RESUMEN

UNLABELLED: Peri-radicular surgery is a valuable treatment modality allowing thorough treatment of chronic infection of the peri-radicular tissues. It is important that this treatment option is prescribed appropriately and steps are taken to help improve outcomes of surgery. We discuss the indications for peri-radicular surgery, considerations when planning treatment for teeth where orthograde endodontics has failed and present the findings of an audit into the appropriateness of referrals for peri-radicular surgery to the Department of Oral and Maxillofacial Surgery at a District General Hospital. CLINICAL RELEVANCE: This article highlights the indications and contra-indications for peri-radicular surgery to general dental practitioners.

Asunto(s)

Auditoría Odontológica , Derivación y Consulta , Obturación Retrógrada/estadística & datos numéricos , Fracaso de la Restauración Dental , Falla de Equipo , Extravasación de Materiales Terapéuticos y Diagnósticos/cirugía , Femenino , Odontología General , Humanos , Masculino , Calidad de la Atención de Salud , Quiste Radicular/cirugía , Retratamiento , Fracturas de los Dientes/cirugía , Diente no Vital , Reino Unido , Procedimientos Innecesarios

RESUMEN

INTRODUCTION: The long-term outcome of apical surgery performed on root-filled teeth presenting with post-treatment apical periodontitis has been the subject of debate; therefore, current evidence is required to support the prognosis of this important procedure. The objectives of this study were (1) to assess the long-term outcome of apical surgery and (2) to identify significant outcome predictors in Phases 3-5 of the Toronto Study, pooled with the previously reported Phases 1 and 2. METHODS: The 4- to 10-year outcome of apical surgery was prospectively assessed by a blinded, independent, calibrated examiner and dichotomized as "healed" (periapical index score 45 years, 84%, 10 mm, 53%). CONCLUSIONS: In this 4- to 10-year cohort study, the outcome was better in subjects >45 years old, teeth with inadequate root-filling length, and crypt size of

Asunto(s)

Periodontitis Periapical/etiología , Periodontitis Periapical/cirugía , Ápice del Diente/cirugía , Diente no Vital/complicaciones , Adulto , Factores de Edad , Apicectomía/estadística & datos numéricos , Estudios de Cohortes , Fracaso de la Restauración Dental , Femenino , Estudios de Seguimiento , Humanos , Modelos Logísticos , Masculino , Persona de Mediana Edad , Análisis Multivariante , Ontario , Pronóstico , Obturación Retrógrada/estadística & datos numéricos , Diente no Vital/cirugía , Resultado del Tratamiento

RESUMEN

The purpose of this survey was to investigate the frequency and characteristics of surgery among active endodontists in the United States. The survey also inquired about residency and postresidency training in endodontic surgery. A Web-based questionnaire regarding endodontic surgery was distributed via e-mail to 2,532 active members of the American Association of Endodontists in the United States. Data from 1,045 surveys, a 41% response rate, indicate that 91.2% of respondents are performing some form of root-end surgery with 89.6% using the operating microscope and ultrasonic instrumentation. Of those surveyed, 33.3% felt as though their endodontic residency training in surgery was inadequate, and 47.9% went on to acquire additional training in surgery postresidency. The anterior maxilla is the most common site of endodontic surgery as indicated by the respondents. Our results show that the most difficult process for surgery is access and visualization followed by root-end filling. Additionally, 53.9% of respondents answered that they are not referring any of their surgical cases, whereas 34.3% of responding endodontists are referring at least some endodontic surgery to oral surgeons; 6.6% of respondents also indicated that they are placing implants.

