Periradicular Surgery of Human Permanent Teeth with Calcium-Enriched Mixture Cement Clinical results with two different methods of root-end preparation and filling in apical surgery: mineral trioxide aggregate and adhesive resin composite. Periradicular regeneration after endodontic surgery with calcium-enriched mixture cement in dogs. Periapical surgery using ultrasonic preparation and thermoplasticized gutta-percha with AH Plus sealer or IRM as retrograde root-end fillings in 160 consecutive teeth: a prospective randomized clinical study. Clinical management of nonhealing periradicular pathosis. Surgery versus endodontic retreatment. Comparison between the use of an ultrasonic tip and a microhead handpiece in periradicular surgery: a prospective randomised trial. Evaluation of Marginal Adaptation of Root-End Filling Materials Using Scanning Electron Microscopy Healing response of apicomarginal defects to two guided tissue regeneration techniques in periradicular surgery: a double-blind, randomized-clinical trial. [Periradicular surgery with endoscopy--a clinical prospective study]. The effect of a bioresorbable matrix barrier in endodontic surgery on the rate of periapical healing: an in vivo study. Endoscopic periradicular surgery: a prospective clinical study. Healing of apical periodontitis after endodontic treatment: a comparison between a silicone-based and a zinc oxide-eugenol-based sealer. Outcome of one-visit and two-visit endodontic treatment of necrotic teeth with apical periodontitis: a randomized controlled trial with one-year evaluation. Super-EBA and IRM as root-end fillings in periapical surgery with ultrasonic preparation: a prospective randomized clinical study of 206 consecutive teeth. A prospective clinical study of periradicular surgery using mineral trioxide aggregate as a root-end filling. [Periradicular surgery with and without endoscopy: a prospective clinical comparative study]. Tissue response to root canal irrigation systems in dogs’ teeth with apical periodontitis
Introduction Root-end preparation and restoration with an endodontic material are required when nonsurgical endodontic retreatment has failed or is impossible . The present clinical study reports the treatment outcomes of periradicular surgery using calcium-enriched mixture ( CEM ) cement . Material s and Methods A prospect i ve outcome study of periradicular surgery using CEM was conducted on 14 permanent teeth with persistent apical periodontitis . Using a st and ardized surgical protocol , 2 - 3 mm of the root apex was resected ; approximately 3 mm deep root-end cavities were ultrasonically prepared and filled with CEM cement .  All patients were available for recall . Results Clinical and radiographic examination revealed complete healing of periradicular lesions , i.e. regeneration of periodontal ligament and lamina dura in 13 teeth ( 93 % success ) during a mean time of 18 months ; moreover , the teeth were functional and asymptomatic . Conclusion Favorable treatment outcomes in this prospect i ve clinical study suggested that CEM cement may be a suitable root-end filling bio material INTRODUCTION The aim of apical surgery is to hermetically seal the root canal system after root-end resection , thereby enabling periradicular healing . The objective of this nonr and omized prospect i ve clinical study was to report results of 2 different root-end preparation and filling methods , ie , mineral trioxide aggregate ( MTA ) and an adhesive resin composite ( Retroplast ) . METHODS The study included 353 consecutive cases with endodontic lesions limited to the periapical area . Root-end cavities were prepared with sonic microtips and filled with MTA ( n = 178 ) , or alternatively , a shallow concavity was prepared in the cut root face , with subsequent placement of an adhesive resin composite ( Retroplast ) ( n = 175 ) . Patients were recalled after 1 year . Cases were defined as healed when no clinical signs or symptoms were present and radiographs demonstrated complete or incomplete ( scar tissue ) healing of previous radiolucencies . RESULTS The overall rate of healed cases was 85.5 % . MTA-treated teeth demonstrated a significantly ( P = .003 ) higher rate of healed cases ( 91.3 % ) compared with Retroplast-treated teeth ( 79.5 % ) . Within the MTA group , 89.5%-100 % of cases were classified as healed , depending on the type of treated tooth . In contrast , more variable rates ranging from 66.7%-100 % were found in the Retroplast group . In particular , m and ibular premolars and molars demonstrated considerably lower rates of healed cases when treated with Retroplast . CONCLUSIONS MTA can be recommended for root-end filling in apical surgery , irrespective of the type of treated tooth . Retroplast should be