Download ESE ROME 2011

ESE ROME 2011
NOT ONLY ROOTS
1 5 TH B I E N N I A L C O N G R E S S
OF THE EUROPEAN SOCIETY
OF ENDODONTOLOGY
R O M E - 2 0 1 1 , S E P T E M B E R 1 4 TH - 1 7 TH
R O M E CAVA L I E R I H OT E L
POSTERS
ESE ROME 2011
NOT ONLY ROOTS
THURSDAY, 15TH SEPTEMBER 2011
Chairpersons: Ove Peters, Johannes Klimscha
Session T1 – 13.30
T1 - 1
Proposal for a clinical practice guide in endodontology in
Romania, according to the AGREE guidelines
Adrian Bacila, Alexandru Bucur, Stefan-Ioan Stratul, Doina Onisei,
Emilia Ianes, Luminita Nica
Faculty of Dental Medicine, Victor Babes University of Medicine and Pharmacy Timisoara, Romania
Faculty of Dental Medicine, Carol Davila University of Medicine and Pharmacy Bucharest, Romania
Abstract
AIM. The last two decades witnessed major changes in the dental
care providers system in Romania: the overwhelming establishment
of private practices and dental health insurances; the establishment
in 2010 of the dental specialties of endodontology, periodontology,
prosthodontics and their national recognition; the developments and
advances in the fields of clinical dentistry. These changes have led to
the identification of the need for the regulation of the clinical practice in the most important dental specialties. METHODOLOGY. In November 2010, following the call of the Professional-Scientific Commission of the Romanian College of Dentists CMDR, professors and
experts in endodontology from 7 leading Romanian dental schools
have been invited to join a consensus team, which aim is to produce
the first Clinical Practice Guide in Endodontology. According to the
requests of CMDR, this first Guide is intended for general practitioners, while a next extended Guide will be issued to regulate the activity of specialists in endodontology. RESULTS. On this occasion,
several proposals of consensus processes were issued. The poster
presents one of the proposals based on the 21 universal criteria of
the AGREE (Appraisal of Guidelines Research and Evaluation) collaboration (www.agreecollaboration.org), gathered under the headlines:
1. Definition of the scope and purpose 2. The stakeholder involvement 3. The rigour of development 4. The clarity and presentation 5.
The applicability and 6. The editorrian independence. CONCLUSION.
To date, a first draft of Clinical Practice Guide in Endodontology has
been distributed nationwide to be commented and amended. The
draft and the ammendements are currently under evaluation by the
CMDR ruling bodies.
T1 - 2
Influence of root canal treatment on leukocytes and neutrophils count: a case report
Iman Hassanzadeh, T. Charles
Université Libre de Bruxelles, Brussels, Belgium
Abstract
The goal of the endodontic therapy is to eliminate the pulpal tissue, to
prevent or heal an infection of the root canal system. In case of an unsuccessful treatment of infected teeth, bacteria’s endotoxins will create a periradicular inflammatory lesion. The mediators of this local
inflammation can generate an inflammatory syndrom with impacts
on systemic diseases, which can induce or complicate many cardiac
pathologies like arrhythmia or high blood pressure. This case report
will illustrate this fundamental aspect of the endodontic therapy. A
72 years old woman was referred by her cardiologist for a persistent
inflammatory systemic syndrom. The patient presents a weakened
general health with histories of cardiac surgery (myxome), high blood
pressure, arrhythmia (atrial fibrillation) and an important leucocytosis of unknowed origin. A scintigraphy had been realized without
any result on the source of the chronic infection. The last blood test
www.eserome2011.com
before the endodontic retreatments showed pathologic results with
a leukocytes count of 11070 (normal count : 4000-11000) and a neutrophils count of 8944 (normal count : 1400-6700). New blood tests
were realized in collaboration with her cardiologist during the period
of the endodontic treatment and showed a significant improvement of
the hyperleucocytosis. A decrease of the leukocytes and neutrophils
was observed: from 11070 (one month before treatment) to 6200 (one
month after treatment) for the leukocytes, from 8944 (one month before treatment) to 3577 (one month after treatment) for the neutrophils. In the same time, the clinical symptoms like the arrhythmia
have been reduced. In conclusion, this case report shows the influence of endodontic treatment on the general health and cardiovascular state. Such an inflammatory syndrome caused by unsatisfactory
root treatment can produce harmful and even lethal effect.
T1 - 3
Long -term bone mass evaluation after endoperiodontal
therapy in woman receiving hormon replacing therapy
Leusic Temmer Jelka, Vera Njemirovskij
Dental Polyclinic Zagreb, Crotia
School of Dental Medicine University of Zagreb, Croatia
Abstract
The aim of this study was to examine the bone mass of the mandible
incisal region after endo-eriodontal treatment in woman receiving
hormon replacing therapy determinated with densitometric measurement..The patient was age 55 with diagnosis of osteoporosis
treated during 9 years with hormon replacing therapy.The reason of
visiting was compromised periodontitis and endodonticaly treated
tooth 41. After endodontic treatment and fixation with extracoronar
splint ,aproached densitometric measurment
using” TROPHY-RWG -UI” digital X- ray system.assesed by following
the gray scale principle.The first stage of periodontal treatment included initial therapy I ,followed by initial therapy II, root scalling. Reevaluation followed by regenerative and surgical treatment. A “Biooss”xenogenic osseus implant and non-resorbic Biogide(Geisslich)
membrane was used.Computer assistted radiodensitometric measurment of surgical region were carried out prior to surgical treatment , six months,a year and three years after treatment. The results
confirmed that hormon replacement therapy assosiated with endoperiodontal therapy did not damage bone mass of mandible.
T1 - 4
Main reasons for endodontic treatment in a population of
Pancevo, Serbia
Kolak Veljko, Dragana Pesic, Irena Melih, Milica Popovic,
Ankica Jakovljevic,
Faculty of Stomatology, Pancevo, Serbia
Abstract
AIM. The aim of this epidemiological study was to evaluate the prevalence of endodontically treated teeth and teeth needing endodontic
treatment, as well as to investigate the frequency of different indications for this therapy in an adult population of the municipality of
Pancevo, Serbia.
METHODOLOGY. An epidemiological study was conducted at the Institute of Stomatology, Faculty of Stomatology in Pancevo during 2009
and 2010. The study included 148 randomly chosen male and female
patients, aged over 20 years from Pancevo, Serbia. Clinical and radiographic examination on each patient was performed. Radiographic
examination included panoramic and periapical radiographs. The
periapical region of the teeth included in this study was examined
using the Periapical index scoring system ( PAI). Data were statistically analyzed using Chi-Square and Mann-Whitney tests.
RESULTS. Of the 3168 teeth that were examined, 208 (7%) were
endodontically treated and 314 (10%) were indicated for endodontic treatment. The most frequent indication for therapy was apical
periodontitis (51%), which showed statistically significant difference
1
1 5 TH B I E N N I A L C O N G R E S S
OF THE EUROPEAN SOCIETY
OF ENDODONTOLOGY
(p<.001) in relation to other reasons for treatment. Between different age groups, the largest number of teeth indicated for endodontic
treatment : 86 (27%) were in the group of patients 20-30 years old.
Anterior teeth were significantly more often indicated for treatment
(47%), (p<.001), compared to premolars and molars.
CONCLUSION.The results of this study show a high prevalence of apical periodontitis, and a high need for endodontic treatment in Pancevo. Furthermore, it indicates a lack of culture in terms of oral health
care, and lack of regular habits of oral hygiene, bad attitude to dental
treatment and low level of preventive care in Pancevo.
R O M E - 2 0 1 1 , S E P T E M B E R 1 4 TH - 1 7 TH
R O M E CAVA L I E R I H OT E L
T1 – 5
Results: In the retreatment group, 77% of lesions healed, whereas
the root canal treatment group had a 100% healing rate. Patients suffering from post extraction ONJ showed periradicular lesions in 57%
of extracted teeth.
Conclusion: This preliminary short-term study suggests that patients taking endovenous bisphosphonates may expect a satisfying
outcome of conventional root-canal treatment or re-treatment, with
satisfactory periradicular healing, and that there is a higher possibility of presenting ONJ if the tooth extracted was already affected
by a periradicular lesion. Thus, root canal treatment may be considered a safe and realistic alternative to extraction in patients following
bisphosphonate therapy.
Determination of mercury in hard tissue of the teeth
T1 - 7
Nexhmije Ajeti, Veton Hoxha, Xhevdet Elezi, Tringa Kelmendi, Violeta
Vula
Operative Dentistry and Endodontology, University of Prishtina, Kosovo
University of Prishtina, Faculty of Agronomy
Abstract
The aim of this study was to determinate the mercury in hard tissue
of the teeth.
Materials and methods: 30 human single root human teeth were tested. They were extracted for different reasons. Depends of preparation of cavity teeth were divided in three experimental group with 10
teeth.Group 1-10 teeth were prepared in occlusal surface,group 2-10
teeth were prepared in approximal-oclusal surface and group 3-10
teeth were prepared in MOD. All of them were filled with amalgam
and after 24 hours, and five teeth of each group were polished. After
9 months the examples were tested.
Before chemical analysis tooth were irrigated four times for 10 minutes in ultrasonic bath.Tooth were grind in size less than in grinder
with sphere (Retch, Germany. After grinder tooth were dry in thermostat on 105°C temperatures, for 3 hours. Every tooth was weight with
weight machine (Kern, Germany). From each tooth was taken 250
mg dust and was mineralized with royal water (HCl+HNO3 in ration
1:3) in microwave oven (Bergenhof, Germany). After mineralization
examples were filtered and were analyzed in ICP-OES (Perkin Elmer,
USA, Optima 2100 DW).
Results: There were significant differences in the amount average of
mercury in both groups polished (One Way Anova, F=110.54, p<0.001),
and unpolished groups (One Way Anova, 69.54, p<0.001).
Conclusions: It may be concluded that mercury was released more in
unpolished amalgam fillings than polished amalgam fillings.
T1 – 6
Endodontic implications in patient taking intravenous
bisphosphonates
Paolo Ambrogio, Paola Franco, Damiano Pasqualini, Nicola Scotti,
Elio Berutti
Department of Endodontics, Prof. E. Berutti
University of Turin Dental School, Turin, Italy
Abstract
Introduction: Bisphosphonates are pharmacological compounds
whose most important biological effect is to reduce bone remodelling. They are associated with a rare adverse event, known as osteonecrosis of the jaws (ONJ). The impact of endovenous bisphosphonates on periradicular healing, and the correlation between ONJ and
periradicular lesions, are yet to be determined. This study evaluated
the healing of periradicular lesions after root canal therapy in patients taking endovenous bisphosphonates, and assessed the correlation between ONJ and periradicular lesions.
Methods: Teeth with or without preoperative periradicular radiolucency were identified in patients undergoing endovenous bisphosphonate
therapy. Each case was examined clinically and radiographically to determine treatment outcome. Non-surgical root canal treatments and
re-treatments were performed by a single endodontist at the Lingotto
Dental School of Turin, using non-standardized protocols.
2
Hepatitis and dentists: our experience
F Shllaku, M Kelmendi, Donika Bajrami, Miranda Stavileci
Faculty of dentistry, University Children’s Hospital, Prishtina, Kosovo
Abstract
AIM. There are many reports which document that dentists, especially oral surgeons are a “high risk” group for developing hepatitis.
The presence of serum markers in dentists is about 16.0% in relation
to other population ( 9.0%). B hepatitis is considered very important
for dentists, because of its frequency and the severity of its clinical picture. The aim of this study was to determine: 1. The incidence
of hepatitis and 2. To focus on the role of preventive measures in
decreasing the prevalence of hepatitis in dentists and other health
workers. METHODOLOGY. The investigation sample consists of two
groups: 1. 20 dentists employed at the Dental Clinic in Prishtina and.
2. 124 dentists from Kosova cities.
Using radioimmuno assay technique, HBS antigen was “screened”
in the first group, whereas information about hepatitis was obtained
from the second dentists group. RESULTS. 11 of 20 dentists were HBS
positive (55.0%) and 9 HBS negative ( 45.0%). Such a high percentage of positive HBS antigen in dentists is probably due to the small
sample size. 13 out of the 124 questioned dentists showed a history
positive for hepatitis ( 10.5%), with a prevalence significantly higher
in Prishtina’s dentists. The prevalence of hepatitis in these dentists
is probably higher due to anicteric forms. CONCLUSION. Our results
confirm the well known phenomenon of high prevalence of hepatitis in dentists. Preventive measures are needed for health workers,
including dentists, with a anti hepatitis vaccine as the best solution.
T1 - 8
Clinical approach of radix entomolaris cases
Petridis Xenos, Georgios P. Dechouniotis, Vasiliki Kondylidou, Maria
K. Georgopoulou
Greece
Abstract
The importance of familiarization with the variations of the tooth and
root canal anatomy is unquestionable in order to achieve an optimal endodontic treatment outcome. Mandibular molars constitute a
group of teeth that shows deviations of varying frequency from the
expected tooth and canal morphology. Pre- and/ or intra- operative
incognizance of such anatomical characteristics may invite treatment failure.
Studies have shown that the first mandibular molars may display deviations from the two-rooted norm that is usually encountered. Additional roots that are located either disto-lingually or mesio-buccally
have been reported, assigning the terms radix entomolaris and paramolaris respectively. A strong correlation between the incidence of
these supernumerary roots and the studied ethnic groups seems to
appear, with Asian populations exhibiting higher frequencies than
the Caucasians.
The external morphological characteristics and the corresponding
internal anatomical features of these additional roots are not easily
distinguishable. Angled periapical radiographs may raise suspicions
ESE ROME 2011
NOT ONLY ROOTS
regarding the existence of a supernumerary macrostructure, but
more advanced means of radiographic visualization, such as conebeam computed tomography (CBCT) offer more precise anatomical
information. Also, means of enhanced magnification as well as endodontic instruments of Ni-Ti manufacture constitute valuable aids in
identifying and preparing the morphologically variable canals of the
radix entomolaris/ paramolaris mandibular molars.
The purpose of this study is to present clinical cases of radix entomolaris first mandibular molars and describe via radiographic and
dental operating microscope images the steps for identifying and
treating such cases.
T1 - 9
Evaluation of the knowledge and attitude of martial art
female masters about encountering to tooth avulsion
and factors related to that in stadiums of the capital city
of Iran
posed pulp were capped with zinc-oxide as control. In group II ,the
exposed pulp were capped with capsaicin as experimental group .All
access cavities were sealed with glass inomer cement (Fuji IX).The
animals were sacrificed at,1,2 and 4 weeks after the procedure. The
specimens were stained with H& E and studied by light microscope.
Results: Inflammatory response including intensity and signs of necrosis decreased significantly during first to fourth week in group
I.(P=0.029,P=0.026)
In capsaicin group hyperaemia decreased significantly during first,
second and fourth week.(p=0.019)
In comparison of the effect of two drugs on pulp in 4 weeks sign
of necrosis increased significantly in capsaicin group.(p=0.029) Two
groups showed difference in dental barrier formation, type of inflammatory response and soft tissue changes but these differences were
not statistically significant.(p>0.05)
Conclusions: according to findings of this study capsaicin could decrease the intensity of inflammation.
Rezvani Yasaman, Peyvand Moeeni, Mehrnaz Rafe ee Anaraki
Tehran azad dental school pediatrics, Tehran, Iran
Chairpersons: Hani Ounsi, Roberto Fornara
Abstract
Aim: Trauma to primary and permanent teeth and supporting structures is one of the common problems in children.Avulsion is one the
most complicated cases of trauma that contains1-16% of trauma in
the children at the age of 7-11 years old. Physical education teachers are the first people who face children have the most time opportunity to put back the avulsed tooth in the Regarding to the lack
of knowledge in physical education teachers from the treatment of
tooth avulsion, we decided to survey the women masters of martial
arts in the capital of Iran and educate them how to handle correctly
with dental traumas.
Methodology: In the present descriptive analytic research,first we
divided Tehran into four parts. 112 masters answered our questionnaires that included 26 questions.7 questions about personal information .9 question about the knowledge of dental traumas emergencies There were 10 questions about trainers consideration in the field
of dental traumas emergencies.
Results: Among 112 people in the survey, 34 people (30.3%) had good
knowledge, 58 people (51.6%) had average knowledge and 20 people
(17.1%) had weak knowledge. There is a significant relation between
knowledge & working experience (P.value= 0.033<0.05) & educational
level (P.value= 0.002<0.05), Among the teachers who were surveyed
33 people (27.6%) had good consideration, 67 people (54.8%) had
average consideration & 14 people (12.6%) had week consideration,
Between attitude & age (P.value= 0.004<0.05) & working experiment
level (P.value= 0.001<0.05) & educational level (P.value= 0.002<0.05)
& significant relation.
Conclusions: Most of the masters had weak knowledge about replanting the avulse tooth .The conclusion shows that to promote the
knowledge of the martial art masters, the training courses in the
field of dental trauma emergencies is necessary.
Session T2 – 13.30
T1 - 10
Histopathologic evaluation of capsaicin on cat dental pulp
Madani Zahra Sadat, Maryam Seyed Majidi, Aliakbar Moghaddamnia,
Amir Zahed pasha
Babol university of medical sciences-dental school Endodontics, Babol,
Iran
Dental school Oral patholog, Babol, Iran
Babol university of medical sciences-Pharmacology, Babol, Iran
Abstract
Aim: The aim of this study was evaluating anti-inflammatory effect of
local administration of capsaicin on cat dental pulp.
Methodology: Twenty four canine teeth of six cats were selected for
this experimental study. after cats had been anesthetized the crown
of were cut three mm upper than CEJ and exposed under sterile condition. The teeth were divided in to two groups .in group I , the ex-
www.eserome2011.com
T2 - 1
Endodontic microsurgery: prognostic factors for clinical
outcomes
Kim Hyun-Joo, Sung-Ju Moon, Minju Song, Euiseong Kim
Dept. of Conservative Dentistry, Yonsei University, Seoul, Korea
Abstract
Introduction: This study examined the potential prognostic factors on
the outcome after endodontic microsurgery. In addition, the predictors of an isolated endodontic lesion were compared with those of
both an isolated endodontic and endodontic-periodontal lesion.
Methods: The data was collected for patients with a history of endodontic microsurgery performed between August 2004 and December 2008, at least 1 year before being evaluated. Surgical procedures
were carried out by the endodontic faculty and residents. After surgery, an operation record form was made with the preoperative, intraoperative and postoperative factors from clinical and radiographic
measures. For statistical analysis of the predisposing factors, the dependent variable was the dichotomous outcome, i.e. success versus
failure.
Results: Of 907 cases, 491 were retained at follow-up. At the 0.05
level of significance, age, gender (female), tooth position (anterior),
root length filling(adequate), lesion type (endodontic lesion), root-end
filling material (MTA and Super EBA) and restoration at follow-up appeared to have a positive effect on the outcome. On the other hand,
with the isolated endodontic lesion, the tooth position (anterior), root
length filling(adequate), and restoration at follow-up were found to
be significant at the 95% confidence level.
Conclusion: Under the control of significant variables in logistic regression, the potential prognostic factors on the outcome were gender, tooth position, lesion type and root-end filling material. On the
other hand, the tooth position was found to be pure predictor of an
endodontic lesion affecting the clinical outcome.
T2 - 2
Endodontic treatment of first and second lower molar
with a massive abscess: nine years control
Marco Capecchi, V Bongiorno, Enrico Semenzato, Ilves Bottion, Kevin
Steffan, Carlo Tocchio
Italy
Abstract
A patient with a massive endodontic abscess, has been visited in
our departement in 2002. After an antibiotic therapy and an exudate
3
1 5 TH B I E N N I A L C O N G R E S S
OF THE EUROPEAN SOCIETY
OF ENDODONTOLOGY
drainage the theet had been treated with a temporary dressing and
two weeks after they had been filled and restored.
A nine years control is presented to underline the good outcome rate
of the endodontic therapy.
T2 - 3
Outcome assessment of the endodontic retreatment of
teeth with chronic apical periodontitis: a longitudinal
study
Mihaela Grigorie, A Iliescu, L Nica, SI Stratul, M Voiculeanu,
AC Didilescu
Faculty of Dental Medicine, Carol Davila University of Medicine and Pharmacy Bucharest, Romania
Faculty of Dental Medicine, Victor Babes University of Medicine and Pharmacy Timisoara, Romania
Abstract
Aim: Assessment of success rate in endodontic retreatment of teeth
with chronic apical lesions, by using three different techniques. Material and method: Seventy-one teeth with periapical lesions were included in the study. Incomplete root-canal fillings were removed with
rotary instruments. Treatment protocol included irrigation with 2.5%
sodium hypochlorite, and intracanal medication with calcium hydroxide. The following filling techniques were used: lateral compaction (n=20), Thermafil (n=24), and vertical condensation (n=27). The
outcome was assessed after two years based on radiographic and
clinical findings, as follows: complete healing, incomplete healing or
failure. Data distributions were expressed as percentages; possible
associations between outcome and filling techniques, sealer extrusion, or transportation, were tested using Pearson Chi-squared Test.
A value of p < 0.05 was considered statistically significant. Results:
The healed cases counted for 4% of the total number, healing cases
86%, and 10% had not healed. Among the teeth with complete healing, 2 were filled with Thermafil, whilst 1 was treated by vertical condensation. Failures were recorded as follows: Thermafil 57%, lateral
condensation 29%, and vertical condensation 14%. No statistical significant associations were recorded. Conclusions: Overall, although
the outcome was favorable (healed and healing cases), the healing
cases were more numerous than healed cases. Longer periods are
needed to observe the evolution of healing cases.
T2 - 4
Success rate and tooth localization of endodontic
treatment in dental-school outpatients
Ines Willershausen, Adriano Azaripour, L. Weimer, B. Briseño, B.
Willershausen
Institute for Dental Material Sciences and Technology - Operative Dentistry University of Mainz
Abstract
Aim: Besides morphological characteristics, the endodontic techniques and the use of a microscope determine the success rate of
endodontic treatments. The aim was to examine endodontic treatment outcome from outpatients of a dental school, treated either by
dental students (62%) or by dentists (38%). Methodology: A total of
1124 endodontically treated teeth were investigated in adult patients
(n=745) over a period of 5 years. The patients’ age ranged from 18 to
87 years (54% male and 46% female). Success was defined as no loss
or extraction of the teeth within five years.
Results: The study showed that more teeth were located in the maxilla (55.2% male, 57.3% female) than in the mandible (44.8% male,
42.7% female), but there was not difference between left and right
side. Exemplarily for both genders, the following frequencies of allocation of the endodontically treated teeth concerning the tooth
group in the maxilla was found: second right premolar 11%, second
left premolar 9.7%, first and second left molars each 9.4%, first left
premolar 7.9%, first right molar 7.6%, second right molar 7%, and
4
R O M E - 2 0 1 1 , S E P T E M B E R 1 4 TH - 1 7 TH
R O M E CAVA L I E R I H OT E L
the first left incisor only in 2.9%. For the mandible, a slightly different situation was detected: first left molar 16.5%, first right molar
13.5%, second right molar 12.8%, second left premolar 11.7%, first
right premolar 9.0%, second left molar 8.6%, second right premolar
8.3%, and the incisors each 0.8-1.5%. Most endodontic treatments
were carried out in patients aged 21-55 years (67%). After the 5-yearobservation time, the success rate of the endodontic treatments done
by students was 91%, whereas it was only 80.2% for the treatments
done by trained dentists. Conclusions: A possible explanation for
this result might be the fact that the students only treated easy cases
with fewer complications, while difficult and problematic teeth were
treated by the dentists.
T2 - 5
Randomized clinical study on patients’ quality of life after
emergency endodontic treatment
Ivan Naymo, Paolo Ambrogio, Nicola Scotti, Damiano Pasqualini, Elio
Berutti
Department of Endodontics, Prof. E. Berutti, University of Turin Dental
School, Turin, Italy
Abstract
INTRODUCTION: Emergency treatment for irreversible pulpitis comprises pulpotomy or pulpectomy. The study evaluated the effectiveness of these emergency treatment protocols in reducing postoperative complications, their influence on patient satisfaction with
treatment, and the consequent impact on their quality of life.
MATERIALS AND METHODS: The first 86 consecutive patients entering the Endodontic Emergency Service, Turin Lingotto Dental School,
during September-October 2010, were recruited who were aware,
collaborative, and suffering from irreversible pulp disease of molar
teeth, without apical periodontitis.
Patients were randomly assigned, by sealed envelope, to one of two
study protocols, pulpotomy or pulpectomy, after completion of the
access cavity.
Postoperatively, patients received instructions, the medical report,
and a VAS evaluation questionnaire to be returned at 7-day follow-up.
The following were investigated: curves of pain scores expressed
through the VAS scale, percentage distribution of scores for bleeding in the pulpotomy group, mean number of analgesic tablets taken
in pulpectomy and pulpotomy, subdivided by bleeding score, days to
pain stop.
The time required to perform the procedure was recorded.
RESULTS: Analysis of pain expressed on the VAS scale showed a statistically significant decrease (p = 0.004) after emergency treatment.
The distribution of bleeding scores in the pulpotomy group showed
that the largest number had score 0, followed by scores 1 and then 2.
Mean analgesic consumption was higher in the pulpotomy group.
Time to pain stop was lower in the pulpectomy group.
The mean time required to perform pulpotomy was 15 minutes,
whereas for pulpectomy it was 25 minutes.
CONCLUSIONS: This randomized clinical trial showed the significant
impact irreversible pulpitis has on patients’ quality of life, and that
appropriate treatment for this disease significantly improves all components of patients’ quality of life that we considered.
T2 - 6
Patient satisfaction with endodontic treatment
Nenad Baltić , Simeon Paris, Jurica Matijević, Dario Repić , Zoran
Karlović , Silvana Jukić Krmek
Croatia
Abstract
Aim: The aim of this study was to evaluate the level of patient satisfaction with endodontic treatment.
Methodology: Sample consisted of 214 endodontic patients treated
in five general dental practices in Zagreb and at the Department of
Endodontics and Restorative Dentistry at School of Dental Medicine,
ESE ROME 2011
NOT ONLY ROOTS
University of Zagreb, during two months. Survey was conducted
through specially designed questionnaire with five groups of questions which encompassed general data, the experience with former
endodontic treatment, the attitude towards following endodontics,
and the source of payment. Fifth group of questions, related to the
experience with just finished treatment, was answered on the end of
treatment. Level of satisfaction was expressed in grades from 1 to
5 (from 1- not satisfied to 5- very satisfied). Data were analyzed with
Student-t test and Spearman’s rho correlation.
Results: Half of male examinees (50.0%) were satisfied, while 51.2%
of females were very satisfied with just performed endodontic treatment. The level of satisfaction positively correlated with lover pain
experience and the greater level of satisfaction with prior endodontic
therapy, positive patient attitude towards success of actual treatment
and willingness to recommend that treatment to others (Spearman’s
rho, p<0.05). Negative correlation was associated with the negative experience with prior treatment, the loss of the priory treated
tooth, and the fear and the level of stress before the actual treatment
(Spearman’s rho, p<0.05).
Conclusions: Considering that half of male endodontic patients were
satisfied and half of female patients were very satisfied, therefore we
can conclude that endodontic part of dental service is acceptable for
patients.
T2 - 7
Non-surgical management of large periapical lesions
using conventional endodontic treatment
Emre Ovsay, RF Kaptan, G Bayer
Yeditepe University Fakulty Of Dentistr, Istanbul, Turkey
Abstract
Surgery as a treatment method for periapical lesions is usually rejected by patients because of it’s complicated procedure and major
complications.Patients prefer to heal in a more simple way.The nonsurgical way includes the conventional endodontic method for healing patients.
According to technolocigal changes in endodontics patients prefer to
get treated in a single visit.Non-surgical endodontic therapy is a way
to treat teeth with large periapical lesions.Usually large periapical lesions can be recognized during radiographic examination.They can
only diagnosed by histologic examination.All periapical lesions should
be initially treated with convential endodontic therapy.This case reports three teeth with apical periodontitis (including two molars and
a premolar) with large periaical lesions and their (1-3 year) follow ups
which are healed with conventional endodontic therapy.In these cases
the healing of large periapical lesions with non-surgical endodontic
therapy is critisized and treatment steps are considered.The periapical
radiographs showed us that the lesions can be treated without surgery.
T2 - 8
The success and quality of endodontic treatment under
NHS: a retrospective study
J. Sobocinski Pawel, SJ Hayes
Cardiff University Postgraduate Medical and Dental Dep., Cardiff, UK
Abstract
Aim: To assess the success of endodontic treatment carried out under NHS contract by one dentist. To assess the quality of root filling using ESE Guidelines and highlight the most common reasons of
marking filling as unsatisfactory.
Methodology: All root canal treatments carried out by one dentist between July 2007 and December 2009 were reviewed. The treatment
outcome and quality of root fillings were decided based on the clinical
notes and radiographs. The treatments carried out under NHS contract with minimum 12 months observation were examined for the
purpose of this study. Failure was classified when the tooth was extracted or there were any symptoms reported by the patient or signs
(swelling, erythema, tooth mobility, tenderness to percussion, sinus
www.eserome2011.com
tract or pus discharge) or the periapical radiolucency was equal or
larger than original area. The success cases were classified either
as definite success or as probable success. The quality of root filling
was classified as satisfactory or unsatisfactory using ESE Guidelines.
Results: Out of 186 endodontic procedures carried out, 99 procedures on 97 teeth qualified for further studies. Out of the 99 fillings
49 (49%) were classified as satisfactory and 50 (51%) as unsatisfactory. The most common faults of root filling for all procedures were:
incomplete apical filling and overfilling. Among the failed treatments:
incomplete apical filling and missed canal. 18 treatments were classified as failures. 16 had unsatisfactory fillings and 2 satisfactory. Out
of 97 teeth, 9 were or are going to be extracted (9%), five teeth (5%)
had re-treatment either in the surgery (4) or by the specialist (1) three
teeth (3%) are under observation and one awaits re-treatment.
Conclusions: Most of the failures were associated with unsatisfactory
root filling. Incomplete apical filling and missing the canal are most
likely to have serious consequences.
T2 - 9
The root canal treatment of teeth associated with a large
periapical lesion: three case reports
Umut Tunga, Ersan Clcek, Ondokuz Mays
University, Faculty of Dentistry, Depertmant of Endodontics, Samsun,
Turkey
Abstract
Treatment options to heal large periapical lesions range from non-surgical root canal treatment and/or apical surgery to extraction. Current
philosophy in the treatment of teeth with large periapical lesions includes the initial use of conventional orthograde root canal treatment.
Radiographic differentiation of periapical cysts and granulomas is
difficult. If the lesion is separate from the apex with an intact epithelial lining it may have developed into a self-perpetuating entity
that may not heal when treated non-surgically. On other occasions,
a periapical lesion may have a direct communication with root canal
system and respond favorably to ortograde root canal treatment.
The purpose of these two cases was to demonstrate the need for
conservative endodontic management of chronic periapical infections. The following case reports describe the endodontic treatment
of single rooted central and lateral incisors teeth which were associated with a large periapical lesion.
In this case report; orthograde root canal treatment provided a successful healing of a large periapical lesion in three separate cases.
This confirms that, large periapical lesions can respond favorably to
non-surgical treatment.
T2 - 10
Biocompatibility of AH plus jet and Epiphany sealers in
rat periapical tissue
Noriko Mutoh, Nobuyuki Tani-Ishii
Division of Endodontics, Department of Oral Medicine, Kanagawa Dental
College, Yokosuka Japan
Abstract
Introduction: The purpose of this study was to evaluate the biocompatibility of resin-based root canal sealer in periapical tissue of rat. Methods: Four-week-old female Wistar rats (n=60) were used for tooth replantation to reproduce the periapical tissue response with root canal
sealers. The resin-based root canal sealer Epipany , AH plus jet, and a
eugenol sealer Canals were used in this experiment. The upper right
first molar was extracted and applied with a root-canal sealer on the
root apex of the extracted tooth. The tooth was then replanted in the
original socket. Jaws were collected from groups of 10 rats at 7 days
and 14 days after tooth replantation. After histological processing, sections were stained with hematoxylin-eosin. Results: Mild inflammation occurred in the periapical tissue of the replanted teeth with both
Epiphany and AH plus jet sealers on day 7, whereas the eugenol sealer
induced severe, oderate inflammation. On day 14, the lesions induced
by all types of sealers were healed and replaced predominantly by fi-
5
1 5 TH B I E N N I A L C O N G R E S S
OF THE EUROPEAN SOCIETY
OF ENDODONTOLOGY
brous connective tissue. Thus, all materials showed high biocompatibility, although the extent of inflammatory reactions during the early
stages varied depending on the types of materials. Conclusions: This
study demonstrated that Epiphany and AH plus jet were biocompatible
materials, and our animal model was useful for the assessment of the
biocompatibility of endodontic sealers.
Chairpersons: Edgar Schäfer, Roberto Sammarco
Session T3 – 13.30
T3 - 1
Increase in interleukin-8 in teeth with irreversible
pulpitis
Alireza Adl, Mohammadyar Mosavi, Zahra Amirghofran, Shohreh Ravanshad
Endodontist, Assistant Professor of Shiraz Dental School
Endodontist, Professor of Immunology, Shiraz University of Medical Science
Associate Professor of Shiraz Dental School
Abstract
Statement of the Problem: As a Chemokine from C-X-C family, Interleukin-8 has a strong activity for Neutrophiles and Lymphocytes. In
addition, it causes Neutrophile granules to release and the release
of enzymes leads to the destruction of tissues. A recent study has
shown that IL-8 increases in Gingival Cerevicular fluid of teeth with
symptomatic irreversible pulpitis. This study was an attempt to investigate and compare the amount of increase in Interleukin-8, in
Gingival Crevicular Fluid of teeth with Symptomatic and Asymptomatic inflammated Irreversible Pulpitis.
Method and Materials: For this study, 40 patients (suffering from
Symptomatic and Asymptomatic Irreversible Pulpitis) were selected
from among those patients referred to Endodontics Department of
Shiraz Dental School. In order to collect the Gingival Crevicular Fluid,
the target zones were isolated and cleaned with cotton roles and suction. Next, 3 paper points were put in the sulcus of selected teeth
alternatively, each of which lasted for 1 minute. Then, the samples
(paper points) were put into Ependorf tubes. The tubes were placed
into ice boxes and sent to Immunology Department of Shiraz Medical School in order to continue the treatment. The level of IL-8 was
measured using Elisa test.
Results: The results indicated that there was not a significant difference between the levels of Gingival Crevicular Fluid in teeth with
Symptomatic and Asymptomatic Irreversible Pulpitis
Conclusion: Disregarding the symptoms, it was concluded that the
levels of Interleuki -increased in teeth with Irreversible Pulpitis; however the increase was n( statistically significant.
Key words: Interleukin-8, Irreversible Pulpitis, Symptom.
T3 - 2
Presence of biofilm in the transition zone in combined
endo-perio lesions. A low-vacuum SEM study.
