sodium-hypochlorite and Periapical-Diseases

Use of magnifying loupe may increase the efficiency of dental care. This clinical trial compared the time in performing non-surgical endodontic therapy with or without the use of a magnifying loupe.. Patients who required primary endodontic treatment in clinical trial centres at the University of Hong Kong (HKU) in Hong Kong and Peking University (PKU) in Beijing were invited to participate in this study. Two HKU dentists and 2 PKU dentists, forming 2 pairs of dentists with similar years of clinical experience, performed endodontic treatments according to the same procedures and used the same materials, either in single or multiple visits. They had no prior experience with the use of a magnifying loupe. One dentist from each pair was trained to use a magnifying loupe (x2.5). The treatment time was recorded.. Eighty-four PKU patients with a mean age of 42.8 years and 98 HKU patients with a mean age of 46.0 years were recruited in this study. Ninety-six teeth were treated with a magnifying loupe and 86 teeth were treated without a magnifying loupe. The results showed that treatment time was not associated with age, gender, tooth vitality, or the presence of apical radiolucency or sinus tract. The results of ANCOVA revealed the treatment time was associated with the clinic (HKU or PKU), root canal system (single or multiple), presence of preoperative pain, treatment visit (single or multiple), the use of a magnifying loupe, and the experience of the operator.. In this study, the use of a magnifying loupe could significantly reduce the endodontic treatment time.. Clinical Trials ChiCTR-IOR-15005988 registered 15 February 2015.

Topics: Adult; Calcium Hydroxide; Clinical Competence; Dental Alloys; Dental Fistula; Dental Pulp Cavity; Equipment Design; Female; Humans; Lenses; Male; Middle Aged; Nickel; Periapical Diseases; Root Canal Irrigants; Root Canal Obturation; Root Canal Preparation; Root Canal Therapy; Sodium Hypochlorite; Time Factors; Titanium; Toothache; Zinc Oxide-Eugenol Cement

To determine the probability of the incidence, intensity, duration and triggering of post-endodontic pain, considering factors related to the patient (age, gender, medical evaluation) and to the affected tooth (group, location, number of canals, pulp vitality, preoperative pain, periapical radiolucencies, previous emergency access, presence of occlusal contacts with antagonist).. A total of 500 one-visit root canal treatments (RCTs) were performed on patients referred to an endodontist. Shaping of root canals was performed manually with Gates-Glidden drills and K-Flexofiles, and apical patency was maintained with a size 10 file. A 5% NaOCl solution was used for irrigation, and canals were filled with lateral compaction and AH-Plus sealer. Independent factors were recorded during the treatment, and characteristics of post-endodontic pain (incidence, intensity, type and duration) were later surveyed through questionnaires. Of the 500 questionnaires, 374 were properly returned and split in two groups for two different statistical purposes: 316 cases were used to adjust the logistic regression models to predict each characteristic of post-endodontic pain using predictive factors, and the remaining 58 cases were used to test the validity of each model.. The predictive models showed that the incidence of post-endodontic pain was significantly lower when the treated tooth was not a molar (P = 0.003), demonstrated periapical radiolucencies (P = 0.003), had no history of previous pain (P = 0.006) or emergency endodontic treatment (P = 0.045) and had no occlusal contact (P < 0.0001). The probability of experiencing moderate or severe pain was higher with increasing age (P = 0.09) and in mandibular teeth (P = 0.045). The probability of pain lasting more than 2 days was increased with age (P = 0.1) and decreased in males (P = 0.007) and when a radiolucent lesion was present on radiographs (P = 0.1).. Predictive formulae for the incidence, the intensity and the duration of post-endodontic pain were generated and validated taking account of the interrelation of multiple concomitant clinical factors. A predictive model for triggering post-endodontic pain could not be established.

Topics: Adolescent; Adult; Age Factors; Child; Child, Preschool; Dental Pulp; Dental Pulp Cavity; Epoxy Resins; Female; Humans; Infant; Male; Mandible; Maxilla; Middle Aged; Pain Measurement; Pain, Postoperative; Periapical Diseases; Prospective Studies; Radiography; Retreatment; Risk Factors; Root Canal Filling Materials; Root Canal Irrigants; Root Canal Preparation; Root Canal Therapy; Sex Factors; Sodium Hypochlorite; Young Adult

The aim of this randomised clinical trial was to compare the clinical and radiographic success rate of 5% sodium hypochlorite (NaOCl) and 20% Formocresol (FC) as a pulpotomy medicament in carious primary molars.. Twenty-four children aged 4-8 years with at least 2 primary molars indicated for pulpotomy were included in this study. Eighty-two teeth received either 5% NaOCl or 20% FC using split mouth design, followed by restoration with IRM base/stainless steel crown (SSC). Clinical and radiographic evaluations were performed at 3, 6 and 12 months.. NaOCl and FC groups demonstrated 100% clinical success at 3 months. At 6 months, NaOCl showed 95% and 87.5% clinical and radiographic success rate respectively, while FC showed 95% clinical and radiographic success rate. After 12 months, the clinical and radiographic success rates were 94.6% and 86.5% respectively for NaOCl, and 92.1% and 86.8% for FC.. The results of this study showed the success rate for NaOCl pulpotomy to be comparable to those for FC pulpotomy.