Asunto(s)

Apicectomía/estadística & datos numéricos , Endodoncia/educación , Obturación Retrógrada/estadística & datos numéricos , Endodoncia/tendencias , Humanos , Microcirugia/educación , Microcirugia/estadística & datos numéricos , Pautas de la Práctica en Odontología , Derivación y Consulta/estadística & datos numéricos , Cirugía Bucal/educación , Cirugía Bucal/tendencias , Encuestas y Cuestionarios , Terapia por Ultrasonido/estadística & datos numéricos , Estados Unidos

RESUMEN

AIM: It is the aim of this paper to consider the factors associated with the need for re-intervention on a crown, and the times to re-intervention. METHODS: A data set was established consisting of patients, 18 years or older, whose birthdays were included within a set of a randomly selected dates, one of which was chosen in each possible year of birth and whose restoration records contained the placement of one or more indirect restorations on courses of treatment with last date on the claim form after 31st December 1990, and with date of acceptance after September 1990 and before January 2002. For each tooth treated with a crown, the subsequent history of intervention on that tooth was consulted, and the next date of intervention, if any could be found in the extended data set, was obtained. Thus, a data set was created of crowns which have been placed, with their dates of placement and their dates, if any, of re-intervention. RESULTS: Data for over 80,000 different adult patients were analysed, of whom 46% were male and 54% female. A total of 47,474 crown restoration occasions were obtained from the data over a period of 11 years. Metal crowns were found to have the longest survival-68% at 10 years, and all-porcelain crowns the shortest-48% at 10 years. Factors which were found to influence outcome of crowns included type of crown, age of patient, patient payment exemption status, patient attendance pattern and placement of a root filling in the same course of treatment as a crown. CONCLUSIONS: Full-coverage all-metal crowns have longer survival times before re-intervention than metal-ceramic crowns and all-ceramic crowns. Root fillings are associated with reduced survival time of the crowns examined in this study.

Asunto(s)

Coronas/estadística & datos numéricos , Adolescente , Adulto , Factores de Edad , Anciano , Anciano de 80 o más Años , Coronas/normas , Aleaciones Dentales/normas , Atención Odontológica/economía , Atención Odontológica/estadística & datos numéricos , Materiales Dentales/normas , Porcelana Dental/normas , Inglaterra , Femenino , Financiación Personal/clasificación , Humanos , Estudios Longitudinales , Masculino , Persona de Mediana Edad , Resinas Sintéticas/normas , Retratamiento/estadística & datos numéricos , Obturación Retrógrada/estadística & datos numéricos , Factores Sexuales , Odontología Estatal , Análisis de Supervivencia , Factores de Tiempo , Diente/patología , Resultado del Tratamiento , Gales , Adulto Joven

RESUMEN

OBJECTIVE: The objective of this study was to identify the most commonly retreated tooth at a postgraduate endodontics program and to compare this result with teeth requiring primary root canal treatment as well as those that required further surgical endodontic treatment. STUDY DESIGN: The study population consisted of 6,894 patients treated between 2000 and 2005 by endodontic postgraduate students at the University of Pennsylvania School of Dental Medicine. Data regarding tooth type and endodontic treatment rendered were obtained from the Penn Endo database. RESULTS: Initial root canal treatment was most commonly done on mandibular molars. Anterior teeth were 1.411 times more likely to undergo NSRT than molars. Maxillary molars were 1.048 times more likely to undergo conventional retreatment than mandibular molars. Maxillary anterior teeth were 3.032 times more likely than mandibular molars to undergo surgical treatment. CONCLUSIONS: Mandibular molars may most commonly receive initial root canal treatment but it is the anterior teeth that are more likely to undergo surgical and nonsurgical retreatment. Maxillary molars are more likely to receive surgical intervention than mandibular molars. These data call for further investigation into the reasons for such discrepancy.

Asunto(s)

Clínicas Odontológicas , Endodoncia/educación , Obturación del Conducto Radicular/estadística & datos numéricos , Bases de Datos Factuales , Educación de Posgrado en Odontología/estadística & datos numéricos , Humanos , Incisivo , Mandíbula , Maxilar , Diente Molar , Pennsylvania , Retratamiento/estadística & datos numéricos , Obturación Retrógrada/estadística & datos numéricos , Estudios Retrospectivos

RESUMEN

This study prospectively assessed the 4 to 8 yr outcome of apical surgery performed by graduate students in phases I and II of the Toronto Study. The study cohort included 155 teeth in 138 patients. Outcome was assessed by a blinded and calibrated examiner. Clinical and radiographic measures were used for a dichotomous outcome: healed (no signs and symptoms, Periapical Index score /= 3). The recall rate was 85% and the overall healed rate 74%. Healed rate was significantly higher for teeth with small (

