Technical aspects of endodontic treatment and influence on periapical tissue health in cross-sectional studies

Apikalni parodontitis (AP) upalni je poremećaj periradikularnih tkiva uzrokovan persistirajućom mikrobnom infekcijom unutar sustava korijenskih kanala aficiranog zuba. Dijagnoza AP-a uglavnom se temelji na radiološkoj detekciji odstupanja od normalne periapikalne anatomije. Cilj suvremene endodontske terapije jest ukloniti infekciju te spriječiti reinfekciju endodontskog prostora, kako bi se stvorili uvjeti za cijeljenje periapikalnih tkiva i zub zadržao u funkciji. Unatoč visokoj prevalenciji endodontskog tretmana, stopa neuspjeha iznimno je visoka. Brojna istraživanja ukazuju da kvaliteta endodontskog punjenja, kao i koronarna restauracija, imaju važne uloge u prevenciji prodora mikroorganizama u periapikalno područje. Cilj ovog preglednog rada bio je raščlaniti literaturu kako bi se utvrdio utjecaj kvalitete endodontskog liječenja na zdravlje periapikalnog tkiva u presječnim studijama.Apical periodontitis is an inflammatory disorder of periradicular tissues caused by persistent microbial infection of the root canal system of the affected tooth. Diagnosis of apical periodontitis is based on radiological detection of deviaton from normal periapical anatomy. The goal of contemporary endodontic treatment is to remove infection and prevent reinfection of endodontic space, in order to create conditions for healing of periapical tissues and keep tooth in function. Despite of high prevalence of root canal treatment, the rate of failure is exceptionally high. Numerous studies indicate that quality of root canal filling and coronal restoration play an important role in prevention of microbial penetration to periapical tissues. The aim of this review was to analyze the literature to evaluate the influence of the quality of endodontic treatment on periapical tissue health in cross-sectional studies

Technical aspects of endodontic treatment and influence on periapical tissue health in cross-sectional studies

Apikalni parodontitis (AP) upalni je poremećaj periradikularnih tkiva uzrokovan persistirajućom mikrobnom infekcijom unutar sustava korijenskih kanala aficiranog zuba. Dijagnoza AP-a uglavnom se temelji na radiološkoj detekciji odstupanja od normalne periapikalne anatomije. Cilj suvremene endodontske terapije jest ukloniti infekciju te spriječiti reinfekciju endodontskog prostora, kako bi se stvorili uvjeti za cijeljenje periapikalnih tkiva i zub zadržao u funkciji. Unatoč visokoj prevalenciji endodontskog tretmana, stopa neuspjeha iznimno je visoka. Brojna istraživanja ukazuju da kvaliteta endodontskog punjenja, kao i koronarna restauracija, imaju važne uloge u prevenciji prodora mikroorganizama u periapikalno područje. Cilj ovog preglednog rada bio je raščlaniti literaturu kako bi se utvrdio utjecaj kvalitete endodontskog liječenja na zdravlje periapikalnog tkiva u presječnim studijama.Apical periodontitis is an inflammatory disorder of periradicular tissues caused by persistent microbial infection of the root canal system of the affected tooth. Diagnosis of apical periodontitis is based on radiological detection of deviaton from normal periapical anatomy. The goal of contemporary endodontic treatment is to remove infection and prevent reinfection of endodontic space, in order to create conditions for healing of periapical tissues and keep tooth in function. Despite of high prevalence of root canal treatment, the rate of failure is exceptionally high. Numerous studies indicate that quality of root canal filling and coronal restoration play an important role in prevention of microbial penetration to periapical tissues. The aim of this review was to analyze the literature to evaluate the influence of the quality of endodontic treatment on periapical tissue health in cross-sectional studies

Technical aspects of endodontic treatment and influence on periapical tissue health in cross-sectional studies

