Apical Periodontitis (apical + periodontitis)

Distribution by Scientific Domains


Selected Abstracts


Persistent, recurrent, and acquired infection of the root canal system post-treatment

ENDODONTIC TOPICS, Issue 1 2003
Markus Haapasalo
Apical periodontitis is an inflammatory process in the periradicular tissues caused by microorganisms in the necrotic root canal. Accordingly, to achieve healing of apical periodontitis, the main goal of the treatment must be elimination of the infection and prevention of re-infection. As shown by recent epidemiological studies in several countries around the world, post-treatment endodontic disease is a far too common finding. To understand the reasons for survival of resistant bacteria in the filled root canal, it is important to know in detail the interaction between treatment procedures and the root canal flora in primary apical periodontitis. Therefore, in the first half of this review, the focus is placed on control of infection in primary apical periodontitis. This is followed by a detailed description of the resistant root canal microflora and a discussion about the present and future strategies to eliminate even the most resistant microbes in post-treatment disease. [source]


Critical role of NFATc1 in periapical lesions

INTERNATIONAL ENDODONTIC JOURNAL, Issue 2 2010
C. Zhang
Zhang C, Yang L, Peng B. Critical role of NFATc1 in periapical lesions. International Endodontic Journal, 43, 109,114, 2010. Abstract Aim, To observe NFATc1 expression in experimental periapical lesions in rats. Methodology, Apical periodontitis was induced in Wistar rats by occlusal pulp exposure in mandibular first molar teeth. After exposure, 30 rats were killed on days 0, 7, 14, 21 and 28. The jaws that contained the first molar were removed and prepared for histological examination, immunohistochemistry and enzyme histochemistry. Results, From day 0 to day 28, the areas of periapical bone loss and the number of NFATc1-positive cells increased, peaking on day 28. The number of TRAP-positive cells increased substantially from day 0 to day 14 and then gradually decreased from day 14 to day 28. Conclusions, NFATc1 was detected and possibly involved in the inflammatory response and bone resorption of periapical tissues, as well as being associated with periapical lesion pathogenesis. [source]


A 20-year follow-up study of endodontic variables and apical status in a Swedish population

INTERNATIONAL ENDODONTIC JOURNAL, Issue 12 2007
M. Eckerbom
Abstract Aim, To re-examine a population after 20 years and evaluate changes in prevalence of endodontic treatment and apical periodontitis, as well as the technical quality of root fillings. Methodology, One hundred and fifteen out of an original 200 patients living in the northern part of Sweden were re-examined with a full mouth radiographic survey after 20 years. Frequencies of root canal treated teeth, apical periodontitis and quality parameters of root fillings were registered. Results, The frequency of root canal treated teeth increased significantly (P < 0.05) from 13.9% at the first investigation to 17.7% after 20 years. There was also a statistically significant increase (P < 0.05) in teeth with apical periodontitis from 3.3% to 6.8%. Apical periodontitis both in connection with root canal treated teeth and teeth without endodontic treatment, had increased during the follow-up period. Even though the quality of the root fillings had improved, there was no corresponding improvement of the apical status in teeth with root fillings. Conclusions, There is still a great need for endodontic treatment in the Swedish population, and no improvement in apical health was found during this 20-year follow up. [source]


Radiological assessment of periapical status using the periapical index: comparison of periapical radiography and digital panoramic radiography

INTERNATIONAL ENDODONTIC JOURNAL, Issue 6 2007
C. Ridao-Sacie
Abstract Aim, To compare the use of periapical radiographs and digital panoramic images displayed on monitor and glossy paper in the assessment of the periapical status of the teeth using the periapical index (PAI). Methodology, A total of 86 subjects were examined. All participants underwent a full-mouth radiographic survey (14 periapical radiographs) and a panoramic radiography. The periapical status, using the PAI score, of all appraised teeth was assessed. Results, Periapical radiographs allowed the assessment of the periapical status of 87% of teeth using the PAI. On the contrary, digital radiography had a significantly reduced potential to allow assessment of the periapical status (P < 0.01). Only 57.6% and 34.1% of teeth could be appraised using digital panoramic images displayed on monitor and glossy paper respectively (P < 0.01). The total percentage of teeth with periapical pathosis was five fold higher when assessed with digital panoramic images displayed on glossy paper compared with periapical radiographs (P < 0.01). Conclusions, Teeth were best viewed on periapical radiographs except maxillary second and third molars, which were better viewed in orthopantomograms. Orthopantomograms on screen were scorable more often than when on printed images. Apical periodontitis was scored more often on paper than on screen, and more often on screen than in periapical radiographs. [source]


Periapical status and quality of endodontic treatment in an adult Irish population

INTERNATIONAL ENDODONTIC JOURNAL, Issue 2 2005
J. J. Loftus
Abstract Aim, To determine the prevalence of apical periodontitis and the quality of root fillings in an adult Irish population using a retrospective analysis of orthopantomograms (OPGs). Methodology, A systematic sample of clinical records and OPGs of 302 adult patients attending the Dublin Dental Hospital, Ireland, were screened by two examiners to determine the quality of root canal treatment and the prevalence of apical periodontitis. The operators who carried out the treatment were unknown. Two examiners inspected OPGs after inter-examiner correlation. European Society of Endodontology (ESE) guidelines were used to determine adequacy of root treatment. Results, Of the 7427 teeth examined 2% had root fillings. Apical periodontitis was evident in 1.6% of all nonroot filled teeth whilst 33.1% of the subjects had at least one tooth with apical periodontitis. Of the root filled teeth, 25% had apical periodontitis and 52.6% were considered technically inadequate by ESE guidelines. There was a statistically significant (P < 0.05) negative correlation between the quality of the root fillings and the prevalence of apical periodontitis. Posterior root filled teeth (premolars and molars) had a greater prevalence of apical periodontitis than anterior root filled teeth. Conclusions, The technical quality of root fillings in an adult Irish population was poor and was consistent with a high prevalence of apical periodontitis. [source]


