Laser Doppler flowmetry (LDF) has been used to investigate pulpal blood flow as a means of pulp vitality testing. Transmission of laser light from the tooth surface to the pulp space may be influenced by caries and restorations. One hundred and twenty-two first and second molars that had caries into dentine, restorations or significant loss of coronal tissue were sectioned in half axio-bucco-lingually. The two sections were illuminated with a laser from their buccal and lingual aspects 2 mm coronal to the amelocemental junction. Light reaching the pulp space was recorded. Buccal and lingual illumination sites were equally effective for 67 teeth (55%). Buccal sites alone were effective for 35 teeth (29%), despite over one-third of these surfaces being restored or featuring enamel or dentine caries. A lingual position alone was effective for 20 teeth (16%). Caries affected light transmission, but for over half the teeth, the pulp could be illuminated from all four probe positions. No effect was found when the influence of mesial and distal restorations on transmission into the corresponding tooth section was examined. The pulp spaces of most (84%) restored, and carious posterior teeth could be illuminated by laser light from their buccal aspect and these teeth could potentially be vitality tested using LDF.

Statement of Problem. Little information exists regarding the outcome of crown build-ups on endodontically treated teeth restored with metal-ceramic crowns or with only a direct-placed composite. Purpose. The aim of this study was to evaluate the clinical success rate of endodontically treated premolars restored with fiber posts and direct composite restorations and compare that treatment with a similar treatment of full-coverage with metal-ceramic crowns. Material and Methods. Subjects included in this study had one maxillary or mandibular premolar for which endodontic treatment and crown build up was indicated and met specific inclusion/exclusion criteria. Only premolars with Class II carious lesions and preserved cusp structure were included. Subjects were randomly assigned to 1 of the following 2 experimental groups: (1) teeth endodontically treated and restored with adhesive techniques and composite or (2) teeth endodontically treated, restored with adhesive techniques and composite, and then restored with full-coverage metal-ceramic crowns. Sixty teeth were included in the first group and 57 in the second. All restorations were performed by one operator. Causes of failure were categorized as root fracture, post fracture, post decementation, clinical and/or radiographic evidence of marginal gap between tooth and restoration, and clinical and/or radiographic evidence of secondary caries contiguous with restoration margins. Subjects were examined for the listed clinical and radiographic causes of failure by 2 calibrated examiners at intervals of 1, 2, and 3 years. Exact 95% confidence intervals for the difference between the 2 experimental groups were calculated. Results. At the 1-year recall, no failures were reported. The only failure modes observed at 2 and 3 years were decementations of posts and clinical and/or radiographic evidence of marginal gap between tooth and restoration. There was no difference in the failure frequencies of the 2 groups (95% confidence interval, −17.5 to 12.6). There was no difference between the number of failures caused by post decementations and the presence of marginal gaps observed in the 2 groups (95% confidence intervals, −9.7 to 16.2 and −17.8 to 9.27). Conclusion. Within the limitations of this study, the results upheld the research hypothesis that the clinical success rates of endodontically treated premolars restored with fiber posts and direct composite restorations after 3 years of service were equivalent to a similar treatment of full coverage with metal-ceramic crowns. (J Prosthet Dent 2002;88:297-301.)

