Success rates for gutta-percha and Kloroperka N- root fillings made by undergraduate students: radiographic findings after 10?17 years
01 Jul 1988-International Endodontic Journal (INTERNATIONAL ENDODONTIC JOURNAL)-Vol. 21, Iss: 4, pp 243-250
About: This article is published in International Endodontic Journal.The article was published on 1988-07-01. It has received 88 citations till now. The article focuses on the topics: Gutta-percha.
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TL;DR: The predictability from clinical and radiographic signs of the treatment-outcome in individual cases with preoperative periapical lesions cases was found to be low and factors which were not measured or identified may be critical to the outcome of endodontic treatment.
1,615 citations
Cites background or result from "Success rates for gutta-percha and ..."
...A large number of studies have demonstrated that the success rate in endodontic therapy is significantly influenced by the presence or absence of a pretherapeutic radiographic lesion (1-7, 9-11)....
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...Our results corroborate earlier findings that teeth with apical periodontitis have a significantly lower rate of success than those without such lesions (1-7, 9-11)....
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TL;DR: The microbial flora in canals after failed endodontic therapy differed markedly from the flora in untreated teeth, and infection at the time of root filling and size of the periapical lesion had a negative influence on the prognosis.
Abstract: Objective. The purposes of this study were to determine what microbial flora were present in teeth after failed root canal therapy and to establish the outcome of conservative re-treatment.
Study design. Fifty-four root-filled teeth with persisting periapical lesions were selected for re-treatment. After removal of the root filling, canals were sampled by means of advanced microbiologic techniques. The teeth were then re-treated and followed for up to 5 years.
Results. The microbial flora was mainly single species of predominantly gram-positive organisms. The isolates most commonly recovered were bacteria of the species Enterococcus faecalis. The overall success rate of re-treatment was 74%.
Conclusions. The microbial flora in canals after failed endodontic therapy differed markedly from the flora in untreated teeth. Infection at the time of root filling and size of the periapical lesion were factors that had a negative influence on the prognosis. Three of four endodontic failures were successfully managed by re-treatment.
1,449 citations
TL;DR: This communication is meant to provide a comprehensive overview of the etio-pathogenesis of apical periodontitis and the causes of failed endodontic treatments that can be visualized in radiographs as asymptomatic post-treatment periapical radiolucencies.
Abstract: Apical periodontitis is a sequel to endodontic infection and manifests itself as the host defense response to microbial challenge emanating from the root canal system. It is viewed as a dynamic encounter between microbial factors and host defenses at the interface between infected radicular pulp and periodontal ligament that results in local inflammation, resorption of hard tissues, destruction of other periapical tissues, and eventual formation of various histopathological categories of apical periodontitis, commonly referred to as periapical lesions. The treatment of apical periodontitis, as a disease of root canal infection, consists of eradicating microbes or substantially reducing the microbial load from the root canal and preventing re-infection by orthograde root filling. The treatment has a remarkably high degree of success. Nevertheless, endodontic treatment can fail. Most failures occur when treatment procedures, mostly of a technical nature, have not reached a satisfactory standard for the control and elimination of infection. Even when the highest standards and the most careful procedures are followed, failures still occur. This is because there are root canal regions that cannot be cleaned and obturated with existing equipments, materials, and techniques, and thus, infection can persist. In very rare cases, there are also factors located within the inflamed periapical tissue that can interfere with post-treatment healing of the lesion. The data on the biological causes of endodontic failures are recent and scattered in various journals. This communication is meant to provide a comprehensive overview of the etio-pathogenesis of apical periodontitis and the causes of failed endodontic treatments that can be visualized in radiographs as asymptomatic post-treatment periapical radiolucencies.
839 citations
Cites background from "Success rates for gutta-percha and ..."
...…by gradual reduction and resolution of the radiolucency on subsequent follow-up radiographs (Strindberg, 1956; Grahnén and Hansson, 1961; Seltzer et al., 1963; Storms, 1969; Molven, 1976; Kerekes and Tronstad, 1979; Molven and Halse, 1988; Sjögren et al., 1990, 1997; Sundqvist et al., 1998)....
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TL;DR: This article provides a comprehensive overview of the causative factors of non-resolving periapical lesions that are seen as asymptomatic radiolucencies post-treatment.
Abstract: Apical periodontitis is a chronic inflammatory disorder of periradicular tissues caused by aetiological agents of endodontic origin. Persistent apical periodontitis occurs when root canal treatment of apical periodontitis has not adequately eliminated intraradicular infection. Problems that lead to persistent apical periodontitis include: inadequate aseptic control, poor access cavity design, missed canals, inadequate instrumentation, debridement and leaking temporary or permanent restorations. Even when the most stringent procedures are followed, apical periodontitis may still persist as asymptomatic radiolucencies, because of the complexity of the root canal system formed by the main and accessory canals, their ramifications and anastomoses where residual infection can persist. Further, there are extraradicular factors -- located within the inflamed periapical tissue -- that can interfere with post-treatment healing of apical periodontitis. The causes of apical periodontitis persisting after root canal treatment have not been well characterized. During the 1990s, a series of investigations have shown that there are six biological factors that lead to asymptomatic radiolucencies persisting after root canal treatment. These are: (i) intraradicular infection persisting in the complex apical root canal system; (ii) extraradicular infection, generally in the form of periapical actinomycosis; (iii) extruded root canal filling or other exogenous materials that cause a foreign body reaction; (iv) accumulation of endogenous cholesterol crystals that irritate periapical tissues; (v) true cystic lesions, and (vi) scar tissue healing of the lesion. This article provides a comprehensive overview of the causative factors of non-resolving periapical lesions that are seen as asymptomatic radiolucencies post-treatment.