used with caution for root-end sealing in apical surgery of m and ibular premolars and molars INTRODUCTION The aim of this in vivo study was to compare the response of periradicular tissues to mineral trioxide aggregate ( MTA ) and calcium-enriched mixture ( CEM ) cement as root-end fillings and to analyze hard tissue healing after periradicular surgery . METHODS Intentional periradicular lesions were induced in 32 premolar teeth in 4 beagle dogs . The root canals were prepared , dried , and obturated with laterally condensed gutta-percha with sealer , and the coronal access cavities were filled with amalgam . After surgical exposure of the apices , 2 - 3 mm of the apical root was resected , and root-end cavities were ultrasonically prepared . The root-end cavities were r and omly filled with MTA or CEM cement . After 2 months , the animals were killed ; tissue blocks were removed and prepared for histologic examination . Hard tissue healing including cementum and new bone formation in addition to concentration and extent of inflammation were evaluated . RESULTS Eight sample s were excluded . The major finding was the cementum deposition adjacent to MTA in 11 of 12 sample s and CEM cement in 10 of 12 sample s. With one-way analysis of variance , no significant difference was observed between the periradicular tissue response to tested material s. CONCLUSIONS CEM cement and MTA were associated with regenerative periapical tissue response when used as root-end filling bio material OBJECTIVE The aim of this study was to evaluate the healing outcome after periapical surgery with an ultrasonic cleaning technique in conjunction with the use of either of 2 different retro grade root-filling material s in teeth with apical periodontitis . STUDY DESIGN One hundred sixty teeth in 139 consecutive patients were r and omly allocated into 2 groups receiving either IRM or thermoplasticized gutta-percha ( GP ) with AH Plus sealer as a retro grade root-end seal . The patients were review ed 12 months after surgery . The results were analyzed with Fisher exact test . RESULTS One hundred forty-seven teeth in 131 patients were review ed . Radiologic evaluation and clinical examination showed an 85 % success rate for the IRM group and 90 % for GP group . There was no statistical significance between the 2 groups . CONCLUSION Both tested material s , IRM and GP , are suitable as retro grade root-end filling material s in conjunction with ultrasonic root-end preparation according to the results of the healing outcome after 12 months follow-up OBJECTIVES This prospect i ve r and omized study compared the outcome of retreatment and surgical intervention in root canal treated teeth with nonhealing periradicular pathosis . STUDY DESIGN One such tooth from each of 38 patients was r and omly allotted to retreatment or root-end resection and root-end filling . Treatment outcome after 1 year was evaluated and compared clinical ly and radiographically . RESULTS The success rate for surgery was higher than for conventional retreatment , but the difference was not statistically significant . CONCLUSIONS For management of nonhealing periradicular pathosis associated with root canal treated teeth , surgical intervention should be considered as an alternative to retreatment . In cases with a similar prognosis for both modes of treatment , the choice should be governed by consideration of intrinsic and extrinsic factors Innovations in periradicular surgery for failed treatment of ortho grade root canal disease have been well-documented . We know of no prospect i ve studies that have compared success rates of conventional methods with these presumed advances . In this prospect i ve r and omised trial we compare the use of an ultrasonic retrotip with a microhead bur in the preparation of a retro grade cavity . Outcome was estimated clinical ly by estimation of pain , swelling , and sinus , and radiographically by looking at infill of bone and retro grade root filling 2 weeks and 6 months postoperatively . Both methods used other surgical techniques including microinstruments to place the retro grade root filling . The success rate of the ultrasonic method was higher ( all patients , n=26 ) than that of the microhead method ( n=19 of 21 ) . A larger study with longer follow up is required to consoli date this evidence Introduction The importance of perfect apical seal in endodontics , more specifically in periradicular surgery , is the motivation/reason for development of root-end filling material s with favorable physical , chemical and biological characteristics . The aim of this in vitro study was to evaluate the marginal adaptation of root-end filling material s using scanning electron microscopy . Material s and Methods Twenty five human