International Endodontic JournalVolume 42, Issue 5 p. 391-398 Ultrasonic Debridement of Root Canals: Acoustic Cavitation and Its Relevance* M. Ahmad BDS, MDSc, M. Ahmad BDS, MDScSearch for more papers by this authorT. R. Pitt Ford BDS, PhD, FDSRCPS, T. R. Pitt Ford BDS, PhD, FDSRCPSSearch for more papers by this authorL. A. Crum BS, MS, PhD, L. A. Crum BS, MS, PhDSearch for more papers by this authorA. J. Walton BA, MSc, PhD, A. J. Walton BA, MSc, PhDSearch for more papers by this author M. Ahmad BDS, MDSc, M. Ahmad BDS, MDScSearch for more papers by this authorT. R. Pitt Ford BDS, PhD, FDSRCPS, T. R. Pitt Ford BDS, PhD, FDSRCPSSearch for more papers by this authorL. A. Crum BS, MS, PhD, L. A. Crum BS, MS, PhDSearch for more papers by this authorA. J. Walton BA, MSc, PhD, A. J. Walton BA, MSc, PhDSearch for more papers by this author First published: 08 April 2009 https://doi.org/10.1111/j.1365-2591.2009.01560.xCitations: 9 * Reprinted from the Journal of Endodontics, 14/10, M. Ahmad, T.R. Pitt Ford, L.A. Crum and A.J. Walton, Ultrasonic debridement of root canals: acoustic cavitation and its relevance, pp.486-493, 1988, with permission from The American Association of Endodontists. Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onEmailFacebookTwitterLinkedInRedditWechat Citing Literature Volume42, Issue5May 2009Pages 391-398 RelatedInformation

Objective. The purpose of this study was to evaluate 50 human periapical lesions for bacteria and epithelium in a case study in dental practice.Study design. Specimens were obtained front the extraction of 50 untreated teeth that had lesions attached to their apices. The specimens were histologically evaluated using serial sections.Results. Bacteria were found in all teeth, colonizing necrotic tissue in the main canal, dentinal tubules, or apical ramifications, and in the body of the periapical lesion in 18 abscesses or cysts. Twenty-one lesions were epithelialized; 14 abscesses, 20 granulomas, and 16 cysts were distinguished. In 18 root canals inflamed tissue was found in the apical part of the canal. A single foramen was present in 13 cases while apical ramifications were found in 37 cases.Conclusions. Granulomas were most common, and most epithelialized lesions were cysts. Bacteria were only detected periapically in abscesses or cysts. Inflamed tissue was present in the apical root canal in one third of. cases.

Objective. To compare the presence or absence of a radiopaque lamina of 60 human periapical lesions with the histological findings from a case study in dental practice.Study design. Paralleling radiographs were taken of 60 teeth with periapical radiolucencies. The periapical radiographs were scanned, and standardized images were evaluated on a computer screen for the presence or absence of a radiopaque lamina by 2 calibrated observers according to agreed criteria. The serially sectioned histological specimens were obtained from the extraction of 13 endodontically treated teeth and 27 nontreated teeth, as well as 20 post-treatment teeth with apical periodontitis removed during periapical surgical procedure; the specimens were classified according to agreed criteria. The findings of the 2 evaluations were compared.Results. Out of 57 electronic images that could be interpreted, 10 lesions had a radiopaque lamina, but of these only 3 were histologically diagnosed as cysts, while 7 were granulomas or abscesses. Out of 47 lesions without a radiopaque lamina, 40 were histologically diagnosed as granulomas or abscesses, while 7 were cysts.Conclusions. The diagnosis of periapical lesions cannot be made on the basis of the presence or absence of a radiopaque lamina, but requires histological examination of serial sections.

Objectives: The aim of this study was to determine the constitution of a commercially available root-end filling material, mineral trioxide aggregate, (MTA) (ProRoot MTA, Tulsa Dental, Tulsa, OK, USA). The surface morphology of the material with various treatment conditions was also evaluated.Methods: The constitution of two commercial versions of MTA was determined before and after mixing with water. The unset material was analysed using Energy Dispersive Analysis by X-ray (EDAX) in a scanning electron microscope (SEM) and X-ray diffraction (XRD). The first technique identified the constituent elements while XRD analysis identified the compounds or phases present. The set material was evaluated using EDAX. The surface morphology of the material stored under various conditions (100% humidity, immersion in water, or immersion in phosphate solution) was evaluated using SEM.Results: The EDAX showed the white MTA to be composed primarily of calcium, silicon, bismuth and oxygen, with the gray MTA also having small peaks for iron and aluminum. The XRD analysis showed gray MTA to be composed primarily of tricalcium silicate and dicalcium silicate. The surface morphology of the materials differed under the various conditions, particularly following immersion in phosphate solution with crystal formation.Significance: The commercial versions of MTA were shown to have broadly similar constitution to ordinary Portland cement except for the addition of bismuth compounds. The white MTA did not contain iron. (c) 2004 Academy of Dental Materials. Published by Elsevier Ltd. All rights reserved.