Apikalni parodontitis (AP) upalni je poremećaj periradikularnih tkiva uzrokovan persistirajućom mikrobnom infekcijom unutar sustava korijenskih kanala aficiranog zuba. Dijagnoza AP-a uglavnom se temelji na radiološkoj detekciji odstupanja od normalne periapikalne anatomije. Cilj suvremene endodontske terapije jest ukloniti infekciju te spriječiti reinfekciju endodontskog prostora, kako bi se stvorili uvjeti za cijeljenje periapikalnih tkiva i zub zadržao u funkciji. Unatoč visokoj prevalenciji endodontskog tretmana, stopa neuspjeha iznimno je visoka. Brojna istraživanja ukazuju da kvaliteta endodontskog punjenja, kao i koronarna restauracija, imaju važne uloge u prevenciji prodora mikroorganizama u periapikalno područje. Cilj ovog preglednog rada bio je raščlaniti literaturu kako bi se utvrdio utjecaj kvalitete endodontskog liječenja na zdravlje periapikalnog tkiva u presječnim studijama.Apical periodontitis is an inflammatory disorder of periradicular tissues caused by persistent microbial infection of the root canal system of the affected tooth. Diagnosis of apical periodontitis is based on radiological detection of deviaton from normal periapical anatomy. The goal of contemporary endodontic treatment is to remove infection and prevent reinfection of endodontic space, in order to create conditions for healing of periapical tissues and keep tooth in function. Despite of high prevalence of root canal treatment, the rate of failure is exceptionally high. Numerous studies indicate that quality of root canal filling and coronal restoration play an important role in prevention of microbial penetration to periapical tissues. The aim of this review was to analyze the literature to evaluate the influence of the quality of endodontic treatment on periapical tissue health in cross-sectional studies

Koronarna restauracija kao predskazatelj periapikalne bolesti u endodontski neliječenim zubima

Objectives: To compare the frequency of apical periodontitis (AP) in non-endodontically treated teeth restored with full coverage crowns, amalgam and resin composite fillings, and to disclose the association of type and quality of coronal restoration with periapical disease. Material and methods: The cross-sectional study involved 597 subjects who attended the Dental Clinic of the Clinical Hospital Centre, Rijeka, Croatia for the first time. Data were collected by means of a clinical and radiological survey. The following data were recorded for all permanently restored non-endodontically treated teeth: the type, the quality of coronal restoration according to clinical and radiographic criteria for marginal integrity as well as the recurrent caries presence, periapical status and marginal bone loss. Chi-square tests were used to analyze the difference in periapical status regarding the type and the quality of restoration. The multivariate logistic regression analysis was used to assess the effect of explanatory tooth-specific variables on periapical status. Results: There was no significant difference in the proportion of AP with regards to the type and material of adequate quality coronal restorations (χ 2 =5.000, P=0.082). The regression analysis revealed significant positive associations with outcome variable (AP) for crowns (OR=3.39; P<0.001), recurrent caries (OR=4.67; P<0.001) and premolar teeth (OR=1.73; P=0.002). Conclusion: If the quality of restorations is adequate, there is no difference in the periapical status of non-endodontically treated teeth regarding the type and material of coronal restoration.Cilj: Svrha studije bila je usporediti učestalost apikalnog parodontitisa (AP) u endodontski neliječenim zubima koji su restaurirani potpunim krunicama te amalgamskim i smolastim kompozitnim ispunima. Također je istraživana povezanost vrste i kvalitete koronarne restauracije s prisutnošću periapikalne bolesti. Materijali i postupci: Presječno istraživanje obuhvatilo je 597 ispitanika koji su prvi put posjetili Kliniku za dentalnu medicinu Kliničkoga bolničkog centra Rijeka. Podatci su prikupljeni kliničkim i radiološkim pregledom. Za sve trajno restaurirane endodontski neliječene zube analizirani su vrsta, kvaliteta koronarne restauracije prema kliničkim i radiološkim kriterijima za rubnu cjelovitost restauracije i prisutnost rekurentnog karijesa, periapikalni status te gubitak marginalne kosti. Hi-kvadrat testovi primijenjeni su u analizi razlike periapikalnog statusa s obzirom na vrstu i kvalitetu restauracije. Multivarijantna logistička regresijska analiza obavljena je u procjeni utjecaja prediktorskih dentalnih varijabli na periapikalni status. Rezultati: Nije dokazana značajna razlika u proporciji AP-a s obzirom na vrstu i materijal koronarne restauracije odgovarajuće kvalitete (χ 2 = 5,000, P = 0,082 ). Regresijskom analizom otkrivena je značajna pozitivna povezanost s ishodišnom varijablom (AP) za krunice (OR = 3,39; P < 0,001), rekurentni karijes (OR = 4,67; P < 0,001) i pretkutnjake (OR = 1,73; P = 0,002). Zaključak: Ako su restauracije primjerene kvalitete, nema razlike u periapikalnom statusu endodontski neliječenih zuba s obzirom na vrstu i materijal korišten za koronarne restauracije

Difference in the periapical status of endodontically treated teeth between the samples of Croatian and Austrian adult patients