Topics: Child; Child, Preschool; Crowns; Dental Alloys; Dental Caries; Dental Pulp; Female; Follow-Up Studies; Formocresols; Humans; Male; Methylmethacrylates; Molar; Periapical Diseases; Prospective Studies; Pulpotomy; Radiography; Root Canal Filling Materials; Root Canal Irrigants; Sodium Hypochlorite; Stainless Steel; Tooth Root; Tooth, Deciduous; Treatment Outcome; Zinc Oxide-Eugenol Cement

The aim of this study was to compare the outcome of a root canal treatment with and without additional ultrasonic activation of the irrigant.. Single-rooted teeth with radiographic evidence of periapical bone loss were randomly assigned to 2 treatment groups. In both groups syringe irrigation was performed, and in one group the irrigant was also activated by ultrasound. Ten to 19 months after treatment, the teeth were examined by using periapical radiography (PA) and cone-beam computed tomography (CBCT). Area and volume of the periapical lesions were measured, and the outcome was presented in 4 categories: absence, reduction or enlargement of the radiolucency, or uncertain. Lesions were classified as reduced or enlarged when the change in size of the radiolucency was 20% or more.. The recall rate was 82%, and 84 teeth were analyzed. CBCT detected significantly more post-treatment lesions than PA (P = .038), but the percentages of absence and reduction of the radiolucency together revealed by CBCT and PA were similar (P = .383). The CBCT results showed that absence of the radiolucency was observed in 16 of 84 teeth (19%) and reduction of the radiolucency in 61 of 84 teeth (72.6%), but there was no significant difference between the results of the 2 groups (P = .470). Absence and reduction of the radiolucency together were observed in the ultrasonic group in 39 of 41 teeth (95.1%) and in the syringe group in 38 of 43 teeth (88.4%).. Root canal treatments with and without additional ultrasonic activation of the irrigant contributed equally to periapical healing.

Topics: Adolescent; Adult; Aged; Cone-Beam Computed Tomography; Dental Pulp Cavity; Edetic Acid; Female; Follow-Up Studies; Humans; Male; Middle Aged; Needles; Periapical Diseases; Radiography, Bitewing; Radiography, Dental, Digital; Root Canal Filling Materials; Root Canal Irrigants; Root Canal Preparation; Root Canal Therapy; Sodium Hypochlorite; Syringes; Therapeutic Irrigation; Treatment Outcome; Ultrasonics; Wound Healing; Young Adult

The objective of this study was to compare postobturation flare-ups following single and two-visit endodontic treatment of molar teeth with periapical radiolucency.. A total of 100 patients with asymptomatic molar teeth with periapical radiolucency were selected. They were randomly allocated into two groups. Fifty patients received complete endodontic treatment in one-visit. Fifty patients received treatment by debridement and instrumentation at the first visit followed by obturation at the second visit.. 10% of patients had flare-ups in the single visit group and 8% of patients had flare-ups in the two-visit group. Number of visits did not affect the success of endodontic treatment (p>0.05). Age, gender and tooth type had no effects on the occurrence of flare-ups regardless the number of visits (p>0.05).. One-visit endodontic treatment was as successful as two-visit endodontic treatment as evaluated by rate of flareups in asymptomatic molar teeth with periapical radiolucency.

Topics: Adolescent; Adult; Age Factors; Calcium Hydroxide; Child; Cross-Sectional Studies; Female; Gutta-Percha; Humans; Male; Molar; Periapical Diseases; Radiography; Recurrence; Root Canal Filling Materials; Root Canal Irrigants; Root Canal Obturation; Root Canal Preparation; Root Canal Therapy; Sex Factors; Sodium Hypochlorite; Treatment Outcome; Young Adult; Zinc Oxide-Eugenol Cement

