Outcomes of vital primary incisor ferric sulfate pulpotomy and root canal therapy.
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PURPOSE: To compare ferric sulfate (FS) pulpotomy and primary tooth root canal therapy (RCT) in cariously exposed vital pulps of primary incisors. METHODS: A total of 133 incisors in 50 children were randomly selected to be treated by FS pulpotomy (64) or RCT (69). RESULTS: Two years after treatment, 77 incisors (41 FS pulpotomy, 36 RCT) were available for clinical and radiographic examination. There was no clinical evidence of pathosis in 78% of FS pulpotomy-treated and 100% of RCT-treated incisors. Two independent pediatric dentists evaluated periapical radiographs of the treated incisors. Incisors were classified into 1 of 4 treatment outcomes: N, normal treated incisor; H, nonpathologic radiographic change present; PO, pathologic change present, but not requiring immediate extraction; PX, pathologic change present, extract immediately. Survival analysis was applied. A moderate level of agreement between raters was found for incisors with outcome PX (K = 0.54). Intra-rater reliability was substantial for incisors with outcome PX (K = 0.61). No difference was demonstrated in the proportion of FS pulpotomy- and RCT-treated incisors rated PX at the 2-year recall (x2 = 0.6). RCT incisors demonstrated a significantly higher survival rate than FS pulpotomy incisors at 2 years (p = 0.04). CONCLUSIONS: Treatment outcomes for RCT incisors were not significantly different from FS pulpotomy-treated incisors at 2 years; however, at 2 years the survival rate of RCT incisors was statistically greater than that of FS pulpotomy-treated incisors. (+info)
Complications of mandibular molar replacement with a single implant: a case report.
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This case report describes prosthodontic complications resulting from the surgical placement of a single implant and treatment following these complications. Both the surgical and prosthodontic procedures are described for the treatment of a 57-year-old man who had previously received a single implant for the replacement of a missing molar. Using 2 implants, 1 mesial and 1 distal to the previously placed single implant proved reliable. A logical treatment solution is to use 2 implants for the replacement of a single molar to avoid prosthodontic complications. (+info)
Implantology and the severely resorbed edentulous mandible.
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Patients with a severely resorbed edentulous mandible often suffer from problems with the lower denture. These problems include: insufficient retention of the lower denture, intolerance to loading by the mucosa, pain, difficulties with eating and speech, loss of soft-tissue support, and altered facial appearance. These problems are a challenge for the prosthodontist and surgeon. Dental implants have been shown to provide a reliable basis for fixed and removable prostheses. This has resulted in a drastic change in the treatment concepts for management of the severely resorbed edentulous mandible. Reconstructive, pre-prosthetic surgery has changed from surgery aimed to provide a sufficient osseous and mucosal support for a conventional denture into surgery aimed to provide a sufficient bone volume enabling implants to be placed at the most optimal positions from a prosthetic point of view. The aim of this paper is to review critically the literature on procedures related to the severely resorbed edentulous mandible and dental implant treatment. The study includes the transmandibular implant, (short) endosseous implants, and reconstructive procedures such as distraction osteogenesis, augmentation of the mandibular ridge with autogenous bone, and bone substitutes followed by the placement of implants. The number of patients participating in a study, the follow-up period, the design of the study, the degree of mandibular resorption, and the survival rate of the dental implants all are considered evaluation parameters. Although numerous studies have described the outcome results of dental implants in the edentulous mandible, there have been few prospective studies designed as randomized clinical trials that compare different treatment modalities to restore the severely resorbed mandible. Therefore, it is not yet possible to select an evidence-based treatment modality. Future research has to be focused on long-term, detailed follow-up clinical trials before scientifically based decisions in treating these patients can be made. This will contribute to a higher level of care in this field. (+info)
Clinical/photographic evaluation of a single application of two sealants after eleven years.
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The clinical behavior of Concise and Prisma Shield sealants for pit and fissure was analyzed by clinical/photographic evaluation. A hematoxylin-based staining solution was applied to the occlusal surface 7 days, 18 months, 36 months, and 11 years after the occlusal sealing, thus allowing the sealant material on the surface to be checked. At each analysis time, each occlusal surface was photographed, and the photographs corresponding to each time were submitted to clinical/photographic evaluation. Although the sealant materials showed marginal alterations over time, they did not require reapplication because the region composed of the pit and fissure remained covered. (+info)
Pathogenesis of apical periodontitis and the causes of endodontic failures.
