Diagnosis Of Vertical Root Fracture With Cone-beam Computerized Tomography In Endodontically Treated Teeth: Three Case Reports

A definitive diagnosis of vertical root fracture (VRF) is often a challenging task for clinicians. This is because two dimensional periapical radiographs are usually unable to detect the fracture line due to the direction of the X-ray beam. This report presents a set of 3 cases of endodontically treated teeth that were diagnosed with VRFs based on findings from clinical, radiographic, and cone-beam computerized tomographic (CBCT) examinations. After extraction, VRFs were confirmed in all cases. The presence of periodontal pockets or other signs which would compromise the correct diagnosis could not be detected in all three cases. Fracture lines were only visible with the aid of CBCT which provided useful information for the diagnosis and management of VRF. 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Fuss, Z., Lustig, J., Ganor, Y., Kaffe, I., Radiographic features of vertically fractured, endodontically treated maxillary premolars (1999) Oral Surg Oral Med Oral Pathol Oral Radiol Endod, 88 (3), pp. 348-352Nesari, R., Rossman, L.E., Kratchman, S.I., Cone-beam computed tomography in endodontics: Are we there yet (2009) Compend Contin Educ Dent, 30 (6), pp. 312-320Kamburoǧlu, K., Ilker Cebeci, A., Gröndahl, H.G., Effectiveness of limited cone-beam computed tomography in the detection of horizontal root fracture (2009) Dent Traumatol, 25 (3), pp. 256-261Mora, M.A., Mol, A., Tyndall, D.A., Rivera, E.M., In vitro assessment of local computed tomography for the detection of longitudinal tooth fractures (2007) Oral Surg Oral Med Oral Pathol Oral Radiol Endod, 103 (6), pp. 825-829Hannig, C., Dullin, C., Hülsmann, M., Heidrich, G., Three-dimensional, non-destructive visualization of vertical root fractures using flat panel volume detector computer tomography: An ex vivoin vitro case report (2005) Int Endod J, 38 (12), pp. 904-913Nair, M.K., Nair, U.D.P., Gröndahl, H.G., Webber, R.L., Wallace, J.A., Detection of artificially induced vertical radicular fractures using tuned aperture computed tomography (2002) Eur J Oral Sci, 109 (6), pp. 375-379Varshosaz, M., Tavakoli, M.A., Mostafavi, M., Baghban, A.A., Comparison of conventional radiography with cone beam computed tomography for detection of vertical root fractures: An in vitro study (2010) J Oral Sci, 52 (4), pp. 593-597Bernardes, R.A., de Moraes, I.G., Húngaro Duarte, M.A., Azevedo, B.C., de Azevedo, J.R., Bramante, C.M., Use of cone-beam volumetric tomography in the diagnosis of root fractures (2009) Oral Surg Oral Med Oral Pathol Oral Radiol Endod, 108 (2), pp. 270-277Hassan, B., Metska, M.E., Ozok, A.R., van der Stelt, P., Wesselink, P.R., Comparison of five cone beam computed tomography systems for the detection of vertical root fractures (2010) J Endod, 36 (1), pp. 126-129Valiozadeh, S., Khosravi, M., Azizi, Z., 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imaging: Part 1.Conventional and alternative radiographic systems (2009) Int Endod J, 42 (6), pp. 447-462Rud, J., Omnell, K.A.K.E., Root fractures due to corrosion diagnostic aspects (1970) Eur J Oral Sci, 78 (1-4), pp. 397-403Tofangchiha, M., Adel, M., Bakhshi, M., Esfehani, M., Nazeman, P., Ghorbani Elizeyi, M., Digital radiography with computerized conventional monitors compared to medical monitors in vertical root fracture diagnosis (2013) Iran Endod J, 8 (1), pp. 14-17Shemesh, H., van Soest, G., Wu, M., Wesselink, P.R., Diagnosis of vertical root fractures with optical coherence tomography (2008) J Endod, 34 (6), pp. 739-742Zou, X., Liu, D., Yue, L., Wu, M., The ability of cone-beam computerized tomography to detect vertical root fractures in endodontically treated and nonendodontically treated teeth: A report of 3 cases (2011) Oral Surg Oral Med Oral Pathol Oral Radiol Endod, 111 (6), pp. 797-801Edlund, M., Nair, M.K., Nair, U.P., Detection of vertical root fractures by using 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Monitoring The Effectiveness Of Root Canal Procedures On Endotoxin Levels Found In Teeth With Chronic Apical Periodontitis