(i) To introduce a new method of quantifying extruded irrigant during root canal irrigation ex vivo. (ii) to evaluate the effect of periapical tissue simulation and pressure equalization and (iii) to determine the effect of needle type, apical preparation size and apical constriction diameter on irrigant extrusion.. Sixteen human single-rooted teeth were sequentially prepared to sizes 25-45, 0.06 taper and mounted on a plastic vial simulating a periapical lesion. The apical constriction diameter was standardized to 0.15-0.35 mm. The vial was filled with distilled water or air and was either open to the environment or closed. A point-conductivity probe was used to determine the volume of extruded irrigant into the vial. NaOCl was delivered by an open-ended or a closed-ended needle at 3 mm short of working length. Results were analysed by two 3-way repeated-measures ANOVAs.. The open-ended needle extruded significantly more irrigant than the closed-ended in the majority of cases (P < 0.002). An increase in the apical size was related to decreased irrigant extrusion (P < 0.024). The effect of constriction diameter was not significant. The water-closed and water-open methods were related to less extrusion than the air-closed and air-open methods, respectively (P < 0.005). Open systems (water-open, air-open) allowed extrusion of larger amounts of irrigant than corresponding closed systems (water-closed, air-closed) (P < 0.005).. The conductivity probe is a reliable method for real-time quantification of irrigant extrusion ex vivo. Not simulating tissue resistance in ex vivo experiments may lead to significant overestimation of irrigant extrusion.

Topics: Air; Conductometry; Dental Pulp Cavity; Extravasation of Diagnostic and Therapeutic Materials; Humans; Needles; Periapical Diseases; Pressure; Root Canal Irrigants; Root Canal Preparation; Sodium Hypochlorite; Therapeutic Irrigation; Tooth Apex; Water

This was to evaluate the clinical and radiographic outcomes of direct pulp capping (DPC) therapy in primary molar teeth following haemostasis with various antiseptics for 12 months.. A total of 70 vital primary molar teeth with deep dentin caries were randomly allocated to different antiseptic groups. After observing the pinpoint exposure, 0.9% saline solution (SS, control), 0.5% sodium hypochlorite (SH), 2% chlorhexidine digluconate (CHX), or 0.1% octenidine dihydrochloride (OCT) was applied with sterile cotton pellets for 3 min before calcium hydroxide (CH) DPC therapy. Statistical evaluation: The intergroup radiographic success criteria were analysed using a Kruskal-Wallis test in each follow-up period at a confidence interval of 95%.. After 12 months, all groups showed a clinical success rate of 100% (no clinical failures were observed at the time of pulpectomy or extraction), and the overall radiographic success rates were OCT (100%) > SH (94.74%) > CHX (93.3%) > SS (84.21%), respectively (p > 0.05). OCT did not exhibit any failures. The undesirable radiographic failure types (pulpectomy or extraction) were mostly observed in the SS group.. Compared with SS, the success of conventional CH usage in DPC therapy of primary molar teeth could be enhanced by providing acceptable disinfection features with antiseptic solutions. OCT seems to have relative beneficial effects compared to SH and CHX.

Topics: Anti-Infective Agents, Local; Calcium Hydroxide; Child; Chlorhexidine; Crowns; Dental Amalgam; Dental Caries; Dental Cavity Lining; Dental Pulp Capping; Dental Restoration, Permanent; Female; Follow-Up Studies; Hemostatic Techniques; Humans; Imines; Male; Methylmethacrylates; Molar; Periapical Diseases; Pulp Capping and Pulpectomy Agents; Pyridines; Radiography; Root Resorption; Single-Blind Method; Sodium Hypochlorite; Stainless Steel; Time Factors; Tooth, Deciduous; Treatment Outcome; Zinc Oxide-Eugenol Cement

This study evaluated the microbiological conditions of root canals, using smears and culture from anterior teeth and premolars with necrotic pulps associated with chronic periapical pathologies, before and after biomechanical preparation (BMP). During double-flared instrumentation, 1, 2.5 and 5% sodium hypochlorite (NaOCl)-based irrigants were used in 3 groups: GI (n=39), GII (n=36) and GIII (n=36), respectively. Before BMP, all cultures were positive and the smears showed microbiologically diverse morphotypes, including fusiforms, pleomorphic, rods, cocci and filaments. Quantitatively, 20, 20 and 23 morphotypes were identified in GI, GII and GIII, respectively). After BMP, the percentages of negative cultures in GI, GII and GIII were 74.2%, 86.3% and 93.4% (p>0.05) and the number of morphotypes decreased to 14, 15 and 5, respectively. All teeth with 2 root canals and/or associated fistulas were microbiologically negative after BMP, regardless of irrigant concentration. Gram-negative morphotypes were more susceptible to the action of irrigants. After irrigation with 5% NaOCl, only structural arrangements consisting of Gram-positive cocci and bacilli persisted. Thus, BMP plus 5% NaOCl offered the best antiseptic potential because in the few positive cultures a significant reduction in the number of microbiological morphotypes was also shown (p<0.05).