AIM To investigate the prevalence of root canal isthmuses in the apical 5 mm of the mesial root of mandibular molars by means of micro-computed tomography (MCT) and to describe the morphology of the isthmuses. METHODOLOGY Twenty extracted mandibular first molars that had fully formed roots were selected. The mesial roots were sectioned from the distal roots and subjected to MCT. The number of sections showing isthmuses in each of the apical 5 mm of the root canals was recorded. In each one of the apical 5 mm of the 20 roots examined, 40 sections were observed, giving a total of 800 sections observed in each group. Data were analysed as a contingency table using the chi-square statistic to test the null hypothesis that location of the sections in each of the apical 5 mm and presence of the isthmus were independent. RESULTS Isthmuses were found to be present at all levels with prevalence figures between 17.25 and 50.25%. The chi-square test indicated a significant difference in the distribution of isthmuses with section (P = 0.001). It was found that sections in the first millimetre from the apex had fewer isthmuses than expected and that sections in the third millimetre from the apex had more isthmuses than expected under the null hypothesis. Calcifications were found to be present in most isthmuses, occasionally lateral canals originated from the central part of the isthmuses. CONCLUSIONS Isthmuses were present in the vast majority of roots observed. The third millimetre from the apex showed more isthmuses than expected. The results of clinical and surgical endodontic procedures performed in the mesial root of mandibular molars may be affected by this aspect of the root canal anatomy.

Prospective clinical studies comparing the results of different types of restorations of endodontically treated teeth are lacking. This study compared the clinical success rate of endodontically treated premolars restored with fiber posts and direct composite to the restorations of premolars using amalgam. Premolars with Class II carious lesions were selected and randomly assigned to one of two experimental groups: (1) restoration with amalgam or (2) restoration with fiber posts and composite. One hundred and nine teeth were included in Group 1 and 110 in Group 2. Patients were recalled after 1, 3 and 5 years. No statistically significant difference was found between the proportion of failed teeth in the two experimental groups. Significant differences were observed between the proportion of root fractures (p=0.029) and caries (p=0.047), with more root fractures and less caries observed in the teeth restored with amalgam at the five-year recall. Within the limits of this study, it can be concluded that restorations with fiber posts and composite were found to be more effective than amalgam in preventing root fractures but less effective in preventing secondary caries.

Objective. To evaluate the pain experience following root-end resection and filling with Mineral Trioxide Aggregate or Intermediate Restorative Material.Study design. Referred adult patients recruited using strict entry criteria were randomly allocated to receive either material. A standardized surgical technique was employed. Postoperative instructions and a pain questionnaire were given to each patient to record the severity of their pain at 3 time intervals-3-5 hours, 24 hours, and 48 hours after surgery-on a standard visual analog scale (VAS). Patients were also asked to record consumption of any self-prescribed analgesics, the type, and dosage.Results. At 3-5 hours after surgery, regardless of the material used, 90% of all patients experienced some level of postoperative pain. Twenty-four hours after surgery 82% of patients experienced pain, as did 72% after 48 hours. Thirty-seven percent of patients did not take any analgesics at all. In order of popularity, the analgesics taken were ibuprofen, acetaminophen, and acetaminophen plus codeine phosphate. The VAS measurements were reduced over time in both treatment groups (P <.001). There was no statistically significant difference in the proportion of subjects taking analgesics in each treatment group. Patients who used analgesics showed higher median VAS measurements at all time periods (P <.05).Conclusions. There was no significant difference in the pain experienced by both treatment groups. The postoperative pain was of a relatively short duration, at its maximum intensity early in the postoperative period but progressively decreased with time. Even if pain relief medication was needed, nonprescription analgesics were adequate and effective.

