GI cement group showed normal morphology and cell density
Yoshimine, cytocompatibility of a glass- even inc over the 7 days. Characteristics of this GI cement according to Friedman are: better dentin bond than Ketac-Endo, reduced
Yamamoto 2003 Sealers ionomer cement sealer microleakage, slower solubility, fluoride release and antibacterial activity. How do you retreat??
Reviews the immunologic rxns involved in a PA lesion. The process of bone resorption is multi-factorial. Viable bacteria, bacterial products
and host defenses all play a role. Two forms of immune response. Antibody mediated where there is an Ab/Ag complex or an IgE reaction
that could initiate the preliminary changes in PA tissues. Cell-mediated immunity is a delayed T-cell hypersensitivity rxn that may play a
Immunology / Immunopathogenesis of role in perpetuating the dz. A PA lesion is very possibly a successful attempt by the body to protect itself from noxious agents. Comments:
Torabinejad 1978 Inflammation chronic periapical lesions this illustrates that the destruction related to bacteria is actually the host's response. It's self-destruction with a purpose.
Immunoglobulins in periapical
Immunology / granulomas: A preliminary 3 PA lesions were studied microscopically and immunologically. 2 were dx as granulomas and were shown to have immunoglobulins, IgG
Naidorff 1975 Inflammation report predominated. 1 was an apical scar and there were no immunoglobulins found.
Prostaglandins: Their PGs are present in many tissues of the body and act like a hormone to mediate biologic activities. Originate from cell membrane
possible role in the phospholipids w/ the assistance of Phospholipase A. They form Arachidonic Acid as the 1st step in PG synthesis. They are involved in a
Immunology / pathogenesis of pulpal and wide range of activities and have their effect by triggering cAMP on the cell wall. PGs have a role in inflammation, pain and bone
Torabinejad 1980 Inflammation periapical diseases, Part 1 resorption. PG formation can be controlled by inhibiting Phospolipase A, preventing the formation of Arachidonic Acid.
Prostaglandins: Their
possible role in the
Immunology / pathogenesis of pulpal and Histamine, bradykinin and PGs are the most important chemical mediators of inflammation. Bradykinin may cause pain indirectly by
Torabinejad 1980 Inflammation periapical diseases, Part 2 activating Phospholipase A, which causes the production of PGs.
Greening, Immunology / Apical lesions contain Portions of apical lesions were studied immunologically. IgG levels in the lesions were greatly elevated when compared to levels in healthy
Schonfeld 1980 Inflammation elevated Ig G levels tissues.
Serum immunoglobulin levels

Immunology / and bacterial flora in subjects Ig levels were correlated w/ bacterial flora in 9 subjects w/ flare-ups. Ig G, M, A,and D levels were all WNL. 7/9 had elevated IgE levels
Nevins 1983 Inflammation with acute oro-facial swellings indicating that the rapid onset of sx associated w/ a flare-up might be due to an immediate hypersensitivity reaction.
Discusses non-specific inflamm rxns and its 4 biochemical systems. 1. The Vasoactive amines (Histamine and Seratonin). Exist
preformed in mast cells, basophils and platelets. They are capable of dilating capillaries, inc vascular perm, and causing smooth mm
contraction. 2. The Kinin system causes chemotaxis, contraction of smooth mm, inc vascular perm and cap dilation. 3. The Complement
system is a complex cascade that has 2 seperate activation pathways that converge to C3 and complete the cascade to form Membrane
Attack Complex. 4. Arachidonic Acid Metabolites lead to the generation of PGs and Leukotrienes. PGs are produced by the COX
pathway and leukotrienes are produced by the lipoxygenase pathway. This all relates to the pathogenesis of PA lesions by the extrusion of
Ag into the PA tissues during RCT. Also describes Acquired Immunity and the 4 types of rxn. Type 1: Anaphylactic rxn caused by IgE
Infalmmatory and activation and mast cell degranulation. Type 2: Cytotoxic rxn involves binding of Ag to Ab on the cell surface and lysing of the cell
imuunological aspects of the membrane. Type 3: Ag-Ab Complex rxn involves the formation of complexes that activate complement. Type 4: Delayed Hypersensitvity
Immunology / pathogenesis of human rxn does not involve Ab, instead T lymphocytes react w/ the Ag and release lymphokines. These lymphokines can stimulate osteoclast
Torabinejad 1985 Inflammation periapical lesions activity and cause bone resorption.
Arachidonic acid metabolism Dental pulps of dogs were thermally irritated. After 48 hrs, the pulps were removed and the concentrations of Arachiconic Acid metabolites
in canine tooth pulps and the were determined. Untreated pulps were used as controls. Additionally, NSAIDs were incubated w/ the pulp samples to determine their
Immunology / effects of nonsteroidal anti- effect of the AA metabolites. Results show a sig increase in AA metabolites in the inflammed pulps. NSAIDs showed a sig inhibition of the
Torabinejad 1986 Inflammation inflammatory drugs synthesis of AA metabolites, though more in the inflamed than the normal tissue.
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40 rats had theirKarmali, Merchant,
pulps exposed Davis Killed at intervals to 90 days and PA tissues were examined for cell composition
to the oral environment.
of inflamm infiltrate. About half of the nucleated cells recovered were inflammatory cells. Lymphocytes comprised about 50-60%, PMNs
were about 25-40%. Macros, blasts, plasma cells and eosinophils were minor constituents. The infiltrate remained fairly constant at all time
periods. The lesions were dominated by T cells, favoring the view that PA lesions are a T cell mediated event, including delayed
Identification of inflammatory hypersensitivity and the secretion of bone resorptive cytokines. Comments: in unflammed tissue PMNs make up 60-70% (they are the first
Immunology / cells in developing rat responders so they float around ready to fire), lymphocytes make up 20%. So the presence of a high conc of lymphocytes imply chronic
Stashenko 1987 Inflammation periapical lesions infection.
Langerhans cells in apical The presence of Langerhans cells were determined by using antigenic markers on 60 PA cysts. 51/60 cysts were positive for Langerhans
Immunology / periodontal cysts: An cells. 58/60 were positive for macrophages. Higher conc of each were found in areas of inflammation. The cell-mediated response seems
Contos 1987 Inflammation immunohistochemical study to be important in PA dz. Discussion: Langerhans cells present antigens to T cells and have limited phagocytic activity.
Human T lymphocyte 7 biopsies were taken on symptomatic teeth w/ PARL. Stained w/ monoclonal Ab. 5/7 specimens were dx's as granulomas. Each stained
Immunology / subpopulations in chronic positively for T helper and T cytotoxic/suppressor cells. 1/7 was dx's as an apical scar and did not show the presence of inflamm cells. 1/7
Nevins 1984 Inflammation periapical lesions was both a scar and a granuloma and had characteristics of both. Confirms the presence of T cells in granulomas.
Good review of chronic inflammation. Chronic inflamm has a pattern of proliferation of fibroblasts and angioblasts, becomes infiltrated w/
inflamm cells. Coins the term "frustrated repair." Cause of chronic inflamm is the persistence of etiologic agents the body cannot
eliminate. There are several main cells involved in immune rxns. Antigen Presenting Cells are non-specific cells which capture the Ag,
break it down into epitopes, place them on the cell's surface and present them to T cells. Macrophages are motile phagocytes. Respond
to chemotactic factors like C5a and cytokines. Activation is mediated by T cells. Can coelesce to form giant cells. There are 3 types of
lymphocytes. B and T cells are programmed to respond to specific antigens. Null lymphocytes do not and they include killer and natural
Immunological aspects of killer cells. T cells play a primary role in chronic inflamm. Hypersensitivity rxns are T cell mediated. T cells become sensitized and
Immunology / chronic inflammation and become memory cells. When re-exposed, they become activate, undergo blast formation and proliferate. In the process of eliminating the
Trowbridge 1990 Inflammation repair Ag, lymphocytes and macrophages destroy nearby host cells. When osteoclasts become involved, bone destruction occurs.
Reviews the importance of cytokines in PA lesion formation. Of the lymphocytes present in a PA lesion, T cells predominate. T Helper
The role of immune cytokines cells, along w/ LPS, activate macros to produce IL-1 a & b, and TNFa. IL-1b is the major constituent of Osteclast-Activating Factor (OAF),
Immunology / in the pathogenesis of IL1-a, TNFa and LT are minor constituents. Speculated that bone resorption occurs to prevent direct hard tissue invasion by bacteria, thus
Stashenko 1990 Inflammation periapical lesions preventing osteomyelitis. Another poss reason is to create an active immunologic buffer zone to better fight the infection.
Tumor necrosis factor
identified in periapical tissue Exudate samples were taken from 6 teeth w/ PARLs. Immunological tests were performed to look for TNF. TNF was detected from all
Immunology / exudates of teeth with apical teeth w/ PARLs and none was detected in the control teeth. Only TNF and IL-1 have osteoclast-activating function. TNF is almost
Safavi 1991 Inflammation periodontitis exclusively produced by activated macrophages.
Immune cells in periapical
granulomas: Morphological Tissue samples from 12 pts w/ PA granulomas that were untreated were obtained. Studied w/ monoclonal Ab and SEM.
Immunology / and immunohistochemical Macrophages/monocytes predominated. A small number of mast cells were found in all samples. IL-2 levels were very low. Since
Piattelli 1991 Inflammation characterization activated T cells release IL-2, it must mean that most of the T cells are inactive in these long-standing chronic infections.
12 samples from acute (assoc w/ pain) and chronic (no pain) PA lesions were obtained. Radioimmunoassay was performed to determine
The concentration of PGE2 conc. The levels were higher in the chronic lesions vs the uninflammed control group. The levels were much higher in the acute
Torabinejad, Immunology / prostaglandin E2 in human group vs the chronic group. Shows that acute lesions have higher PGE2 levels than chronic lesions and conifrms the role of PGs in PA
Bakland 1991 Inflammation periapical lesions lesions.
Specificity of antibodies
Immunology / present in human periapical 20 tissue samples were obtained from pts w/ CAP. ELISA test was performed w/ 16 common microorgs. 3 dsitinct Ig classes were present
Torabinejad 1991 Inflammation lesions in all the lesions. IgG was the most common, followed by IgA and IgM.
12 PA lesions from symptomatic and asymptomatic pts were compared to controls of uninflamed pulp (neg control) and inflamed ging (pos
Concentrations of leukotriene control) for the presence and conc of LT B4. Liquid chromotography was used. There was a statistically sig inc in conc in inflammed,
B4 in symptomatic and symptomatic lesions when compared to asymptomatic lesions. The asymptomatic lesions were comparable to the inflammed gingival
Immunology / asymptomatic periapical levels which were sig more than uninflammed pulp tissue. There was also a correlation btwn the presence of sx and the number of PMNs,
Torabinejad 1992 Inflammation lesions so more PMNs means more LT B4.
Detection of interleukin-1 8 PA lesions were compared to healthy pulp tissue to determine differences in IL-1b concentrations. ELISA was used. IL-1b was found in
Immunology / beta in human periapical all 8 PA tissues. None was found in healthy pulp tissues. There was no correlation btwn the conc of IL-1b found and the size of the PARL.
Barkhordor 1992 Inflammation lesions IL-1b is a cytokine that is released from macrophages and monocytes. IL-1 stimulates osteoclasts, PG and collagenase production.
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Karmali,
LPS from G- bacteria Merchant,
play a major Davis
role in the release of OAF. LPS has 3 distinct structural regions, the O-specific polysaccharide, the
common core and a lipid comonent called Lipid A. The biologic effects of LPS is lost if Lipid A is modified. In this experiment, glass tubes
of LPS were mixed w/ CaOH2 or water and incubated for 7 days. The amt of free fatty acid, which demonstrates the breakdown of Lipid A,
was analyzed. The amt of free fatty acid was universally higher in the LPS group than in the control group. So CaOH2 can hydorlyze
Effect of calcium hydroxide residual LPS left in canal btwn appts. This hydrolization may be one of the mechanisms by which CaOH2 works. Comments: G+ bacteria
Immunology / on bacterial release toxins. G- bact do not secrete toxins, but when they die, endotoxin is released from the cell wall. So by cleaning/shaping, you are
Safavi 1993 Inflammation lipopolysaccharide killing G- bacteria, thereby inc the amt of endotoxin.
31 pts w/ PARL had exudate from the apical third aspirated w/ a syringe. Electrophoresis was used to determine the prensence of IgA.
Teeth that were opened to the oral environment had significantly more IgA than those that were closed. Pt age, symptoms, presence of
stoma were not contributing factors. Higher conc of IgA are found in cysts. So there is a possibility that leaving a tooth open inc the
Immunology / Presence of secretory IgA in chances of cyst development. Comments: I doubt it. The IgA is probably contamination from the saliva or from epithelium being stimulated
Torabinejad 1994 Inflammation human periapical lesions from HERS.
Relationship between
prostaglandin E2
concentrations in periapical Samples of PA exudates were obtained from 77 root canals w or w/o PARL. Clinical findings were also recorded. Exudates were collected
exudates from root canals w/ paper points and the presence of PGE2 was measured by radioimmunoassay. PGE2 levels were sig higher in teeth w/ PARL. The
Immunology / and clinical findings of larger the PARL, the lower the conc of PGE2. This may be due to the increase in volume or due to down regulation of PGE2 when lesions
Takayama 1996 Inflammation periapical periodontitis reach a certain size. There was also a correlation btwn clinical signs and elevated PGE2 levels.
Immunoglobulins in periapical
exudates of infected root
canals: Correlations with the IgG and IgA levels in 69 single rooted teeth w/ PARL were analyzed and correlated to the size of the lesion and symptoms using ELISA.
Immunology / clinical findings of the Exudates from large (>1mm) lesions showed inc amts of IgG and IgA than that of smaller lesions. Teeth that were palpation + also had
Matsuo 1995 Inflammation involved teeth higher levels of both. The mean level of IgG was 110 times grtr than IgA. During the course of RCT, the levels of both decrease.
Compared the accuracy, under clinical conditions, using the Root ZX and Sybron's Endo Analyzer. Evaluated 32 teeth slated for EXT.
An in vivo comparison of two Flattened coronal 1/2. Flared coronal 1/3 of canal w/ GGD. Established WL using EAL. Cemented files at determined length. EXT teeth
frequency-based electronic and shaved split apical 4 mm. Measured difference of file length to microscopic minor diameter. The Root ZX was accurate 91% of the
Baumgartner 2003 Instruments apex locators time. The Endo Analyzer was accurate 34% of the time and it was always long.
Elimination of Candida Dentin from bovine incisors were sterilized then infected w/ C albicans. 15 specimens were exposed to CaOH/glycerine paste, 15 to
albicans infection of the CaOH/CPMC/Glycerine, 15 to CaOH/.12% CHX and 15 to .12% CHX/ZnO. Incubated for 1 hr, 2 d and 7 d. The CaOH/CPMC group and
Irrigation / radicular dentin by intracanal the CHX/ZnO group eliminated the Candida w/in an hour. The CaOH/CHX group was ineffective at 7 d. CHX is effective at a pH of 5.5-
Siqueira 2003 Medication medications 7.0, adding CaOH inc the pH too much. The CaOH group had eliminated Candida in 4/5 specimens at 2 d and 5/5 specimens at 7 d.
The effect of insertion rates
on fill length and adaptation Standardized a Mx incisor w/ created canal irregularities in a resin block. MAF was a 40/.04. Placed ThermaFils at vaying rates, 18mm/s,
Himmel, of a thermoplasticized gutta- 6mm/s and 3mm/s. As the rate decreased, so did the extent of the obturation and the replication of the irregularities. When placed at
Levitan 2003 Obturation percha techique 18mm/s, there was an avg of a .88mm overextension. So fill it fast, but stop about a mm short.
Crown-down tip design and Evaluated 3 tip designs in the crown-down shaping of curved canals in plastic blocks. Compared Flex-R (biconical), Flex-O (pyramidal) and
Roane 2003 Instruments shaping More-Flex (conical) files. Evaluated transportation, ledges, fracture and file damage. Flex-R files proved superior.
Identification of resected root- Cracks were formed at the apices of 27/50 EXT max incisors. 4 evaluators used no mag, 3.3X loupes, 10X scope and 35X orascope.
end dentinal cracks: A There was a trend of increased accuracy in dx cracks as mag inc. W/ the Orascope, there was an accuracy of only 58%. No dyes or
Surgical comparative study of visual transillumination was used. A side finding was that the dentin around an area of strain appears opaque or frosted prior to a crack forming,
Pashley 2003 Endodontics identification this could be a good clinical clue.
Patterns of vertical root Studied VRF using a computer model based on root shape, canal shape, and dentin thckness. Found a counter-intuitive pattern of
fracture: Factors affecting decreasing proximal dentin thickness causing a tendency of increased BL stress concentration. Theory is that the thin proximal walls can
stress distribution in the root expand more readily to force, this asymmetrical expansion creates additional tensile force on the thicker areas. Of the three variables
Messer 2003 Diagnosis canal tested, canal shape had the largest influence, w/ a reduced radius of curvature strongly influencing stress conc.
Finite element analysis and
strain-gauge studies of Used a max and a md ant to do the same thing as in the above study. Compared it ti strain-guage techniques. Results were basically the
Messer 2003 Diagnosis vertical root fractures same as the above study. Strain-gauge techniques are inaccurate.
PCR was used to evaluate the presence of Actino in 129 cases of infected canals, abscesses or cellulitis. Actino was found in 56% of the
samples. A. viscosus was the most common --> A. israelii --> A. naesulundii. Actino was found most commonly in the canal --> in
abscesses --> in cellulitis. This trend make it likely that the source of infection is oral. Previous studies (Barnard) shows that Actino is
Occurrence of Actinomyces killied w/in 1 min using 1% NaOCl and w/in 7 d using CaOH. A 7 day course of Ab is ineffective. With the prevelance of actinomyces in
in infections of endodontic endo infections, NSRCT and SRCT are sufficient in a majority of cases. Comments: They are not talking about actinomycosis. In these
Baumgartner 2003 Microbiology origin cases you will need surgery or long-term Ab.
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Karmali,
2 sets of experiments Merchant,
were done Davis from bovine teeth.
on the dentin shavings One measured the temperature dependence on dissolution of
organic debris and the other measured the time dependence. In the temp part of the experiment, 2.5% NaOCl was used at RT, 37C and
70C. Inc the temp inc the organic dissolution. 70C for 60 min removed on 40% of the organic component. In the 2nd experiment, they
used 6.25% NaOCl at 70C for varying times. It took only 10 min is dissolve out 90% of the organic debris. This study showed that as the
Irrigation / Removal of organic debris temp inc, the amt of protein degraded also inc. With inc heat, proteins unfold and are degraded faster. Why did they use different conc of
Kamburis 2003 Medication from bovine dentin shavings NaOCl?? This makes me angry...grrrr. You can only conclude that time, temp and conc are interrelated.
The effect of passive 94 single canal EXT teeth were divided into 5 groups. 1. 21 canals irrig w/ 2% CHX. 2. 21 canals irrig w/ 2% CHX, then passively irrig
ultrasonic activation of 2% ultrasonically for 1 min. 3,4. Same as above but w/ 5.25% NaOCl. 5. Saline. Canals rinsed and filled w/ saline. Saline extracted from
CHX or 5.25% NaOCl irrigant canals from 6-168 hrs and placed on agar plates infected w/ S. sanguinis. Zones Of Inhibition were measured. CHX w/ U.S activation had
Irrigation / on residual antimicrobial the largest ZOI, followed by CHX w/o activation. Both had antimicrobial effects at 168 hrs. The NaOCl groups showed small ZOI up to 24
Johnson 2003 Medication activity in root canals hrs. Using passive U.S activation w/ 2% CHX may eradicate need for inter-appt CaOH use.
Effectiveness of selected
materials against E. faecalis: Did agar diffusion tests. Agar was inoculated w/ E. faecalis. Group 1 was CaOH powder w/ water. G 2: Pulpdent. G 3: .12% CHX. G 4:
Part 3. The anitbacterial .12% CHX w/ CaOH powder. G5: .12% CHX w/ Pulpdent. At 24 hrs, no differnce btwn groups. At 72 hours, the CHX alone or the CHX
Irrigation / effect of CaOH and CHX on containing groups did much better, Zone of inhibition was about 5mm. Inhibition was 1mm w/ CaOH alone. It could be that CaOH is not
Mickel 2003 Medication E. faecalis as diffusable or that the buffer in the agar reduces the pH of the CaOH.
Used and Endogramme to analyze the vertical forces and torque used to instr EXT teeth w/ narrow and wide straight canals. ProTapers
were used. The Safety Quotient (torque to fx instr / torque to cut dentin) was determined. ProTapers definitely have a screwing effect
especially when the coronal part of the canal is engaged. The vertical forces for all files were low, however, torque increased as the file
moved deeper into the canal. Makes sense b/c more dentin is engaged. The SQ for the Shaper files were all >1, indicating that they were
Analysis of mechanical safe. The F1 had an SQ of .93. None of the other Finishing files were listed...curious, no?? This low SQ makes sense b/c the Finishing
preparations in extracted file engage at the tip and the torque is higher b/c it is further from the handle. Tips when using ProTapers: 1. The shaping files can be
teeth using ProTaper rotary used in a brushstroke manner against a single lateral wall to reduce the screwing effect. It will still cut effectively b/c it has a pos rake
instruments: Value of the angle. 2. Be careful w/ the Finishing files. Secure a glide path. Insert passively and slowly. Clean flutes freq. Don't be afraid to hand
Machtou 2003 Instruments safety quotient instr. Using a brushtstroke w/ Finishing files does not reduce torque and is ineffective.
5 groups of 15 teeth each were made of EXT single-rooted anterior teeth. Pulp was removed and teeth were autoclaved. Infected w/ E.
faecalis. Group A: Instr/irrig w/ 1.3% NaOCl and 5 min MTAD soak. Group B: Instr/irrig and 5 min soak w/ 1.3% NaOCl. Group C:
Instr/irrig w/ 1.3%, 1min 17% EDTA and 5 min 1.3% soak. Group D: Instr/irrig and soaked w/ 5.25% NaOCl. Group E: Same as D, but 1
Effect of MTAD in E. faecalis min EDTA soak prior to final NaOCl soak. Teeth were then dropped in vials w/ broth to assess trubidity. Shavings from all the negatives
Irrigation / contaminated root canals of were further cultured. The MTAD group showed no growth in fluid or in shavings. All the remaining groups showed growth in about half
Torabinejad 2003 Medication extracted human teeth the samples. MTAD seems to be more effective than NaOCl in eliminating E. faecalis in canals and in tubules.
Comparison of apical
transportation in four Ni-Ti
rotary instrumentation
Iqbal 2003 Instruments techniques
Cultivated bacteria from 200 teeth that already had RCT initiated and intracanal medicament placed. Followed the positive cultures w/
more medicament and further sampling until a negative culture was obtained. 53% of the 1st culture had postiive growth. 57% of these
were positive after the 2nd culture, 13% of these after the 3rd and none after the 4th. Large PA lesions (over 2mm) were assoc w/ bacteria
in the canals. Inverse was true about small lesions. Only 1-2 strains were isolated per case (this is lower than other studies, so how
Bacteria recovered from teeth accurate was their culturing techniques??) . Reapplication of intracanal meds reduced the quantity and growth rate of microbes. IKI was
w/ apical periodontitis after slightly more effective than CaOH. G+ bacteria were isolated frequently, meaning they were more refractory to disinfection than G-.
antimicrobial endodontic Lactobacillus and E. faecalis were commonly isolated. E. faecalis seemed to be the most resistant to tx. How effective are intracanal
Bergenholtz 2003 Microbiology treatment meds???
Percentage of filled canal Took 40 EXT Md 3rd molars. Half the group was instr by hand and obt w/ warm GP. The other half was cleaned using Lussi's vacuum
area in Md molars after pump and obt w/ a silicone based sealer placed under vacuum. The roots were then x-sectioned and the % of canals filled were
conventional root canal calculated. Overall, there was not much different, though the hand instr fared slightly better. Adv to the NIT are that the canals can be
instrumentation and after a cleaned w/o removal of the chamber roof or root dentin leaving the tooth more resistant to fx. Tx is quicker. Disadv are that the PA tissues
Wesselink, noninstrumentation technique may be damaged and fluids may seep into the canal under vacuum. Post space? Re-tx?? How do you remove intracanal meds??
Wu 2003 Obturation (NIT) Heavily infected dentin is not mechanically removed.
Experiment 1: resected the apical 3mm of 30 EXT Mx incisors. Counted microcracks. Apical prep was created w/ either diamond coated,
KiS zirconium nitride, or CT-5 stainless steel tips. Microcracks again counted. No sig difference btwn the three. The diamond coated was
Evaluation of root-end cavity sig faster than the other two instr, Experiment 2: 55 teeth had root end preps created w/ the above tips and were filled w/ SuperEBA.
Surgical preparation using ultrasonic Microleakage was assessed w/ India Ink. No sig difference in leakage. Under SEM, there was no real diff in the number of dentinal
Suda 2003 Endodontics retrotips tubules that were exposed (w/o smear layer).
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Karmali,
Apical surgery was performed Merchant, Davis
and data collected at 24 mo from 108 pts. Entry criteria was strict and required PARL, quality RCT, and
A prospective clinical study of excellent coronal seal. Retrofills were randomly divided into two groups, MTA and IRM. Success was lumped as complete or incomplete
MTA and IRM when used as (scar) healing. Failure was lumped as uncertain and unsatisfactory healing. At 12 mo, MTA had a success rate of 84% for MTA and 76%
Retrofilling root-end filling materials in for IRM. At 24 mo, success was 92% for MTA and 87% for IRM. MTA showed earlier signs of healing. These differences were not stat
Pitt Ford 2003 Materials endodontic surgery sig. Discussion: Gives an idea of success rate using modern surgery techniques.
Osteoblasts and MG-63
osteosarcoma cells behave ProRoot and White MTA were prepared into cylinders and placed into wells. Primary osteoblasts were placed on half the samples and
differently when in contact osteosarcoma cells were placed in the other half. Evaluated w/ SEM to 13 days. At day 6 and 9, both cell types were growing well around
Retrofilling with ProRoot MTA and White both types of MTA. At day 16, the primary osteoblasts could not be seen on the Whtie MTA, only on the ProRoot. Osteosarcoma cells
Gutmann 2003 Materials MTA grew on both types. Possible reasons are the difference in surface roughness and the lack of iron content in the White MTA.
Healing of apical periodontitis
after endodontic tx: a
comparison btwn a silicone- 199 single roots w/ PARL were treated with either Roeko Sealer (silicone based) or Grossman's. All had a minimum of a 35 MAF and
Success/failur based and a ZOE based CaOH for at least a week. 3 and 12 mo recall. No sig difference. Success was 76% at 12 mo. 47% showed improvement at 3 mo. You
Orstavik 2003 e sealer can see healing as early as 1 week (Orstavik 1997). In this study, almost half showed signs of healing at 3 mo. Nice.
The movability of vital and Did ortho tx on vital and RCT'd teeth. Sacrificed at 6 and 6 weeks. Studied microscopically and histologically. Found no difference in the
Huettner, Root devitalized teeth in the movement of vital or pulpless teeth. Side of compression showed osteoclastic activity and a compromised blood supply. On the side of
Young 1955 Extrusion Macacus Rhesus Monkey tension, there was osteoblastic activity and a rich blood supply
Combined endodontic-
orthodontic treatment of Describes 2 methods of treating transverse fxs. Method 1 is doing NSRCT, cementing a post and activating it w/ the coronal segment in
Root transverse fractures in the place. Method 2 is similar, but the coronal segment is removed. Method 1 has the advantage of better isolation and esthetics. Method 2 is
Hiethersay 1973 Extrusion region of the alveolar crest advantageous in that the post and ortho are easier. Bith work though and regression is not a problem.
Forced eruption. Part 1. A
method of treating isolated
one and two wall infra-bony
Root osseous defects, rationale
Ingber 1974 Extrusion and case report Describes how slow (1mm/wk) forced eruption can may be used to tx 1-2 wall bony defects. Tension on PDL fibers cause bone deposition.
Forced eruption. Part2. A
method of treating non-
restorable teeth- periodontal
Root and restorative
Ingber 1976 Extrusion considerations Presents the rationale and technique for forced eruption. One drawback is the smaller root diameter that is more difficult to restore.
Root Extrusion of endodontically
Simon 1978 Extrusion treated teeth Describes techniques for root extrusion using ortho wire as a hooked post. Extrusion usu req 1-3 wks. Stabilize for 8-12 wks.
Clinical and histological
evaluation of extruded Orthodontic extrusion of RCT'd teeth was evaluated in dogs at postactivation intervals of 2,4, and 7 wks. Radiographically, the radiolucent
Root endodontically treated teeth areas seen during extrusion appeared normal by the 4th week. Histologically, new bone was formed periradicularly at 7wks. Extrusion
Simon 1980 Extrusion in dogs may bring the alveolar housing with it, which may not be deisrable. Rpidiity of movement and amt of force used may play a role.
Gives indications, contraindications, etc. Goal is to have the distance btwn the alveolar crest and the coronal extent of tooth structure be 3-
4mm. Extrusion elevates the tooth from its socket. Since PDL fibers and bone are not being crushed by this movement, resorption is rare.
Indicated when there is any cervical third root problem that extends below the alveolar crest 0-4 mm. The advantage is that it is very
Root Root extrusion. Rationale conservative. Disadvantages are the time, esthetics and minor perio surg may still be required. Contraindications are insufficient root for a
Simon 1984 Extrusion and techniques 1:1 ratio, perio implications and insuff space to extrude tooth. Variations in technique are then given. Stabilization for 8 wks is stressed.
Problems with the
endodontic-orthodontic
Root management of fractured Discusses some of the problems that may occur w/ extrusion. Beware of micrfractures that may not be detectable clincially. Restoration of
Feiglin 1986 Extrusion teeth. contours may be difficult. Proper retention is imperative. Pt selection is also important.
Surgical extrusion of root