Topics: Adolescent; Adult; Anti-Infective Agents, Local; Bacteria; Biomechanical Phenomena; Chelating Agents; Dental Caries; Dental Pulp Cavity; Dental Pulp Necrosis; Edetic Acid; Gram-Negative Bacteria; Gram-Positive Bacteria; Gram-Positive Cocci; Humans; Middle Aged; Oral Fistula; Periapical Diseases; Root Canal Irrigants; Root Canal Preparation; Sodium Hypochlorite

In this study, the antibacterial activity of the different antibacterial solutions using as root canal irrigant was compared in the teeth with pulpal necrosis and with periapical pathosis. Thirty root canals of incisors and premolars of 20 patients were used. Before and after the root canal preparation, two canal samples were obtained by a harvesting method using a sterile paper point in the first appointment. During the biomechanical preparation, both irrigant solutions were used for each tooth which were randomly divided into two groups. Last samples were also obtained before the root filling procedure. Samples obtained from the root canals were subjected to microbiologic processing, including anaerobic incubation on trypticase soy agar for 5 to 7 days. After counting of CFU on the plates, we concluded that both chlorhexidine gluconate and sodium hypochlorite were significantly effective to reduce the microorganisms in the teeth with necrotic pulp, periapical pathologies, or both, and could be used successfully as an irrigant solution.

Topics: Adult; Anti-Infective Agents, Local; Bacteria, Anaerobic; Bicuspid; Chi-Square Distribution; Chlorhexidine; Colony Count, Microbial; Dental Pulp Cavity; Dental Pulp Necrosis; Humans; Incisor; Matched-Pair Analysis; Middle Aged; Periapical Diseases; Root Canal Filling Materials; Root Canal Irrigants; Root Canal Preparation; Sodium Hypochlorite; Statistics, Nonparametric

This 10-year study evaluated the clinical and radiologic outcomes of teeth with necrotic pulp, immature apices, and periapical lesions treated with the mineral trioxide aggregate (MTA) apical plug technique.. Seventeen single-rooted immature teeth with necrotic pulp and periapical lesion from 17 patients treated between January 2001 and December 2001 were included in this study. Apical obturation on all teeth included in the study was completed in 2 visits: first using calcium hydroxide as an interappointment intracanal medication and a second visit for the creation of the artificial apical barrier with MTA. The outcome, based on clinical and radiographic criteria, was assessed by 2 calibrated investigators using the periapical index (PAI). The Friedman test was used to verify the differences between baseline and the 1-, 5-, and 10-year PAI scores.. Of the 17 patients treated, 1 patient dropped out at 5 years. At the 10-year follow-up, 15 teeth were healed (PAI ≤2), and 1 tooth had been extracted because of the presence of a longitudinal root fracture. The PAI score exhibited a significant decrease between baseline and 1 year and between 1 and 5 years. The difference between 5 and 10 years was not significant.. The apical plug with MTA was a successful and effective technique for long-term management of this group of teeth with necrotic pulps with immature root development and periapical lesions.

Topics: Aluminum Compounds; Apexification; Calcium Compounds; Calcium Hydroxide; Dental Pulp Cavity; Dental Pulp Necrosis; Drug Combinations; Follow-Up Studies; Gutta-Percha; Humans; Oxides; Periapical Diseases; Radiography; Root Canal Filling Materials; Root Canal Irrigants; Root Canal Preparation; Silicates; Sodium Hypochlorite; Tooth Apex; Treatment Outcome; Zinc Oxide-Eugenol Cement

The periapical film radiograph (PFR) and digital periapical radiograph (DPR) techniques have some limitations in the visualization of small periapical lesions (PLs) when compared with cone-beam computed tomography (CBCT). However, the evidence supporting their effectiveness is very limited. This retrospective longitudinal cohort study evaluated the outcome of endodontic treatments measured/monitored by PFR, DPR, and CBCT during a 5-year follow-up and also determined the prognostic factors that influenced treatment success.. A total of 132 teeth (208 roots) with vital pulps received endodontic treatment. The periapical indexes with scores ≥2 for PFR and DPR and ≥1 for CBCT indicated the presence of PLs. Prognostic factors were determined by bivariate and multivariate analyses. Statistical significance was defined at a P level <.05.. CBCT detected a higher number of PLs (18.7%, n = 39 roots), followed by DPR (7.7%, n = 16 roots) and PFR (5.7%, n = 12 roots). Likewise, CBCT was more sensitive than PFR and DPR in detecting deficiencies in extension and density of the root canal filling (P ≤ .001). Of the 17 prognostic factors evaluated, 4 were significantly associated with poor outcome to the treatment (P < .05): root canal curvature, disinfection of gutta-percha, presence of missed canals, and the quality of definitive coronal restoration.. The success outcome of endodontic treatment after 5 years in teeth with vital pulps varied with each radiographic method: 94.3%/PFR, 92.3%/DPR, and 81.3%/CBCT.

