Thursday, 21 November 2013

Success and failure in periradicular surgery A longitudinal retrospective analysis

Special thanks to Dr B Praveen for compiling this abstract

1. Success and failure in periradicular surgery A longitudinal retrospective analysis
2. Primary leiomyosarcoma of the mandible in a 7-year-old girlReport of a case and review of the literature
3. Considerations in the selection of a root-end filling material
4. Treatment of Peri-implant Defects with Guided BoneRegeneration: A Comparative Clinical Study with Various
    Membranes and Bone Grafts

5. Clinical and Histologic Evaluation of an Active Implant Periapical Lesion : A Case Report Intl journal of aral and
   maxillo facial implants

6. Removal Torque Values of Titanium Implants in the Maxilla of Miniature Pigs -Intl journal of aral and maxillo facial
   implants

7. Topical Vaccine Eliminates Streptococcus Mutans for up to 4 months

Success and failure in periradicular surgery A longitudinal retrospective analysis
Tiziano Testori, MD, DDSa
Matteo Capelli, DDSb
Silvano Milani, PhDc Roberto L. Weinsteind
Milan, Italy
The objective of the present study was to compare the success rates of 2 different periapical surgical techniques, the traditional technique with rotary instruments and the ultrasonic technique, which uses ultrasonic retrotips. A longitudinal retrospective study was carried out on 302 apices (181 teeth) that had undergone periapical surgery. Surgical outcome was evaluated by 2 independent operators using standardized periapical radiographs. Each radiographic finding was classified into 1 of 4 groups: complete healing, incomplete healing, uncertain healing, and unsatisfactory outcome (failure). An SAS statistical analysis system was used for data management and analysis. Prognostic factors were determined by means of the Fisher exact test. Complete healing after 4.6 years (the average follow-up period) was observed in 68% of the teeth treated through the use of the standard technique and 85% of those treated through the use of the ultrasonic technique. The success rate increased as the follow-up period lengthened (68.4% at 2 years vs 80% at 6 years). The success rate was higher in maxillary (77.9%) than in mandibular (66.1%) teeth. A comparison between the retrofilling materials was not feasible because all teeth in the standard technique group were retrofilled with amalgam and all teeth in the ultrasonic group were retrofilled with Super-EBA.
(Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1999;87:493-8)

Primary leiomyosarcoma of the mandible in a 7-year-old girlReport of a case and review of the literature
Laurie C. Carter, DDS, MA, PhDa
Alfredo Aguirre, DDS, MSb
Barry Boyd, DMD,
Mark D. DeLacure, MDd Buffalo, NY
Leiomyosarcoma is a malignant neoplasm of smooth muscle origin that manifests itself uncommonly in the oral cavity because of the paucity of smooth muscle in that location. To the best of our knowledge, only 10 cases of leiomyosarcoma primary to the jawbones have been reported in the English language literature. We report the first pediatric case of leiomyosarcoma arising from the mandible. Facial asymmetry and swelling were accompanied by a rapidly growing exophytic soft tissue mass that caused buccal displacement of the mandibular left permanent first molar. The lesion, observed radiographically as an extensive ill-defined area of osteolytic alveolar destruction, perforated the lingual cortex, displaced the inferior alveolar nerve canal inferiorly, and produced a "floating-in-air" appearance of the first molar. Diagnosis of leiomyosarcoma was made after initial incisional biopsy of the lesion. A 5-cm segmental mandibulectomy and supraomohyoid neck dissection were followed by reconstruction with a dynamic mandibular reconstruction plate and placement of a multidimensional mandibular distraction device in a transport rectangle of bone to promote bifocal distraction osteogenesis. Forty millimeters of distraction (the technical limit of the device) were performed; this was followed by terminal iliac crest bone grafting. Seventeen months after the definitive surgical procedure, the patient remains free of disease.
(Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1999;87:477-84)