Darian Rusu, Luminita Nica, Andreea Didilescu, Cosmin Locovei,
Aurel Raduta, Alexandru Ogodescu, Adrian Kasaj, Holger Jentsch,
Stefan-Ioan Stratul
Faculty of Dental Medicine, Victor Babes University of Medicine and Pharmacy Timisoara, Romania
Faculty of Dental Medicine, Carol Davila University of Medicine and Pharmacy Bucharest, Romania
Politechnical University Traian Vuia Timisoara, Romania
University Johannes Gutenberg Mainz, Germany
University of Leipzig, Germany
Abstract
Introduction: Presence of bacterial biofilms on the external surface
of apex of teeth with pulp necrosis has been previously investigated
using SEM. Conventional SEM requires a complicate procedure, consisting in fixation of samples, dehydration, and coating (sputtering) of
biofilm with conductive materials.Aim:Evaluation of the morphology
6
R O M E - 2 0 1 1 , S E P T E M B E R 1 4 TH - 1 7 TH
R O M E CAVA L I E R I H OT E L
of biofilm of the transition zone between apical lesions and periodontal pockets in combined endo-perio lesions with a modified protocole
involving a simplified histologic sample preparation and low-vacuum SEM examination.Materials&Methods:21 teeth with combined
endo-perio lesions, diagnosed clinically and radiographically, were
extracted and washed with saline, underwent fixation in modified
Karnovsky solution and were dehydrated in alcohol series. The transition zone was located and examined under low-vacuum SEM (INSPECT S-FEI,Hillsboro,OR,USA), at 80-250Pa and 15kV.The presence
of established biofilm, isolated glycocalyx strands, isolated bacteria,
nude cement areas, periodontal ligament fibers, resorbtions, calculus, unstructured debris, and the type of microorganisms (cocci,
rods, filaments, spirils) was assessed on each sample. Results were
quantified and expressed as percentage.Results:The transition zones
displayed established biofilms in 38% of the cases, isolated glycocalix
strands in 9.5%, resorbtive areas in 28.5%, scattered bacteria in 24%,
nude cement areas in 71%, calculus deposits in 24%, unstructured
debris in 28.5%, and periodontal ligament fibers in various degrees of
destruction in 24% of the samples, respectively. When present, cocci
were found in 57%, bacilli in 14%, and filaments in 24% of the samples.No spirils were found.Conclusion:The transition zone between
the apical lesion and the periodontal pocket in combined endo-perio
lesions displays a relatively low incidence of established biofilm.
When present, coccoid forms were predominant, while bacilli and
filamentous forms were rather seldom observed. Rezorbtive areas
appeared in only one third of samples.The low-vacuum SEM method
is simple, cost-saving, results in excellent biofilm images, avoids
sputtering and destruction of samples and electrostatic charges.
T3 - 3
The role of TGF-β1 in matrix remodeling in periapical
granuloma
Andreea Diaconu Oana, M Banita, L Gheorghita, M Tuculina, C Pisoschi,
P Surlin
Department of Endodontics, School of Dentistry, University of Medicine
and Pharmacy, Craiova, Romania
Abstract
AIM: Periapical granuloma represents a chronic lesion of the periapical tissues due to pulpal inflammation induced by the persistent
presence of microorganisms. Granulomatous inflammation is considered a protective host response to limit periapical tissue damage
through the inflammatory response. The histological feature of periapical granuloma is an onion leaf-like appearance, the external leaf
being a dense connective structure.
TGF-β1 is a family of multifunctional cytokines known to be involved
both in the inflammatory response - inhibiting the proliferation of Tlymphocytes and deactivated macrophages - and in wound healing
and fibrosis by inhibiting metalloproteinases synthesis and promoting collagen deposition.
The aim of our study was to assess the expression of TGF-β1 isoform
in periapical granuloma in relation with matrix remodeling (examined through MMP-2 and TIMP-2 expression) and its role in activation of myofibroblasts, cells known for their involvement in collagen
deposition.
METHODOLOGY: Formalin-fixed paraffin-embedded sections from 7
periapical granulomas were used to performe immunohistochemical
reactions in order to assess the localization of TGF-β1, α-SMA - a
specific marker for myofibroblasts, MMP-2 and TIMP-2.
RESULTS: We noted a concentric distribution of morphological structures within the granuloma, the core being formed by proinflamatory
cells with many new vessels TGF-β1 positive. On serial sections we
noted some α-SMA and TIMP-2 positive pericytes. Macrophages and
plasma cells express also TGF-β1. The edge of the structure was formed
mainly by a dense tissue with fibroblasts and α-SMA positive cells myofibroblasts. Some peripheral cells with epithelial features (Mallassez epithelial rests) displayed discrete positive reaction for MMP-2.
CONCLUSION: These data suggest that TGF-β1 could have a dual action in periapical granuloma: to induce the decrease of extracellular
matrix breakdown and to activate fibroblasts towards a myofibroblast
phenotype.
ESE ROME 2011
NOT ONLY ROOTS
T3 - 4
Evaluation of five periopathogens in endo-periodontal
lesions
A.C. Didilescu, D. Rusu, M. Greabu, A.A. Iliescu, G. Bancescu, A.
Anghel, L. Nica, F. Leghel, S-I. Stratul
Department of Dental Anatomy and Embriology, Faculty of Dental Medicine,
Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
Department of Periodontology, Faculty of Dental Medicine, Victor Babes
University of Medicine and Pharmacy, Timisoara, Romania
Department of Biochemistry, Faculty of Dental Medicine, Carol Davila
University of Medicine and Pharmacy, Bucharest, Romania
Department of Oral Rehabilitation, Faculty of Dental Medicine, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
Department of Oral Microbiology, Faculty of Dental Medicine, Carol Davila
University of Medicine and Pharmacy, Bucharest, Romania
Department of Biochemistry, Victor Babes University of Medicine and
Pharmacy, Timisoara, Romania
Department of Endodontology, Faculty of Dental Medicine, Victor Babes
University of Medicine and Pharmacy, Timisoara, Romania
Department of Biochemistry, Victor Babes University of Medicine and
Pharmacy, Timisoara, Romania
Department of Periodontology, Faculty of Dental Medicine, Victor Babes
University of Medicine and Pharmacy, Timisoara, Romania
Abstract
Aim: To evaluate five periopathogens: Aggregatibacter actinomycetemcomitans (Aa), Porphyromonas gingivalis (Pg), Tannerella
forsythia (Tf), Treponema denticola (Td), Prevotella intermedia (Pi),
in samples from endo-periodontal lesions. Subjects and Methods:
Forty-one patients were investigated. A clinical examination was
performed, together with periapical radiographs and microbiological
investigation of the endodontic and periodontal biofilms. Qualitative
and semi-quantitative evaluation of the bacteria was performed using
a commercially available kit (micro-IDent®, Hain. Lifescience GmbH,
Nehren, Germany). The Spearman’s rank correlation coefficient was
used to test possible associations between pathogen detections, as
well as between bacterial scores and clinical parameters. A value of
p < 0.05 was considered statistically significant. Results: The most
prevalent species found in endodontic samples were: Tf (66% of the
cases), Pg (61%), and Pi (46%). Both Tf and Pi had a positive correlation (r = 0.52, p < 0.01, n = 41), as well as Tf and Pg (r = 0.47, p < 0.01,
n = 41) in endodontic samples. Positive correlations were also found
between Tf and Pg (r = 0.53, p < 0.01, n = 41) in periodontal samples.
Abnormal mobility was positively associated with detection of Pg (r =
0.37, p < 0.05, n = 41) and Tf (r = 0.43, p < 0.01, n = 41) in periodontal
samples. Conclusion: The findings suggest that at least three of the
five investigated species may play specific roles in the pathogenesis
of endo-periodontal lesions: Pg, Tf, and Pi, respectively.
This study was funded by the Romanian Council of Scientific Research (CNCSIS) and the European Society of Endodontology (ESE).
T3 - 5
Selective detection of viable Enterococcus faecalis using
propidium monoazide in combination with real-time PCR
Kim Sin-Young, Jung IY
Department of Conservative Dentistry, Seoul St. Mary’s Dental Hospital,
Catholic University of Korea, Seoul, Korea
Department of Conservative Dentistry, College of Dentistry, Yonsei University, Seoul, Korea
Abstract
Polymerase chain reaction (PCR) can detect bacteria more rapidly
than conventional plate counting.
However, DNA-based assays cannot distinguish between viable and
dead cells due to persistence of DNA after cells have lost their vitality. Recently, propidium monoazide (PMA) treatment has been introduced. The purpose of this study is to evaluate the applicability of
the PMA treatment and real-time PCR method for cell counting in
comparison with plate counting and to evaluate the antibacterial efficacy of 2% CHX on E. faecalis using PMA treatment in combination
with real-time PCR.
Firstly, to elucidate the relationship between the proportion of viable
www.eserome2011.com
cells and the real-time PCR signals after PMA treatment, mixtures
with different ratios of viable and dead cells were used. Secondly,
relative difference of viable cells using PMA treatment in combination
with real-time PCR was compared with CFU by plate counting. Lastly,
antibacterial efficacy of 2% CHX on E. faecalis was measured using
PMA treatment in combination with real-time PCR.
The results were as follows :
1. Ct value increased with decreasing proportion of viable E. faecalis.
2. There was correlation between viable cells measured by real-time
PCR after PMA treatment and CFU by plate counting.
3. Relative difference of viable E. faecalis decreased more after longer application of 2% CHX.
T3 - 6
Rezorbtion pattern analysis of radicular tips involved in
combined endo-perio lesions: a low-vacuum SEM study
Nica Luminita Maria, Alexandru Ogodescu, Stefan-Ioan Stratul, Darian Rusu, Rodica Jianu, Cosmin Locovei, Aurel Raduta, Mircea Nicoara, Camil Ianes, Andreea Didilescu
Faculty of Dental Medicine, Victor Babes University of Medicine and Pharmacy Timisoara, Romania
Politechnical University Traian Vuia Timisoara, Romania
Faculty of Dental Medicine, Carol Davila University of Medicine and Pharmacy Bucharest, Romania
Abstract
Introduction:The rezorbtion lacunae of the root tip area of teeth involved in chronic apical lesions has been recently investigated (Felippe et al. 2009) using conventional SEM, which requires a complicate procedure, consisting in fixation of samples, dehydration
using either critical point drying with liquid CO2 or alcohol series,
and coating (sputtering) of biofilm with conductive material (Au,Pa
or Carbon). Aim:Evaluation of the resorbtion pattern of the root tip
surface in teeth with combined endo-perio lesions with a modified
protocole involving a simplified histologic preparation and a lowvacuum SEM examination method.Materials&Methods:21 teeth with
combined endo-perio lesions, diagnosed clinically and radiographically, were extracted and washed with saline solution, underwent
fixation in modified Karnovsky solution (2.5% glutaraldehyde,4%
paraformaldehyde,0.1M sodium cacodilate,pH7.2-7.4) and were dehydrated in alcohol series. The presence of rezorbtion lacunae and
their pattern (isolated, multiple and merging, generalized, apparently deep, apparently shallow, the presence of isolated bacteria or
established biofilm) was examined and assessed under the low-vacuum SEM (INSPECT S-FEI,Hillsboro,OR,USA), at 80-250 Pa and 15kV.
Results:Cemental rezorbtive lacunae were observed in 18 of the
evaluated samples (85.7%). Out of these, 7 (33%) displayed isolated
patterns, 7 (33%) were multiple and merging, while 8 (38%) were generalized, involving the entire apical periforaminal area. Most of the
rezorbtive areas displayed a honeycomb-type of lacunae. Established
biofilms were found in 24% of the samples, while scattered free bacteria in only 29%. Conclusion: The rezorbtion area patterns of radicular tips involved in combined endo-perio lesions observed under
low-vacuum SEM are relatively similar to those observed in apical
lesions. They decrease in number and surface coverage towards the
transition zone to the periodontal pocket, where the cement tends
to be covered with calculus deposits. When present, bacteria (cocci
better represented than bacilli) are either organized in biofilms, sheltered by resorbtive lacunae, or isolated.
T3 - 7
Mast cells in periapical lesions: comparative study in
non-diabetic versus diabetic population
Sanchez Perez Rosa, Francisco J. Vera, Leopoldo Forner, Beatriz
Vera, Carmen Llena
Department of Stomatology, University of Valencia, Spain
Department of Pathology, University of Valencia. Molecular Biology Laboratory, University Hospital “La Fe”, Valencia, Spain
Abstract
Introduction: Diabetic patients often show different changes in inflammatory reaction. Aim of our study is to detect the presence of mast
7
1 5 TH B I E N N I A L C O N G R E S S
OF THE EUROPEAN SOCIETY
OF ENDODONTOLOGY
cells in periapical lesions in both diabetic and non-diabetic patients.
Methods: Two groups (n=10 each) of periapical lesions from type II
diabetic and non-diabetic patients were immunohistochemically
studied by using CD117 (c-kit) monoclonal antibody. Cytometry was
made under 40x magnification. Anova test was made.
Results: Diabetic and non-diabetic lesions showed a mean of 31.4
and 36.9 mast cells/HPF respectively. In diabetics patients, 44, 23 and
10 mast cells/HPF in cyst, granuloma and scar tissue were founded
respectively, and in the non-diabetic group, 28, 29 and 47 mast cells/
HPF were observed at the same lesions. The higher incidence of
mast cells was seen in scar tissue of non-diabetic group (47/HPF)
and periapical cysts of diabetic group (55/HPF). Mast cells are spread
all over the different areas in the non-diabetic group, but in the diabetic one, mast cells are highly predominant at the fibrous areas
without statistical significance (p>.05).
Conclusions: In our study CD117 appears with a predominant presence of mast cells in fibrous lesions of the diabetic group, and mainly
related to cystic lesions.
T3 - 8
In vitro ameloblast differentiation affected by wnt
signaling
Takahashi Satomi, N Kawashima, K Katsube, T Sugiyama, H Suda
Tokyo Medical and Dental University Pulp Biology and Endodontics, Tokyo, Japan
Tokyo Medical and Dental University Oral Pathology, Tokyo, Japan
Akita University School of Medicin Department of Biochemistry, Akita, Japan
Tokyo Medical and Dental University Global Center of Excellence (GCOE)
Program; International Research Center for Molecular Science in Tooth
and Bone Diseases, Tokyo, Japan
Abstract
Aim. Ameloblast differentiation is initiated and maintained by the
epithelial-mesenchymal interaction, where various growth factors
are synthesized, and they are believed to be related to differentiation
of ameloblasts. Wnt signaling is reported to be involved in the development and differentiation of many cells, including ameloblasts.
We found that expressions of Wnt-related genes were up-regulated
following the ameloblast differentiation in vitro. The objective of this
study was to evaluate the effects of up- and down-regulation of Wnt
signaling on ameloblast differentiation.
Methodology. Ameloblast-like cells (ALC) were cultured in spinner
modified MEM supplemented with 10% FBS and antibiotics. Wnt signaling was modified by LiCl (50mM), an inhibitor of GSK3, and Axin,
a negative regulator of the Wnt signaling pathway, RNAi. Presence
of LiCl activates the Wnt signaling, and knock-down of Axin prohibits the Wnt signaling. mRNA expressions of Wnt-related signaling
molecules and ameloblast differentiation markers were analyzed by
real-time RT-PCR using specific primers.
Results. Ameloblastic marker expression was up-regulated in the
presence of LiCl and down-regulated by Axin RNAi in ALC. These results suggest that Wnt signaling may accelerate the ameloblast differentiation.
Conclusion. Up- and down-regulation of Wnt signaling increased and
decreased the expression of ameloblast differentiation markers in
ALC, respectively.
T3 - 9
Biofilm morphology of the internal wall of the cemental cone
in combined endo-perio lesions. A low-vacuum SEM study.
Stratul Stefan Ioan , Darian Rusu, Doina Onisei, Mircea Nicoara,
Luminita Nica, Ciprian Sarbu, Mihaela Grigorie, Andreea Didilescu
Faculty of Dental Medicine, Victor Babes University of Medicine and Pharmacy Timisoara, Romania
Politechnical University Traian Vuia Timisoara, Romania
Faculty of Dental Medicine, Carol Davila University of Medicine and Pharmacy Bucharest, Romania
Abstract
Introduction:While bacterial biofilm of the terminal root canal and of
the periforaminal external area has been extensively described us-
8
R O M E - 2 0 1 1 , S E P T E M B E R 1 4 TH - 1 7 TH
R O M E CAVA L I E R I H OT E L
ing conventional SEM (Kishen et al.2005, Richardson et al.2009), the
biofilm on the intraforaminal walls (the “cemental cone” described
by Kuttler) is relatively unknown.Aim:evaluation of the biofilm morphology on the internal wall of the cemental cone in combined endoperio lesions lesions with a modified protocole involving a simplified
histologic sample preparation and a low-vacuum SEM examination
method.Materials & Methods: 21 teeth with combined endo-perio
lesions, diagnosed clinically and radiographically, were extracted
and washed with saline solution, underwent fixation in modified Karnovsky solution (2.5% glutaraldehyde, 4% paraformaldehyde, 0.1M
sodium cacodilate, pH7.2-7.4) and were dehydrated in alcohol series.
The structures found on the internal walls of the cemental cone were
examined and assessed under the low-vacuum SEM (INSPECT SFEI,Hillsboro,OR,USA), at 80-250Pa and 15kV. The presence of established biofilm, isolated glycocalyx areas, isolated bacteria, nude cement areas, resorbtion areas, filling materials, unstructured debris,
and the type of microorganisms (cocci, rods, filaments, spirils) was
assessed on each of the samples and the results were quantified and
expressed as percentage.Results:Low-vacuum inspection resulted
in electrical charge-free images of the non-conductive or contaminated surfaces. The internal walls of the cemental cone displayed
established biofilms in 24% of the cases, isolated glycocalix strands
in 14%, resorbtive areas in 14%, scattered bacteria in 9.5%, nude cement areas in 76%, filling material in 9.5%, and unstructured debris
in 33%, respectively. When present, coccii were found in 38%, bacilli
in 5%, and no filaments or spirils.Conclusions:Structured bacterial
biofilm was found present in the majority of samples; when present,
the morphology of the intraforaminal biofilm resembles to the biofilm in periodontal pockets.
However, a continuity between the intraforaminal biofilm and the periforaminal and pocket biofilm could not be testified in the present study.
Chairpersons: Carsten Appel, Michael Hülsmann
Session T4 – 13.30
T4 - 1
The modern endodontic surgery: microscope, ultrasounds,
and Mta. An evaluation of clinical and radiographic success
after 2-years follow-up.
Lorenzo Comin Chiaramonti, Alessandro Cucchi, Giacomo Cavalleri
Departement of Endodontics, Verona University, Italy
Resident, Institute of Oral Surgery and Dentistry, University of Milan, Italy
Abstract
INTRODUCTION: An endodontic treatment performed according to
“ideal” protocol allows to achieve a long-term success rates of 90%.
In recent years, endodontic surgery has increased its predictability by
introducing new tools and materials: operative microscope for magnification and illumination;micro-curettes, micro-mirrors, microopeners or micro-carriers for easy access and manoeuvrability; ultrasonic tips for preparing mini-invasive cavity; and MTA to a perfect
apical seal. This study aims to evaluate the clinical and radiographic
success of endodontic cases treated with surgical approach, using
modern technologies that were introduced in endodontic surgery in
order to ensure greater predictability of the result.
MATERIALS AND METHODS: 39 patients underwent endodontic surgery between January 2006 and July 2007, using a protocol based
on the principles of “modern” endodontics. This protocol has been
standardized in order to provide the use of operative microscope, the
removal of endodontic lesions with micro-curette, the apicoectomy
through progressive abrasion of root apex, the retrograde instrumentation with ultrasonic tips, and the 3-D apical seal with MTA. All
intra-and post-operative complications, reported by patients and/
or highlighted by clinicians, were recorded. Patients were clinically
and radiographically evaluated at 6, 12 and 24 months, in order to
determine the clinical and radiographic success rates based on preestablished success criteria.
ESE ROME 2011
NOT ONLY ROOTS
RESULTS: The 2 years follow-up: 29 teeth (74.4%) showed clinical
and radiographic complete healing; 4 teeth (10.3%) showed a clinical
healing, but an incomplete radiographic healing (scar); and 2 teeth
(5.1 %) showed a clinical healing, but uncertain radiographic healing;
in addition, four teeth (10.3%) were extracted because of vertical root
fractures (FVR), that were visible only at the time of surgery.
DISCUSSION AND CONCLUSIONS: The success rates of this study
demonstrate the effectiveness and validity of “modern” surgical endodontics, which allows to reach very predictable results. This surgical protocol was applied in other scientific studies, in which success rates were between 88% and 97%. Others authors have reached
more or less different percentages by applying more or less different
surgical protocols. Using operative microscope, ultrasounds, and
MTA seems to be the most important factor to have a more predictable result. This study demonstrated that the “modern” endodontic
surgery can achieve high success rates, minimizing intra-and postoperative complications.
T4 - 2
Surgical endodontics. Report of a case
Alonso Ezpeleta Luis Oscar, Nieto De Pablos Jose Maria, Piñero
Yébenes Rafael, Del Valle Alexandre Beatriz
University of Zaragoza, Zaragoza, Spain
University of Alfonso X el Sabio, Madrid, Spain
Abstract
Introduction: Prognosis of endodontic surgery has been often considered more questionable. However, the development of new instrumentation and obturation techniques using ultrasounds and MTA,
allows the procedure to be more predictable as well as a reliable
option to preserve the tooth. A literature review about endodontic
surgery will be presented, with a clinical case of apical surgery. The
endodontic treatment of a three-rooted bicuspid was accomplished
through a combined orthograde and retrograde approach. The case
report will show how apical surgery represents an effective and predictable technique when orthograde tretament is not feasible. A correct diagnosis, treatment plan and correct surgical approach with
a three-dimensional shaping and filling of the retrograde cavity are
crucial for successful clinical outcomes.
T4 - 3
Autotransplantation of an ectopic impacted premolar
with sinus lift and allogenic bone graft
Bo-hyun Ban, Ji Yau Sun, Se young hwang, Bock young Jung, KeeDeog Kim, Nan sim Pang
South Corea
Abstract
Aim: This paper presents a case report of autogenous tooth transplantation to a site which had insufficient bone volume using sinus
lift and allogenic bone graft.
Summary: An ectopic, fully impacted premolar tooth was autotransplanted from its ectopic impaction site into its original site, where
there was insufficient recipient vertical bone volume due to sinus
pneumatization. The deciduous tooth was extracted from recipient
site and the sinus membrane detached and elevated via the alveolar socket. Allogenic bone grafting was performed, and the impacted
premolar was transplanted into the prepared site. To improve the adaptation, the recipient site was prepared using a rapid prototype (RP)
tooth model, a replica tooth which allowed complete socket preparation in advanced of the actual removal of the donor tooth. The donor tooth was fixed with sutures and maintained for 17 days to allow
physiologic movement. Rootcanal treatment was initiated 24 days
after autotransplantation, and MetaPaste medicament was used for
4 months. Canal filling was completed 5 months after autotransplantation. There was no root resorption of the transplanted too!
th and the grafted bone was well preserved and had no signs of infection until 2 year check up.
www.eserome2011.com
T4 - 4
Cause of failure in non-surgical endodontic treatment
through the endodontic microsurgery
Bona Kim, Hyun Kim, Minju Song, Euiseong Kim
Dept. of Conservative Dentistry, Yonsei University, Seoul, Korea
Abstract
Aim: The purpose of the study was to investigate the clinical causes
of failure and the limitation of the previous endodontic treatment by
inspection of the root apex and resected root surface at 26x magnification during endodontic microsurgery of failed teeth with previous
endodontic treatment.
Methodology: The data was collected from patients in the Department of Conservative Dentistry at the Dental College, Yonsei University in Seoul, Korea between March 2001 and January 2011. All rootfilled cases with symptomatic or asymptomatic apical periodontitis
were included in this study. All surgical procedures were performed
using an operating microscope(OPMI R PICO; Carl Zeiss, Göttingen,
Germany), and the surface of the apical root to be resected or resected root surface after Methylene blue staining were examined during
the surgical procedure and recorded carefully with 26x magnification
to determine the state of previous endodontic treatment by using an
operating microscope.
Results: Among 557 cases with periapical surgery, 493 teeth were
included in this study. With exclusion of unknown cases, the most
common possible causes of failure was leaky canal(30.4%), followed
by missing canal(19.7%), underfilling(14.2%), anatomical complexity(8.7%), overfilling(3.0%), iatrogenic problem(2.8%), periodontal
problem(1.8%) and crack(1.2%). The frequency of possible failure
causes was different among the tooth position statistically (p<0.001).
Conclusion: Appreciation of root canal anatomy using an operating microscope in non-surgical endodontic treatment can make the
prognosis enhance more predictable and favorable considerably.
T4 - 5
Immediate post extractive implant rehabilitation of an
endodontic failure: a case report
Nadia Medea Ferrarese, Nicolà Maria Balzano, T Costa, E Bressan,
Carlo Tocchio
University of Padua. Italy
Abstract
BACKGROUND: Post extractive implant rehabilitation give a solution in
case of endodontic failure or the impossibility of rebuilding the tooth.
MATERIALS AND METHODS: tooth 36 have been extracted for an endodontic failure. A post extractive treatment using astra-tech implant (h
11, ø 4,5) have been done. Implant have been loaded after two month
with a conical abutment cement-retained restoration. RESULTS: the
case present a post extractive implant placement. Conical abutment
have been used for the connection between the fixture and the crown.
DISCUSSION: Rehabilitation of single tooth could be done with different therapeutic possibilities: conventional fixed prosthesis, removable prosthesis or implant solution. In case of vitality and integrity of
contiguous teeth implant therapy is suggested.
CONCLUSIONS: Single implant placement with conical connection is
a valid option for single tooth rehabilitation, maintaining the integrity
of contiguous teeth.
T4 - 6
Endodontic and surgical treatment of a maxillary central
teeth with expansive internal resorption
Ö. Genc, T.B. Özkan, Devrim Akyol Gulter, V. Kaplan
Yuzuncuyıl University, Faculty of Dentistry, Van, Turkey
Abstract
This case presents the endodontic and surgical treatment of a maxillary central tooth with extensive internal root resoption. A 33-year-
9
1 5 TH B I E N N I A L C O N G R E S S
OF THE EUROPEAN SOCIETY
OF ENDODONTOLOGY
old patient was referred to our clinic with the complaint of a discoloration on the maxillary right central tooth. Radiographs were taken
and a large internal resoptive defect was detected in the apical and
middle thirds of the canal. Endodontic access cavity was opened
and 30# K file was inserted into the canal. At the time severe bloody
exudate was started to drain from the canal orifice. Drainage lasted for half an hour time and, then calcium hydroxide dressing was
placed. Dressing was changed for six times in two months period
but no signs of healing was observed. Therefore, an obturation was
performed using an MTA based root canal paste and gutta percha,
and, in the same visit apical surgery was initiated. Unhealty situation
of the periodontium was observed during the surgical treatment,
therefore it was decided to extract and reimplant the tooth, to allow
curetage. Apical part of the root was sealed with amalgam. Tooth was
put again in the socket in infra-occlusion after alveoler bone was
shaped . then it was fixed to adiacent teeth for three weeks. After 1
month the mobility was class 1. After 2 months there was no mobility.
A zirconium crown was prepared for the tooth. Follow up radiographs
over 12 months demonstrated the maintenance of a functional tooth.
T4 - 7
A longitudinal retrospective study on the success rate of
endodontic microsurgery
Lui Jeen-Nee, Ma-Ma Khin, Benny Goh, Leslie Ang, Nah-Nah Chen
National Dental Centre of Singapore
Abstract
Aim: The aim of this study was to evaluate the outcome of endodontic
microsurgery and variables related to success.
Method: Clinical records of all patients who had undergone an endodontic microsurgery by endodontists over a 6-year period (19972003) in the National Dental Centre of Singapore were examined. Anterior and posterior permanent teeth with a recall period of 1-2 years
were selected for the study. All surgical procedures, except for flap
raising and suturing, were performed using a surgical operating microscope. After root resection and retro-preparation with ultrasonic
tips, root end cavities were filled with either Intermediate Restorative
Material or Mineral Trioxide Aggregate. Periapical radiographs were
taken after surgery and every 6 months subsequently. Teeth were
evaluated for clinical signs and symptoms at each post-surgery visit.
Pre-operative and post-operative radiographs were evaluated independently by 2 endodontists in a blinded manner and categorized
into complete healing, incomplete healing, uncertain healing and
failure. For analysis, teeth with complete and incomplete healing was
grouped together and defined as “success”.
Results: 264 apical surgeries had been performed over the 6 year
period. 101 teeth were eligible for the study and subjected to further
analysis. The percentage of complete healing, incomplete healing,
uncertain healing and failure was 61.4%, 11.9%, 15.8% and 10.9%
respectively. Overall, the success rate was 73.3% and failure was
26.7%. A multivariable logistic regression model (c-statistic=0.74)
showed that females had a higher likelihood of success compared
to males (OR=5.6, 95% CI 1.3-24, p=0.02). When detected intra-operatively, presence of an isthmus (OR=0.24, 95% CI 0.05-1.19, p<0.1)
or crack (OR=0.20, 95% CI 0.04-0.98, p<0.1) was associated with a
higher risk of failure.
Conclusions: A success rate of 73.3% was achieved in teeth with a recall
period of 1-2 years after endodontic microsurgery. Gender, presence of
isthmus and crack are possible prognostic determinants of the outcome.
T4 - 8
Management of a large endodontic lesion by means of decompression and endodontic surgery
Meire Maarten , Filip L. Calberson, Roeland J. G. De Moor
Department of Operative Dentistry and Endodontology, Dental School,
Ghent University, De Pintelaan 185/P8, B9000 Gent, Belgium
Abstract
Although evidence suggests that the size of an apical lesion does not
affect the prognosis of orthograde root canal treatment, the clinician
10
R O M E - 2 0 1 1 , S E P T E M B E R 1 4 TH - 1 7 TH
R O M E CAVA L I E R I H OT E L
is sometimes faced with large cyst-like periapical lesions that do not
respond to non-surgical root canal treatment. A such situation is presented in this case report. A 28 year old caucasian female was referred to the Endodontic Department for treatment of a large radiolucency surrounding the apex of tooth 12. This lesion was discovered
after an episode of acute pain in that area. Orthograde endodontic
treatment was initiated and a calcium hydroxide intracanal dressing was placed for several months and refreshed regularly. After six
months, the patient was symptom free and the canal was filled with
gutta percha and sealer. Four months later, symptoms reappeared
and radiographic evidence of reduction of the lesion size was lacking.
The patient agreed upon a decompression procedure, in order to limit
the risk of damage to the vascular supply to neighboring teeth or encroachment into the nasal antrum with a surgical enucleation. After
six months of decompression, only minor decrease in lesion size was
noted and it was decided to perform endodontic surgery. A full thickness flap was raised followed by curettage of the lesion. The root end
of 12 was resected and a retrocavity was prepared with ultrasonic
tips and filled with MTA. The bone lesion was packed with absorbable
gelatine sponges and covered by a collagen membrane before suturing the flap. Fifteen months later, the patient remains symptom-free,
the soft tissues are healthy and apart from a small apical scar, the
lesion is completely healed.
T4 - 9
Healing of periapical lesion after retrograde mta obturation
Burcu Serefoglu, U. Tekin, B. Yildirim
Ege University School of Dentistry, Izmir, Turkey
Abstract
Objective: To present the healing of a large periapical lesion after the
second surgical endodontic treatment of a 63 years old male patient
who had received surgical management 27 years ago.
Methodology: The patient referred to our clinic with complaint of
swelling in the labial vestibule of maxillary anterior region and pain.
A large radiolucent lesion around the maxillary left central and lateral teeth was seen on radiographic examination. The adopted treatment protocol was started with drainage and only posts were removed from the teeth. Although filling material was tried to removed,
it couldn’t achieved. As a result, surgical endodontic treatment was
decided to perform. Before the surgery, the teeth were restored with
fiber post and composite. At the surgery stage, apical piece of the
root filling material removed with an ultrasonic and MTA was used
as a retrograde sealing material. After surgical treatment, the teeth
were restored with metal reinforced full porcelain crown.
Results: Clinic and radiographic examinations at 24 months followup revealed healthy apical healing.
Conclusion:This case report demonstrated that previously treated
teeth that exhibit large periapical lesions can be retreated by using
MTA as a retrograde sealing material to achieve periapical healing.
T4 - 10
The influence of different bevels of root-end resections
and burs in the exposure of dentinal tubules. An ex-vivo
study.
Lyssaris Vasileios, CH Beltes, N Economides
Aristotle University Thessaloniki Department of Endodontology, School of
dentistry, Thessaloniki, Greece
Abstract
Aims. The purpose of the present study has two-folds: a) to evaluate
how the apical root resection angle may influence the overall number
and type of exposed dentinal tubules, b) to compare different types of
burs in relation with the exposure of dentinal tubules after root-end
resections.
Methods. Sixty single-rooted extracted human teeth, endodontically
ESE ROME 2011
NOT ONLY ROOTS
treated, were included in this study. The teeth were divided into three
groups of twenty each. In the first group the apical 3mm of the roots
were resected perpendicular to the long axis of the roots, whereas
in the second and the third group apicectomies of 20 and 45 degrees
were performed respectively. Each group was subdivided according
to the type of the bur and the application of EDTA solution on roots
surface. All specimens were examined under scanning electron microscope.
Results. Dentinal tubules were not exposed in the specimens without
EDTA preparation, regardless the bevel of resection and the type of
bur. Only in the specimens with EDTA preparation pores and tubes of
dentinal tubules were exposed. The amount and the type of exposure
were influenced by the handling of the burs during root-end resections.
Conclusions. Based on the findings of this study, the influence of exposed dentinal tubules during periapical surgery in relation with the
overall success is possibly overestimated. The root surfaces seem to
be covered with the products of bur cutting during root-end resections.
Chairpersons: Jean Yves Cochet, Katia Greco
Session T5 – 13.30
T5 - 1
Apexification with calcium oxide: three case reports
Bodrumlu Emre, Ersan Clcek , Bura Güler
Samsun University, faculty of dentistry, department of endodontics, Turkey
Abstract
AIM. Calcium oxide, available for decades as a root canal filling material, has not been frequently used in recent years due to its lack
of radiopacity, and due to the expectation that it would lead to an
excess of root fractures. These case reports were performed to determine the clinic and radiographic success of calcium oxide in the
apexification treatment. METHODOLOGY. This clinical report describes an apexification procedure on three maxillary central incisors presenting with chronic apical periodontitis. The pulp of the
teeth had become necrotic following a traumatic injury. According to
the treatment procedure the root canals were biomechanically prepared, medicated and filled with calcium oxide to stimulate hard tissue barrier formation. RESULTS. Follow-up clinical and radiographic
examinations confirmed apical barrier at 6 months. CONCLUSION It
is concluded that calcium oxide may be considered a safe and viable
alternative to other current methods of apexification.
homogeneous root canal filling extended beyond the apical constriction. A CBCT was used as an additional diagnostic tool to assess the
relevant area more accurately. An extensive iatrogenic perforation
on the labial site was detected. Retreatment of the root canal filling was performed using the operating microscope and ultrasonic
instruments. After disinfection of the root system, the perforation
and the apical 2 mm of the root canal were sealed with MTA. The remaining root canal system was obturated with warm vertically compacted gutta-percha. The access cavity was sealed with composite.