maxillary anterior teeth were prepared using a K-File # 50 to 1 mm short of the apical foramen and filled with gutta-percha and Sealapex using the lateral compaction technique . The apical 3 mm of the roots were sectioned perpendicularly to the long axis of the teeth . A 3-mm-deep root-end cavity was prepared using ultrasonic tips powered by an Enac ultrasonic unit . The teeth were r and omly assigned to five groups according to the material s tested including IRM , amalgam , ProRoot MTA , Super-EBA and Epiphany/Resilon . Root-end cavities were filled with the material s prepared according to the manufacturers ’ instructions . The root apices were carefully prepared for sputter coating and later evaluation using Scanning Electron Microscope ( SEM ) . The images of root-end fillings were divided into four quadrants and distributed into five categories according to the level of marginal adaptation between the root-end material and the root canal walls . The Fisher exact test with Bonferroni correction was used for statistical analysis . The level of significance was set at P = 0.005 . Results SEM images showed the presence of gaps in the root-end filling material s. No significant difference was observed between the tested material s ( P > 0.005 ) . Conclusion ProRoot MTA , IRM , amalgam , Super-EBA and Epiphany/Resilon showed similar marginal adaptation as root-end filling material AIM To compare healing responses to periosteal sliding grafts and polyglactin 910 periodontal mesh used as guided tissue regeneration ( GTR ) material s/techniques when both periapical and periradicular bone loss are present . METHODOLOGY Thirty patients with suppurative chronic apical periodontitis with apicomarginal communication were selected and allocated r and omly into two groups according to the barrier technique to be used during periradicular surgery : periosteal graft group ( n = 15 ) and bioabsorbable membrane group ( n = 15 ) . Clinical and radiological evaluations were completed prior to surgery , a week later and every 3 months after surgery up to 12 months to measure the periodontal pocket depth ( PD ) , clinical attachment level ( CAL ) , gingival margin position ( GMP ) , size of periapical lesion , percentage reduction of the periapical rarefaction , and periapical healing . RESULTS Both groups showed highly significant ( P < 0.001 ) reductions in periodontal PD , CAL and size of periapical lesion at 12 months whilst GMP was unaltered . No significant difference between the experimental groups was evident for these parameters , or for the percentage reduction of size of the periapical lesion and clinical -radiographic healing . CONCLUSION Guided tissue regeneration applied to apicomarginal defects using sliding periosteal grafts and use of bioabsorbable membranes led to similar enhancements of the clinical outcome of periradicular surgery in terms of periapical healing , gain of periodontal support , PD reduction and minimal recession of the gingival margin Using an endoscope in periradicular surgery provides an impressive optical enlargement and may lead to better clinical diagnostics and a high rate of success . Aims of this investigation were examining this hypothesis as well as detecting influencing factors . In 2002 and 2003 , 114 teeth of 91 patients were root-end resected using endoscope .  Before surgery , the tooth , number of resected root-ends , content of root channels , clinical diagnosis and moment of surgery were recorded . Patients were controlled one year after surgery and success was evaluated as a summary of clinical and radiological findings . Four patients did not reappear for the control examination . Out of 110 teeth , treatment was successful in 91.8 % and failed in 7.3 % . 0.9 % could not be classified . Statistically , more failures were noted after periradicular surgery in molars . The rate of success increased during the study by means of a learning curve . The results confirm the hypothesis that where using an endoscope periradicular surgery is highly successful The purpose of this prospect i ve clinical study was to assess the rate of healing of periapical bony defects created at the time of endodontic periapical surgery  by measuring the densitometric ratio change in periapical osseous tissues , after periapical endodontic surgery was performed , by using or not using Guidor bioresorbable membrane material . Periapical surgeries were performed on 25 patients where nonsurgical root canal therapy had failed and a periapical lesion was present . For inclusion in the study , the osseous defect to be analyzed had to be confined to the apical area , with bone covering the entire root surface coronally , and an intact lingual cortical plate had to be present . A series of radiographs