ENDO, 04/2013

The success rate of endodontic treatment is lower than expected, and is both time-consuming and expensive. Thus, techniques to enable a clinician to avoid it deserve more attention. Indirect pulp treatment (IPT) is a simple and effective treatment to preserve pulp vitality in teeth with deep carious lesions. Scientific data supports this treatment as means to preserving a healthy, vital pulp. Keywords: deep caries lesion, endodontic treatment, IPT, pulp vitality preservation

After pulp exposure, direct pulp capping can help preserve pulp vitality. As reported in the related literature on direct pulp capping recently, good results have been obtained when MTA was used as capping material. Before the placement of the MTA, all infected dentine was removed. In this article, three case reports are presented describing this treatment procedure, combined with a follow-up of the treatment. Keywords: deep caries lesion, direct pulp capping, MTA, pulp vitality preservation

Introduction: Iatrogenic root perforation is a major complication of endodontic and restorative treatments, leading to impairment of tooth prognosis. The aim of this article is to report two cases of successful non-surgical management of lateral perforation using mineral trioxide aggregate (MTA). Case report: This article presents two cases of lateral root perforation due to incorrect post space preparation and iatrogenic cementation of prefabricated posts in the furcation area. A standard disinfection protocol was utilised for the non-surgical root canal retreatment. White and grey MTA were the biomaterials of choice to seal the perforating defects. A novel technique for MTA placement and compaction was applied. The affected teeth were then referred for coronal restoration. Postoperatively, the affected teeth remained asymptomatic and functional. After an 18-month follow-up period, the radiological examination displayed favourable healing outcome and periodontal ligament regeneration in the furcation area. Conclusion: Despite the advances in the endodontic armamentarium, including the application of magnification and the availability of biomaterials, the management of root perforation remains a challenging clinical issue. Apart from effective root canal disinfection and obturation, the intracoronal application of MTA provided an effective seal upon the perforative defects, promoted biological repair and improved the prognosis in two cases of compromised, perforated teeth. Keywords: disinfection, furcation, lateral root perforation, mineral trioxide aggregate, treatment outcome

The prognosis for teeth that exhibit root fractures is strongly influenced by patient age, stage of root development, tooth mobility, dislocation of the coronal fragment and potential degree of segment separation, repositioning of the segments and the type of splint used. This is a case of a horizontal chisel-type root fracture in the middle third of a maxillary central incisor with the added complication of lateral luxation of the coronal fragment. Addressed in this case are the treatment, clinical and radiographic changes observed over a 3-year period where the pulp vitality status was preserved, thus achieving healing and possible revascularisation of the segments, along with completion of root development. During this time frame, the tooth remained clinically asymptomatic with no signs of periradicular pathosis. However, a subtle discoloration in the crown was observed along with the tooth being slightly malposed. Keywords: luxation injuries, prognosis, root fracture, root fracture healing

Endodontic endosseous implants (EEI) have been historically advocated to retain teeth or roots that have been compromised by trauma, periodontal disease, and resorption due to orthodontic tooth movement. The EEI has an advantage in that it can be totally intraosseous without communicating with the oral cavity. While successful in some cases, many failures resulted, which led to their falling out of favour during treatment planning. Presently their use has been significantly overshadowed by the use of endosseous implants following tooth extraction. The paper will discuss the history of EEI, their primary causes for failure, and tissue responses to their placement, coupled with a case of long-term success using this modality for tooth retention following trauma. Keywords: diodontic implant, endosseous implant, stablilisers

Aims and objective: To evaluate the effect of various reinforcement techniques with polyethylene fibre and fibre post on the fracture resistance of endodontically treated teeth. Materials and methods: Forty intact maxillary premolars receiving endodontic treatment and MOD cavity preparation were divided into four groups: Group I - restored with resin composite; Group II - fibre post inserted into the palatal canal followed by resin composite restoration; Group III - polyethylene fibre inserted in the occlusal third of the MOD cavity followed by resin composite restoration; and Group IV - fibre post transfixed horizontally in a buccolingual direction within the MOD cavity, followed by resin composite restoration. Fracture resistance was evaluated using the Universal testing machine. Results: ANOVA statistical analysis showed no significant difference in the fracture resistance between Group 1 and Group 2, whereas, a significant difference was seen between Group 1 and Group 3 and also Group 1 and Group 4. The difference in mean fracture resistance was found to be statistically significant between Group 2 and Group 3 as well as between Group 2 and Group 4. No statistically significant difference was observed between Group 3 and Group 4 with respect to the mean fracture resistance (P > 0.05). Conclusion: Horizontally transfixed fibre post and polythelene fibre placed within the resin composite restoration showed improved fracture resistance. Keywords: fibre post, fracture resistance, polyethylene fibre

Aim: The aim of this study was to evaluate the microtensile bond strength of a low viscosity flowable resin composite and two different highly filled resin composites as core materials. Materials and methods: Three experimental groups with three different resin composites were established (Group I - Filtek Flow/3M ESPE; Group II - Core Max II/Dentsply; and Group III - Filtek Z350/3M ESPE). Twenty beam-shaped 1-mm thick specimens per group were obtained by sectioning from cylinders (10 × 10 mm) resin composite materials built up around the fibre-reinforced composite (FRC) posts conditioned with 24% hydrogen peroxide and silane. Each specimen was loaded with tension on a universal testing machine until failure occurred at either one of the two post core interfaces present in each specimen. The differences in the interfacial bond strength among the groups were tested for statistical significance with one-way ANOVA test, followed by the Dunnet test for post hoc comparisons. Results and conclusions: The statistical analysis revealed that Group I achieved significantly higher bond strength than Groups II and III (P 0.000001). Flowable composites appear to be preferable to light-activated nano-composite or self-cure composite materials for core build-up on a fibrereinforced resin post treated with hydrogen peroxide and silane as regards to bond strength. Keywords: core material, fibre-reinforced composite post, microtensile bond strength, resin composite, surface treatment