For aesthetic reasons, both central incisors were restored using a
polychromatic composite layering approach. RESULTS.Follow-ups
up to 24 months showed an asymptomatic tooth and a completely
healed periradicular lesion.
CONCLUSION. For treatment of complex endodontic problems, sophisticated equipment such as Cone Beam Computed Tomography,
the operating microscope and biocompatible endodontic materials
may be essential in order to obtain favourable results.
T5 - 3
Intentional replantation
Mario Castro, J Reichsthaler, M Lee, Justo Sosa
Private Practice Vienna, Austria
Private Practice Los Angeles, USA
Private Practice Tenerife, Spain
Abstract
AIM “Intentional Replantation” is the intentional removal of a tooth
and its re-insertion into the socket after endodntic manipulation or
obturation of the canals or both. According to the AAE (American
Association of Endodontists) it is the insertion of a tooth into its alveolus after the tooth has been extracted for the purpose of performing
a treatment such as a root end filling or perforation repair. METHODOLOGY There are several indications for this treatment option as:
limited accessibility, close proximity to critical anatomical structures,
detection and treatment of perforation, treatment of failed apical surgery. As every procedure it has its contraindications such as: moderate to severe periodontitis, furcation involvement, severely dilacerated roots, inability to remove the tooth atraumatically, vertical root
fracture, non-restorable tooth/extensive caries and large restoration.
When performing an “Intentional Replantion” every effort should be
made to replant the tooth within 10-15 minutes in order to achieve
proper periodontal ligament and bone healing. There are only a few
steps to follow for this procedure: extraction, resection, MTA fill and
replantation. RESULTS. According to Kratchman et al., the procedure
is reliable and predictable and should be considered as treatment
option. CONCLUSION. It is our conclusion that “Intentional Replantation” is an excellent endodontic treatment option with a predictable
and successful prognosis. It should be considered as an alternative
treatment option, when microsurgical root end surgery can not be
performed.
T5 - 2
Non-surgical management of a traumatized central incisor with apical root perforation and large periapical lesion
Leodard Buttel, Roland Weiger, Gabriel Krastl
Department of Periodontology, Endodontology and Cariology, Institute of
Dentistry, University of Basel, Switzerland
Abstract
AIM. Root perforations are undesired complications that may impede
endodontic therapy and jeopardize the treatment outcome. Cone
Beam Computed Tomography (CBCT) has proved to be a useful tool
to properly assess the size and location of the perforation.
METHODOLOGY. A 14-year-old boy was referred to the clinic for
endodontic treatment due to pain on his upper left central incisor.
He gave a history of trauma with crown fractures on both maxillary
central incisors 4 years ago. The clinical examination revealed the
presence of a sinus tract.
The periapical radiograph showed a large periapical lesion and an in-
www.eserome2011.com
T5 - 4
The vital treatment of hyperplastic pulpitis with MTA and
Ca(OH)2: two case reports
Clcek Ersan, Bura GÜler, Hikmet Aydemr
Ondokuz mays university, faculty of dentistry, depertmant of endodontics,
Samsun, Turkey
Abstract
AIM. Vital pulp therapies are the treatment of choice for pulp exposures in immature/mature teeth with hyperplastic pulpitis and/or
traumatic injuries. The procedure is primarily based on the healing
ability of the healthy pulp. Two well-established methods for pulp
preservation are direct pulp capping and pulpotomy. Pulpotomy involves the partial or total coronal pulp amputation and capping the
wounded surface with a suitable material. METHODOLOGY. In these
case reports, two different materials were used for coronal pulp amputation in maxillary and mandibular first molars with hyperplastic
11
1 5 TH B I E N N I A L C O N G R E S S
OF THE EUROPEAN SOCIETY
OF ENDODONTOLOGY
pulpitis in separate patients. White mineral trioxide aggregate (MTA)
was used in the first case. In the second case, calcium hydroxide
(Ca(OH)2) was used and these cases were controlled after the treatment through one years with three months period. RESULTS. Any
symptoms and pathologies were not observed in the both cases end
of the one year.
T5 - 5
Iatrogenic dentistry: case presentation
Dragidella Fatmir, Metush Disha, Blerim Kamberi
University of Prishtina, Medical Faculty, School of Dentistry, Kosovo
Abstract
Introduction: iatrogenic dentistry is disease-inducing dentistry or
dental procedures which reduce natural resistance to disease.
Objectives: the aim of this paper is to present a very unusual placement of gutta-percha points during endodontic treatment.
Material and methods: patient N.N., 42 years old came to our department for the reason of pain and swelling in region of right mandibular second premolar. After clinical and radiological examination we
found three gutta-percha points placed outside of root canal anatomy. Results: A minor periodontal surgery has been performed to
remove gutta-percha points.Discussion and conclusions: the dentist
play an important role in maintaining the health of oral tissues. On
the other hand the dentist can cause damage to the tissues as result
of inappropriate dental therapy.
T5 - 6
Tooth saving
Jeong Hye Jeon, JS Kim
Hallym university Department of conservative dentistry Seoul Republic
of Korea
Abstract
Introduction: Endodontics as a discipline has offered patients the
opportunity to maintain the nature teeth.
Occassionally, we meet the very difficult cases nevertheless do our
best. Management of failing endodontic treatment may present significant challenges. The following case report describes successful
treatment these challenging cases.
Case Presentation
Case1: Use of Mineral trioxide aggregate(MTA): in case of invasive
external root resorption on Lt. Mandibular premolar.
Case2: Hemisection on Mandibular first molar tooth and amputation
of mesial root combined bridge restoration.
Case3: Intentional Replantation: Extraction and replantation with
180-degree rotation of traumatic abulsive anterior tooth.
Conclusions: This case report demonstrate the importance of establishing a multidisplinary approach for a successful dental trauma management. Although this case reports present a favorable clinical outcome,
further studies are necessary to provide more efforts about tooth savings.
T5 - 7
Endodontic management of external apical pulpal
infection root resorption. A case-series study
Konstantinos Ioannidis, Georgios Tsombanides, Konstantinos
Mastoras, Christos Gogos, Theodoros Lambrianidis
Department of Endodontology, School of Dentistry, Aristotle University of
Thessaloniki, Greece
Abstract
AIM. External root resorption varies in etiology and can be classified
in two major categories, including inflammatory and replacement
resorption. However, the variations among the two main categories
should be identified according to the existing local or systemic stimulation and aetiological factors, in order to diagnose, reverse and treat
the process successfully.
In the presence of external apical pulpal infection root resorption it
is critical to control the biofilm formation within the root canal sys-
12
R O M E - 2 0 1 1 , S E P T E M B E R 1 4 TH - 1 7 TH
R O M E CAVA L I E R I H OT E L
tem and especially in the distorted apical terminus. In this study,
the patients’ records with diagnosed external apical pulpal infection root resorption that presented in a post-graduate clinic in a
three-year period are described. METHODOLOGY. The management
of all affected teeth included conservative endodontic treatment or
re-treatment. Therapeutic procedures included chemomechanical
preparation of the root canal system (hand files / ultrasound activation of NaOCl 2.5%, EDTA 15%, chlorhexidine 2%), and application of
inter-appointment medication (Ca(OH)2) from 1 week up to 3 months.
Several obturation methods were used for the resorbed root canals
including thermo plasticized gutta-percha, MTA apical plugging and
back-filling with gutta-percha or entire filling with MTA. All patients
were scheduled for a 6 to 12 months follow-up examination cons ecutively. RESULTS. In the majority of the cases the healing outcome was
evaluated as favorable with clinical and radiological criteria.
T5 - 8
Intentional replantation of C-shaped mandibular second
molars: case reports
Lim Ji Hyui, Chang SW, Yoo HM, Park DS, Oh TS
Department of Conservative Dentistry, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
Abstract
Although nonsurgical endodontic treatment usually has high success
rates, it may fail eventually. These can be managed by alternative
treatments, such as intentional replantation. Intentional replantation
is indicated for limited access, anatomic limitations, failed periapical
surgery, persistent chronic pain, or patient management. However,
in case of mandibular second molar, there are many root canal variations including C-shaped canal. C-shaped canal systems have complicated canal configuration, so conventional root canal treatment
can be easily failed. Also, the mandibular second molar has anatomic
limits to perform periapical surgery.
Two clinical case reports present the intentional replantation of Cshaped mandibular second molars with previously failed nonsurgical
endodontics. In both cases, the molar was extracted, and the root
appeared to be C-shaped. The root apices were resected extra-orally, retrograde cavities were prepared, and retrofilled with Super EBA
(Harry J. Bosworth Co., Skokie, IL). Then the tooth was replanted. The
patient returned for follow-up at 1 month, 3 months, 6 months, and
once yearly thereafter. At the last visit, the patient was asymptomatic
and periapical radiograph showed no evidence of root resorption or
peripaical lesion.
In conclusion, the presented cases show that intentional replantation
may be a reliable procedure. Intentional replantation should be considered as a viable treatment option to preserve the natural dentition,
in situations where other procedures would likely to fail.
T5 - 9
Endodontic management of internal root resorption.
A case series study
Konstantinos Mastoras, Konstantinos Ioannidis, Georgios
Tsombanides, Christos Gogos, Theodoros Lambrianidis
Department of Endodontology, School of Dentistry, Aristotle University of
Thessaloniki, Greece
Abstract
AIM. The hard tissues (dentin, cementum and enamel) of permanent
teeth do not normally undergo resorption. Tooth resorption may occur as a result of inflammatory conditions, mechanical stimulation,
or neoplastic processes. The resorption may occur in bone, dentin
or cementum but the process is similar. The key cells involved in resorption are multinucleated giant cells, called osteoclasts, cementoclasts, or dentinoclasts depending on the tissue being resorbed.
The aetiology of internal root resorption varies and may occur as a
result of chronic inflammation/infection in the vital pulp secondary
to caries, trauma, pulpotomy, restorative procedures, orthodontic
movement and herpes zoster. In this study, the patients’ records with
diagnosed internal inflammatory root resorption that presented to
ESE ROME 2011
NOT ONLY ROOTS
post-graduate clinic in a three-year period are described.
METHODOLOGY.The management of all affected teeth included conservative endodontic treatment or re-treatment. Therapeutic procedures included chemomechanical preparation with hand and rotary
files, ultrasound activation of NaOCl 2.5%, EDTA 17%, chlorhexidine
2% and Ca(OH)2 as inter-appointment medicament from 10 days up
to 1 month. Different obturation techniques were performed, including warm vertical compaction, continuous wave vertical condensation and carrier-based systems. All patients were scheduled for follow up examination from 6 to 12 months.
RESULTS. The healing outcome was evaluated as favorable with clinical and radiological criteria.
T5 - 10
Intentional replantation of a vertically fractured lateral incisor, reconstructed with dentin – bonded resin. Case report.
Michael Ioannou, AA Iacovidou
Private Dental Practices, Nicosia, Cyprus
Abstract
Intentional replantation of a vertically fractured root after reconstruction with dentin – bonded resin could be an alternative treatment rather than extraction or root resection.
In our case a lateral incisor #22, which was retreated 5 years ago,
came back with sensitivity on palpation and positive percussion. A
new retreatment was decided.
During the observation on the walls of the canal, with the operating
microscope, an incomplete vetrical root fracture was noticed. It was
extended from the middle to, probably, the apex of the root.
An intentional replantation and a reconstruction of the root with dentin bonded dentin were decided. Consent of the patient was obtained,
explaining the nature of the procedure and the possible risk benefits.
The tooth was extracted with special caution to avoid damaging the periodontium. The tooth was observed with an operating microscope (OPMI
PICO MORA, Carl Zeiss) at 8,5x and 13,6x magnification to examine the
extension of the fracture line and the condition of the fractured surface.
The incomplete fracture was detected and could be characterized a
thin, one surface fracture. It was sealed with dentin – bonded resin,
after a shallow preparation of the fracture line with a fine diamond,
on a high torque handpiece.
During the reconstruction, the tooth was kept under moisturizing
condition with saline. Care was taken to touch the periodontal ligament as little as possible. The socket was gently curetted to remove
inflamed tissue and debris.
Then the tooth was replanted into the socket with gentle finger pressure. Enamel matrix proteins contained in Emdogain ( Biora AB ) was
used for augmentation of periodontal tissue regeneration.
The tooth was splinted with 0.9mm wire for three months.
The tooth was followed up based on a protocol used at the University
of Athens (Dr. Siskos G.). For the last 2,5 years the tooth is symptom
free and the radioqraphical status is fine.
Under specific circumstances, intentional replantation is an optional
treatment. Even if we don’t have a lot of evidence for the value of
this technique, we may conclude that this technique has the potential
to become a basic treatment in specific cases, to preserve vertically
fractured teeth.
Chairpersons: Sashi Nallapati, Frank Paqué
Session T6 – 13.30
T6 - 1
Increase of the temperature during the ultrasonic removal of endodontic posts
Nadia Medea Ferrarese, Giulia Carli, Nicolò Maria Balzano, Carlo
Tocchio
School of Dentistry , University of Padua, Italy
Abstract
The literature suggests the reduction of the temperature during the
www.eserome2011.com
removal of endodontic posts using ultrasonic devices. The heat’s
control is important to avoid damages to periodontal ligament, i.e.
external gingival recession.
The aim of this study is the comparison, in vitro, of different techniques and materials used in retreatment of endodontically treated
teeth restored with custom or preformed posts.
Several artificial canals have been constructed using epoxy resin.
An internal and an external thermo-probe have been connected to a
thermocouple that measured the increases of the temperature when
ultrasonic tip is applied to remove the post.
Six groups have been analyzed with three types of posts removed with
cooled and not cooled ultrasonic tip.
Group A1: cast metal post removed with not cooled ultrasonic tip
Group A2: cast metal post removed with cooled ultrasonic tip
Group B1: glass-fiber post removed with not cooled ultrasonic tip
Group B2: glass-fiber post removed with cooled ultrasonic tip
Group C1: retractable glass-fiber removed with not cooled ultrasonic
tip
Group C2: retractable glass-fiber removed with cooled ultrasonic tip
Results demonstrate that the use of a cooled tip is important to remove all types of posts. Retreatment of glass-fiber posts with soft
core showed much less increase of temperature if compared with all
other posts.
Conclusions: considering the limits of this in vitro study, it can be
concluded that using retractable posts removed by cooled ultrasonic
tips is the best condition in retreatment to avoid excessive heating of
the root surface.
T6 - 2
Use of calcium silicate cements as root canal sealer in
endodontics: a clinical trial
Livio Gallottini, Konstantinos Besharat Laith, Guido Migliau
Department of Dental and Maxillo Facial Sciences, School of Dentistry,
Master’s Degree in Endodontics, La Sapienza University of Rome, Italy
Abstract
AIM. To evaluate from a clinical point of view the new calcium silicate
cements proposed for endodontic application as root canal sealers
associated with gutta-percha orthograde obturation techniques.
METHODOLOGY. 105 adult patients who presented a mandibular molar to be treated endodontically, where divided into 3 groups of 35
patients (30 teeth presenting periapical lesion ,10 previous root canal
treatments and 5 widened periodontal ligament). Endodontic single
visit treatments were performed by the same operator. Working
length was determined by the joint use of an electronic apex locator
(PROPEX II-DENTSPLY MAILLEFER,Ballaigues,CH) and an intraoral
radiograph. Cleaning and shaping was performed using the simultaneous technique with Mtwo NI-TI rotary files and Mtwo Apical NI-TI
rotary files (Sweden & Martina SPA,Padova,IT) for the preparation of
the apical area. Alternated irrigation of 5% NaOCl and 2.5% EDTA
was used after each instrument. In cases of retreatment, Mtwo R
25/05 file(Sweden & Martina SPA,Padova,IT) was used to remove filling materials. The obturation of the root canal system of all teeth was
done using the Domino system(Sweden & Martina SPA,Padova,IT). A
different endodontic sealer was used for each group:
-Group I Epiphany (Pentron Clinical Tecnologies,Orange CA,USA)
-Group II Top Seal (DENTSPLY MAILLEFER,Ballaigues,CH)
-Group III Tech BIOSEALER ENDO (Isasan srl,Rovello Porro,IT)
Follow-ups were carried out 3 and 6 months after treatment. Results
were analysed using the software Statistical Package for Social Sciences (SPSS Inc, ver. 13.0, Chicago, IL, USA), chi-squared test was
used for statistical evaluation of proportions. Treatment success was
assessed by the healing of periapical tissues and no response to percussion.
RESULTS. Success rate in Group I was 77.14%; in Group II was 80%
and in Group III was 94%.The difference between the first two groups
and the third one is statistically significant(p=0.03933).
CONCLUSION. Tech BIOSEALER ENDO exhibited promising results
and a good biocompatibility. It shows all the advantages of calcium
silicate cements (excellent antibacterial properties) being at the
same time more fluid and offering a suitable working time.
13
1 5 TH B I E N N I A L C O N G R E S S
OF THE EUROPEAN SOCIETY
OF ENDODONTOLOGY
T6 - 3
Different healing results of the M1 superior depending on
using a microscope during treatment
Herman M Kostelijk, G Slaus, P Bottenberg
Dept.of conservative dentistry, Free University of Brussels, Belgium
Abstract
Aim: to compare the long term healing results after endodontic treatment of the M1 superior with or without microscope and to establish
a relation between healing results, the use of a microscope in endodontic treatment and the number of canals found and treated.
Methodology : in 2006, 90 upper first molars were treated endodontically in a dental office in Tilburg, the Netherlands by four different
dentists. Patients were not preselected and treated at random by one
of the practitioners involved. This also applied for the use of a dental
microscope. All treatments were done mechanically using NaOCl as
the main cleaning liquid and a guttapercha or resilon canal filling was
placed. After treatment a final x-photo was taken. After at least one
year a control x-photo was taken. Both photos were digitally recorded on Phosphor plates and read by a Digora Optime reader (Soredex,
Finland). In 2011 a panel of three dentists compared the initial and
control x-photo, projected side by side on a large screen and gave a
verdict about the healing, being successful, or failing. Success was
defined as the absence of apical periodontitis, failure as the presence of apical periodontitis on the control x-foto (no matter if it was
present on the initial x-foto). Data were analyzed using the Chi2- test.
Results: 92 % of the 60 molars treated with the aid of a microscope
showed healing, whereas 63% of 30 molars treated without a microscope had a successful outcome. This was significant according to
the Chi-square test (p= 0.0025).
Nevertheless, The Chi-square test showed no significance (p=0.18)
concerning the number of treated canals: 48 molars with four canals were treated and showed a successful healing result in 88% of
the cases, and 42 molars with three canals treated had a successful
outcome for 76%.
Conclusions: sing a microscope in the endodontic treatment of first
upper molars had a positive effect on the healing of apical periodontitis, irrespective of slight differences in treatment procedures
caused by the individual practitioner. At the same time, the finding
and treating of a fourth canal had a positive, but not significant effect on the healing of apical periodontitis. The use of a microscope
reduces the number of not found and treated fourth canals in such a
way that there is no significant difference in long term healing results
left between molars with four or three canals treated.
Therefore it is important to use a microscope in the endodontic treatment of the M1 superior.
T6 - 4
Micro-tomographical evaluation of mesiobuccal root
canal system in maxillary molars among the Turkish
population
Kerem Askin¸ M. Ozgur Uyanik, Fugen Comert
Turkey
Abstract
Aim: The aim of this study was to invastigate root canal morphology
of mesiobuccal root canal system of three-rooted maxillary first molar teeth by using micro-computed tomography (μCT) scans.
Methods: 30 freshly extracted maxillary first molar teeth were selected and scanned with μCT device. (SkyScan 1074, Aartselaar,
Belgium). These images were reconstructed by using NRecon software programme (SkyScan 1074, Kontich, Belgium) in order to obtain
two-dimensional cross-sectional slices of the root structure. After
constructing two individual 3Dimages exhibiting the shape of the root
by using 3D-Doctor software programme (v.3.5 Able Software Corp,
Lexington, MA).The morphology and frequency of second mesiobuccal root canal was investigated by this model.
Results: Second mesiobuccal root canal was detected in 76,6%
14
R O M E - 2 0 1 1 , S E P T E M B E R 1 4 TH - 1 7 TH
R O M E CAVA L I E R I H OT E L
(23/30) of the samples analyzed. Single mesiobuccal root canal was
only detected in 7 of the teeth investigated. (23,4%).
Conclusion: Morphology of the mesiobuccal root canal system in
maxillary molar teeth generally present a more complex structure
than the other root canals. Based on the results of this study, it can
be concluded that care should be taken during preparation of maxillary molar teeth due to the high frequency of second root canal.
T6 - 5
Endodontic treatment of C-shaped mandibular molars.
Report of five cases.
Theodora Zarra, Z Psimma, C Boutsioukis
Department of Endodontology, Dental School, Aristotle University of
Thessaloniki, Thessaloniki, Greece
Abstract
Aim: The aim of this work was to describe the endodontic management of five C-shaped mandibular molars.
Summary: Five cases of C-shaped mandibular molars in Caucasian
patients were referred to the Postgraduate Clinic of the Department
of Endodontology over the last year. Pulp necrosis and/or periapical
lesions were identified in all cases. The presence of C-shaped root
canals was suspected during routine pre-treatment radiographic
examination and was verified clinically during probing and scouting
of the canals with small hand-files and the aid of an operative microscope. A single C-shaped root canal was only found in one case,
while slightly varying canal configurations were evident in the other
four cases. Root canals were instrumented using Hedstroem files in
a circumferential filing manner and obturated using warm lateral or
vertical condensation. All teeth received permanent restorations and
were followed for up to 12 months. None of the cases presented signs
of failure within this period.
Conclusions: The C-configuration is one of the most common variations of root canal anatomy in mandibular molars. Identification and
successful treatment of such cases pose a challenge to the clinician.
Implications of this anatomical variation may also extend to the prosthetic rehabilitation of these cases.
T6 - 6
Acute pain of the trigeminal nerve due to amalgam in the
mandibular canal
Georgios Mikrogeorgis, O Pantelidou, V Thomaidis, Kleoniki Lyroudia
Department of Endodontology, Dental School, Aristotle University of
Thessaloniki, Greece.
Department of Medicine, Democritus University of Thrace, Alexandroupoli, Greece
Abstract
Aim: This is a rare case of amalgam allocation in an alveolar cavity of
an extracted third molar. This case report has an educational value
and it is presented in order to be avoided such a traumatic injury in
the future.
Case presentation: A 36 years old woman went to a private practice
for a regular examination. The dentist decided at that time to make
an extraction of the tooth #38. During the extraction tooth #37 was
broken. The dentist decided that an amalgam filling had to be done
to the tooth #37 directly after the extraction and during the same appointment. The patient showed an acute continuous pain of the whole
facial region innervated from the trigeminal nerve that was imitated
endodontic pain. A panoramic radiograph of the patient after three
days showed a large piece of amalgam near or inside the mandibular
canal. A surgery was followed at the region. Amalgam was removed
from the mandibular canal and as a result acute pain disappeared
during the post operative days.
Conclusion: Restoration with amalgam has to be avoided during a post–
extraction time. Amalgam can appear toxic effects to the mandibular
nerve that can transferred to the whole trigeminal nerve as well.
ESE ROME 2011
NOT ONLY ROOTS
T6 - 7
Endodontic treatment of an unusual maxillary dens
invaginatus with sinus tract: 5 year follow-up
Steffen Heike, A Eltahir
University School of Dentistry, Greifswald, Germany
Abstract
A healthy 11-year-old girl was referred by an orthodontist to maintain the affected tooth because the left lateral incisor and the left
canine were missed and the right lateral canine showed an atypical
anatomy. On presentation the maxillary right lateral incisor showed
a nearly destroyed clinical crown and a sinus tract in the buccal area
releasing pus. The tooth responded to vitality tests. The radiograph
showed a dens invaginatus, and an extended area of radiolucency.
The patient received local anaesthesia, rubber dam was placed, and
adequate access under the microscope was provided. Approximately
4-5 mm below the level of the gingival margin, a wide Cshaped canal
with vital tissue and a second very narrow necrotic canal were detected. Bleeding pulp was removed and both canals were prepared
using combined hand and rotary instrumentation after establishing
the working length. A passive irrigation with hypochlorite and CHX by
the use of ultrasonic was used, calcium hydroxide was inserted and
the tooth was temporarily sealed. Four month later the sinus tract
had disappeared. After removal of medication an apical barrier to the
wide opened apex with collacote was created and a plug of ProRootMTA was condensed; the apical part of the tooth was filled by vertical
compaction and AH plus (Dentsply/ DeTrey, Konstanz, Germany).
To prevent a fracture a fiber post was inserted and the crown was
completely restored with light-cured composite.
The patient returned for clinical and radiographic follow-ups after 1
and 5 years. Apical repair was observed, as well as absence of clinical symptoms.
This case show the long-term success for a combined therapy with
MTA, vertical compaction, fiber post and composite to maintain teeth
with an anusual anatomy to maintain the tooth until orthodontic therapy is finished and an implant is possible.
Chairpersons: Sema Belli, Mario Lendini
Session T7 – 13.30
T7 - 1
Comparison of different solutions for final rinse
optimization
Raffaele Paragliola, Vittorio Franco, Cristiano Fabiani, Luciano
Giardino, Simone Grandini
Tuscan School of Dentistry, Dept of Endo/Restorative, University of Siena,
Italy
Abstract
Introduction: The purpose of this study was to assess the penetration
of a new modified sodium hypochlorite solution labelled with 0.2%
alizarin red into dentinal tubules when used in root canals with PUI
activation.
Materials and Methods: 32 extracted human single-rooted teeth were
selected for the study. Crowns were at 2 mm above the CEJ. 30.06
was the last file used at the WL. The teeth were randomly divided
into four groups (N=8). A final rinse of each canal was performed
with different agitation procedure: control, NaOCl+PUI, Hypoclean,
Hypoclean+PUI. Specimen was cut at 1, 3, and 5 mm from the apex
and were examined with a fluorescence light microscope at 100X.
Images were evaluated following a set of scores used to assess the
penetration of solution into the dentinal tubules. Statistical analysis
was performed by using Kruskal-Wallis analysis.
Results: Differences were found among groups in relation to the irrigation regimen used. Groups were ranked in the following order:
control<Hypoclean<NaOCl+PUI= Hypoclean+PUI Group. At 1 mm
www.eserome2011.com
from the root apex, the Hypoclean+PUI group exhibited the highest
score.
Discussion: In the present study Hypoclean was compared to 5.25%
NaOCl. The two irrigant were tested without activation into root canal
and in association with PUI. Hypoclean showed a better result when
was used without activation, but no differences were found when was
used in combination with PUI.
T7 - 2
In vitro comparison of antimicrobial activity of calcium
hydroxide with different vehicles and ready-to-use
calcium hydroxide against enterococcus faecalis and
candida albicans
Ali Çan YÜcel, Ertan Emek Onuk, Evren Sariyilmaz, Bekir Krarbucak
Ondokuz Mays University, Faculty of Dentistry, Department of
Endodontics, Turkey
Ondokuz Mays University, Faculty of Veterinary Medicine, Division of
Preclinic Science, Turkey
University of Pennsylvania, School of Dental Medicine, Department of
Endodontics, USA
Abstract
One of the goals of root canal treatment is to eliminate bacteria and
their by-products from the roor canal system before filling. Resistant
microorganisms, such as Enterococcus faecalis and Candida albicans, can remain in the root canals even after thorough mechanical
instrumentation and irrigation procedures because of the complex
anatomy of the root canal system and the ability of microorganisms
to survive under adverse conditions. The use of intracanal medication has been advocated in the treatment of infected root canals. The
aim of the present study was to evaluate the antimicrobial efficiency
of calcium hydroxide (CaOH2) mixed with different vehicles: saline,
glycerin+CMCP, CHX and proprietary brands of CaOH2 pastes: Calcicur, MM paste, Metapaste and to determine the most appropriate
treatment for endodontic infections caused by Enterococcus faecalis
and Candida albicans. An agar diffusion method was used to investigate the antimicrobial activity of calcium hydroxide mixed with different vehicles, %2 water based CHX, sterile saline, Glycerin+CMCP,
and proprietary brands of calcium hydroxide pastes: Metapaste, Calcicur, MM paste. Enterococcus faecalis and Candida albicans were
used as the standard test organisms. Data were analyzed using the
statistical software package SPSS. One way analysis of variance
(ANOVA) and Duncan’s test were performed for C. albicans whereas
t test was performed for E. faecalis, with the level of significance set
as p =.05. When the antibacterial effects of the CaOH2 pastes were
compared the highest inhibition zones were observed in CHX- CaOH2
and Glycerin+CMCP- CaOH2, the difference between them was not
statistically significant (P>.05). When comparing antifungal effects
the highest inhibition zone was observed in glycerin+CMCP- CaOH2
group and it was significantly higher than CHX- CaOH2 and Calcicur.
T7 - 3
Root canal disinfection with 6% NaOCl at different
exposure times using two irrigation techniques
Carrillo Vasquez Ana Gabriela, Leticia Reyes
University of Baja California, Tijuana, Mexico
Abstract
The purpose of this study was to evaluate disinfection of the root
dentin using 6% sodium hypochlorite, by observing effectiveness at
different exposure times and using two irrigation techniques: conventional (syringe) and passive ultrasonic irrigation (PUI).
70 freshly extracted teeth were used in the present study. After cleaned
and shaped of the root canal using the Crown Down technique with
ProTaper (Dentsply Maillefer, Switzerland) rotary NiTi files. The smear
layer was removed and teeth were sterilized. The teeth were divided
into four groups of 15 teeth each (A, B, C and D) were contaminated with
E. Faecalis. The remaining 10 served as positive and negative control
groups. Groups A and B were irrigated using a conventional technique
15
1 5 TH B I E N N I A L C O N G R E S S
OF THE EUROPEAN SOCIETY
OF ENDODONTOLOGY
R O M E - 2 0 1 1 , S E P T E M B E R 1 4 TH - 1 7 TH
R O M E CAVA L I E R I H OT E L
and 6 % NaOCl, which was left for 10 (group A) and 15 minutes (group
B). After irrigation regimen a hedstrom file (Sybron) number 25 was introduced to file the dentin walls to produce dentin shavings and paper
points were use for debri collection. The other 2 groups were irrigated
as previously shown for 9 (group C) and 14 minutes (group D), with
the last minute of passive ultrasonic irrigation. Then the teeth and the
paper points were placed in a brain heart infusion (BHI) broth and were
incubated for 24 hrs. Disinfection of the samples was determined by
the presence or absence of turbidity in the broth. Data were collected
and statistically analyzed (Chi Square test).
Presence of infection was observed in group A and B. In groups C and
D there was no presence of turbidity. A statistically significant difference was noted between all groups A, B, C and D (p <0.05)
Hence, we may conclude that 6 % NaOCl passive ultrasonic irrigation is more effective than conventional irrigation, regardless of different exposure times.
3% NaOCl (1:3 ratio). 100Ð of each experimental solution was placed
in micro-tube which contained 900 Ð of PBS for dilution. Autoclaved
filter paper disk of 8 mm diameter was soaked in the E.faecalis cultured solution. The infected filter paper disk was placed into the experimental antimicrobial solutions. After 3, 30, and 300 minutes of
incubation period, the filter paper disks were transferred in the micro-tube containing 1ml PBS. E. faecalis fallen from the filter paper
disk was serially diluted with PBS (10-1~10-12). After spreading was
performed in the BHI agar media in anaerobic condition at 37Ð for 24
hours, the total number of CFUs was measured.
Results: 3 minute soaking of HEBP13 group and 30 minute soaking
of HEBP11, 12, 13 groups were capable of killing 100% of E. Faecalis,
while EDTA group showed no antimicrobial effect.
Conclusions: 9% HEBP/NaOCl solution in 1: 3 ratio is recommended
for antimicrobial effect.
T7 - 4
The tissue dissolving and smear layer removal
performance of HEBP/NaOCl solution in different
temperatures
Cleaning of root canals with the combination of passive
ultrasonic irrigation and different irrigating solutions
F Haznedaroglu, Helin Ozkan, G. Barut
Istanbul University, Department of Endodontics, Istanbul, Turkey
Abstract
Aim:To evaluate the efficacy of passive ultrasonic irrigation (PUI)
with sodium hypochlorite individually or in combination with different irrigation solutions in removing debris and smear layer.
Methodology: A total of 45 single-rooted teeth were divided into
four experimental groups, each containing 10 teeth and one positive
control group containing 5 teeth. The canals of all the teeth were
prepared biomechanically with hand instruments using a step- back
technique . The control group was not instrumented. The four irrigation sequences used in this study were performed (total 30 ml) as
follows: Group 1: irrigation manually with 3% NaOCl. Groups 2, 3 and
4: in all groups PUI with 3% NaOCl during biomechanical preparation and the final irrigation was done with PUI using 3% NaOCl, 15%
EDTA followed by PUI using 3% NaOCl or 10% citric acid followed by
PUI using 3% NaOCl, respectively. The remaining debris and smear
layer were evaluated by SEM photomicrographs taken from the
coronal, middle, and apical thirds of the canals. A 5-grade scoring
system for remaining debris and smear layer was used. Statistical
analysis was carried out using the Mann-Whitney U tests.
Results: Statistical analysis showed that in group 2 debris and smear
layer at the middle and coronal thirds were removed more effectively
than in group 1( p<0.05). Groups 3 and 4 were found to be more effective in removing debris and smear layer in apical, middle and coronal
thirds than groups 1 and 2 (p<0.05). There was no statistically significant difference between groups 3 and 4.
Conclusion: The use of PUI with EDTA and citric acid as the final irrigation was effective in cleaning the canals, especially at the middle
and coronal thirds.
T7 - 5
Assessment of the mixture of 9% HEBP/NaOCl solution
for antimicrobial activity
Lee Ji Hae, GW Choi, W Nam
School of dentistry, Kyung Hee university Department of conservative
dentistry, Seoul, Republic of Korea
Abstract
Aim: The aim of this study is to assess the antimicrobial activity of
1-hydroxyethylidene-1,1-bisphosphonate (HEBP)/ Sodium hypochlorite (NaOCl) solution in different composition ratio.
Methodology: Enterococcus faecalis (ATCC 4083) cells were cultured
in 10ml Brain Heart Infusion Broth in anaerobic condition (85% N2,
10% H2, 5% CO2) at 37Ð for 24 hours. Experimental antimicrobial
solutions were prepared according to different composition of HEBP/
NaOCl as follows: Control, Distilled water; NaOCl, Distilled water and
3% NaOCl (1:1 ratio); ethylenediaminetetraacetic acid(EDTA), 17%
EDTA and 3% NaOCl (1:1 ratio); H11, 9% HEBP and 3% NaOCl (1:1
ratio); H12, 9% HEBP and 3% NaOCl (1:2 ratio); H13, 9% HEBP and
16
T7 - 6
Kim Kun Young, GW Choi, HR Kang
School of dentistry, Kyung Hee university Department of conservative
dentistry, Seoul, Republic of Korea
Abstract
Aim: The aim of this study is to assess the tissue dissolving and
smear layer removal performance of various irrigation solution in
different temperatures.