Objective: The aim of this study was to monitor the effectiveness of root canal procedures by using different irrigants and intracanal medication on endotoxin levels found in root canals of teeth with chronic apical periodontitis. Material and methods: Thirty root canals of teeth with pulpal necrosis associated with periapical lesions were selected and randomly divided into groups according to the irrigants used: GI - 2.5% NaOCl, GII - 2% chlorhexidine (CHX) gel, and GIII - saline solution (SS) (all, n=10). Samples were collected with sterile/apyrogenic paper points before (S1) and after root canal instrumentation (S2), after use of 17% ethylenediaminetetraacetic acid (EDTA) (S3), and after 30 days of intracanal medication (Ca(OH)2+SS) (S4). A turbidimetric kinetic Limulus Amebocyte Lysate assay was used for endotoxin measurement. Results: Endotoxins were detected in 100% of the root canals investigated (30/30), with a median value of 18.70 EU/mL. After S2, significant median percentage reduction was observed in all groups, irrespective of the irrigant tested: 2.5% NaOCl (99.65%) (GI), 2% CHX (94.27%) (GII), and SS (96.79%) (GIII) (all p<0.05). Root canal rinse with 17% EDTA (S3) for a 3-minute period failed to decrease endotoxin levels in GI and a slight decrease was observed in GII (59%) and GIII (61.1%) (all p>0.05). Intracanal medication for 30 days was able to significantly reduce residual endotoxins: 2.5% NaOCl (90%) (GI), 2% CHX (88.8%) (GII), and SS (85.7%) (GIII, p<0.05). No differences were found in the endotoxin reduction when comparing S2 and S4 treatment groups. Conclusion: Our findings demonstrated the effectiveness of the mechanical action of the instruments along with the flow and backflow of irrigant enduring root canal instrumentation for the endotoxin removal from root canals of teeth with chronic apical periodontitis. Moreover, the use of intracanal medication for 30 days contributed for an improvement of endotoxin reduction.226490495Berutti, E., Marini, R., Angeretti, A., Penetration ability of different irrigants into dentinal tubules (1997) J Endod, 23, pp. 725-727Buck, R.A., Cai, J., Eleazer, P.D., Staat, R.H., Hurst, H.E., Detoxification of endotoxin by endodontic irrigants and calcium hydroxide (2001) J Endod, 27, pp. 325-327Burton, A.J., Carter, H.E., Purification and characterization of the lipid A component of the lipopolysaccharides from Escherichia coli (1964) Biochemistry, 3, pp. 411-418Csako, G., Elin, R.J., Hochstein, H.D., Tsai, C.M., Physical and biological properties of U.S. Standard endotoxin EC after exposure to ionizing radiation (1983) Infect Immun, 41, pp. 190-196Gomes, B.P., Endo, M.S., Martinho FC Comparison of endotoxin levels found in primary and secondary endodontic infections (2012) J Endod, 38, pp. 1082-1086Gomes, B.P., Martinho, F.C., Vianna, M.E., Comparison of 2.5% sodium hypochlorite and 2% chlorhexidine gel on oral bacterial lipopolysaccharide reduction from primarily infected root canals (2009) J Endod, 35, pp. 1350-1353Hong, C.Y., Lin, S.K., Kok, Cheng, S., Lee, M.S., Wang, T.M., The role of lipopolysaccharide in infectious bone resorption of periapical lesion (2004) J Oral Pathol Med, 33, pp. 162-169Horiba, N., Maekawa, Y., Abe, Y., Ito, M., Matsumoto, T., Nakamura, H., Correlations between endotoxin and clinical symptoms or radiolucent areas in infected root canals (1991) Oral Surg Oral Med Oral Pathol, 71, pp. 492-495Jacinto, R.C., Gomes, B.P., Shah, H.N., Ferraz, C.C., Zaia, A.A., Souza-Filho, F.J., Quantification of endotoxins in necrotic root canals from symptomatic and asymptomatic teeth (2005) J Med Microbiol, 54, pp. 777-783Lüderitz, O., Tanamoto, K., Galanos, C., McKenzie, G.R., Brade, H., Zähringer, U., Lipopolysaccharides: Structural principles and biologic activities (1984) Rev Infect Dis, 4, pp. 428-433Marinho, A.C., Martinho, F.C., Zaia, A.A., Ferraz, C.C., Gomes, B.P., Influence of the apical enlargement size on the endotoxin level reduction of dental root canals (2012) J Appl Oral Sci, 20, pp. 661-666Martinho, F.C., Chiesa, W.M., Leite, F.R., Cirelli, J.A., Gomes, B.P., Antigenic activity of bacterial endodontic contents from primary root canal infection with periapical lesions against macrophage in the release of interleukin-1beta and tumor necrosis factor alpha (2010) J Endod, 36, pp. 1467-1474Martinho, F.C., Chiesa, W.M., Marinho, A., Zaia, A.A., Ferraz, C.C., Almeida, J.F., Clinical investigation of the efficacy of chemomechanical preparation with rotary nickel-titanium files for removal of endotoxin from primarily infected root canals (2010) J Endod, 36, pp. 