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PR 16 Endodontic or surgical therapy of periapical lesions
302 • Journal of Endodontics
Vol. 25, No. 4, April 1999
P~I
Nonsurgical root canal retreatment in single or multiple visits: clinical evaluation o f the post-operative pain rate. E Kado, M E M Sayago*, J P Collesi, R Hizatugu*. EAP-APCD (Escola de Aperfei(}oamento Profissional da A s s o c i a ~ o Paulista de Cirurgires Dentistas) and ABESP ([email protected] Brasileira de Endodontia - S~o Paulo) - Brazil Single visit root canal treatment is a reality in modern endodontics, both for vital and nonvital teeth. On the other hand, according to some authors, fewer flare-ups after retreatments could be achieved if an mira canal medication was used between appointments. The purpose of this clinical investigation was to compare the post-operative pain incidence after retreatments, when done in one or two visits. Two hundred teeth were endodontically retreated and divided into two groups o f 100 each. In group 1 retreatment was done in one visit and in group 2 the retreatment was done in two visits. All teeth were instrumented with the crown down technique, using K type files, 5.25% NaOC1 and RC Prep. Whenever necessary, eucaliptol was the solvent of choice. After complete instrumentation apical patency and forarnen enlargement was performed. In group 2, Ca(OH)_, + PMCC + glycerin was the intra canal medication used. Root canals were obturated with Pulp Canal Sealer and gum pereha cones, using vertical compaction. Post-operative pain was verified at 24, 48 and 72 hours after the first appointment and statistically analysed by the student t-test. The results o f this study showed that there was no significant difference between the two groups, as far as post-operative pain is concerned. No differences were found when a solvent was emploved either.
2Z_J
P~I The Concentrations of ProstaglandinE2, ..LLJ 6- keto-Pr0staglandin F1 a and LeukotrieneB4 in pulpal and periapical lesions W.J. Shon, S.S. Lira Seou/ National University. Seoul, Korea Prostaglandins (PGs) and Leukotrienes (LTs) have been implicated in the genesis of pulpal and periapicaI inflammation. In this study, the relationships among PGE2, 6-keto-PG F1 a (a stable metabolite of PGI2) and LTB4 concentrations in inflamed pulp and periapical lesions were discussed. Pulp tissue were obtained in routine endodontic treatment and periapical lesions in periapical surgery after clinical diagnoses were made. These specimens were divided into four groups as normal pulp group(control group), acute pulpitis group, chronic pulpitis group, and periapical lesion group. Pulp tissue and periapical lesions were stored in liquid nitrogen. The concentration of PGE2, PGI2 and LTB4 were measured with ELISA. The data were analyzed by one-way ANOVA. Group Control (n=9)
t
I
Mean cone-+SEM (pg/mg tissue) PGE2
PGI2
LTB4
3.86-+0.73 10.97-+0.58 2.62_+0.67 Acute pulpitis (n=11) 165.79-+18.86 105.89±13.81 82.13--+16.62 IChronic pulpitis (n=12) 10.50-+1.63 20.64-+2.91 10.67-+1.51 Periapieal lesion (n=14) 31.04+5.56 21.74-+3.25 24A3+-4.17 Significantly higher levels of PGE2, 6-keto-PG F1 aand LTB4 were found in acute pulpitis group than chronic pulpitis group and periapicaI lesion group. (p<0.05) Periapical lesion group showed significantly higher mean concentrations of PGE2 and LTB4 than chronic pulpitis group. In control and chronic pulpitis group, significant higher levels of PGI2 than PGE2 and LTB4 were found. These results suggested that the high levels of PGE2 and LTB4 in periapical lesions may be due to rich endothelium, fibroblast and lvmnhocvte known as the main nroducers of PGE2 and LTB4. PGI2 mav thought ~o be one of abundant PGs in normal aulo tissue.