Methodology :
1. Tissue dissolving assay
Pulp tissue was obtained from extracted bovine incisors. Initial weight
of each specimen was measured and recorded. Specimens were randomly divided into 9 groups. Specimens were placed into propylene
tube which contained various kinds of solution: NaOCl alone, NaOCl
in combination with either Ethylenediaminetetraacetic acid(EDTA) or
1-hydroxyethylidene-1,1-bisphosphonate(HEBP). Specimens were
then incubated at 22Ð, 45Ð and 60Ð. After an incubation period of 0,
15, 30, 60, 90, and 120 min at each temperature, the weight of pulp
tissue was measured. The weight loss of pulp tissue of each group
was expressed as percentage of initial weight of the pulp tissue.
2. Smear layer removal effect test
One hundred mandibular incisor teeth of young bovine were used.
Cylindrical specimen (a height of 5±0.1mm) was fabricated by cutting away the crown portion at the CEJ and mid-root portion. Pulpal
lumen was drilled around with high-speed #2 round bur and instrumented with rotary K3TM rotary Ni-Ti files. The lumen was irrigated
with one of three experimental solutions. Specimens were then longitudinally sectioned and evaluated by SEM.
Results: As the temperature of experimental solution rises, the tissue solubility increases accordingly (p<0.05). At same temperature,
the tissue solubility of NaOCl is the highest followed by HEBP and
EDTA in order (p<0.05). In the smear layer removal test, NaOCl group
did not remove the smear layer. EDTA group and HEBP group efficiently removed the smear layer and the EDTA group was most efficient (p<0.05).
Conclusion: with certain temperature limit, NaOCl/HEBP in higher
temperature is recommanded as an irrigant in endodontic treatment
in order to increase the tissue dissolving effect.
T7 - 7
Effects of passive and ultrasonic irrigation on push-out
bond strength of two different luting cement
Akyuz Sefika Nur, A Erdemir, A Turkyilmaz, AU Eldeniz
Kirikkale University Department of Endodontics, Kirikkale, Turkey
Selcuk University Department of Endodontics, Konya, Turkey
Abstract
Aim To evaluate the effects of passive and ultrasonic smear layer removal techniques on the push-out bond strength of a glass fiber post
adhesively luted with self-etching and self-adhesive luting cements.
ESE ROME 2011
NOT ONLY ROOTS
Methodology Thirty maxillary incisor roots were endodontically treated. After post space preparation, they were assigned to 5 groups:
group 1 was served as control. The smear layer was removed passively (5.25% NaOCl and 18% EDTA in group 2 and 5.25% NaOCl and
20% citric acid in group 3) or ultrasonically (5.25% NaOCl and 18%
EDTA in group 4 and 5.25% NaOCl and 20% citric acid in group 5).
Each group was divided according to the adhesive approach, into
the two categories. Posts (FRC Postec Plus) were luted with either
a self-etch (Panavia F 2.0, Kuraray Medical, Japan) or self adhesive
(G-Cem Automix, GC Corp., Japan) cement. Luting agents were then
light-activated using a blue light–emitting diode curing unit. Roots/
cemented posts were transversally sectioned. Push-out tests were
performed using a Universal Testing Machine at a crosshead speed of
1 mm min-1. The data were calculated as MPa and analyzed by using
two way analysis of variance and Tukey tests.
Results Push-out bond strengths were significantly affected by the
smear layer removal techniques (p<0.05) and the type of luting agent
(p<0.05). The use of ultrasonic system in removal of the smear layer
was significantly increased push-out bond strength (p<0.05). The
bond strength of the self-etch resin cement (Panavia F) was significantly higher than that of the self adhesive resin cement (G-Cem Automix) (p<0.05).
Conclusions Within the limits of this in vitro study, the use of ultrasonic system in removal of the smear layer and the choice of selfetch resin cement can be increased the push-out bond strength of
the glass fiber posts.
T7 - 8
Assessment of mixture of HEBP/NaOCl solution for
smear layer removal and tissue dissolving capacity
Nam Wook, GW Choi
School of dentistry, Kyung Hee university Department of conservative
dentistry, Seoul, Republic of Korea
Abstract
Aim: To evaluate the capacity of smear layer removal and tissue dissolving with the mixture of 1-hydroxyethylidene-1,1-bisphosphonate
(HEBP) and NaOCl solution.
Methodology:
1. Smear layer removal test
Cylindrical root segments of bovine incisors were irrigated as
follows(n=20 per groups): NaOCl group, 3% NaOCl during and after instrumentation; Ethylenediaminetetraacetic acid(EDTA) group,
3% NaOCl during, 17% EDTA after instrumentation; HEBP11 group,
1:1-mixture 9% HEBP and 3% NaOCl during and after instrumentation; HEBP12 group, 1:2-mixture of 9% HEBP and 3% NaOCl during
and after instrumentation; HEBP13 group, 1:3-mixture of 9% HEBP
and 3% NaOCl during and after instrumentation. Irrigant volume and
contact time were 15ml/15min during and 5ml/2min after instrumentation. Specimens were evaluated by SEM.
2. Tissue dissolving assay
Bovine pulp specimens were previously weighed and immersed in
each experimental solution. Experimental solutions were prepared
as follows: NaOCl group, 1:1-mixture of distilled water and 3% NaOCl; EDTA group, 1:1-mixture of 17% EDTA and 3% NaOCl; HEBP11
group, 1:1-mixture of 9% HEBP and 3% NaOCl ; HEBP12 group,
1:2-mixture of 9% HEBP and 3% NaOCl; HEBP13 group, 1:3-mixture
of 9% HEBP and 3% NaOCl.
After an incubation time of 0, 15, 30, 60, 90, 120 minutes, the specimens were weighed. Results are expressed as percentage of the remaining tissue weight to the original tissue weight.
Results :In the smear layer removal test, EDTA group and HEBP
groups showed favorable ability to remove the smear layer, the EDTA
group was most effective (p<0.05). No significant difference was
found among HEBP groups (p>0.05). In the tissue dissolving test,
the tissue solubility of NaOCl group is the highest followed by HEBP
and EDTA groups in order. HEBP12 and HEBP13 group dissolved the
tissue more effectively than HEBP11 group (p<0.05).
Conclusions: The 1:2 and 1:3-mixture of 9% HEBP/NaOCl is recommended for the smear layer removal and tissue dissolving.
www.eserome2011.com
T7 - 9
Prevention of precipitate formation between CHX and
NaOCl in curved canals: an in-vitro study
Yaylali Ibrahim Ethem, K. Demirkaya, Y.M. Tunca
Gülhane Military Medical Academy, Centre of Dentistry Science, Department of Endodotics, Ankara, Turkey
Abstract
Aim: To compare prevention of precipitation formation between
Chlorhexidine and Sodium hypocholorite solutions by using traditional irrigating needles and Passive Ultrasonic Irrigation (PUI) in
curved root canals.
Material and Method: Thirty extracted maxillar first molar with curved
palatinal roots were selected and sectioned palatal roots. The roots
were divided in 3 groups (n=10). Apical foraminas were sealed with
composite resin. WL was determined as 16 mm. and were sectioned
from coronal parts. All root canals were prepared and irrigated with
EDTA % 5 , NaOCL % 5 and Chlorhexidine % 2 sequently in according
to irrigation protocol. Distilled water was used prior to Chlorhexidine
to remove NaOCl. Traditional irrigation needles were used as 5 ml.
to deliver distilled water in Group T. Distilled water was activated ultrasonically as 5 cc. / 20 sec. in Group U. None distilled water was
performed in Group C as control group. Each roots were sectioned in
3 parts apicocoronally and then mesiodistall . Each part of root were
examined and the results were subjected to Mann–Whitney U test.
Results: The coronal and medial thirth of roots had no precipitation
in two techniques. In apical parts of the roots, Group U had lesser
precipitation areas than Group T (p<0,05).
Conclusions : In our study we used distilled water as 5 ml. for both
techniques. If the durations and/or amounts of irrigation is much
more than 5 ml. and / or 20 second, the beter results can be taken.
T7 - 10
Antimicrobial effectiveness of 2% Chlorhexidine liquid
and Ca(OH)2 in root canals infected with E. faecalis (ex
vivo)
Konstantinos Kalogeropoulos, G Khabbaz Marouan
Dpt. of Endodontics, Athens Dental School, University of Athens, Athens,
Greece
Abstract
Aim of this investigation was to compare the antimicrobial effectiveness of 2% CHX liquid with that of Ca(OH)2 as intracanal medicaments against E. faecalis.
Methods: 80 human intact freshly extracted single rooted teeth were
prepared to apical size 50. Smear layer was removed and the specimens were immersed in BHI broth and underwent a sterilization process. Sterility was checked by the absence of turbidity. Infection of
the specimens was done by a microbial suspension of E. faecalis renewed every second day. After 4 days the specimens were assessed
for bacterial growth and divided into 4 groups of 15 each and 2 control
groups of 10 each. The tested intracanal medications were commercially available Ca(OH)2 paste and liquid 2% Chlorhexidine solution.
The medications were inserted in the root canals and infection was
evaluated after three and seven days. Fisher’s Exact test and Bonferroni–Holmes post hoc test were used for the statistical analysis.
Results: The infected specimens in the 2% CHX liquid group were
found to be 5/15 (33.33%) and 4/14 (28.6%) for the 3 and 7 days period
respectively whilst the infected specimens in the Ca(OH)2 group were
found to be 13/15 (86.67%) and 11/15 (73.33%) respectively for the
same period of time. The difference in antibacterial activity between
the two medicaments was statistically significant in all the test periods. Conclusion: Under the limitations of the present investigation
2% liquid CHX seems to be an effective alternative intracanal medicament against E. faecalis, compared to Ca(OH)2 in three and seven
days period of time.
17
1 5 TH B I E N N I A L C O N G R E S S
OF THE EUROPEAN SOCIETY
OF ENDODONTOLOGY
Chairpersons:
Ashraf El Ayouti, Francesco Riccitiello
Session T8 – 13.30
T8 - 1
Effect of different irrigation solutions on shear bond
strength of composite resin to dentin
Sefika Nur Akyuz, A Erdemir, K Altinoluk, B Kalaycioglu
Kirikkale University, School of Dentistry, Kirikkale, Turkey
Abstract
Aim: To evaluate the effect of endodontic irrigation solutions on shear
bond strength of composite resin to dentin.
Methodology: Sixty extracted mandibular molars were sectioned parallel to the occlusal surface to expose midcoronal dentin. The dentin
surfaces were polished with waterproof-polishing papers. The specimens were randomly divided into six groups of 10 each. While Group
1 served as a control, the specimens in groups 2 to 6 were treated
with a different irrigation solution respectively that included 5.25%
NaOCl, 18% EDTA (Ultradent, South Jordan), 15% EDTA gel (SurePrep, Diadent, Korea), 2% Chlorhexidine solution (Drogsan, Turkey),
1% Chlorhexidine gel (Drogsan, Turkey). The Clearfil SE Bonding system (Kuraray, Japan) was applied to dentin surfaces and the composite (Clearfil photo-posterior, Kuraray, Japan) build ups were created.
After the specimens were stored in an incubator for 24 h, the shear
bond strength was measured at a cross-head speed of 1 mm/min and
calculated as MPa. The data were analyzed using one way ANOVA and
Tukey tests.
Results: There was a statistically significant decrease on shear
bond strength of composite resin to dentin associated to irrigation
with NaOCl, EDTA or EDTA gel (p<0.05), whereas chlorhexidine and
chlorhexidine gel irrigation had no effects on adhesion (p>0.05).
Conclusions: It was concluded that the use of NaOCl, EDTA or EDTA
gel in endodontic treatment affected adversely shear bond strength
of composite resin to dentin. Further studies are still needed to solve
any negative effect of these solutions on dentin.
T8 - 2
PerioFilm preparation in the complicated endodontic and
orthodontic therapy of the tooth with apical resorption
Banaszek Katarzyna
Department of Endodontics, Medical University of Lodz, 92-231 Lodz, ul.
Pomorska 251, Poland
Abstract
The article presents the use of the PerioFilm adhesive dressing
containing antibiotic piperacillin and biodegradable resins (Italmed,
Italy, Firenze and Laboratorios Inibisa, S.A. Spain, Barcelona) in the
complicated endodontic retreatment of tooth 11 with advanced apical
resorption in an eighteen-year-old female patient during orthodontic
therapy. Orthodontic treatment caused the shortening of 1/3 of the
original root length, alveolar bone loss to 2/3 of the root length, pathological pockets on the mesial and distal side of the root, purulent
exudate from the pockets, tooth mobility of degree 3 and the presence of chronic apical periodontitis with active fistula at the bottom of
the pocket. Exacerbations resulted in periapical abscess formation,
and oedema of the oral mucosa, lips as well as subnasal area. Standard endodontic and periodontal therapy was performed. Endo-perio
lesions were treated with PerioFilm because of its wide spectrum
of action against anaerobic bacteria in pathological pockets and a
longlasting release of piperacillin.
The dressing was prepared according to the manufacturer’s recommendations and applied to the dried canal and the bottom of the
pockets by a syringe with a blunt needle (1-2 drops delicately blown
up with the air spray). The product hardened in contact with air. After
1 min the canal was obturated and the patient was asked not to drink
18
R O M E - 2 0 1 1 , S E P T E M B E R 1 4 TH - 1 7 TH
R O M E CAVA L I E R I H OT E L
or eat for the next 3 hours. PerioFilm was applied 4 times in 7-10 day
intervals. After the last application, the root canal was filled with calcium hydroxide-based non-hardening material and the cavity in the
tooth crown was tightly sealed.
Forty days after the beginning of therapy the radiograph showed
decreased inflammation around tooth 11; the clinical examination
revealed the tooth stabilisation, reduction in tooth mobility (degree
2), lack of marginal periodontitis and decrease in pocket depth. The
fistula closure occurred after the first application of PerioFilm.
T8 - 3
Experimental study on the use of diode laser in endodontic
resistant infections by Enterococcus faecalis
Gilda Cretella, M Inchingolo, L Marigo, Daniele Angerame, Francesco
Somma
Università Cattolica del Sacro Cuore, Rome, Italy
Università degli Studi di Trieste, Trieste, Italy
Abstract
Background: The aim of this study was to evaluate the bactericidal
effect of diode laser irradiation against intracanal Enterococcus faecalis by colony counts and SEM analysis.
Methods and Materials: 160 extracted single-rooted and monocanalar teeth were treated with ProTaper instruments (Dentsply Maillefer,
Ballaigues, Switzerland). 152 root canals were inoculated with Enterococcus faecalis for 21 days, 8 teeth were not contaminated and
their canals were irrigated with saline solution. The samples were
randomly divided into 3 groups: group A (n=48) was irrigated with
saline solution colored with methylene blue activated by diode laser
ENJOY5 (Sweden & Martina, Padova, Italy); group B (n=48) was irrigated with saline solutions activated by diode laser; Group C (n=48)
was treated with 5.25% sodium hypochlorite activated by diode laser.
8 teeth were used as positive control and 8 were used as negative
control.
Results: ANOVA test and Bonferroni’s test were used for statistical
analysis. A statistically significant reduction of bacterial count was
observed using the Uro-Quick system in all groups. Starting from an
initial charge an average of 5 x 106 CFUs / ml, a final average charge
of 30 x 103 CFUs / ml was reached for group A, 57 ◊ 103 CFUs/ml for
group B, while the samples of group C were completely decontaminated. The SEM analysis confirmed the results obtained by the plate
count: significant differences, regarded to the presence of biofilm,
are observed from group B to group C. The samples of group C have
an almost complete absence of biofilm, compared to those of group B
in which the dentinal wall is mostly covered by bacterial mat.
Conclusions: The diode laser has been effective in reducing both the
free bacteria and the biofilm of root canal system, especially when it
is used in association with sodium hypochlorite.
T8 - 4
Effect of superoxidised water on debris and smear layer
removal in the root canals of ex vivo human teeth
Saulius Drukteinis, Daiva Sabakiauskiene, V Peciuliene, R Maneliene
Institute of Odontology, Faculty of Medicine, Vilnius University, Vilnius,
Lithuania
Abstract
Aim. The aim of this study was to measure and compare the root canal cleanliness and smear layer removal effectiveness of superoxidised water (Sterilox) when used as an endodontic irrigating solution
in comparison with sodium hypochlorite and ethylenediaminetetraacetic acid.
Methodology. Forty single-rooted human teeth were distributed randomly into two groups of 20 teeth each. Root canals were shaped with
ProTaper rotary nickel-titanium instruments. The irrigation treatments investigated were superoxidised water (Group 1) and 3.0%
sodium hypochlorite + 17% ethylenediaminetetraacetic acid (Group
2). Roots were splited longitudinally and subjected to scanning elec-
ESE ROME 2011
NOT ONLY ROOTS
tron microscopy. The presence of debris and smear layer at coronal,
middle and apical thirds was evaluated by using a 5-grade scoring
system with 200X and 1000X magnification, respectively.
Results. Concerning debris and smear layer removal, the irrigation
with NaOCl and EDTA was slightly superior to superoxidised water,
but no significant differences among groups were detected.
Conclusions. Irrigation with electrochemically activated water
cleaned root canal walls and may be a possible alternative to NaOCl
and EDTA in conventional root canal treatment. Further investigation
of superoxidised water solution as root canal irrigant is warranted.
T8 - 5
Antibacterial activity of propolis extract as a vehicle of
calcium hydroxide
Erdemir Ali, S.N. Akyuz, A. Turkyilmaz, N. Unal
Kirikkale University, Faculty of Dentistry, Kirikkale, Turkey
Kirikkale University, Faculty of Veterinary Medicine, Kirikkale, Turkey
Abstract
Aim: To evaluate antibacterial activity of propolis extract as a vehicle
of calcium hydroxide using agar diffusion and direct contact tests.
Methodology: Calcium hydroxide combinations were prepared by
adding calcium hydroxide powder into either distilled water (Group
1), glycerin (Group 2), 1% chlorhexidine gel (Group 3), or 10% dimethyl-sulfoxide (DMSO) extract of propolis (Group 4). Antibacterial activities of the calcium hydroxide combinations were evaluated using
Staphylococcus Aureus (ATCC 6538), Escherichia Coli (ATCC 25922),
Candida Albicans (ATCC 10231) and Enteroccocus Faecalis (ATCC
29212). For ADT, the freshly mixed calcium hydroxide combinations
were placed into the prepared wells of agar plates inoculated with
the test microorganisms. After varying periods of incubation (24, 48
and 72 hours, 7 and 10 days), the zones of growth inhibition were
measured. For DCT, two microtiter plate wells were used. The freshly
mixed calcium hydroxide combinations were placed on the walls of
microtiter plate wells. 10 μL bacterial suspensions were allowed to
directly contact the prepared materials for 1 hour and 24 !
hours at 37oC. Fresh media were added and 15 μL were transferred
from these plates to another plates containing fresh medium. Bacterial growth was then spectrophotometrically measured every 1 hour
for 16 hours.
Results: ADT results indicated that Calcium hydroxide combinations
with chlorhexidine gel and DMSO extract of propolis were significantly
higher antibacterial activity than the other combinations (p<0.05). In
DCT results, although one hour direct contact was enough to kill all
test bacteria when Calcium hydroxide combinations with chlorhexidine gel and DMSO extract of propolis were used, 24 hours were
needed for the other combinations.
Conclusions: The results of this in vitro study indicated that Calcium
hydroxide combinations with chlorhexidine gel and DMSO extract of
propolis showed better antimicrobial activity than calcium hydroxide
manipulated with distilled water and glycerin.
T8 - 6
Chlorhexidine effectiveness against Enterococcus
faecalis, when associated or not to calcium hydroxide as
intracanal medication
CXM Ferreira, FRF Alves, LS Gonçalves, Julio Cezar Machado Oliveira
Estácio de Sá University, Graduate Program in Dentistry, Rio de Janeiro,
Brazil
Abstract
Several agents have been proposed to be employed as intracanal medicaments, among them calcium hydroxide and chlorhexidine have
been reported to offer effectiveness without side effects. However,
the combination of these two antimicrobial agents has not been
deeply evaluated and the aim of this study was to compare the an-
www.eserome2011.com
tibacterial effect of seven different formulations based on calcium
hydroxide and/or chlorhexidine against four endodontic isolates and
a standard strain of Enterococcus faecalis. The tested formulations
were 0.12%, 0.2% and 2% chlorhexidine gluconate associated to zinc
oxide or calcium hydroxide, and calcium hydroxide associated to
glycerin. The negative control as tested by a paste composed by zinc
oxide and glycerin, and the positive control group by a 2% chlorhexidine gel. All the formulations were prepared in creamy consistence.
The agar diffusion test was used to evaluate the antibacterial effect
of the medicaments. There was no significant statistical difference
amongst the inhibition zones growth presented by the seven different
formulations and the positive control group (p>0.05), when the action
against the four wild strains was compared to that against the ATCC
reference strain of E. faecalis. When comparing medicaments in
which chlorhexidine was combined with zinc oxide or calcium hydroxide, statistical difference was observed only between medications
containing 2% chlorhexidine, where the combination of chlorhexidine
with zinc oxide was more effective than the combination of chlorhexidine with calcium hydroxide (p<0.05). Calcium hydroxide mixed with
glycerin was significantly less effective than pastes prepared with
chlorhexidine, but more effective than the negative control group
(p<0.05). Considering the limitations of the method employed in this
study, our results suggest that calcium hydroxide seemed to jeopardize the antibacterial activity of chlorhexidine against E. faecalis, and
accordingly chlorhexidine should be employed as intracanal dressing
combined with some neutral powder agent as zinc oxide, mainly in
retreatment cases.
T8 - 7
Laser as an adjunct to chemo-mechanical disinfection of
infected root canals. A systematic review
KM Larsson, Eva Wolf, H Fransson
Department of Endodontics, Faculty of Odontology, Malmö University,
Malmö, Sweden
Abstract
Aim Laser devices for endodontic purposes are suggested to reduce
bacterial load when used as an adjunct to conventional root canal
treatments. The aim of this study was to evaluate the efficacy of laser as an adjunct to chemo-mechanical disinfection of infected root
canals with the end-point measures healing of apical periodontitis or
reduction of the microbial load.
Methodology A PubMed and CENTRAL literature search with specific
indexing terms and a subsequent hand search were made with stated
limits and criteria. Relevant publications were retrieved, followed by
interpretation. The three authors independently assessed level of
evidence of the studies that fulfilled the inclusion criteria. Level of
evidence for each included publication was assessed as high, moderate or low.
Results The initial search process yielded 211 publications. All abstracts of these publications were read, and the reference lists of
relevant publications were hand searched. Ten articles were read
in full text and interpreted according to a data extraction form. Five
were included in the systematic review and assessed with a level of
evidence. Four of the five included studies reported a positive effect
when laser treatment was used as an adjunct to conventional chemomechanical treatment of infected root canals. A meta-analysis was
impossible to perform, as the included studies were heterogeneous
regarding study designs, treatment and end-point measures. Each
included study was assigned a low level of evidence, primarily due to
lack of a power analysis, blinding and reproducibility.
Conclusions The evidence grade for whether laser can be recommended as an adjunct to chemo-mechanical disinfection of infected
root canals was insufficient. This does not necessarily imply that laser should not be used as an adjunct to root canal treatment but instead underscores the need for future high-quality studies.
19
1 5 TH B I E N N I A L C O N G R E S S
OF THE EUROPEAN SOCIETY
OF ENDODONTOLOGY
R O M E - 2 0 1 1 , S E P T E M B E R 1 4 TH - 1 7 TH
R O M E CAVA L I E R I H OT E L
T8 - 8
Chairpersons: Hagay Shemesh, Giovanni Cavalli
Effectiveness of EDTA and MTAD on Debris and Smear
Layer Removal using a Self-Adjusting File
Session T9 – 13.30
Adiguzel Ozkan, Senem, T ÖZER, Sadullah Kaya, Zeki
Dicle University, Faculty of Dentistry, Department of Operative Dentistry
and Endodontics, Diyarbakir, Turkey
Dicle University, Faculty of Medicine, Department of Statistical Analysis,
Diyarbakir, Turkey
Abstract
Introduction: In this study, we evaluate the cleaning ability of a selfadjusting file (SAF) system in terms of debris and smear layer removal using EDTA or MTAD.
Methods: In total, 45 root canals were randomly divided into two irrigation groups of 20 canals each and a negative control group of five
canals. The canals in each of the irrigation groups were irrigated using sodium hypochlorite (2.6%) as an initial irrigant following 17%
EDTA or MTAD in a continous flow with SAF for 2 min in a closed
system. The roots were split longitudinally and subjected to scanning
electron microscopy (SEM). The presence of debris and smear layer
in the coronal, middle, and apical thirds of the canal was evaluated
using a 5-grade scoring system with 200X and 2000X magnification,
respectively.
Results: The SAF operation with continuous irrigation using MTAD resulted in 85%, 70%, and 60% of the coronal, middle, and apical thirds
of the root canal, respectively. The SAF operation with continuous irrigation using EDTA resulted in 85%, 60%, and 50% of the coronal,
middle, and apical thirds of the root canal, respectively. Evaluation by
SEM showed no significant difference between tested irrigants in removing the smear layer among the different regions of the root canal.
Conclusions: When using the SAF, the protocols used in this study
were effective for debridement of all parts of the root canal.
T8 - 9
In vitro comparison of the Vibringe system with conventional syringe in root canal debridement
Raffaella Castagnola, Valentina Aprile, L Marigo, Daniele Angerame,
Francesco Somma
Università Cattolica del Sacro Cuore, Rome, Italy
Università di Trieste, Trieste, Italy
Abstract
Background The aim of this in vitro study was to compare the efficacy
of root canal wall debridement using either conventional syringe irrigation or a sonic device (Vibringe).
Methods and Materials 136 extracted monoradicular and monocanalar teeth were randomly divided into two equal groups. The canals
of the teeth in each group were instrumented with ProTaper Universal rotary files (Dentsply Maillefer, Switzerland). Final irrigation was
performed with either conventional syringe in group 1 or Vibringe
system (BV Corp Vibringe, Amsterdam, Netherlands) in group 2. The
teeth were then decoronated and each root split longitudinally into
two halves to be examined in the apical, middle, and coronal thirds
using the scanning electron microscope (SEM). The presence of
smear layer was evaluated by a standardized 4-point scoring system,
and the resulting scores submitted to Chi-square statistic test.
Results The apical thirds of the root canals in group 1 showed lower
smear layer removal than those in group 2, and the difference was
statistically significant (P < 0.05). There was no significant difference
in the coronal and middle score between the groups (P > 0.05).
Conclusions In conclusion, the protocol used in this study was not
efficient to completely remove the smear layer, but the Vibringe System demonstrated significantly better results than syringe irrigation
in the apical root canal third.
20
T9 - 1
An endodontic lesion or not? An uncommon case presentation of an odontogenic keratocystic tumor
S.O. Basoudan, H.A. Balto, A.S. Al-Rasheed
College of Dentistry, King Saud University. Riyadh, Saudi Arabia
Abstract
A 34-year old female patient presented with symptoms, mostly pus
discharge, that had not subsided after root canal treatment, and retreatment, over the last 4 years. Radiographs showed a very large
periradicular lesion related to tooth 12 (FDI) and involving the proximal area between teeth 12 and 13. The root canal treatment on 12
seemed adequate. Clinically, the tooth was mobile with an isolated
10-mm pocket distolingually. The initial differential diagnosis was
mainly a periapical lesion related to root fracture/crack or abnormality of the tooth, or a lateral periodontal cyst (possibly infected).
Endodontic surgery was initiated, there were no signs of fractures
or cracks or abnormalities on #12. Only soft tissue debridement was
performed. The histopathology report of the soft tissue indicated an
odontogenic keratocystic tumor. A 2-year follow up shows absence of
the patient’s symptoms, no recurrence and bone healing of the whole
periapical area.
Diagnosis of odontogenic keratocystic tumors prior to intervention
is advantageous because this tumor requires special management.
Reports in the literature show high recurrence rates of odontogenic
keratocystic tumors. Recent systematic reviews have suggested a relationship between treatment modalities and the recurrence rates.
Resection shows nearly no recurrence and enuclation alone shows
the highest rates. The use of Carnoy’s solution is a conservative approach with lower recurrence rates than enuculation alone. Taking a
biopsy prior to surgery is valuable. But where not possible, complete
and careful curettage of the lesion is very important. In addition, the
patient should be kept under follow-up for long terms.
T9 - 2
A study of endodontic practice amongst Turkish dentists
Kaptan Figen, F Haznedaroglu, MB Kayahan, H Ozkan
Yeditepe University faculty of dentistry, Turkey
Istanbul University faculty of dentistry, Turkey
Abstract
Aim: The purpose of this study was to gather information on routine
endodontic treatment performed by Turkish dentists.
Methodology: 47 questions with multiple-choise answers were given
to 1400 dentists either at the Turkish Dental Association Congress
where they attended or were reached by e-mail. Basic information
(age, gender, year ofgraduation, practice profile) and information of
various issues relating to the cleaning, shaping and obturation of root
canals was collected.
Results: Of 1400 questionnaires a total of 602 were returned, 589
(42%) of which were valid. The majority (84%) of respondents categorized themselves as general practitioners. 9.4% mentioned a
clinical interest or speciality in practice and 7.3% were postgraduate
students. Most practitioners (72.3%) did not use rubber-dam. A vast
majority of respondents (90.2%) used sodium hypochlorite as an irrigant, but 7% did not know the concentration they used; EDTA was
used in 44.1% of the practices. The majority of respondents (77.8%)
took a radiography with an instrument of known length in situ to
gauge the working length; electronic root canal length determination was often used (41.1%); 17.1% relied on tactile sense. Among
the respondents 21.1% didn’t perform retreatment. The majority of
respondents (95.7%) used hand instruments (H-file or combined with
K-file) to prepare root canals, 58.1% used ni-ti rotary inrtruments.
81.5 percent of participants attended postgraduate continuing edu-
ESE ROME 2011
NOT ONLY ROOTS
cation seminars, while only 32.4% attended an endodontic congress.
Among the respondents 33.8% used cold lateral condensation as
root canal obturation technique. The most popular sealer was AH
Plus 46.2%. According to the results of this study, Turkish dentists
are aware of current trends in endodontics, but incapable of bringing
these into everyday practice.
T9 - 3
Combined endodontic and surgical treatment of
extensive maxillary frontal teeth crown destruction: case
presentation
Disha Metush, Fatmir Dragidella, Kastriot Meqa, Zana SllamnikuDalipi, Teresa Disha, Saranda Disha, Donika Disha, Burim Gutiqi,
Melisa Disha
Dentistry School, Medical Faculty, University of Prishtina, Prishtina, Kosovo
Private Dentistry Clinic “Dental- D”, Peja , Kosovo
Abstract
Extensive carious lesions, especially in the maxillary frontal teeth
represent not only functional and esthetic problems, but also psychosocial discomfort due to an “awkward appearance”. A case report
will be presented of a a patient KB, age 16, with extensive destruction of maxillary teeth 12, 11, 21, 22, and periapical lesions of 21 and
22, with intraoral vestibular sinus tract. The periapical involvement
has been documented with intraoral radiography. After the removal
of carious lesions of the abovementioned teeth and endodontic treatment of 21 and 22,a full crown composite restoration of 12, 11, 21 and
22 was carried out. The periapical lesions in 21 and 22 were surgically
removed with surgically . The reconstruction of the maxillary frontal
teeth has restored functionality and esthetics, and satisfactory pshycological impact to the patient.
T9 - 4
Endodontic treatment of a maxillary first molar tooth
with a C-shaped canal morphology: case report
Dincol Muzaffer Emir, Handan Ersev, Bülent lmaz
Research assistant, Istanbul University, Faculty of Dentistry, Department
of Endodontics, Istanbul, Turkey
Abstract
This clinical report presents the endodontic treatment of a maxillary
first molar with a C-shaped distopalatally located root canal system.
According to the endodontic literature, the C-shaped root canal is
most frequently seen in the mandibular second molar. However, occurence of this unusual morphology in maxillary first molars has only
been described in a limited number of case reports. A 16-year-old
male patient presented to our clinic with the complaint of discoloration in his left maxillary first molar. Radiographic examination revealed two distinct roots (palatal and mesio-buccal) and as well as
a periapical radioluceny associated with the mesio-buccal root end.
The disto-buccal root end was not identified and it was believed to
be superimposed on the palatal root. Upon completion of the access
cavity, only one canal orifice was found in the mesio-buccal root as
well as a deep semilunar groove which extended from the palatal to
the disto-buccal aspects of the cavity. Neither the palatal, nor the
disto-buccal root canal orifices were identified and whenever an
instrument was inserted into any side of the Cshaped canal, it was
always ended in the disto-palatal foramen of the tooth. The clinical
conclusion was that the palatal and the disto-buccal canals were
merged in a C-shaped single canal and that there was only one canal
in the mesio-buccal root. The two root canals were rinsed with copious amounts of 2.5% sodium hypochlorite solution and shaped with
stainless-steel K-type files by using the step-back technique. Obturation was performed with laterally condensed gutta-percha and
AH-Plus sealer. A 6-months follow-up radiograph showed complete
resolution of the periapical lesion.
www.eserome2011.com
T9 - 5
Surgical extrusion of a crown-root fractured tooth: 3-year
follow-up
Onay Emel Olga, M Ungor, B Kaya, F Veziroglu
Baskent University School of Dentistry, Ankara, Turkey
Abstract
AIM. Different treatment approaches are indicated for fractured
teeth. Although it is suggested that using orthodontic forces is a biological way of extruding teeth, surgical extrusion is a one-step procedure which is simpler and less time-consuming than orthodontic
extrusion. A case is presented.
METHODOLOGY. A 50 year-old female was referred for treatment
with the primary complaint of discomfort in her maxillary left second premolar, which was reported to have been traumatized 1-week
previously while chewing on hard food. The intra-oral examination
revealed an oblique crown-root fracture on the tooth. Following the
extraction of the mobile fractured palatal fragment under local anesthesia, temporary endodontic treatment was initiated. The surgical
procedure involved careful mobilization of the tooth with elevator and
cutting of the marginal periodontal fibers with a sharp scalpel. The
tooth was extruded for 4 mm using extraction forceps. Stabilization
of the root in its new position was achieved with an orthodontic archwire (Nitinol; 3M-Unitek, Monrovia, CA, USA) and Edgewise brackets
(Clarity; 3M-Unitek, Monrovia, CA, USA) for 4 month-period. Ten days
following the extraction root canal therapy was completed. The root
canal was instrumented with ProTaper rotary files (Dentsply-Maillefer, Ballaigues, Switzerland). One ml. of 5.25% NaOCl was used
for irrigation between instruments. The root canal was filled with
gutta-percha (Diadent, Chongju, Korea) and AH Plus sealer (Dentsply, Konstanz, Germany) using lateral condensation technique. The
tooth was temporarily restored with glass ionomer cement (IonofilU; Voco, Cuxhaven, Germany). After the resolution of the periapical
radiolucency, the tooth was restored with porcelain fused to metal
crown. RESULTS. Three years follow-up examination showed that
there were no radiographic and clinical signs of progressive root resorption, marginal bone loss or periapical disease.