787 citations
Cites background from "Success rates for gutta-percha and ..."
...…with hard tissue regeneration, that is characterized by reduction of the radiolucency on follow-up radiographs (Strindberg 1956, Grahnén & Hansson 1961, Seltzer et al. 1963, Storms 1969, Molven 1976, Kerekes & Tronstad 1979, Molven & Halse 1988, Sjögren et al. 1990, 1997, Sundqvist et al. 1998)....
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TL;DR: It seems that more research should be done on leakage study methodology, instead of continuing to evaluate the sealing ability of different materials and techniques by methods that may give little relevant information.
Abstract: An increasing number of endodontic leakage studies have been published. In the 1990 volumes of Journal of Endodontics and International Endodontic Journal, there was one leakage study to every 4.3 scientific articles. The most popular method was linear measurement of tracer (dye or radioisotope) penetration along a root filling. Comparing some data on linear measurement of dye penetration following the cold lateral condensation of gutta-percha that were published between 1980 and 1990, a high level of variation has been found, although the experimental methods used in these studies were quite similar. In almost all studies evaluating various techniques, the cold lateral condensation technique has been used as a standard control for comparison. The reliability of these results is questionable. The problems with such studies are discussed. It seems that more research should be done on leakage study methodology, instead of continuing to evaluate the sealing ability of different materials and techniques by methods that may give little relevant information.
543 citations
References
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TL;DR: It was concluded that the standardized endodontic technique led to an improvement in the technical standard of the root fillings, and that the technique may be used regularly in all groups of teeth.
514 citations
TL;DR: The case to be described in this paper is an example of unusual localization in the head, neck, and oral cavity of multiple neurofibromatosis of Recklinghausen.
Abstract: Typical cases of multiple neurofibromatosis of Recklinghausen are easy to diagnose from a clinical point of view. The mono-symptomatic cases can also be easily diagnosed i f they occur in patients with hereditary backgrounds. However, unusual localization in both types may render the diagnosis difficult. The case to be described in this paper is an example of unusual localization in the head, neck, and oral cavity. From the view point of differential diagnosis, the dentist should be familiar with the disease in its oral manifestation.
501 citations
TL;DR: The present study indicates that the large variation noted among clinical and radiographic studies on the results of endodontic therapy could partly be explained by difficulties in defining and maintaining criteria for radiological evidence of periapical disease.
Abstract: In radiographic evaluation of the results of endodontic therapy the development or persistence of periapical radiolucencies often serve as criteria for therapeutic failure. In the present study the influence of inter- and intraexaminer variation on these results was investigated. Three endodontists and three radiologists interpreted periapical conditions and quality of root filling seal in radiographs of 119 endodontically treated roots. Consensus on the presence of periapical lesion was reached in 27% of cases classified as pathologic. In 6% reports of increased width of the periodontal membrane space accorded. The examiners agreed completely on normal periapical conditions in 37% of the cases. On assessing the quality of root filling seal the opinions of observers differed even more. Complete agreement on cases with adequate and defective seal was reached in 25% and 12%, respectively. For the individual examiner the widened periodontal membrane space was the diagnosis most difficult to reproduce. The present study indicates that the large variation noted among clinical and radiographic studies on the results of endodontic therapy could partly be explained by difficulties in defining and maintaining criteria for radiological evidence of periapical disease.
139 citations
TL;DR: it analysis provided optimal discrimination between subgroups of roots with regard to the radiographic status of the periapical tissues as a measure of the clinical performance of the materials, and it was concluded that the perapical index is a useful discriminatory tool for assessment of treatment results in endodontics.
Abstract: The clinical performance of three endodontic sealers, AH 26®, Kloroperka N-O® and ProcoSol®, was assessed in a prospective study of endodontic treatment in 810 roots. The roots were treated by undergraduate students according to a standardized procedure, and were filled with laterally condensed gutta-percha and sealer. The sealer was randomly selected just prior to filling. The patients were recalled yearly for 4 years for a clinical and radiographic control examination, and the radiographs were scored using the periapical index (PAI) scoring system. Ridit analysis provided optimal discrimination between subgroups of roots with regard to the radiographic status of the periapical tissues as a measure of the clinical performance of the materials. The periapical status of roots filled with AH 26® or ProcoSol® was better than that of roots filled with Kloroperka®. The difference was significant after 1 year and persisted through the 4-year observation period. The difference was also evident after stratification of the material with regard to preoperative pulpal and periapical diagnoses. It is concluded that the choice of sealer may influence the outcome of endodontic treatment, and that the perapical index is a useful discriminatory tool for assessment of treatment results in endodontics.
127 citations