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Apical periodontitis is a sequel to endodontic infection and manifests itself as the host defense response to microbial challenge emanating from the root canal system. It is viewed as a dynamic encounter between microbial factors and host defenses at the interface between infected radicular pulp and periodontal ligament that results in local inflammation, resorption of hard tissues, destruction of other periapical tissues, and eventual formation of various histopathological categories of apical periodontitis, commonly referred to as periapical lesions. The treatment of apical periodontitis, as a disease of root canal infection, consists of eradicating microbes or substantially reducing the microbial load from the root canal and preventing re-infection by orthograde root filling. The treatment has a remarkably high degree of success. Nevertheless, endodontic treatment can fail. Most failures occur when treatment procedures, mostly of a technical nature, have not reached a satisfactory standard for the control and elimination of infection. Even when the highest standards and the most careful procedures are followed, failures still occur. This is because there are root canal regions that cannot be cleaned and obturated with existing equipments, materials, and techniques, and thus, infection can persist. In very rare cases, there are also factors located within the inflamed periapical tissue that can interfere with post-treatment healing of the lesion. The data on the biological causes of endodontic failures are recent and scattered in various journals. This communication is meant to provide a comprehensive overview of the etio-pathogenesis of apical periodontitis and the causes of failed endodontic treatments that can be visualized in radiographs as asymptomatic post-treatment periapical radiolucencies. (+info)
Periimplantitis.
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Orodental rehabilitation through the use of implants offers very high success rates. In this paper, we describe some of the complications involved with this technique, such as periimplant disease and, within this category, periimplantitis, an inflammatory reaction in which there is a loss of the bony support of the implant accompanied by inflammation. The aetiology of the disease is conditioned by the status of the tissue surrounding the implant, implant design, degree of roughness, the poor alignment of implant components, external morphology and excessive mechanical load. The microorganisms most commonly associated with implant failure are spirochetes and mobile forms of Gram-negative anaerobes, unless the origin is the result of simple mechanical overload. Diagnosis is based on changes of colour in the gum, bleeding and probing depth of periimplant pockets, suppuration, x-ray and gradual loss of bone height around the tooth. Treatment will differ depending upon whether it is a case of mucositis or periimplantitis. Therapeutic objectives focus on correcting technical defects by means of surgery and decontamination techniques (abrasion with carbon particles, citric acid solution, topical tetracycline application and laser surgery). This study also presents a microbiological study of periimplantitis conducted by the Barcelona School of Dentistry that determined that the antibiotic therapy proven to be most efficacious in the antibiogram was the association of amoxycillin and clavulanic acid. (+info)
Single-unit implants versus conventional treatments for compromised teeth: a brief review of the evidence.
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The goal of preserving the natural dentition has long provided the foundation for clinical decision making in dentistry. Current trends in implant dentistry have weakened this paradigm as many practitioners have moved quickly to adopt implant dentistry as a new standard of care; however, the rapidity of this shift is a cause for concern among others. Many short-term studies have reported favorable data supporting the growth of single-unit implant dentistry, but the lack of standardized outcome evaluations and broadly conceived dimensions of performance makes it difficult to compare these reports. Thus, even with the exciting new treatment options implant dentistry offers patients and practitioners, all due consideration should first be given to treatments aimed at preserving and restoring compromised teeth before pursuing extraction and replacement. This article examines this premise from five perspectives: form, function, survival, management of complications, and quality of life. (+info)
Implant rehabilitation of the atrophic upper jaw: a review of the literature since 1999.
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The severely resorbed maxilla presents serious limitations for conventional implant placement. As a result, different techniques have been developed in the last two decades, with variable results. The most significant approaches comprise the placement of implants in anatomical abutments, elevation of the sinus floor, and reconstructive surgery with bone grafting. The present study reviews the most important articles on the management of the atrophic upper jaw published in the literature since 1999. (+info)