Prevalence of apical periodontitis and frequency of root-filled teeth in an adult Spanish population

INTERNATIONAL ENDODONTIC JOURNAL, Issue 3 2004
A. Jiménez-Pinzón
Abstract Aim, To estimate the prevalence of teeth with apical periodontitis (AP) and root-filled teeth in an adult Spanish population. Methodology, A total of 180 subjects, aged 37.1 ± 15.7 years, presenting as new patients to the Faculty of Dentistry, Seville, Spain, were examined. All participants underwent a full-mouth radiographic survey (14 periapical radiographs). The frequency of root canal treatment and the periapical status of all teeth, using the periapical index (PAI) score, were assessed. An intraobserver agreement test on PAI scores produced a Cohen's kappa of 0.77 (substantial agreement). Results were analysed statistically using the Chi-square test. Results, Apical periodontitis in one or several teeth was found in 110 subjects (61.1% prevalence), and 73 (40.6% prevalence) had at least one root-filled tooth. Among subjects with root-filled teeth, 48 (65.8%) had AP affecting at least one root-filled tooth. A total of 4453 teeth were examined, of these 186 (4.2%) had AP. The total number of root-filled teeth was 93 (2.1%), of which 60 (64.5%) had AP. Among non-root filled teeth, only 2.9% had AP. The prevalence of AP in connection with molar teeth was higher (5.5%) than for premolar (4.5%) and anterior teeth (3.2%; P < 0.01). More premolar and molar teeth were root-filled (2.8 and 2.7%, respectively) than anterior teeth (1.3%; P < 0.01). The prevalence of AP increased with age. Conclusions, The prevalence of AP in root-filled and untreated teeth, and the frequency of root-filled teeth were comparable to those reported in previous similar studies carried out in European countries. The prevalence of root-filled teeth with AP was found to be higher compared to that demonstrated in other epidemiological studies. [source]


Interleukin-6 and granulocyte-macrophage colony-stimulating factor in apical periodontitis: correlation with clinical and histologic findings of the involved teeth

MOLECULAR ORAL MICROBIOLOGY, Issue 1 2003
T. Radics
Apical periodontitis is characterized by the presence of immunocompetent cells producing a wide variety of inflammatory mediators. Releasing cytokines with long-range action, such as interleukin-6 (IL-6) and granulocyte-macrophage colony-stimulating factor (GM-CSF), apical periodontitis may induce changes in remote organs of the host. This study quantified the levels of IL-6 and GM-CSF in symptomatic and asymptomatic human periradicular lesions. Lesions were also characterized by size and histologic findings. Tissue samples were homogenized and supernatants were assayed using an enzyme-linked immunosorbent assay (ELISA). Correlations between cytokine levels and characteristic features (as single variables) of the lesions were analysed. There was a trend for higher levels of IL-6 and GM-CSF in symptomatic than in asymptomatic lesions, but the difference was not significant. Levels also tended to be higher in large than in small lesions, in polymorphonuclear (PMN) cell-rich than in PMN cell-poor samples, and in epithelialized than in non-epithelialized lesions. Significantly higher levels of IL-6 (778.1 ± 220.5 pg/,g) and GM-CSF (363.3 ± 98.4 pg/,g) were found in samples coincidentally possessing symptomatic and epithelialized features than in asymptomatic, small, PMN cell-poor, non-epithelialized lesions (IL-6: 45.2 ± 13.1 pg/,g and GM-CSF: 135.1 ± 26.4 pg/,g). These results suggest that symptomatic lesions containing epithelial cells represent an immunologically active stage of apical periodontitis, whereas asymptomatic, small, PMN cell-poor, non-epithelialized lesions represent healing apical lesions. [source]


Bacteria of asymptomatic periradicular endodontic lesions identified by DNA-DNA hybridization

DENTAL TRAUMATOLOGY, Issue 5 2000
J. J. Gatti
Abstract , Possible inclusion of contaminant bacteria during surgery has been problematic in studies of periradicular lesions of endodontic origin. Therefore, in this study, two different surgical techniques were compared. A second problem is that some difficult to cultivate species may not be detected using bacteriological methods. Molecular techniques may resolve this problem. DNA-DNA hybridization technology has the additional advantage that DNA is not amplified. The purpose of this investigation was to determine if bacteria from periradicular endodontic lesions could be identified using DNA-DNA hybridization. A full thickness intrasulcular mucoperiosteal (IS) flap (n=20) or a submarginal (SM) flap (n=16) was reflected in patients with asymptomatic apical periodontitis. DNA was extracted and incubated with 40 digoxigenin-labeled whole genomic probes. Bacterial DNA was detected in all 36 lesions. Seven probes were negative for all lesions. In patients with sinus tract communication, in teeth lacking intact full coverage crowns, and in patients with a history of trauma, 4,13 probes provided positive signals. Seven probes were positive in lesions obtained by the IS, but not the SM technique. Two probes were in samples obtained with the SM technique, but not the IS. Only Bacteroides forsythus and Actinomyces naeslundii genospecies 2 were present in large numbers using either the IS or the SM technique. The SM flap technique, in combination with DNA-DNA hybridization, appeared to provide excellent data pertaining to periradicular bacteria. These results supported other studies that provide evidence of a bacterial presence and persistence in periradicular lesions. [source]


