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Journal of the Korean Association of... Jun 2024The necessity of retrograde filling after apicoectomy is controversial in cases of non-inflammatory cysts as opposed to bacteria-related periapical abscesses. This study...
OBJECTIVES
The necessity of retrograde filling after apicoectomy is controversial in cases of non-inflammatory cysts as opposed to bacteria-related periapical abscesses. This study aims to investigate whether the presence or absence of retrograde filling during apicoectomy has differential long-term prognostic implications between inflammatory and non-inflammatory cysts.
MATERIALS AND METHODS
This retrospective study included patients who underwent tooth apicoectomy during jaw cyst enucleation between 2013 and 2022, and who underwent follow-up cone-beam computed tomography for at least 6 months. The prognosis of the tooth was evaluated during the follow-up period according to the cyst type, the presence or absence of retrograde filling, mandible or maxilla, and location.
RESULTS
A total of 147 teeth was included in this study. All the operated teeth underwent preoperative root canal treatment by an endodontic specialist. Apicoectomy was performed for 119 inflammatory cysts and 28 non-inflammatory cysts. Retrograde filling was performed on 22 teeth with inflammatory cysts and 3 teeth with non-inflammatory cysts. All teeth survived the 3.5-year follow-up (range, 1.0-9.1 years). However, 1 tooth with an inflammatory cyst developed complications 1 year after surgery that required re-endodontic treatment.
CONCLUSION
The prognosis of a tooth treated by apicoectomy without retrograde filling during cyst enucleation is favorable, regardless of the cyst type.
PubMed: 38940650
DOI: 10.5125/jkaoms.2024.50.3.140 -
International Endodontic Journal Jun 2024To elucidate whether mitochondrial biogenesis disorder and damage from oxidative stress promote refractory apical periodontitis (RAP) in rat and human.
AIM
To elucidate whether mitochondrial biogenesis disorder and damage from oxidative stress promote refractory apical periodontitis (RAP) in rat and human.
METHODOLOGY
Twenty Enterococcus faecalis-induced RAPs were established in the maxillary first molars of male Wistar rats. Concurrently, 12 periapical lesion specimens from patients presenting with RAP were obtained by apicoectomy. Radiographic examination and histologic analysis were conducted to evaluate periapical bone tissue destruction and morphological changes. The expression of key regulators of mitochondrial biogenesis, PGC-1α and Nrf2, were detected by immunohistochemistry and double immunofluorescence staining, Western blot and real-time PCR were also assayed. Mitochondrial ROS (mtROS) was identified by MitoSOX staining. Mitochondrial function was detected by the quantification of ATP production, mitochondrial DNA (mtDNA) copy number and activities of mitochondrial respiratory chain complexes. Furthermore, mitochondrial oxidative stress was evaluated by the determination of 3-nitrotyrosine (3-NT), 4-hydroxy-2-nonenal (4-HNE) and 8-hydroxy-deoxyguanosine (8-OHdG) expression levels, as well as malondialdehyde (MDA) expression and antioxidant capacity. Student's t-test was performed to determine significance between the groups; p < .05 was considered significant.
RESULTS
In the maxilla, significantly more bone resorption, greater number of periapical apoptotic cells and Tartrate-resistant acid phosphatase (TRAP)-positive multinucleated cells were observed in the RAP group compared with the control group (p < .01). PGC-1α and Nrf2 were significantly reduced in rat and human RAP lesions compared to the control group (p < .01) at both the mRNA and protein levels. Double immunofluorescence analysis of PGC-1α or Nrf2 with TOMM20 also indicated that mitochondrial biogenesis was impaired in RAP group (p < .01). Additionally, mitochondrial dysfunction was observed in RAP group, as reflected by increased mtROS, decreased ATP production, reduced mtDNA copy number and complexes of the mitochondrial respiratory chain. Finally, the expression levels of mitochondrial oxidative stress markers, 3-NT, 4-HNE and 8-OHdG, were significantly increased in the RAP group (p < .01). Consistent with this, systemic oxidative damage was also present in the progression of RAP, including increased MDA expression and decreased antioxidant activity (p < .01).
CONCLUSIONS
Mitochondrial biogenesis disorder and damage from oxidative stress contribute to the development of RAP.
PubMed: 38881187
DOI: 10.1111/iej.14106 -
Journal of Conservative Dentistry and... Apr 2024Dentinal microcracks formed during apical resection may lead to increased susceptibility to root fracture and improper sealing of apical preparation that may negatively...