Aim To compare the periapical status of endodontically treated teeth between Austrian and Croatian adult patients and determine its relation to age, sex, position of teeth, and length of root canal filling. Methods The study was conducted from 2007 to 2009 at two university dental clinics and included 163 Croatian (412 teeth) and 101 Austrian (430 teeth) patients. We assessed the periapical status of endodontically treated teeth by using the periapical index system and determined its relation to age, sex, position of teeth, and length of root canal filling. Results Austrian patients had a greater number of diseased endodontically treated teeth than Croatian patients (P = 0.001). In the age group 31-40 years, Austrian patients had apical periodontitis significantly more often (22.1% vs 12.2%, P < 0.001) than Croatian patients. In relation to sex and position of teeth, no significant difference was found between the two groups. In Croatian patients, apical periodontitis was significantly more often present in molar than premolar (46.2% vs 29.7%, P = 0.022) and front teeth (46.2% vs 24.1%, P < 0.001). In Austrian patients, apical periodontitis was significantly more often present in molar and premolar than front teeth (molar-front teeth: 38.2% vs 25.5%, P = 0.011; premolar-front teeth: 36.3% vs 25.5%, P = 0.029). Croatian and Austrian patients significantly differed in the number of adequately filled and underfilled teeth with AP (both P<0.001). Conclusion Apical periodontitis was significantly more present in endodontically treated teeth in Austrian patients. The difference in the periapical status between Croatian and Austrian patients was most related to age and length of root canal filling

Tumor Necrosis Factor-Alpha and Interleukin 6 in Human Periapical Lesions

Aim. The aim of this study was to evaluate the presence of the cytokines tumor necrosis factor-alpha (TNF-α) and interleukin-6 (IL-6) in human periapical lesions. Subjects and methods. Samples were obtained from three groups of teeth: symptomatic teeth, asymptomatic lesions, and uninflamed periradicular tissues as a control. Results. TNF-alpha levels were significantly increased in symptomatic lesions compared to control. Group with asymptomatic lesions had significantly higher concentrations compared to control. There were no significant differences in TNF-alpha levels between symptomatic and asymptomatic lesions. In group with symptomatic lesions, IL-6 levels were significantly higher than in group with asymptomatic lesions. The IL-6 levels in symptomatic group also showed significantly higher concentration in comparison with control group. In asymptomatic group, the IL-6 level had significantly higher concentrations compared to control. Conclusion. These results indicate that symptomatic lesions represent an immunologically active stage of disease, and asymptomatic lesions are the point from which the process advances toward healing

Determination of inflammation mediators PGE2 and TXB2 in gingival crevicular fluid in patients with chronic periodontitis

Cilj: Čimbenici uključeni u patogenezu upalnih parodontnih bolesti su zubni plak, imunosni i upalni i obrambeni sustav domaćina, genetički čimbenici te čimbenici okoliša. Gingivna sulkularna tekućina (GST) sadrži mnoge upalne medijatore, među ostalima i prostaglandin E2 (PGE2) i tromboksan E2 (TXB2). Za navedene medijatore poznato je da su povezani s pojavom parodontne bolesti. Cilj ovog istraživanja bio je ispitati povezanost između vrijednosti PGE2 i TXB2 u GST-u i prisutnosti ili odsutnosti parodontne bolesti. Ispitanici i metode: Istraživanje je provedeno na 30 ispitanika s dijagnozom kroničnog parodontitisa (eksperimentalna skupina) i 20 ispitanika koji nemaju parodontitis (kontrolna skupina). Uzorci GST-a uzeti su od svakog ispitanika papirnatom trakom. Vrijednosti PGE2 i TXB2 određivane su komercijalnim ELISA testom. Rezultati: Vrijednosti PGE2 i TXB2 u GST-u bile su statistički značajno veće kod ispitanika s kroničnim parodontitisom u usporedbi s kontrolnom skupinom. Zaključak: Rezultati istraživanja upućuju da bi upalni medijatori PGE2 i TXB2 u GST-u mogli imati veze s patogenezom parodontne bolesti.Aim: Microbial dental plaque, host defense mechanisms, genetic and environmental factors are involved in the pathogenesis of periodontal diseases. Gingival crevicular fluid (GCF) contains various inflammation mediators – prostaglandin E2 (PGE2) and tromboxan B2 (TXB2), among others. These mediators have been reported to correlate with the progression of periodontal disease. The aim of this study was to examine the relationship between levels of inflammatory mediators PGE2 and TXB2 in the GCF and the periodontal status. Materials and methods: The study was conducted on 30 chronic periodontitis patients as the experimental group and 20 healthy subjects as control group. Samples of GCF were collected from each patient using paper strips. The levels of PGE2 and TXB2 were determined using a commercially available enzyme immunoassay kit (EIA). Results: PGE2 and TXB2 levels in GCF were significantly higher in chronic periodontitis patients as compared to healthy individuals. Conclusion: The results of this study indicate that inflammation mediators PGE2 and TXB2 might be implicated in the pathogenesis of periodontal disease