Postoperative discomfort associated with surgical and nonsurgical endodontic retreatment

DENTAL TRAUMATOLOGY, Issue 2 2000
T. Kvist
Abstract , Endodontic retreatment decision-making must include an appraisal of the costs of the different strategies proposed. In addition to direct costs, postoperative discomfort may have other consequences in terms of time off work, unscheduled visits and suffering. To establish a foundation for the appraisal of such indirect and intangible costs the present study was set up in which patients' assessments of pain and swelling after surgical and nonsurgical retreatment procedures were recorded. Ninety-two patients with 95 root-filled incisors and canine teeth exhibiting apical periodontitis were included in the study. The mode of retreatment was randomly assigned. Each day during the first post-treatment week patients assessed their degree of swelling and pain on horizontal 100-mm visual analog scales (VAS). The scales ranged from "no swelling" to "very severe swelling" and "no pain" to "intolerable pain", respectively. Consumption of self-prescribed analgesics and time off work were also recorded. Significantly more patients reported discomfort after surgical retreatment than after nonsurgical procedures. High pain scores were most frequent on the operative day while swelling reached its maximum on the first postoperative day followed by progressive decrease both in frequency and magnitude. Postoperative symptoms associated with nonsurgical retreatment were less frequent but reached high VAS values in single cases. Analgesics were significantly more often consumed after periapical surgery. Patients reported absence from work mainly due to swelling and discoloration of the skin. This was found to occur only after surgical retreatment. Conclusively, surgical retreatment resulted in more discomfort and tended to bring about greater indirect costs than nonsurgical retreatment. [source]


Treatment choices for negative outcomes with non-surgical root canal treatment: non-surgical retreatment vs. surgical retreatment vs. implants

ENDODONTIC TOPICS, Issue 1 2005
STEVEN A. COHN
The revision of negative treatment outcomes is a significant part of current endodontic practice. Both non-surgical and surgical retreatment procedures share the problem of a significant negative outcome in the presence of apical periodontitis. More positive results may be achieved in certain teeth with a combination of both procedures rather than either alone. However, there are pressures to replace these ,failed' endodontically treated teeth with implants. When comparable criteria are applied to outcomes, the survival rates of endodontic treatment and implant placement are the same. Time, cost, and more flexible clinical management indicate that endodontic retreatment procedures should always be performed first unless the tooth is judged to be untreatable. Endodontists should be trained in implantology to assist patients and referring colleagues in making informed treatment decisions. [source]


Salient virulence factors in anaerobic bacteria, with emphasis on their importance in endodontic infections

ENDODONTIC TOPICS, Issue 1 2004
Ingar Olsen
Endodontic infections by microbial invasion of the necrotic pulp lead to apical periodontitis of both acute and chronic forms. Acute lesions often develop from multiplication of bacteria in primary infections. Such lesions may also occur as exacerbations of chronic forms provoked for example in conjunction with endodontic treatment measures. The clinical course appears related to the character of the microflora. While primary infections are predominated by a mixed flora of anaerobic bacteria and resembles that of aggressive marginal periodontitis, chronic forms of apical periodontitis emerge following regression of the acute infection, whereupon prevailing bacteria have assumed low activity. The significance of virulence factors is easy to understand as far as acute inflammatory conditions are concerned. The role of virulence factors for sustaining chronic inflammation is more unclear and complex. This review is about salient virulence factors in some selected bacterial genera such as Peptostreptococcus, Porphyromonas, Prevotella and Fusobacterium, which often predominate the root canal microbiota in the acute phase of endodontic infections. [source]


How does the periapical inflammatory process compromise general health?

ENDODONTIC TOPICS, Issue 1 2004
Idikó.
Several lines of evidence support the causative role of oral inflammatory lesions and certain systemic diseases, such as atherosclerosis and cardiovascular diseases, adverse pregnancy outcome and lung diseases. Properly executed epidemiologic studies identified increased odds ratios. Local or metastatic spread of oral microorganisms, local production of microbial or host-derived soluble regulatory molecules, that may initiate or sustain inflammatory events in remote tissues and organs and the presence of (a) common , extrinsic- or intrinsic-pathological mechanism(s) may result in or contribute to both local and systemic inflammation. A number of cross-sectional studies addressing a possible association between oral health and systemic diseases have also investigated the presence or the absence of periapical lesions. However, these studies cannot either confirm or refute a role of the periapical inflammatory lesion in the observed associations, since other variables of oral health might have exerted an inestimable influence on general health of the assessed population. The literature, dealing with patients with root canal infections and apical periodontitis as sole oral inflammatory lesions is extremely sparse. Our group has demonstrated that young adults with apical periodontitis exhibit certain biochemical changes, such as elevated levels of C-reactive protein and an increased whole blood chemiluminescence, which have been shown to elevate the risk for cardiovascular diseases. Future research will be required to determine whether and to what extent may endodontic diseases affect general health. [source]


Epidemiologic issues in studies of association between apical periodontitis and systemic health