Asunto(s)

Apicectomía/estadística & datos numéricos , Fracaso de la Restauración Dental , Obturación Retrógrada/estadística & datos numéricos , Femenino , Humanos , Modelos Logísticos , Masculino , Persona de Mediana Edad , Análisis Multivariante , Ontario/epidemiología , Evaluación de Resultado en la Atención de Salud , Periodontitis Periapical/epidemiología , Estudios Prospectivos , Reoperación

RESUMEN

AIM: To determine the five-year success rates, site or sites of failure, prognostic indicators and lower lip morbidity associated with molar apicectomy using amalgam root-end filling. DESIGN: Multicentre, prospective study. SETTING: The departments of oral and maxillo-facial surgery in two district general hospitals. METHOD: One thousand and seven molar apicectomy procedures, combined with amalgam root-end filling were expedited during the period 1974-1995. A five-year review of each operated tooth was carried out or attempted between 1979-2000. RESULTS: Of the 790 (78%) operated molars successfully reviewed at 5 years or later 451 (57%) exhibited 'complete healing' and 39 (5%) 'uncertain healing'. Three hundred (38%) were classified as 'unsatisfactory healing' (failures), and these included 12 which were assumed to be of periodontal origin. Whilst longitudinal root fracture, perforation and/or infection in the furcation, periodontal disease or a non-restorable crown accounted for treatment failure and often the need to remove teeth subsequently, the study probably pointed to the apical ends of the roots rather than the furcation as being the major sites at which 'unsatisfactory healing' occurred. Mandibular first molars attracted the highest 'complete healing' rate (60%) and mandibular second molars the lowest (46%). 'Good' root canal treatment (RCT) at the outset improved the prognosis of a root-end filling (REF) whilst the absence of RCT compromised it. Cystic change pointed to a better prognosis than apical granulomatous change as did a deep compared with a shallow 'bone cuff'. Disease at the furcation suggested a worse prognosis. Teeth which showed 'complete healing' at 1 year had a 75% probability of maintaining this outcome at 5 years. Sensory disturbance of variable duration occurred in the lower lip following 20-21% of mandibular molar procedures. In the majority of cases (79-80%) this had remitted within 3 months. A permanent deficit occurred in 8 patients (1%) where the apicectomy could definitely be incriminated as causative. Four were associated with first molar apicectomy and four with second molar apicectomy. CONCLUSIONS: Molar apicectomy with amalgam root-end filling attracts an overall 'complete healing' rate at 5 years of 57%, the results being best with mandibular first molars and worst with mandibular second molars. The prognosis is also better where there is 'good' initial orthograde root filling, an associated radicular cyst as compared with granulomatous change and where the buccal sulcus is deep rather than shallow. It is worse when orthograde root filling is absent and when there is disease in the furcation. 'Complete healing' at 1 year can be expected to be maintained at 5 years in 75% of cases. The commonest site of subsequent periradicular rarefaction seems to be 'apical' whilst failure at the furcation is probably comparatively rare. There is a threefold increase in the occurrence of permanent lower lip sensory impairment following second molar surgery in comparison with first molar surgery, the overall incidence being 1%.

Asunto(s)

Apicectomía/estadística & datos numéricos , Diente Molar/cirugía , Obturación Retrógrada/estadística & datos numéricos , Adulto , Apicectomía/efectos adversos , Amalgama Dental , Fracaso de la Restauración Dental , Femenino , Humanos , Labio/lesiones , Londres , Masculino , Persona de Mediana Edad , Pronóstico , Estudios Prospectivos , Obturación Retrógrada/métodos , Materiales de Obturación del Conducto Radicular , Trastornos Somatosensoriales/etiología , Resultado del Tratamiento