at the 3- , 6- , and 12-month recalls were compared with the radiograph taken immediately after surgery by using digital imaging and a densitometric ratio that gave a numerical estimation of osseous healing . Using repeated-measure ANOVA , it was shown that there was no statistical difference between the rate of healing in those cases where a Guidor resorbable membrane was used and those cases where no membrane was used . The results suggest that placement of a guided tissue membrane over the bony opening created during an endodontic periapical surgical procedure has no beneficial effect on the rate of healing and the added expense to the patient would not be warranted in these cases We  did apicectomies  of 30 teeth with periradicular lesions in 23 patients , using a 3 mm endoscope . Two patients failed to attend for postoperative assessment and of the remaining 21 patients who had 28 teeth treated the operation was judged after 1 year to be a success in 26 ( 93 % ) AIM To assess the treatment results up to 1 year after  endodontic treatment of apical periodontitis using a silicone-based sealer in comparison with Grossman 's sealer , and to compare the results at 3 months after treatment with the 12-month follow-up to assess the prognostic value of a 3-month control . METHODOLOGY A total of 199 teeth were treated at three centres . The sealer was r and omly chosen at the time of filling . Treatment results were evaluated clinical ly and radiographically 3 and 12 months after root-canal filling . The periapical status was evaluated using the periapical index ( PAI ) . RESULTS AND CONCLUSIONS Average PAI scores decreased from 3.43 at start to 2.21 at 12 months for Grossman 's sealer and from 3.40 to 2.26 for the silicon-based material . No significant difference between the groups at start or any of the follow ups was seen . The 3-month control was adequate in establishing significant healing in both groups . The improvement of the periapical condition continued at the 12-month examination The choice of one-visit versus two-visit root canal therapy for necrotic teeth with apical periodontitis is a source of current debate . The primary objective of this r and omized controlled clinical trial was to compare radiographic evidence of periapical healing after root canal therapy completed in one visit or two visits with an interim calcium hydroxide/chlorhexidine paste dressing .  Ninety-seven patients met the inclusion criteria and consented to participate in this study . Patients were r and omly assigned to either the one-visit or two-visit group , and root canal therapy was performed with a st and ardized protocol . Patients in the two-visit group received an intracanal dressing of calcium hydroxide/chlorhexidine paste . Sixty-three patients , 33 in the one-visit group and 30 in the two-visit group , were evaluated at 12 months . The primary outcome measure was change in apical bone density by using the periapical index ( PAI ) . Secondary outcome measures were proportion of teeth healed or improved in each group . Both groups exhibited equally favorable periapical healing at 12 months , with no statistically significant differences between groups OBJECTIVE This study evaluated the treatment outcome after periapical surgery with the use of 2 different retro grade root-filling material s and the influence of 3 pre- and perioperative variables on the periapical healing . STUDY DESIGN Two hundred six teeth in 164 patients were r and omly allocated to receive either IRM or Super-EBA as a retro grade root-end seal . The teeth were review ed 12 months after surgery . The influence of lesion size , lesion type , and ortho grade root filling quality on healing was analyzed . RESULTS One hundred ninety-four teeth in 153 patients were review ed . Radiologic evaluation and clinical examination revealed 91 % success rate for the IRM group and 82 % for the Super-EBA group . There was no statistical significance in the healing outcome between the 2 groups ( Fisher exact test ) . The analyzed pre- and perioperative variables had no significant influence on the treatment outcome ( Z test ) . CONCLUSIONS Both retro grade material s tested in this study can serve as a root-end seal in periapical infected teeth , according to the results of the healing outcome after 12 months ' follow-up A prospect i ve outcome study of  periradicular surgery  using microsurgical techniques and root-end filling with mineral trioxide aggregate ( MTA ) was performed . Nonhealing endodontically treated teeth ( n = 321 ) were included in the study . Surgery was completed under local anesthesia using a st and ardized clinical protocol . Patients were recalled periodically and examined for signs and symptoms of failure . Thirty-nine teeth were