Root fractured teeth- A follow-up
Kahnberg 1988 Extrusion study of two surgical methods
Rapid orthodontic extrusion Prospective study of 32 teeth undergoing extrusion. Most teeth were extruded 2-3 mm btwn 3-9 wks. RDX taken pre-op, post-extrusion, 3
Malmgren, Root of crown root nad cervical mo and 1 yr post-op. 0.5 mm relapse occurred in 3 pts. Limited root resorption occurredin 6 teeth, severe resorption in 1 tooth (prob due
Frykholm 1991 Extrusion root fractured teeth to traumatic occ). To avoid relapse, consider fiberotomy and retention for at least 3-4 wks.
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Root
Surgical extrusion of a
completely intruded
Caliskan 1998 Extrusion permanent incisor
Surgical extrusion of intruded

immature permanent incisors:
Caliskan, Root Case report and review of the
Turkun 1998 Extrusion literature
Compared dye penetration, dye extraction and fluid filtration methods in the sealing ability of 4 sealers. 40 EXT single rooted teeth were
instr and obt using GP and cold lateral. Group 1 was Pulp Canal Sealer. Group 2 was Sealapex. Group 3 was AH Plus. Group 4 was
Ketac-Endo. On the same teeth, fluid filtration was performed, then dye-penetration, then dye-extraction. Fluid extraction and dye-
extraction correlated well with each other, dye-penetration was garbage. Dye-extraction is cheaper, easier and faster than fluid filtration.
Sealapex leaked sig more than all the other sealers which were stat similar. Comments: Dye extraction measures volume while dye
Reliability of dye penetration leakage is a linear measurement. This study is giving dye extraction too much credit. The standard deviations in this study are huge for
Pashley 2003 Sealers studies dye extraction.
Dentin conditioned w/ citric acid, H3PO4, EDTA and saline were sealed w/ GP and either Grossman's, Apexit, Ketac-Endo, AH Plus and
RoekoSeal. Tensile bond strengths were measured and the samples were studied w/ SEM and spectroscopy. Removal of the smear layer
Adhesion of endodontic did not increase bond strengths. In some cases leaving the smear layer increased the bond strength. No data was given though.
sealers: SEM and energy Comments: the value of this study is whether to remove the smear layer or not. Removing the smear layer does not affect the bond...but
Orstavik 2003 Sealers dispersive spectroscopy does it affect the seal??
Human PDL and gingival fibroblasts were evaluated for their attachment to Geristore, Tytin, SperEBA and MTA. These materials were
mixed and ground to 150-500 micron grain sizes before being assayed w/ the fibroblasts. There was a superior attachment to
Adhesion of human Geristore...by a long shot. Indicates that Geristore may be a superior root-end material w/ regards to cell attachment and biocompatibilty.
Jeansonne, Retrofilling fibroblasts to root end rilling Comments: they ground all these substances up. This is not how this material exists. The body does not like sharp edges. This study
Camp 2003 Materials materials does not rip on MTA, it just confirms the biocompatibility of Geristore.
Taxonomic changes of
bacteria associated with Bacteroides, Spirochetes and Firmicutes occur in over 80% of primary endo infections when molecular techniques of identification are
Siqueira 2003 Microbiology endodontic infections used.
Incidence of flare-ups and
evaluation of quality after
retreatment of resorcinol- 58 teeth treated w/ RF resin were evaluated. More than half the teeth had less than half the canals obturated. Concluded that teeth w/ RF
Gound, formaldehyde resin (Russian resin may be retreated w/ a good px but with a higher incidence (12%) of flare-up. This high rate may be due to pushing the toxic RF resin
Schwandt 2003 Retreatment Red) endodontic therapy out the apex during shaping and cleaning.
Calcium hydroxide as an
Irrigation / intracanal medication: Effect 140 pts were divided into a group receiving CaOH and another not. Shaping and cleaning to at least an MAF of #25 w/ 2.5% NaOCl. Pain
Walton 2003 Medication on posttreatment pain ratings to 48 hrs. No sig difference in pain btwn the two groups.
The significance of needle
deflection in success of
inferior alveolar nerve block 64 adult pts w/ IP were divided into two groups. 1. 2.8 ml Xylo w/ traditional tehcnique and bevel oriented away from the ramus. 2. The
in patients with irreversible wand was used w/ a bi-directional rotation during insertion to avoid deflection. Access was made 17 minutes later and a VAS was used to
Reader 2003 Pharmacology pulpitis determine pain if any. No sig diff was found. Success was 50% w/ the conventional technique and 56% w/ the rotational technique.
Long-term survival or root
canal treated teeth: A 190 RCT'd (by students) teeth were evaluated for at least 10 yrs to determine success. If they tooth was in situ, tx was considered a
Reiner, Success/failur retrospective study of over 10 success. 85% success rate. 92% if there was a post and crown present (not stat sig). Pre-op apical lesions decrease success rate.
Dammaschke 2003 e years Success rate also dec if the tooth was overfilled or under-filled grtr than 2 mm.
25 EXT canines were accessed, instrumented, sterilized and infected w/ P. endodontalis. Group 1 was exposed to atmospheric air for 5
min. Group 2 was filled w/ 3% H2O2 for 5 min. Group 3 was exposed to air for 45 min. Group 4 was filled w/ H2O2 for 45 min. Incubated
for 7 days. Cultures were obtained and evaluated for turbidity. The H2O2 group showed no turbidity at 18 hrs and at 7 days. Both the
atmospheric air groups showed growth. H2O2 apparently kills or retards anaeobic growth w/ as little as 5 min of exposure. Comments: we
Aerotolerance of an don't use H2O2 b/c we have NaOCl that will do the job. If you combine the two, there is an exuberant effervesence that bubbles both
Eleazer 2003 Microbiology endodontic pathogen solutions out of the canal.
Evaluation of cytotoxicity of Used L929 fibroblasts to determine cytotoxicity of MTAD, diff conc of NaOCl, Eugenol, 3% H2O2, 0.12% CHX and CaOH paste. MTAD
Irrigation / MTAD using the MTT- was less cytotoxic than CaOH, 5.25% NaOCl and CHX. It was similar to 17% EDTA. It was more cytotoxic than 2.5% NaOCl. CHX is
Torabinejad 2003 Medication tetrazolium method actually pretty cytotoxic stuff.
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64 EXT PM wereKarmali,
decoronated Merchant,
and instr to a #40Davis
MAF w/ GTs and ProFiles. EDTA for 5 min followed by 5.25% NaOCl. Group A was obt
w/ a single cone and EndoRez (Ultradent). Group 2 was a single cone and AH Plus. Group 3 was warm vert w/ AH Plus. Fluid filtration
An in vitro evaluation of the was used to measure leakage. Group 1 leaked sig more than Groups 2 and 3 which were stat similar. They all leaked though.
sealing ability of a new root Comments: in reality, in warm vertical, if you are not getting your System B to w/in 3 mm of the apex, you're doing a single cone technique
Dorn 2003 Obturation canal obturation system (see Weller 2000).
The accuracy of the Root ZX
electronic apex locator using
stainless steel and nickel
Hartwell 2003 Instruments titanium files Used 20 EXT Mx incisors to compare Root ZX readings w/ stainless steel and a variety of NiTi files. No sig difference was found.
SEM observations of new Lightspeed and ProFile .04 were compared under SEM after 0-6 simulated uses in extracted teeth. For the ProFile, there was some
and used nickel titanium rollover and minor wear at the edges. There was little change at the tip of the lightspeed. Tooth deposits were found on the instruments
Alapati 2003 Instruments rotary files after simulated use. No substantial changes in the regions of these two brands that are involved in the preparation of root canals.
The crystallization of sodium
hypochlorite on gutta percha GP cones were examined under an SEM and an Elemental Analysis Machine (EAM). They were examined new, and after soaking w/
cones after the rapid 5.25% and 2.5% NaOCl. Rinsing w/ 96% EtOH, 70% Isopropyl alcohol and distilled water were evaluated. Crystals formed on GP after
sterilization technique: An soaking in both conc of NaOCl for 1 min. All methods of rinsing removed the crystals. Discussion: Are these crystals of clinical
Dorn 2003 Obturation SEM study significance.
A comparison of the cleaning
efficacy of short-term sonic
and ultrasonic passive 100 EXT Mx molars were hand instrumented. Group 1 was the control. Group 2 and 3 were passively cleaned w/ sonics for 30 and 60
irrigation after hand sec. Group 4 and 5 were passively cleaned w/ ultrasonics for 30 and 60 sec. Roots were split and remaining debris was analyzed. Sonic
Sabins, Irrigation / instrumentation in molar root irrig performed better than the control and ultrasonics performed better than the sonics. 30 seconds was no better than 60 sec. Though
Johnson 2003 Medication canals there were no dings on the canal walls, a smooth file is recommended.
Placement of MTA into ethylene tubes by hand and by U/S were evaluated. In the hand method, the MTA was placed and packed w/ a 5/7
Retrofilling Placement of MTA using two plugger. In the U/S group, placement and packing was w/ a CT-1 U/S tip. Quality of placement was analyzed by microscope and RDX.
Hartwell 2003 Materials different techniques There were sig less voids when MTA was placed by hand.
Made perforations in dogs and studied them radiographically. Sealed w/ GP, ZnPO4 cement or amal. Some were sealed immediately
after perf, others were left open to the oral environment. If the perf was filled immed w/ GP, no perio destruction. If perf was immed sealed
w/ cement, bone destruction took place until cement was replaced by GP. If the perf was left open, destruction took place until it was
Experimental root sealed w/ GP. In cases where the perf remained unfilled, progressive bone destruction ocurred. If the perf was surgically exposed immed
Lantz, perforations is dogs' teeth: A and the GP was trimmed or an amal was placed, rapid healing occurred. Basically, the quicker you can seal the defect, the better. Once
Persson 1965 Perforations roentgen study you seal it, regeneration of lost bone should occur. ZnPO4 cement leaks, and that is why they think it didn't work.
The second part to the previous experiment. Histologic study after perfs were made in dogs. 3 diff txs: perf was filled w/ GP immediately;
Periodontal tissue reactions perf was was filled w/ ZnPO4 immediately and then GP later; and perf was filled w/ ZnPO4. Healing tended to occur once the perf was
after root perforations in sealed from bacterial leakage. The GP alone group showed initial inflamm then healed. The combined group showed inflamm until the
Lantz, dogs' teeth. A histologic cement was removed. Then healing occurred, albeit slower, once the perf was sealed w/ GP. In the ZnPO4 group progressive bone
Persson 1967 Perforations study destruction occurred. Bugs cause destruction.
Nonsrugical therapy for the Discusses a nonsurgical technique for resorptive perfs. Treat it like an open apex case. Clean and shape. Place thick mix of CaOH and
perforative defect of internal CMPC. 4-6 wks later, replace. Final appt, dry canal and obt w/ GP. Intent is to heal the perio tissues so that they can act as a matrix upon
Frank, Weine 1973 Perforations resorption which to compact against. W/o healthy perio tissues, you cannot effect a good seal.
Procedural accidents and
Oswald 1979 Perforations their repair Describes how perf can occur, how to avoid them, and how to repair them. The repair methods are outdated b/c of present day materials.
57 molars w/ iatrogenic perfs were repaired w/ amal or GP. Followed RDX and clinically from 3-72 mo. Overall success was 54%. GP
Recall evaluation of repairs were less successful, presumably b/c of ample extruded material. Almost 70% of the failures had extruded GP or amal. Surgical
iatrogenic root perforations intervention to remove extruded material was successful in 5/5 cases. Amal was more successful than GP b/c there tended to be less
repaired with amalgam and extruded material. There was a delay of up to 2 mo prior to repairing perf, this time frame did not seem to have an impact on success rate.
Simon 1986 Perforations gutta percha Comments: the real reason that GP did poorly was the lack of seal.
15 teeth from dogs were cleaned, shaped and obturated. Perfs were made in the coronal third. Perfs were either dressed w/ CaOH w/
Root perforations dressed Iodoform, ZOE or left open. Block resections for histo study at 90 days. Best response was w/ CaOH. There was an area of coagulation
with calcium hydroxide or necrosis w/ a marked tendency to repair. The ZOE and control groups showed severe inflamm w/ abscess formation. Discussion: Good
Bramante 1987 Perforations zinc oxide and eugenol thing to know if a GP calls w/ a furcal perf. Don't put IRM or Cavit in there. Cotton pellet and send them right over.
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Histological study of furcation
perforations treated with
tricalcium phosphate, 120 perfs were created in monkey teeth. Repaired w/ tricalcium phosphate, HA, amal, and Life (hard setting CaOH). Sacrificed at 2,4,and
hydroxylapatite, amalgam 6 mo and studied histologically. No hard tissue formation was observed w/ any of the materials. TP showed the most severe inflamm
Balla, Lin 1991 Perforations and Life reaction. In general, intensity of inflamm reactions dec over time. Epith was present in the furcation of some groups.
Sealing ability of three Lateral apical third perfs were simulated in 30 EXT human teeth that had been filled w/ GP. Perfs were then filled w/ amal w/ cavity
materials used to repair varnish, EBA or Ketac Silver. Implanted into the backs of rats for 5 days. Removed and soaked in Ca-45 to determine leakage. EBA
Moloney 1993 Perforations lateral root perforations sealed the best, followed by amal and then Ketac Silver.
Evaluation of sealing ability of
amalgam, Cavit, and glass
Alhadainy, ionomer in the repair of Perfs were created in the pulpal floor of 30 EXT molars. Repaired w/ amal, Cavit, or Vitrebond. Dye leakage study using 2% Erythrocin
Himel 1993 Perforations furcation perforations blue dye. Sectioned after soaking for 1 wk. Vitrebond sealed better than Cavit which was better than amal.
Perforation repair comparing
MTA and amalgam using 2 groups of 18 EXT human molars were perforated and repaired w/ amal or MTA. Allowed to set for 3 days. Dual chamber anaerobic
anaerobic bacterial leakage model w/ F. nucleatum was used with turbidity of the lower chamber checked every 2-3 days. After 45 days, there was no leakage of the
Baumgartner 1998 Perforations model MTA group. 8/18 of the amal group leaked.
Retrograde sealing of Surgical tx was performed in 100 iatrogenic perfs. 94 had lucencies and 83 had exposed posts. Repaired w/ Gluma and Retroplast. F/u
accidental root perforations was from 1-11 yrs (mean 4 yrs). If the perf did not involve the furcation 71% completely healed, 11% partially healed, 3% uncertain and
Rud, with dentin bonded 15% failed. If the furcation was involved 30% healed, 41% partially healed, 11% uncertain adn 18% failed. Presence or absence of bone
Munksgaard 1998 Perforations composite resin btwn the perf and the cervix had no sig effect on healing.
Torabinejad 1999 Perforations Clinical applications of MTA Describes clinical procedures for the application of MTAin capping, apexification, perf repairs and as a root end filling material.
Cohen, Endodontic complications
Schwartz 1987 Law and the law Discusses some standards of care.
Understanding informed
consent and its relationship
to the incidence of adverse
treatment events in
conventional endodontic Endo cannot be guaranteed. Overfills and underfills occur fewer than 5% of the time. More complications occur during retreats or mid-
Selbst 1990 Law therapy treatment referrals.
Evaluated effects of dowel design, length, diameter, and type of cement (ZP, carboxylate, epoxy resin) on dowel retention. 360 specimens
Retention of endodontic with 36 combinations. Dowel design had the greatest impact on retention (screw>parallel serrated>tapered.) Even though the screw posts
dowels: Effects of cement, had the greatest retention, when they failed it usu caused a root fx. Parallel sided posts failed by dislodgement. Length of the post was also
dowel length, diameter, and significant in retention, the longer the better. Having a close adaptation of post to canal increased retention. Cement type and diameter of
Standlee 1978 Restorative design the post did not have a significant effect on retention.
An amalgam coronal-
radicular dowel and core
technique for endodontically Describes core with amalgam 2 to 4mm into each canal to eliminate need for cast dowel and core or prefab dowels or pins. If fast-set amal
Nayyar 1980 Restorative treated posterior teeth is used, crown prep and impression can be done in the same visit.
Evaluated 1273 endo treated teeth to compare clinical succes rate of 6 coronal-radicular stabilization methods, record the failure of dowel
systems and determine the effect of dowel length on success. Success rate for teeth without coronal-radicular stabilization was 90%,
tapered cast dowels and cores 87%, parapost and core 98%. Failures were too small of a sample size but trend was parallel-sided failures
Clinically significnt factors in were restorable while tapered cast dowel and core were tooth fxs often requiring ext (1/3 of the time). There was a direct correlation
Sorensen 1984 Restorative dowel design between the length of the dowel and the success rate. Longer is better (equal or greater than crown length has 97% success rate).
Part of study Sorensen 1984 - Root canal tx'd tooth w/o a crown had a success of 75%. If a crown was present, success =95%. If it was
an FPD abutment = 89%. RPD abutment = 77%. The presence of a post didn't make much of a difference in single crown or FPD
Endodontially treated teeth abutments. In RPD abutments, however, teeth w/ a post had a 93% success compared to 57% w/o a post. RPD abutments are under
Sorensen 1985 Restorative as abutments much greater torqueing forces than single crowns or FPD and require additional retention.
Compared the contribution of endodontic and restorative procedures to the loss of strength by using nondestructive occlusal loading on 42
extracted intact max. 2nd bicuspids. Stages evaluated were unaltered tooth, access preparation, instrumentation, obturation, MOD cavity
Reduction in tooth stiffness preparation. Then in another series unaltered tooth, occlusal cavity prep, two-surface cavity preparation, MOD cavity preparation, access,
as a result of endodontic and instrumentation, obturation. Results indicate endo tx has small effect on the tooth reducing stiffness by 5%. Occ prep reduced stiffness by
Messer 1989 Restorative restorative procedures 20% and an MOD reduced it by 63%. Loss of marginal ridge integrity was the greatest contribution to loss of tooth strength.
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Karmali,
40 freshly ext max Merchant,
centrals were Davis
endo txed, restored according to four groups and loaded at an angle of 130 degrees to their long axis. 1)
para-post with apical 3mm engaging 2) cast post and core 3) para-post and cast core 2mm into canal 4) para-post only obturating canal. 1
and 4 had equal mean failure threshold. Cement thickness (ZP) did not significantly affect failure load. Load to failure was not affected
Effect of post adaptation on when only the apical 3 mm of the para-post was engaged vs the entire length of the root. Upon failure, para-posts have a lower freq of
fracture resistance of endo fracture, with minimal tooth structure loss. Maximum adaptation of a cast post and core to the canal greatly increases the load to failure,
Sorensen 1990 Restorative treated teeth but when failure does occur it is catastrophic. Tapered posts should be used with extreme caution.
6 groups of 10 RCT'd Md molar with pulp chamber depths of 2, 4 or 6mm. 3 groups had the amalgam build-up extending into canals 3mm
Fracture resistance of and 3 groups without amalgam into the canals. Results showed amalgam extension into canals contributed minimally to fx resistance of
amalgam coronal-radicular amalgam if 4 or more millimeters of chamber depth remained. If less than 4mm remained, the fx load was substantially increased. No
Summitt 1990 Restorative restorations need to place amal into canals if more than 4mm of chamber height remains.
Are endodntically treated A comparison of 23 endo tx teeth and their contralateral vital pairs of punch shear strength, toughness, and load to fx. No significant
Messer 1992 Restorative teeth more brittle? difference found. Vital dentin was 3.5% harder which is not too significant
141 mand. premolars divided into seven tx groups and evaluated by applying vertical and lateral forces. Groups were unaltered tooth,
composite core w/o bonding, composite core after treating dentin with EDTA and bonding agent, prefab post w/ composite resin core w/
EDTA and bonding agent, cast post/core cemented with ZP, tooth preparation without restoration, composite resin tooth simulating
prepared tooth. No statistical difference was found, except for the unrestored tooth which had a much lower load to failure. Factors of
Strength of roots before and importance to prevent fracture were amount of remaining tooth structure, strength of post and core, bonding between core material and
after endodontic treatment dentin. Composite core following the use of EDTA to remove the smear layer may be a successful tx when sufficient tooth structure
Sornkul 1992 Restorative and restoration remains.
Moisture content of vital vs. 23 matched pairs of endo tx and vital contralateral teeth weighed then placed in an oven to remove the unbound water from the dentin and
Messer 1994 Restorative endodontically treated teeth weighed again. There was no significant difference in the moisture content between endodontically tx teeth and vital dentin.
Evaluated the significance of retaining intact marginal ridges and selective cusp coverage in preserving tooth stiffness during restoration.
Endodontic access was followed by MO or MOD preps. Teeth were restored with either amalgam, amalgam overlay, or gold overlay with
partial or complete cusp coverage. Relative stiffness was calculated in closed-loop servohydraulic system. Full occlusal coverage with
Effect of restorative both amal and gold increased the stiffness of the teeth. Selective cusp coverage did not strengthen the tooth. Loss of the marginal ridge
procedures on the strength of dramatically weakened teeth (40% weaker for MO, 60% weaker for MOD). Take home: It is more important to cover cusps than to
Messer 1994 Restorative endodontically treated molars preserve tooth structure (including a marginal ridge) in endodontically treated molar teeth.
Periapical status of
endodontically treated teeth The restoration is more sig than quality root canal tx in the success of the case. The following #'s are for the absence of PA path: Good
in relation to the technical endo/good rest = 91%, good endo/poor rest = 44%, poor endo/good rest = 68%, poor endo/poor rest = 18%. Over 1000 radiographs were
quality of the root filling and taken, no dental tx was performed for a minimum of 1 yr prior to the rdx used in this study. This is a well cited study, but is very weak.
Trope 1995 Restorative the coronal restoration Cross sectional study, which is just a snap shot in time, as a result this is over analyzed...the results are taken as dogma. Know this article.
Cuspal deflection in molars in Cuspal flexure of 13 ext molars with preparation of increasingly extensive MO or MOD cavity preparations followed by endodontic access.
relation to endodontic and Cuspal deflection increased with increasing cavity size and was greatest following endodontic access. Reinforced importance of cuspal
Messer 1995 Restorative restorative procedures coverage to minimize the danger of marginal leakage and cuspal fx.
To test the fx resistance of endo tx premolars restored with and without bonding agents, 56 intact teeth divided into 7 groups: 1)unaltered
In vitro fracture strength of 2)access only 3)MOD and RCT 4)MOD, RCT and amalgam restoration 5)MOD, RCT, amalgam with 4-META bonding agent 6)MOD, RCT
endodonticaly treated and composite 7)MOD, RCT, composite w/ 4-META bonding. Results: Unaltered teeth and those with access only demonstrated similar fx
Johnson 1999 Restorative premolars strengths. No significant difference in fx strength between the groups w/ MOD preps regardless of whether bonding agent was used or not.
Fracture resistance and
primary failure mode of
endodontically treated teeth To test fx resistance and mode of fx of endo tx incisors restored with cast post-and-core, prefabricated SS post, carbon fiber-reinforced
restored with a carbon fiber- comp post systems. 10 teeth with each technique and compressive load @ 130-degrees . Failure loads in 3 groups were not significant.
reinforced resin post system Conclusion: Carbon fiber-reinforced composite posts did not change the fracture resistance or the failure mode of endodontically tx central
Chai 2001 Restorative in vitro incisors compared to the use of metallic posts.
Survival Rate & Fracture