ENDODONTIC TOPICS, Issue 1 2004
Daniel J. Caplan
Perhaps the most exciting issue currently facing the dental research community centers around a hypothesized connection between chronic inflammatory oral infections, most notably periodontal disease, and the development of adverse systemic health conditions. To date, inflammation of endodontic origin (i.e., apical periodontitis (AP)) has not been extensively studied in this regard despite being a commonly found sequel to bacterial infection of the dental pulp space. Although numerous differences exist between chronic inflammatory disease of periodontal and endodontic origins, there are some notable similarities, primarily that: (1) both often are associated with Gram-negative anaerobic bacteria, and (2) elevated cytokine levels may be released systemically from acute and chronic manifestations of both disease processes. This article provides a brief review of several important concepts concerning adverse general health outcomes as they relate to periodontal disease, summarizes recent epidemiologic studies of AP and root canal therapy, and reviews some general issues involved in the conduct of epidemiologic studies as well as how these issues apply to investigations that address potential links between endodontic inflammatory disease and adverse systemic health outcomes. [source]


Persistent, recurrent, and acquired infection of the root canal system post-treatment

ENDODONTIC TOPICS, Issue 1 2003
Markus Haapasalo
Apical periodontitis is an inflammatory process in the periradicular tissues caused by microorganisms in the necrotic root canal. Accordingly, to achieve healing of apical periodontitis, the main goal of the treatment must be elimination of the infection and prevention of re-infection. As shown by recent epidemiological studies in several countries around the world, post-treatment endodontic disease is a far too common finding. To understand the reasons for survival of resistant bacteria in the filled root canal, it is important to know in detail the interaction between treatment procedures and the root canal flora in primary apical periodontitis. Therefore, in the first half of this review, the focus is placed on control of infection in primary apical periodontitis. This is followed by a detailed description of the resistant root canal microflora and a discussion about the present and future strategies to eliminate even the most resistant microbes in post-treatment disease. [source]


Influence of residual bacteria on periapical tissue healing after chemomechanical treatment and root filling of experimentally infected monkey teeth

EUROPEAN JOURNAL OF ORAL SCIENCES, Issue 4 2006
Lars Fabricius
The purpose of this study was twofold: first, to determine the influence on the healing of the periapical tissues when selected bacterial strains and combinations thereof remain after root canal treatment; and, second, the relationship to healing of the quality of the root filling. In eight monkeys, 175 root canals, previously infected with combinations of four or five bacterial strains and with radiographically verified apical periodontitis, were endodontically treated, bacteriologically controlled, and permanently obturated. After 2,2.5 yr, the periapical regions were radiographically and histologically examined. Of these teeth, 48 root canals were also examined for bacteria remaining after removal of the root fillings. When bacteria remained after the endodontic treatment, 79% of the root canals showed non-healed periapical lesions, compared with 28% where no bacteria were found. Combinations of residual bacterial species were more frequently related to non-healed lesions than were single strains. When no bacteria remained, healing occurred independently of the quality of the root filling. In contrast, when bacteria remained, there was a greater correlation with non-healing in poor-quality root fillings than in technically well-performed fillings. In root canals where bacteria were found after removal of the root filling, 97% had not healed, compared with 18% for those root canals with no bacteria detected. The present study demonstrates the importance of obtaining a bacteria-free root canal system before permanent root filling in order to achieve optimal healing conditions for the periapical tissues. [source]


A multivariate analysis of the outcome of endodontic treatment

EUROPEAN JOURNAL OF ORAL SCIENCES, Issue 3 2004
Dag Řrstavik
In the present study, multivariate analyses were performed on clinical and treatment variables that may influence the outcome of endodontic treatment. Data collected in a previous clinical-radiographic follow-up study were used. Of 810 treated, 675 roots in 498 teeth were followed for 6 months to 4 yr. Of these, 192 (the CAP group) had pre-existing, chronic apical periodontitis and 483 (the NAP group) had not. Root canal treatment followed a standard procedure with one of three sealers chosen at random. Demographic, clinical and radiographic variables were recorded at the start of, and during treatment. The periapical index (PAI) score was used to record the outcome of treatment, and applied in two different endpoint modes (END1 and END2) as the dependent variable for multivariate statistical analyses using logistic regression and the general model. The modes reflected increasing PAI scores (END1) and conventional success/failure assessment (END2). Dropouts were largely similar to the cases followed up. A total of 10 preoperative and peroperative variables were found to be significantly associated with treatment outcome by the multivariate analyses of either the total material or the NAP or CAP subgroups. Several of these were not significant in univariate analyses (e.g. the effect of sealer). Conventional success/failure analyses (END2) identified fewer of the influential variables and had low explanatory power, whereas PAI scores on an ordinal scale (END1) were most sensitive in identifying variables of influence on the treatment outcome. [source]


Tobacco smoking and dental periapical condition

EUROPEAN JOURNAL OF ORAL SCIENCES, Issue 2 2004
Jan Bergström
The relation between smoking and apical periodontitis has been little studied to date. The aim of the present study was to investigate whether tobacco smoking might be associated with the prevalence or severity of periapical lesions. A total of 247 individuals, 81 current smokers, 63 former smokers, and 103 non-smokers participated in the study. The periapical condition was expressed as the number and percentage of radiographically detectable lesions and, in addition, as a severity index. The overall prevalence of apical periodontitis was 52% and the overall prevalence of endodontic treatment 58%. There was no significant influence of smoking on the prevalence of either apical periodontitis or endodontic treatment. The mean number (percentage) of periapical lesions per person was 1.9 (6%) in current smokers, 1.5 (4%) in former smokers, and 1.0 (3%) in non-smokers. Controlling for age, the association between smoking and periapical lesions was not statistically significant. The mean periapical severity index including all teeth, or teeth affected by periapical lesions alone, did not significantly differ between smoking groups. It is concluded that the present observations do not lend support to the assumption that tobacco smoking is associated with apical periodontitis. [source]