BACKGROUND
Dentinal microcracks formed during apical resection may lead to increased susceptibility to root fracture and improper sealing of apical preparation that may negatively influence the outcome of endodontic microsurgery.
AIMS
This study was performed to analyze the root-end surface for dentinal microcracks using a scanning electron microscope (SEM) after resection with high-speed bur and trephine drill.
MATERIALS AND METHODS
Thirty extracted single-rooted maxillary premolar teeth were selected and randomly distributed into two groups ( = 15). Working length was established using a #15 K-type file. Canals were prepared with a rotary Ni-Ti system to size 30/0.06 using endomotor, irrigated with 3% sodium hypochlorite, dried with paper points, and obturated with gutta-percha cones using a single-cone technique. All samples were mounted on preformed molds and poured using a mixture of sawdust and gypsum. In Group A; tungsten carbide bur was used to perform a freehand apicoectomy. In Group B; a trephine drill was used with a three-dimensional guide to perform 3 mm of root resection. Apicoectomy was performed in both groups under a dental operating microscope. Resected root ends were inspected for microcracks using SEM. The Shapiro-Wilk and Mann-Whitney U-test were used for statistical analysis.
RESULTS
Microcracks were observed in all samples in both study groups. Trephine drill produced more microcracks on the resected root surface compared to the use of high-speed tungsten carbide bur with a statistically significant difference ( < 0.05).
CONCLUSIONS
The trephine drill used during targeted endodontic microsurgery produced more microcracks on the resected root dentine surface compared to the high-speed tungsten carbide bur used during freehand apicoectomy.
PubMed: 38779202
DOI: 10.4103/JCDE.JCDE_77_24 -
BMC Oral Health May 2024Apical surgery with standard retrograde maneuvers may be challenging in certain cases. Simplifying apical surgery to reduce operating time and streamline retrograde... (Comparative Study)
Comparative Study
BACKGROUND
Apical surgery with standard retrograde maneuvers may be challenging in certain cases. Simplifying apical surgery to reduce operating time and streamline retrograde manipulation is an emerging need in clinical endodontics.
AIM OF THE STUDY
The aim of the study was to compare the bacterial sealing ability of a calcium silicate-based sealer with the single cone technique combined with root end resection only, and calcium silicate-based sealer as a retrograde filling versus MTA retrofilling, and to analyze bacterial viability using confocal laser scanning microscope (CLSM).
MATERIALS AND METHODS
In this in vitro experimental study, 50 extracted human maxillary incisor teeth were instrumented and randomly divided into five groups: three experimental groups, a positive control group, and a negative control group (n = 10/group). In the experimental groups, the roots were obturated using the single cone technique (SCT) and a calcium silicate-based sealer. In group 1, the roots were resected 3 mm from the apex with no further retrograde preparation or filling. In groups 2 and 3, the roots were resected, retroprepared, and retrofilled with either a calcium silicate-based sealer or MTA, respectively. Group 4 (positive control) was filled with a single gutta-percha cone without any sealer. In group 5 (negative control), the canals were left empty, and the roots were sealed with wax and nail varnish. A bacterial leakage model using Enterococcus faecalis was employed to assess the sealing ability over a 30-day period, checking for turbidity and analyzing colony forming units (CFUs) per milliliter. Five specimens from each group were examined using CLSM for bacterial viability. Data for the bacterial sealing ability were statistically analyzed using chi-squared and Kruskal-Wallis tests.
RESULTS
The three experimental groups did not show significant differences in terms of bacterial leakage, or bacterial counts (CFUs) (P > 0.05). However, significant differences were observed when comparing the experimental groups to the positive control group. Notably, the calcium silicate-based sealer, when used as a retrofilling, yielded the best sealing ability. CLSM imaging revealed viable bacterial penetration in all the positive control group specimens while for the experimental groups, dead bacteria was the prominent feature seen.
CONCLUSION
Within the limitations of this study, it could be concluded that the bacterial sealing ability of calcium silicate-based sealer with the single cone technique combined with root end resection only and calcium silicate-based sealer as a retrograde filling were comparable with MTA retrofilling during endodontic surgical procedures.
Topics: Silicates; Calcium Compounds; Humans; Root Canal Filling Materials; Oxides; Drug Combinations; Aluminum Compounds; In Vitro Techniques; Microscopy, Confocal; Dental Leakage; Retrograde Obturation; Enterococcus faecalis; Microbial Viability; Incisor; Apicoectomy
PubMed: 38773504
DOI: 10.1186/s12903-024-04309-3 -
BMC Oral Health May 2024The operation accuracy and efficiency of dynamic navigated endodontic surgery were evaluated through in vitro experiments. This study provides a reference for future...