The efficacy of chelating agent in the removal of smear layer during root canal therapy

Cilj: Ispitati u in vitro uvjetima učinkovitost uklanjanja zaostatnog sloja nakon kemijsko–mehaničke obrade korijenskog kanala uporabom 17 %-tne otopine etilendiamintetraoctene kiseline (EDTA) tijekom jedne i pet minuta. Metode: Istraživanje je provedeno na tri skupine od 15 izvađenih jednokorijenskih ljudskih zuba. U prvoj, kontrolnoj skupini, nismo koristili otopinu EDTA-e, dok su u drugoj i trećoj skupini zuba korijenski kanali na kraju instrumentacije ispirani opinom EDTA-e tijekom 1, odnosno 5 minuta. Analiza zaostatnog sloja na poprečnim rezovima provedena je stereomokroskopom i svjetlosnim mikroskopom (Olimpus BX50, Tokyo, Japan) s adaptiranom kamerom (TMC 76S Pulnix, Tokyo, Japan). Statistička analiza provedena je pomoću jednosmjerne analize varijance (one-way ANOVA) i post hoc Scheffe testom uz P < 0.05. Rezultati: U uzorcima koji su tretirani otopinom EDTA-e tijekom 5 minuta količina zaostatnog sloja znatno je manja nego u kontrolne skupine uzoraka (P = 0,039). Na razini cervikalne trećine korijenskih kanala količina zaostatnog sloja u uzoraka tretiranih otopinom EDTA-e tijekom 1 min (P < 0,001) i otopinom EDTA-e tijekom 5 minuta (P < 0,001) znatno je manja u usporedbi s kontrolnom skupinom. U središnjoj trećini uočeno je da otopina EDTA učinkovitije uklanja zaostatni sloj u usporedbi s kontrolnom skupinom, djelovanjem tijekom 1 minute (P = 0,023) i 5 minuta (P = 0,007). Usporedbom uklanjanja zaostatnog sloja u sve tri skupine uzoraka na razini apikalne trećine korijenskih kanala nije utvrđena statistički značajna razlika (P = 0,428). Zaključak: Najučinkovitije uklanjanje zaostatnog sloja kelacjiskom otopinom EDTA-e postignuto je u cervikalnoj i središnjoj trećini korijenskog kanala, dok je u apikalnoj trećini, kao posljedica otežanog prodora irigansa, zaostalo najviše zaostatnog sloja.Objective: To investigate the efficacy of smear layer removal after mechanical and chemical root canal treatment using 17% EDTA solution in in vitro conditions. Methods: Research was performed on three groups of 15 extracted single-rooted human teeth. In the first group, the control group, EDTA was not used. In the second and third groups teeth root canals were irrigated with EDTA solution through one and five minutes after instrumentation. Analysis of smear layer was performed on cross-sectional slices using stereomicroscopy and light microscopy (Olimpus BX50, Tokyo, Japan) with adapted camera (TMC 76S Pulnix, Tokyo, Japan). Statistical analysis was performed using one-way analysis of variance (one-way ANOVA) and post hoc Scheffe test with P < 0.05. Results: In specimens treated with EDTA through five minutes the amount of smear layer was significantly lower when compared to control group (P = 0,039). At the cervical third of root canal the amount of smear layer in specimen treated with EDTA trough one minute (P < 0,001) and five minutes (P < 0,001) was significantly lower when compared to control group. In the middle third, we found that EDTA removes the smear layer through one minute (P = 0,023) and five minutes (P = 0,007) more efficiently when compared to control group. When the removal of smear layer in apical third was compared in all three groups, no differences were found (P = 0,428). Conclusion: The most effective removal of smear layer using EDTA solution was accomplished in the cervical and middle level of root canal, whilst in the apical level the largest amount of smear layer remained as a consequence of difficult penetration of the irrigant

The influence of load during rotary ProTaper® and ProFile® instrumentation on vertical root fracture occurrence