CONCLUSION. The favorable results of this case demonstrate that
surgical extrusion may be an alternative treatment to orthodontic
extrusion.
T9 - 6
Re-attachment of fractured anterior tooth
Seo-Ryeong Kim, Jiwan Yum, Jeong-Kill Park, Bock Hur, HyeonCheol Kim
Department of Conservative Dentistry, Pusan National University, Yangsan, Korea
Abstract
I. Introduction
Crown fractures or crown-root fractures of anterior teeth are the
most frequent form of acute dental injury that mainly affects children
and adolescents. Today, restoration of such traumatized incisors by
reattachment of the original tooth fragment appears to be the most
conservative treatment approach. Reattachment of the fractured
fragment is currently the preferred technique representing a simple
and low cost method, which allows the maintenance of incisal function in dental structure, provides better esthetic results, maintains
the tooth form and color.
Following case reports present clinical cases of tooth reattachment
performed in a fractured upper incisor with pulp exposure or crownroot fracture, which was restored with an original crown fragment.
II. Case Presentation
< Case 1 >
1. Sex/age : F/15
2. Chief Complaint(C.C) : Crown fracture of #11
3. Past Dental History(PDH) : N-S
4. Present Illness(P.I) : #11- Crown fracture with pulp exposure
5. Impression : Complicated crown fracture with pulp exposure of #11
6. Tx plan : Cvek pulpotomy and crown re-attachment on #11
21
1 5 TH B I E N N I A L C O N G R E S S
OF THE EUROPEAN SOCIETY
OF ENDODONTOLOGY
< Case 2 >
1. Sex/age : M/13
2. Chief Complaint(C.C) : Tooth mobility and cold sensitivity of #21
3. Past Dental History(PDH) : 35 days ago, #21 was fractured by fist
trauma
4. Present Illness(P.I) : #21- Cervical crown-root fracture(extended
subgingivally on the palatal area), apical horizontal root fracture,
per(+), mob(+), cold(+)
5. Impression : Complicated crown-root fracture of #21
6. Tx plan : Fragment re-attachment on #21
III. Conclusion
Reattachment of the intact fractured segment can be considered as a
conservative method for aesthetic rehabilitation. This procedure was
useful to preserve a natural tooth structure.
T9 – 7
Managment of endo-perio lesion in first upper incisor: a
case report
Sepic Matanovic Branka Mikica, M Molnar, B Pazin
Department of Endodontics, Oral Medicine and Periodontology, Dental
Clinic Zagreb, Zagreb, Croatia
Abstract
The relationship between periodontal and endodontic disease brings
speculation, confusion, and controversy. Pulpal and periodontal problems are responsible for more than 50% of tooth mortality today. Diagnosis is difficult since these diseases have been studied primarily
as separate entities. The infection of the pulp may initiate periodontal
defects through canal ramifications and dentinal tubules, impairing
wound healing in regenerative procedures. Although no studies exist addressing the direct effect of pulpal infection on the outcome
of guided tissue regeneration (GTR) procedures, several studies indicate that pulpal status may play a significant role toward the end
results of GT and periodontal treatment A 42-year old female was
referred for the periodontal treatment, during which a translucency
around intact first anterior incisor 21 was discovered. The patient
was unaware of it and had no previous symptoms. Vital response was
missing so we preformed a root canal treatment with ProTaper Universal System (Maillefer, Baillaigues, Switzerland). After one week
of calcium hydroxide (Ultracal SX, Ultradent Products, South Jordan,
UT) the root canal was finished with ProTaper gutta percha points.
A surgical periodontal treatment started with a full thickness flap.
Intra operationem we observed a significant bone loss on the medial
aspect of tooth 21 going from the upper third to the periapical aspect
of the root. We did not observed a root fracture even with the size and
a position of the radiographed bone loss indicating it. The bone defect
was filled with natural bone substitute material Bio-Oss (Geistlich,
Geistlich Pharma AG) and the defect was later covered with a collagen membrane Bio-Gide (Geistlich, Geistlich Pharma AG).
One, three and six months follow up radiographs and clinical examinations were done after the periodontal surgery.
T9 – 8
An interdisciplinary approach to treating a severely
discoloured central incisor with gingival recession
Babur Taner, C Walter, H Hecker, R Weiger, G Krastl
Switzerland
Abstract
Background: Discoloured teeth and uneven gingival contours may
pose a considerable challenge for the dental clinician.
Case: This report presents the case of a 39-year-old female patient
exhibiting a distinct discoloration and a gingival recession on her upper left central incisor. She presented a history of trauma to the upper
anterior region 25 years ago. The patient’s desire was to keep the tooth
and to improve the appearance of her front teeth. The clinical examination revealed a severe internal staining and an exposed root surface
(Miller class 1) on tooth 21 (FDI). The periapical radiograph showed an
insufficient root canal filling but no visible apical periodontitis.
22
R O M E - 2 0 1 1 , S E P T E M B E R 1 4 TH - 1 7 TH
R O M E CAVA L I E R I H OT E L
Treatment: After endodontic retreatment internal bleaching was
performed with sodium perborate according to the walking bleach
method. Despite five bleaching sessions, a complete metamorphosis of the discoloured tooth could not be achieved. The access cavity was sealed with composite. A coronally positioned flap technique
was chosen for root coverage of the recession defect. The tooth was
restored with a bonded all-ceramic crown six months later. At the
5-year follow-up an apical periodontitis was diagnosed on the periapical radiograph. Apical surgery was performed. The root-end cavity
was filled with MTA cement.
Follow up: At the 7 years follow-up (2 years after surgery) the aesthetic
appearance was satisfying. Clinical examination revealed no mobility
of the tooth, probing depths up to 3mm, and normal function without
any symptoms. The radiograph revealed a reduced radiolucency and
provided evidence of ongoing healing of the periapical pathology.
Conclusion: The present case demonstrates the challenging synoptic
treatment of an upper incisor. The combination of endodontic treatment, the walking bleach method, periodontal plastic surgery and reconstruction with an all ceramic crown creates a sufficient aesthetic
result that may not have been obtained with either treatment alone.
T9 – 9
Efficiency and duration of anaesthesia with Ubistesin
(Articaine 1:400.000) during outpatient dental treatment
in a dental school
Hassan Muhamed, Adriano Azaripour, M. Försch, M. Daubländer, B.
Willershausen
Departments of Operative Dentistry, Dental Surgery University of Mainz,
Mainz, Germany
Abstract
Aim To test the efficiency and duration of anaesthesia with Ubistesin
(Articaine 1:400.000 adrenalin; 3M ESPE, Neus Germany) during dental treatments such as restorations, endodontic treatments or root
planing.
Methodology A total of 380 patients (52.1% female, 47.9 % male) with
an age range from 18 to 78 years were included. Overall 515 maxillary
teeth and 311 mandibular teeth underwent treatment and had to be
anaesthetized. In total 287 patients were treated with a block (conduction) anaesthetic (1.7 mL) and in 97 cases an infiltration anaesthetic
(1-1.7 mL) was used. The dental treatment included tooth preparation, restorations as well as periodontal therapies such as scaling and
root planing and other minor dental procedures. All patients received
a questionnaire to indicate the duration of anaesthesia.
Results In 327 (86%) patients it was not necessary to give a supplementary injection during the dental treatment; for 369 patients it was
possible to complete the dental treatment and most of the patients
(377) had no after-pain. In most cases the treatment involved removal of caries (42%), root canal access (8%), scaling and root planing
(17%), restoration (11%) and others (22%). The average time course
of the treatments was: commencing 5 min after the anaesthesia, repeat injection after 54 min, to finish the dental treatment within 90
min. The mean time for normal sensation to return was 164 min. All
patients had satisfactory anesthesia following Articaine (1:400.000),
although the individual sensation of pain constituted a factor that was
not easy to estimate.
Conclusions In this study population; satisfactory local anaesthesia
was achieved using Articaine with only 1:400,000 epinephrine. Dentists should justify the use of agents with higher vasoconstrictor concentration on a case by case basis.
ESE ROME 2011
NOT ONLY ROOTS
friDAY, 16TH SEPTEMBER 2011
Chairpersons: Ivana Miletic, Etienne Deveaux
Session F1 – 13.30
F1 - 1
Chronic maxillary sinusitis and pulpal complication:
a case report
Bulent Yilmaz, H Ersev, ME Dinçol
Istanbul University, Faculty of Dentistry, Department of Endodontics,
Istanbul, Turkey
Abstract
Maxillary sinusitis of dental origin has extensively been investigated
by various researchers. It usually occurs when the integrity of the sinus floor membrane is disrupted by iatrogenic complications, trauma,
or pathological causes such as periapical or periodontal diseases of
the adjacent maxillary teeth and odontogenic cysts. However, to the
best of our knowledge, there is no information about chronic rhinogenic maxillary sinusitis causing pulpal complication in the literature.
The aim of this report is to present a case of periapical lesion supposedly evolved secondary to the chronic rhinogenic maxillary sinusitis.
A 30-year-old male patient was referred for dental consultation by
an otorhinolaryngologist who stated that chronic maxillary sinusitis
might have eroded sinus floor. Computed tomography showed sinus
membrane thickening and a close anatomical relationship between
the sinus floor and the molar teeth. Oral examination was noncontributory, but a sinus tract located at the buccal mucosa overlying the
left first molar tooth was observed. Adjacent teeth to the sinus were
intact. Periodontal probing did not show any attachment loss. Periapical radiograph revealed that mesiobuccal root of the first molar
has periapical radiolucency. This tooth was negative to vitalometric
test. Any etiological factor other than sinusitis could not be found for
pulp infection. A nonsurgical endodontic treatment was initiated. Root
canals were shaped by using ProTaper instruments (Dentsply Maillefer, Ballaigues, Switzerland). As an interappointment medicament,
calcium hydroxide was applied for a period of eight-month. Then the
root canals were obturated by using AH Plus sealer (Dentsply, DeTrey, Konstanz, Germany) and lateral condensation of gutta-percha
cones. At this visit, it was detected that the periapical lesion and the
membrane thickening were significantly resolved. In conclusion, this
report presents a case in which chronic maxillary sinusitis might have
caused a retrograde pulpal infection in the adjacent tooth.
F1 - 2
Root canal retreatment of a mandibular first molar with
five root canals: a case report
Anais Ramirez, José Antonio González, Francesc Abella, Fernando
Durán Sindreu, Miguel Roig Cayón
Universitat Internacional de Catalunya, Barcelona, Spain
Abstract
A third middle root canal was found between mesiobuccal and mesiolingual root canals during a root canal retreatment. This report
shows a very rare configuration with separate apical terminations of
the three distal root canals and the importance of looking for additional canals when we are in front of a retreatment.
F1 - 3
Endodontic treatment of the first and second maxillary
premolars with unusual anatomy
Boris Pazin, Marijana Molnar, Branka Mikica Sepi, Matanovi Ljiljana
Pater Henigsman, Ana Mal
Department of Endodontics, Periodontology and Oral medicine, Dental
Clinic, Zagreb, Croatia
Department of Endodontics and Restorative Dentistry, School of Dental
Medicine, University of Zagreb, Croatia
Abstract
The main objectives of endodontic treatment are the elimination of
microorganism from the root canal system and prevention of reinfec-
www.eserome2011.com
tion of the system. Inability to find and properly clean root canals may
be the cause of treatment failure.
These case reports show endodontic therapy of the first and second
maxillary premolars with three root canals. According to Ingle and
Bakland, only 6% of the first and 1% of the second maxillary premolars have three root canals.
The first patient, aged 35, was referred to the Department of Endodontics, Periodontology and Oral Medicine for endodontic therapy
by his general dentist. The chief complaint was persistent pain in
relation to upper right first premolar, not decreasing despite chemomechanical preparation. Intraoral exam and radiographic analysis showed second buccal root canal that was not treated. Treatment
consisted of chemomechanical preparation of all three root canals
using the step-back technique. Root canals were filled by using cold
lateral condensation technique. All symptoms were relieved and the
tooth was reconstructed using Filtek Supreme XT composite material
(3M ESPE, St. Paul, USA).
The second patient, aged 28, was referred to our Department for endodontic or periapical surgical therapy of the second left upper premolar. Intense spontaneous and percussion pain was relieved after
locating the third, distobuccal root canal. The treatment consisted of
chemomechanical preparation of three root canals by using Ni-Ti rotary system ProTaper (Sx, S1, S2, F1) and filling with ProTaper (Dentsply, Tulsa, USA) Gutta Percha cones (F1) and AH+ sealer (Dentsply,
DeTrey, Zurich, Switzerland).
The six-month follow-up showed periapical osseus healing and fully
functional asymptomatic teeth.
F1 - 4
Treatment of inflammatory gingival lesion caused by vertical root fracture (case report)
Esnaashari Ehsan, Arezou Pezeshkfar, Hamid Moghadas
Iran
Abstract
Treatment of a tooth with vertical root fracture can be difficult and
unpredictable. Quite often, the most predictable treatment possible
is simply extraction.
This article presents a patient with an inflammatory gingival lesion
on the labial aspect of the maxillary right central incisor due to vertical root fracture. This diagnosis confirmed during surgery. There was
also a super contact on the mentioned tooth. Root canal therapy was
done and super contact eliminated. After 5 weeks the gingiva gained
normal appearance. 12 months follow up showed that the results remained stable and the tooth treated remained asymptomatic.
It is necessary to emphasize that, it is not possible to extend the result of this treatment to all patients with vertical root fracture and
at the present there is no predictable treatment for such teeth and
extraction may be the only choice of treatment.
F1 - 5
Management of taurodontism of maxillary first molar
Jeon Hyo Jin, Bock Hur, Hyeon-Cheol Kim, Jeong-Kil Park
Department of conservative dentistry, Pusan National University School
of Dentistry, Yangsan, Korea
Abstract
A 16-years-old patient was referred from local dental clinic for the
management of maxillary left first molar. On radiographic view, access cavity of maxillary left first molar was prepared. The apex of
tooth was opened and taurodontism was observed. On panoramic
view, all first and second molars were taurodontism. On his medical
history, lupus was suspected. The canal of left maxillary first molar
was cleaned and shaped and filled with MTA. On 4 month follow-up,
periapical lesion of left maxillary first molar was healed.
23
1 5 TH B I E N N I A L C O N G R E S S
OF THE EUROPEAN SOCIETY
OF ENDODONTOLOGY
F1 - 6
Detection of fractured endodontic files and simulated external root resorptions with three types of lcd monitors
using three different imaging receptors and cbct: an exvivo study
Kaan Orhan, Atakan Kalender, Umut Aksoy, Fatma Basmaci
Near East University, Department of Oral, Teeth and Jaw Radiology, Mersin 10, Turkey, Near East University, Department of Endodontics, Mersin
10, Turkey
Abstract
Aim: Careful reading of diagnostic radiographs and other images to
prevent misdiag¬nosis is crucial before and after endodontic treatment. They must optimize their viewing conditions, regardless of
whether they use film, the gold standard for image quality, particularly for spatial resolution. Thus, the aim of this study is to compare
different LCD monitors in order to detect simulated external root resorptions and fractured endodontic files in mandibular molar teeth
at three different tube potential settings using two phosphor plate
systems (SPP), a charge-coupled device (CCD) and a CBCT unit.
Methods: Fifty extracted human mandibular molars were used for
this study. 30 root canals were prepared for simulation of fractured
endodontic file. External root resorption defects in different locations were simulated in 40 human mandibular molar root surfaces..
All teeth were then were placed in a cadaver mandible and radiographed with four different imaging modalities- Newtom 3G-CBCT
(6 inch) scanner, Digora-Optime SPP system, VistaScan-Perio, Planmeca CCD,-at 60-, 66-, and 70-kV tube potentials, different angles
and exposure-times. Three observers scored the resultant images
using one LCD monitor and two medical monitors (1.5mp and 3mp)
for the presence or absence of fractured files and resorptions. The
diagnostic accuracy for each imaging modality was expressed as the
area under the ROC curves (Az).
Results: Inter and Intra-observer agreement were higher for CBCT
than three digital imaging receptors for detecting simulated external
root resorptions and fractured endodontic files. Medical monitors exhibited better performance than LCD monitor (p>0.05).
Conclusions: Resolution, contrast ratio, and luminance are different between the LCD and medical monitors which may be related to
higher diagnostic accuracy for endodontic imaging. Despite the high
cost, medical monitors can be recommended for the imaging interpretation in endodontics.
F1 - 7
Study of the internal anatomy of upper molars, in vitro
and in vivo comparison
Benages Hernica Meritxell, Guillermo Topham, Fernando DuranSindreu, Rufino Bueno, Miguel Roig
Spain
Abstract
Comparative study between in vitro and in vivo results of the internal anatomy of first and second molars using diafanization technique
(clearing technique). After a literature review we found no previous
studies where in vitro and in vivo are compared in the same population. Our objetive is to verify that the internal anatomy of maxillary
molars observed in in vitro studies match those when working in vivo.
The study was carried out in a population of Gran Canaria, Canary Islands, Spain, Europe. The inhabitants of these islands are Caucasian.
The upper molars to study in the in vitro part are classified at the time
of extraction as 1st and 2nd molars. The teeth were disinfected and
stored in wet condition. We perform the cameral opening and classify them according to the number of canals located. We apply the
protocol technique of diaphanisation, used in previous studies at our
university. Once transparent, teeth are injected India ink and photographed. Then they are sorted according to the Vertucci classification. Clinical cases of the in vivo are made, all from a single dentist,
with an MSc in Endodontics. Working conditions are the same in all
24
R O M E - 2 0 1 1 , S E P T E M B E R 1 4 TH - 1 7 TH
R O M E CAVA L I E R I H OT E L
cases and they are sorted according to the Vertucci classification. The
statistics we get are descriptive. We carry out a comparative study
between in vitro and in vivo. The conclusion we get from this comparison is that the most common internal anatomy observed in vitro
is not the same as the one observed in vivo.
F1 - 8
A case of extraordinary resilience of the human body after a dental trauma
Rafael Michiels, RJG De Moor
Department of Operative Dentistry and Endodontology, Dental School,
Ghent University Hospital, Ghent University, Gent, Belgium
Private Practice limited to Endodontics, Hasselt, Belgium
Abstract
A 9-year-old girl was referred for a second opinion after traumatic
injury of the upper right central incisor. Since the tooth showed a
vertical crown fracture with pulpal exposure and with the fracture
extending into the root, it was decided to extract the tooth. A temporary replacement by means of a spoon denture was planned, until an implant could be placed at appropriate age. At the moment of
the first appointment i.e. 1 month after the trauma, no clinical complaints were present. The tooth was temporarily restored with Fuji IX
GP Extra A1 (GC Europe, Belgium) by the referring dentist. An open
apex and a vague apical radiolucency was seen. All sensibility and
clinical tests indicated a vital pulp without acute/persisting peri-apical pathology. The performed tests included: palpation, percussion,
cold testing, determining possible probing defects and electric pulp
testing. It was decided not to perform a root canal treatment, but to
conduct a systematic follow-up. A first follow-up visit after 10 weeks
showed the persisting vague apical reaction, but no clinical symptoms
and all sensibility and clinical tests were normal. Further follow-up
was advised. Six months after the initial trauma the tooth remained
free of clinical symptoms and responded normally to all sensibility and
clinical tests, furthermore the vague apical reaction seemed to have
disappeared. During this visit, a permanent coronal restoration with
Herculite XRV A2 enamel (Kerr, USA) was made. Twelve months after
the initial trauma the tooth remained free of clinical symptoms and
responded normally to all sensibility and clinical tests. Further apexogenesis is to be expected.
Conclusion: Non surgical root canal treatment or extraction may be
avoided in certain cases of severe dental trauma. Proper selection
and good follow-up are key factors contributing to the success of
these cases.
F1 - 9
Incidence of teeth with endodontic disease in patients
presenting to general dentists in Norway
S. Bjørntvedt, G.J. Debelian, L. Døving, Gerner Nina Wiencke, E.
Lange, I. Pedersen, J. Ulstad, T. Willumsen
Dental Health Services’ Competence Centre for Eastern Norway, TK, Endodontic private practice, Norway,
Department of Endodontics, School of Dentistry, University of Oslo, Norway, Institute for Clinical Dentistry, School
of Dentistry, University of Oslo, Norway
Abstract
Aim: The aim of the present study was to identify the incidence of
teeth with endodontic disease, factors causing disease, the frequency of symptomatic cases, selected therapy and the number of cases
referred to a specialist in endodontics.
Methodology: 316 randomly selected dentists were invited to participate to this study. All selected dentists received an electronic form
containing 20 questions concerning clinical practice related to endodontics obtained from one selected week.
Results: Ninety-five dentists returned the questionnaire where 87
where selected for analysis. Three hundred and two teeth were diagnosed with endodontic disease ranging from 0 to 16 cases per dentist in one week (mean 3.5). The major causative factor was caries
ESE ROME 2011
NOT ONLY ROOTS
(40.4%) and apical periodontitis was present in 183 teeth (60%). Two
hundred and eleven teeth (70%) were symptomatic (including teeth
sensitive to percussion, palpation and spontaneous pain). 76.5% of
the diagnosed teeth were rescheduled for conventional endodontic
therapy where 6.9% were referred to an endodontist.
Conclusions: The result of this study shows a high incidence of teeth
needed for endodontic therapy in patients presenting to a randomly
selected group of Norwegian general dentists. Apical periodontitis
was the predominant endodontic disease.
F1 - 10
Comparision of three digital imaging receptors and cbct
for detection of simulated external root resorptions: an
ex-vivo study
Aksoy Umut, Atakan Kalender, Kaan Orhan, Fatma Basmaci
Near East University, Department of Endodontics, Mersin 10, Turkey
Near East University, Department of Oral, Teeth and Jaw Radiology, Mersin 10, Turkey
Abstract
Aim: The diagnosis of external root resorption is often based on radiographic and clinical examinations. The usefulness of standard radiographs in endodontics, conventional radiographic techniques do
not provide a safe method for identifying and locating external root
resorptions. Thus, the aim of this study is to evaluate the diagnostic
ability of cone-beam computed tomography (CBCT) to detect simulated external root resorptions in mandibular molar teeth at three
different tube potential settings using two phosphor plate systems
(SPP), a charge-coupled device (CCD) and a CBCT unit.
Methods: External root resorption defects in different locations
were simulated in 40 human mandibular molar root surfaces in 50
teeth. Of all these 50 teeth, 30 had endodontic treatment while 20
had no treatment. 200 root surfaces in 50 teeth were served as control group. All teeth were then were placed in a cadaver mandible
and radiographed with four different imaging modalities- Newtom
3G-CBCT (6 inch) scanner, Digora-Optime SPP system, VistaScanPerio, Planmeca CCD,-at 60-, 66-, and 70-kV tube potentials, different angles and exposure-times. Three observers scored the resultant
images for the presence or absence of fractured files. The diagnostic
accuracy for each imaging modality was expressed as the area under
the ROC curves (Az).
Results: Inter and Intra-observer agreement were higher for CBCT
than three digital imaging receptors. Highest correct readings were
obtained at the proximal regions for intra-oral imaging modalitie
(p>0.05).
Conclusions: These results suggest that the CBCT radiographic
method is more sensitive than conventional radiography to detect
simulated external root resorption cavities.
Chairpersons: Yuan Ling Ng, Panos Panapoulos
Session F2 – 13.30
F2 - 1
The assessment of the histomorphometric cementum
layer in patient with chronic periodontitis
N. Keklikoglu, S. Asçı Kaan, H.A. Balcıoglu, I. Bolat, S. Yesil Isık, M.
Gerek, Eli Defne Tacettinoglu, D. Erdilek, E. Fıratlı
Division of Basic Science, Faculty of dentistry, University of Istanbul
Department of Endodontology, Faculty of Dentistry, University of Istanbul
Department of Periodontology, Faculty of Dentistry , University of Istanbul
Department of Endodontology, Faculty of Dentistry , University of Yeditepe, Istanbul
Department of Cariology and Restorative , Faculty of Dentistry, University
of Istanbul
Abstract
Aim: Periodontal diseases may cause alterations in the structural
integrity and the biochemical structure of cementum. Alterations
www.eserome2011.com
occuring in the morphology of cementum in the advanced ages and
the effects of periodontal diseases have an importance in terms of
various clinical applications. The aim of this study is to determine
the difference on the thickness of cementum in two different age
groups over 45 year-old (aged between 45-50 and over 50 year-old)
diagnosed with chronic periodontitis.
Methodology : Following the extraction, teeth were placed in a 10%
buffered neutral formaldehyde solution for fixation for 24 hours. After fixation, teeth were decalcified in 8% formic acid solutions. Crosssections of 5-7 microns were prepared in the longitudinal axis of
parafin embedded teeth. The sections were stained with hematoxylin and eosin. Measurements and histological examination were
performed with light microscopy (X100, with immersion oil) (Olympus
CH20) and metric oculars (oculometer).
Results: No statistically significant difference was detected between the two groups in the comparison of the mean of the thickness
of cementum acquired from the measurements.
Conclusion: Further research is required on how periodontal diseases effect the cementum morphologically and development of cementum with regenerative techniques.
F2 - 2
Retreatment in a patient with rheumatoid arthritis: a
case report
A. El Ayouti, T. Connert, Nadia Medea Ferrarese, Giulia Carli, Balzano
Nicolò Maria, Carlo Tocchio
University of Padova School of Dentistry
Abstract
Rheumatoid arthritis is an autoimmune disease with an unknown
etiology. A female patient affected by R.A.,had been visited in 2005.
She was taking Azathioprine (an Immunosoppressive drug) and corticosteroid. She needed an endodontic retreatment of a second lower
molar with an extensive bone resorption.
The rapid periapical bone destruction that occurred during the endodontic treatment of a rheumatoid arthritis patient taking azathioprine and a corticosteroid has been descrive in the literature and the
cause of the rapid destruction is unclear nd may be related to the
drugs.
Despite the assumption of azathioprine and corticosteroid, the endodontic treatment led to a successful conclusion.
A five years control is presented.
F2 - 3
Root canal anatomy of Korean mandibular first molars by
cone-beam computed tomography
Sun Ji Yau, Bo hyun Ban, Se Young Hwang, Bock Young Jung, KeeDeog Kim, Nan Sim Pang
Abstract
This study investigated canal curvatures in Korean mandibular first
molars by using cone-beam computed tomographic (CBCT) images.
Methods: 320 mandibular first molars from 165 Korean patients were
scanned by CBCT and their canals were reconstructed by 3D modeling software. Three dimensional CBCT images were analyzed to
measure the direction and radius of the curvature of the canals by
using V-Works software and Kappa software. The degrees of canal
curvatures measured by Schneider method in periapical radiographic views were compared with those from CBCT.
Results: The average angles of primary curvatures were 25.3 degrees
for the mesiobuccal canal, 27.8 degrees for the mesiolingual, 20.2
degrees for the distobuccal and 38.6 degrees for the distolingual canal. The direction of each curvature was distobuccal for the mesiobuccal and mesiolingual canals and distolingual for the distobuccal
and distolingual canals.
Conclusions: For successful endodontic outcomes, the precise and
reliable anatomic information of root canal system is essential. The
CBCT-aided method is available for determination of 3 dimensional
canal curvatures.
25
1 5 TH B I E N N I A L C O N G R E S S
OF THE EUROPEAN SOCIETY
OF ENDODONTOLOGY
F2 - 4
Distribution of root resorptions in patients referring to
department of endodontics
Merve Ozgul, S. Ascı Kaan
Istanbul University, Faculty of Dentistry, Department of Oral Medicine and
Surgery, Istanbul, Turkey
Istanbul University, Faculty of Dentistry, Department of Endodontics, Istanbul, Turkey
Abstract
Aim. This research has been designed to analyse the distribution and
etiologic factors of external root resorption diagnosed through radiographic examination of the patients referring to the Deparment of
Endodontics, Faculty of Dentistry in Istanbul University.
Methodology. Periapical radiographs of 170 patients , (100 women, 70
men) aged between 13-81 years (median age:40 years) were evaluated. The study was performed on 3850 teeth. A detailed medical
history, including systemic diseases and history of trauma were recorded. The previous root canal treatments were evaluated clinically
and radiographically. Patients undergoing orthodontic treatment
were excluded from the study. A grading scale for root resorption
0-4 (Levander at al.,1998), was made with the help of graph paper by
comparing symmetrical teeth: 0= regular root contour; 1= Irregular
root contour; 2= Apical Root resorption,(< 2 mm); 3= Apical Root
resorption , ( 2 mm to 1/3 of original root length); 4= Root resorption
(> 1/3 of original root length). RESULTS. The prevalence of external
root resorption was 7.84% on females and 9.43% on males. The distribution of external root resorption was 55% ( mandible) and 45%
(maxilla). Resorptive defects were distributed mostly in the apical
region of the root, followed by lateral and cervical regions respectively. Root canal treatments had been performed in 108 (35%) of 308
root resorbed teeth. Unsuccessful treatments were observed in 80%
of the endodontically treated and root resorbed teeth. CONCLUSION.
Infection and failed root canal treatment are considered as the most
important etiologic factors of external root resorption. Trauma is
also an important etiologic factors. To determine the etiology and
distribution of root resorptions long-term clinical studies are needed.
F2 - 5
Frequency of different indications for endodontic retreatment in population of Pancevo, Serbia
Dragana Pesic, V. Kolak, I. Melih, M. Popovic, A. Jakovljevic
Faculty of Stomatology, Pancevo, Serbia
Abstract
Aim. The aim of this study is to determine the prevalence of different
indications for endodontic retreatment, and the influence of specific
factors on this frequency.
Matherial and methods. For this study 3168 teeth from 148 patients,
from both genders and different ages, who came to receive dental
care at the Department of Endodontics, Faculty of Stomatology in
Pancevo during the years 2009-2010 were examined. The sample
of this investigation was selected randomly and data were collected
using clinical and radiographic examination of patients. Different indications for root canal retreatment were investigated: underfilled
canal; overextension of filling material; voids or unfilled regions in a
canal; fractured instruments; untreated canal; adequate endodontic
treatment with presence of radiolucency. The influence of different
factors on retreatment frequency was also examined: age of patients, functional group of teeth, restorative material. PAI index was
determined on each tooth that required retreatment. Data were statistically analyzed using Chi-Square and Mann-Whitney tests.
Results. Of the 3168 teeth examined, 208 were endodontically treated. In 126 teeth (60%) the necessity for endodontic retreatment was
determined. The most frequent reason for retreatment was the
presence of underfilled canals: 71 cases (56 %) with a statistically
significant difference (p<.001) to other reasons for retreatment. ChiSquare test showed significant difference (p<0.001) when teeth with
26
R O M E - 2 0 1 1 , S E P T E M B E R 1 4 TH - 1 7 TH
R O M E CAVA L I E R I H OT E L
different restorative material and need for root canal retreatment
were compared. Endodontic retreatment was significantly most frequently needed in anterior teeth ( p<0.05).
Conclusion. The need for retreatment among endodontically treated teeth had an incidence of 60 %. The most frequent reason was
due to underfilled canals, and the most frequently involved teeth
were in the anterior group. The study indicates that the approach to
initial endodontic therapy needs improvement with implementation
of contemporary concepts of working length determination.
F2 - 6
Long-term clinical evaluation of Thermafil and warm
gutta-percha techniques. A retrospective investigation
Chiara Pirani, G.L. Acquaviva, F. Iacono, S. Chersoni, C. Prati
Department of Odontostomatological Sciences, Endodontics Unit, University of Bologna, Italy
Abstract
Aim. To compare the long-term clinical outcome of endodontic treatments performed with Thermafil (TH) plus AH Plus or with warm
gutta-percha (WG) and AH Plus.
Methodology. A total of 143 endodontically treated teeth (67 patients)
were evaluated. For each tooth included following data have been
collected: initial pathology, initial treatment or retreatment, diameter of periapical radiolucency before treatment, endodontic obturation technique (WG or TH) and quality of obturation. Patients were
examined during control sittings for at least 4 years. For every case
symptomatology and periapical radiographic status have been evaluated and compared with preoperative status.
Results. Total success rate was 88% (79% healed, 9% incomplete
healing cases), failure rate was 12%. Kruskal-Wallis analysis showed
no statistically significant differences between TH technique (88%)
and WG technique (87%). The success rate for initial treatments resulted meaningfully higher than the one for retreatments both in
TH group and in WH group. Initial treatments presented a total success rate of 87% in TH group and of 91% in WG group. Retreatments
showed a total success rate of 78% in TH group and of 73% in WG
group. Treatments without initial periapical radiolucency showed
a significantly higher success rate than treatments with periapical
radioluncency (96% vs. 88%, p<0.01). Obturation classified as “adequate” showed a meaningfully higher success rate than “inadequate”
obturation cases (90% vs. 79%, p<0.05).
Conclusions. The present study indicated that success probability
of endodontic therapy performed with TH or WG is superimposable.
Independently from the obturation technique, the present study confirmed the quality of obturation as the main prognostic factor both for
initial treatments and for retreatments.
F2 - 7
Endodontic pain or TMD - case report
Goranka Prpic Mehicic, M Valentic-Peruzovic, Z Blazic-Potocki
School of Dental Medicine, University of Zagreb, Croatia
Dental Clinic, Zagreb, Croatia
Abstract
The problem of differential diagnosis in patients coming with referred
pain into the office of general dental practitioners is often very complex and demanding.
Case report: A fourthy eight year old male patient was referred to the
Department of Endodontics with a chief complaint of mild to severe
pain in the left part of the mandible spreading to the area of the left
TMJ, left ear and left temporal area. Previously he was examined by
his GDP, who didn’t detected dental course of pain and patient was
sent to the neurologist with suspicion on trigeminal neuralgia. He
was treated with the Tegretol and acupuncture for six months. During the treatment the intensity of pain decreased from time to time,
but it was constantly present. During the period of pharmacological
treatment his quality of life was poorer, and he was asking for sec-
ESE ROME 2011
NOT ONLY ROOTS
ond opinion. He was sent for examination to the Centre for TMD, examination and functional analysis did not confirm any muscular or
intracapsular disorder, and he was sent to the Dept. of Endodontics.
Thorough examination and radiographs revealed periapical lesion on
37 and a caries lesion under filling on 36. After endodontic treatment
was completed the patient was finally relived from pain and his quality of life came back to normal.
Because of diffuse spreading of pain it is sometimes difficult for patient to identify the origin of pain, and differential diagnosis should be
very carefully provided to avoid unnecessary treatments.
In this time of very sophisticated technological and scientific advances, it has become more important than ever, that a careful and well
thought communication exists between practitioner, specialist and
patient, in order not only to provide the best available treatment, but
also to give the patient realistic expectations on the decisions that he
will be required to make.