P~I Endodontic or surgical therapy of periapical lesions ...LEJ T Schwarze*, H Guenay. Medical University Hannover Germany Aim of this retrospective clinical study was to compare the success rates of surgical and nonsurgical endodontic therapies of periapical lesions. 103 teeth with periapical lesions were evaluated clinically and radiologically _>6 months after treatment. According to the method of treatment, the patients were classified into two groups: conservative endodontic treatment (group I) and apicoectomy (group II). In addition, to determine whether a difference exists with respect to a preoperative endodontic treatment and time of root-canal-filling the second group treated by apicoectomy, was subdivided. The periapical radiographs of the endodontically treated teeth were analysed using the Periapical Index (2rrstavik et al 1986) whereas the criteria of Krug (1955) were applied for interpretation of radiographs after surgical therapy. The findings were defined as "success", "failure", or "uncertain". The success rates were 75% (group I) and 69% (group II). Furthermore, statistical analysis (ChiLtest) did not reveal any significant difference between conservative and surgical treatment. Additionally, endodontically pretreated apicoectomies resulted in a higher success rate (87%) than apicoectomies with no endodontic pre-treatment (50%)(p<0.05). From our data we conclude that conservative endodontic treatment of periapical lesions reveals a hiqh success rate. Furthermore. sur,qical therapy is more successful after endodontic pre-treatment.
P181 .-----I
hi vitro assessment of the ability of four barriers materials
to prevent coronal microleakage. CCR Ferraz*, FB Teixeira, APP Leite, FJ Souza Filho. Dental Faculty of Piracicaba-FOP-UNICAMP, Brazil. The purpose of this study was to assess the sealing ability of four barriers materials, applied over the top of the obturation and the floor of the pulp chamber, aiming to prevent microleakage through root filling/walls of the root canal interface. Fifty freshly extracted lower molars, presenting intact crowns and complete root formation were utilized. The canals were cleaned and shaped, irrigated with NaOCI 0.5% and obturated by the lateral condensation technique. The pulp chamber was cleaned, and the external portion & t h e crown and root were sealed with two layers o f nail varnish. The teeth were randomly divided into five groups of ten teeth: group A- nail varnish; group B- Super Bonder, group C- Heliobond; group D- Scotchbond MP+ and group E- no material was applied (control). After application and setting of the barriers materials, the teeth were submitted at 350 thermocycles~ " Indian " Ink, wath " _9 minutes " ' (5 o C + 2 o C a n d .5 5° C :i: 2 ° C) m interval between them. After the thermocycling, the teeth were removed f r o m the dye, washed and the nail varnish removed. The teeth were decalcified, dehydrated and cleared. The microleakge was examined by stereoscopic microscopy. The values of dye penetration for each group were compared, utilizing the KruskalWallis test followed by the Pair-wise Comparison test. No statistically significant result was found between the battles materials tested. It is concluded that any of the materials tested in the present study was able to prevent microleakage through root filling/walls & t h e root canal interface.
Vol. 25, No. 4, April 1999
P~I
Nonsurgical root canal retreatment in single or multiple visits: clinical evaluation o f the post-operative pain rate. E Kado, M E M Sayago*, J P Collesi, R Hizatugu*. EAP-APCD (Escola de Aperfei(}oamento Profissional da A s s o c i a ~ o Paulista de Cirurgires Dentistas) and ABESP ([email protected] Brasileira de Endodontia - S~o Paulo) - Brazil Single visit root canal treatment is a reality in modern endodontics, both for vital and nonvital teeth. On the other hand, according to some authors, fewer flare-ups after retreatments could be achieved if an mira canal medication was used between appointments. The purpose of this clinical investigation was to compare the post-operative pain incidence after retreatments, when done in one or two visits. Two hundred teeth were endodontically retreated and divided into two groups o f 100 each. In group 1 retreatment was done in one visit and in group 2 the retreatment was done in two visits. All teeth were instrumented with the crown down technique, using K type files, 5.25% NaOC1 and RC Prep. Whenever necessary, eucaliptol was the solvent of choice. After complete instrumentation apical patency and forarnen enlargement was performed. In group 2, Ca(OH)_, + PMCC + glycerin was the intra canal medication used. Root canals were obturated with Pulp Canal Sealer and gum pereha cones, using vertical compaction. Post-operative pain was verified at 24, 48 and 72 hours after the first appointment and statistically analysed by the student t-test. The results o f this study showed that there was no significant difference between the two groups, as far as post-operative pain is concerned. No differences were found when a solvent was emploved either.