Strength of Incisors Restored Survival of mx ants after 1.2 million loads and thermocycling of various post and cores were evaluated in vitro. 1) cast post and core and
w/ Different P & C Systems & procera crown - 90% success 2)zirconia post with a prefab bonded ceramic core - 80% 3)resin-ceramic interpenetrating phase composite
Endo Treated Incisors w/out post (experimental) with a prefab bonded ceramic core - 60% 4)Access opening restored with bonded composite 100% success.
Coronoradicular Determined that preservation of tooth structure is of the utmost importance when restoring endo tx'd teeth. Discussion: in an anterior tooth,
Hutter 2002 Restorative Reinforcement if the cingulum is intact and it has only one Cl 3 restoration, a composite is sufficient.
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Stainless steel bands in
endodontics: Effects on
cuspal flexure and fracture Bands reduce cuspal flexure and increase fx resistance dramatically. Indicated for aid in crown build-up, retain large temp, managing cusp
Messer 2002 Restorative resistance fx and as a dx aid in cracked teeth.
In vitro studies indicate that that a ferrule effect occurs when the crown can brace against dentin extending coronal to the crown margin.
Significant increase in resistance to failure in single rooted teeth is observed when there is at least 1.5mm ferrule. Ideally, this dentin should
be about 1 mm thick. The cost of getting this support in teeth with no coronal dentine is loss of tooth tissue, which will weaken the root. A
The ferrule effect: A literature ferrule is desirable but not at the expense of the remaining tooth/root structure. If a ferrule is not obtainable, consider using bonded posts,
Wilson 2002 Restorative review cores and crowns.
Adresses modern controversies in restoration of endodontically tx teeth. Emphasizes major decision-making elements in post placement
and restoration of endodontically tx teeth. Conclusions: Avoid bacterial contamination, provide cuspal coverage, preserve tooth structure,
use posts w/ adequate strength in thin diameters, provide adequate post length for retention ( at least the length of the crown w/ 4-5 mm of
Post placement and remaining GP), maximize resistance form including adequate ferrule, use retrievable posts. Titanium posts tend to be too weak in thin
restoration of endodontically diameters and are difficult to remove. Screw posts should be used only when maximal retention is required. Ceramic and zirconium posts
Schwartz, treated teeth: A literature are not retrievable and should not be used. Literature is generally favorable towards fiber posts, they have a better mode of failure when
Robbins 2004 Restorative review compared to metal posts.
90 EXT canines had steel and titanium posts cemented using ZnO, GI and Panavia. Some were vibrated w/ U.S. for 16 minutes and
Hauman, Factors influencing the removed. Others were removed w/o any vibtration. Post type, cement type and U.S. vibration were all insig in the tensile strength req to
Chandler 2003 Retreatment removal of posts remove the posts.
Measurement of periapical
pressure created by occlusal Mx centrals were embedded in resin that mimics the properties of bone and periodontium. Forces were then applied to the teeth and
Wesselink 2003 Endo/Perio loading measured at the apex. The amt of force applied and the force measured were proportional.
The effect of cleaning
procedures on fracture Different rotary files were cleaned using either 1% NaOCl or 1% NaOCl/saline for up to 10 cycles. Files were then fx'd with measurements
properties and corrosion of taken and SEM eval. The washings did not affect fx resistance of any of the files. The saline mix was more corrosive. Files should not be
Messer 2003 Instruments NiTi files kept overnight iin NaOCl as they will corrode.
140 dog teeth were inocculated w/ LPS. Cleaned and shaped using 1%, 2.5% and 5% NaOCl or 2% CHX or irrig w/ saline and filled w/
Effect of different irrigation CaOH. After 60 d. the dogs were sacrificed. None of the irrigants inactivated the endotoxin, only the CaOH group was succesful.
Irrigation / solutions and calcium Suggests the routine use of CaOH in cases w/ CAP. Discussion: these roots were filled w/ LPS. Are those concentrations found in vivo???
Tanomaru 2003 Medication hydorxide on bacterial LPS Good argument against using CHX as intracanal medicament.
Root canal preparation with
FlexMaster: Canal shapes
analysed by micro-computed Mx molars were instr w/ FlexMaster files. Evaluated w/ micro CT before and after instr. Effectively instr canals to a 40-45 MAF w/o any
Peters 2003 Instruments tomography gross procedural errors. Worked well in both narrow and wide canals.
Bacterial status in root filled
Coronal teeth exposed to the oral
Leakage, environment by loss of 32 teeth that had adeq obt but were exposed to bacteria and caries for at least 3 mo were EXT and studied. 30/32 did not show the
Bleaching, restoration and fracture or presence of bacteria in the middle and apical thirds. PARLs were noted in 5 cases. There was soft tissue and inflamm infiltrates noticed
Bergenholtz, and Cervical caries- a histobacteriological on 7/32, giving credence to Brynolf's statement that RDX is a poor prognosticator of PA path. Well prepared and obturated teeth seem to
Ricucci 2003 Resorp study of treated cases resist bacterial penetration regardless of exposure to the oral environment for at least 3 mo.
Nonsurgically retreated root 265 roots. PA's taken at 10-17 yrs and then at 20-27 yrs. Late changes towards healing was observed. 17 cases (6.5%) were late
Molven, filled teeth- radiographic successes and 4 (1.5%) were late failures. Over-extension of filling materials showed a tendency towards delayed healing. Small PARLs
Fristad 2004 Retreatment findings after 20-27 years around over-extended filling materials should not be prematurely deemed failures.
Prevalence of and factors Prospective study of 272 pts w/ PARLs tx'd by different dentists in 2 visits. Each were given a VAS scale to fill out after instrumentation
affecting postpreparation pain visit. 65% reported some pain 1-2 days post-op. Severe pain was reported by 10% on day 1 and 7% on day 2. Pre-op pain is the single
in patients undergoing two- best predictor of post op pain. Pre-op swelling was slightly sig. Molar teeth also had a sig higher correlation to post op pain b/c of more
Gulabivala 2004 One-visit visit root canal treatment canals or intricacy of canal system. Steroid therapy sig dec post-op pain.
Irrigation / Dissolution of pulp tissue by
Siqueira 2004 Medication aqueous CHX and CHX gel CHX does not act as a tissue solvent. The rate of tissue dissolution inc as the conc of NaOCl inc.
RCT in 48 EXT incisors. 1 group was restored w/ comp immediately. 3 groups were bleached for 1 week w/ carbamide peroxide. 1 was
Effect of nonvital bleaching restored immediately after removal of bleach. Another group was restored after 1 week of soaking in saliva. The final group was irrigated
with 10% carbamide peroxide w/ an anti-oxidant for 3 hrs. The seal in the group that was restored immed after bleach removal had a weaker seal than the other groups.
on sealing ability of resin Non-vital bleaching w/ carbamide peroxide adversely affected the immediate sealing ability of composite rest. Sealing improved after a 1
Turkun 2004 Restorative composite restorations week delay.
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Surgical
Resolution of persistant
periapical infection by
Gomes 2004 Endodontics endodontic surgery
A clinical radiographic
retrospective assessment of
the success rate of single-
Gutmann 2004 One-visit visit root canal treatment
GI bonds to dentin, releases fluoride, biocompat and anitmicrobial. Bonds better w/ removal of the smear layer, etchant better than EDTA.
Anitmicrobial b/c of low pH, fluoride and zinc release. Biocompatible b/c sets w/ little exotherm, acid is neutralized rapidly, has low
The use of glass ionomer solubility. Often used in single-cone obturation techniques leaving a thick layer of sealer. As with all sealers, the thicker the layer, the more
cements in both conventional shrinkage and therfore, the more leakage. When used w/ cold lateral, the leakage was less than w/ Roth's. Retreatment is diff. Use as a
De Bruyne 2004 Obturation and surgical endodontics root end filling material is comparable to amal. In vitro, GI seems to work well as a coronal seal.
In vitro antimicrobial effect of
chlorhexidine impregnated
gutta percha points on E.
Lui 2004 Obturation faecalis
In vitro penetration of
bleaching agents into the
Benetti 2004 Restorative pulp chamber
Sectioned 500 teeth and looked for landmarks and canal configurations. Came up w/ "laws." Law of centrality: The floor of the pulp
chamber is always located in the center of the tooth @ the level of the CEJ. Law of the CEJ: The CEJ is the most consistent landmark for
locating the pulp chamber. Law of symmetry 1: Except for Mx molars, the orifices of the canals are equidistant from a line drawn in a M-D
direction through the chamber floor. Law of symmetry 2: Except for Mx molars, the orifices lie perpendicular to this M-D line. Law of color
change: The color of the pulp floor is always darker than the walls. Law of orifice location 1: the orifices are always located @ the junction
of the walls and the floor. Law of orifice location 2: The orifices are located @ the angles in the floor wall junction. Law of orifice location 3:
Krasner, Anatomy of the pulp chamber The orifices are located at the terminus of fusion lines. Claims 95% predicatability. Exceptions are 2nd and 3rd Md molars where law of
Rankow 2004 Morphology floor canal location can be deviant. Personal experience: look all along fusion lines to locate additional canals.
The effect of calcium sulfate
Surgical on hard tissue healing after
Torabinejad 2004 Endodontics periradicular surgery Placement of calcium sulfate in osteotomy sites does not affect dentoalveolar or alveolar healing.
Hard tissue healing after 24 roots from dogs were shaped and cleaned. 12 were filled orthograde w/ MTA and 12 were filled w/ GP. 2 wks later, apicos were done
application of fresh or set and the GP filled roots were retroprepped and filled w/ fresh MTA. The MTA filled roots were left. Dogs sacrificed 16 wks later.
Retrofilling MTA as root end filling Cementum formation to the MTA was found in 8/12 set samples and 12/12 fresh samples. The remaining 4/12 set samples had fibrous
Torabinejad 2004 Materials material CT surrounding the MTA. No difference in bone healing.
Attachment and
morphological behavior of
Retrofilling human PDL fibroblasts to
Balto 2004 Materials MTA: A SEM study Fibroblasts did not like freshly prepared-MTA group, but were flattened and appeared to be tightly attached to MTA.
Placed CaOH w/ different vehicles in sealed teeth. Same mixtures were placed in unsealed polyethylene tubes. All groups placed in water
Diffusion of Ca(OH)2 assoc for 70 days. Chromatography results compared. Some profiles were similar w/ only the values for the sealed teeth being lower b/c of the
Irrigation / w/ different vehicles: effect of diffusion through dentin. Others were different showing that the dentin can completely block the penetration of certain meds. One
Camoes 2004 Medication Chromatographic study group had formaldehyde in the mixture, this showed a bunch of wacky substances diffusing through it. What is this doing to the PDL??
Predictable Thermafil
removal technique using the .06 plugger is set to 400 degrees, place into canal to a depth of 3 mm. Turn off heat and let cool for 5 sec. Pull coronally w/o heat. Plastic
Guess 2004 Retreatment System-B heat source carrier will melt and adhere to System B tip as it cools.
Relationship of radiologic and
histologic signs of 53 root filled teeth from cadavers were evaluated radiographically and histologically. About 50% were inflammed at the PA. Odds ratio of
Periapical inflammation in human root finding inflamm when there was a PARL was 9.2. OR of uninflammed PA w/ tight coronal seal is 3.7. Trope supports his idea that the
Trope 2004 Pathology filled teeth coronal seal is more important than the quality of the obturation.
Repair of root perforations Describes 16 perf repairs at various levels w/ MTA. Follow-up was at least 1 yr and avg 25 mo. All cases showed resolution or no
Torabinejad 2004 Perforations using MTA: A long term study formation of radiolucency if none was present preoperatively.
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Antibacterial activity of 2%
chlorhexidine gluconate and
5.25% sodium hypochlorite in 30 necrotic canals were sampled pre-op, then instr w/ step-back. Irrig w/ 2% CHX or 5.25% NaOCl. Sampled after instrumentation.
Irrigation / infected root canal: In vivo Temped w/o intra-canal meds. Another sample taken after 48 hrs. CHX was found to be a better antimicrobial than NaOCl. Results are
Ercan 2004 Medication study suspect. Downplays the need for tissue dissolution in this article.
Effectiveness of sodium
hypochlorite in preventing 20 single canal teeth were instrumented and autoclaved. Apical 3mm immersed in culture medium and canals filled w/ 5.25% NaOCl.
inoculation of periapical Group 1: a #15 file was inoculated w/ S. sanguis. Placed through NaOCl in canal and 3 mm long into culture medium. Group 2: a #15 file
Irrigation / tissues with contaminated was inocculated, soaked in NaOCl for 10 s and then placed through canal w/ NaOCl and 3 mm long into culture medium. Neither group
Izu 2004 Medication patency files showed growth, positive controls did show growth. Passing a patency file through NaOCl in the canal is sufficient to disinfect them.
MTA and amal were placed in polyethylene tubes and implanted in rats. Evaluated histologically to 90 days. No difference in inflamm
Reactions of connective response in both groups. Inlfammation was present at 7 days and was absent by day 90. MTA did show hard tissue formation in the rat
Yaltirik 2004 tissue to MTA and amalgam CT.
A comparison of laterally
condensed gutta percha,
thermoplasticized gutta Dye leakage study on 60 bovine teeth. Instrumented then obt by 3 methods. 20 teeth w/ cold lateral. 20 teeth w/ Obtura (compaction only
percha, and MTA as root when fully obturated). 20 teeth w/ MTA, placed 2 mm thick w/ lentulo, remaining canal filled w/ a single GP cone and sealer. Obturation
Liewehr 2004 Obturation canal filling materials methods were suspect. MTA leaked a shit load more than GP. Questionable methods.
35 matched pairs of cadaver teeth. Instr to either a 20/.06 or a 40/.06. EDTA and 5.25% NaOCl were alternated as irrigants in all cases.
Cleaning / Influence of instrument size Teeth extracted, decalcified and sectioned. The 40/.06 group showed less apical debris, it was stat sig. Debris remained in all canals.
Baumgartner 2004 Shaping on root canal debridement The 40/.06 allowed deeper penetration of the irrigating syringe.
Effect of medications for root
canal treatment on bonding 14 EXT human teeth were instr w/ different irrigants. C&B Metabond used to obt canals. Bond stregths measures w/ Instron. NaOCl and
Erdemir 2004 Restorative of root canal dentin H2O2 sig decreased bond strengths. .12% CHX increased bond strengths…huh??
Mental nerve paresthesia
associated with an adhesive
resin restoration: A case Report of paresthesia caused by an allergic reaction to bonding agent used as a pulp cap. Patch testing by derm showed dermatitis from
Zmener 2004 Restorative report methacrylate in bonding agent.
Treatment outcome in
endodontics: The Toronto Assessed the tx outcome at 4-6 yrs. "Healed" if no PARL and sx (except percussion): 81%. Rate much higher if no PARL prior to tx: 92%
Success/failur Study. Phase 1: Initial vs 74%. If "healed" and "healing" categories are combined: 92% success. 97% were functional (no clinical signs/sx). Multi-visit tx in the
Friedman 2003 e treatment presence of a PARL was numerically superior, but not stat sig.
A comparison of survival of
teeth following endodontic
treatment performed by Success was defined by 5 yr survival. Endodontists had a 98% success rate and generalists had a 90% success rate. Looked at 350
Success/failur general dentists or by teeth. Teeth that were filled >2mm short and those that did not have a coronal restoration had a higher failure rate. Cites implant studies
Eleazer 2004 e specialists that show a 5% failure rate at 5 yrs and a 8% failure rate at 7 yrs.
Reviews treatment outcome studies of the past and compiles the information. A great review. Prevention of apical perio: Success is 83-
100%. 76% of the failures are apparent w/in 1 yr. Success for re-tx w/o PARL is 89-100%. Therapy of apical perio: Range of success is
46-93%. Of the teeth that heal, 89% demonstrate signs of heailing w/in 1 yr and almost 50% are healed. Since reversal of healing is rare,
prolonged observation of teeth that demonstrate signs of healing are unneccesary. Retreatment of teeth w/ PARLs have a success range
of 56-84%. This lower success rate can be due to bacteria harbored in unremoved filling materials. Apical surgery: Weighted success
rate is 66% w/ 20% uncertain and 14% failure. Healing is faster after surg than with orthograde tx and 60% of the cases demonstrate
complete healing at 1 yr. Most of the studies that were looked at used old techniques and materials. Extract/replant had a success range
of 34-93% w/ a survivability of 71-100%. If resorption occurs, it is evident w/in 1 yr. Realistic outcomes for this cannot be determined from
existing studies. Prognostic factors: Presence of PARL negatively affects success. Large lesions take longer to heal. Age,gender, tooth
Treatment outcome and type and health do not sig infleunce tx outcome. Over-extension of GP dec success if the canals are infected b/c it is preceded by
prognosis of endodontic overinstrumentation and transportation of infected debris periapically. Neg culture at obt shows higher success (94% vs 68% per Sjogren).
Success/failur therapy (Ch 15, Essential Single-visit vs multi-visit does not seem to be a major factor, though it seems logical to tx cases that have a PARL w/ intracanal meds.
Friedman 1998 e Endodontology) Teeth w/ inad coronal rest showed a poorer tx outome.
The main factor in dx is being aware that cracked teeth occur. Primary sx is discomfort to chewing and unexplained thermal sens. Look for
Success/failur cracks at the marg ridge. Isolating bite to specific cusps can be diagnostic. Mand 2nd molars are most likely to crack. Pts can often dx a
Cameron 1964 e Cracked-tooth syndrome cracked tooth themselves if they have experienced one in the past.
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Karmali,
94 replanted teeth Merchant,
w/ incomplete root formation Davis
were studied. Pulp healing occurred 34% of the time. Pulp sensibility frequently occurred
around 6 mo (range 4 mo to 2 yrs). Almost all of the pulps that healed underwent calcific metamorphosis. Necrosis or inflamm resorption
Replantation of 400 avulsed were usually evident rdx after 3 wks. A very stong correlation btwn pulp length and pulpal healing. Lengths of 17mm or less did better.
permanent incisors. 2. Hypothesized that the grtr the distance to revascularize, the grtr the chance of infection. Extra-alveolar storage was also am important
Factors related to pulp prognosticator. Wet storage was better than dry. Storage soln (saliva, other's saliva or saline) did not seem to matter. Replantation w/in 5
Andreasen 1995 Trauma healing. min was the best.
30 replanted teeth w/ incomplete root formation were studied. Extent of root formation was related to pulpal revascularization or necrosis.
Replantation of 400 avulsed 11/13 teeth w/ pulpal healing showed complete or partial root formation. 10/15 necrosed teeth showed arrested root formation. There was
permanent incisors. 3. a tendency towards more root formation if the extra-oral dry time was less than 45 min. Also describes the necessity of maintaining vitality
Andreasen 1995 Trauma Factors related to root growth of the HERS, without which, root formation would cease.
400 replanted perm incisors were followed. Complete PDL healing was found in only 24% of the cases. When resorption occurred, 60% of
Replantation of 400 avulsed the time it was replacement resorption, 30% inflamm and 5% surf resorp. Replacement resorption was clinically evident w/in the first
