1/12. Thermal sensitivity of endodontically treated teeth. case reports: The problem of thermal sensitivity following non-surgical root-canal treatment is explored and case reports are presented. Possible causes for post-treatment discomfort from endodontic and restorative aetiologies are discussed, as are the mechanisms to explain the patients' painful experiences. Treatment of this problem may vary from the simple replacement of a defective restoration to a more extensive non-surgical retreatment of the case, despite radiographic evidence of an acceptable root filling and normal periradicular tissues. ( info) |
| The clinical diagnosis of secondary caries is by far the most common reason for replacement of restorations, but the scientific basis for the diagnosis is meager. The purpose of this article is to review the literature on secondary (recurrent) caries and present case reports to document the problems encountered in the clinical diagnosis of secondary caries. The literature on secondary caries was critically reviewed and subdivided into clinical diagnosis, location of secondary lesions, histopathology, microleakage, and microbiology. The case reports included restorations that were scheduled to be replaced because of secondary caries or stained margins of composite restorations. The lesions were photographed preoperatively and postoperatively. Based on the limited literature available, secondary caries appears to be a localized lesion similar or identical to primary caries. It is most often localized gingivally on restorations. Narrow gaps, crevices, ditches, and "microleakage" do not lead to secondary caries, but wide voids may. Secondary caries is difficult to diagnose clinically. Consistency or hardness and discoloration of dentin and enamel are the best parameters. Secondary caries is the same as primary caries located at the margin of a restoration. ( info) |
3/12. Composite crown-form crowns for severely decayed primary molars: a technique for restoring function and esthetics. Current developments in esthetic dentistry center around new techniques and materials that improve the ability of the clinician to provide esthetic services. This article describes a step-by-step method of placing composite crown-form crowns on severely decayed primary mandibular molars. The described technique allows for restoring, as close as possible, form and function lost to caries in an esthetic mode in cases of severely decayed primary molars that would have required stainless steel crowns had they been treated traditionally. Disadvantages of this treatment mode are that dryness may not be prevented in the proximal margins, especially where subgingival carious involvement is encountered and the margin areas may be contaminated with gingival fluid or blood. Although no long-term follow-up has been reported for the technique, when strong opposition by the parent or child to the stainless steel crown is encountered, and a desire for esthetic restoration is strongly expressed, the composite crown-form crowns may be considered as an alternative. ( info) |
4/12. Vital pulp therapy with bipolar electrocoagulation after intentional pulp exposure of fixed prosthodontic abutments: a clinical report. A clinical protocol is described for the treatment of intentional and unavoidable exposed pulps during crown preparation. The protocol includes a definitive cavity preparation to create space in the exposed dentin for an adhesive pulp barrier; procedures to develop the highly desirable hybrid zone to prevent microleakage; the use of a specific resinous material that serves as a long-term pulp barrier with a relatively neutral and biocompatible impact on the pulp; and the use of precise bipolar electrocoagulation to provide durable hemostasis for restoration of the pulp wall and a relatively clot-free surgical wound to facilitate healing. The protocol involves the application of gentle surgical and restorative procedures to support the inherent healing process to restore the health of the pulp. The patient presented was part of a larger investigation and was selected in an attempt to identify a fixed prosthodontic application of the proposed pulp therapy protocol. ( info) |
5/12. Clinical response to a vacant post space. AIM: To report a case demonstrating a radiolucency of developing adjacent to an unfilled post space. SUMMARY: A mandibular left first molar was root filled before post-space preparation. The tooth was restored coronally but the post space was left empty, and 14 months later, pain and furcal radiolucency developed. Cleaning, shaping, medicating and filling the post space resulted in the resolution of symptoms and healing of the radiolucency. KEY learning POINTS: Post space should be prepared under conditions of asepsis. A post space must not be allowed to remain empty when a tooth is restored. ( info) |
6/12. Dental fractures on acute exposure to high altitude. There is little in the literature on dental restoration breakage in the aviation environment since reports of problems in combat aviators in war World II. We report two cases of dental fractures during acute exposure to a hypobaric environment. Case 1 was a young officer who suffered an amalgam restoration breakage during a 25,000-ft decompression chamber simulation. Case 2 occurred in an experienced aviator who had a tooth cusp fracture in a molar with a defective amalgam restoration during an unpressurized helicopter flight to 18,000 ft. In both cases, after removing the defective fillings, deep secondary caries were found; both teeth were successfully restored. Because hard-tissue tooth fracture during a high-altitude flight is a rare event, few flight surgeons or dentists are familiar with this phenomenon. We recommend regular dental examinations with careful assessment of previous dental restorations in aircrew subject to decompression. ( info) |
| This report presents a case in which undiagnosed coronal leakage resulted in failure in the endodontic management of a tooth. Coronal leakage occurred during root canal treatment as a result of the presence of deficient composite resin fillings and secondary caries. Despite repeated visits of cleaning and dressing, the canal continued to be contaminated and symptoms persisted. On referral, the reason for treatment failure was diagnosed. The tooth was successfully treated by the replacement of the deficient fillings, after the elimination of underlying caries. Symptoms resolved enabling the completion of the root canal treatment. ( info) |
8/12. Apical marginal adaptation of orthograde and retrograde root end fillings: a dye leakage and scanning electron microscopic study. A few studies have attempted to examine the correlation between clinical success of root canal therapy and in vitro examinations. In this case report we examined the apical adaptation of three orthograde fillings and four retrograde amalgam root end fillings from four radiographically successful teeth and one unsuccessful case by using dye leakage and scanning electron microscopic methods. Despite the radiographic appearance of successful root canal therapy, these examinations showed penetration of methylene blue dye through the apical foramina to the levels of the root canal filling materials in the roots treated nonsurgically and the presence of small gaps between filling materials and the dentinal walls. The methylene blue dye also penetrated through the interface between amalgam and root end cavities, and there were varying size gaps between the root end cavities and amalgam. Similar examinations on the radiographically unsuccessful retrograde filling showed the presence of gaps between the amalgam and the root end cavity preparation and complete penetration of methylene blue dye between amalgam, root canal filling materials, and the dentinal walls. ( info) |
9/12. Management of diffuse tissue argyria subsequent to endodontic therapy: report of a case. A case of severe mucogingival argyria secondary to leakage around and corrosion of silver cone root canal obturations and apical amalgam restorations is presented. Following removal of the silver points and re-treatment of the root canals, periradicular surgery was performed to remove the amalgam root-end restorations and reduce the amount of dispersed metallic particles in the subcutaneous tissues. Subsequent free gingival grafting created an esthetically pleasing and biologically acceptable result. ( info) |
10/12. Multidisciplinary aspects of root resection failure: a case report. Creative approaches to tooth maintenance often include tooth resection and retention of one or more of the roots. Although this procedure is reasonably successful, failure of supportive endodontic, periodontic, and restorative management of the retained roots can jeopardize a successful outcome. The following is a case report evaluating multiple aetiologies contributing to root resection failure. ( info) |