Topics: Anatomic Variation; Calcium Sulfate; Cohort Studies; Cone-Beam Computed Tomography; Dental Pulp Cavity; Dental Restoration, Permanent; Dental Restoration, Temporary; Female; Follow-Up Studies; Humans; Longitudinal Studies; Male; Methylmethacrylates; Microscopy; Middle Aged; Periapical Diseases; Radiography, Bitewing; Radiography, Dental, Digital; Retrospective Studies; Root Canal Filling Materials; Root Canal Irrigants; Root Canal Obturation; Root Canal Preparation; Root Canal Therapy; Rubber Dams; Sodium Hypochlorite; Tooth Root; Treatment Outcome; Zinc Oxide-Eugenol Cement; Zinc Sulfate

For selective detection of viable bacteria with molecular methods, propidium monoazide (PMA) treatment has been successfully applied to a wide range of bacteria. The purpose of this study was to compare the quantity of live cells with the total amounts of both live and dead cells before and after chemomechanical preparation by using PMA in combination with real-time polymerase chain reaction (qPCR).. Twenty-one teeth with pulp necrosis and a periapical lesion were included. Bacterial sampling of the root canals was performed before (S1) and after (S2) chemomechanical root canal treatment. Each sample was separated into 2 different tubes. PMA was added to one of the tubes, and the other was left untreated. Then, DNA extraction and qPCR were performed. To evaluate the validity of the PMA treatment, the defined mixtures containing different ratios of live and dead cell suspensions of Enterococcus faecalis were either subjected to PMA treatment or not subjected to PMA treatment, followed by qPCR quantification.. A paired t test showed a highly significant difference in the mean threshold cycle values between S1 with and without PMA (P = .0002), and this difference (0.89) was similar to that (0.96) obtained from the samples consisting of 80% live cell suspension and 20% dead cell suspension of E. faecalis. The threshold cycle values between the S2 samples with and without PMA were also significantly different (P = .0134), and this difference (0.37) was similar to that obtained from the 100% live cell suspension of E. faecalis (0.42).. PMA in conjunction with qPCR appeared to be useful in analyzing the primary infections of root canals because there were significant amounts of dead bacteria in the root canals. Although the use of PMA treatment in post-preparation samples significantly reduced the detection of dead bacteria, this difference was still small, so further studies should be carried out to confirm the necessity of PMA treatment.

Topics: Azides; Bacteria; Bacterial Load; Bacteriological Techniques; Calcium Sulfate; Coloring Agents; Dental Cements; Dental Pulp Cavity; Dental Pulp Necrosis; Dentin; DNA, Bacterial; Edetic Acid; Enterococcus faecalis; Humans; Microbial Viability; Periapical Diseases; Propidium; Real-Time Polymerase Chain Reaction; Root Canal Filling Materials; Root Canal Irrigants; Root Canal Preparation; Sodium Hypochlorite; Vinyl Compounds; Zinc Oxide

To describe a technique for the placement of apical Mineral trioxide aggregate (MTA) plugs in canals with wide apices.. A novel technique to fill root canals with an apical diameter larger than 0.4 mm is presented. The technique includes three main stages; three Thermafil carriers of increasing size, previously de-sheathed by removing the Gutta-percha coating, are selected to engage 1, 2 and 3 mm short of the apex. Their use allows the negotiation of acute curvatures and ledged canals. Subsequently, an MTA plug matching the apical gauge is pre-formed with a pellet block, placed and condensed using the modified carriers in sequence. The presented protocol for the management of teeth with apices of a diameter greater than 0.4 mm allows a favourable apical control of the MTA. Clinical cases completed using this methodology are presented.. MTA placement in teeth with wide apices was facilitated by using de-sheathed Thermafil carriers, to create an appropriate seal and stable platform for Gutta-percha backfilling or subsequent fibre post placement. The use of de-sheathed Thermafil carriers of different sizes allows predictable placement of pre-formed MTA plugs. Gauging of Thermafil carriers enhances control of the condensation phase to limit the extrusion of MTA.

Topics: Adult; Aluminum Compounds; Calcium Compounds; Dental Pulp Cavity; Drug Combinations; Equipment Design; Female; Humans; Male; Odontometry; Oxides; Periapical Diseases; Periapical Periodontitis; Post and Core Technique; Retreatment; Root Canal Filling Materials; Root Canal Irrigants; Root Canal Obturation; Silicates; Sodium Hypochlorite; Tooth Apex; Young Adult

Inflammatory external root resorption is one of the major complications after replantation of avulsed teeth. Here we report a case of inflammatory external root resorption in a maxillary left central incisor in an 11-year old male patient that was managed and treated by using calcium enriched mixture (CEM) cement.. The patient's chief complaint was mobility of avulsed and replanted maxillary left central incisor and pain in chewing on left central and lateral incisors. Radiographic examination showed progressive inflammatory external root resorption of the left central incisor with an inadequately obturated root canal treatment. Both teeth were immature and had periapical radiolucencies. Both teeth were irrigated copiously with 2.5% NaOCl and obturated with CEM cement. However, the central incisor was treated with calcium hydroxide 6 weeks before CEM cement obturation.. The clinical and radiographic examinations at 3-, 6-, 12-, 24-, and 40-month follow-up showed that treated teeth were functional with normal mobility, the progression of the inflammatory external root resorption ceased, the resorptive lacunae were filled with newly formed bone, and periapical radiolucencies healed.. Considering the biological properties of CEM cement, especially its alkalinity and sustained calcium hydroxide release, using this novel cement for treatment of inflammatory external root resorption and obturation of immature necrotic teeth might be an applicable choice.