Limitations of previously published systematic reviews evaluating the outcome of endodontic treatment

INTERNATIONAL ENDODONTIC JOURNAL, Issue 8 2009
M-K. Wu
Abstract The aim of this work was to identify the limitations of previously published systematic reviews evaluating the outcome of root canal treatment. Traditionally, periapical radiography has been used to assess the outcome of root canal treatment with the absence of a periapical radiolucency being considered a confirmation of a healthy periapex. However, a high percentage of cases confirmed as healthy by radiographs revealed apical periodontitis on cone beam computed tomography (CBCT) and by histology. In teeth, where reduced size of the existing radiolucency was diagnosed by radiographs and considered to represent periapical healing, enlargement of the lesion was frequently confirmed by CBCT. In clinical studies, two additional factors may have further contributed to the overestimation of successful outcomes after root canal treatment: (i) extractions and re-treatments were rarely recorded as failures; and (ii) the recall rate was often lower than 50%. The periapical index (PAI), frequently used for determination of success, was based on radiographic and histological findings in the periapical region of maxillary incisors. The validity of using PAI for all tooth positions might be questionable, as the thickness of the cortical bone and the position of the root tip in relation with the cortex vary with tooth position. In conclusion, the serious limitations of longitudinal clinical studies restrict the correct interpretation of root canal treatment outcomes. Systematic reviews reporting the success rates of root canal treatment without referring to these limitations may mislead readers. The outcomes of root canal treatment should be re-evaluated in long-term longitudinal studies using CBCT and stricter evaluation criteria. [source]


A preliminary study on the technical feasibility and outcome of retrograde root canal treatment

INTERNATIONAL ENDODONTIC JOURNAL, Issue 9 2008
P. Jonasson
Abstract Aim, To investigate the technical feasibility and outcome of retrograde root canal treatment. Summary, Endodontic access cavity preparation in abutment teeth may jeopardize the retention of the coronal restoration leading to prosthodontic failure. In such cases leaving the crown intact and performing retrograde root canal treatment might be an alternative approach. The potential to promote healing with retrograde endodontic treatment, and the technical feasibility to shape, clean and fill the canal was evaluated retrospectively. The study consisted of 21 incisors, canines and premolar teeth followed-up clinically and radiographically from 6 to 48 months. In 14 teeth the canals were completely negotiated. These cases were all judged as completely healed. In five cases no canal could be explored by files and a conventional ultrasonic root-end preparation and filling was performed. Two of these were classified as completely healed and three as ,uncertain'. In 2 two-rooted premolars a combination was performed with complete instrumentation of the buccal canal and the ultrasonic root-end preparation of the palatal root. One case was judged as a failure and the other was classified as completely healed. The results from this preliminary evaluation of retrograde root canal treatment are promising and merit a randomized clinical trial. Key learning points ,,Abutment teeth with vital pulps may develop pulp necrosis and apical periodontitis in 10% of cases. ,,Endodontic access preparation through an artificial crown may weaken its retention and jeopardize the longevity of a bridgework. ,,Retrograde root canal treatment is often feasible in maxillary teeth. ,,Results from this preliminary study suggest that treatment outcome for retrograde and orthograde root canal treatment is similar. [source]


A 20-year follow-up study of endodontic variables and apical status in a Swedish population

INTERNATIONAL ENDODONTIC JOURNAL, Issue 12 2007
M. Eckerbom
Abstract Aim, To re-examine a population after 20 years and evaluate changes in prevalence of endodontic treatment and apical periodontitis, as well as the technical quality of root fillings. Methodology, One hundred and fifteen out of an original 200 patients living in the northern part of Sweden were re-examined with a full mouth radiographic survey after 20 years. Frequencies of root canal treated teeth, apical periodontitis and quality parameters of root fillings were registered. Results, The frequency of root canal treated teeth increased significantly (P < 0.05) from 13.9% at the first investigation to 17.7% after 20 years. There was also a statistically significant increase (P < 0.05) in teeth with apical periodontitis from 3.3% to 6.8%. Apical periodontitis both in connection with root canal treated teeth and teeth without endodontic treatment, had increased during the follow-up period. Even though the quality of the root fillings had improved, there was no corresponding improvement of the apical status in teeth with root fillings. Conclusions, There is still a great need for endodontic treatment in the Swedish population, and no improvement in apical health was found during this 20-year follow up. [source]


Development of an ex vivo model for the study of microbial infection in human teeth

