Microsurgical re-treatment of an endodontically treated tooth with an apically located incomplete vertical root fracture: a clinical case report

Although it is challenging, the early diagnosis of a vertical root fracture (VRF) is crucial in order to ensure tooth preservation. The purpose of this clinical case report was to describe reparative surgery performed to treat a tooth affected by an incomplete VRF. A 26 year old male patient was suspected to have a VRF in a maxillary left central incisor, and an exploratory flap was performed in order to confirm the diagnosis. After detecting the fracture, the lesion was surgically treated, the fracture and the infected root-end were removed, and a platelet-rich plasma membrane was used to cover the defect in order to prevent bacterial migration. A 24 month clinical and radiological follow-up examination showed that the tooth was asymptomatic and that the healing process was in progress. The surgical approach described here may be considered an effective treatment for a combined endodontic-periodontal lesion originating from an incomplete VRF and a recurrent periapical lesion

The trend of quality of publications in endodontic surgery : a 10-year systematic survey of the literature

OBJECTIVES: The aims of the present systematic literature analysis were to evaluate, over a 10-year period, the trend of the proportion of RCT, SR, MA published on endodontic surgery, and to investigate if the impact factor (IF) of the main endodontic Journals correlates with the proportion of RCT, SR, MA they publish. METHODS: An electronic search of the RCT, SR and MA published on the topic "endodontic surgery" from 2001 to 2010 was performed on Medline and Cochrane CENTRAL database using specific search terms combined with Boolean operators. Endodontic Journals impact factor was retrieved by the Thomson Scientific database. The proportion of each study type over the total number of articles on endodontic surgery published per year was estimated. The correlation between the number of high-evidence level studies published on the main endodontic Journals and the IF of such Journals per year was estimated. RESULTS: From a total of 900 articles published in 2001-2010 on endodontic surgery, there were 114 studies of high evidence level. A significant increase of the proportion of either RCT, SR and MA over the years was found. A modest to unclear correlation was found between the Journal IF and the number of high-evidence articles published. CONCLUSIONS: There is a positive trend over the years among researchers in performing studies of good quality in endodontic surgery. The impact factor of endodontic Journals is not consistently influenced by publication of high-evidence level articles

Impact of the use of plasma rich in growth factors (PRGF) on the quality of life of patients treated with endodontic surgery when a perforation of sinus membrane occurred : A comparative study

Introduction The aim of this retrospective investigation was to evaluate the postoperative quality of life after endodontic surgery in maxillary molars when a sinus membrane perforation occurred and platelet concentrates were used. Materials and methods Included patients were treated by microsurgical endodontic treatment in molar and premolar maxillary regions between 2007 and 2010. Patients who fulfilled the inclusion criteria were screened. Data from the quality of life questionnaire were analyzed. The use of plasma rich in growth factors (PRGF) (test group) was compared with a control group when a Schneiderian membrane perforation occurred during endodontic surgery performed with a modern technique in maxillary molars and premolars. Results A total of 20 patients (12 in the control group and eight in the test group) fulfilled the inclusion criteria. No differences were evaluated at baseline for clinical parameters. Significantly improved patients' quality of life was observed in the test group considering symptoms as swelling, bad breath or taste, and pain. Functional activities were less impaired in the test group and swelling was significantly higher in the control group. In the test group, pain was significantly lower than the control group during the first 6 days after surgery and also, the consumption of painkillers was lower for patients belonging to the test group even if it was not statistically significant. Discussion In general, a small sinus membrane perforation (less than 6 mm) during endodontic surgery did not cause severe complications. The use of platelet concentrates could be effective in reducing the impact on patients' quality of life, decreasing pain and surgery side effects as well as swelling

Computerized Tomography Technique for the Investigation of the Maxillary First Molar Mesiobuccal Root

The aim of this paper was to review the literature about the use of computerized tomography to evaluate the presence and characteristics of the second mesiobuccal canal in the maxillary first molar. An electronic search was performed. Frequencies of the presence of second mesiobuccal canal and root anatomy characteristics were extracted from the selected studies. Pooled frequencies were calculated as weighted means. Seven articles were included. A second mesiobuccal canal was present in 59.32% of the teeth, and it was noncommunicating in 58.45% of teeth presenting the canal itself. The most common root canal morphology was single canal or two separated canals. The present paper showed that cone beam CT is a viable radiologic device for the evaluation of the mesiobuccal root of maxillary first molars. In fact, it was observed that the frequency of second mesiobuccal canal detection is similar to those presented by clinical studies or micro-CT evaluations

Postextraction implant in sites with endodontic infection as an alternative to endodontic retreatment : a review of literature