Chairpersons:
Domenico Ricucci, Roeland De Moor
F2 - 8
Session F3 – 14.00
Immediate implant placement in endodontically infected
sites: an alternative to secondary endodontic treatment
F3 - 1
Stefano Corbella, Silvio Taschieri, Igor Tsesis, Luca Francetti, Massimo Del Fabbro
Department of Health Technologies, Milan University, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
Department of Endodontology, Maurice and Gabriela Goldschleger
School of Dental Medicine, Tel Aviv University,
Tel Aviv, Israel
Abstract
Scientific literature suggested that in case of failure of primary endodontic treatment or both surgical and non-surgical retreatment,
the only alternative is tooth extraction and replacement with dental
implants. Although the presence of active infection has long been
considered a major contraindication to the insertion of implants immediately after tooth extraction, several articles reported excellent
results with the latter therapeutic alternative. The aim of this literature review is to evaluate and discuss the clinical outcomes of restorations supported by implants placed immediately after extraction in
endodontically infected sockets. A Medline and EMBASE search was
performed on articles published from 1966 to April 2009 using the
terms “dental implants”, “immediate implant*”, “extraction socket*”, “infected teeth”, “infected site*”, “infected socket*”. No restriction was placed regarding the study design or the species involved.
For clinical articles at least 6 months of follow-up was required for
inclusion. Data analysis of the selected articles showed that immediate implant insertion in endodontically infected sites after careful
debridement of the socket, could be a viable technique with success
rates comparable to those of secondary endodontic treatment. Since
the clinical reports on this topic are scarce, the level of evidence is
low and the followup period is limited, more well-designed studies
are required in order to assess relevance of this treatment alternative.
In vitro comparison of antimicrobial activity of calcium
hydroxide against enterococcus faecalis and candida
albicans
Ali Cagin Yücel, Ertan Emek Onuk, Evren Sariyilmaz, Bekir Karabucak
Ondokuz Mays University, Faculty of Dentistry, Department of Endodontics
Ondokuz Mays University, Faculty of Veterinary Medicine, Division of
Preclinic Science
University of Pennsylvania, School of Dental Medicine, Department of
Endodontics
Abstract
Aim: The aim of the present study was to evaluate the antibacterical
efficiency of calcium hydroxide mixed with different vehicles: saline,
glycerin+CMCP, CHX and proprietary brands of CH pastes: Calcicur,
MM paste, Metapaste and to determine the most appropriate treatment for endodontic infections caused by Enterococcus faecalis and
Candida albicans. Methodology: Standard holes in the cultivated agar
plates were filled with one of the CH pastes and control agents. The
zones of microbial inhibition were measured after incubation period.
Results: The CH pastes could be ranked from strongest to weakest
as follows CHX-CH, Glycerin+CMCP-CH. Sterile saline-CH, Calcicur,
MM paste, Metapaste study groups did not demonstrated any antibacterial effect against E. faecalis. The antifungal effects of the CH pastes
were ranked from strongest to weakest as follows: Glycerin+CMCP
-CH, CHX-CH, Calcicur, Sterile saline-CH, Metapaste, MM paste.
Conclusion: When various medicaments! added to CH pastes, antimicrobial efficiency of CH pastes might seem to enhance in this study
but it should be confirmed by in vivo studies. This knowledge should
be used to improve ready-to-use CH pastes which has an increasing
usage in endodontic recently.
F3 - 2
F2 - 9
Best treatment is the best treatment planning: case report
Effect of vehicle on diffusion of calcium hydroxide paste
through dentinal tubules: in vitro study
Yalcin Turgut Yagmur, Gozde Acar
Istanbul University Faculty of Dentistry, Department of Endodontics
Donika Bajrami, V Hoxha, B Kamberi, L Istrefi, A Dragidella
Department of Dental Pathology and Endodontics, Faculty of Medicine,
School of Dentistry, Prishtina, Kosovo
Abstract
The purpose of this case demonstrate the importance of treatment
planning.
Endodontic therapy has advanced to provide long-term clinical success, and preservation of the natural dentition is a primary goal of
dentistry. Dentistry is restoratively driven, supplemented by endodontic and surgical components. When a tooth cannot be restored,
then it does not matter whether endodontic treatment can be or is
rendered. Treatment planning decisions need to focus on the restorability of the tooth when deciding what treatment will provide reasonable long-term success. If the tooth can be restored, then pursuing
endodontic treatment is the best treatment decision. But when this
cannot be accomplished or the restorative prognosis cannot provide
reasonable long-term success, then extraction and implant placement is the more prudent treatment option.
Abstract
The purpose of this study was to compare the pH changes of calcium hydroxide mixed with different vehicles. We used 30 single
rooted human extracted teeth. Crowns were sectioned transversally
at cement-enamel junction and teeth were instrumented manually
with step-back technique using K files ( K-files Niti-Flex, Dentsply,
Maillefer,Switzerland), irrigation regimen was performed using NaCl
0.9% and EDTA 17 % (Calasept, EDTA, Nordiska Dental, Sweeden) for
3 min. Specimens were divided in 5 groups of 6 teeth each, based on
the vehicle used to mix calcium hydroxide paste (Calcium Hydroxide
U.S.P, Vision, Henry Schein, Made in Germany): group 1 - distilled
water; group 2- anesthetic solution; group 3- chlorhexidine 0.2% (diluted from CHX 2%); group 4 - chlorhexidine 2% (Calasept, CHX 2%,
Nordiska Dental, Sweeden); group 5 - MTAD (Bio Pure MTAD, Dentsply Tulsa Dental). PH was measured after 1, 3, 7, 15 and 30 days
www.eserome2011.com
27
1 5 TH B I E N N I A L C O N G R E S S
OF THE EUROPEAN SOCIETY
OF ENDODONTOLOGY
with pH meter (Ecoscan, Eutech Instruments, Singapore). The data
were analyzed and compared statistically with Tukey test. All groups
showed similar pH values, but group III, IV and V presented a better
diffusion capacity through dentin than group I and II. Our results suggests that CHX and MTAD are efficient vehicle in calcium hydroxide
paste.
R O M E - 2 0 1 1 , S E P T E M B E R 1 4 TH - 1 7 TH
R O M E CAVA L I E R I H OT E L
F3 - 5
The sealing ability of AH plus jet and Epiphany to Resilon
by thermoplastic obturation
Tani-Ishii Nobuyuki, Noriko Mutoh
Division of Endodontics, Department of Oral Medicine, Kanagawa Dental
College, Yokosuka Japan
F3 - 3
Comparison of ProRoot MTA, Geristore and Retroplast on
attachment of human gingival fibroblast
Banafsheh Amani, Ehsan Esnaasharl
Azad dental school Endodontic department tehran iran
Abstract
Aim :this study compared the effect of three root end filling materials: mineral tioxide aggregate ,Geristore,Retroplast on human gingival fibroblast adhesion. Methodology : human gingival fibroblasts
were incubated on set materialspeciments,and the number of cells
adhered to each material was counted at 24,72 hours and 1 week
by using sem and observing the surfaces of disks. Results result
showed that cell count was higher for retroplast than other material
at all times,and ccultured cells adhered to retroplast significantly increased with time.MTA was significantly better than Geristore. Conclusions retroplast have good biocompatibility which enhance apical
tissue regeneration.
F3 - 4
Antibacterial activity evaluation of various root canal
sealers with a direct contact test
AU Eldeniz, Nur Mutlu Seref, I Capar, H Ari
Faculty of Dentistry, Selcuk University, Konya, Turkey
Abstract
AIM: The purpose of this study was to evaluate the antibacterical activity of leachable components of a new glass ionomer sealer Activ
GP in comparison with six resin-based sealers; Acroseal-Septodont,
France, AH Plus-Dentsply DeTrey, Germany, EndoREZ-Ultradent,
USA, RealSeal-SybronEndo, USA, MMSeal, MicroMega, France, Hybrid Root SEAL-Sun Medical, Japan, Apexit Plus-Ivoclar Vivadent,
LS, Sealapex-Kerr, MI, GuttaFlow-Roeko, Germany and RoekoSealRoeko, Germany using a modified direct contact test using E. faecalis
(A197A), C. albicans (ATCC 90028) and S. mutans (NTCT 10449) as test
microorganisms.
Methodology: The materials were tested immediately after application to the microtiter wells (n=6) (fresh samples) and after setting
for 3 days (set samples). Ten microliters of bacterial suspension was
added to each well for direct contact with each material for 1 h at
37°C. Growth of surviving bacteria was then measured in a microplate spectrophotometer hourly at 600 nm for 24h. Twelve uncoated
wells using identical inoculum size served as positive controls.
Results: Direct contact test results indicated that Hybrid Root SEAL
is more potent bacterial growth inhibitor than the other resin based
sealers. ActiV GP sealer was more potent growth inhibitor on S.
mutans than C. albicans and E. faecalis. Silicone based RoekoSeal
and GuttaFlow sealers had very little antibacterial activity when
compared with other sealers except Apexit Plus. Calcium hydroxide
based Sealapex sealer demonstrated better antibacterial activity on
tested bacteria than Apexit Plus. Generally, all the sealers were less
effective in inhibiting E. faecalis than C. albicans and S. mutans.
Conclusion: Apexit Plus, GuttaFlow and RoekoSeal were less potent
bacterial growth inhibitors than the other tested sealers on all test
microorganisms.
28
Abstract
Aims. The present study assessed the warm vertical obturation and
evaluate the sealing ability of canals filled with resin-based sealer
and Resilon by thermoplastic obturation.
Methods. The total of 72 plastic standard teeth (Dentsply-Maillefer,)
were used and divided into 2 group of 36 teeth. In group 1 root canals were filled with Resilon (Pentron) / Epiphany (Pentron) and in
group 2 with Resilon / AH plus jet (Dentsply-Maillefer,) sealer by Obturator beta (Pentron). The canal walls were throughly coated with
AH plus jet or Epiphany by using a sterile paper point, and Resilon
was obturated by Obturator beta. The mean penetration of Resilon
was measured until root apex by Olympus microscope SZX16 with a
digital camera DP71. The sealing ability of obturation was evaluated
by dye leakage test. All canals were obturated, and the teeth were
sectioned horizontally at 1,3, and 5 mm from the root apex. Sections
were taken by a digital microscope, and quantified the proportion of
core material in each canal. A one-way analysis of variance (ANOVA)
and Scheffe testing were used to compared and identify any statistically significant differences at p<0.05.
Results. The result indicated that the both Resilon penetration was
perfectly until root apex, and the sealing ability of both Epiphany and
AH plus jet was significantly high in both groups. The proportion of
the both Resilon was more than 91 % at level of 1 mm, and more than
96% at level of 3 and 5 mm from apex.
Conclusions. It was conclude that Resilon / Epiphany and Resilon /
AH plus jet obturation were showed significantly less leakage with
warm vertical obturation.
F3 - 6
Clinical applications of new calcium-silicate cements for
root perforation repair: 12-24 months follow-up
Francesco Iacono, C. Pirani, S. Chersoni, M.G. Gandolfi, Carlo Prati
Endodontics Unit, University of Bologna, Italy
Abstract
Introduction New formulation of calcium-tetrasilicate cements (CS)
have been recently proposed for different clinical applications such
as root perforation repair cement. Objective of this clinical study was
to evaluate a 12-24 months follow-up.
Methods Six case reports are presented documenting clinical outcomes after the application of new CS as root perforation repair
material. Under rubber dam isolation, perforation site was cleaned,
sealed with a CS and covered with a CVI layer. A composite material was used to restore the teeth. A follow-up of 12-24 months was
performed.
Results and Conclusions The procedure was shown to be successful in five cases of this series demonstrating the effectiveness of the
new CS in resolving apical periodontitis in case of root perforation.
One case of root perforation did not show the complete radiographic
resolution but it does not present clinical symptoms.
ESE ROME 2011
NOT ONLY ROOTS
F3 - 7
A comparative study on effects of adding CaCl2 &
K-YJelly on solubility of MTA
Mohebbi Pooneh, Hengameh Akhavan, Nazanin Aryan, Azin Sedighnia
Tehran azad dental school endodntics, Tehran, Iran
Shahid Beheshti dental school, Tehran, Iran
Abstract
Aim: Mineral Trioxide Aggregate(MTA), mixed with water has a short
working time, delayed setting time and poor consistency. A preliminary study, suggested that substituting K-Y Jelly and/or CaCl2 5%
as a mixing vehicle decreases the setting time of MTA. An adequate
solubility is an important property of root end filling materials ,that
can affect the result or root canal therapy. The present study compared the solubility of ProRoot MTA mixed with water to that of mixed
with K-Y Jelly and of CaCl2 5%.
Methodology In this experimental study all the materials were mixed
following mixing procedure which advised based on manufactures
and researches. The standardized samples,(n:5 per group), Stain
less Steel matrices(20±1 diameter, 1.5±0.1 height) were filled with
Pro Root MTA +distilled water, Pro Root MTA + CaCl2 5%, Pro Root
MTA + K-Y Jelly. These samples were immersed in double-distilled
water for 24h, 7 days, 28 days. Mean loss of weight was determined
and analyzed statistically using a one way ANOVA and paired Tukey
test for all pair- wise comparisions.
Result : Pro Root MTA + CaCl2 5% , showed the best results after 28
days but difference among Pro Root MTA + water& Pro Root MTA +
Ca Cl2 5%, was not statistically significant after 24h and 7 days.( P
Value:0.413, .0918). K-Y Jelly + Pro Root MTA showed the worst result
after 28 days.
Conclusions All the materials had acceptable solubility but based on
the finding of this study, we can conclude that MTA mixed with CaCl2
5%, has shown better solubility than MTA mixed with water & K-Y.
technique and the continuous wave technique.
Material and method: Forty single rooted extracted teeth of similar
size and root shape were selected. Biomechanical preparation was
performed with rotary instrumentation, using NiTi Twisted Files
(SybronEndo, CA, USA). The apical portion of all roots was prepared
at the working length to a size 35/06. Irrigation was performed with
NaOCl 5% (Chlorax, P.P.H. Cerkamed, Poland) after each file, EDTA
17% (META Biomed, Korea) and Clorhexidine 2% (Gluco-Chex, P.P.H.
Cerkamed, Poland) as final rinse.
The specimens were randomly divided into four groups of ten samples each and root canal fillings were performed using gutta-percha
(SybronEndo, CA, USA) /Sealapex (Kerr, Italya) and Resilon (RealSeal, SybronEndo, CA, USA) /Epiphany (SybronEndo, CA, USA) with
lateral condensation and continuous wave technique.
Apical leakage was estimated using a dye penetration test with 2%
methylene blue. Next, the teeth were cleared in order to observe and
compare the dye penetration. The transparent specimens were examined with a digital camera mounted on a binocular microscope,
recording only the largest measurement in millimeters.
Results: Dye penetration was inhomogeneous within and between
the four groups.
The Resilon/Epiphany groups displayed significantly more dye penetration than the gutta-percha/Sealapex groups.
Specimens filled with Resilon/Epiphany leaked to an extent that
could be easily measured using the current setup.
Conclusion: Under the condition and within the limitations of the current study it was shown that Resilon/Epiphany root fillings showed
significantly more dye penetration compared with gutta-percha/Sealapex counterparts with regard to obturation method.
Chairpersons:
Maria Giovanna Barboni, Davide Castro
F3 - 8
Session F4 – 13.30
Thermal characterization by DSC of a new endodontic
cement
F4 - 1
Benedetta Tosini, Stefano Pagano, Alessandro Conversini, Guido
Lombardo, Potito D’Errico
Faculty of Medicine and Surgery, Department of Odontostomatological
Sciences, University of Perugia, Italy
Abstract
In the reconstruction endodontic, the cement dentin adhesion is a
critical factor .That can cause detachment system.
The purpose of the study was to evaluate, by means of differential
thermal analysis, the degree of polymerization of a new endodontic
cement, subjected to several cycles of treatment by car or light curing .
The data showed a higher polymerization obtained by curing with respect to autopolimerization.
Differential thermal analysis is a predictable method for the determination of the degree of care of different materials. Its use in root
canal area could be a great help in clinical.
F3 - 9
Gutta-percha versus Resilon root fillings: an apical microleakage analysis
Timis Lucia Iacobina, Dragan Oana Carmen, Cimpean Sanda
Faculty of Dentistry, University of Medicine and Pharmacy, Cluj-Napoca,
Romania
Abstract
One of the keys to success of root canal therapy is to obtain a root
filling that will prevent penetration of fluids and microorganisms. The
aim of this study was to investigate apical microleakage of root canals filled with Resilon or gutta-percha using lateral condensation
www.eserome2011.com
Comparison of vertical forces generated during root
canal filling
Anja Baraba, I. Katalinic, I. Anic, I. Bago, S. Segovic, I. Miletic
School of Dental Medicine Department of Endodontics and Restorative
Dentistry, Croatia
Abstract
Aim: To examine vertical forces exerted during root canal obturation
with three techniques, cold lateral condensation, ProTaper thermoplasticized and ProTaper Single-cone technique. Also to evaluate
vertical forces exerted during root canal obturation with the cold lateral condensation technique performed by undergraduate students,
dentists on specialty training in endodontology and specialists of
endodontology.
Methodology: Fourty-five single-rooted permanent teeth were used
for the first part of the study. All specimens were instrumented using
the ProTaper technique to F2 instrument and were randomly divided
into three experimental groups (n=15 per group), obturated using the
cold lateral condensation technique, ProTaper thermo-plasticized
and ProTaper Single-cone technique. Ten single-rooted permanent
teeth were used for the second part of the study. All specimens were
instrumented using the step-back technique to master apical file size
#25. Three groups of operators: 1) undergraduate students (n=10); 2)
dentists on specialty training in endodontology (n=10) and 3) specialists of endodontology (n=10) obturated the root canals using the cold
lateral condensation technique. Vertical forces were measured using
the force measurement device, developed for simulation of endodontic treatment.
Results: When cold lateral condensation obturation technique was
used, vertical force of 1.21±0.24 kg was measured which was statistically significantly different in comparison to other techniques
29
1 5 TH B I E N N I A L C O N G R E S S
OF THE EUROPEAN SOCIETY
OF ENDODONTOLOGY
R O M E - 2 0 1 1 , S E P T E M B E R 1 4 TH - 1 7 TH
R O M E CAVA L I E R I H OT E L
(p=0.0001). Vertical force recorded during root canal obturation by
undergraduate students was 1.54±0.47 kg, 1.65±0.46 kg by dentists
on specialty training in endodontology and 1.32±0.41 kg by specialists of endodontology. The results showed no statistically significant
difference (p>0.05) between three groups of operators.
Conclusions: The cold lateral condensation technique exerted higher
vertical forces in comparison to the ProTaper thermo-plasticized and
ProTaper Single-cone technique. There was no difference between
vertical forces exerted by undergraduate students, dentists on specialty training in endodontology and specialists of endodontology during root canal obturation using cold lateral condensation technique.
respective of the section level. In contrast, group III proved to have
significantly (p<0.05) superior gutta-percha percentages, both at 6
and 8 mm compared to the other two groups. Accordingly, radiological examination proved the superiority of group III that had significantly better scores.
Conclusion: within the limits of the present study, the thermomechanical condensation has been shown to be a better alternative to
the traditional root filling techniques.
F4 - 2
CBCT to Evaluate Tridimensional Obturation of Endodontic
System
Comparison of obturation density of cold lateral
compaction versus BeeFill in vitro
Amir Abbas Moshari, Arjang Falahdoust, Rezvan Nasiri
Tehran azad dental school endodntics, Tehran, Iran
Abstract
Aim: The most important failure of obturation is non efficiency and
low density of obturation material.A maximum volume of gutta-percha and a thin layer of sealer are preffered.
Different techniques have been introduce. Purpose of this study was
to compare the density of BeeFill system and cold lateral compaction
technique.
Methodology: In this experimental study sixty transparent acrylic
blocks with thirty degree curves were instrumented. The blocks were
weighed and randomly divided into two groups.
Group A was obturated with cold lateral compaction.
Group B was obturated with BeeFill system. Each block was reweighed and difference calculated. Independent sample t –test were
used as statistical method of evaluating the results.
Results and Conclusions: The mean density of cold lateral group was
0.0297273 gr and for Beefill group was 0.0322687 gr. Independent
sample t-test showed that density between the groups significant.
(P<0.001)
F4 - 3
Radiological and microscopic assessment of the root
filling quality by three filling techniques
Gabriela Chiriac, M. Bud, C. Culic, Dana Hrab, Sanda Cimpean
Department od Cariology&Endodontics, Faculty of Dentistry,University of
Medicine and Pharmacy “I.Hatieganu” Cluj-Napoca, Romania
Abstract
The final goal of a successful endodontic treatment is a three dimensional filling of the root canal system by maximizing the gutta-percha
and minimizing the sealer quantity.
In the present study we aimed at comparing the results obtained
through three different endodontic filling techniques.
Material and methods: 30 extracted teeth with oval-shaped root canals (long:short ratio >2:1 at a distance of 5 mm from the root apex)
were included into the study. Initial radiographs of the specimens
were realized using a CCD sensor (RVG Visiodent, France). The root
canals were prepared afterwards with a rotative technique- Twisted
files (SybronEndo, Orange, CA, USA). The samples were randomly
distributed in one of the following groups receiving different root fillings:
I. Group I (n=10), cold lateral condensation technique
II. Group II (n=10), continuous wave of condensation filling technique
III. Group III (n=10), thermomechanical technique
The root filling quality was evaluated initially by the radiological
method by 5 observers who gave scores to the analyzed images. The
voids along the root filling were hereby assessed.
Consecutively, roots were sectioned horizontally at 3, 6 and 8 mm
from the apex and micro-photographs taken. Using imaging software, gutta-percha percentage at each level was calculated.
Results: Within each group, there were no significant differences ir-
30
F4 - 4
Leila Mihaela Gheorghita, O. Diaconu, A. Camen, M. Tuculina, I. Moraru
University School of Dentistry, Craiova, Romania
Abstract
Aim. This study aims to evaluate tridimensional root canal obturation
using CBCT.
Matherial and methods. 40 maxillary and 40 mandibular premolars
extracted for orthodontic reasons were studied. Preoperative radiographs were taken, pulp tissues were removed and chemomechanical treatment was performed using ProTaper System, sodium hypoclorite 5% and EDTA. Root canal obturation was performed using cold
lateral condensation of gutta-percha. Postoperatives radiographs
and CBCT was made after root canal obturation in order to evaluate
tridimensional obturation of the endodontic system.
Results. The postoperative radiographs analysis showed in 87,6% of
the cases correct tridimensional obturation. On the other hand analizing CBCT data only 67,8% of the cases presented correct tridimensional obturation, because of lack of instumentation of the second
root canal in lower premolars, the third root canal in upper first premolars and type V Vertucci canals.
Conclusions. CBCT offers an important aid in evaluating endodontic
treatment, especially in cases of complex endodontic anatomy. CBCT
has become over the last years an important investigation tool that
offers important information about root canal anatomy, intercanalar
communications, supplementary canals. The comprehension of root
canal morphology clearly improves therapeutical perspective and
leads to a more successful endodontic treatment.
Key words. CBCT, endodontic system, tridimensional obturation.
F4 - 5
New sealer based on MTA: report of three cases
Jose Antonio Gonzalez Sanchez, F. Abella Sans, A. Ramirez Sebastia,
S. De Noé Hernandez, J. Tomas Aliberas, R. Bueno Martínez
University International of Catalunya, Barcelona, Spain
Abstract
A new sealer based on mineral trioxide aggregate, Fillapex (Angelus®, Brazil), has been recently developed. It consists of two biocompatible components: Mineral Trioxide Aggregate and Salicylate Resin. Its MTA-based composition provides sealing integrity (due to the
low solubility of MTA), biological regeneration and antibacterial properties (due to high Ph). The features of this sealer are an excellent
radiopacity, easy handling, adequate working time (35 minutes) and
adequate setting time (130 minutes). Moreover has been described
as the only root canal sealer that promotes cementum regeneration.
The aim of this poster is to review clinical case reports in which the
new sealer based on MTA was used in root canal obturation. Conclusion: sealer based on mineral trioxide aggregate was found to be
successful when used as root canal sealer. Further histological and
biological investigations are needed to support these clinical results.
ESE ROME 2011
NOT ONLY ROOTS
F4 - 6
F4 - 8
An evaluation of the use of different sizes and techniques
of thermoplasticized obturators on the apical seal: a
comparative study
Comparing the ability Gutta-Percha, Resilon and a New
Thermoplastic Carrier to obturate a simulated apical
lateral canal when using two different apical sizes
preparations
Al-Huwaizi Hussain , Th. Neama
College of dentistry, University of Baghdad - Ministry of Health, Conservative dentistry, Iraq
Abstract
Aim Thermoplasticized gutta-percha is molded into the intricacies
of the root canal walls and seals the root apex more tightly than cold
gutta-percha. The objective of this in vitro study was to evaluate and
compare the apical microleakage of root canals filled with a cold
lateral condensation, thermafil obturators size(35,40), soft core(low
heat, regular heat)size(35,40) obturations.
Methodology Seven groups of eighty four extracted human teeth of
single and straight root canals (twelve samples were used for each
group).The teeth were instrumented by protaper files (hand use).
Groups(1, 3, 5 and 7) obturated with size (40) (matched size) while
group( 2, 4 and 6) had been obturated with a master cone size (35).
All the samples were sealed coronally then stored in normal saline
at 37ºC for one week then all the roots were submerged in Indian ink
for one week. The roots were cleared and the degree of linear dye
penetration was measured in millimeter by stereomicroscope under
40X magnification and calibrated grid.
Results The result showed that the group of lateral condensation
leaked apically significantly higher than thermoplasticized obturator
techniques while the group of Soft core (low heat) obturator size (40)
exhibited the least value of apical microleakage. Conclusions Lateral
condensation had the highest leakage value of dye penetration, Soft
core low heat showed better apical sealing than soft core regular
heat and the obturators size (40) showed less apical leakage than
size (35).
Nogueira Paulo, D. Duggan, E. Rivera
University of North Carolina Endodontics, Chapel Hill, US
Abstract
Aim of this study is to compare the ability Gutta-Percha, Resilon and
a New Thermoplastic Carrier to obturate a simulated apical lateral
canal when using two different apical sizes preparations.
Methodology: Sixty epoxy resin blocks with simulated single root
canals and one apical lateral canal were used for this study (Tulsa
Dental Products, Tulsa). Each canal has the original dimension of a
ISO # 10 K file, 12 mm in length with a curvature of approximately 30
degrees. Each block was prepared using rotary Profile Vortex M-wire
Nickel Titanium Rotary files 21 mm in length, (Dentsply Tulsa Dental
Products, Tulsa. The resin blocks were divided into six groups (n=10).
The groups A, B and C were instrumented up to size ISO # 25, taper
.06, while the groups D, E and F were be instrumented up to size ISO
# 45, taper .06. Obturation: Group A: Calamus Singles, Group B: Calamus Singles Resilon, Group C: Guttacore size # 25 Obturators, Group
D: Calamus Singles, Group E: Calamus Singles Resilon and Group F:
Guttacore size # 45 Obturators.
Data: Digital photography exported as jpeg images were evaluated
into the AutoCAD 200 program (Autodesk Inc, San Rafael, CA) to measure the depth of penetration of the filing obturation material into the
lateral canals.
Results: The results are being recorded and a multiple-comparison
analysis of variance test followed by a Tukey post hoc test will be used
to compare filling material flow into lateral canals of each of the experimental groups (p< 0.05).
Conclusions: The conclusions will be write after the statistical analyse is concluded.
F4 - 9
F4 - 7
In vitro apical Leakage evaluation of straight root canals
filled using protaper Gutta-Percha
Jose Maria Nieto De Pablos, Luis Oscar Alonso Ezpeleta, Alexandre
Beatriz Del Valle, Jose Grabiel Diaz Martín, Alvarez Jesus Mena
University of Alfonso X el Sabio, Madrid, Spain
University of Zaragoza, Zaragoza, Spain
Abstract
The achievement of hermetic root canal filling is essential in endodontics considering that more than 58,66% failures depend on unproper obturation of the root canal system.
60 single rooted teeth and bicuspids with straight root canals have
been shaped using NiTi Protaper rotary instruments and filled according to the lateral condensation technique. Teeth were sealed using two coats of nail varnish exposing only 5 mm of the apical area.
Specimens were immersed in 0,5% methylene blue solution, and
centrifuged during 72 hours to facilitate dye penetration. Apical microleakage was evaluated using a digital caliper under a stereomicroscope (at 40 x magnification).
In 80% of the tested specimens, less than 1 mm of apical leakage
was recorded. 15,4% of specimens recorded an extent of leakage between 1 and 2 mm and only 3,8% of cases leakage was higher than
2 mm.
According to the achieved results, it can be concluded than the tested filling technique is fast and safe in terms of in vitro resistance to
dye leakage, although it is more expensive than conventional lateral
technique.
www.eserome2011.com
An evaluation of four thermoplastic gutta-percha
techniques
Sinziana Adina Scarlatescu, A. Iliescu, D.S. Stefan, B. Dimitriu
Faculty of Dental Medicine, “Carol Davila” University, Bucharest, Romania, “Politehnica” University of Bucharest, Romania
Abstract
Aim: To assess the quality of root fillings by using four methods of
thermoplastic gutta-percha techniques. Methodology: Forty extracted mandibular incisors and premolars were treated with ProTaper
Universal instruments (Dentsply-Maillefer, Switzerland) and randomly divided into four groups, ten teeth per group. Four techniques
were used for root canal filling: Group A - continuous wave of condensation, Group B - warm vertical condensation, Group C - thermomechanical compaction and Group D - a hybrid technique: warm vertical
condensation in the apical third followed by thermomechanical compaction. In each group the obturation was performed using ProTaper
Universal gutta-percha points corresponding to the size of the latest
instrument and Tubliseal EWT (Kerr, USA) as a sealer. Sealer and
gutta-percha extrusions were observed. Radiographic assesment of
obturations was done using the following scores: 1: well-condensed
and adapted filling; 2: imperfectly condensed filling with irregularities less than 1 mm in adaptation; 3: irregularities more than 1 mm
but less than 2 mm; 4: irregularities more than 2 mm. Results: At
radiographic evaluation, thermocompaction presented score 1 in
95% of teeth, score 2 in 5%; hybrid technique: score 1 - 65%, score 2
- 35%; continuous wave: score 1 - 45%, score 2 - 30%, score 3 - 15%,
score 4 - 10%, while multiple waves showed score 1 - 10%, score
2 - 50%, score 3 - 25%, and score 4 - 15%. Sealer/gutta-percha extrusions were absent in 85% of cases filled by multiple waves, 80%
- continuous wave, 70% - hybrid techniques, and 50% - thermocom-
31
1 5 TH B I E N N I A L C O N G R E S S
OF THE EUROPEAN SOCIETY
OF ENDODONTOLOGY
paction. Conclusions: Overall, the techniques analyzed presented
good results. The hybrid, thermocompaction and continuous wave
of condensation techniques showed more precision of filling, fewer
voids and good penetration into lateral canals, than warm vertical
condensation did.
F4 - 10
Applications of Cone-Beam Computed Tomography in
Dental Practice: A Literature Review
Alamri Hadi, Alshalhoob Mazen, Alshehri Mohammed
Intern, Riyadh Colleges of Dentistry and Pharmacy
Consultant, Restorative and Implant Dentistry at Riyadh Military Hospital
Abstract
Objectives.This article presents a review of the clinical applications of
cone-beam computed tomography (CBCT) in different dental disciplines.
Methods. A literature search was conducted via PubMed for studies
on dental applications of CBCT published between 1998 and 2010.
The search revealed a total of 540 results, of which 130 articles were
clinically relevant and were analyzed in detail.
Results. The results of this systematic review show the different applications of CBCT imaging in dental practice, 36 articles (27.7%) related
to applications in oral and maxillofacial surgery (OMFS), 33 articles
(25.4%) related to endodontic clinical applications, 22 articles (16.9%)
related to clinical applications in implant dentistry, 15 articles (11.5%)
related to orthodontic clinical applications, 10 articles (7.7%) about
clinical applications in general dentistry, 8 articles (6.2%) about the
temporomandibular joint (TMJ), 5 articles (3.8%) related to applications in periodontology, and 1 article (0.8%) about CBCT applications
in forensic dentistry. 36 articles (27.7%) related to applications in oral
and maxillofacial surgery (OMFS), 33 articles (25.4%) related to endodontic clinical applications, 22 articles (16.9%) related to clinical applications in implant dentistry, 15 articles (11.5%) related to orthodontic clinical applications, 10 articles (7.7%) about clinical applications in
general dentistry, 8 articles (6.2%) about the temporomandibular joint
(TMJ), 5 articles (3.8%) related to applications in periodontology, and 1
article (0.8%) about CBCT applications in forensic dentistry.
Conclusions. The majority of CBCT applications in the practice of
dentistry are found in the specialties of OMFS, endodontics, implant
dentistry, and orthodontics. Future research should focus on obtaining
accurate data regarding the radiation doses of CBCT systems and the
clinical of CBCT applications in forensic dentistry and prosthodontics.
Chairpersons:
Francesco Mannocci, Miguel Miñana
Session F5 – 14.00
F5 - 1
Working length variation during mechanical preparation
of curved root canals using rotary instruments
Arkadiuz Dziedzic, T. Piekarz, E. Michalak, B. Mosler, M. Tanasiewicz
Department of Conservative Dentistry with Endodontics, Medical
University of Silesia, Bytom, Poland
Abstract
Aim: An in vitro comparison of endodontic working length (WL), measured at different stages of mechanical preparation of severly curved
root canals using sequences of new type S5 nickel-titanium rotary
instruments.
Methodology: The material consisted of 17 selected root canals of extracted molars and premolars with curvature more than 20 degrees
defined by the radiological Scheider’s method. Horizontally sectioned
roots were cemented in the mass of acrylic in order to obtain mechanical resistance. Intracanal spaces were prepared in vitro using
crown-down technique and sequence of five rotary instruments S5
(Poldent) and a dedicated cordless endodontic S5 Endo Motor with the
32
R O M E - 2 0 1 1 , S E P T E M B E R 1 4 TH - 1 7 TH
R O M E CAVA L I E R I H OT E L
speed ranged 150 rpm-300 rpm. A solution of sodium hypochlorite 2%
and Filecare EDTA compound (VDW, Germany), a chemical adjunct to
mechanical debridement, were applied to remove the organic remnants and inner smear layer. Initial and subsequent working length
measurements were determined by means of ‘C’ File size ISO 08 or
10 (VDW, Germany) and electronic caliper with an accuracy 0.01mm.
An undoubtful reference point was set for the anatomical opening of
the root canal (mechanical resistance due to acrylic mass), the second
point was on the bottom edge of the silicone stopper sidewall.
Results: The average working length of initially nagotiated intracanal spaces was 15.34mm (+/-1.38SD), while the final WL after full
chemo-mechanical preparation was established with the value
15.05mm (+/-1.4SD). The average reduction of WL after completed
process for all measurements was 0.28mm with respect to the initial
value. The biggest average variation in WL (0.07mm) was observed
after third S5 instrument with 4% taper and 30 ISO size. The differences were not statistically significant.
Conclusions: Mechanical root canal preparation using S5 Ni-Ti rotary
instruments with increased taper and crown-dawn technique can affect and slightly decrease the final working length of severly curved
root canals in clinical settings.