1766-1769Martinho, F.C., Gomes, B.P., Quantification of endotoxins and cultivable bacteria in root canal infection before and after chemomechanical preparation with 2.5% sodium hypochlorite (2008) J Endod, 34, pp. 268-272Oliveira, L.D., Carvalho, C.A., Carvalho, A.S., Alves, J.S., Valera, M.C., Jorge, A.O., Efficacy of endodontic treatment for endotoxin reduction in primarily infected root canals and evaluation of cytotoxic effects (2012) J Endod, 38, pp. 1053-1057Oliveira, L.D., Jorge, A.O., Carvalho, C.A., Koga-Ito, C.Y., Valera, M.C., In vitro effects of endodontics irrigants on endotoxins in root canals (2007) Oral Surg Oral Med Oral Pathol Oral Radiol Endod, 104, pp. 135-142Ozdemir, H.O., Buzoglu, H.D., Calt, S., Cehreli, Z.C., Varol, E., Temel, A., Chemical and ultramorphologic effects of ethylenediaminetetraacetic acid and sodium hypochlorite in young and old root canal dentin (2012) J Endod, 38, pp. 204-20818- Paredes-Vieyra, J., Enriquez, F.J., Success rate of single- versus two-visit root canal treatment of teeth with apical periodontitis: A randomized controlled trial (2012) J Endod, 38, pp. 1164-1169Pérez-Heredia, M., Ferrer-Luque, C.M., González-Rodríguez, M.P., Martín-Peinado, F.J., González-López, S., Decalcifying effect of 15% EDTA, 15% citric acid, 5% phosphoric acid and 2.5% sodium hypochlorite on root canal dentine (2008) Intendod J, 41, pp. 418-423Petsch, D., Anspach, F.B., Endotoxin removal from protein solutions (2000) J Biotech, 76, pp. 97-119Pitts, D.L., Williams, B.L., Morton, T.H., Jr., Investigation of the role of endotoxin in periapical inflammation (1982) J Endod, 8, pp. 10-18Schein, B., Schilder, H., Endotoxin content in endodontically involved teeth (2006) J Endod, 32, pp. 293-295Silva, L.A., Leonardo, M.R., Assed, S., Tanomaru-Filho, M., Histological study of the effect of some irrigating solutions on bacterial endotoxin in dogs (2004) Braz Dent J, 15, pp. 109-114Silva, L.A., Nelson-Filho, P., Leonardo, M.R., Rossi, M.A., Pansani, C.A., Effect of calcium hydroxide on bacterial endotoxin in vivo (2002) J Endod, 28, pp. 94-9825- Sousa, E.L., Martinho, F.C., Nascimento, G.G., Leite, F.R., Gomes, B.P., Quantification of endotoxins in infected root canals and acute apical abscess exudates: Monitoring the effectiveness of root canal procedures in the reduction of endotoxins (2014) J Endod, 40, pp. 177-181Tanomaru, J.M., Leonardo, M.R., Tanomaru Filho, M., Bonetti Filho, L., Silva, L.A., Effect of different irrigation solutions and calcium hydroxide on bacterial LPS (2003) Int Endod J, 36, pp. 733-739Thaler, A., Ebert, J., Petschelt, A., Pelka, M., Influence of tooth age and root section on root dentine dye penetration (2008) Int Endod J, 41, pp. 1115-1122Vera, J., Siqueira, J.F., Jr., Ricucci, D., Loghin, S., Fernández, N., Flores, B., One- versus two-visit endodontic treatment of teeth with apical periodontitis: A histobacteriologic study (2012) J Endod, 38, pp. 1040-105229- Vianna, M.E., Horz, H.P., Conrads, G., Zaia, A.A., Souza-Filho, F.J., Gomes, B.P., Effect of root canal procedures on endotoxins and endodontic pathogens (2007) Oral Microbiol Immunol, 22, pp. 411-418Xavier, A.C., Martinho, F.C., Chung, A., Oliveira, L.D., Jorge, A.O., 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Influence Of Cement Type And Relining Procedure On Push-out Bond Strength Of Fiber Posts After Cyclic Loading

Purpose: The aim of this study was to evaluate the influence of cement type and relining procedure on push-out bond strength of fiber posts (FPs) after cyclic loading. Materials and Methods: Forty bovine incisor roots were divided into four groups: group 1, FP luting with RelyX Unicem; group 2, FP relined with resin composite (FPC) luting with RelyX Unicem; group 3, FP luting with RelyX ARC; group 4, FPC luting with RelyX ARC. Afterwards, half the specimens were exposed to 250,000 cycles in a controlled chewing simulator. With the other half of the specimens in each group, the push-out test was performed 24 hours after FP luting (immediate groups). All roots were sectioned transversely, producing 1-mm-thick slices, and the push-out test was performed. Statistical analysis was performed using ANOVA and the Tukey test for post hoc comparisons (α = 0.05). Results: FPC had higher bond strengths than FP (p 0.05). Conclusion: The relining procedure and the cement type are important factors for the bond strength of FPs to root dentin