permanent incisors. 4. couple of months. Rdx dx was evident around 1 yr. Immediate replantation was the single most important factor. When replanted
Factors relating to immediately, healing occured in 85-97% of the cases, depending upon root formation. PDL healed less freq in older groups, prob due to a
Andreasen 1995 Trauma periodontal ligament healing. thinner PDL which is easier to injure. Longer extra-oral times resulted in less healing.
Lack of scientific basis for 2 major types of oral anticoags. Coumadin which blocks the formation of prothrombin and other clotting factors, also prevents the
routine discontinuation of oral metabolism of vitamin K. Antiplatelets are the other group. ASA permanently affects platelet aggregation. PTs that cannot tolerate ASA
anticoagulation therapy can take Plavix or Ticlid. Anticoagulation is measured by INR (International Normalized Ratio) which corrects for differences in PT btwn
Jeske 2003 Pharmacology before dental treatment labs. Routine withdrawal of anticoag therapy for routine dental, including extractions, is not indicated.
The properties of Endocal 10
and its potential impact on 39 md incisors were instr and obt w/ either GP or Endocal 10 ( aka Biocalex). Observed for fracture at 24 h, 7 d and 30 d. Fluid filtration
the structural integrity of the was also done. 3 (20%) of the Endocal teeth fx'd w/in 7 d. None of the GP teeth fx'd. No teeth from either teeth showed any leakage.
Dorn 2004 Obturation root. Endocal can seal well and promotes tubular calcium diffusion but casues root fxs.
Did both a leakage study and a fracture resistance study. All teeth were prepared to simulate an immature, open apex w/ divergant walls.
Evaluation of ultrasonically For the leakage study, 54 premolar were seperated into 3 groups. 1 group had MTA placed w/o US cavitation, 2 groups had MTA placed
placed MTA and fracture w/ US. One of these groups were then back filled w/ composite. Leakage was determined by turbidity. US cavitation of the MTA provided
resistance with intracanal a better seal, though study was vague about stat sig. For the fracture resistance study, 36 Mx incisors recieved a 4 mm apical MTA plug
composite resin in a model of placed w/ US cavitation. Group 1 did not receive a back fill. Group 2 was back filled w/ composite and group 3 was back filled w/ GP.
Lawley 2004 Obturation apexification Instron was used after 24 h. The composite group performed sig better. The GP and empty group were about the same.
42 canines were instr and obt w/ GP. Seperated into 6 groups. 3 groups had posts cemented w/ ZnPO4 and 3 groups were cemented w/
Panavia. Enac (piezoelectric) US was used for 4 min (1 min ea on the bu, li and prox sides) of some of the posts. Some also had water
Influence of ultrasound, with spray coolant while others did not. An instron was used to measure the traction force necessary to remove the posts. The US groups
and without water spray fared better than the non-US groups. Using water with ZnPO4 cement was much better than dry activation. ZnPO4 has low thermal
cooling on removal of posts conductivity. The US energy breaks the luting layer while the water affects the solubility of the cement. In the Panavia group, however, dry
cemented with resin or zinc activation was much better than using a water cooling spray. This is b/c resins are prone to thermal expansion and their elasticity prevents
Sousa-Neto 2004 Retreatment phosphate cements mechanical plastic deformation. Be careful about damaging the PDL w/ too much heat if used dry.
Case report of 11 yo boy w/ an immature necrotic md premolar. Sensibility tests were neg, sinus tract on Li, perc and palp +. Rdx showed
large PARL. Tooth was accessed and purulent discharge was noted. Flushed w/ 5.25% NaOCl and Peridex. Paste mixture or Cipro,
Revascularization of Metro and minocycline was placed. Pt returned 3 wks later. Asymptomatic, sinus tract gone. Paste was irrigated out with NaOCl. Canal
immature permanent teeth filled w/ blood from PA tissues. Sealed w/ MTA and composite. 2 yr f/u showed closure of apex, thickening of dentin walls and pos
with apical periodontitis: New sensibililty tests. This worked b/c tooth had an open apex (4mm) and was short. CaOH was not used b/c high pH will cause tissue to
Trope 2004 Open Apex treatment protocol? necrose. The trick is to disinfect the canal and allow new tissue to form before re-infection.
Geographical differences in Aspirates from endo abscesses were taken in Portland and in Brazil. PCR was used to determine target bacterial content. There were stat
bacteria detected in sig differences in the bacteria found. Differences may have occurred b/c of different methods used at each lab, but this is not the current
endodontic infections using thought. Geography plays a role b/c of host factors, genetics, quality of water and food, hygiene differences, stress, smoking habits,
Siqueira 2004 Microbiology polymerase chain reaction climate, ethnicity, etc.
26 teeth w/ VRF ranging from hairline cracks to fully fractured teeth were evaluated. Super Bond C&B was used. In hairline cracks, a
Prognosis of intentional shallow prep was made and sealed. In fractures, opposing edges were cleaned w/ an US and bonded together. All teeth were restored w/
replantation of vertically a post and crown. 6/26 were successful, 12/26 were functional, 8/26 were failures. Longevity was 89% @12 mo, 80% @24 mo, 70% @36
Surgical fractured roots reconstructed mo and 60% at 60 mo. Length of fracture and depth of fracture were sig in determining longevity. Anterior teeth also showed better
Hayashi 2004 Endodontics with dentin-bonded resin results, presumably b/c of less occ loading. Early dx and tx are nec to avoid loss of cortical plate.
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In vitro microbial leakage of
140 single rootedKarmali, Merchant,
teeth were obturated Davis
using different methods and studied using a split chamber leakage model. Lateral, vertical, Obtura,
SimpliFill w/ Obtura, FibreFill, and a SimpliFill w/ FibreFill combination. FibreFill is a a combination obturation technique that utilizes GP in
endodontically treated teeth the apical 1/3 and a resin core post w/ a resin sealer in the coronal 2/3. Leakage was studied out to 30 days. Leakage occurred more
using new and standard quickly in the lateral and vertical groups. SimpliFIll fared much better. The best was the ThermaFill/SimplFill combination. Resin
Trope 2004 Obturation obturation techniques obturation systems show promise for creating a better seal.
Morphology of the
physiological foramen: 1. Studied 1097 permanent molars of an Egyptian population w/ a computer assisted stereo-microscope. Found a high percentage of 2
Maxillary and mandibular physiologic foramina in mesial (87%) and MB (71%) of Md and Mx molars respectively. About 30% of M canals in molars have accessory
Marroquin 2004 Morphology molars foramina. 70% of the foramena were oval in shape. The foramen size ranged from about .20-.30 mm.
Effect of dentin on the
Irrigation / antimicrobial activity of dentin Tested the antimicrobial activity of various bonding agents and CHX by using agar diffusion. Perfussion through dentin decreases the
Schmalz 2004 Medication bonding agents efficacy of CHX. 200 microns of dentin thickness reduced zone of inhib by 1/2. 500 microns of dentin thickness reduced zone by 7/8.
Effect of seperated 26 EXT Md premolars were fully instr to 40/.04. Group 1 then had a 40/.04 seperated in the canal. Group 2 was obt w/ GP and sealer. S.
instruments on bacterial Sanguis solution was placed in the chambers and the apices were suspended in broth. Both groups took about 45 days to leak. No sig
penetration of obturated root diff. Comments: These teeth were fuly cleaned and shaped prior to seperation of the instrument. Still remains a good argument against
Saunders 2004 Retreatment canals Trope's belief that obturation is the weak link in endo tx. Small sample size.
This study tests growth in culture tubes while inc pH in 0.5 increments. A ph of 10.5 and 11.0 showed a retardation of growth. A pH of
Irrigation / pH required to kill E. faecalis 11.5 and higher showed no growth. Comments: This was done in a test tube. This article does address the affect of dentin on pH and
Eleazer 2004 Medication in vitro serves as a good review article for E. faecalis and CaOH.
Pilot studies on bioactive glass (BAG). In the first study, bovine dentin cylinders were inocculated w/ E faecalis. Medicated w/ either CaOH
or BAG. BAG samples showed no growth after 5 days, dramatically outperforming CaOH. The second study measured pH changes on
the root surface of EXT teeth. The CaOH group showed a pH as high as 9, the BAG group showed no change. The third experiment
Preliminary evaluation of placed BAG alone or BAG mixed w/ dentin particles in soln. Different bacteria were added. The BAG alone was ineffective. The
bioactive glass S53P4 as an BAG/Dentin was a very effective antimicrobial. Mechanism of action of BAG is unclear. It is speculated that BAG draws Ca and P out from
Irrigation / endodontic medication in dentin and causes a precipitate to form on the bacteria. There is a breakdown in the "mineralized" bacteria's cell wall and...poof. This
Waltimo 2004 Medication vitro material has promise.
Intracanal placement of
calcium hydroxide: A Compared placing CaOH w/ an Ultradent polyethylene capillary tip, a lentulo spiral and both combined. Used a plastic block. Found that
Irrigation / comparison of techniques, the lentulo spiral was slightly better at the apical 1 mm. Although it was stat sig, it looks pretty darn close. Comments: Lentulos can
Apicella 2004 Medication revisited. seperate and are a bitch to remove. In this study, they did have a seperation.
Influence of manual Used the ProTaper files to failure in resin blocks. Variables studied were the presence of a glide path and differnce in torque settings. A
preflaring and torque on the glide path to a #20 dramatically increased the life expectancy of all the files. The S1 was used 60 times before failure. A glide path
failure rate of ProTaper rotary prevents torsional failure from tip lock. A higher torque setting also inc the life of these instruments. This was b/c at the higher torque, the
Berutti 2004 Instruments instruments auto-reverse was not being activated. Auto-reverse kicks in when the instrument in most stressed, they were vague in this explanation.
Detoxification of endotoxin by Measured the breakdown products of LPS in vitro using gas spectrometry. LPS (endotoxin) is a powerful inflamm mediator.
Irrigation / endodontic irrigants and Irrigants/medicaments used were 2.6% NaOCl, 0.12% CHX, EDTA and CaOH. CaOH did sig better than any other group. High pH is req
Eleazer 2001 Medication CaOH for LPS breakdown. CaOH with its hihg pH is also present in the canal for days to weeks, making its effects pronounced.
Biocompatibiltiy of dental NaOCl: pH of 11-12. Antimicrobial action is due to its ability to hydrolyze and oxidize cell protiens. Due to pH and available free chlorine.
materials used in Heating bleach is beneficial. 0.5 and 5.25% have similar clinical efficacy in mechanical debridement. Freq irrigation with lower conc is
contemporary endodontic better. (Doesn't mention tissue dissolution.) EDTA: Enhances mechanical enlargment of the canal, removes smear layer, and aids in
therapy: a review. Part 1. disinfection. CHX: pH 5.5-7. Active against a wide spectrum of bacteria. Static at low conc and cidal at high conc. Substantive. Toxic,
Irrigation / Intracanal drugs and but the least toxic of antiseptic irrigants. Pts can be allergic to CHX. CaOH: Introduced in the 1920's. Antibacterial effect due to high pH
Hauman 2003 Medication substances (11-12.5). Slow acting, needs at least 7 days. Eliminates LPS.
Irrigation / Interactions of EDTA with In vitro study. EDTA maintains its chelating ability when combined w/ NaOCl. NaOCL lost its free chlorine and therefore, it's antimicrbial
Grawehr 2003 Medication NaOCl in aqueous solutions and tissue dissolution effects when EDTA was added. It is advised to thoroughly irrigate out EDTA to ensure effectiveness of NaOCl.
Papilla healing following FTMP flaps reflected w/ meticulous care in 13 pts. All had healthy periodontium. Sulcular recession measured pre-op, 1 mo and 3 mo
Surgical sulcular full thickness flap in post-op. Loss of papilla height observed in all cases. 1.1 mm loss at 1 mo and 1.3 mm loss at 3 mo (both w/ +/- about .8mm). In
Velvert 2004 Endodontics endodontic surgery periodontally healthy cases, esp w/ crown margins at stake, consider other flap designs (e.g. Sub-marginal or papillary base incisions).
60 bovine roots were standardized, shaped and sterilized. Experimental group was soaked in 2% CHX for 10 min prior to obturation.
Stored for varying times up to 12 wks. After elapsed storage time, dentin cylinders were split and inner dentin layer was ground out.
Grindings were analyzed w/ spectrophotometry and cultured w/ E. Faecalis and C. albicans. It was found that all of the dentin samples had
residual CHX and that it was available in antimicrobial amounts. The 1 day storage group had the most remaining CHX and the 12 wk had
Irrigation / Chlorhexidine substantivity in the least. Effectiveness seems to decrease w/ time. Discussion: this might be a valid argument for single-visit when CAP is present. Note
Spangberg 2004 Medication root canal dentin that the soak was for 10 minutes.
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In vitro evaluation of the
Karmali,
Cultured E. facialis, C. albicansMerchant, Davis spp w/ varying conc of CHX (liquid and gel) and NaOCl. 1% and 2% CHX
and various Porphyromonas
liquids were effective against all bacteria tested w/in 30 sec. The gels took longer, 15 min for 1% gel and 1 min for 2% gel. 0.5% NaOCl
Irrigation / antimicrobial activity of took 30 min, 2.5% took 10 min and 5.25% took 15 sec. Discussion: The gels may have taken longer b/c they didn't mix as well as the
Gomes 2004 Medication chlorhexidine and NaOCl liquids, relied on surface area contact vs mixing.
Monkey teeth were endo tx to rule out inflamm root resorption. Extracted. Negative control group was immed replanted. Positive control
group was bench dried for an hour before replanting. All other groups were dried for an hour and various methods, w/ and w/o removal of
PDL, or Emdogain application was performed before replantation. Block resections at 16 wks. Immed replantation had a 99% healing rate.
1 hr bench dry had a 17% healing rate. Removing the PDL and replanting healed at 5%. Adding Emdogain after an hour of bench drying
The effect of Emdogain on brought the healing rate to about 20%. Not much different than leaving the PDL on and just replanting. Removing the dried PDL before
periodontal healing in replantation is not a good idea. A good quote that is at the crux of replacement resorption: "The competitive wound healing of the
Sae-Lim 2004 Trauma replanted monkeys' teeth damaged root surface would favor the endosteal osteoblasts over the PDL fibroblasts."
A comparison of Polyethylene tubes containing Ultrafil, GP condensed w/ McSpadden and Obtura. Evaluated inflammatory response out to 120 days. The
subcutaneous connective first 7 days showed identical responses: granulation tissue, edema, severe vascular hyperemia and inflamm cell infiltration. At 120 days
tissue responses among Ultrafil had mature granulation tissue and a few lymphocytes. McSpadden showed more inflamm cells. The Obtura was surrounded by a
three different formulations of hyalinzed capsule, severe inflamm cell infiltrate and granulation tissue w/ edema. Discussion: It seems that a GP cone thrown long has a
gutta-percha used in very benign histological reaction while heated GP that is in the PA tissues causes inflammation. This might be due to changes in the
Leonardo 1990 Obturation thermetic techniques. molecular structure of GP when it heated, presence of surface roughness etc. Is this clinically apparent??
Antibacterial efficacy of
CaOH, IKI, Betadine and
Betadine scrub with and Used bovine roots infected with E. faecalis. Exposed to irrigants for 15 min and for 24 hrs. The addition of surfactants did not increase the
Irrigation / without surfactant against E. efficacy of any of the medicaments. IKI was the only agent to eliminate E. faecalis w/in 15 min. At 24 hrs, CaOH failed to consistently
Liewehr 2004 Medication faecalis in vitro disinfect dentin while betadine scrub and IKI rendered 90% of the samples bacteria free.
Effect of three different time
periods of irrigation with 90 EXT canines received each of the 3 irrigants for time periods of 3, 10 and 15 minutes each. SEM was used on split roots to count open
EDTA, EDTA-T, EDTA and tubules. There were more open tubules at the 3 min interval for all of the irrigants. Theory is that longer time periods will saturate the
Irrigation / citric acid on smear layer irrigant with minerals that will precipitate and occlude tubules. 17% EDTA did the best but it wasn't that big of a difference. Discussion:
Scelza 2004 Medication removal Yamada (1983) recommended 1 min of EDTA. It would have been nice if this study looked at that time interval.
Cyclic fatigue testing of 225 ProTapers were divided into 3 groups of 75 each. 1: Control. 2: Used in 2 molars. 3: Used in 4 molars. Rotations to failure were then
ProTaper NiTi rotary measured in a 90 degree simulated canal. The finishing files took progressively less rotations to failure as the file size increased.
Britto 2004 Instruments instruments after clinical use Discarded distorted files as they developed while instrumenting real teeth to develop sample groups. Results were vague.
Factors associated with the
removal of fractured NiTi Instrument removal was attempted in 72 teeth. Overall success was 53% (Mx=67%, Md=46%). Success rates were higher if the
instruments from root canal instrument was fx'd at the curve (60%) than if it was fx'd beyond the curve (31%). Success was lower in severely curved canals. Longer
Peng 2004 Instruments systems fragments were easier to remove.
SEM observations of the
attachment of human
periodiontal ligament Placed HPDL fibroblast solutions over freshly extracted human root slices that had had the apical 4 mm resected. The smear layer was not
fibroblasts to non- removed. Evaluated at 4,24 and 72 hrs w/ SEM. The cells were seen to be fully spread and attached to the dentin surface. It was
Surgical demineralized dentin surface concluded that resected dentin provides an excellent surface for the attachment of fibroblasts. Additionally, the smear layer did not affect
Al-Nazhan 2004 Endodontics in vitro the cell attachment.
Histologic evaluation of
pulpotomies in dog using two
types of MTA and regular and
Retrofilling white Portland cements as Mechanical pulp exposure were made in dogs. Treated w/ 2 brands of MTA (ProRoot, Angelus) and regular and white Portland cements.
Bramante 2004 Materials wound dressings Block resections made at 120 days for histo evaluation. All showed hard tissue bridging w/o any inflammation. No differences were found.
Comparison of long-term Flap design was evaluated on 12 pts. On each pt, one papilla was fully elevated and another papilla had a papilla base incision.
papilla healing following Recession was evaluated at 1, 3, and 12 mo. For the PBI the mean recession was .07mm, .10 mm, and -.06mm at the respective recall
sulcular full thickness flap time periods. For the full papilla elevation the mean recession was 1.1mm, 1.25mm and .98mm, respectively. Less recession was visible
Surgical and papilla base flap in at 12 mo than at 3 mo due to creep...the tendency for the ging to move in a coronal direction. Other studies have shown that papilla level is
Velvert 2004 Endodontics endodontic surgery pretty steady after 12 mo ((Harris 1997).
Treated over 1100 teeth and evaluated healing at 1 yr. Overall failure rate was 5%. Multi-visit showed a failure rate of 3% while single-visit
showed a failure rate of 9%, approx equal. The highest failure rate was w/ re-treats (16%). Teeth that were sx at time of obt did not fail at
The incidence of failure a higher rate. Teeth that were prev opened for emergency tx had a failure rate of 3% while those not prev opened failed 9% of the time,
following single-visit this was stat sig. Existing PARL had a higher failure rate. Teeth left open for drainage showed a similar failure rate than those not left