Topics: Apexification; Calcium Compounds; Calcium Hydroxide; Child; Dental Cements; Dental Pulp Necrosis; Follow-Up Studies; Humans; Incisor; Male; Osteogenesis; Oxides; Periapical Diseases; Root Canal Filling Materials; Root Canal Irrigants; Root Canal Obturation; Root Canal Therapy; Root Resorption; Sodium Hypochlorite; Tooth Avulsion; Tooth Replantation

To investigate the probability of and factors influencing periapical status of teeth following primary (1°RCTx) or secondary (2°RCTx) root canal treatment.. This prospective study involved annual clinical and radiographic follow-up of 1°RCTx (1170 roots, 702 teeth and 534 patients) or 2°RCTx (1314 roots, 750 teeth and 559 patients) carried out by Endodontic postgraduate students for 2-4 (50%) years. Pre-, intra- and postoperative data were collected prospectively on customized forms. The proportion of roots with complete periapical healing was estimated, and prognostic factors were investigated using multiple logistic regression models. Clustering effects within patients were adjusted in all models using robust standard error.. proportion of roots with complete periapical healing after 1°RCTx (83%; 95% CI: 81%, 85%) or 2°RCTx (80%; 95% CI: 78%, 82%) were similar. Eleven prognostic factors were identified. The conditions that were found to improve periapical healing significantly were: the preoperative absence of a periapical lesion (P = 0.003); in presence of a periapical lesion, the smaller its size (P ≤ 0.001), the better the treatment prognosis; the absence of a preoperative sinus tract (P = 0.001); achievement of patency at the canal terminus (P = 0.001); extension of canal cleaning as close as possible to its apical terminus (P = 0.001); the use of ethylene-diamine-tetra-acetic acid (EDTA) solution as a penultimate wash followed by final rinse with NaOCl solution in 2°RCTx cases (P = 0.002); abstaining from using 2% chlorexidine as an adjunct irrigant to NaOCl solution (P = 0.01); absence of tooth/root perforation (P = 0.06); absence of interappointment flare-up (pain or swelling) (P =0.002); absence of root-filling extrusion (P ≤ 0.001); and presence of a satisfactory coronal restoration (P ≤ 0.001).. Success based on periapical health associated with roots following 1°RCTx (83%) or 2°RCTx (80%) was similar, with 10 factors having a common effect on both, whilst the 11th factor 'EDTA as an additional irrigant' had different effects on the two treatments.

Topics: Adult; Chelating Agents; Chlorhexidine; Cohort Studies; Contraindications; Dental Fistula; Dental Pulp Cavity; Edetic Acid; Female; Follow-Up Studies; Gutta-Percha; Humans; Male; Periapical Diseases; Periapical Tissue; Post and Core Technique; Prognosis; Prospective Studies; Radiography; Retreatment; Root Canal Filling Materials; Root Canal Irrigants; Root Canal Preparation; Root Canal Therapy; Sodium Hypochlorite; Tooth Apex; Toothache; Treatment Outcome; Wound Healing; Zinc Oxide-Eugenol Cement

The objective of this prospective clinical study was to evaluate the incidence of flare-ups (pain and/or swelling requiring endodontic interappointment and emergency treatment) and identify the risk factors associated with their occurrence in patients who received endodontic treatment from June 2006 to June 2007 at the endodontics clinic of the São Paulo Dental Association (APCD), Jardim Paulista branch, São Paulo, Brazil. The incidence of flare-ups was 1.71% out of 408 teeth that had received endodontic therapy. Statistical analysis using the chi-squared test (P < .05) indicated a direct correlation between the flare-up rate and the presence of a periradicular radiolucency.

Topics: Adult; Brazil; Edema; Edetic Acid; Emergency Treatment; Female; Humans; Incidence; Male; Middle Aged; Pain, Postoperative; Periapical Diseases; Postoperative Complications; Prospective Studies; Retreatment; Risk Factors; Root Canal Irrigants; Root Canal Preparation; Root Canal Therapy; Sodium Hypochlorite; Toothache; Young Adult

This study is a retrospective analysis of the outcome of initial nonsurgical root canal treatment of teeth with open apices, obturated with mineral trioxide aggregate when no apical barrier existed. One hundred sixteen patients from a single private endodontic office were treated between 1999 and 2006. Treatments on 144 teeth were completed either in one (92/144) or two visits with an interim calcium hydroxide interappointment medication (52/144). Fifty-four percent (78/144) of the teeth were available for recall (60.3% one visit and 39.7% two visits). The maximum time to recall was 4.87 years. The mean time to recall was 19.4 months. Of the cases recalled for period of 1 year or longer, 93.5% of teeth treated in 1 visit healed, and 90.5% of teeth treated in 2 visits healed.