INTERNATIONAL ENDODONTIC JOURNAL, Issue 5 2007
B. Patel
Aims, (1) To infect human teeth artificially to mimic root canal and dentine infection, using the Constant Depth Film Fermenter (CDFF); (2) To verify the similarity of the infections to those found, in vivo, using culture and microscopy (SEM, LM and TEM). Methodology, Human teeth [n = 38 and n = 28, for phases I (preliminary) and II (definitive), respectively] were infected within the CDFF for a period of 28 days and at pre-selected time points were removed, externally decontaminated using validated protocols and subjected to either culture-dependent or microscopy protocols. The condition of the teeth was varied in phase I to establish the feasibility of the approach and identify optimal conditions. This informed the selection of optimal conditions for definitive test in phase II. For culture-dependent analysis in this phase, a dentine filing sample was obtained from the apical 5 mm of the root canal and cultured anaerobically to allow isolation of individual strains. Bacterial DNA was extracted from purified isolates, the 16S rRNA genes amplified by PCR and the amplicons sequenced for identity using sequence databases. Teeth assigned for microscopy were post-fixed in 3% gluteraldehyde after removal from the CDFF and then subjected to appropriate protocols prior to microscopic evaluation of the infection. Results, All three microscopy techniques and culture-dependent analysis confirmed infection of the human teeth using the CDFF, with root canal infections visually resembling closely those seen in vivo. Furthermore, partial 16S rRNA gene sequencing of DNA from cultured isolates confirmed a selective number of 7,9 genera/species in the apical portion of two teeth each at 7 and 28 days; these taxa are also commonly recovered from teeth with apical periodontitis, in vivo. There were no objective measures other than speciation and topographical evaluation to compare the artificial and real (in vivo) infections. Conclusions, The proposed ex vivo model has the potential for development into an investigative tool for studying the dynamics of bacterial ecology in infected root canals, both before and after treatment. Its advantage is the ability to control both the abiotic and biotic factors. There is a need for the development of objective measures to compare artificial and real bacterial biofilms. [source]


Antibacterial efficacy of calcium hydroxide intracanal dressing: a systematic review and meta-analysis

INTERNATIONAL ENDODONTIC JOURNAL, Issue 1 2007
C. Sathorn
Abstract Aim, To determine to what extent does calcium hydroxide intracanal medication eliminate bacteria from human root canals, compared with the same canals before medication, as measured by the number of positive cultures, in patients undergoing root canal treatment for apical periodontitis (teeth with an infected root canal system). Methodology, CENTRAL, MEDLINE and EMBASE databases were searched. Reference lists from identified articles were scanned. A forward search was undertaken on the authors of the identified articles. Papers that had cited these articles were also identified through the Science Citation Index to identify potentially relevant subsequent primary research. Review methods, The included studies were pre-/post-test clinical trials comparing the number of positive bacterial cultures from treated canals. Data in those studies were independently extracted. Risk differences of included studies were combined using the generic inverse variance and random effect method. Results, Eight studies were identified and included in the review, covering 257 cases. Sample size varied from 18 to 60 cases; six studies demonstrated a statistically significant difference between pre- and post-medicated canals, whilst two did not. There was considerable heterogeneity among studies. Pooled risk difference was ,21%; 95% CI: ,47% to 6%. The difference between pre- and post-medication was not statistically significant (P = 0.12). Conclusions, Calcium hydroxide has limited effectiveness in eliminating bacteria from human root canal when assessed by culture techniques. [source]


Longitudinal study of periapical and endodontic status in a Danish population

INTERNATIONAL ENDODONTIC JOURNAL, Issue 2 2006
L.-L. Kirkevang
Abstract Aim, To describe and discuss changes in periapical and endodontic status in a general Danish population. Methodology, In 1997, 616 randomly selected individuals had a full-mouth radiographic survey taken. In 2003, 77% of the participants attended for a new full-mouth radiographic examination. Information on endodontic treatment and periapical status was obtained. The periapical index (PAI) was used to assess apical periodontitis (AP). Results, More participants had root filling(s) and AP in 2003 than in 1997. More teeth had AP and/or root fillings in 2003. Fewer of the root-filled teeth (RFT) had AP in 2003. Less than 3% of the teeth without root fillings (NRFT) that in 1997 had no AP, developed AP and/or received a root filling. Of the NRFT which in 1997 had AP, more than 35% still had AP and no root filling in 2003. Approximately, 30% of the NRFT with AP in 1997 received a root filling. Of the teeth that received a root filling, 40% had healed, whereas 60% had not. Approximately, 25% of the NRFT that in 1997 had AP had been extracted. In 1997 there were 618 RFT, 314 of the RFT had no AP in 1997. Almost 20% of the RFT that in 1997 were periapically sound, developed AP. Of the 304 RFT with AP in 1997, approximately 30% had healed, in 60% AP persisted, and 10% were extracted. Conclusions, The present study indicates that caution must be exercised when statements on the outcome of root canal treatment are made based on the cross-sectional studies. [source]


Periapical status and quality of endodontic treatment in an adult Irish population

INTERNATIONAL ENDODONTIC JOURNAL, Issue 2 2005
J. J. Loftus
Abstract Aim, To determine the prevalence of apical periodontitis and the quality of root fillings in an adult Irish population using a retrospective analysis of orthopantomograms (OPGs). Methodology, A systematic sample of clinical records and OPGs of 302 adult patients attending the Dublin Dental Hospital, Ireland, were screened by two examiners to determine the quality of root canal treatment and the prevalence of apical periodontitis. The operators who carried out the treatment were unknown. Two examiners inspected OPGs after inter-examiner correlation. European Society of Endodontology (ESE) guidelines were used to determine adequacy of root treatment. Results, Of the 7427 teeth examined 2% had root fillings. Apical periodontitis was evident in 1.6% of all nonroot filled teeth whilst 33.1% of the subjects had at least one tooth with apical periodontitis. Of the root filled teeth, 25% had apical periodontitis and 52.6% were considered technically inadequate by ESE guidelines. There was a statistically significant (P < 0.05) negative correlation between the quality of the root fillings and the prevalence of apical periodontitis. Posterior root filled teeth (premolars and molars) had a greater prevalence of apical periodontitis than anterior root filled teeth. Conclusions, The technical quality of root fillings in an adult Irish population was poor and was consistent with a high prevalence of apical periodontitis. [source]