Abstract Objective: the aim of this literature review was to evaluate the outcomes of implants placed after extraction of teeth with infections of endodontic origin.Study design: an electronic search was performed through electronic databases (Medline and EMBASE) using the terms "immediate implant", "post-extractive implants", "endodontic infection", "infected site", "extraction socket" combined with the use of Boolean operators ("AND" and "OR"). Only articles on human subjects were considered. At least 12 month of mean follow-up was required for inclusion. No restriction was placed regarding study design.Results: Ten studies were included in this review. Survival rates ranged from 92% to 100%. A total of 497 implants were placed in sites with endodontic infection. In nine studies the use of bone substitutes was associated with immediate implant placement.Conclusion: because of the low number of included study and the heterogeneity in study design, more well-designed studies are required in order to assess relevance of this treatment alternative

Endoscopic minimally invasive management of a periradicular lesion invading the maxillary sinus

A referred patient presented with a lesion of endodontic origin located at the apex of tooth #27. The tooth had been endodontically treated and re-treated. A periapical radiograph revealed a close relationship between the lesion and the maxillary sinus. A cone-beam computed tomography scan confirmed that the lesion had invaded the sinus cavity. The treatment plan consisted of periapical surgery using an endoscope as a magnification device. Due to a sinus membrane perforation, a new sinus membrane repair technique was performed. Twelve months after surgery, a cone-beam computed tomography scan revealed successful healing of the lesion. The continuous preservation of the sinus physiology was also observed. The use of an endoscope as a magnification device and a tailored technique for sinus membrane management allowed us to achieve a successful treatment outcome in the case of an endodontic lesion invading the maxillary sinus

Immediate implant placement in endodontically infected sites : an alternative treatment for compromised teeth

In certain clinical conditions when endodontic treatment is either impractical or unlikely to improve the previous results, tooth extraction and replacement with a dental implant becomes a viable alternative. Although the presence of active infection has long been considered a major contraindication to the insertion of implants immediately following tooth extraction, several articles assessing this treatment modality reported excellent and promising results. The aim of this literature review is to evaluate and discuss the clinical outcome of implants placed immediately following extraction in endodontically infected sockets. A Medline and EMBASE search was performed to identify articles published from 1966 to 2010 using the keywords "dental implants", "immediate implant", "extraction socket", "infected teeth", "infected site", "infected socket". No restrictions were placed regarding the study design. Only clinical articles with at least 6 months of follow-up were included. The available relevant literature concerning this topic was limited, and based on relatively low level of evidence study designs with limited follow-up periods. However, the data analysis of the selected articles showed that an immediate implant insertion in endodontically infected sites following tooth extraction and careful debridement of the socket, could be a predictable viable technique. Additional large scaled, well-designed studies are required in order to further assess the clinical applications of this treatment alternative

Cone beam computed tomography for the diagnosis of vertical root fractures : a systematic review of the literature and meta-analysis

Objective The aim of this review was to compare the efficiency of cone beam computed tomography (CBCT) and conventional intraoral radiography for the detection of vertical root fractures (VRFs).Study Design Data from comparative and noncomparative studies investigating CBCT, conventional radiography, or both for the diagnosis of VRFs were searched. The main outcome variables were sensitivity, specificity, and accuracy of the techniques. Data were separated into 4 groups: in vivo, ex vivo/untreated teeth, ex vivo/treated teeth, and ex vivo with post. The weighted mean of each parameter was estimated.Results Twelve articles were considered for the analysis. There was a large heterogeneity of the characteristics of the studies and a wide variability in outcome variables. No significant differences were found between radiographic techniques.Conclusions No superiority of CBCT compared with conventional radiography was found for VRF detection. Adequate choice of voxel size seems to be important when diagnosing VRFs

Focus and the Semantic Component

In studying the facts of language, two domains have been devised in the process of defining grammatical relations: a. Sentence Grammar which encompasses phenomena belonging to clause level, with NP and S (or S') as the relevant domains in which to specify syntactic constraints and dependencies. This theoretical abstraction is so restricted to be able to account for basic facts of competence in language acquisition; b. Discourse Grammar which is crucially grafted into rules of sentence grammar; it does not directly relate to unconscious and innate LAD mechanisms but stems and develops on extralinguistic, contectual/situational or pragmatic conditions

Immediate implant placement in endodontically infected sites : an alternative treatment for compromised teeth

In certain clinical conditions when endodontic treatment is either impractical or unlikely to improve the previous results, tooth extraction and replacement with a dental implant becomes a viable alternative. Although the presence of active infection has long been considered a major contraindication to the insertion of implants immediately following tooth extraction, several articles assessing this treatment modality reported excellent and promising results. The aim of this literature review is to evaluate and discuss the clinical outcome of implants placed immediately following extraction in endodontically infected sockets. A Medline and EMBASE search was performed to identify articles published from 1966 to 2010 using the keywords "dental implants", "immediate implant", "extraction socket", "infected teeth", "infected site", "infected socket". No restrictions were placed regarding the study design. Only clinical articles with at least 6 months of follow-up were included. The available relevant literature concerning this topic was limited, and based on relatively low level of evidence study designs with limited follow-up periods. However, the data analysis of the selected articles showed that an immediate implant insertion in endodontically infected sites following tooth extraction and careful debridement of the socket, could be a predictable viable technique. Additional large scaled, well-designed studies are required in order to further assess the clinical applications of this treatment alternative