lost from recall . Of the 276 teeth examined , 163 showed complete healing radiographically with no other signs and symptoms ; 82 teeth had no symptoms but incomplete or uncertain healing , and 31 teeth showed nonhealing ( three had persistent pain despite evidence of complete radiologic healing and eight teeth did not heal for reasons unrelated to the surgical treatment ) . The overall success rate was 88.8 % , including all teeth with no clinical symptoms . In this study , the use of MTA as a root-end filling , following microsurgical techniques , showed a high success rate A total of 129 teeth with periradicular surgeries ( apicoectomies ) were analyzed in a prospect i ve clinical study . In the test group including 62 teeth , an endoscope ( Tele-Otoscope with a 70 degrees viewing angle ) was used as an intraoperative visualization aid to monitor the following surgical steps : root-end resection , root-end cavity preparation and retro grade root-canal obturation . In the control group including 67 teeth , intraoperative diagnostics were carried out using micromirrors . Fifty-four and 61 teeth could be re-examined after one year . Based on the clinical and radiographic findings they were categorized as success , uncertain healing or failure . In the test group with endoscopy , the success rate was 88.9 % , whereas in the control group it was only 75.4 % . However , statistically no significant difference was found between the two groups . Additional experimental and clinical studies will show if endoscopy will improve the success rates in periradicular surgery any further Objectives The aim of this study was to compare the efficacy of apical negative pressure irrigation ( ANP ) and passive ultrasonic irrigation ( PUI ) with apical positive pressure irrigation ( PP — conventional irrigation ) in the periapical repair of dogs ’ teeth with apical periodontitis . Methods Forty-nine mesial and distal root canals of premolars of three dogs with experimentally induced periapical lesions were subjected to a single-session root canal treatment . The teeth were r and omly assigned to three groups : ANP , PUI , and PP ( control ) . After 180 days , the animals were euthanized , and the anatomic pieces were removed and subjected to histotechnical processing for morphological and morphometric histological analyses of hematoxylin and eosin (HE)-stained sections under conventional and fluorescence microscopy . Periapical lesion size before and 180 days after root canal treatment was measured by periapical radiographic examination . Tartrate-resistant acid phosphatase ( TRAP ) histoenzymology was performed for osteoclast counting and Brown and Brenn staining to assess bacteria . Data were analyzed statistically by the Kruskal-Wallis test ( α = 5 % ) . Result There were no statistically significant differences among the groups regarding periapical lesion size in the radiographic evaluation ( p = 0.91 ) . In the comparison of histopathological parameters , group ANP presented more homogeneous results . There was a statistically significant difference ( p = 0.02 ) between groups ANP and PP , with better results for group ANP in which milder infiltrate inflammatory was observed . No statistically significant difference ( p > 0.05 ) was found among the groups with respect to periodontal ligament space , presence of mineralized tissue resorption , size of the periapical lesions , and number of osteoclasts . Conclusion Although the three irrigation systems elicited similar periapical tissue response with respect to almost all evaluated parameters , ANP presented the mildest inflammatory infiltrate , suggesting an advantage over PP in the indication for clinical use . Clinical relevance Irrigation of the root canal systems is an extremely important step in root canal treatment . Therefore , it is of relevance to evaluate the efficacy of these systems by in vivo experimental models to provide scientific background for the clinical practice
Bioceramics has significantly higher success rates than amalgam , but they were statistically similar to intermediate restorative material ( IRM ) and Super ethoxybenzoic acid ( Super EBA ) when used as retro grade filling material s in apical surgery .
However , it seems that the high success rates were not solely attributable to the type of the root-end filling material s. The surgical/microsurgical techniques and tooth prognostic factors may significantly affect treatment outcome
Introduction Periradicular surgery involves the placement of a root-end filling following root-end resection , to provide an apical seal to the root canal system .
Historically several material s have been used in order to achieve this seal .
Recently a class of material s known as Bioceramics have been adopted .