F5 - 2
Comparison of two techniques for assessing the shaping
efficacy of repeatedly used nickel-titanium rotary
instruments
Hani F. Ounsi, Giovanni Franciosi, Raffaele Paragliola, Khalid Al Huzaimi, Ziad Salameh, Franklin R. Tay, Marco Ferrari, Simone Grandini
Tuscan School of Dental Medicine
Abstract
Introduction: The shaping capacity of nickel-titanium (NiTi) rotary
instruments is often assessed by photographic or micro–computed
tomography (micro-CT) measurements, and these instruments are
often used more than once clinically. This study was conducted to
compare photographic and micro-CT measurements and to assess
if the repeated use of NiTi instruments affected the shape of canal
preparation. Methods: Ten new sets of ProTaper Universal instruments (Dentsply-Maillefer, Ballaigues, Switzerland) were used in
60 resin blocks simulating curved root canals. Groups 1 to 6 (n = 10)
represented the first to sixth use of the instrument, respectively. Digitized images of the prepared blocks were taken in both mesiodistal
(MD) and buccolingual (BL) directions and area measurements (mm2)
were calculated using AutoCAD (Autodesk Inc, San Rafael, CA). The
volumes of the same prepared canals were measured using micro-CT
(mm3). Statistical analysis was performed to detect differences between photographic and volumetric measurements and differences
between uses. Results: Two-way repeatedmeasures analysis of variance revealed significant differences between groups (P < .001).
Regarding measurement type, there were no significant differences
between BL and MD measurements, but there were significant differences between micro-CT and BL measurements (P < .001) and
micro-CT andMD measurements (P = .001). Significant differences
were also noted between uses.
Conclusions:Within the limitations of the present study, micro-CT
scanning is more discriminative of the changes in canal space associated with repeated instrument use than photographic measurements. Canal preparations are significantly smaller after the third
use of the same instrument.
F5 - 3
Postoperative pain following glide path: manual vs
mechanical with pathfile
Mario Alovisi, Luca Cerrato, Damiano Pasqualini, Nicola Scotti, Elio
Berutti
Department of Endodontics – Prof. E. Berutti, University of Turin Dental
School, Turin, Italy
Abstract
Introduction: Rotary Ni-Ti instruments prevent expulsion from the
apical foramen of infected debris, produced during shaping; their
ESE ROME 2011
NOT ONLY ROOTS
introduction into endodontics has thus greatly reduced patient perception of postoperative pain. However, the need for manual creation
of a glide path before rotary instruments may be used, to prevent
torsional stresses, means that some debris is expelled from the foramen during this phase. In 2008, Maillefer introduced a system of rotary instruments, the Pathfile system, with which to create the glide
path mechanically.
This study evaluates postoperative pain in patients in whom the glide
path was created mechanically using the PathFile system, versus
others in whom it was done by manual preflaring with stainless steel
K-Files.
Materials and methods: 295 patients requiring endodontic treatment were subdivided into two groups. In group 1 (n=149) the glide
path was created mechanically using the new PathFile instruments;
in group 2 the glide path was created manually with traditional kfiles. The presence and intensity of postoperative pain were evaluated
through a questionnaire, in which each patient recorded symptoms
twice daily for seven days after treatment on a VAS scale. The results
were analyzed statistically with the ANOVA model (p<0.05).
Results: The distribution of postoperative pain in the two groups produced two curves. The curve for group 1 (Pathfile) showed a more favorable trend for variation of pain over time than the curve for group 2
(k-files), the difference being statistically significant (p<0.001). In the
ANOVA model, adjusted for analgesic ingestion, this significance was
attenuated, though still present (p = 0.039).
Conclusions: Use of the new PathFile system of rotary instruments to
create the glide path produced a statistically significant reduction in
postoperative pain (p < 0.001) perceived by patients after endodontic
treatment.
F5 - 5
F5 - 4
F5 - 6
An evaluation of root canal treatment: in vitro study
Conservative endodontics-a savior in a lost case: case
report
M. Chirila, G.F. Moldoveanu, N. Maru
Carol Davila University Endodontics Bucharest Romania
Carol Davila University Clinical and Topographical Anatomy Bucharest
Romania
Abstract
Aim. To assess the performances of root canal treatment using three
different techniques: step-back, manual and rotary ProTaper.
Methodology. We divided 45 extracted single rooted teeth, preserved
in saline solution, into 3 groups for each technique. Root canal instrumentation was done during endodontic practice, together with
our group of students and according to the protocol specified from
the beginning. For rotary ProTaper we needed a low speed torque
motor X-Smart (Dentsply, Maillefer, Switzerland). After finishing all
endodontic treatments, the teeth were sectioned at 3 mm from the
apex, the sections were stereomicroscopically analyzed and then pictures were taken.
Results. On the resulted sections we analyzed the reports between
the surfaces of shaped and non-shaped root canals and the concordance between root canals morphology and post shaping design.
Distribution depending on apical master file was: 20% F1, 20% F2,
60% F3 for rotary ProTaper technique, 7% F1, 13% F2, 80% F3 for
manual ProTaper technique and 27% ISO 40, 20% ISO 35, 20% ISO 20,
13% ISO 25, 6% ISO 50, 7% ISO 30, 7% ISO 45 for step-back technique.
Regarding the analyzed sections we found out that for the step-back
technique 62% were regular surfaces and 38% irregular, for manual
ProTaper 67% regular and 33% irregular and for rotary ProTaper 75%
regular and 25% irregular. The dentinal detritus was: 20% out of all
the surfaces analyzed for step-back, 10% for manual ProTaper and
13% for rotary ProTaper. Some teeth were not shaped at the level
of our sections: 3% of the teeth instrumented with step-back techniques and 6% for manual ProTaper.
Conclusions. All three techniques had questionable performances
especially for wide root canals of upper central incisors and upper
canines and for oval root canals. The step-back technique proved to
be more efficient when used for oval root canals. The rotary ProTaper
technique reduced the operating time and simplified the instrumentation procedure.
www.eserome2011.com
Comparison of apically extruded debris between Mtwo
and ProTaper systems
Henhameh Akhavan, Masoumeh Dibaj, Mohamadreza Fouladloo,
Peyman Mehrvarzfar, Azin Sedighnia, Mohebbi Pooneh
Tehran azad dental school endodntics, Tehran, Iran
Shahid Beheshti dental school, Tehran, Iran
Abstract
Aim: The purpose of this in vitro study was to determine the quantity
of extruded apically debris using the proper rotary system compared
to Mtwo rotary system.
Methodology: In this experimental study, forty disto-buccal root canals
of human maxillary first molars were selected and divided into two
groups of twenty canals. One group was instrumented with Mtwo rotary system and the other with ProTaper rotary system according to the
manufacturer. A standard amount of irrigant was used for each canal.
Apically extruded debris and irrigant were collected in pre-weighted
vials. Then the vials were located in the desicator and after removing
the irrigant ,the weight of dry debris was estimated. The mean weight
of the extruded debris for each group was analysed using one sample
Kolmogorov smirnov test and independent sample test.
Results: Both instrumentation systems produced extruded debris
and irrigant. There was no difference between two groups. Apically extruded debris for ProTaper was 0.0008195 and for mtwo was
0/.0008010(p=0.104)
Conclusions: Both of the systems had the same level of extrusion
debris. Mtwo had no advantage to the ProTaper.
Marijana Molnar, B.M. Sepic Matanovic, B. Pazin, M Klemencic
Department of Endodontics Oral Medicine and Periodontology, Dental
Clinic Zagreb, Zagreb, Croatia
Abstract
Children and adolescents are subject to several periodontal diseases.
Although there is a much lower prevalence of destructive periodontal diseases in children than in adults, children can develop severe
forms of periodontitis. Aggressive periodontitis AP is characterized
by severe and rapid loss of periodontal attachment often commencing at or after the circumpubertal age. Since early diagnosis ensures
the greatest chance for successful treatment, it is important that
children receive a periodontal examination as part of their routine
dental visits.
In 2006 a 12-year-old boy presented with generalized gingival inflammation, extensive localized bone loss, and mobility of 32,31,41,42, as
well as the beginning of bone loss in the first molars. Neither unusual infection, nor traumas were detected. The presence of Actinobacillus actinomycetemcomitans was detected. Other specialists have
recommended extraction and removable prosthesis, but in view of
his young adolescent age we advise a different approach. Treatment
consisted of supragingival and subgingival debridement, devitalizing
and splinting mobile teeth, root scaling and planing combined with 10
days prescription of Amoxicillin and Metronidazole. Clinical follow-up
was to be continued over next year but patient quit therapy.
Next we saw him was in 2011, now 18-year with a full-blown AP. Intraoral examination revealed severe gingival inflammation, dental
abscesses, pathological tooth mobility, bleeding upon probing and
attachment loss around first and second molars, also premolars. Radiographs revealed severe horizontal and vertical bone loss. The only
unchanged part was a lower front block and with that in mind and
with insufficient bone amount for implants conservative endodontic
therapy coupled with initial and surgical periodontal therapy with antibiotics is the only option.
33
1 5 TH B I E N N I A L C O N G R E S S
OF THE EUROPEAN SOCIETY
OF ENDODONTOLOGY
F5 - 7
Cyclic fatigue resistance of three different nickel-titanium
instruments after immersion in sodium hypochlorite
Eugenio Pedullà, Nicola Maria Grande, Gianluca Plotino, Alfio Pappalardo, Ernesto Rapisarda
Surgery Department, University of Catania
Odontostomatology Department, “La Sapienza” University of Rome
Abstract
Aim: To assess resistance to cyclic fatigue of three brands of NiTi files
after immersion in NaOCl solutions in conditions similar to those
used in clinical practice.
Methodology: A total of 150 new Twisted File (SybronEndo, Orange,
California), Revo S SU (Micro Mega, Besançon, France) and Mtwo
(Sweden&Martina, Due Carrare - Padova, Italy) endodontic NiTi rotary files size 25.06 taper were used. The fifty files of the same brand
were randomly assigned to five different groups of 10 each. Group 1
(control group) was composed of new instruments not immersed in
solution. Instruments of groups 2, 3, 4 and 5 were immersed in 5%
NaOCl (Niclor, OGNA laboratory, Muggiò - Milano, Italy) at 37 °C for
16 mm. Files of Group 2 and 3 were statically immersed in NaOCl
solution for 5 and 1 minutes respectively; instruments of Group 4
and 5 were dynamically (300 rpm/min) immersed in solution for 5
and 1 minutes respectively. All files were submitted to cyclic fatigue
test and numbers of cycles to failure (NCF) were recorded. Data were
analysed by Two way ANOVA (P < 0.05).
Results: There’s not statistical differences between the five groups of
the same brand but Post-hoc analysis revealed a significantly higher
resistance to cyclic fatigue in all groups of Twisted File when compared
to respective groups of Revo S SU (P < 0.001 for each comparison). The
comparison between the same groups of Twisted File and Mtwo or Mtwo
and Revo S did not show statistically significant differeces (P>0.05).
Conclusions: In our experimental conditions immersion in sodium
hypochlorite as in clinical practice not significatively reduce the cyclic fatigue resistance of nickel-titanium instruments. However, the
cyclic fatigue changes with the type of instruments. In particular,
Twisted File were more resistant. Furthermore static or dynamic immersion did not reduce significatively the cyclic fatigue resistance of
the same endodontic file.
F5 - 8
Working with considerations of the apical third
J. Reichsthaler, G. Castro Mario, M. Lee, Justo Sosa
Private Practice, Vienna, Austria
Private Practice, Los Angeles, USA
Private Practice Tenerife, Spain
Abstract
The main goal of endodontics is to diagnose, treat and prevent the
bacteria that is responsible for the development of periapical changes in the root canal system. Chemomechanical preparation and obturation of the root canal is the protocol to attain these goals. In order
clean and shape the apical third of the root canal system, Anatomical consideration, proper clinical determination of the apical size, and
concept of bacterial reduction are important concepts that need to be
incorporated to the root canal therapy by the clinician. Considerations
for widening the apical third are: To remove bacteria and their substrates, to remove dead pulp tissue,to increase the capacity of the root
canal to retain a larger amount of sterilizing agent,to prepare the tooth
to receive the canal filling. Understanding of the importance of the apical size or “the forgotten dimension” is important in performing the
root canal treatment with a biological aim of anatomical considerati!
on and the concept of bacterial reduction.
F5 - 9
Shaping root canals using only two files in reciprocating
motion
E. Semenzato, I. Bottion, K. Steffan, N.M. Ferrarese, P.O. Carli, C. Tocchio
University of Padova School of Dentistry
Abstract
The the aim o the sudy is to investigate if it is possible to prepare root
34
R O M E - 2 0 1 1 , S E P T E M B E R 1 4 TH - 1 7 TH
R O M E CAVA L I E R I H OT E L
canals using only two rotary files in a reciprocating motion.
38 teeth extracted for periodontal reasons have been used . The elements have been inserted in high-density silicons blocks. X-rays images have been taken using the parallel technique and classified in
base to the radius of curvature. They was endodontically shaped according to the technique proposed by the dott. Yared in 2008 modified
using a K file #10 used in combination with the reciprocating handpiece M4 (SybronEndo) and the rotating file NiTi RevoS #0.06 taper
called SU (MicroMega, France). At the end of the preparation, the
canals have been irrigated with mean of contrast based of iomeprolo,
and X ray exams have been taken using parallel technique.
The images have been overlapped in order to appraise if the preparation had maintained the original trajectory.
The maintenance of the anatomy has been possible.
F5 - 10
Management of fusuion of maxillary second molar and
third molar
Jang Soon Ham , Bock Hur, Hyeon-Cheol Kim, Jeong-Kil Park
Department of conservative dentistry, Pusan National University School
of Dentistry, Yangsan, Korea
Abstract
This poster presents the management of fusion of maxillary left second
molar and third molar. The patient was referred from local clinic for
the morphologic abnomality of maxillary left second molar. The tooth
was prepared for full veneer crown and access cavity was formed. The
tooth was symptommatic and perforation of pulpal floor was observed.
Using dental CT, 4 canals of fused second molar were cleaned, shaped
and filled. The perforated floor was treated with MTA.
Chairpersons:
Mohammad H. Nekoofar, Lise Lotte Kirkevang
Session F6 – 14.00
F6 - 1
Effect of three glide path preparation techniques on
maintenance of curvature in simulated curved canals
Hofmann Norbert, J. Grote, B. Klaiber
Department of Operative Dentistry and Periodontology, University of
Wuerzburg, Wuerzburg, Germany
Abstract
The study compares the influence of three glide path preparation techniques on maintenance of curvature in simulated curved root canals.
Plastic training blocs featuring curved canals (angulation: 60°; radius: 5mm; VDW, Munich, Germany) were used. Glide path was prepared using: 1) carefully pre-bent stainless steel hand instruments
(K-FlexoFile, Maillefer, Ballaigues, Switzerland) sizes 010 to 020; 2)
NiTi rotary instruments sizes 013, 016 and 019 taper 0.02 (PathFiles,
Maillefer); 3) NiTi rotary instruments sizes 010 to 020 (MTwo, VDW).
Final instrumentation was performed using NiTi rotary instruments
up to size 040 (MTwo, VDW). Instrumentations were performed by undergraduate students, each preparing one canal with each technique
at random sequence respectively. Reproducible photographs of the
specimens were taken before instrumentation, after glide path and
after full preparation. The contours of the canals were traced using
an image analysis software (SigmaScan Pro 5, SPSS Inc., Chicago IL,
USA), and a custom-made software was used to determine the deviations from ideal preparations defined according to the geometry
of the instruments and initial curvature. Differences were tested for
significance using the Friedman test (SPSS).
After glide path preparation, over-instrumentation was observed at
the outer curvature between 0 and 4mm short of WL. Between 0 and
1.5mm, the over-instrumentation was significantly higher with hand
instruments (P<0.001). An under-instrumentation of the outer curva-
ESE ROME 2011
NOT ONLY ROOTS
ture was found with MTwo between 4.5 an 6mm short of WL. At the inner curvature, over-instrumentation was seen between 2 and 6.5mm
short of WL with hand instruments and between 3.5 and 6mm with
PathFiles and MTwo. Over-instrumentation was more pronounced in
hand instruments. After full canal instrumentation, similar results
were observed irrespective of the type of glide path preparation.
During glide path preparation, straightening of the canal was more
pronounced with hand instruments, whereas the NiTi rotary instruments produced similar results.
F6 - 2
Comparison of the centering ability of the twisted filet
and revo-s® by using cone beam computed tomography
Menezes Aguiar Carlos, Camille Gomes Faria, Andréa Cruz Câmara
Universidade Federal de Pernambuco, Brazil
Abstract
The aim of root canal preparation is to form a continuously tapered
shape with the smallest diameter at the apical foramen and the largest at the orifice to allow effective irrigation and filling without deviating from the original trajectory. By means of the cone beam computed tomography, the present study aims to determine the centering
ability of the Twisted FileT rotary system compared with the Revo-S®
rotary system. Twenty mesiobuccal canals of human maxillary first
molars whose curvature ranged from 50° to 60° were divided into two
groups with 10 root canals each according to the instrument used:
Group 1, Revo-S® Rotary System; Group 2, Twisted FileT Rotary System. All teeth were scanned by cone beam computed tomography
to determine the root canal shape before and after instrumentation.
The exposure time was 26.9 seconds, operating at 120kV and 7mA.
The images were sectioned into four points, located respectively at
15 mm, 9 mm, 3mm, and 1mm from the apex. The images were captured digitally for further analysis using the Image Tools Software.
The results were statistically analyzed using the Kruskal-Wallis and
Student’s t test. A level of significance of .05 was adopted.
F6 - 3
Curved root canals: CT-based assessment of root canal
geometry after preparation using 3 techniques
Sanda Ileana Cimpean, Gabriela Chiriac, C. Culic, M. Hedesiu, R.
Savu, D. Lazar
Department of Cariology&Endodontics, Faculty of Dentistry, University of
Medicine and Pharmacy `Iuliu Hatieganu’ Cluj-Napoca, Romania
Department of Radiology, Faculty of Dentistry, University of Medicine and
Pharmacy `Iuliu Hatieganu’ Cluj-Napoca,Romania
Private dental office, Bucharest, Romania
Private dental office, Oradea, Romania
Abstract
The accomplishment of a tapered, uniform root canal preparation is
a great challenge in endodontics. Therefore the establishment of a
gold standard preparation technique, with the occurrence of fewest
procedural errors and their sequels has been the subject to numerous research studies.
The aim of the current study was to investigate the changes in root
canal volume and surface area in moderately curved root canals,
following preparation with hand Vs rotary instrumentation using CT
measurements.
Material and Methods:
45 moderately curved (10-30°) mesio- and distobuccal roots of extracted maxillary molars were included in the study. After preparation of the access cavity, initial radiograph and determination of the
root canal curvature, the specimens were randomly distributed into
one of the following groups:
1. Group I (n=15) included manually prepared root canals (Kerr files,
SybronEndo, Orange, USA)
2. Group II (n=15), consisted in root canals prepared with K3 (SybronEndo, Orange, USA)
3. In Group III (n=15), Twisted files (SybronEndo, Orange, USA) were
utilized for preparation.
www.eserome2011.com
Pre instrumentation and post instrumentation three dimensional CT
images were obtained from root cross sections starting at 1mm from
the apex up to the coronal orifice. Nine levels were chosen for CT
evaluation. Scanned images were superposed and compared. The investigated parameters were the remaining dentine thickness, canal
transportation and centering ability.
The results indicate a comparable centering ratio of the K3 and Twisted files groups, superior to the one observed in the manual preparation technique. Furthermore, no significant difference between the
groups was noticed with regard to canal transportation and remaining root dentine at apical levels.
Conclusion: Rotary instruments can be successfully used in the
treatment of moderately curved root canals, if judiciously utilized.
F6 - 4
The effect of working length and root canal preparation
technique on root fracture resistance of maxillary
premolars
Davut Çelik, Ahmet Serper, Tamer Tademir, Küat Er, Kahraman
Saime Asl
Department of Endodontics, Karadeniz Technical University, Trabzon,
Turkey
Department of Endodontics, Hacettepe University, Ankara, Turkey
Abstract
Aim: To evaluate the effect of two different rotary instruments on root
fractures in maxillary premolars with different root lengths.
Methodology: Two groups of teeth were selected from a pool of freshly extracted human maxillary premolars. The first group of 56 teeth
had root canal working lengths of 16 mm and the second group of 56
teeth had root canal working lengths of 14 mm which were measured
after crowns were sectioned at the cementoenamel junction. Each
group was assigned into 3 subgroups: canals prepared with ProTaper to F3 file (n=16), canals prepared with GTX to .06/30 file, canals
prepared with manuel K-flexofiles to a size 30 file; the remaining
eight teeth were used as the control group. After preparation, root
tips were embedded in acrylic resin blocks exposing coronal 9 mm
of each root. A steel tipped rod attached to an Instron testing machine was positioned against the orifice of each canal and applied
vertical force with a constant speed of 1mm min-1 until root fracture
occurred.
Results: Data were analysed using the Kruskal-Wallis and Dunn
tests. Control groups were more resistant than all experimental
groups (p<0.01). 16 mm group which was prepared with ProTaper instruments was found less resistant to breakage than other groups
(p<0.01) whereas no statistically significant differences were found
between the other experimental groups (p>0.05).
Conclusions: For the maxillary premolar roots with 16 mm working
lengths, the use of ProTaper instruments at full working length, decreased fracture resistance.
F6 - 5
Endodontic treatment of a C-shaped maxillary first
molar: a case report
Emir Dincol Muzaffer, H. Ersev, B. Imaz
Istanbul University, Faculty of Dentistry, Department of Endodontics,
Istanbul, Turkey
Abstract
This clinical report presents the endodontic treatment of a maxillary
first molar with a C-shaped disto-palatally located root canal system.
According to the endodontic literature, the C-shaped root canal is
most frequently seen in the mandibular second molar. However, occurence of this unusual morphology in maxillary first molars has only
been described in a limited number of case reports. A 16-yr-old male
patient presented to our clinic with the complaint of discoloration in
his left maxillary first molar. Radiographic examination revealed two
distinct roots (palatal and mesio-buccal) and as well as a periapical
radioluceny associated with the mesio-buccal root end. The distobuccal root end was not identified and it was believed to be superim-
35
1 5 TH B I E N N I A L C O N G R E S S
OF THE EUROPEAN SOCIETY
OF ENDODONTOLOGY
posed on the palatal root. Upon completion of the access cavity, only
one canal orifice was found in the mesio-buccal root as well as a deep
semilunar groove which extended from the palatal to the disto-buccal
aspects of the cavity. Neither the palatal, nor the disto-buccal root
canal orifices were identified and whenever an instrument was inserted into any side of the C-shaped canal, it was always ended in the
disto-palatal foramen of the tooth. The clinical conclusion was that
the palatal and the disto-buccal canals were merged in a C-shaped
single canal and that there was only one canal in the mesio-buccal
root. The two root canals were rinsed with copious amounts of 2.5%
sodium hypochlorite solution and shaped with stainless-steel K-type
files (Dentsply Maillefer) by using the step-back technique. Obturation
was performed with laterally condensed gutta-percha and AH-Plus
(De Trey, Dentsply, Konstanz, Germany) sealer. A 6-months follow-up
radiograph showed complete resolution of the periapical lesion.
Whereas C-shaped root canal morphotypes are clasically reported in
mandibular molars, the present case has demonstrated this configuration in a maxillary first molar.
R O M E - 2 0 1 1 , S E P T E M B E R 1 4 TH - 1 7 TH
R O M E CAVA L I E R I H OT E L
of each type were sectioned transversely at 1mm, 3mm, 6mm and 10mm
from the tip and also were examined by scanning electron microscopy at
the magnification ×150. All images were captured digitally and the following design parameters were assessed by a direct measurement technique: tip angle, helical angle, pitch length, depth of flutes, ratio between
the external and internal diameters, angles of cutting blades. All measurement values then were processed with the mathematics program
Mathcad 14.0 (PTC, Needham, Massachusetts, USA).
Results Technical analysis based on the measured parameters enabled to calculate the important instrument properties which influence its behaviour inside the root canal: distribution of torsion rigidity
along the axis of the instrument, torsion angle per unit length along
the axis, self-feeding force component, volume of fluting along the
axis, safe depth of cutting per unit step of treatment.
Conclusions Physics-mathematical analysis is accurate and objective method for the assessment of the principal design parameters of
rotary endodontic instruments. It enables evaluating of outstanding
characteristics of each instrument and carrying out comprehensive
comparative analysis of the instruments of different types.
F6 - 6
Endodontic treatment of a maxillary second molar with
four roots
Chairpersons:
Paul McCabe, Maria Teresa Sberna
Enver Ozturk, Vildan Mert Gunduz, Kemal R. Subay
Department of Endodontics, Faculty of Dentistry, Istanbul University, Istanbul, Turkey
Session F7 – 13.30
Abstract
Aim: Variations in the root numbers of maxillary second molar teeth
are occasionaly seen during root canal treatments. Clinical and radiographical diagnosis of extra roots of maxillary second molars by
clinicians is important for successful root canal treatment. Presence
of four-rooted maxillary second molars was known as very rare
(0.4%). In this report, we present a case of four-rooted maxillary second molar that has three separated buccal roots (2 distobuccal,one
mesiobuccal), each containing single root canal.
Case Report: The tooth responded positively to vitaliy tests and was
showing symptoms of irreversible pulpitis. Control radiography revealed a four-rooted appareance with presence of an extra distobuccal root. The radiographic control of symmetric tooth showed a
three-rooted appareance. After local anesthesia and isolation, an
endodontic access was prepared. There was four root canal orifices
on pulp chamber floor. The locations of canals were mesiobuccal,
palatal, distobuccal-one and distobuccal-two. Distobuccal-two canal orifice was between distobuccal-one and mesiobuccal and located buccally and near distobuccal-one orifice. The working lengths
were determined with an electronic apex locator and controlled with
a periapical radiograph. All four root canals were biomechanically
prepared using step-back technique. Canals were irrigated with 2.5%
sodium hypochloride between each file during instrumentation. Root
canals were obturated by lateral condensation with gutta-percha and
AH-plus! sealer. The tooth was restored with an amalgam filling.
Conclusion: This case demonstrates the presence of a rarely seen
four-rooted maxillary second molar tooth in order to avoid possible
failure of endodontic treatment in such teeth.
F6 - 7
Design features of rotary endodontic instruments and its
physico-mathematical analysis
Tatiana Belyaeva, E.A. Rzhanov
Moscow State University of Medicine and Dentistry Department of Operative Dentistry and Endodontics, Moscow, Russia
Abstract
Aim:To develop a new procedure for the analysis of the basic design
parameters of rotary endodontic instruments, which allows carrying
out comprehensive comparative evaluation of its properties.
Methodology: Four systems of nickel-titanium rotary instruments with
different geometries were selected: ProFile (Tulsa Dental, Tulsa, Oklahoma), ProTaper (Dentsply Maillefer, Ballaigues, Switzerland), FlexMaster
(VDW, Munich, Germany) and Mtwo (VDW, Munich, Germany). A scanning
electron photomicrographs were taken of each instrument from each
system at the magnification ×25, ×100 and ×120. Then three instruments
36
F7 - 1
Effects of fiber-reinforced composite post systems on
fracture resistance of non-circular root canal teeth
Thong-ngarm Weeranuch, Issarawan Boonsiri
Department of Restorative Dentistry and Periodontology, Faculty of Dentistry, Chiang Mai University, Thailand. Department of Prosthodontics,
Faculty of Dentistry, Chulalongkorn University, Thailand
Abstract
Purpose: To compare the fracture resistance and fracture mode
of non-circular premolar root canals restored with different fiberreinforced composite post systems. Materials and methods: Forty
non-circular single premolar root canals were randomly assigned to
four groups (n=10). Coronal portions of the teeth were removed at a
level 2 mm incisal to the cemento-enamel junction (CEJ). In Group 1
(Var), FibreKleer® posts were cemented with Variolink® II; in Group
2 (Ref), FibreKleer® posts and REFORPIN were cemented with Variolink® II; in Group 3 (Mul), FibreKleer® posts were cemented with
Multicore® flow; in Group 4 (Evo), Variolink® II was used for cementation of Evolution posts and cores. Metallic crowns were cemented
with Variolink® II in all teeth. The samples were loaded in an Instron® universal testing machine with a crosshead speed of 0.5 mm/
min at a 45° angle to the long axis of the tooth. The mean fracture
load of each group was analyzed using the one-way ANOVA, Tukey
multiple comparison test (p<0.05). The fracture modes of all experimental groups were analyzed. Results: The mean fracture resistance
of the Var group was statistically significantly lower than that of the
others (p<0.05). No statistically significant difference was found between the Ref, Mul and Evo groups. Restorable failures were most
frequently found in the Ref group (70%). Conclusions: The use of Multicore® flow instead of the high thickness of resin cement layer can
increase fracture resistance of theeth with non-circular root canals.
Fiber-reinforced composite posts and REFORPIN accessory posts or
Evolution posts and cores with Variolink® II can be used as an alternative treatment in teeth with non-circular root canals.
F7 - 2
Fiber posts bonding to root canal dentin after ethanol
drying
Alberto Dagna, M. Lombardini, M. Colombo, M. Chiesa, C. Poggio, S.
Bianchi
Department of Endodontics, School of Dentistry, University of Pavia, Italy
Abstract
Aim. To verify by SEM the influence of root canal walls ethanol drying
ESE ROME 2011
NOT ONLY ROOTS
in promoting the adhesion of fiber posts.
Methodology. Thirty extracted human maxillary incisors with an average length of 22±1 mm were prepared with Revo-S Ni-Ti instruments (MicroMega, France) and shaped to ISO size 25 and .06 taper.
All root canals were irrigated with 5% NaOCl and 17% EDTA solutions. The samples were obturated with gutta-percha and AH Plus
sealer (Dentsply DeTrey, Germany) using the continuous wave warm
vertical compaction technique. After a week the post space were prepared. All the specimens were randomly divided into two groups: in
group 1 post space was etched and bonded with All Bond 3 (Bisco Inc.
USA), in group 2 it was etched, dried with ethanol and bonded with
the same adhesive system. Then a D.T. Light Post (Bisco Inc., USA)
was placed using the same dual-cured resin cement (Duo Link, Bisco
Inc. USA) and the same restorative protocol. Restored samples were
longitudinally sectioned and prepared for SEM observation in order
to evaluate the characteristics of the interfaces between root dentin,
resin cement and fiber posts at coronal, middle and apical third. Each
section was observed separately by two investigators and the incidence of gaps was recorded and scored (0: no gaps; 1: gap no longer
than 200 μm; 2: gap between 200 and 500 μm; 3: gap longer than 500
μm) in order to perform statistical analysis.
Results. All the interfaces between resin cement and fiber post were
free of gaps. The interfaces between resin cement and root dentin
showed significant differences (P<0.05): 58% of samples dried with
ethanol showed presence of voids/bubbles and gaps at cement-dentin interface.
Conclusions. Ethanol drying seems to be not effective in improving
the adhesion of fiber posts into root canal.
F7 - 3
Experimental evaluation of two new restoring techniques
of endodontically treated tooth
Nicola Maria Grande, Carla Cumbo, Rocco Zaccone, Daniele
Angerame, Francesco Somma
Università Cattolica del Sacro Cuore, Rome, Italy
Sapienza Università di Roma, Rome, Italy
Università di Trieste, Trieste, Italy
Abstract
Background: the aim of this study was to evaluate the differences
in maximum static load to fracture and the type of failure of single
roothed teeth restored with traditional preformed fiber posts, with
anatomical fiber posts and with Ellipson system (Satelec Acteon,
Bordeaux, France) through the application of a static load.
Methods and Materials: 20 extracted seconds premolars and 10 extracted canines were divided into 3 groups of 10 teeth each in order to
obtain a uniform distribution of the oval canals. All canals were prepared with NiTi rotary instruments M-two (Sweden & Martina, Due
Carrare, Italy) and obturated with guttapercha and TopSeal cement
(Maillefer - Dentsply, Ballaigues, Switzerland). The groups have been
restored in different ways: group A with preformed fiber posts, group
B with adapted fiber posts and group C with Ellipson posts.
A core of light-curing composite was created above the fiber post and
standardized silicon layers was created to simulate the periodontal
ligament. Samples were tested in a universal load testing machine.
The fracture loads were measured in N and the kinds of fracture were
recorded and defined favorable or not favorable. ANOVA and Tukey
test were used to determine the differences in fracture loads between the groups. A nonparametric test (chisquare) was conducted
for the statistical evaluation of the fracture model.
Results: The highest fracture resistance was detected for the modified fiber posts followed by the oval Ellipson posts and finally by the
traditional fiber posts (B: 83 ± 6, C: 79 ± 2; A: 73 ± 6). In group B 90%
of fractures was favorable, in group C 80% of fractures was favorable
and in group A 70% of fractures was favorable.
Conclusions: maximum load results were favorable to the elements
restored with adapted fiber post and with Ellipson oval fiber post. The
adapted fiber posts showed a higher percentage of favorable fractures.
www.eserome2011.com
F7 - 4
Bacterial leakage of temporary filling materials used in
endodontic treatment
Igor Kriznar, K. Seme, A. Fidler
Department of Dental Diseases and Endodontology, Faculty of Medicine,
University of Ljubljana, Vrazov trg 2, 1000 Ljubljana, Slovenia
Institute of Microbiology and Immunology, Faculty of Medicine, University
of Ljubljana, Zaloska 4, 1000 Ljubljana, Slovenia
Abstract
The aim of our study was to assess the bacterial leakage of materials
used for short and long term temporization in endodontics. A standardized access cavity was prepared in 124 upper third molars and irrigated with 2 ml of 2.5 % NaOCl followed by 4 ml of saline. The teeth
were divided into six groups of 20 teeth each and two teeth as negative and two as positive controls. The access cavities were filled with
1) Cavit, 2) Fuji II LC, 3) Fuji IX, 4) Voco Clip, 5) Tetric EvoCeram with a
self-etch adhesive AdheSE and 6) Tetric EvoCeram with an etch and
rinse adhesive Excite according to the manufacturer’s instructions.
After storage in saline for 24 hours the crown of each tooth was sectioned to obtain 5.5 mm high disks. Each disk was assembled in a
standard setup for bacterial leakage studies with Streptococcus mutants and monitored for 90 days. Kaplan-Meier survival analysis was
performed. The lowest amount of leaking samples was found in Tetric - AdheSE (31.3%), Cavit (33.3%) and Tetric - Excite groups (35.3%),
followed by Fuji II LC (66.7%), Voco Clip (83.3%) and Fuji IX (88.2%)
groups. Materials could be classified in three groups with statistically
significant differences (p<0.5). In the first group were Cavit (70 days),
followed by Tetric - AdheSE (68 days) and Tetric - Excite (65 days), in
the second group were Voco Clip (44 days) and Fuji II LC (43 days),
and in the third group was Fuji IX (21 days). In conclusion, none of
the tested materials was able to completely prevent bacterial leakage
during the time of the study. Adhesively bonded composites and Cavit
offer better sealing of the access cavity compared to GIC, RMGIC and
composites without the use of an adhesive system.