RESUMEN

Endodontic failures associated with poor quality of endodontics respond favorably to retreatment. Nevertheless, under certain clinical conditions, apicoectomy should be the preferred procedure. A retrospective survey of 200 roots that were referred for apical surgery revealed that 83% of the roots were inadequately obturated, including 8.5% with no root canal filling at all. In 49 of the roots in this group (24.5% of the referred cases) nonsurgical retreatment was judged by an endodontist as either impossible or improbable because it might jeopardize the root integrity. Retreatment should have been the preferred treatment modality for the rest of the group, provided that coronal restorations could be safely bypassed or removed. Posts were found in 63 of these teeth, however 35 of them were either short or loosely fitting and could safely be removed. The rest of the posts were longer than 5 mm, which might have presented a problem if their removal was attempted. In 45% of the 200 cases in the present study, surgical intervention was justified. The rest of the cases (55%) should have either been subjected to a follow-up (10.5%) or retreated nonsurgically by a skilled endodontist (44.5%). These results indicate that referring dentists may not appreciate the retreatment possibilities offered by modern endodontics, and they emphasize the need for a shift of concept: endodontists should be involved in the decision making before referring a patient to surgery.

Asunto(s)

Fracaso de la Restauración Dental , Selección de Paciente , Periodontitis Periapical/cirugía , Obturación Retrógrada/estadística & datos numéricos , Apicectomía/estadística & datos numéricos , Toma de Decisiones , Humanos , Técnica de Perno Muñón , Pautas de la Práctica en Odontología , Derivación y Consulta , Retratamiento , Estudios Retrospectivos , Procedimientos Innecesarios

RESUMEN

A retrospective study was carried out on anterior teeth which had undergone apicectomy between 1995 and 1997. More maxillary teeth were treated (94.7%) than mandibular teeth (5.3%). Radicular cyst was the most frequently diagnosed reason for the treatment (47.3%), followed by chronic apical infection/granuloma (44.0%). The overall success rate was 71.9%, while treatment outcome was doubtful in 14.0% of the apicectomised teeth. The presence of pre- or postoperative signs and symptoms did not have any statistically significant effect on the treatment outcome. A higher percentage of roots with retrograde amalgam fillings healed successfully than roots with orthograde fillings, but the difference was not statistically significant (P > 0.05). More lesions classified histopathologically as radicular cysts healed successfully than those classified as granulomas (Fisher exact test, 2-tailed P value = 1.0).

Asunto(s)

Apicectomía/estadística & datos numéricos , Adolescente , Adulto , Enfermedad Crónica , Diente Canino/cirugía , Femenino , Estudios de Seguimiento , Humanos , Incisivo/cirugía , Masculino , Mandíbula , Maxilar , Persona de Mediana Edad , Enfermedades Periapicales/cirugía , Granuloma Periapical/cirugía , Quiste Radicular/cirugía , Obturación Retrógrada/estadística & datos numéricos , Estudios Retrospectivos , Tratamiento del Conducto Radicular/estadística & datos numéricos , Estadística como Asunto , Resultado del Tratamiento

RESUMEN

A previous report demonstrated 96.8% healing within 1 yr after apical surgery was performed with the surgical operating microscope and Super-EBA as the root-end filling material. The purpose of this paper is to report on the long-term follow-up of those cases that were considered healed at the short term. Clinical examinations were made and radiographs were evaluated 5 to 7 yr after the case had first been considered healed. Criteria for determining healed cases were the same as those used in the first report. Of the 59 roots evaluated, 54 (91.5%) remained healed, whereas 5 (8.5%) showed evidence of apical deterioration.

Asunto(s)

Fracaso de la Restauración Dental , Obturación Retrógrada/estadística & datos numéricos , Enfermedades de la Pulpa Dental/clasificación , Enfermedades de la Pulpa Dental/diagnóstico por imagen , Enfermedades de la Pulpa Dental/cirugía , Recubrimientos Dentinarios , Estudios de Seguimiento , Humanos , Microcirugia , Radiografía , Recurrencia , Obturación Retrógrada/métodos , Materiales de Obturación del Conducto Radicular

RESUMEN

The prime aim of this series of six articles has been to improve the quality of endodontic treatment in general dental practice by considering what is currently being taught in dental schools. This final article considers what may go wrong following completion of root canal treatment, whether orthograde retreatment is possible and how it may be achieved, and if or when periradicular surgery may be indicated.