Considerations in the selection of a root-end filling material
Bradford R. Johnson, DDSa Chicago, Ill
Surgical root canal treatment often includes the placement of a root-end filling material. New materials have recently emerged to challenge the long-standing position of amalgam as the root-end filling material of choice. This review discusses several of the commonly used root-end filling materials, with emphasis on indications and contraindications for the use of each.
(Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1999;87:398-404)

Treatment of Peri-implant Defects with Guided BoneRegeneration: A Comparative Clinical Study with Various Membranes and Bone Grafts
Intl journal of aral and maxillo facial implants
Vol. 13, No. 5 1998 Page: 639
Author(s): Lorenzoni/Pertl/Keil/Wegscheider
Abstract: In this clinical study, a bioabsorbable membrane (Biofix) and two augmentation membranes made of exapnded polytetrafluoroethylene (Gore-Tex) were tested for their osteopromotive potential. Forty-six implants were augmented with Gore-Tex membranes, 45 implants with titanium-reinforced Gore-Tex membranes, and 38 peri-implant defects with a resorbable polyglycoid membrane (Biofix). Autogenous bone (n= 85) and bovine bone matrix (Bio-Oss, n = 16) were used as filling materials beneath membranes. The results showed that bone repair is significantly improved by the use of membrane techniques. The average rate of bone regeneration with non-resorbable memb ranes was 84% (GTAM) and 81% (TR-GTAM). The use of Biofix membranes resulted in an average bone gain of 60%. The differences in efficacy established for the three types of membranes were found to be statistically significant (P < .001). Barrier membranes represent a valid technique for the treatment of peri-implant defects. Clinical and histologic results showed that Bio-Oss is an osteoconductive scaffold that promotes new bone formation.

Clinical and Histologic Evaluation of an Active Implant Periapical Lesion : A Case Report Intl journal of aral and maxillo facial implants
Vol. 13, No. 5 1998 Page: 713
Author(s): Piattelli/Scarano/Balleri/Favero
Abstract: A new entity called implant periapical lesion has recently been described. This lesion could be the result of, for example, bone overheating, implant overloading, persence of a preexisting infection or residual root fragments and foreign bodies in the bone, contamination of the implant, or implant placement in an infected maxillaary sinus. This case report describes a titanium implant that was placed in the maxillary premolar region. A fenestration involving the middle portion of the implant was present. After 7 months, the apical portion of the implant showed radiolucency. This lesion rapidly increased in size and a vestibular fistula appeared. A systemic course of antibiotics was not successful, and the implant was then removed. The histologic examination showed the presence of necrotic bone inside the antirotational hole of the implant. The etiology of the implant failure in this instance could possibly be related to bone overheating associated with an excessive tightening of the implant and compression of the bone chips inside the apical hole, producing subsequent necrosis.

Removal Torque Values of Titanium Implants in the Maxilla of Miniature Pigs -Intl journal of aral and maxillo facial implants
Vol. 13, No. 5 1998 Page: 611
Author(s): Buser/Nydegger/Hirt/Cochran/Nolte
Abstract: The purpose of this study was to compare side-by-side two different titanium screw-type implants in the maxillae of miniature pigs. The test implants had a machined and acid-etched surface (Osseotite) whereas the control implants were sandblasted and acid-etched (SLA). After 4, 8, and 12 weeks of healing, removal torque testing was performed to evaluate the shear strength of the bone-implant interface for both implant types. The results demonstrated significant differences between both implant types (P < .01). Osseotite implants revealed mean removal torque values (RTV) of 62.5 Ncm at 4 weeks, 87.6 Ncm at 8 weeks, and 95.7 Ncm at 12 weeks of healing. In contrast, the SLA implants demonstrated mean RTV of 109.6 Ncm, 196.7 Ncm, and 186.8 Ncm at corresponding healing periods. The mean RTV for SLA implants was 75% to 125% higher than for Osseotite implants up to 3 months of healing.