AIM:To test the hypothesis that there would be no statistically significant difference in viscosity-related measures of endodontic sealers or change in these with strain rate, internal diameter or powder : liquid ratio in a capillary system.METHODOLOGY:Materials used were Apexit, Tubliseal EWT, Grossman's sealer and Ketac-endo. Viscosity-related measures were tested in a two-plate test, and in a capillary rheometer. The mean values (n = 12) for thickness and diameter of material formed between two glass plates were tested with one-way analysis of variance. Pressure was applied to a capillary rheometer at strain rates 5 and 10 mm min(-1) in tubes of internal diameter 0.6 and 1.2 mm.RESULTS:Tubliseal EWT had a thinner film thickness than the other sealers (alpha = 0.05). The difference in diameter between Tubliseal EWT and the other sealers was significant apart from Apexit. Increased strain rate gave a significant increase (alpha = 0.05) in the flow of all sealers. Narrower tubes produced increased velocity, which was significant for all sealers, and reduced volumetric flow, which was significant for all sealers except Grossman's 2 : 1 (Wilcoxon signed rank test). Reduction in powder : liquid ratio of Grossman's significantly increased flow in narrow tubes and at higher strain rate (Mann-Whitney test).CONCLUSION:There was a significant difference between the flow of Tubliseal EWT and the other sealers tested in the two-plate test; capillary flow was affected by sealer, internal diameter, strain rate and powder : liquid ratio. The null hypotheses were rejected.

The aim was to determine whether radiographs provide a clinically useful indication of pulp size in diseased/restored human first molar teeth, and to investigate accessibility of pulp tissue for diagnostic testing using laser Doppler flowmetry (LDF). Extracted teeth of known age were collected. Restorative materials were removed and teeth with evidence of pulp exposures excluded. Fifty-six teeth were radiographed from buccal and mesial aspects, and then their crowns were sectioned axiobuccolingually and photographed. Images were digitally scanned and measurements made of the total pulp area (above a line across the most superior part of the pulpal floor) and the pulp area in the clinical crown (superior to a line between the amelocemental junctions). The pulp width at the cervix and the highest point of the pulp were also recorded. Data were analysed using Pearson correlations. Pulp areas within the clinical crowns were significantly larger than indicated by radiographs, by 23% in the case of the clinically attainable buccal view (P < 0.05). Pulps may be more accessible to flowmeter testing than they appear. Absence of pulp tissues in the crown was recorded in equal numbers of teeth on radiographs and sections, but with agreement for only one tooth. Sixteen per cent of the teeth had no pulp area in the clinical crown when sectioned, but might still be suitable for testing using LDF.

AIM:To examine the biocompatibility of two commercial forms of mineral trioxide aggregate (MTA), by evaluating the morphology of an established cell line.METHODOLOGY:The two cements were cast on glass cover slips and cured for 1 or 28 days. Saos-2 osteosarcoma cells were trypsinized and seeded at a density of 1 x 10(5) cells and were then placed in medium over the material-coated coverslips for 1, 5 and 7 days. After these time intervals the media were discarded and the cells fixed. Cell morphological investigation was performed by scanning electron microscopy at various magnifications ranging from x 250 to x 500. The biocompatibility of cement constituents, alusilicate flux and bismuth oxide was also investigated.RESULTS:All cement samples cured for 1 day showed a confluent cell monolayer after 5 and 7 days. The response to both materials was similar. Materials cured for 28 days showed incomplete cell confluence after 1 and 5 days. Alusilicate flux and bismuth oxide did not demonstrate biocompatibility.CONCLUSIONS:The 1-day cured samples of two commercial forms of MTA showed good biocompatibility. However, the 28-day cured samples were less biocompatible after 1 and 5 days.