Periapical status and quality of root fillings and coronal restorations in an adult Spanish population

INTERNATIONAL ENDODONTIC JOURNAL, Issue 8 2004
J. J. Segura-Egea
Abstract Aim, To investigate the quality of root fillings and coronal restorations and their association with periapical status in an adult Spanish population. Methodology, A total of 180 subjects, aged 37.1 ± 15.7 years, who presented as new patients at the Faculty of Dentistry, Seville, Spain, were examined. All participants underwent a full-mouth radiographic survey incorporating 14 periapical radiographs. The periapical region of all root filled teeth, excluding third molars, were examined. The technical quality of root fillings was evaluated in terms of length in relation to the root apex and lateral adaptation to the canal wall. Radiographic signs of overhang or open margins associated with coronal restorations were also evaluated. Periapical status was assessed using the Periapical Index score. Statistical analyses were conducted using the Cohen's , test and logistic regression. Results, The total number of root filled teeth was 93, and 60 (64.5%) had apical periodontitis (AP). Presence of AP in root filled teeth was associated with inadequate adaptation of the filling (OR = 2.29; P = 0.06), inadequate length of the root filling (OR = 2.44; P = 0.048), and with poor radiographic quality of the coronal restoration (OR = 2.38; P = 0.054). Only 34.4% of the root fillings were adequate from a technical perspective. When both root fillings and coronal restorations were adequate the incidence of AP decreased to 31.3% (OR = 5.50; P < 0.01). Conclusions, The incidence of AP in root filled teeth was high. Many root fillings were technically unsatisfactory. Adequate root fillings and coronal restorations were associated with a lower incidence of AP; an adequate root filling had a more substantial impact on the outcome of treatment than the quality of the coronal restoration. [source]


Prevalence of apical periodontitis and frequency of root-filled teeth in an adult Spanish population

INTERNATIONAL ENDODONTIC JOURNAL, Issue 3 2004
A. Jiménez-Pinzón
Abstract Aim, To estimate the prevalence of teeth with apical periodontitis (AP) and root-filled teeth in an adult Spanish population. Methodology, A total of 180 subjects, aged 37.1 ± 15.7 years, presenting as new patients to the Faculty of Dentistry, Seville, Spain, were examined. All participants underwent a full-mouth radiographic survey (14 periapical radiographs). The frequency of root canal treatment and the periapical status of all teeth, using the periapical index (PAI) score, were assessed. An intraobserver agreement test on PAI scores produced a Cohen's kappa of 0.77 (substantial agreement). Results were analysed statistically using the Chi-square test. Results, Apical periodontitis in one or several teeth was found in 110 subjects (61.1% prevalence), and 73 (40.6% prevalence) had at least one root-filled tooth. Among subjects with root-filled teeth, 48 (65.8%) had AP affecting at least one root-filled tooth. A total of 4453 teeth were examined, of these 186 (4.2%) had AP. The total number of root-filled teeth was 93 (2.1%), of which 60 (64.5%) had AP. Among non-root filled teeth, only 2.9% had AP. The prevalence of AP in connection with molar teeth was higher (5.5%) than for premolar (4.5%) and anterior teeth (3.2%; P < 0.01). More premolar and molar teeth were root-filled (2.8 and 2.7%, respectively) than anterior teeth (1.3%; P < 0.01). The prevalence of AP increased with age. Conclusions, The prevalence of AP in root-filled and untreated teeth, and the frequency of root-filled teeth were comparable to those reported in previous similar studies carried out in European countries. The prevalence of root-filled teeth with AP was found to be higher compared to that demonstrated in other epidemiological studies. [source]


The relationship of intracanal medicaments to postoperative pain in endodontics

INTERNATIONAL ENDODONTIC JOURNAL, Issue 12 2003
E. H. Ehrmann
Abstract Aim, To investigate the relationship of postoperative pain to three different medicaments placed in the root canal after a complete biomechanical debridement of the root canal system in patients presenting for emergency relief of pain. Methodology, Two hundred and twenty-three teeth belonging to 221 patients presenting as emergencies to the Royal Dental Hospital of Melbourne were included in the study. Inclusion was limited to patients with a diagnosis of pulp necrosis and acute apical periodontitis. All teeth underwent conventional root canal treatment, which involved the instrumentation to the apices of each canal at the first visit. Canals were instrumented using a stepback technique and hand-files along with irrigants using Milton's (1% sodium hypochlorite) solution followed by 15% EDTAC. The canals were dried and one of the following three medicaments was inserted into the canal in random sequence: Group 1: Ledermix paste (Lederle Pharmaceuticals, Division of Cyanamid, Wolfratshausen, Germany); Group 2: calcium hydroxide paste (Calcipulpe, Septodont, France); and Group 3: no dressing. Before dismissal, the preoperative pain experienced on the previous night was recorded using a visual analogue pain scale. Patients were then instructed to record the degree of pain experienced 4 h after treatment and daily for a further 4 days. Results, The mean score pain for all three groups was between 42 and 48 prior to treatment being commenced. After 4 days, the pain score for Group 2 was 10, for Group 3 was 7 and for Group 1 was 4. Mean preoperative pain level was 44.4 (of a maximum 100) for all groups, and declined by 50% (to 22.1) after 24 h. Patients in Group 1 (Ledermix) experienced significantly less (P = 0.04) postoperative pain than those in the other two groups. There was no significant difference between Group 2 (calcium hydroxide) and Group 3 (no dressing). Conclusion, Under the conditions of this study, painful teeth with acute apical periodontitis that had been dressed with Ledermix paste gave rise to less pain than that experienced by patients who had a dressing of calcium hydroxide or no dressing at all. Ledermix is an effective intracanal medicament for the control of postoperative pain associated with acute apical periodontitis, with a rapid onset of pain reduction. [source]