F7 - 5
Evaluation of fracture strength and mode of molars
restored using polyethylene fiber and different posts
Kara Tuncer Aysun, F. Haznedaroglu, S. Tuncer
Faculty of Dentistry, Istanbul University,Istanbul, Turkey
Abstract
Objectives: To compare the resistance of teeth restored with fiber/
titanium post, polyethylene fiber and adhesive composite.
Study design: The mesial, distal and palatal walls of the human maxillary molar teeth were removed so only buccal wall was remained.
Group I with caries free maxillary molars were used as a positive control group and the remaining groups were restored as follows: group
II with only adhesive composite, group III with polyethylene fiber and
adhesive composite, group IV with fiber post and adhesive composite,
group V with fiber post, polyethylene fiber and adhesive composite,
group VI with titanium post and adhesive composite, group VII with
titanium post, polyethylene fiber and adhesive composite. Universal
testing machine was used for fracture tests. Compressive loads were
applied at an angle of 90 degrees on the occlusal surface of the specimens at crosshead speed of 1mm/min until fracture was occurred.
Kruskal Wallis and Mann Whithney U tests were adopted for statistical analysis.
Results: The study shows that based on the fracture strength, the
teeth group: restored with glass fiber post, polyethylene fiber and adhesive composite has the most significant improvement over all the
other teeth groups. The mean force of fracture values were 2667.07,
1665.20, 1735.21, 1731.05, 2184.87, 1749.27 and 1640.25 N for groups
I,II,III,IV,V,VI and VII respectively. Based on the fracture mode, the
teeth groups; restored with only glass fiber post, adhesive composite
and polyethylene fiber, adhesive composite have relatively more restorable cohesive fractures observed.
37
1 5 TH B I E N N I A L C O N G R E S S
OF THE EUROPEAN SOCIETY
OF ENDODONTOLOGY
Conclusions: The combined use of glass fiber dowel, polyethylene fiber and composite resin was improved the mechanical properties of
restored teeth and ultimately fracture resistance of teeth.
F7 - 6
Root canal pretreatment increased push-out bond
strength of self-adhesive resin cement with FRC posts
Duronwong Supaporn, Issarawan Boonsiri, Siriporn Arunpraditkul
Postgraduate student of Prosthetics department, Chulalongkorn University, Bangkok, Thailand
Prosthetics department, Chulalongkorn university. Bangkok, Thailand
Prosthetics department, Chulalongkorn university. Bangkok, Thailand
Abstract
Our study objectives were to evaluate push out bond strength (PBS)
of fiber-reinforced-composite (FRC) posts luted with three resin
cement systems and to investigate the effect of root canal surface
treatments before FRC posts luting on PBS. Sixty single-rooted mandibular premolars were divided into six groups (n=10), endodontically
treated and post-space was prepared for Fibrekleer® posts. Root canal surfaces were treated as follows, group 1-total etch resin cement,
applied Excite® DSC and Variolink®II. Group 2-self etch resin cement, applied ED primer II and PanaviaTF 2.0. Group 3-self adhesive
resin cement, RelyXTUnicem. In groups 4-6; root canal surfaces were
treated with 37% H3PO4 for 5 s, 17% EDTA for 60 s, and 17% EDTA
for 60 s/2.5% NaOCl for 15 s, respectively before posts were luted
with RelyXTUnicem. Six slices of 1±0.05 mm were prepared from
each root. Push out tests were performed by an Instron® machine
at a crosshead speed of 0.5 mm/min. Data were analyzed by twoway ANOVA and Tukey test at P<0.05. PBS was significantly affected
by root regions only in group 1 which that of the coronal region was
higher than middle and apical regions (P<0.05). PBS of group 1 in the
coronal region was higher than group 2 and 3 for all regions (P<0.05).
The bond strength of group 1 in the middle region was higher than
group 2 but not different from group 3 for all regions (P<0.05). PBS
of group 1-3 in the apical region were not different (P<0.05). Moreover, PBS of group 4 was significantly higher than group 3, 5, and 6.
However, there was no significant difference between group 3 and
6. Thus, we did not observe meaningful differences in PBS between
groups 1-3 while canal pretreatment resulted in increased PBS for
group 4 and 5.
F7 - 7
Evaluation of the root canal seal with a secondary
monoblock as root canal filling
Cos Tine, Filip Calberson, Mieke De Bruyne, Roeland De Moor
Dept. Restorative, Dentistry & Endodontology, Dental School, Ghent University, Ghent, Belgium
Abstract
Aims: (I) To evaluate microleakage of three different set-ups for creating a monoblock in a root canal. (II) To visualize the integrity of the
interface of the created monoblocks.
Methodology: One hundred and twenty extracted teeth were endodontically treated and obturated. They were randomly divided into
3 groups according to the tips/bur used for post-space preparation
and the type of post: (1) oval shaped canal + oval ultrasonic tip + oval
post, (2) round canal + round ultrasonic tip + round post, (3) round
canal + round calibration bur + round post. Each group was divided
into 2 groups: (A) EDTA 17% conditioning before acid-etch procedure,
(B) only acid-etch procedure. Groups 4 and 5 were control groups.
A section of root and post was made resulting in an 8 mm sample.
Results of capillary flow porometry (CFP) performed on the samples
were analysed statistically using nonparametric Kruskal-Wallis and
Mann-Whitney tests with Bonferroni correction (p < 0.05). Samples
were each cut into 4 slices of 2 mm thickness. Digital images of the
slices were examined for post fit, voids and cracks in the root dentin.
38
R O M E - 2 0 1 1 , S E P T E M B E R 1 4 TH - 1 7 TH
R O M E CAVA L I E R I H OT E L
Results: Through and through leakage was observed in all samples.
Group 1A showed significantly more leakage than groups 2A, 3A and
5. Group 1B showed significantly more leakage than group 5. Digital
images displayed good cone fit in root canals with a circular diameter and a less consistent cone fit in the ovoid canals. Voids could be
categorized as air bubbles or as interfacial gaps and were seen in
several samples.
Conclusion: It can be concluded that monoblocks created with glass
fibre posts and resin cement do not provide a hermetic seal of the
root canal. Voids may negatively influence microleakage. The additional use of EDTA resulted in no significant reduction of the microleakage.
Chairpersons: Andrea Gesi, Linda Peters
Session F8 – 13.30
F8 - 1
In vivo evaluation of the effectiveness of electronic locator
foraminal low cost ROOT-PI ®
Carvalhal Julio Cesar, Ricardo Augusto Aguiar De Lira Santos, Walter
Cavalcante De Sa Neto, Liliane Pereira Do Nascimento, Frederico
Antonio Genezini
Departament of Endodontics Faculty of Catholic Queen of the Wild,
Quixadá, Brazil
Clinical Private,Quixadá, Brazil
Departament of division of environmental analysis IPEM/CNEM, São
Paulo, Brazil
Abstract
The aim of this study was to evaluate the in vivo efficiency of a low
cost electronic apex locator ROOT-PI ® compared to other electronic
apex locators. A total of 19 adult patients that were undergoing endodontic treatment, 9 patients with vital teeth and 10 patients with
non-vital teeth were followed for this study. The subjects were divided
in three groups (GI, GII and GIII) according to each electronic device:
Group I(ENDEX®), Group II(Novapex®) and Group III(ROOT-PI ®). For
GroupI were obtained 30 measurements, for GroupII 30 measures
and and for GroupIII 23 measures. 7 measures was discarded for
technical limitations of the devices. A total of 83 measurements, 43
measurements were analyzed relating to vital teeth and 40 teeth not
vital related to measurements obtained by the same operator and at
the same clinic session. The resulting values were statistically analyzed using student’s t-test. Results showed significant differences (p
<0.05) for tooth length values in Groups I, III and II, and III in vital teeth
with no statistically significant differences between Groups I, II, III (p>
0.05) in non-vital teeth. The efficiency of the apical locator ROOT-PI®
low cost resulted in inaccurate readings in teeth with vital pulp and in
accurate readings for non-vital teeth when compared with electronic
tracking devices ENDEX® and Novapex®.
F8 - 2
Comparison of Apex locators integrated into rotary
endodontic motors and conventionally electronical length
determination
Holly Matthias, J. Klimscha, M. Erdem, M. Sabo
Bernhard Gottlieb University Clinic of Dentistry Division for Dental Education Vienna Austria
Abstract
Aim: To compare the accuracy of two rotary endodontic motors with
integrated apex locators, the Dentaport Root ZX (Morita, USA) and the
VDW Gold Raypex 5 (VDW, Germany) with the conventional method of
electronically root canal length determination and preparation.
Methodology: A number of 160 root canals of recently extracted teeth
ESE ROME 2011
NOT ONLY ROOTS
were were divided into two groups of 80 root canals (device A and B)
and mounted in a special apparatus to establish standardised measurements and X-rays. In each group the accuracies of the devices
were compared to standard electronic root canal measurements of
the canals with stainless steel files iso 10 and the preparation of
canals to the determined working length with (40 canals) and without
(40 canals) simultaneously measuring the root canal length by the integrated apex locators. Data was acquired by measuring the distances
of file tips to radiological apex in X-rays taken after each step of the
procedure and then statistically evaluated. Furthermore the correlation of root canal curvature and accuracy was evaluated.
Results: No statistically correlation was found between the degree root
canal curvature and the accuracy of the devices and the methods of
use. Significant statistically difference (p<0,001) was found for the device A (Dentaport Root ZX) and the methods of use. No statistically difference was found for the device B (VDW Gold Raypex 5) and the methods of use, although in the measurement five big outliners occurred.
Conclusions: The rotary preparation of root canals with simultaneously measuring the root canal length by the integrated apex locators is comparable to the standard procedure of electronically length
determination and root canal preparation, but it occurred a sign of
technique sensibility in the combined method for one of the devices.
F8 - 3
Diagnosis vertical root fracture using MSCT
Maria K. Makeeva, Svetlana F. Byakova, Nina V. Novozhilova
First Moscow State Medical University Operative Dentistry, Moscow,
Russia
Abstract
Aim: To optimise the diagnostic of vertical tooth fracture using MSKT.
Methodology: Twenty-five patients with 26 teeth in which vertical root
fracture was clinically suspected underwent dental radiography and
MSCT. Two clinicians estimated the results. The results were compared with intraoperative findings. Five cracked extracted teeth were
investigated using MSKT with and without metal post in the root canal.
Results: 25 of the 26 teeth were proved intraoperatively to be fractured. The sensitivity and specificity averaged for the two reviewers
in the assessment of vertical fractures were 20 and 75%, respectively, with dental radiography and 100% and 100%, respectively, with
MSCT. One case was false positive – extracted tooth had no crack.
Conclusions: MSCT is superior to dental radiography in the detection
of dental vertical root fractures, but it show false positive result if
there is metal post in the root canal.
F8 - 4
Accuracy of the apex locating function of different
endodontic motors
Gurel Melek, Ondokuz May
Turkey
Abstract
Aim: To compare ex vivo the accuracy of the apex locating function of
different endodontic motors;VDW.Gold,X-SmartT Dual and SIROEndo
Pocket during root canal treatment.
Methodology: Sixty freshly extracted human anterior teeth were selected. following access cavity preparation the length of root canals
measured visually with a K-file 1mm short of apical foramen (true
working length- TWL) .All samples were mounted in an alginate and
randomly divided to three groups. Group A: before root canal preparation only apex locator function of VDW Gold was used according
to the manufacturer’s recommendations and working lengths measured (WL1-A). During root canal preparation constant length monitoring was performed with VDW Gold.(WL2-A). Group B: before root
canal preparation only apex locator function of X-SmartT Dual was
used according to the manufacturer’s recommendations and working lengths measured (WL1-B). During root canal preparation constant length monitoring was performed with X-SmartT Dual (WL2-B).
Group C: before root canal preparation only apex locator function of
www.eserome2011.com
SIROEndo Pocket was used according to the manufacturer’s recommendations and working lengths measured (WL1-C). During root
canal preparation constant length monitoring was performed with
SIROEndo Pocket(WL2-C). Differences between working lengths
were calculated.
Results: There were no statistically significant differences between
both working lengths and endodontic motors.
Conclusion: With the limitation of this ex vivo study the combination of electronic apex locators with endontic motor was accurate in
terms of length control during root canal treatment.
F8 - 5
Synchrotron light based μCT imaging of the shaping of
root canals and presence of dentinal micro-crack post
rotary and reciprocating NiTi instrumentation
Ioana Pop, F. Zanini, G. Tromba, S. Patel, F. Mannocci, F. Foschi
Department of Conservative Dentistry, Dental Institute, King’s College
London, London, UK
Sincrotrone Trieste S.C.p.A. in Area Science Park I, Basovizza, TS 34012,
Italy
Abstract
Background: Despite benefits introduced by NiTi instrumentation, recent investigations reported that mechanized preparation may damage dentin and create microcracks. To date destructive investigation
methods, that may introduce preparatory artifacts, have been used.
Non-destructive imaging technique (e.g. μCT, CBCT) would be more
appropriate to investigate these alterations; nevertheless their resolution is technically limited by power fluency and beam coherence.
Synchrotron Radiation as a source for μCT overcomes these limitations. Synchrotron provides a monochromatic laminar-section X-ray
operating at 2.0 GeV.
Materials and Methods: Twelve mandibular and maxillary roots of extracted molars (South East London ethical approval 10/H0804/056),
randomly distributed, have been scanned pre and post instrumentation. Half of the roots were prepared with rotary ProTaper (Dentsply
Maillefer, Baillagues, Switzerland) size F2 and half with reciprocating Wave One (Dentsply Maillefer, Baillagues) size 25, according to
manufacturer’s instruction. Specimens were analysed with the SRμCT at SYRMEP Beamline (Elettra, Trieste, Italy). The samples were
re-positioned on the rotational stage with an impression silicon putty
matrix. The tomographies were performed at 0 to 180°, in steps of
0.2°, resulting in 900 projections. The tomographic reconstructions
were completed with “Tomo Project” program.
Results: The synchrotron light based μCT could detect microcracks
present in the thickness of dentine to a resolution of up to 10 μm.
Microcracks developed and propagated post instrumentation in dentine. These microcracks often developed firstly on the outer surface
of dentin.
Conclusions: Conventional rotary and rotary “reciprocating” instrumentation within the limitation of this in vitro study may result in the
formation of microcracks in root dentine. SR-μCT is a suitable mean
for the detection of these cracks.
F8 - 6
In vitro endodontic imaging: 3-D high resolution microcomputed tomographic study
Arbab Chirani Reza, G. Bourbouze, J. D’Arboneau, V. Chevalier, C. Roux
Bretagne Occidentale University, School of Dentistry and Laboratory of
Medical Information Processing (LATIM) – INSERM U650 Endodontics and
Conservative Dentistry Brest, France
CRT (Technical Resource Centre) / Morlaix, France
University Hospital Odontology Brest, France
School of Dentistry Endodontics and Conservative Dentistry Brest, France
LATIM – INSERM U650 / Brest, France
Abstract
Aim: The aim of this study was to evaluate a 3-D reconstruction
methodology applicable to endodontic images. This paper provides
in vitro study to illustrate the usefulness of 3-D reconstruction for
39
1 5 TH B I E N N I A L C O N G R E S S
OF THE EUROPEAN SOCIETY
OF ENDODONTOLOGY
evaluation of complex endodontic anatomy and to assess root canal
geometry and changes after endodontic preparation (apical transportation, surface changes,…).
Methodology: Two steps have been used to obtain root canal images:
image acquisition by high resolution micro-computed tomography
and three-dimensional (3-D) reconstruction. Acquisition: The specimens (freshly extracted human maxillary and mandibular molars
and kept in 10% buffered formalin) have been scanned, before and
after root canal shaping with different rotary NiTi systems. Acquisitions have been realized using a very high resolution micro-computed tomographic scanner, v|tome|x 240D® (General Electric, MA,
USA) with an isotropic resolution of 5/20 μm. 3-D Reconstruction:
Three major steps have been involved by this generic task: 1) data
filtering; 2) delineation and registration of the 3-D shape of the ROI;
and 3) mapping measurements over these shapes. The second step,
i.e., 3-D image segmentation and registration, has been performed
using Amira® (Visage Imaging Inc, CA, USA).
Results: Three-dimensional images of the root canal have been obtained, and the assessment of the anatomical changes done. Volumes
and surfaces area and canal axis for each canal before and after preparation have been also calculated. Changes after endodontic preparation were calculated for each canal before and after canal shaping.
Conclusions: This methodology seems to be a very adequate in vitro
endodontic methodology to explore root canal geometry and to assess anatomical changes.
F8 - 7
Clinical evaluation of the accuracy of two electronic apex
locators
Tsaltas Konstantinos
Department of Endodontics, University of Athens, Athens, Greece
Abstract
AIM. To examine the clinical reliability of two last generation electronic apex locating devices, Propex and Apex Finder 7005.
METHODOLOGY. A total of 180 root canals from 100 teeth of 81 patients, who were informed and consented, were used for the study.
All measurements were made after instrumentation of the coronal
and middle thirds of the root canal (with Profile) and irrigation with
NaOCl 5%. Thereafter, a file was introduced into the canal and forwarded until the apex locator showed that it reached the apex. A radiograph was then taken and the distance of the end of the file from
the radiographic root apex was measured. As accurate were designated all measurements in which the distance of the file to the root
apex ranged from 0-2mm.
RESULTS. The electronic device Propex was accurate in all of 86 root
canals (success rate: 100%). Apex Finder had an overall success rate
of 80%. The success rate was 87% in teeth with vital pulp, 81% in
teeth with non vital pulp and 65% in retreatment cases.
CONCLUSIONS. The results of the present investigation showed that
the clinical accuracy of both electronic devices was high. However, it
is still necessary to verify their measurements with the radiographic
method.
F8 - 8
Reliability of an endodontic motor integrated with an
apex locator
Umberto Baracchi, Paolo Ambrogio, Livio Mollo, Damiano Pasqualini,
Elio Berutti
Department of Endodontics – Prof. E. Berutti, University of Turin Dental
School, Turin, Italy
Abstract
Aim: This in-vivo study assessed the reliability of an endodontic motor integrated with an apex locator, compared with a convential apex
locator .
Materials and methods: The study was performed on cooperating
patients of Turin University Dental School with irreversible pulpitis
or pulp necrosis. After access cavity preparation, the root canal was
scouted with a #10 k-file (Dentsply Maillefer, Baillague, Switzerland) and the first working length (WL1) was recorded with Root ZX
40
R O M E - 2 0 1 1 , S E P T E M B E R 1 4 TH - 1 7 TH
R O M E CAVA L I E R I H OT E L
(J.Morita MFG. Corp, Kyoto, Japan). The glide path was created with
NiTi rotary instruments PathFile (Dentsply Maillefer, Baillague, Switzerland) using X-Smart Dual (Dentsply Maillefer, Baillague, Switzerland). WL2 was determined using X-Smart Dual, with PathFile 3.
WL3 was determined with a #20 k-file (Dentsply Maillefer, Baillague,
Switzerland) with Root ZX, and the radiographic WL was checked with
an intraoral x-ray. 5% sodium hypochlorite (Ogna Niclor 5, Muggiò,
Italy) was used as irrigant during the procedure.
Results: Within a 9-month period, 40 teeth were analyzed, for a total
of 80 root canals. An exact match was found between X-Smart Dual
WL2and Root ZX WL3 in 38 root canals. However, in 42 root canals
there was no correspondence between WL2 and WL3. In most cases,
WL2 was significantly shorter than WL3.
Conclusions: X-Smart Dual proved to be reliable only in 47.5% of cases. However, the endodontic motor with electronic apex locator function can be very useful clinically, since rotary instruments can be very
efficient in cutting and particular attention must be paid to avoiding
excessively widening and/or altering the apical foramen
Keywords: Working length, apex locator, pre-flaring, endodontic motor.
F8 - 9
Effect of ultrasonic activation on the efficacy of MTA filling
in simulated root canals
Park JC, Ha JH, Jin MU, Kim YK, Kim Sung Kyo
Department of Conservative Dentistry, School of Dentistry, Kyungpook
National University, Daegu, Korea
Abstract
Aim: The aim was to investigate the effect of ultrasonic activation on
the filling efficacy of MTA in accessory canals.
Methodology: Twenty simulated root canals with 3 accessory canals
(Obtura Spartan, Fenton, USA) was used. The first accessory canal
was located in apical third of the main canal with 45 degree, the second one was located more apically with 45 degree in an opposite side
to the first one, and the third one was at the apical end of the main
canal with the same direction of main canal. A special hinge arm was
designed with aluminum on which an endodontic plugger (Obtura
S-Kondenser 40-80, Obtura Spartan) was mounted and ultrasonic
unit (Suprasson Pimax, Satelec, Merignac, France) was connected.
White MTA (ProRoot, MTA, Tulsa, USA) was mixed with sterile water
and placed into the coronal third of the simulated root canals with an
amalgam carrier. In control group, ten root canals were filled with
MTA using 200 g of apparatus weight only. In ultrasonic group, ten
root canals were filled with MTA using ultrasonic activation in addition to 200 g of apparatus weight. Digital photo images of the MTA
obturation in each canal were taken and MTA obturated areas of each
canal were analyzed using an image software (Image J, National Institutes of Health, Bethesda, USA). Mann-Whitney U test was used for
statistical analysis.
Results: Ultrasonic group showed significantly higher filled area ratio
than control group in all the three accessory canals (p<0.001). Filled
area ratios of two lateral accessory canals were significantly higher
than that of apical accessory canal in the control group (p<0.001),
while there were no difference in the ultrasonic group(p<0.05) Conclusion: Ultrasonic activation might improve the filling efficacy of
MTA in accessory canals.
F8 - 10
Single-matched, taper-sized cone technique: introduction
of a novel obturation method
Mohammed Abdullah Alshehri, BDS, AEGD, SSC-ARD
Riyadh Military Hospital, Departments of Restorative Dentistry, Saudi Arabia
Abstract
Aim: To describe a novel canal obturation method using the singlematched, taper-sized cone technique.
Summary of the technique: A root canal system prepared using specific rotary nickel-titanium files. Obturation is performed with filling
cones that match the taper and size of the rotary instruments in order to provide three-dimensional obturation of the root canal over its
entire length. This can be performed without the need for accessory
ESE ROME 2011
NOT ONLY ROOTS
cones or spending time on lateral condensation.
Conclusion: The advantages of employing this technique include safe
coronal extrusion of excess cement, the ability to create a uniform
mass of gutta-percha with less sealer at the canal wall interface and
within the filling mass, a higher percentage of sealer-coated canals
and a better sealer distribution and elimination of the use of lateral
stresses (which may result in overfills and root fractures) during obturation. In addition, higher quality obturation is obtained compared
to other methods, and the potential to cause tissue damage due to
an increase in the root surface temperature and obturation material
shrinkage is minimised. Finally, the technique takes significantly less
time comparing with other obturation techniques, is easy to learn
and incurs less cost to implement.
Chairpersons: Bettina Basrani, Charlotte Ulin
Session F9 – 13.30
F9 - 1
Calcium hydroxide induced apexification with partial
apical root development: a case report
Selcuk Gokyay, I. Karagöz-Küçükay
Istanbul University, Faculty of Dentistry, Istanbul, Turkey
Abstract
Aim: To present a case of a traumatized immature incisor where
apexification was induced with apical root development partially by
long-term calcium hydroxide (CaOH2) treatment.
Methodology: A 14-year-old boy was referred to our endodontic clinic
with a history of trauma three-years previously. He informed that
endodontic treatment was initiated a-year ago, but he gave up since
extraction or apical surgery were advised. Intraoral examination
showed that the left maxillary incisor had discoloration and crownfracture with a large endodontic cavity which had been exposed to
oral contamination. Oral mucosa had a swelling and was sensitive
to palpation. The tooth had tenderness to percussion and slight mobility. Radiological examination revealed a wide radioluscent lesion
surrounding the mesial side and whole apex of the root with a wide
apical opening located on the mesial side of root apex. The root canal
was extremely wide as well. An apexification tretment was initiated
on this tooth. The root canal was biomechanically prepared under
copious irrigation of %5 sodium hypochlorite and filled with CaOH2
powder mixed with physiologic saline to a dense consistency. Access cavity was then sealed with glass-ionomer cement. CaOH2 was
changed in intervals of one or three months upon the radiographic
examination. The apical barrier was detected after 6 months, and the
root canal was permanently obturated and the tooth was restored. At
recall visits, the tooth was evaluated clinically and radiographically.
Results: In this clinical case, long-term CaOH2 treatment was found
to induce periapical repair through the closure of apical foramen.
Over a period of 24-months follow-up, partial root growth and healing of bone were assessed radiographically. The tooth was clinically
asymptomatic.
Conclusions: This case report confirms the efficacy of CaOH2 as an
aid in inducing apexification. The use of long-term CaOH2 is a valid
treatment in immature teeth with periapical lesions.
F9 - 2
Treatment of traumatised anterior teeth: an interdisciplinary approach
Ilgin Akcay, B. Yasa, G. Oncag
School of Dentistry, Ege University, Izmir, Turkey
Abstract
Treatment of crown-root fractures often requires an interdisciplinary approach. It is important for the patient to reestablish a proper
esthetic and function. Tooth fracture at or below the gingival attachment or alveolar bone crest presents restorative complexities.
A 35-year-old female patient with epilepsy presented with horizontal
crown-root fracture of the maxillary right and an oblique crown-root
fracture of the left central incisor under the cervical region, as a re-
www.eserome2011.com
sult of fall from the stairs. Radiographic and intraoral examinations
of the teeth revealed crown-root fractures with pulpal exposures of
the central teeth. Treatment planning was as follows: endodontic
therapy for both incisors and to extrude the remaining tooth segment
with orthodontic forces to provide sufficient tooth structure with
proper dento-gingival relationships and reestablish proper esthetics
and function for the patient.
The patient received local anaesthesia. The mobile coronal portion
of the left central incisor was extracted. The teeth were subjected
to endodontic treatment in a single appointment. The canals were
obturated with lateral condensation technique with gutta percha and
AH Plus sealer (Dentsply DeTrey GmbH, Konstanz, Germany). A hook
was luted with resin-based luting agent into the root canal of left central incisor. As a result of this procedure, use of the adjacent teeth as
an anchorage for the extrusion was avoided. The upper traumatised
teeth were bonded, and the root was extruded via light orthodontic
forces. All extrusion was completed in 14 weeks.
After healing of the gingiva, maxillary right canine, lateral and left
lateral were restored with porcelain laminate veneers, right central
was restored with full ceramic crown and left cental was restored
with zirconium crown.
The patient is on a recall schedule for 1 year and has reported asymptomatically. The subsequent monitoring of the radiographs did
not demonstrate any signs of pathology.
F9 - 3
Modern management of crown fractures of permanent
incisors- a case series
R.S. Austin, S. Djemal
King’s College London Dental Institute, London, UK
Abstract
Crown fractures are unfortunate, painful and distressing events
which, if managed inappropriately, may have life-long oral health,
psychosocial and economic consequences. Vital pulp therapy using
modern techniques and materials for teeth with enamel-dentinepulp fractures can maintain 95 % vitality after five years. High quality treatment can therefore reduce costs to individuals and society at
large. This clinical poster shows how modern management of crown
fractures of permanent incisors can result in optimal outcomes using
the 2007 IADT evidence-based guidelines. Special features of clinical
cases: Case 1: diagnosis: enamel-dentine crown fractures of 11 and
22 presented 7 hours after fall; procedure: bonding of tooth fragment
using composite resin with fragment handling and isolation using
OptraStick and OptraGate (Ivoclar Vivadent AG, Schaan, Liechtenstein), outcome: excellent aesthetics and pulp vital at follow-up. Case
2: diagnosis, enamel-dentine-pulp fractures of 11 and 21 presented
less than 12 hours after assault; procedure, partial pulpotomy with
white mineral trioxide aggregate (ProRoot®, Tulsa Dental, USA) and
immediate restoration with Enamel plus HFO® composite (Enamel
Plus HFO; Micerium Spa, Italy); outcome, excellent aesthetics and
pulp vital at follow-up. Case 3: diagnosis, enamel-dentine fracture
11 and enamel-dentine-pulp fracture 21 and enamel-dentine-pulp
crown-root fracture 22 presented less than 12 hours after road traffic accident; procedure, fragment removal, gingivectomy and partial
pulpectomy with white mineral trioxide aggregate (ProRoot®, Tulsa
Dental, USA) and restoration with composite resin; outcome: excellent aesthetics and pulp vital at follow-up. Conclusion: This poster
has shown how evidence-based management of crown fractured
permanent incisors, using modern techniques and materials, ensures optimal treatment outcomes, as well as potentially reducing
negative impacts on patients oral health and psychosocial wellbeing.
F9 - 4
Intraalveolar root fracture: a case report
García Briones Julio Cesar, JF Raygoza, A Percevault, A Guizar, ME
Hofmann, MA Cadena
Universidad Autonoma de Baja California, Campus Tijuana, USA
Abstract
A sequelae to a traumatic injury of a tooth is a root fracture. When a
41
1 5 TH B I E N N I A L C O N G R E S S
OF THE EUROPEAN SOCIETY
OF ENDODONTOLOGY
root fracture is horizontal and the fragment is completely encased by
the bone, it has a favorable prognosis. An 18 year old female patient
sufferd 10 years ago a traumatic injury in tooth # 9 (ULI) . This tooth
presented a horizontal root fracture, the radiographic visualization
showed a displaced apical fragment and a wide diastasis with a radiolucency present between the fragments. The coronal segment
was treated endodontically. The coronal fragment was cleaned and
shaped. NaOCl 5.25% was used to irrigate, later the coronal fragment
was dried with paper points and Ca(OH)2 was placed as intracanal
medication. In the second appointment a surgical intervention was
required to seal the apical area of the coronal fragment and the removal of the apical fragment. The surgical intervention started with
a flat and an osteotomy of the site. The granulation tissue was curetted and the area rinsed witn saline solution. The apical fragment
wasn’t removed because it showed ankylosis and also to prevent
damage to adjacent tissues. The coronal fragment was sealed using thermo plasticized technique (obtura II) and the guttapercha was
adapted in the apical area in the surgical act. The surgical flat was
closed. Post-op radiographic controls showed a healed bone and
the patient didn’t mention any signs or symptoms after 4 years of
the surgery.
Conclusion: Endodontic treatment and surgical intervention is an
excellent treatment plan for intraalveolar root fractures, and has a
good prognosis.
F9 - 5
Treatment of horizontal root fracture: case report
Acar Gozde, T.Yagmur Yalcin
Istanbul University Faculty of Dentitry, Department of Endodontics, Turkey
Abstract
Root fractures of permanent tooth are the most frequent type of
dental injury. Restoration of teeth becomes more complex when the
involved teeth exhibits a cervical root fracture.
The development and use of fiber- root canal posts make possible the
stabilized of the fragments of fractured root.
The present paper reports a case in which the treatment of a cervical root fracture was accomplished by stabilized the tooth fragment
with a fiber post. The author will also discuss the concept of adhesive
restorations and clinicall show how to utilize the best materials and
techniques for this specific use.
F9 - 6
Endodontic treatment of root fractures using mineral
trioxide aggregate: case reports
Jung Kyoung hwa, Jiwan Yum, Hyeon-Cheol Kim , Bock Hur, Jeongkill Park
South Korea
Abstract
Introduction: Dental traumas, which can lead to a wide range of injuries, are the most common damages among all facial injuries. Complicated crown fractures and root fractures of fully developed teeth
are examples of these injuries. Root fractures commonly occur at the
anterior maxilla, and generally teeth with complete root formation
are affected. Root fractures may be located at the coronal, middle, or
apical thirds. Although the coronal fragment is commonly indicated
to be treated endodonitcally, it is not easy to get an adequate sealing
of the apical end of the coronal fragment. Mineral trioxide aggregate
(MTA) has been shown to be very effective in sealing the pathways
of communication between the root canal system and periodontal
42
R O M E - 2 0 1 1 , S E P T E M B E R 1 4 TH - 1 7 TH
R O M E CAVA L I E R I H OT E L
tissue. The root canal could be filled in orthograde way using MTA.
These case reports describe the treatment and follow-up of teeth
with root fratures treated with MTA as apical plug.
Case Presentation
<Case 1>
1. Sex/age: F/56
2. Chief Complaint (C.C): Fractured tooth after accident.
3. Past Dental History (PDH): Apical fragment of #43 was removed
on open reduction
4. Present Illness (P.I): Extraoral multiple laceration and #43 root
tip fx.
5. Impression: Horizontal foot fx. in the apical third of #43
6. Tx. plan: #43 root canal treatment and MTA filling
<Case 2>
1. Sex/age: M/15
2. Chief complaint (C.C): Fractured tooth after slip-down accident.
3. Past Dental History (PDH): N/S
4. Present Illness (P.I): #11 horizontal foot fx., temporary filling state
5. Impression: Horizontal fx. in the middle third of #11
6. Tx. plan: #11 root canal treatment of coronal fragment and MTA
filling
Conclusion
In all traumatic injuries, early diagnosis and appropriate intervention dramatically enhance the outcome. The use of MTA as an apical
plug seems to be an appropriate application in the treatment of root
fractures and may secure favorable prognosis.
F9 - 7
Rehydration of the reattached fractured tooth fragment
after prolonged dehydration
Ungor Mete, Neslihan Arhun, Emel O. Onay
Turkey
Abstract
The reattachment of dental fragments is a conservative treatment
and should be considered as a first treatment choice in the restoration of anterior tooth fractures. This article presents a clinical technique for the restoration of a fractured maxillary lateral incisor by
reattaching the tooth fragment which was kept in dry conditions for 5
days with the aid of adhesive dentistry. The fractured tooth fragment
was recovered by a witness at the site of outdoor accident injury,
handed to the patient and maintained in a paper tissue for 5 days.
After disinfection of the fragment, the fracture site and the fragment
were treated acid etched with 37% phosphoric acid for 30 seconds
and rinsed thoroughly with water for 10 seconds but not dried. A single step adhesive (Single Bond, 3M, St. Paul, MN, USA) was applied,
gently dried for 5 seconds. The fragment was carefully repositioned
to the fractured tooth with firm finger pressure and light cured for
20 s from each direction. After reattaching the fragment, a circumferential groove in the fracture site was prepared with a round diamond bur and etched with 37% phosphoric acid. The same adhesive
system was applied and light cured for 20 seconds, and the groove
was restored with a hybrid resin composite (Z250, 3M) and finishedpolished with finishing disks (Sof-Lex, 3M). However, the crown fragment was much whiter than the fractured tooth because of excessive
dehydration as it was kept in dry conditions for 5 days. The esthetic
compromise in white color was compensated after 1 month service
in the mouth by gaining the natural color by rehydration. One year
clinical evaluation revealed successful results for this technique and
the patient was with the esthetic outcome of the conservative treatment modality.
ESE ROME 2011
NOT ONLY ROOTS
NOTES
www.eserome2011.com
43
1 5 TH B I E N N I A L C O N G R E S S
OF THE EUROPEAN SOCIETY
OF ENDODONTOLOGY
NOTES
44
R O M E - 2 0 1 1 , S E P T E M B E R 1 4 TH - 1 7 TH
R O M E CAVA L I E R I H OT E L