Asunto(s)

Fracaso de la Restauración Dental , Tratamiento del Conducto Radicular , Remoción de Dispositivos , Humanos , Técnica de Perno Muñón , Retratamiento , Obturación Retrógrada/estadística & datos numéricos

RESUMEN

The recent introduction of the surgical microscope to the practice of endodontics, especially for surgery, has allowed clearer visualization of the periapex during root-end resection and filling. However, despite this and other technologic advances, it has not been demonstrated that in the absence of thorough canal debridement the success rate of periapical surgery has improved over the 50% to 60% demonstrated in most long-term prognosis studies. Therefore it remains important to fully instrument and obturate the root canal system with conventional therapy before surgery is considered; this considerably improves the long-term prognosis. Each of the case reports in this article involves a situation in which conventional treatment was performed when a surgical approach might have been considered as the treatment of choice. Surgery should not be considered to be the primary treatment when root canal treatment or retreatment may be readily achieved. Indeed, the operating microscope and other technical aids will probably allow more cases to be treated and retreated conventionally that might otherwise have required surgical intervention.

Asunto(s)

Apicectomía/estadística & datos numéricos , Periodontitis Periapical/terapia , Obturación Retrógrada/estadística & datos numéricos , Tratamiento del Conducto Radicular/estadística & datos numéricos , Adolescente , Anciano , Anciano de 80 o más Años , Necrosis de la Pulpa Dental/terapia , Femenino , Humanos , Incisivo , Masculino , Maxilar , Persona de Mediana Edad , Granuloma Periapical/terapia , Quiste Radicular/terapia

RESUMEN

Healing results were compared among 551 infected roots apically sealed with a dentin-bonded resin composite (Gluma-Retroplast). These roots contained either 1) root filling to apex after resection, 2) insufficient root filling, or 3) empty root canals with necrotic pulp remnants. At 2- to 4-yr follow-up, complete bone healing was found to be 92%, 85%, and 81% in groups 1, 2, and 3, respectively. The results from groups 1 and 3 were significantly different, and the results from group 2 did not differ significantly from that of groups 1 or 3. Reasons for "Failures" were found to be mainly loose filling or uncovered canal. After 21 roots classified as "Failures" were reoperated, 76% of these showed "Complete Healing" after 1 yr.

Asunto(s)

Bisfenol A Glicidil Metacrilato/uso terapéutico , Cavidad Pulpar/efectos de los fármacos , Recubrimientos Dentinarios/farmacología , Obturación Retrógrada , Materiales de Obturación del Conducto Radicular/uso terapéutico , Cicatrización de Heridas/efectos de los fármacos , Adulto , Anciano , Cavidad Pulpar/diagnóstico por imagen , Femenino , Humanos , Masculino , Persona de Mediana Edad , Radiografía , Obturación Retrógrada/estadística & datos numéricos , Ápice del Diente/diagnóstico por imagen , Ápice del Diente/efectos de los fármacos , Insuficiencia del Tratamiento

RESUMEN

The aim of this study was to compare the backfilling capabilities of System B, Obtura II and Alphaseal. Forty-six lower premolar teeth were prepared chemomechanically and allocated to four experimental and two control groups. Ten were obturated using lateral condensation as a standard and 30 were obturated in the apical third using the System B. The latter 30 teeth were then backfilled using one of three techniques, System B, Obtura II or Alphaseal (n = 10 in each group). The remaining six teeth served as controls. Roots were radiographed from the proximal in order to evaluate voids and then placed in India ink for 65 h prior to being demineralized and rendered transparent, coronal leakage was quantified by linear measurement of ink penetration. No significant difference was found between the four groups with respect to the presence of voids radiographically (P < 0.05). The difference in leakage between the System B and Obtura II groups was not significant (P > 0.05). Both System B and Obtura II leaked significantly less than Alphaseal and lateral condensation (P < 0.001).