2Z_J
P~I The Concentrations of ProstaglandinE2, ..LLJ 6- keto-Pr0staglandin F1 a and LeukotrieneB4 in pulpal and periapical lesions W.J. Shon, S.S. Lira Seou/ National University. Seoul, Korea Prostaglandins (PGs) and Leukotrienes (LTs) have been implicated in the genesis of pulpal and periapicaI inflammation. In this study, the relationships among PGE2, 6-keto-PG F1 a (a stable metabolite of PGI2) and LTB4 concentrations in inflamed pulp and periapical lesions were discussed. Pulp tissue were obtained in routine endodontic treatment and periapical lesions in periapical surgery after clinical diagnoses were made. These specimens were divided into four groups as normal pulp group(control group), acute pulpitis group, chronic pulpitis group, and periapical lesion group. Pulp tissue and periapical lesions were stored in liquid nitrogen. The concentration of PGE2, PGI2 and LTB4 were measured with ELISA. The data were analyzed by one-way ANOVA. Group Control (n=9)
t
I
Mean cone-+SEM (pg/mg tissue) PGE2
PGI2
LTB4
3.86-+0.73 10.97-+0.58 2.62_+0.67 Acute pulpitis (n=11) 165.79-+18.86 105.89±13.81 82.13--+16.62 IChronic pulpitis (n=12) 10.50-+1.63 20.64-+2.91 10.67-+1.51 Periapieal lesion (n=14) 31.04+5.56 21.74-+3.25 24A3+-4.17 Significantly higher levels of PGE2, 6-keto-PG F1 aand LTB4 were found in acute pulpitis group than chronic pulpitis group and periapicaI lesion group. (p<0.05) Periapical lesion group showed significantly higher mean concentrations of PGE2 and LTB4 than chronic pulpitis group. In control and chronic pulpitis group, significant higher levels of PGI2 than PGE2 and LTB4 were found. These results suggested that the high levels of PGE2 and LTB4 in periapical lesions may be due to rich endothelium, fibroblast and lvmnhocvte known as the main nroducers of PGE2 and LTB4. PGI2 mav thought ~o be one of abundant PGs in normal aulo tissue.
P~I Endodontic or surgical therapy of periapical lesions ...LEJ T Schwarze*, H Guenay. Medical University Hannover Germany Aim of this retrospective clinical study was to compare the success rates of surgical and nonsurgical endodontic therapies of periapical lesions. 103 teeth with periapical lesions were evaluated clinically and radiologically _>6 months after treatment. According to the method of treatment, the patients were classified into two groups: conservative endodontic treatment (group I) and apicoectomy (group II). In addition, to determine whether a difference exists with respect to a preoperative endodontic treatment and time of root-canal-filling the second group treated by apicoectomy, was subdivided. The periapical radiographs of the endodontically treated teeth were analysed using the Periapical Index (2rrstavik et al 1986) whereas the criteria of Krug (1955) were applied for interpretation of radiographs after surgical therapy. The findings were defined as "success", "failure", or "uncertain". The success rates were 75% (group I) and 69% (group II). Furthermore, statistical analysis (ChiLtest) did not reveal any significant difference between conservative and surgical treatment. Additionally, endodontically pretreated apicoectomies resulted in a higher success rate (87%) than apicoectomies with no endodontic pre-treatment (50%)(p<0.05). From our data we conclude that conservative endodontic treatment of periapical lesions reveals a hiqh success rate. Furthermore. sur,qical therapy is more successful after endodontic pre-treatment.
P181 .-----I
hi vitro assessment of the ability of four barriers materials
to prevent coronal microleakage. CCR Ferraz*, FB Teixeira, APP Leite, FJ Souza Filho. Dental Faculty of Piracicaba-FOP-UNICAMP, Brazil. The purpose of this study was to assess the sealing ability of four barriers materials, applied over the top of the obturation and the floor of the pulp chamber, aiming to prevent microleakage through root filling/walls of the root canal interface. Fifty freshly extracted lower molars, presenting intact crowns and complete root formation were utilized. The canals were cleaned and shaped, irrigated with NaOCI 0.5% and obturated by the lateral condensation technique. The pulp chamber was cleaned, and the external portion & t h e crown and root were sealed with two layers o f nail varnish. The teeth were randomly divided into five groups of ten teeth: group A- nail varnish; group B- Super Bonder, group C- Heliobond; group D- Scotchbond MP+ and group E- no material was applied (control). After application and setting of the barriers materials, the teeth were submitted at 350 thermocycles~ " Indian " Ink, wath " _9 minutes " ' (5 o C + 2 o C a n d .5 5° C :i: 2 ° C) m interval between them. After the thermocycling, the teeth were removed f r o m the dye, washed and the nail varnish removed. The teeth were decalcified, dehydrated and cleared. The microleakge was examined by stereoscopic microscopy. The values of dye penetration for each group were compared, utilizing the KruskalWallis test followed by the Pair-wise Comparison test. No statistically significant result was found between the battles materials tested. It is concluded that any of the materials tested in the present study was able to prevent microleakage through root filling/walls & t h e root canal interface.