Pekruhn 1986 One-visit endodontic therapy open.
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Influence of infection at the
time of root filling on the
outcome of endodontic tx of 55 single visit one rooted txs. Cultured prior to obturation. 94% w/ neg cultures were successful after 5 yrs. 68% of pos cultures were
Sjogren 1997 One-visit teeth w/ apical periodontitis successful after 5 yrs. Presence of cultivable bacteria sig affects the success rate. Big proponent of CaOH2 to kill remaining bacteria.
Endodontic tx of teeth w/ Blatant manipulation of statistics to prove his point. The study did not show a sig difference btwn the two. Power analyses was used
periapical periodontitis: single backwrds to state that if the sample size was larger, then it would be significant. PAI was used to determine success, which has huge
Trope 1999 One-visit vs. multivisit tx potential for error.
Evaluated in vivo the effectiveness of "Lesion Sterilization and Tissue Repair." 87 infected primary teeth in 56 pts were used. Tx group
Endodontic treatment of included evidence of root resorption, fistula, swelling and pain. Teeth were accessed, walls were cleaned w/ 35% phosphoric acid soln.
primary teeth using a 3Mix was placed which is comprised of cipro, metro, and minocycline in a 1:3:3 ratio mixed w/ sealer or glycol as a carrier. 3Mix was
combination of antibacterial placed in the chamber and orifice opening only. 83/87 were successful with a singl tx, the remaining 4 were successful after a second tx.
Hoshino 2004 Pedo-Endo drugs This procedure offers an excellent alternative to extraction and placement of a space maintainer.
3 composites (flowable, packable and hybrid) were cured using 3 different curing lights (halogen standard, halogen fast cure and LED soft
Cytoxicity of composite resins start cure). Composite samples were placed in soln to draw out eluents for 1,2,3,5, and 7 days. Extracts were placed in culture wells
polymerized with different containing mouse fibroblasts. Cell survival was measured. Results were kinda all over the place. Curing methods did not seem to have
Nalcaci 2004 Restorative curing methods any effect on cytotoxicity. Not sure how clinically relevant this study is.
In vitro study. Different formulations of CaOH were used w/ different sealers. The first part looked at how much CaOH remains in the
canal after attempted removal w/ files and irrigants. About 30-60% of the apical third had CaOH remaining. Vitapex (oil based) was the
worst. In general, flow and setting time decreased if CaOH was present, making it easier for voids to form. Varying results on dye leakage
Effects of CaOH on physical were found, results were equivocal. Removal of all CaoH was impossible with files and irrigation alone. The presence of CaOH affected
Irrigation / and sealing properties of the physical properties of sealers. Discussion: This might be another good argument of single visit. It would be interesting to know what
Hosoya 2004 Medication canal sealers effect CHX as an intracanal medicament would have on sealers.
Cylinders of human roots were enlarged w/ a #2 Peezo and sterilized after removal of smear layer. Infected w/ E. faecalis. Obt w/ GP and
one of the test sealers. Sealers used were Grossmans (ZOE), AH Plus (resin), Ketac Endo (GI), Apexit (CaOH), Roeko Seal (silicone).
Survival of E. faecalis in Control was CaOH mixed w/ water. Incubated for 7 days. Peezo #5 was used to remove internal dentin chips and cultured. Grossman's
infected dentinal tubules after and AH Plus killed all of the E. Faecalis. CaOH killed most, this was followed by the rest of the sealers which were about the same.
root canal filling with different Grossman's and AH Plus are very effective against E. Faecalis. Comment: another good argument for single-visit. Why rely upon CaOH
Orstavik 2004 Sealers root canal sealers in vitro which is difficult to remove when your sealer does a better job...in vitro.
Comparative investigation of Resin blocks w/ 28 and 35 degree curves were used. ProTaper was instr, in the recommended sequence, to an F3. The RaCe was instr to
two rotary NiTi instruments: a 35/.02. Computer used to analyze the amount and lcoation of resin removal. Time to instr was also measured. All done by the same
ProTaper vs RaCe. Part 1: operator. The canals instr w/ RaCe were more centered and were slightly faster (by about 45 sec). Discussion: The ProTaper group had a
Shaping ability in simulated taper of .09 while the RaCe group had an .02 taper. Looking at the pictures, the ProTaper group had a shape that appeared to be more
Schafer 2004 Instruments curved canals conducive to cleaning w/ irrigants.
Comparative investigation of
two rotary NiTi instruments:
ProTaper vs RaCe. Part 2: Used 48 roots in extracted human molars. Instr w/ ProTaper to an F3 and w/ RaCe to a 35/.02. Used a computer model to assess effect
Cleaning effectiveness and on curvature and used an SEM to evaluate remaining debris and smear layer. Irrigated w/ 2.5% NaOCl. No EDTA was used. The RaCe
shaping ability in severely left less debris and maintained the curvature better than ProTaper. Discussion: The ProTaper was a .09 taper compared to a .02 taper for
curved canals of extracted the RaCe. Logic dictates that the ProTaper removed more dentin, therefore, there would be more debris. The larger taper may also
Schafer 2004 Instruments teeth account for more straightening of the canals.
96 extracted human teeth were standardized in length. Sterilized then infected w/ E. faecalis and C. albicans. Cultures were taken after
In vitro evaluation of the use w/ different medicaments and irrigants. CaOH mixed w/ CPMC elimanated essentially all cultivable bacteria at 7 and 15 days. CaOH
effectiveness of irrigants and alone faired pretty darn well. 2.5% NaOCl eliminated all bacteria immediately after irrigation, but pre-irrigation numbers of bacteria returned
intracanal medicaments on after the canals were left empty for 7 days. 2% CHX eliminated all bacteria immediately after irrigation. C. albicans began to return after 7
Irrigation / microorganisms within root days of the canals being empty while the E. faecalis remained uncultivable. Don't leave canals empty. CaOH/CPMC was the most
Menezes 2004 Medication canals effective medicament. CHX was showed a substantive antibacterial effect against E. faecalis.
Comparison of apical
transportation between
ProFile and ProTaper NiTi MB canals of 40 Md molars were divided into 2 groups. Group 1 were instr w/ ProFile .06 series to size 6 (ISO .36). Group 2 was instr to a
Iqbal 2004 Instruments rotary instruments ProTaper F3. Results showed no statistical difference in loss of WL and transportation.
70 palatal roots were obturated using different techniques: cold lateral, mechanical, Schiler WV, continuous wave, Thermofil, and Simplifill.
Percentage of canals filled in Roots were decalcified and % of obt canal was measured. Simplifill, Thermafil, Schilder WV and mechanical were all in the 96-97% filled
apical cross sections- an in range. Cold lateral was about 94%, continuous wave was 92%. Palatal roots were chosen b/c they are more oval therfore offering a better
vitro study of seven test of the ability to fill irregularities. The Schilder WV was a modified technique using a master cone, System B and pluggers to do the
Gound 2004 Obturation obturation techniques obturation in 3 down packs to a level 3-4 mm short of the apex.
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Accuracy of the DTC torque
control motor for NiTi rotary
Used 5 new DTC motors to determine if the torque settings were accurate. Found that the torque was about the same for all the motors
Yared 2004 Instruments instruments but this value was higher than advertised. This could lead to potential fx of instruments.
Review article. Grove 1930: CDJ is ideal place to end instrumentation. Sjogren 1990: best px when the root filling lies w/in 2 mm of the rdx
apex. Kuttler 1955: Anatomy of apex changes with age, foramen to apex is .5mm in young and .8 mm in older. EAL first investigated by
Custer 1918. Followed by Suzuki 1942. Sunada 1962 made the first device. Root ZX has 95% of the world market, it is a third generation
model, 90% accuracy to +/- .5 mm. Sybron's Elements is a 4th generation. Uses changes in resistance and impedence and compares it to
a database of averages. No accuracy % stated in this review. EAL can also be used to detect root fx, perforations, resorption...basically
anything that connects thePDL with the canal. Stabholz 1995: tactile sense of apical constriction can be detected 75% of the time in a pre-
Chandler 2004 Instruments Electronic apex locatoer flared canal. Garofalo 2002: bench top study showing most EAL do not affect cardiac pacemakers.
The efficacy of pain control
following nonsurgical root
canal treatment using
ibuprofen or a combination of 57 pts w/ pre-op pain of 50-100 mm on a 100mm VAS scale. Pulpectomy done. Pts rx'd 600mg IBU, 600mg IBU/1000mg APAP, or
ibuprofen and placebo. Given pain diaries out to 8 hours. Combination resulted in a 96% decrease in pain, IBU alone reduced pain by 76% and placebo
acetominophen in a by 71%. Placebo group shows either the placebo effect or the importance of definitive tx in symptomatic teeth. Combination group did
randomized, double-blind, very well. IBU works in the periphery by limiting PG synthesis through the COX enzymes. APAP limits PG in the CNS by interacting with
Gutmann 2004 Pharmacology placebo controlled study. seratonin and nitirc oxide mechanisms, crosses the blood-brain barrier.
Increased width of th apical
periodontal membrane space Another long-term follow-up of a tx outcome study done 20-27 years earlier. 5-10% of the original material had an increased width of PDL
in endodontically treatd teeth (IW). 8% had IW at 10 yrs post-op and 5% at 20-27 yrs. Of the 5% with IW at 20-27 yrs, 1% were judged as unfavorable. The remaining
Success/failur may represent favourable 4% were judged as a favourable healing pattern related to surplus filling material or functional and physical factors. The presence of IW
Molven 2004 e healing does not necessarily indicate failure of RCT. Most IW favor healing in the long term.
Antimicrobial activity of
varying concentrations of
NaOCl on the endodontic
microorganisms A. israelii, A. Organisms were tested in soln to different concentrations of NaOCl for varying time periods. 0.2 ml of culture were added to 9.8 ml of
Irrigation / naeslundii, C. albicans and E. NaOCl…hell of a ratio. A. naeslundii and C. albicans was killed in 10 s w/ 0.5% NaOCl. E. faecalis was more refractory. 0.5% NaOCl took
Drucker 2004 Medication faecalis 30 min. 5.25% took 2 min.
Used FlexMaster, GT rotary, ProTaper and Hedstrom's w/ and w/o eucalyptol to remove GP and AH Plus in extracted single-rooted canals.
Efficacy, cleaning ability and The ProTaper w/ or w/o solvent were the fastest. The rotary GTs were the slowest. This had to do w/ flute design. The ProTaper heated
safety of different rotary NiTi the GP up and also was able to cut through it. The GTs heated up the GP and burnished it into the walls. Overall cleanliness improved
instruments in root canal with the use of solvent. Eucalyptol was used b/c it is less cytotoxic than chloroform, even though it is a less effective solvent. None of the
Hulsmann 2004 Retreatment retreatment systems were able to remove all of the GP, especially in the apical third.
Semilunar, intra-sulcular and sub-marginal flaps were made in beagles. Healing evaluated to 60 days. Inflammatory changes persisted for
A comparative study of the longer and demonstrated a delay in collagen formation in the semilunar and intrasulculars when compared to the sub-marginal. Loss of
wound healing of 3 types of alveolar bone and recession occurs w/ the intrasulcular, though less scar formation was evident. The semilunar flap bled more than the
Surgical flap design used in periapical others and hemostasis was an issue. If a dehiscence was present, the author states that the submarginal allowed for better wound closure
Osetek 1984 Endodontics surgery and therfore, better healing.
Results of endodontic
retreatment: A randomized
clinical study comparing Randomly assigned 95 failing incisors and canines to either an orthograde re-tx goup or to a surgical re-tx group. Follwed for 4 yrs. At 12
Surgical surgical and non-surgical mo, the surg group showed a statistically higher healing rate. At 4yrs, however, both groups equalized. The surgery group had more "late
Kvist, Reit 1999 Endodontics procedures failures". The orthograde group took longer to show radiographic signs of healing. Success was just above 50% for both groups.
Coronal
Leakage,
Bleaching, Apcial healing of an Case report. #26 Nec/CSPP. Treated in one visit. IRM placed in access. Pt returns 2.5 yrs later. Temp intact, no sx, RDX healing
and Cervical endodontically treated tooth evident. Decided to restore w/ comp instead of re-tx. Article questions whether coronal leakage is that big of an issue if healing ahs
Vail 2002 Resorp with a temporary restoration occured.
51 EXT molars, cleaned and shaped. Group 1 obt w/ GP w/o sealer and coronal seal placed w/ Clearfil Liner Bond 2V. Group 2 obt w/ GP
and Kerr Root Canal Sealer EW and coronal seal w/ Clearfil placed. Group 3: GP w/ Kerr, no coronal seal. Turbidity test carried out for 90
Coronal days. No leakage evident in groups 1 or 2. Group 3 leaked w/in 15-76 days. Group 2 was used to test the effect of a eugenol containing
Leakage, In vitro bacterial penetration sealer on the seal of a bonding agent. Chamber was cleaned w/ chloroform prior to placement of bonding agent and results indicate that
Bleaching, of endodontically treated this is sufficient. 2 coats of bonding agent used, thickness averaged about 3 mm. Discussion: 3mm thickness of bonding agent!!! How
and Cervical teeth coronally sealed with a does this affect retention and radiographic appearance. Might be better to use a more radioopaque bonding agent to prevent
Loushine 2001 Resorp dentin bonding agent misinterpretation of bonding agent as a void in the restoration.
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Chloroform and Karmali, Merchant,
halothane solvents Davis
to remove GP decrease bond strength to dentin. 30 roots were instrumented and irrigated w/ water,
chloroform or halothane. C&B Metabond was placed in canals. 24 hrs later, roots sectioned and bond strength was measured. Bond
strengths were 23 MPa for water, 18 for chloroform and 17 for Halothane. The water group was stat sig over both the solvents.
Effect of solvents on bonding Discussion: The use of a eugenol sealer and GP would probably have dec the bond strengths further b/c they would have formed a layer
Pashley 2004 Restorative to root canal dentin on the dentin prior to bonding. This study did not utilize any filling material prior to irrig w/ solvent.
Accuracy of the TCM Endo II
torque-control motor for Orifice shapers were placed into motors and the tip was grasped w/ a chuck attached to a torque meter. Different torque settings were
nickel titanium rotary measured. The actual torque reached prior to motor reversal were sig higher than advertised in every case. Some of these values were
Yared 2004 Instruments instruments higher than what is required to fx some instruments.
72 pts w/ IP and pain were used in this random , double-blind study. Received either 2.2 ml of 2% Lido or 4% Articaine. Waited 15
minutes. 7 pts did not exhibit lip signs (5 w/ Lido and 2 w/ Art…not stat sig). Access was made in the remaining pts. If pain was felt, pt
Anesthetic efficacy of rated it on a VAS scale. Articaine was succesful 24% of the time and Lido was 23%. Discussion: Other studies have shown the same
Articaine for IA nerve blocks thing, namely Malamed. Articaine also has a higher incidence of parasthesias. Note that twice the conc of articaine was used here (4% vs
Reader 2004 in patients with IP 2%).
Microbiological evaluation of
one and two visit endodontic 96 teeth w/ Nec/CAP which were asymptomatic were used. Access. Sampled. Instr to 40-60 MAF using 0.5% NaOCl. Sampled. 1 group
treatment of teeth with apical had smear layer removed and 10 min soak w/ IKI. Sampled and obturated. Other group had CaOH placed for 1 wk. Re-accessed and
periodontitis: A randomized, sampled. Distribution was random and balanced. After instr, about 60% of all teeth still had cultivable bact. In the one visit IKI group, 29%
Kvist, Reit 2004 One-visit clinical trial had bacteria after medication. In the 2 visit CaOH group, 36% had bact. Not stat sig. Discussion: Great argument for single visit.
Treatment outcome in
endodontics: The Toronto
Success/failur Study. Phases 1 and 2:
Friedman 2004 e Orthograde retreatment
Antibacterial efficacy of
Irrigation / CaOH and CHX irrigants at Dentin disks were infected w/ E. faecalis. Soaked w/ saline, CaoH or .12% CHX at different temps. Dentin ground and cultured. The
Liewehr 2004 Medication 37 and 46 degrees C. CaOH and CHX were equally effective at respective temps. Heat made both of them better.
Sealing ability of One-Up
bond and MTA with and
without a secondary seal as Furcal perfs were made in 40 extracted teeth. Sealed w/ MTA alone, One-Up bond alone or MTA w/ a secondary seal of One-Up or Super
furcation perforation repair EBA. Fluid filtration at 1 day and 1 month. MTA alone leaked sig more at 1 day than the other groups. At 1 month the MTA was the same
Pashley 2004 materials as the One-up. The MTA w/ Super-EBA began to leak more. As time progresses, the seal with MTA improves.
In vivo study on the
biocompatibility of newly
developed calcium Studied biocompatibility of new Portland Cement containing sealers agianst Pulp Canal Sealer EWT. Placed freshly mixed sealer in tubes
phosphate based root canal that were placed in rat CT. Histo sections out to 12 wks. No stat sig differences among the test materials. Inflammation decreased over
Kim 2004 Sealers sealers time.
Infected bovine dentin cylinders w/ E. faecalis and S. Mutans. Irrigated w/ ozonated water (4mg/L) for 10 min w/ and w/o US activaton.
Compared it to 2.5% NaOCl for 2 min w/o US activation. Found that the ozonated water performed almost as well as the NaOCl. Also
Antimicrobial effect of placed test solutions on fibroblasts and found that the ozonated water was less cytotoxic. Concludes that ozonated water would be a good
Irrigation / ozonated water on bacteria irrigant. Comments: 10 min w/ US vs 2 min w/o US...you decide. Might be a good alternative if you have an open apex and no CHX
Nagayoshi 2004 Medication invadiing dentinal tubules around.
Tested ice, CO2 snow and Endo Ice (TFE) on extracted PM. Looked at uprepped tooth, FGC, PFM and all ceramic crowns. Used a
thermocouple placed in the pulp chamber to record temp changes. A #2 cotton pellet that was saturated w/ Endo Ice performed the best
giving a sig temp decrease from 10-30 seconds. Using Endo Ice resulted in a 7-8 degree temp change whether trhough a virgin tooth,
Cold testing through full PFM or all-ceramic crown. Through a FGC, the temp decreased about 15 degrees. Discussion: Backs up findings by Walton 2002 and
Johnson 2004 coverage restorations Jones 1999.
Identification of resected root- Used 50 ext Mx incisors. Created cracks in 25. Specimens were examined by 4 endodontists using scope, transillumination and dyes.
end dentinal cracks: A Accurate about 70-80% of the time regardless of the technique used. The dyes were better able to tell if a crack was not present
Surgical comparative study of (specificity). Transillumination was better able to tell if a crack was present (sensitivity). Logical that using both together would be the most
Loushine 2004 Endodontics transillumination and dye. accurate, although in this study, no sig diff.
Three step vs single step use
of System B: Evaluation of Instrumented incisors, PM and canines to a 45/.10. Used a split tooth model w/ internal depressions. Fitted Autofits. Group 1: A fine
GP root canal fillings and System B plugger at 200 degrees was placed 1 mm from WL 3 times. Each time was done in the typical manner w/ 10 sec of pressure,
their adaptation to the canal seperation burst etc. Group 2: down packed only once. The 3 step performed sig better than the 1 step. Discussion: Why use a Fine
Suda 2004 Obturation walls plugger for a 45/.10. Would the single step have performed better if a Med plugger or larger was used??