Topical Vaccine Eliminates Streptococcus Mutans for up to 4 months A clinical trial conducted by researchers from guys Hospital Dental School in London utilized a vaccine applied to teeth and Streptococcus mutants was unable to recognize the teeth.The vaccine was used as mouth wash twice a week for three weeks. Control subjects had Streptococcus mutants back in their mouths at two months while the vaccine group had no return of Streptococcus mutants for 4 months.

Effect of Treatment on Cyclosporine- and Nifedipine-Induced Gingival Enlargement: Clinical and Histologic Results

Effect of Treatment on Cyclosporine- and Nifedipine-Induced
Gingival Enlargement: Clinical and Histologic Results

Vol. 18, No. 1 1998 Page: 81
Author(s): Santi/Bral



Abstract: The clinical and histologic responses to periodontal treatment of gingival enlargements, induced when cyclosporine and nifedipine were administered singly or in combination, were evaluated. A significant corerlation was noted between plaque, gingivitis, and gingival overgrowth.Severity of enlargement appeared to be greater in patients on combined therapy. All treatment appraoches such as scaling, root planing, gingivectomy, and periodontal flaps, and a combination of therapies, wre effective in the management of gingival overgrowth up to 1 year after completion of treatment. Adjunctive use of chlorhexidine was found to be beneficial.
Advancements in Endodontic Surgery

Many practitioners still believe that the objective of endodontic surgery is to eliminate infected root apicies and/or periapical tissue. Often endodontic surgery is referred to incorrectly as an apicoectomy. According to Schoeffel, apicoectomy by itself is seldom enough to resolve root canal failures. The purpose of an apicoecomy is only to allow us to ³read² the root and examine the canals. To seal the canals, some form of retrofilling is usually necessary. Apicoectomy may be considered definite treatment, however, in cases of mechanical failure such as apical blockage or perforation. Such complications may result in failure of an otherwise perfectly obturated root canal system. Surgical removal of the untreated apical portion of the root will correct the problem.
Burnishing gutta-percha is another fruitless maneuver according to Schoeffel. If you simply try to burnish the gutta-percha, you will pull it away from one wall as you burnish toward the opposite wall. Therefore, apicoectomy is merely one step toward the final objective - the retroseal.
Retroseal is the process that finally resolves most endodontic failures. Since the 1950s most clinicians have realizedthat virtually all failures result from leaking root canal systems. The often quoted Washington Study attributed root canal failures to apical percolation (63.46%), operator error (14.42%) root perforation (9.61%), calcified canals (3.85%), broken instrument (.96%), or case poor selection. Apicoectomy and retroseal can reverse all of these errors except improper case selection and some types of operator error.
It should be emphasized that endodontic surgery is not to be used instead of conventional endodontics. Surgery is indicated when conventional techniques cannot be used.

New retrofill material
Materials used to fill retro-preparations vary according to current research, but Bosworth's Super EBA is a fortified ZOE that is rapidly gaining acceptance as the retrofill of choice over traditional amalgam. The problem with amalgam retrofills is that they corrode and degenerate. Super EBA sets rock hard in minutes, is easily injected into the preparation, and will not corrode. Gary B. Carr, DDS, a San Diego endodontist, invented the Ultrasonic Retrotip. Retrotip fits into limited access areas to produce practically perfect preparations.

EMDOGAIN® is a Swedish product which, in a biological way, recreates the tooth attachment lost due to periodontitis. The important ingredient in EMDOGAIN® is amelogenin, a protein that the body itself produces. This protein has an important function in the creation of teeth and their support, but is produced only during the time that our teeth are developed.

The New Apex Finder A.F.A.