Topics: Adolescent; Adult; Aged; Aluminum Compounds; Anti-Infective Agents, Local; Calcium Compounds; Calcium Hydroxide; Chelating Agents; Child; Chlorhexidine; Drug Combinations; Edetic Acid; Female; Follow-Up Studies; Humans; Male; Middle Aged; Oxides; Periapical Diseases; Retrospective Studies; Root Canal Filling Materials; Root Canal Irrigants; Root Canal Obturation; Root Canal Preparation; Root Canal Therapy; Silicates; Smear Layer; Sodium Hypochlorite; Tooth Apex; Treatment Outcome; Young Adult

A patient with a large periapical lesion around the apices of her mandibular incisors is presented. During the conservative non-surgical endodontic treatment, sodium hypochlorite was used for irrigation, and calcium hydroxide was used for the intra-canal dressing. Periapical healing was observed 1 month after obturation and continued in the 12-month recall. This report confirms that the large size of a periapical lesion does not mandate its surgical removal, and that even cyst-like periapical lesions heal following a conservative endodontic therapy.

Topics: Calcium Hydroxide; Child; Female; Humans; Incisor; Periapical Diseases; Radiography; Root Canal Irrigants; Root Canal Therapy; Sodium Hypochlorite; Wound Healing

The purpose of this study was to evaluate the outcome of nonsurgical retreatment of teeth with periapical lesions, which had been previously managed by either endodontic or surgical intervention, and to identify factors that might influence the prognosis.. Seventy-five endodontically and 11 surgically treated teeth with persisting periapical lesions ranging in size from 2 to 11 mm in diameter were included in this study. The teeth were nonsurgically retreated, using calcium hydroxide as intracanal medicament, and were followed for a period of 2 to 8 years.. Clinical and radiographic assessment of retreatment showed that complete healing for all cases was 61.6% with an additional category of incomplete healing of 14%; 24.4% failed. The size of the periapical lesions and previous surgical treatment had marginally negative influences on the prognosis, but the differences were not statistically significant.. The favourable results of this study demonstrated that nonsurgical root canal retreatment is an alternative to surgical intervention of postendodontic or postsurgical failure.

Topics: Calcium Hydroxide; Dental Restoration Failure; Female; Humans; Male; Periapical Diseases; Retreatment; Root Canal Filling Materials; Root Canal Irrigants; Root Canal Obturation; Root Canal Preparation; Root Canal Therapy; Sodium Hypochlorite; Tooth Apex

By re-examining 10 previously published "universal" PCR assays using the ARB phylogenetic software package and database with 41,000 16S rRNA gene sequences, we found that they differed considerably in their coverage of the domain Bacteria. We evaluated the broadest-range real-time quantitative PCR protocol for its efficacy in measuring the antimicrobial effects of endodontic treatments.

Topics: Adult; Aged; Anti-Infective Agents, Local; Bacteria; Bacterial Infections; Chlorhexidine; Dental Pulp Cavity; DNA Probes; Endodontics; Humans; Middle Aged; Periapical Diseases; Phylogeny; Polymerase Chain Reaction; Reverse Transcriptase Polymerase Chain Reaction; RNA, Ribosomal, 16S; Sodium Hypochlorite; Software

The objective of this study was to evaluate the apical and periapical repair after endodontic treatment of teeth with pulp necrosis and a chronic periapical lesion in dogs. Seventy-two root canals from four mongrel dogs were submitted to biomechanical preparation, using 5.25% sodium hypochlorite or 2% chlorhexidine digluconate as the irrigating solution. The root canals were subsequently either filled immediately with Sealapex, using active lateral gutta-percha condensation, or a calcium hydroxide root canal dressing was applied for 15 days before filling with Sealapex. After 210 days, the animals were killed by anesthetic overdose, and the obtained histological sections were stained with hematoxylin and eosin for optical microscopic analysis of apical and periapical repair. There was better histological repair in the groups with the root canal dressing (p < 0.05) than the groups with immediate obturation. Comparing the immediate obturation groups, irrigation with chlorhexidine solution resulted in better repair than sodium hypochlorite.