BACKGROUND
The operation accuracy and efficiency of dynamic navigated endodontic surgery were evaluated through in vitro experiments. This study provides a reference for future clinical application of dynamic navigation systems in endodontic surgery.
MATERIALS AND METHODS
3D-printed maxillary anterior teeth were used in the preparation of models for endodontic surgery. Endodontic surgery was performed with and without dynamic navigation by an operator who was proficient in dynamic navigation technology but had no experience in endodontic surgery. Optical scanning data were applied to evaluate the length and angle deviations of root-end resection. And the operation time was recorded. T tests were used to analyze the effect of dynamic navigation technology on the accuracy and duration of endodontic surgery.
RESULTS
With dynamic navigation, the root-end resection length deviation was 0.46 ± 0.06 mm, the angle deviation was 2.45 ± 0.96°, and the operation time was 187 ± 22.97 s. Without dynamic navigation, the root-end resection length deviation was 1.20 ± 0.92 mm, the angle deviation was 16.20 ± 9.59°, and the operation time was 247 ± 61.47 s. Less deviation was achieved and less operation time was spent with than without dynamic navigation (P < 0.01).
CONCLUSION
The application of a dynamic navigation system in endodontic surgery can improve the accuracy and efficiency significantly for operators without surgical experience and reduce the operation time.
Topics: Humans; Pilot Projects; In Vitro Techniques; Printing, Three-Dimensional; Surgery, Computer-Assisted; Apicoectomy; Operative Time; Surgical Navigation Systems
PubMed: 38764019
DOI: 10.1186/s12903-024-04306-6 -
Journal of Dental Sciences Apr 2024Apical root resection pattern affects the stress distribution behavior in the apical region of the resected tooth. The purpose of the study was to compare the...
BACKGROUND/PURPOSE
Apical root resection pattern affects the stress distribution behavior in the apical region of the resected tooth. The purpose of the study was to compare the biomechanical responses of resected teeth between endodontic microsurgery (horizontal resection) and targeted endodontic microsurgery (round resection).
MATERIALS AND METHODS
Five different models were developed. The basic model without resection (NR) was regarded as the control model, and the others involved: horizontal resection without bone grafting (HN), horizontal resection with bone grafting (HG), round resection without bone grafting (RN), and round resection with bone grafting (RG) models. A static load of 100 N was applied to the buccal and palatal cusps of all the teeth in a 30° oblique direction. The maximum von-Mises stress and tooth displacement values were analyzed and compared.
RESULTS
Both the HN and RN models exhibited lower stress distribution values on bone compared with the NR (control) model. Regarding maximum stress distribution at the root apex, the stress value of the RN model was slightly higher compared to the HN model, whereas the RG model displayed a slightly lower stress value in comparison with the HG model. For maximum tooth displacement value, there were no significant differences between the HN and RN models, as well as the HG and RG models.
CONCLUSION
The round resection pattern had comparable stress distribution behaviors at the root apex and tooth displacement values with the horizontal resection pattern. Targeted endodontic microsurgery might provide better biomechanical response of the resected tooth after root-end resection.
PubMed: 38618133
DOI: 10.1016/j.jds.2023.08.029 -
Journal of Pharmacy & Bioallied Sciences Feb 2024In this systematic review, we assessed whether the effects of the usage of various devices help with magnification in endodontics and whether they resulted in any...
AIM
In this systematic review, we assessed whether the effects of the usage of various devices help with magnification in endodontics and whether they resulted in any significant changes in the clinical result of treatment.
MATERIALS AND METHODS
An exhaustive search was performed across MEDLINE and Cochrane Registers for various clinical studies, which were focused on comparing regenerative endodontic treatment based on the usage of magnification devices. Various terms were used to search these clinical trials such as microscope, regenerative endodontic surgery, apicoectomy, endoscope, and loupes.
RESULTS
After scrutinizing the studies, around three clinical trials based on magnification in endodontic surgeries were included in the present review. It was observed that no statistically noteworthy betterment of treatment outcome was seen in patients treated with either of the magnification devices such as loupes and microscope.
CONCLUSION
It was evident that these magnification devices can alter the effectiveness of regenerative endodontic treatment in a very minimal way. However, we believe that more randomized clinical studies should be conducted in this area.