Asunto(s)

Filtración Dental/prevención & control , Gutapercha , Obturación Retrógrada/métodos , Diente Premolar , Resinas Compuestas , Filtración Dental/diagnóstico por imagen , Técnica de Dilución de Colorante , Estudios de Evaluación como Asunto , Humanos , Técnicas In Vitro , Mandíbula , Radiografía , Distribución Aleatoria , Obturación Retrógrada/instrumentación , Obturación Retrógrada/estadística & datos numéricos , Estadísticas no Paramétricas , Corona del Diente , Raíz del Diente/diagnóstico por imagen

RESUMEN

Records of 302 root-filled teeth treated by dental undergraduates were reviewed by four lecturers in the Department of Conservative Dentistry, University of Malaya. Preoperative and operative factors were evaluated for their association with postoperative pain experience of patients during the visit immediately after completion of biomechanical preparation. Eighty four percent of patients did not experience any pain after biomechanical preparation whilst the remaining 16 percent only complained of slight or moderate pain. The incidence of pain after biomechanical preparation is not high even when performed by inexperienced undergraduates. Teeth with a pre-existing painful condition had a higher chances of postoperative of pain. The incidence of postoperative pain was halved when teeth were associated with a sinus tract.

Asunto(s)

Dolor Postoperatorio/etiología , Obturación Retrógrada/estadística & datos numéricos , Preparación del Conducto Radicular/efectos adversos , Odontalgia/etiología , Adolescente , Adulto , Anciano , Niño , Femenino , Humanos , Masculino , Persona de Mediana Edad , Dimensión del Dolor , Obturación Retrógrada/efectos adversos , Preparación del Conducto Radicular/estadística & datos numéricos , Estudiantes de Odontología

RESUMEN

Reported high failure rates of endodontic surgical procedures seemed to be inconsistent with the clinical impression of a high success rate. A retrospective study of endodontic surgical cases treated longer than 10 yr ago was done to look at long-term results. Forty-one teeth in 39 patients were able to be evaluated. These teeth had either an apicoectomy, an apicoectomy with a root-end amalgam, or in two cases, a root amputation. Of the 23 teeth that had an apicoectomy, 19 (82.6%) completely healed. Of the 16 teeth that had an apicoectomy followed by a root-end amalgam, 10 (62.5%) completely healed. Surgical endodontic procedures performed before the use of magnification, newer root-end filling materials, and ultrasonics, still had a high rate of success.

Asunto(s)

Apicectomía , Enfermedades Periapicales/cirugía , Obturación Retrógrada , Adulto , Apicectomía/estadística & datos numéricos , Distribución de Chi-Cuadrado , Femenino , Humanos , Masculino , Persona de Mediana Edad , Obturación Retrógrada/estadística & datos numéricos , Estudios Retrospectivos , Raíz del Diente/cirugía , Insuficiencia del Tratamiento , Resultado del Tratamiento

RESUMEN

This paper describes the application of a new material, Biocem, for retrograde root canal filling. A total of 234 roots in 222 teeth were treated during the period 1987-1992. Biocem consists of two components and once mixed, the autopolymerisation results in a three-dimensional structure. The biomechanical and histologic properties and a clinical longterm follow-up confirm the optimal qualities of this material. It fulfills the requirements in regard to biocompatibility, watertight sealing and application. The material proved superior in comparison to conventional materials and ceramics. The evaluation of the results are most encouraging.

Asunto(s)

Fosfatos de Calcio/uso terapéutico , Ácidos Polimetacrílicos/uso terapéutico , Obturación Retrógrada/métodos , Materiales de Obturación del Conducto Radicular/uso terapéutico , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Fosfatos de Calcio/efectos adversos , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Ácidos Polimetacrílicos/efectos adversos , Estudios Prospectivos , Radiografía , Obturación Retrógrada/estadística & datos numéricos , Materiales de Obturación del Conducto Radicular/efectos adversos , Temperatura , Factores de Tiempo , Raíz del Diente/diagnóstico por imagen