Cilj: Cilj rada bio je analizirati vrijednosti apikalno usmjerene sile i okretnog momen- ta tijekom strojne ProTaper® i ProFile® instrumentacije, te proučavati utjecaj opterećenja na nastanak vertikalne frakture korijena. Materijali i metode: U istraživanje je uključeno 40 izvađenih jednokorijenskih ljudskih zuba s jednim ravnim kanalom. Svi su zubi početno šireni ručnim K-proširivačima do promjera 0,15 mm, zatim su slučajnim odabirom podijeljeni u dvije skupine, po 20 u svakoj. U skupini 1 kanali su obrađeni strojnom ProTaper®, a u skupini 2 ProFile® tehnikom. Opterećenje je mjereno posebno konstruiranim uređajem. Nakon kanalne obrade, korijeni su horizontalno prerezani u cervikalnoj, središnjoj i apeksnoj trećini. Nativni preparati promatrani su svjetlosnim mikroskopom pod povećanjem 40 x. Vrijednosti sile i momenta su izražene kao medijan i raspon. Rezultati su uspoređeni Mann-Whitneyjevim U- testom za statističku značajnost P < 0,05. Rezultati: Vertikalna fraktura korijena nije uočena. Medijan sila bio je statistički značajno veći kod F2 instrumenta u odnosu na S2 instrument (P = 0,020). ProFile® OS3 instrument imao je statistički značajno veću silu u odnosu na OS2 (P < 0,001), 25/0,06 (P = 0,003) i 20/0,06 (P = 0,030). Statistički značajno veći okretni mo- ment bio je kod F2 instrumenta u odnosu na F1 (P = 0,003), te kod S1 u odnosu na F1 (P = 0,004) tijekom instrumentacije na radnoj dužini. Instrument OS3 imao je značajno veći okretni moment u odnosu na OS2 (P < 0,000) i 25/0,06 (P = 0,038). Zaključci: Oblikovanje korijenskog kanala strojnim ProTaper® i ProFile® instrumentima neće dovesti do vertikalne frak- ture korijena ako se kontroliraju sila i moment za vrijeme instrumentacije i kanal se prethod- no oblikuje ručnim K-proširivačima do promjera 0,15 mm.Aim: The aim of this study was to analyze the value of vertical forces and torque during rotary ProTaper® and ProFile® instrumentation and analyze the influence of the load on the vertical root fracture formation. Methods: The study included 40 extracted human teeth with single root. All teeth were prepared initially with hand K-files, to a diameter of 0.15 mm, and then were randomly divided into two groups of 20 each. In the group 1, canals were instrumented by rotary ProTaper®, in the group 2 by rotary ProFile® technique. Load was measured with specially designed device. The roots were cut horizontally in the cervical, middle and apical third. The samples were observed with a light microscope at a magnification 40x. Values of force and torque were expressed as median and range. Results were com- pared to the Mann-Whitney U-test. Statistically significant differences were defined as P < 0.05. Results: the vertical root fracture was not observed. The median force was significantly higher in the F2 instrument in relation to S2 instrument (P = 0.020). ProFile® OS3 instrument had a significantly greater strength compared to the OS2 (P < 0.001), 25/0.06 (P = 0.003) and 20/0.06 (P = 0.030). Significantly more torque was at F2 with respect to F1 (P = 0.003), S1 with respect to F1 (P = 0.004) during working length. Instrument OS3 had a significantly high- er torque compared to OS2 (P < 0.000) and 25/0.06 (P = 0.038). Conclusion: Shaping of the root canal with rotary ProTaper® and ProFile® instruments will not lead to fracture of the root if load is low, irrigating solu-tion is in the root canal and the canal is pre-shaped with hand K-Files

Socio‐economic and health status as a predictor of apical periodontitis in adult patients in Croatia

OBJECTIVE: A few studies focused on determinants of apical periodontitis other than technical or biological factors. This research aimed to investigate to what extent socio-economic and health status can predict apical periodontitis in adult patients. SUBJECTS AND METHODS: The cross-sectional study included 599 adult patients. Medical history, health habits and socio-economic status of each participant were recorded using a self-administered structured questionnaire. For caries detection, the World Health Organization diagnostic thresholds were used, and oral hygiene level was estimated using plaque index. Periapical index system was used to analyse the periapical status of all teeth. Dental, socio-economic and health-related variables were tested against dependent variable (periapical disease ratio) in a multiple linear regression analysis. RESULTS: Dental independent variables explained 71.7% of the observed variation in periapical disease ratio (R2 = 0.717; p < 0.001). Periapical disease ratio increased with the increase in number of carious teeth, plaque index and number of root-filled teeth, but also with decrease in number of coronal fillings (all p < 0.001). Socio-economic and health-related variables accounted for lower portion of variability, 15.5% and 12.9%, respectively (both p < 0.001). CONCLUSIONS: Dental variables are more important predictors of periapical status than socio-economic and health-related variable