AIM:To: (i) study coronal pulp dimensions in human first molar teeth; (ii) investigate the effects of restorations on pulp size; (iii) determine differences in dimensions between teeth of Mongoloid patients and teeth of other ethnic groups; and (iv) record the presence of pulp stones.METHODOLOGY:Bitewing radiographs of 121 subjects (mean age, 20.9 years) were taken under standardized conditions. The films were digitally scanned and nine measurements were made from the image of each first molar. The data were analysed in terms of presence or absence of restorations and in terms of racial group. Differences were examined using Student's t-test, Pearson correlations and Levene's test.RESULTS:A total of 445 teeth were analysed. Large crowns were correlated to large pulps. Teeth restored with occlusal and proximal restorations had significantly smaller pulps (P = 0.044 and 0.004, respectively), but no difference was found in pulp area in the clinical crown between the restoration types. Mongoloid crowns were shorter and more bulbous. Pulp areas of maxillary molars and pulp widths at the cervix of mandibular molars were significantly larger in Mongoloids. The pulp area in the clinical crown correlated to pulp horn height for Mongoloids and others and for maxillary and mandibular teeth. No differences were found between the heights of pulp horns in the Mongoloid and other teeth. Four of the pulp measurements demonstrated sexual dimorphism. Stones were present in almost 10% of the subjects, representing 4% of the tooth pulps examined.CONCLUSION:Even teeth with shallow occlusal restorations had reduced pulp spaces. There were significant differences in pulp and crown dimensions between the teeth of Mongoloid patients and those of other patients.

Biocompatibility of two variants of accelerated Portland cement (APC) were investigated in vitro by observing the cytomorphology of SaOS-2 osteosarcoma cells in the presence of test materials and the effect of these materials on the expression of markers of bone remodelling. Glass ionomer cement (GIC), mineral trioxide aggregate (MTA) and unmodified Portland cement (RC) were used for comparison. A direct contact assay was undertaken in four samples of each test material. collected at 12, 24, 48 and 72 h, Cell morphology was observed using scanning electron microscopy (SEM) and scored. Culture media were collected for cytokine quantification using enzyme-linked immunosorbent assay (ELISA).On SEM evaluation, healthy SaOS-2 cells were found adhering onto the surfaces of APC variants. RC and NITA. In contrast. rounded and dying cells were observed on GIC. Using ELISA. levels of interleukin (IL)-1beta, IL-6. IL-18 and OC were significantly higher in APC variants compared with controls and GIC (p < 0.01), but these levels of cytokines were not statistically significant compared with NITA.The results of this study provide evidence that both APC variants are non-toxic and may have potential to promote bone healing. Further development of APC is indicated to produce a viable dental restorative material and possibly a material for orthopaedic application. (C) 2002 Elsevier Science Ltd. All rights reserved.

AIM:The purpose of this study was to compare the efficacy in vitro of gutta-percha removal from obturated root canals using ProFiles.METHODOLOGY:Forty-eight human root canals with curvatures ranging between 25 and 45 degrees were instrumented by a standardized method to an apical ISO size 30 and 0.04 taper. They were obturated with vertically condensed gutta-percha. Retreatment was performed with the following techniques: K-Flexofiles with chloroform; Hedstrom files with chloroform; ProFiles 0.04 taper with chloroform; ProFiles 0.04 taper alone. The time for each method was measured. A microfocal macroradiographic technique was used to evaluate the amount of debris remaining within the root canals after the retreatment procedure. Roots were divided into apical, middle and coronal parts and scored on a scale of 0 (no debris) to 3 (> 50% of walls covered with debris) by trained observers on two separate occasions.RESULTS:The scores for debris remaining within root canals for K-Flexofiles with chloroform and ProFiles with chloroform were the lowest and not significantly different at all three levels of the roots examined (P > 0.05), and Hedstrom files with chloroform and ProFiles with chloroform were not significantly different in the apical part. In general, coronal parts were cleaner than apical parts. The difference in scores at the three levels between ProFiles with chloroform and ProFiles alone were each significant (P < 0.01). Instrumentation using ProFiles with chloroform (mean 6.42 min) was significantly faster than using hand files (mean 11.67 min) (P < 0.01).CONCLUSION:The results indicated that ProFiles or hand files with chloroform produced similarly clean canals, but that ProFiles were faster.