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rotary NiTi endodontic
Karmali,
Factors influencing defects of Looked at over 7,000 discardedMerchant,
rotaries from 14Davis
endodontists. Unwinding occurred in 14% of the files and fx in 5%. The most important
factor was operator influence, which may be related to clinical skill or a conscious decision to use instr only a limited # of times. Instrument
Messer 2004 Instruments instruments after clinical use type also played a role.
Coronal
Leakage, Bacterial leakage with MTA Bacterial leakage model using human saliva was used to evaluate the seal of gray MTA, white MTA and Fuji II LC. All temps placed in 3
Bleaching, or a resin modified glass mm increments. The canals were obt poorly w/ minimal sealer to enhance the effect of coronal leakage. All groups first showed leakage at
and Cervical ionomer used as a coronal 50-60 days. No sig diff btwn groups. Seals were acceptable to 90 days. Discussion: Fuji II LC looks great. Dentin was not conditioned
Baumgartner 2004 Resorp barrier prior to placement.
Soft tissue dissolution of
Irrigation / currently used and potential Nectrotic tissue from pig palates was incubated w/ 1% NaOCl, H202, 10% CHX and various other irrigants. After 120 minutes, only the
Zehnder 2004 Medication endodontic irrigants NaOCl showed sig dissolution of necrotic tissue.
Effect of 2% chlorhexidine gel 42 human extracted mx ants were instrumented to a #50 MAF. Group 1 was obt immediately. Group 2 and 3 were medicated for 14 days
as an intracanal medication w/ CaOH or 2% CHX gel, then obturated. Fluid filtration model assessed leakage. CaOH numerically leaked much more than other
Irrigation / on the apical seal of the root groups, but not stat sig. CHX and immed obt were the same. Discussion: There are other studies that show that CaOH effects the seal
Pashley 2004 Medication canal system (Kim 2002).
Great review on the removal of posts and seperated instruments. Stresses sufficient straight-line access. Ultrasonics should be used at
Ruddle 2004 Retreatment Nonsurgical retreatment the lowest effective setting and dry. Lots of tips, too many to list, good stuff here.
Endodontic treatment
outcomes in a large patient
Success/failur population in the USA: An Data from 1.4 million pts were obtained from Delta Dental. 97% of all endo tx'd teeth were retained at 8 yrs. Most adverse tx outcomes
Salehrabi 2004 e epidemiological study were evident during the first 3 yrs. Of all the teeth that were extracted, 85% lacked cuspal covg.
Comparative study of white 44 ext human incisors were instr to simulate an open apex case. Apical barriers of MTA were placed using US and pluggers. Variables
and gray MTA simulating a were white vs gray MTA, 2mm vs 5mm depth, and one vs two visit placement. Apices placed in moist environment for 4 wks. Gray MTA
Retrofilling one or two step apical barrier leaked sig less than white. Two step placement leaked sig less than one step. A 5mm barrier had stat sig more microhardness than a 2
McClanahan 2004 Materials technique mm barrier.
MTA obturation of pulpless
teeth with open apices:
Bacterial leakage as detected 34 ext human single rooted teeth were instr to simulate an open apex. 1,2 and 3 mm of MTA were placed by an orthograde technique w/o
Retrofilling by polymerase chain reaction US. E. faecalis was placed in the canals and apices were placed in culture medium. Leakage was assessed out to 50 days. At day 50,
Berutti 2004 Materials assay 17% of the cultures were contaminated. There was no sig diff btwn the different thicknesses placed.
50 human single rooted teeth were instr and irrigated w/ 1.3% NaOCl. 5 groups of 10. Groups 1 and 2 were controls. Group 3 was
obturated w/ GP and AH26. Group 4 was soaked w/ 17% EDTA for 5 min followed by NaOCl then obt. Group 5 was irrig w/ MTAD (5 min
The effect of MTAD on the soak, and 4 ml flush) and then obt. Dye was placed in chambers for 48 hours. Group 3 showed sig more leakage than 4 or 5. The MTAD
Irrigation / coronal leakage of obturated group did numerically better than the EDTA group, but not stat sig. Discussion: Soaking a tooth for 5 min in EDTA can be destructive to the
Torabinejad 2004 Medication root canals dentin and can effect leakage. It would have been better of EDTA was used for 1 min as recommended.
Dog teeth were used. Group 1: RCT, extracted, grooved and replanted. Group 2: Pulpectomy, infected w/ saliva, temped w/o intracanal
Effect of different endodontic meds, extracted, grooved and replanted. 2 wks later, CaOH for a week then obt. Group 3: Treated like group 2, but CaOH for 8 wks, no
treatment protocols on obt. Teeth studied histologically after 8 wks. 8/8 teeth in group 1 showed complete cemental repair. Group 2 and 3: 7/9 complete and 2/9
periodontal repair and root partial cemental repair. 1 tooth in the long-term CaOH group showed ankylosis, theorized that it was the high pH of the CaOH that caused
Trope, resorption of replanted dog necrosis of the PDL cells. Discussion: The pH at the external root surface remains the same after CaOH b/c of the buffering effect of the
Friedman 1992 Trauma teeth dentin...so why ankylosis???
4 types of healing for fx teeth. 1. Healing w/ calcified tissue. 2. Interproximal CT. 3. Interproximal bone and CT. 4. Interproximal granulation
tissue (this is assoc w/ pulp necrosis). Necrosis occurs in coronal segment 44% of the time, apical segment almost always retains vitality.
Treatment of fractured and PDL heals in 3 ways after avulsion and replantation. 1. Healing w/ normal PDL. 2. Healing with ankylosis. 3. Inflamm resorption. Length of
Andreasen 1971 Trauma avulsed teeth extra-oral period is the primary clinical factor assoc w/ healing.
Rapid neurologic assessment
and initial management for
the patient with tramatic
Croll 1980 Trauma dental injuries
The efficacy of ultrasonic
irrigation to remove artificially Instr plastic blocks to a standardized MAF and taper (20/.04, 20/.06 and 20/.08). Placed a groove in the apical third of the plastic blocks
placed dentine debris from and filled groove w/ dentinal debris. Irrig using US streaming w/ a #15 file for 3 min under constant flow of 2% NaOCl. 20/.06 had a 58%
Irrigation / different sized simulated reduction in debris. 20/.06 - 83% reduction. 20/.08 - 94% reduction. Diff btwn 20/.06 and 20/.08 were not stat sig. Diameter and taper of
Wesselink 2004 Medication plastic root canals the instrumented canal influenced the effectiveness of US irrigation.
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Effectiveness of
Karmali,
Electrochemically Merchant,
activated water is created by Davis
running a current through saline and harvesting the solutions that accumulate aroudn the
anode (anolytes) and cathodes (catholyte). Canals were instrumented and infected w/ an E. faecalis biofilm and irrigated w/ carying forms
electrochemically activated of these anolytes and catholytes w/ and w/o US streaming. Compared to 3% NaOCl. NaOCl was sig better. Anolytes reduced CFUs.
Irrigation / water as an irrigant in an Catholytes increased CFUs when compared to control. Discussion: difficult and confusing write up. Bottom line seems to be that activated
Gulabivala 2004 Medication infected tooth model water is not an ideal irrigating soln.
The effectiveness of syringe Used the split tooth model in human canines. Instr to a #50 MAF and created grooves and depressions in the canal's apical 1/3 and filled
irrigation and ultrasonics to them w/ dentin mud. The ultrasonic group was irrigated for 3 min using 200 ml of 2% NaOCl. The syringe group was irrigated using 50 ml
remove debris from simulated over 7 minutes. Different volumes were used to simulate the actual volumes that would probably be used in each clinical technique.
Irrigation / irregularities within prepared Remaining debris was then evaluated. Percent reduction of debris in grooves and depresions were 25% and 52%, respectively, in the
Wesselink 2004 Medication root canal walls syringe group and 88% and 82% in the US group.
Evaluated 36 pts with homozygous sickle cell anemia. 6% of teeth w/o any rests or trauma were nec. 83% of the pts had orofacial pain
w/o an obvious cause. Radiographic bone density was often shown to be deteriorated and a step ladder pattern was often seen. SCA
Pulpal necrosis with sickle causes a deformation in RBCs. Macrophages are too busy eliminating them to be available to fight off other infections. Deformed RBCs
Unsal 2004 Diagnosis cell anemia also occlude microvasculature.
Effect of obturation technique 4 different instr and obt techniques were evaluated on ext md molars. ProFiles (.04) w/ cold lat. GT w/ cont wave, ProFile w/ Thermafil and
on sealer cement thickness LightSpeed w/ SimpliFill. AH26 was the sealer used. Cement thickness and dentinal penetration were measured. Simpltfill had about a 50
and dentinal tubule micron thickness, CW and cold lat had 10 microns and Thermafill had almost none. Sealer penetration was inconsistent btwn and w/in
Messer 2004 Obturation penetration groups. 0.2% of Thermafil had voids, no stripping was evident, 2% of CW and cold lat had voids and 12% of Simplifill displayed voids.
Evaluated white and gray MTA with cell culture. MTA, both forms, that were cured for 1 day showed a confluent cell monolayer after 5 and
7 days. MTA that was allowed to cure for 28 days showed incomplete cell confluence after 1 and 5 days. Discussion: nobody is sure why
Surgical Biocompatibility of two MTA is so biocompatible. This shows that it is more biocompatible early after curing. What impact does this have on orthograde obt w/
Pitt Ford 2004 Endodontics commercial forms of MTA MTA followed by root resection at a later date??
Susceptibility to localized
corrosion of stainless steel
and NiTi endodontic
instruments in irrigating Tested SS and NiTi files in 5.25% NaOCl and 17% EDTA. None of the tested materials are susceptible to pitting or corrosion in the
Darabara 2004 Instruments solutions irrigating solns.
75 roots were extracted w/ attached PA lesions. Classified as cystic and non-cystic, SEM was used to evaluate and correlate the amount
Internal apical resorption and of apical resorption. Non-cystic abscesses were the most common finding. PA granulomas were present in only 9% of the sample. 20%
Periapical tis correlation with the type of were cystic, but the definition would include bay cysts. Of the canals w/ PA lesions, 75% had internal apical resorption, 48% of these had a
Figueiredo 2004 Pathology apical lesion large area of resorption. There was no correlation btwn the type of PA lesion and internal apical resorption.
A comparative histological
evaluation of the Intraosseous implants using ZOE, MTA and Z-100 were placed in guinea pigs. Evaluated histologically at 4 and 12 wks. The toxicity of all
Surgical ciocompatibility of materials materials diminished with time. ZOE was highly toxic at 4 wks but became more biocompatible after 12 wks. The MTA showed the best
Sousa 2004 Endodontics used in apical surgery biocompatibility although the composite was not far behind.
The effect of two different
Irrigation / CaOH combinations on root Human dentin cylinders were filled w/ two mixed of CaOH, one with water and one with glycerine. Evaluated for microhardness at 1,3 and
Yoldas 2004 Medication dentine microhardness 7 days. Both combinations decreased the microharness of dentin, the glycerine combination had a grtr loss of hardness.
Can CAP occur before a pulp is totally necrotic?? Histologically examined 75 pulps from cariously involoved teeth w/ PARL. The size of
Pulp biopsies from the teeth the PARL was related to the amt of pulpal destruction. Teeth w/ small PARL may respond to sensitivity testing and usu reveal only coronal
Periapical associated w/ periapical necrosis. PA inflamm changes often develop before total inflamm of the pulp occurs. Intact nerve fibers can persist in pulps having severe
Langeland 1984 Pathology radiolucency inflamm and partial necrosis. Comments: if you see a PARL but the tooth tests pos to cold, keep this article in mind.
Susceptibilities of two 3% NaOCl, 0.2% CHX, iodine, 17% EDTA and CaOH were studied on E. faecalis that was either in suspension, in a biofilm or centrifuged
Enterococcis faecalis into pellet form. Looked out to 60 min. Only NaOCl was effective in eliminating the bacteria regardless of form and it occured within the
Irrigation / phenotypes to root canal first minute. The bacteria in the biofilm was the hardest to kill. Only NaOCl was able to do so. Hypothesized that the tissue dissolution
Gulabivala 2005 Medication medications properties were able to dissolve the organic portion of the biofilm matrix.
Antimicrobial efficacy of Ext human single rooted teeth were instr to a 40 MAF and inoculated w/ E faecalis for 9 days. Medicated w/ water, CaOH, 2% CHX and
chlorhexidine and two CaOH/2% CHX, let soak for 3 days. Canals were then instr sequentially w/ a 45-60 Hedstrom w/ dentin shavings collected after each.
calcium hydroxide Cultured and analyzed. Only 2% CHX was effective in eliminating E faecalis (10% reduction w/ a 45 Hedstrom, 50% w/ a 50 H, 100% w/ a
Irrigation / formulations against E. 55H and 60H). The CaOH/CHX mixture did numerically better than CaOH alone, but not stat sig. A side finding was that E faecalis can
Schafer 2005 Medication faecalis penetrate at least 200 microns into the dentin.
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Human Mc incisors were split. Internal surfaces were sanded. Group 1: 17% EDTA/5.25% NaOCl for 150 sec each. Group 2: 19% Citiric
Effect of EDTA and citric acid Acid/5.25% NaOCl for 150 sec ea. Control was saline. Differences in microhardness were stat sig btwn all solutions: Control was the
solutions on the hardest --> EDTA --> CA was the softest. CA was rougher (stat sig) than either EDTA and Control groups. EDTA group was rougher than
microhardness and the saline, but not stat sig. Discussion: What does this all mean?? Microhardness is a way to determine the change in dentinal Ca/P ratio.
Irrigation / roughness of human root This, taken with roughness, may affect the way obturating materials react to and seal the dentin. I don't think the microhardness in this
Erdemir 2005 Medication canal dentin case implies that the root is weakened b/c the changes in the dentin caused by the irrigants would be very superficial.
Surgical Soft tissue management in
Velvert 2005 Endodontics endoontic surgery Destined to be a classic read. Lots of good info, should be read in its entirety. Too much gold to be summarized.
Pulp-Dentine complex Placed intrusive ortho forces on PM bilaterally in the same pts. Group 1 had placebo and group 2 had nabumetone (NSAID). Teeth
changes and root resorption extracted and studied histologically. The odontoblastic layer in the coronal third was altered in both groups (not stat sig). External root
Pulp during intrusive orthodontic resorption was found more commonly in the placebo group than in the NSAID group (65% vs 35%). Theorized that intrusive force releases
Physiology tooth movement in patients PGs through an inflamm rxn. The NSAIDs reduce this PG release. Discussion: Would NSAIDs be a good idea in traumatized teeth were
Villa 2005 and Pathology prescribed nabumetone there has been damage to the protective cementoblastic layer??
12 teeth w/ necrotic, asymptomatic pulps. Accessed and sampled. Instr and irrig w/ 5.25% NaOCl. Dressed w/ CaOH for 14 d. Accessed
and sampled again. Confirmed the presence of a polymicrobial obligate anaerobe population. There was a mean number of 17
Endodontic therapy spp/sample on the initial sampling. The most predominant orgs were Actino, Fuso, Strep, and the black pigmented. After CaOH, a meam
associated with CaOH as an of 8 spp/sample were found. Interestingly, E. faecalis was present in 1/3 of the pre-op samples and were eradicated after CaOH. It is
intracanal dressing: theorized that E.f exists in sufficienttly small numbers in a primary infection that CaOH is effective. In a re-tx, the numbers of E. f are much
Microbiologic evaluation by higher initially. CaOH was useful, but not the magic bullet. Discussion: CaOH relies on close contact w/ bacteria. If they are in the tubules
Irrigation / the checkerboard DNA-DNA or deep in a smear layer...CaOH ain't gonna cut it. A possible downside to this methodology is that it doesn't distinguish btwn DNA from
de Souza 2005 Medication hybridization technique live microorgs and floating DNA from dead ones.
12 teeth w/ necrotic, asymptomatic pulps. Accessed and sampled. Instr and irrig w/ 5.25% NaOCl. Dressed w/ CaOH for 14 d. Accessed
Endodontic therapy and sampled again. Confirmed the presence of a polymicrobial obligate anaerobe population. There was a mean number of 17
associated with CaOH as an spp/sample on the initial sampling. The most predominant orgs were Actino, Fuso, Strep, and the black pigmented. After CaOH, a mena
intracanal dressing: of 8 spp/sample were found. Interestingly, E. faecalis was present in 1/3 of the pre-op samples and were eradicated after CaOH. It is
Microbiologic evaluation by theorized that E. f exists in sufficienttly small numbers in a primary infection that CaOH is effective. In a re-tx, the numbers of E. f are much
the checkerboard DNA-DNA higher initially. CaOH was useful, but not the magic bullet. Discussion: CaOH relies on close contact w/ bacteria. If they are in the tubules
de Souza 2005 Microbiology hybridization technique or deep in a smear layer...CaOH ain't gonna cut it.
Periapical inflammation after Teeth in beagles were instr and obt using diff methods. Group 1: GP/AH26 cold lat. Group 2: GP/AH26 warm vert. Group 3:
coronal microbial inoculation Resilon/Epiphany cold lat. Group 4: Resilon/Epihany warm vert. Chambers were inoculated w/ plaque and sealed for 14 wks. Block
of dog roots filled with gutta resections taken and studied histologically. 82% of the PA tissues in the GP groups showed mild inflamm. 19% of the Resilon groups
Trope 2005 Obturation percha or Resilon showed mild inflamm. Trope relates this to the better sealing ability of Resilon.
Studied the interacition between MTA and synthetic tissue fliuds using spectrophotometry and SEMs. Found that a precipitate of
hydroxyapatite forms when the two are combined. Suggests that the biocompatibility and the sealing ability of MTA comes from this
Retrofilling Physiochemical basis of the formation of HA. As MTA is placed, the Ca and other ions dissolve, crystals nucleate and grow. This fills the microscopic void btwn the
Sarkar 2005 Materials biologic properties of MTA MTA and the dentin forming a chemical seal. MTA is not an inert material, rather it is bioactive.
RetrofillingChemical differences Used an SEM and electron probe microanaylsis. White MTA has smaller particle sizes than gray MTA. White MTA also has considerably
Parirokh 2005 Materials betwwen white and gray MTA lower conc of FeO, Al2O3, and MgO.
Evaluated the microhardness of light cured composites in simuated canals using a light-transmitting plastic post (LTPP), glass-fiber
Microhardness of composites reinforced composite post (GFRCP) and conventional light curing. All methods showed a steady decrease in microhardness as the
in simulated canals cured distance inc from the light source. At 4 mm, the conventional curing was too soft to test. At 10 mm, the GFRCP was too soft to test. At 14
with light transmitting posts mm, the GFRCP were too soft. Discussion: The microhardness decreased rapidly and steadily as the distance from the light source
and glass-fiber reinforced increased. Good reason to use a dual-cure resin. The benefit of the GFRCP is that it is a one-step method, the light transmitting device is
Yoldas 2005 Restorative composite posts the post itself, meaning that it doesn't have to be removed and replaced with another type of post.
Quality of gutta percha root Used a split tooth model that was instr to a 45/.10. Two types of GP were used…a 0.02 taper and a 0.10 Autofit taper. System B was
canal fillings using differently placed to w/in 3 mm of the apex, backfilled w/ Obtura. The 0.02 cone showed better reproductions of the dimples placed near the apex.
tapered gutta percha master This was because the binding point of the 0.02 cone was more apical than the 0.10 cone. Additionally, the 0.02 cone had less mass, so it
Suda 2005 Obturation points was heat softened better than the 0.10 cone.