The Apex Finder A.F.A. is a state-of-the-art apex locator that incorporates the highest level of technology possible to locate the apical terminus in a root canal.
System B Heat Source:

Developed by noted clinician Dr. L. Stephen Buchanan, the "Continuous Wave" technique utilizes heat carriers that closely match the shape of the root canal created during instrumentation. Once the master cone is seated, heat is delivered instantly to the "Buchanan plugger". When the heated tip contacts the master gutta percha cone, the material softens instantly, and can be condensed apically with ease. The downpack not only fills the canal to within 5 millimetres of the apex, but it obturates lateral and accessory canals within 10 seconds. We refer you to our obturation section for material on the technique.
EIE/Analytic MiniEndo

The MiniEndo is a sleek, compact ultrasonic unit designed specifically for endodontic applications. It is controlled by microprocessors which deliver the correct amount of power and amplitude to the universal tip to successfully complete all manner of endodontic procedures. In contrast to other units available, it is not a modified scaler.,
Forced eruption technique: Rationale and clinical report
Daniel Ziskind, DMDa
Ami Schmidt, DMDb
Zvia Hirschfeld, DMDc
Hebrew University, Faculty of Dental Medicine Jerusalem, Israel
Clinical Report Discussion Summary
Forced orthodontic eruption was first described in 1973 by Heithersay. 1 The clinical benefits of this procedure have been repeatedly demonstrated by restoring submerged roots, 2-13 root perforations at the coronal third, 14 and treating infrabony pockets. 15 Extrusion elevates the root, expands periodontal fibers, and results in coronal shift of marginal gingiva and bone. 2 Periodontal surgery is performed when necessary, before proceeding with restorative procedures to compensate for this process. 16-21 Orthodontic brackets that use edgewise, and Johnson twin-wire, or Universal bracket techniques were bonded to three or four adjacent teeth, at a specific height from the tips of their cusps. A straight piece of wire was then laid passively in the horizontal channel of the brackets. This orthodontic device has certain disadvantages both for patient and dentist, such as an increased risk of dental caries, trauma to adjacent soft tissue, compromised esthetics, and technically difficult construction of a therapeutic device.
This clinical report describes an alternative for forced eruption that minimizes the need for special orthodontic devices.


Effect of 2% chlorhexidine on microtensile bond strength of composite to dentin

J Adhes Dent. 2003 Summer;5(2):129-38.
de Castro FL, de Andrade MF, Duarte Junior SL, Vaz LG, Ahid FJ.

Department of Restorative Dentistry, Araraquara School of Dentistry, UNESP
Araraquara, Sao Paulo, Brazil. fabriciodecastro@hotmail.com

PURPOSE: To evaluate the effect of 2% chlorhexidine on the microtensile bond
strength of composite resin to dentin treated with three dentin bonding systems.
MATERIALS AND METHODS: Flat dentinal surfaces were prepared in 24 extracted
human third molars. Teeth were randomly divided into 8 distinct experimental
groups according to the adhesive applied (Prime & Bond NT, Single Bond and
Clearfil SE Bond), the application (yes/no) of chlorhexidine, and the time point
at which it was applied (before or after acid etching the dentin). Composite
resin blocks were built up over treated surfaces, and teeth were then stored in
water at 37 degrees C for 24 h. Samples were thermocycled, stored under the same
conditions, and then vertically sectioned, thus obtaining specimens with 1.0 +/-
0.1 mm2 cross-sectional area. Specimens were stressed in tension at 0.5 mm/min
crosshead speed. Bond strength results were evaluated using a one-way ANOVA (p <
0.05). The modes of failures were verified using optical microscopy. Dentin
disks were obtained from 3 additional teeth treated in the same manner for
observation under SEM. The most representative samples of fractured specimens
were also observed under SEM. RESULTS: No statistically significant differences
of bond strength values were found between any groups. Failures occurred mainly
within the bond; exclusively adhesive fractures (adhesive-dentin) were not
observed. CONCLUSION: The 2% chlorhexidine solution, applied before or after
acid etching of the dentin, did not interfere with the microtensile bond
strength of composite resin to the dentin treated with Prime & Bond NT, Single
Bond, or Clearfil SE Bond bonding systems.