Two case reports with dens evaginatus are presented. Each patient had one tooth affected. There was a prominent tubercle on the occlusal surface of the mandibular second premolar. Under local anesthesia and rubber dam isolation a partial pulpotomy was conducted and mineral trioxide aggregate was placed. After 6 months the teeth were removed as part of planned orthodontic treatment. Histological examination of these teeth showed an apparent continuous dentin bridge formation in both teeth, and the pulps were free of inflammation. These cases show that mineral trioxide aggregate can be used as an alternative to existing materials in the proplylactic treatment of dens evaginatus.

Epidemiological studies reveal that one out of two children sustain a dental injury, most often between the ages of 8 and 12. Crown fracture is the most frequent type of trauma, generally resulting from accidents, sport activities or violence. In most dental trauma, a rapid and appropriate treatment can lessen its impact from both an oral health and an aesthetic standpoint. New technology and an improved understanding of the inflammatory process have led to a more conservative approach in managing dental trauma. The International Association of Dental Traumatology (IADT), conscious of the variation in the treatment of dental trauma has developed these guidelines as a type of consensus statement. These guidelines (Table 1) reflect much thoughtful discussion among members of the IADT as well as a detailed review of international dental literature. In cases in which the data did not appear conclusive, recommendations were based on the consensus opinion of the IADT board members. Guidelines are needed to assist dentists as well as other health care professionals in delivering the best care possible in the most efficient manner. It is very important to promote public awareness and to educate the population at greatest risk for dental injury. Therefore, this report includes basic information on both prevention and first aid. The correct application of these techniques immediately following the trauma should improve short and long-term outcome. Because the management of injuries to the primary and permanent dentition differs significantly, separate guidelines were developed for children with primary dentition (Table 2) and cases where permanent teeth are involved. In addition, these guidelines do not address issues relating to the diagnosis and treatment of major facial trauma of the bone and soft tissue, which is a critical first step in the overall management of trauma patients. The evaluation and treatment of maxillofacial trauma which may coexist with dental trauma, goes beyond the scope of these recommendations. The classifications listed below summarize diagnostics steps and therapeutic interventions and will be referenced throughout the guidelines. Conditions for which there is evidence and/or general agreement that a given procedure or treatment is beneficial, useful, and effective. Conditions for which there is conflicting evidence and/or a divergence of opinion about the usefulness/efficacy of a procedure or treatment. Conditions for which there is evidence and/or general agreement that a procedure/treatment is not useful/effective and in some cases may be harmful. Andreasen JO, Andreasen FM, Bakland LK, Flores MT. Traumatic dental injuries. a manual. Copenhagen: Munksgaard; 1999. Andreasen JO, Andreasen FM. Textbook and color atlas of traumatic injuries to the teeth, 3rd edn. Copenhagen: Munksgaard; 1994. Andreasen JO, Ravn JJ. Epidemiology of traumatic dental injuries to primary and permanent teeth in a Danish population sample. Int J Oral Surg 1972;1:235–9. Blomlof L. Milk and saliva as possible storage media for traumatically exarticulated teeth prior to replantation. Swed Dent J 1981;Suppl 8:1–26. Cvek, M. Endodontic management of traumatized teeth. In: Andreasen JO, Andreasen FM, editors. Textbook and color atlas of traumatic injuries to the teeth, 3rd edn. Copenhagen: Munksgaard; 1994. Cvek M. Changes in the treatment of crown-fractured teeth during the last two decades. In: Proccedings of the Second International Conference on Dental Trauma; 1991. p. 53–64. Ryan TJ, Anderson JL, Antman EM, Brannif BA, Brooks NH, Califf RM, et al. ACC/AHA guidelines for the management of patients with acute miocardial infarction: a report of the American College of Cardiology/American Heart Association Task Force on practice guidelines (Committee on Management of Myocardial Infarction). J Am Coll Cardiol 1996;28:1328–428. Tronstad L. Pulp reactions in traumatized teeth. In: Gutmann JL, Harrison JW, editors. Proceedings of the International Conference on Oral Trauma. AAE Chicago, Illinois; 1986.