208 canals with severe curvatures were used. Instr to a 25 or 30 /.06 K3, a 25 or 30 /.06 ProFile or a F3 ProTaper. Coronal pre-flairing
The influence of a manual and a glide path was created to a #20. Found that as the radius of the curvature decreased, the risk of fx increased. Also, as the angle of
glide path on the seperation curvature increased, so did the fx rate. The number of uses for each file had the greatest impact on the fx rate. The highest fx rate was for
Patino 2005 Instruments rate of NiTi rotary instruments files that were used 8X of more.
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50 single rooted Karmali, Merchant,
teeth had were instr to simulateDavis
immature apices. Group1 had 2 mm of MTA placed in an orthograde manner. G 2 had 5
In vitro evaluation of an mm placed. G3 had 2mm placed, which was allowed to set for 24 hrs and then had another 2 mm placed over that. The theory being that
orthograde apical plug of the first plug would offer a matrix upon which the second plug could be compacted against, thereby improving the seal. G4 had 2 mm of
MTA in permanent teeth with MTA placed, allowed to set for 24 hrs then backfilled w/ GP/Kerr. G5 was the positive control. Bacterial leakage model was used to
Shostad 2005 Obturation simulated immature apices evaluate the seal. Only G2 with the 5 mm of MTA showed no leakage after 70 d. All others leaked like hell.
Prepared simulated blocks using 2 techniques. One group was instr using only .04 tapered ProFile varying the tip size. The other group
Analysis of torque and force alternated between .04 and .06 tapers as well as tip size. The torque and the contact areas on the files were evaluated. The .04 taper
with differently tapered rotary alone registered higher torque values and this was extraolated to mean that they experience more fatigue as well. The contact areas of the
Peters 2005 Instruments endodontic intruments in vitro files were the same btwn both instrumentation methods. Varying tapers during instr seems to be safer.
Influence of dentin on the Evaluated the influence of dentin on the effects of triclosan, gluteraldehyde and NaOCl against three types of bact. Zones of inhibition on
Irrigation / effectiveness of antibacterial agar w/ and w/o bovine dentin cylinders were used. The presence of dentin decreased the effect of triclosan while it increased the
Schmalz 2005 Medication agents antimicrobial effects of gluteraldehyde and NaOCl.
A great review!! Preferable not to use a pellet in chamber. If you do, you should place a secondary seal over the pulp floor. Mentions that
air abrasion of the chamber is a good idea before bonding. RMGI are a good option for long-term temps (2-3 wks). Discusses the
necessity of using hydrofluoric acid for 1 min to etch porc prior to bonding. A silane coupling agent must also be used. Without these two
steps, bonding to porcelain is very weak. Bonding to metal of PFMs only requires that the metal be roughened w/ air abrasion or a bur.
Adhesive dentistry and Eugenol weakens bond strengths. Surface should be cleaned w/ EtOH and air abrasion. NaOCl, chloroform, RC Prep and elctro-
endodontics: Materials, chemically activated water also dec bond strengths. "Etch and Rinse" bonding systems, especially the 3-steps, perform much better than
clinical strategies and the "self-etching" systems. Also, "self-etching" systems should not be used w/ self or dual-cure composite systems. The acid remaining in
procedures for restoration of the etching primer react with the high pH required for these to self-cure. For access closures, recommends bulk filling w/ RMGI then
Schwartz 2005 Restorative access cavities: A review. veneering remaining 3 mm w/ composite.
36 md human molars were treated prior to EXT. Both groups were instr to a #30 MAF w/ a larger taper (prob .08 or .10, unclear in article).
Irrig w/ 6% NaOCl. Experimental group was then irrig for 1 min in each canal using a 25 gauge needle that was attached to an ultrasonic
In vivo debridement efficacy needle holder. 6% NaOCl was fed thru the needle via a luer-lock tube. A MiniEndo was used at max power. Needle was placed 4-5 mm
of ultrasonic irrigation from the apex w/o binding. High suction was used as well. Teeth were then extracted and split. The experimental group did much, much
following hand-rotary better...canals were 99-100% free of debris and isthmuses were 85-95%ish free of debris. The non-ultrasonic group were 75-100% free of
Irrigation / intrumentation in human debris in the canal and only 15-35%ish free of debris in the isthmuses. Discussion: ultrasonic streaming should be a no-brainer. Using this
Reader 2005 Medication mandibular molars needle technique can produce excellent results in 1 min/canal.
Effect of MTAD on
Irrigation / postoperative discomfort: A
Torabinejad 2005 Medication randomized clinical trial Compared MTAD with EDTA methods in smear layer removal. No difference in post op pain.
Retrospective record review of 94 patients. Included were teeth that were PARL neg before tx, irrev pulpitis, root canal tx'd. Group 1 had
The effect of distance no gap between the post and the GP, Group 2 had a gap less than 2 mm and Group 3 had a gap grtr than 2 mm. Recall rdx ranged from
between post and residual 1 to 5 yrs. Normal was considered no radiolucency. Disease was a widened PDL or a PARL. Clinical sx were not factored in. Success
gutta-percha on the clinical was 83% for no gap, 53% for a gap < 2mm, and 29% for a gap > 2mm. Discussion: Is it the space that is causing the dec healing?? Or is
outcome of endodontic it the saliva that gets in there b/c most posts are placed w/o a rubber dam. If a post is placed to the level of GP, the saliva is either
Goldberg 2005 Restorative treatment squeezed out or the cement has enough antibacterial properties to disinfect the space.
Rotations to cyclic fatigue failure were established for all files in this system using a steel canal phantom w/ a 90 degree curve. New instr
were then prestressed to 30, 60 and 90% of these predetermined cyclic fatigue scores. Static fx loads were then determined on these files
by binding the tip and measuring the angle of rotation that the fx occured at. The F1-F3 were sig more resistant to torque than the Shaping
files. Makes sense b/c of their increased mass. Rotations to fx dec as the size of the file inc...also makes sense b/c of the mass. Various
files reacted differently to the pre-stressing. Torsional resistance for the S1 and S2 were unchanged, torques to failure dec sig for the
finishing files...esp the F3. Found that the larger instr, esp the F3, were less resistant to cyclic fatigue and were the most affected by pre-
Effect of cyclic fatigue on stressing. Use the F3 only once...and use it with care. Discussion: They also reported the # of rotations to failure of new files (this was in
static fracture loads in the simulated steel canal w/ a 90 degree curvature and a 5mm radius). The rotations to failure dec from 450 --> 350 as you went from S1
ProTaper NiTi rotary to F2. The F3 was at 166 and the SX was at 158. No wonder those damn things snap all the time. Must be the increased mass of these
Peters 2005 Instruments instruments files.
Used rat aortas to test the effect that bonding agents have on the vasculature. Found that there was a concentration-dependent relaxation
Pulp Vasorelaxant effect of resin- of the vasculature. It has been advocated that dental adhesives can be used for pulp capping. This study shows that you can lose
Physiology based, single-bottle dentin hemostasis b/c of the relaxation of the vasculature. Etchant also seems to have this effect. Also mentions the cytotoxicity of these agents
Pashley 2005 and Pathology bonding systems when placed directly on the pulp.
In vitro study to evaluate fibroblast biocompatibility. Discs were made using Geristore, Ketac Fil and IRM. Growth of fibroblasts on the
surface of these discs were evaluated w/ SEM. On the Geristore, the fibroblasts grew and attached as well as on the control. Fibroblasts
Preferential attachment of attached poorly to IRM and Ketac. Next, eluents from the materials were taken that were assayed w/ fibroblasts. Only the Geristore
Retrofilling human gingival fibroblasts to showed biocompatibility after 24 and 72 hours. Geristore seems to have minimal cytotoxicity. Discussion: Do you use bonding agent with
Kirkwood 2005 Materials the resin ionomer Geristore this?? If so, what happens to the biocompatibility???
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Investigated the Karmali, Merchant,
response of human Davis
pulps to direct pulp capping using Scotchbond Multi-Purpose Plus. 16 Md PM had their pulps exposed
in a Cl V prep. 10 had SMPP placed. The methods describe diff in hemorrhage control and the re-application of the bonding agent on a
heme-contaminated field. The control group of 6 had Dycal placed, followed by SMPP. Both groups had a comp placed. 40 days later,
the teeth were ext. None of the pts reported any sx and rdx was WNL. Teeth were sectioned and studied histologically. In the Dycal
group, 6/6 showed no to slight inflamm and 3/6 had incomplete dentin bridge formaion. The SMPP group showed 1/10 w/ no to slight
Pulp tissue reactions to a inflamm, 8/10 w/ mod inflamm and 1/10 w/ severe inflamm. None had dentin bridge formation. Discussion: Seems that bonding agents
dentin bonding agent as a don't work well as direct pulp caps. The composites placed on the SMPP teeth probably leaked like hell b/c they couldn't control the
Demirci 2005 Restorative direct pulp capping agent hemorrhage well during placement. This could be a factor.
Effects of endodontic Used spectrometry to eval change in mineral content of root canal dentin after irrig w/ 0.2 % CHX, 3% H2O2, 17% EDTA, 5.25% NaOCl,
irrigation solutions on mineral 2.5% NaOCl or water. Found that all irrigants changes the Ca and P content significantly, except the 5.25% NaOCl, which compared well
Irrigation / content of root canal dentin with water. Irrigants alter the chemical content of dentin and this may affect bonding. Discussion: Although the reduction in Ca and P was
Erdemir 2005 Medication using ICP-AES technique sig, numerically, they are very close. How could 5.25% not have a sig impact while 2.5% does??
30 canines were instr to a 60/.04, smear layer was removed and teeth were sterilized. Inoculated w/ a luminescent bacteria. Irrigated w/
saline to assess the role of mechanical removal of bacteria in real-time. Group 1 had the needle placed 1 mm short of WL. Group 2 had
Influence of irrigant needle the needle 5 mm short of WL. Irrigated w/ 3 ml and 6 ml of saline. In group 1, 3 ml of saline left 25% of the bacteria and 6 ml left 9%. In
depth in removing group 2, 3 ml left 33% and 6 ml left 26%. Depth of needle penetration was a sig factor in reduction of bacterial counts. 6 ml of solution
bioluminescent bacteria was sig less effective when the needle penetrated 5 mm than at 1 mm. Discussion: Answers some important questions. Does not
inoculated into instrumented address the role of a biofilm, which would make mechanical debridement w/ irrigants less effective. Although this study did not use an
Irrigation / root canals using real-time antimicrobial irrigant b/c they wanted to focus purely on the mechanical debridement, NaOCl would probably be even more effective. I
Sedgley 2005 Medication imaging in vitro wonder how U/S streaming would fare??
Frequency and type of canal Endoscope was used to evaluate the presence and anatomy of isthmuses after standard root resection in vivo. Looked at 124 roots in
isthmuses in first molars molars. Isthmuses were present in 76% of MB roots of Mx molars and the isthmus was often a hair-like thin tissue connection. Isthmuses
detected by endoscopic were found in 83% of M roots in Md molars. Most often existed as canals extending into the isthmus or as a broad tissue connection btwn
Surgical inspection during the canals. In D roots of Md molars, an isthmus was present 36% of the time and most often presented as a broad tissue connection.
von Arx 2005 Endodontics periradicular surgery Isthmuses were not found in DB or P roots of Mx molars. None of the isthmuses were obturated during orthograde tx.
Prevalence of persistent pain
after endodontic treatment
and factors affecting its 175 pts/teeth were reviewed 1-5 yrs post-op. Investigated the assoc between risk factors and persistent pain after succesful endo tx.
occurrence in cases with Success was determined by the absence of clinical and rdx signs of dz. Persistent pain was present in 12% of the cases. Duration of pre-
complete radiographic op pain (3 mo or grtr) had an Odds Ratio of 8.6. Pre-op pain and percussion tenderness had ORs of 7.8 each. Females had an OR of 4.5
Gulabivala 2005 Flare-ups healing as did previous chronic pain problems.
37 teeth that were scheduled for EXT were used. Measurements taken, tooth extracted and lengths confirmed visually. Root ZX and Apex
Finder were used. WL measurements were taken at 5 intervals. 1: immed after access w/ #6 file. 2. after coronal and middle 1/3 shaping
w/ #6 file. 3. RC prep during instr w/ #6. 4. after instr w/ NaOCl in canal w/ #15. 5. after instr in dry canal w/ #15 file. Root ZX had the
most stable readings at stages 1 and 4. Most unstable at 2 and 3. If a stable reading was made, the accuracy was pretty comparable and
clinically insignificant. Discussion: Root ZX seemed to perform better in conditions of high conductivity. RC Prep has almost no
A comparison between two conductivity. Taking WL right after access might give you more stable readings but shaping the coronal 1/3 after WL determination
electronic apex locators: an changes the WL anyway. Verifying initial WL after instrumentation in a canal filled w/ NaOCl also gave very stable readings...good time to
Breschi 2005 Instruments in vivo investigation double check. Would using a #6 file to check WL have an affect on accuracy and stability of the readings??
2 case reports. Large perf repairs using resorbable collagen as a matrix. This matrix is used to push the granulation tissue outside of of
Perforation repair with MTA: the perf and to hold it there. Forms an external matrix upon which MTA can be placed. Credits Lemon 1992 with the external matrix
Bargholz 2005 Perforations a modified matrix concept concept. Lemon used HA as the matrix and amal as the repair material.
60 human md molars. Group 1 consisted of intact controls. Group 2: RCT and unrestored MOD prep. Group 3: RCT and MOD
The effect of fibre insertion composite. Group 4: RCT and MOD composite using a liner of flowable. Group 5: RCT and fiber reinforced MOD composite using
on fracture resistance of root Ribbond. Tested w/ an Instron. Force in Newtons. G1: 1676 G2: 376 G3: 733 G4: 786 G5: 943. Using Ribbond embedded in the
filled molar teeth with MOD composite sig improved fx resistance. Using a flowable liner under the composite did not have a dramatic impact. Discussion: The
prepartations restored with thought of using a flowable liner under a large composite is that the low viscosity material flows into the shrinkage gaps and acts as a
Erdemir 2005 Restorative composite cushion against debonding.
97 cases of consecutive instr fx that were referred to an endo practice. Success was determined as the complete removal of the instr w/o a
perf. Success rate was 87%. The longer it took to remove the instr, the lower the success. Recommended that 45-60 minutes should be
the max time alloted, after that, other options should be considered. Almost half of the fx instr were in M canals of Md molars. Straight line
Probability of removing access to the coronal portion of the file was created and was essential. U/S vibrations and tube and glue systems were used extensively.
fractured instruments from No difference in success rate based on location of seperation (coronal, middle or apical thirds). Discussion: Use common sense, in certain
Lussi 2005 Retreatment root canals situations, it is better to leave the file.
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Karmali,
Studied MTA (white), Merchant,
Fuji IX and Davis
IRM as retrofills. Measured leakage using fluid filtration and measure the presence of pores in the
material using a new method (Capillary Flow Porometry). CFP uses a wetting agent that flows into all of the pores, pressure is then applied
Longitudinal study on on one end of the material and the pore size is determined by how much pressure it takes to remove the wetting agent. 33 single rooted
microleakage of three root- teeth in cadavers were RCT'd and apico/root resection/retropreps were done. Teeth were EXT. Retrofills of the 3 materials were placed.
end filling materials by the Fluid flow was measured over 24 hrs after the setting of the materials, at 1 mo and at 6 mo. Fuji IX performed as well or slightly better than
Retrofilling fluid transport method and by MTA. Concluded that this is a good material for retrofills. Discussion: You have to take into account biocompatibility and antimicrobial
De Bruyne 2005 Materials capillary flow porometry properties as well as leakage.
Effect of ProRoot MTA mixed Fresh and set MTA mixed either w/ sterile saline or 0.12% CHX were placed in wells containing mouse fibroblasts and macrophages. Cell
with chlorhexidine on apoptosis was used as a measure of cytotoxicity. There was sig apoptosis with the MTA/CHX fresh mix when compared to the controls
apoptosis and cell cycle of and MTA/saline. Discussion: Looking at the results, it seems that the set MTA/CHX did as well as the control and the MTA/saline group.
Retrofilling fibroblasts and macrophages No mention of that result in the discussion. Is the increased short term cytotoxicity of the MTA/CHX mix worth the potential increased
Nor 2005 Materials in vitro antimicrobial action??
Nine contralateral pairs of PM that were slated for ortho EXT were used. Teeth were isolated and pulp exposures were made. One group
Dental pulp capping: effect of had Emdogain placed and the other had CaOH. Teeth were sealed and followed for 12 wks. Sx were recorded during that time. EXT and
Emdogain Gel on studied histologically. The CaOH group had slightly more post-op sens than the Emdogain group. The emdogain group showed hard
experimentally exposed tissue formation but never bridge formation. The CaOH group showed bridge formation in all samples. There was also much less pulpal
Olsson 2005 Restorative human pulps inflamm in the CaOH group.
40 bacterial samples were taken from single rooted teeth w/ lesions undergoing re-tx. PCR was used to isoated DNA from Enterococcus.
No solvents or antimicrobial irrigants were used to remove the root filling. 6 pts had diabetes. Enterococcus was found in only 22% of the
cases. It did not matter if these teeth had acceptable coronal restorations or obturations. Diabetics had a 33% occurrence of
Molecular detection of Enterococcus, not stat sig due to small sample size. Discussion: Fouad had a study in 2003 that looked at treatment outcomes of pts w/
Enterococcus species in root diabetes, found a dec healing rate at 2 yrs. He added diabetics as a variable in this current study to determine if Enterococcus plays a role.
canals of therapy-resistant Different point: There is a wide range of numbers re: the prevelance of E. faecalis in non-healing cases...22-77%. Could be due to
Fouad 2004 Microbiology endodontic infections regional differences, culturing methods, etc.
Prevention of alveolar osteitis Reviewed 7 randomized clinical trials. Compared the dec in rate of dry socket after 3rd molar EXT when a single pre-op rinse of CHX was
Surgical w/ chlorhexidine: A meta- used when compared to a single pre-op rinse followed by several days of post-op rinsing. Found that mult rinses sig reduced to incidence
Caso 2004 Endodontics analytic review but a single rinse did not. Many confounding variables in this study.
Calculus-like deposit on the
apical external root surface of Presents 2 cases of refractory CSPP. Even after mult uses of CaOH, the sinus tract would not resolve. Apical surg or EXT was done and
teeth with post-treatment root surfaces were examined. Both showed evidence of an apical plaque that resembled calculus. Theorized that a bacterial plaque can
Periapical apical periodotitis: report of form on the root surface which becomes mineralized by oral fluids through the sinus tract or from the inflamm exudate around the PA
Ricucci 2005 Pathology two cases lesion.
Effect of liquid and paste-type