Prevalence of yeasts in saliva and root canals of teeth associated with apical periodontitis

INTERNATIONAL ENDODONTIC JOURNAL, Issue 4 2002
M. W. Egan
Abstract Egan MW, Spratt DA, Ng Y-L, Lam JM, Moles DR, Gulabivala K. Prevalence of yeasts in saliva and root canals of teeth associated with apical periodontitis. International Endodontic Journal, 35, 321,329, 2002. Aims To determine: (i) the relative prevalence and diversity of yeasts in salivary and root canal samples from the same patients; and (ii) the clinical factors associated with their presence in saliva and root canals. Methodology Sixty root canal samples from teeth associated apical periodontitis and the corresponding whole unstimulated saliva samples were obtained from 55 patients. The medical history including antibiotic therapy and clinical/radiographic data on the teeth were recorded. The samples were serially diluted and cultured on yeast & fungi-selective sabouraud dextrose agar. Isolates were characterized and speciated by the germ tube formation test, hyphal morphology and a commercial biochemical test kit (Rapid ID32C® system). Results Twenty-three yeast isolates were recovered from 19 saliva samples and eight isolates from six root canal samples. Candida albicans (17/23 & 3/8) and Rodotorula mucilaginosa (2/23 & 4/8) were the most prevalent isolates from saliva and root canal samples. It was significantly (13.8 times) more probable that yeasts would be recovered from root canals when they were also present in the saliva (P = 0.021). The effect of coronal restoration leakage (P = 0.08) and previous root canal treatment (P = 0.123) were equivocal. The history of antibiotic therapy had no association with the presence of yeasts in saliva (OR = 1.1). Conclusions Yeasts occurred relatively infrequently (10%) in root canals. Their presence in root canals was significantly associated with their presence in saliva. The role of yeasts in the initiation and perpetuation of periapical disease remains to be determined. [source]


Isolation of yeasts and enteric bacteria in root-filled teeth with chronic apical periodontitis

INTERNATIONAL ENDODONTIC JOURNAL, Issue 6 2001
V. Peciuliene
Abstract Aims The aim of this study was to determine the occurrence and role of yeasts, enteric gram-negative rods and Enterococcus species in root-filled teeth with chronic apical periodontitis, and the antimicrobial effect of iodine potassium iodide (IKI) irrigation. Methodology Forty symptom-free root-filled teeth with chronic apical periodontitis were included in the study. The patients were divided into two groups. In group A the canals were filled with calcium hydroxide for 10,14 days after cleaning and shaping; in group B the canals were irrigated with IKI for 5 min after cleaning and shaping followed by a permanent root filling. Microbiological samples were taken from the canals before and after the chemomechanical preparation and after iodine irrigation (group B). Results Microbes were isolated from 33 of 40 teeth in the initial sampling. Yeasts were isolated from six teeth, three of them together with E. faecalis. Enteric rods (Escherichia coli, Klebsiella pneumoniae and Proteus mirabilis) were present in three teeth and E. faecalis was isolated from 21 of the 33 culture positive teeth, 11 in pure culture. Growth was detected in 10 teeth of the second samples. Six of the 10 cases were E. faecalis, with five being a pure culture. All third samples (after IKI) except one were negative. The number of microbial cells per sample did not correlate with lesion size. Two flare-ups were recorded, both in teeth with a mixed infection. Conclusion The high prevalence of enteric bacteria and yeasts in root-filled teeth with chronic apical periodontitis was established. IKI improved the antimicrobial effect of the treatment. [source]


Apical inflammatory root resorption: a correlative radiographic and histological assessment

INTERNATIONAL ENDODONTIC JOURNAL, Issue 6 2000
M. Laux
Abstract Aim To assess the reliability of routine single radiographs in the diagnosis of inflammatory apical root resorption by correlating the radiographic and histological findings. Methodology The material comprised serial and step serial sections of plastic-embedded root-apices with attached apical periodontitis lesions that were prepared for a previous study and the diagnostic radiographs. The histological sections of 114 specimens were analysed by light microscopy and categorized into three groups: (i) those without any resorption (0); (ii) those with moderate resorption (+); and (iii) those with severe resorption (+ +). The radiographs were examined by a separate examiner and graded with a similar categorization of no resorption (0); moderate (+); and severe (+ +) apical resorption. Results Radiographically, 19% of the teeth were diagnosed as having apical inflammatory root resorption, whereas histologically, 81% of the teeth revealed apical inflammatory root resorption. A correlative radiographic and histological assessment (n = 104) revealed a coincidence of diagnosis in 7% of the specimens and noncoincidence of diagnosis in 76% of the specimens. Conclusions The results indicate that routine single radiographs are not sufficiently accurate or sensitive to consistently diagnose apical root resorptive defects developing as a consequence of apical periodontitis. [source]