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      Microbiologic analysis of teeth with failed endodontic treatment and the outcome of conservative re-treatment

      , , ,

      Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontology

      Elsevier BV

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          Most cited references 37

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          Factors affecting the long-term results of endodontic treatment.

          The influence of various factors that may affect the outcome of root canal therapy was evaluated in 356 patients 8 to 10 yr after the treatment. The results of treatment were directly dependent on the preoperative status of the pulp and periapical tissues. The rate of success for cases with vital or nonvital pulps but having no periapical radiolucency exceeded 96%, whereas only 86% of the cases with pulp necrosis and periapical radiolucency showed apical healing. The possibility of instrumenting the root canal to its full length and the level of root filling significantly affected the outcome of treatment. Of all of the periapical lesions present on previously root-filled teeth, only 62% healed after retreatment. The predictability from clinical and radiographic signs of the treatment-outcome in individual cases with preoperative periapical lesions cases was found to be low. Thus, factors which were not measured or identified may be critical to the outcome of endodontic treatment.
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            Influence of infection at the time of root filling on the outcome of endodontic treatment of teeth with apical periodontitis.

            This study investigated the role of infection on the prognosis of endodontic therapy by following-up teeth that had had their canals cleaned and obturated during a single appointment. The root canals of 55 single-rooted teeth with apical periodontitis were thoroughly instrumented and irrigated with sodium hypochlorite solution. Using advanced anaerobic bacteriological techniques, post-instrumentation samples were taken and the teeth were then root-filled during the same appointment. All teeth were initially infected; after instrumentation low numbers of bacteria were detected in 22 of 55 root canals. Periapical healing was followed-up for 5 years. Complete periapical healing occurred in 94% of cases that yielded a negative culture. Where the samples were positive prior to root filling, the success rate of treatment was just 68%--a statistically significant difference. Further investigation of three failures revealed the presence of Actinomyces species in each case; no other specific bacteria were implicated in failure cases. These findings emphasize the importance of completely eliminating bacteria from the root canal system before obturation. This objective cannot be reliably achieved in a one-visit treatment because it is not possible to eradicate all infection from the root canal without the support of an inter-appointment antimicrobial dressing.
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              Disinfection by endodontic irrigants and dressings of experimentally infected dentinal tubules.

              The effect of endodontic irrigants and dressings was tested on bacteria in bovine dentin specimens experimentally infected with Enterococcus faecalis, Streptococcus sanguis, Escherichia coli, or Pseudomonas aeruginosa. Standardized, cylindrical dentin test pieces were prepared and cleaned by ultrasonic treatment with EDTA and sodium hypochlorite. The specimens were infected with the test organism for periods up to 14 days, and the degree of infection into the tubules was monitored using Brown & Brenn stain, scanning electron microscopy, and culturing of dentin dust from sequential bur samples starting from the pulpal side. E. faecalis rapidly infected the whole length of the tubules; S. sanguis required up to 2 weeks for complete infection; E. coli only penetrated to some 600 microns, even after prolonged incubation periods. P. aeruginosa infected dentin quickly, but apparently in very low numbers. E. faecalis persisted for at least 10 d after withdrawal of nutrient support, whereas the other 3 organisms died within 4 to 48 h. Endodontic medicaments were applied to infected specimen for comparison of antibacterial potency. Camphorated p-monochlorophenol was generally more efficient than Calasept, and of the irrigants tested, iodine potassium iodide appeared more potent than sodium hypochlorite or chlorhexidine. The presence of a smear layer delayed, but did not eliminate, the effect of the medicaments.
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                Author and article information

                Journal
                Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontology
                Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontology
                Elsevier BV
                10792104
                January 1998
                January 1998
                : 85
                : 1
                : 86-93
                Article
                10.1016/S1079-2104(98)90404-8
                © 1998

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