PubMed: 38595596
DOI: 10.4103/jpbs.jpbs_555_23 -
Journal of Pharmacy & Bioallied Sciences Feb 2024The most frequent cystic lesions that affect the jaw are radicular cysts. The current case report describes the surgical management of a radicular cyst in the periapical...
The most frequent cystic lesions that affect the jaw are radicular cysts. The current case report describes the surgical management of a radicular cyst in the periapical region of maxillary central and lateral incisors, and highlights the efficacy of natural platelet concentrate [platelet-rich fibrin (PRF)] along with Ostoden bone graft material used for postoperative healing. A 46-year-old male patient presented to the department with swelling in the palatal aspect of the maxillary anterior region. On radiographic examination, a radiolucent periapical lesion was evident in relation to the left maxillary central and lateral incisor. In the maxillary anterior region, root canal therapy was performed, followed by periapical surgery, and PRF with Ostoden bone graft was placed in the surgical site to initiate the healing at a faster rate. The patient was recalled at follow-ups after 7 days, 3, 6, and 9 months. No symptoms such as pain, inflammation, or discomfort were observed during the review period.
PubMed: 38595372
DOI: 10.4103/jpbs.jpbs_979_23 -
Journal of Clinical Medicine Mar 2024To assess the association between demographic and clinical variables and the outcome of root-end surgery using digital periapical radiographs (PA) and cone-beam...
To assess the association between demographic and clinical variables and the outcome of root-end surgery using digital periapical radiographs (PA) and cone-beam computed tomography (CBCT). One hundred and fifty teeth that received endodontic microsurgery were clinically and radiographically examined (PA and CBCT scans) after 1 and 2 years. Two calibrated endodontists evaluated the radiographic healing based on a six-point outcome classification. The outcome was classified using both strict (healed) and loose (healing) criteria. The success rates were calculated, and several outcome prognostic factors were assessed. One hundred and fifty teeth were assessed with both radiographic systems. When "loose" success criteria were applied using PA, 90% (n = 135) of teeth were assessed as having had a favourable outcome (90%; 95% CI: 85.2-94.8%), whereas 90.7% (n = 136) of teeth showed a successful outcome when assessed with CBCT (90.7%; 95% CI: 86.0-95.3%). When "strict" success criteria were applied, there was a statistically significant difference ( = 0.018) between the success rates of mineral trioxide aggregate (MTA) (63.7%) and Biodentine (95.5%). Within the limitations of this study, endodontic microsurgery showed a high success rate. Among all the demographic and clinical variables assessed, in the multiregression analysis, only the use of Biodentine was associated with a higher proportion of "complete" healings compared to MTA or Intermediate Restorative Material (IRM) when assessed using CBCT. MTA and Biodentine performed similarly when "incomplete" healings were regarded as successful outcomes.
PubMed: 38541917
DOI: 10.3390/jcm13061692 -
World Journal of Clinical Cases Mar 2024Radicular cyst is a lesion of odontogenic origin that arises from epithelial remains due to periapical periodontitis caused by inflammatory reactions generated at the...
BACKGROUND
Radicular cyst is a lesion of odontogenic origin that arises from epithelial remains due to periapical periodontitis caused by inflammatory reactions generated at the apex of affected teeth with infected or necrotic pulps. The therapeutic management of radicular cysts is controversial. There is only one case report of enucleation of a radicular cyst managed with microsurgery and apicoectomy, but without the use of the guided tissue regeneration (GTR) technique in the same surgical procedure. The present clinical case describes the management of a radicular cyst with microsurgical approach, performance of an apicoectomy of the tooth associated with the entity, application of GTR technique, use of a resorbable membrane of type I bovine collagen, and bovine xenograft.
CASE SUMMARY
A 68-year-old patient presented with a radicular cyst from an upper lateral incisor. The microsurgical management used was aimed at enucleating the chemical membrane, performing apicoectomy of the tooth along with careful and precise retrograde filling, and implementing GTR technique using a resorbable collagen membrane and bovine xenograft. The diagnosis of radicular cyst was confirmed using histopathological analysis. The patient underwent follow-up evaluations at 10 and 30 d postoperatively. At 4 months postoperative evaluation, she remained asymptomatic, and radiographs showed significant periapical healing with adequate bone formation.
CONCLUSION
These results suggest that microsurgical management using the GTR technique with collagen membrane and xenograft, contributes to bone regeneration.
PubMed: 38524520
DOI: 10.12998/wjcc.v12.i7.1346