Topics: Animals; Bone Resorption; Calcium Hydroxide; Chlorhexidine; Dental Pulp Necrosis; Disease Models, Animal; Disinfectants; Dogs; Female; Gutta-Percha; Male; Periapical Diseases; Periapical Periodontitis; Periapical Tissue; Periodontal Ligament; Root Canal Filling Materials; Root Canal Irrigants; Root Canal Obturation; Root Canal Preparation; Root Canal Therapy; Root Resorption; Salicylates; Sodium Hypochlorite; Statistics as Topic; Statistics, Nonparametric; Time Factors; Wound Healing

To describe the role of calcium hydroxide in infection control during complex endodontic retreatment.. A case is presented in which two conventional endodontic treatments and two surgical interventions failed to bring periapical healing. Despite this history, a further conventional treatment augmented by long-term disinfection with calcium hydroxide finally delivered a successful outcome.. Periapical healing follows proper intracanal infection control. Despite repeated surgical and nonsurgical intervention, careful retreatment can often bring healing. Calcium hydroxide has long-acting antimicrobial and soft-tissue dissolving activity. It is a helpful adjunct in endodontic retreatment.

Topics: Calcium Hydroxide; Dental Fistula; Dentin, Secondary; Disinfectants; Follow-Up Studies; Humans; Male; Middle Aged; Periapical Abscess; Periapical Diseases; Retreatment; Root Canal Irrigants; Root Canal Therapy; Sodium Hypochlorite; Tooth Apex; Treatment Failure; Treatment Outcome

This report describes 2 endodontic patients who had persistent signs and symptoms after conventional root canal treatment. The aim of this study was to determine what microorganisms were present in the root canals of the teeth with failed endodontic therapy.. After removal of the root fillings, the canals were sampled by advanced microbiological techniques and the isolates were characterized by various tests.. Bacteria, which grew in pure cultures, were isolated in each case. The bacteria were similar to each other and were classified as Actinomyces on the basis of phylogenic and phenotypic evidence. The bacteria were different from others within the genus, thus warranting designation as a new species, Actinomyces radicidentis.. The 2 cases of endodontic failure were infected with A radicidentis, a new Actinomyces species. This bacterium joins a restricted group of other microorganisms that have been associated with failure of root canal treatment.

Topics: Actinomyces; Actinomycosis; Adult; Aged; Aged, 80 and over; Anti-Infective Agents, Local; Calcium Hydroxide; Dental Pulp Cavity; Drug Resistance, Microbial; Female; Humans; Male; Microscopy, Electron; Periapical Abscess; Periapical Diseases; Periapical Granuloma; Periapical Periodontitis; Phenotype; Phylogeny; Root Canal Irrigants; Root Canal Therapy; Root Resorption; Sodium Hypochlorite; Treatment Failure

The aim of the present study was to evaluate the in vivo antimicrobial activity of 2% chlorhexidine gluconate (FCFRP-USP) used as a root canal irrigating solution in teeth with pulp necrosis and radiographically visible chronic periapical reactions. Culture techniques and measurement of the inhibition zone were used. Twenty-two root canals of incisors and molars of 12 patients were used. After accessing the canal, the first root canal sample was collected with two sterile paper points that were transferred to a tube containing reduced transport fluid. The root canal was instrumented using chlorhexidine solution. A small sterile cotton pellet was placed at the root canal entrance, and the cavity was sealed with zinc oxide-eugenol cement. The canals were maintained empty for 48 h. Three sterile paper points were then introduced to absorb the root canal fluid (second sample). One paper point was placed on an agar plate inoculated with Micrococcus luteus ATCC 9341 and incubated for 24 h at 37 degrees C, and the other two were submitted to microbiological evaluation. Present in 10 cases at baseline, mutans streptococci was reduced by 100% at the second assessment. Treatment showed an efficiency of 77.78% for anaerobic microorganisms at the second assessment. These data suggest that chlorhexidine prevents microbial activity in vivo with residual effects in the root canal system up to 48 h.

Topics: Adolescent; Adult; Bacteria, Anaerobic; Birefringence; Chlorhexidine; Colony Count, Microbial; Dental Pulp Cavity; Dental Pulp Necrosis; Female; Humans; Male; Microbial Sensitivity Tests; Micrococcus luteus; Middle Aged; Periapical Diseases; Root Canal Irrigants; Root Canal Therapy; Sodium Hypochlorite; Streptococcus mutans

Actinomyces israelii has been repeatedly implicated as a cause of failure of endodontic therapy. This study investigated the antimicrobial effect of antibiotics as well as intracanal medicaments, sodium hypochlorite solution and calcium hydroxide, on this important pathogen. Growth of A. israelii was inhibited by low concentrations of antibiotics, yet high concentrations were not bactericidal for A. israelii over 1 week. When A. israelii was exposed for 2-6 weeks at concentrations equivalent to clinical serum levels, the antibiotics were lethal. The results reveal a species-specific antibiotic tolerance for A. israelii. Both sodium hypochlorite solution and calcium hydroxide were found to be highly effective in killing A. israelii.

Topics: Actinomyces; Actinomycosis; Anti-Bacterial Agents; Bacterial Adhesion; Calcium Hydroxide; Drug Resistance, Microbial; Humans; Microbial Sensitivity Tests; Periapical Diseases; Root Canal Irrigants; Sodium Hypochlorite; Species Specificity; Time Factors