lubricants on torque values Created standardized human dentin discs. Tested liquid EDTA, Glyde, water and no lubrication using ProFile 30/.06 and ProTaper F2.
Irrigation / during simulated rotary root Measured torque and force. Liquid lubricants generally performed better than pastes, especially w/ the U-shaped flute designs. Theory is
Peters 2005 Medication canal instrumentation that the pastes cause more dentin debris to get lodged in the flutes while liquids wash them away.
40 human ext mx premolars were decoronated and RCT was completed. 3 groups had different fiber and metal posts used. The 4th group
Ex vivo fracture resistance of did not have a post placed and acted as the control. Panavia was used to cement the posts. The entire crown was then built using
direct resin composite composite. Thermocycled. Instron was placed on occ at 30 degree angle to the buccal cusp. Force to fx was measured. None of the
complete crowns w/ and w/o results, including the control, were stat sig. The control group did show a trend towards higher force to fx. 90% of the fx were non-
Fokkinga 2005 Restorative posts on maxillary premolars restorable. Maybe posts are not needed when using composite b/u materials.
Treated 16 necrotic md molars w/ PARLs. MB canals were shaped to a 25/.05. ML canals were instr to a #40 Light Speed. Irrig w/ 5.25%
Microbial status of apical root NaOCl w/ a final flush of EDTA. Obturated w/ GP and Roth's sealer in one-visit. Root was then resected and studied w/ TEM. 14/16 or
canal system of human 88% of the samples had microbes in the apical canal system. Often, the microbes were hiding in little nooks and crannies that were
mandibular first molars with uninstrumented. Concludes that these cases should be done in multiple visits using in intra-canal medicament. Discussion: Apices of
primary apical periodontitis teeth treated in multiple visits were not studied. How can you make the claim that multi-visits will eliminate more bacteria when the study
after "one-visit" endodontic didn't compare them??? Also, NaOCl was not used after the EDTA to eliminate the organic component of the smear layer...probably would
Nair 2005 One-visit treatment not have made a difference in this study but it is noteworthy.
98 strains of bacteria were isolated from 12 abscesses. Anbitbiotic susceptibility tests were performed. 85% were susceptible to Pen VK,
91% to Amox, 100% to amox/clavulanic acid, 96% to Clinda, and 45% to Metro. If Metro is used in combo w/ Pen VK or Amox,
Antibiotic susceptibility of effectiveness inc to 93% and 99% respectively. Ab are indicated when infection is systemic, pts w/ progressive infections or in
bacterai associated with immunocompromised pts. Pen VK is still the Ab of choice. If a pt has recently taken Pen or other beta-lactam ring Ab, then
Baumgartner 2003 Microbiology endodontic absecesses Amox/Clavulanic acid is recommended. Clindamycin is an excellent alternative to Pen allergic pts.
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Effectiveness of various
medications on post-
operative pain following Retrospective record review comparing 1000 pts with flare-up w/ 1000 pts w/o flare-up. Pre-op pain, tooth type, sex, age, hx of allergy and
Torabinejad 1988 Flare-ups complete instrumentation re-tx were sig predictive of flare-ups. Intra-canal meds, systemic disease and patency had no effect of flare-up rate.
Prophylactic penicillin: effect
on post-treatment symptoms
following root canal treatment
of asymptomatic periapical Randomized prosepctive double-blind clinical trial. 80 pts w/ Nec/CAP were divided into 3 groups. The first 2 groups were administered
Walton 1993 Flare-ups pathosis either penicillin or placebo in a double blind fashion. Pain diaries were kept fot 48 hrs. No difference in pain was found.
Comparison of quality of life 66 pts req SRCT were divided into 2 groups. The first group consisted of the first 33 pts and traditional techniques were used (no mag, 45
after surgical endodontic degree bevel, retroprep w/ bur and IRM retrofill. Group 2 consisted of the next 33 consecutive pts and microscopic technique was used (0
treatment using two degree bevel, US retroprep and IRM retrofill). Pt's pain and sx were measured out to 7 days using a pain dairy. The microscopic group
Surgical techniques: A prospective experienced sig less pain and took sig less analgesics. Pain was the highest during the first 3 days. Interestingly, the avg time to tx group
Tsesis 2005 Endodontics study 1 was 20 min, group2 was 40 min.
Effect of rotary or manual
instrumentation, with or
without a CaOH/1% CHX Created CAP in dogs (82 canals). 4 groups. Group 1 and 2 were prepared w/ hand files. Group 3 and 4 were prepared w/ rotary. #70
intracanal dressing, on the MAF w/ 2.5% NaOCl. Group 2 and 4 had CaOH/CHX dressing placed for 15 days. Group 1 and 3 were obt immed. All had GP w/ AH
healing of experimentally Plus. No sig diff in reduction of lesions in any group out to 75 days. At 120 days, the intracanal dressing group had a sig decrease in the
Irrigation / induced chronic periapical size of the lesion. Discussion: This study does not provide any data to back-up findings. Also fails to mention the confidence interval so
Silva 2005 Medication lesions no idea what stat sig means here.
Effect of low-concentration Human single rooted teeth were instrurmented and divided into 6 groups. In these groups, various flushes were performed using different
Irrigation /EDTA solution on root canal conc of EDTA for 1 or 3 min. Removal of debris and smear layer were evaluated w/ SEM. 8% EDTA for 3 min did as well as 17% EDTA
Perez 2005 Medication walls: A SEM study for 1 min. Discussion: They point out that with 8% EDTA you are doing less damage to the dentinal tubules. Is that clinically relevant???
Absence of in vivo effects of
dental instruments on Tested an Airscaler, ultrasonic, electrosurg, EAL, electric pulp tester, curing light and a Diagnodent on pts with pacemakers. Measured
Glick 2005 Instruments pacemaker function pacemaker function w/ an ECG and real time intracardiac telemetry. None of the instruments had an effect on pacemaker function.
Based upon a large population study. 31,000 pts were interviewed about the presence of facial pain. Women were more than twice as
Gender gap in facial pain likely to report facial pain than men. Females w/ menopausal or menstrual problems were more than twice as likely as other women to
Hargreaves 2005 Flare-ups among US adults report facial pain. May imply hormonal imbalances that might require further study.
Investigation of pH at 120 extracted teeth were cleaned and shaped. CaOH was placed using either paper points or a lentulo spiral. Stored for either 7 or 28
different dentinal sites after days. Teeth were split and pH was measured at the root canal surface and 1 mm into the dentin. Placing CaOH w/ a lentulo resulted in sig
placement of calcium higher pH values at the root canal surface and 1 mm into the dentin. The surface pH was about 11 and the pH 1 mm deep was about 8.
Irrigation / hydroxide dressing by two Discussion: There is a theory out there that bacteria can move deeper into the canals to avoid the high pH. Can act as a resevoir of
Trope 2005 Medication methods bacteria after obturation.
Enterococcus faecalis- a
mechanism for its role in E. faecalis can invade the dentinal tubules and adhere to collagen in the presence of human serum. The remain viable and can act as a
Love 2001 Microbiology endodontic failure pathogen in failed RCT.
69

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Long Beach VA Hospital

Long Beach VA, Endodontic Section

Rahim Karmali DDS, Steven Merchant DDS, Stephen Davis DDS

Wound healing in the tissues

Eriksen, Healing of apical periodontitis

The root canal morphology of

Endo retreatment: evaluation

Spangberg 2002 Sealers Sealers/Cements (Pathways)

Endo interappt flare-ups: A

A bacterial study of human

Pulpal and pericapical tissues

Pulp SEM of the blood vessels of

Search for evidence of three

Prognosis of luxated non-vital

Hargreaves, Endodontic Pharmacology,

Serum immunoglobulin levels

Surgical extrusion of root

Surgical extrusion of intruded

Survival Rate & Fracture

Effect of liquid and paste-type

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