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Patterns of bone loss around teeth restored with endodontic posts
Abstract
This retrospective study described the pattern of bone loss around teeth with endodontic posts in periodontitis patients, and compared it with contra-lateral teeth without posts. Material and
From full-mouth radiographic surveys of 146 periodontitis patients (> or =35 years), 194 roots with endodontic posts and contra-laterals without posts were selected. Upper molars, pre-molars with two posts and roots of lower molars with two posts were excluded. Technical parameters of the post space preparation, endodontic and restorative status were evaluated. The level of alveolar bone measured in millimetre from the cemento-enamel junction (CEJ)/restoration margin and the pattern of bone loss (angular/horizontal) were evaluated on both mesial and distal aspects of roots with posts and contra-laterals, but not on the furcal areas of lower molars.
The distance from the bone level to the CEJ/restoration margin was similar for teeth with posts and contra-laterals. However, teeth with posts had more angular defects mesially (18.8%versus 7.3%) as compared with their contra-laterals without posts. The defects around teeth with posts appeared to be typical in the sense that their apical level approximated the tip of the endodontic post.
In periodontitis patients, teeth restored by an endodontic post had angular bony defects on the mesial aspect more frequently in comparison with their contra-laterals.
... Katsamakis et al. [3] evaluated 146 complete sets of periapicals from patients with periodontal disease, and reported a greater marginal bone loss in 194 teeth restored with an intracanal post when compared with their cotralateral tooth. Additionally, their findings included the presence of angular bone defects in 18% of post-restored teeth against 7.8% in their contralateral counterparts. ...
... The aim of this study was to evaluate marginal bone loss in patients with intacanal post-retained restorations, as per reported by Timmerman & Weijden [6] and Katsamakis et al. [3], using sagittal and coronal slices from CBCT. ...
... Katsamakis et al. [3] reported higher bone loss in teeth restored with intracanal posts when compared to the non-post restored contralateral teeth, though such difference did not reach statistical significance, which may have been justified on the fact that 28 of the contralateral teeth had been endodontically treated and therefore may have influenced the outcome of their statistical analysis. In addition, and contrary to Müller & Ulbrich [8], Katsamakis et al. [3] reported a higher rate of angular bony defects in the post-restored teeth than in the non-post restored contralateral teeth. ...
The aim of this study was to assess marginal bone loss in teeth restored with endodontic posts on all four aspects of the teeth using cone beam tomography. Bone loss was assessed via scores (0-5) in relation to root length and bone height. The results showed that the scores for the contralateral and restored sides, respectively, ranged from 0 to 3 and 0 to 5 buccally, 0 to 4 and 0 to 4 palatally, 0 to 3 and 0 and 4 mesially and 0 to 3 and 0 to 4 distally. A significant difference in bone loss was observed between the post-restored teeth and their contralaterals for the buccal, lingual/palatal and mesial aspects (p<0.05), with teeth bearing endodontic posts scoring highest. In conclusion, marginal bone loss was higher in teeth restored with intra-canal posts when compared to their sound contralaterals.
... At least proper RCF do not seem to affect healing after regenerative periodontal surgery (Cortellini & Tonetti 2001). Katsamakis et al. (2009) compared the radiographic bone loss at teeth with endodontic post and at contra-laterals without endodontic posts. Only a minority (14%) of these contra-laterals were endodontically treated. ...
... Only a minority (14%) of these contra-laterals were endodontically treated. However, the study failed to find a significant difference in bone loss between teeth with and without endodontic posts (Katsamakis et al. 2009). This observation contrasts with the results of Timmerman & van der Weijden (2006). ...
... This observation contrasts with the results of Timmerman & van der Weijden (2006). Katsamakis et al. (2009) failed to find a statistically significant difference between teeth with posts and teeth without posts, of which only 14% were endodontically treated. Thus, they compared, to some extent, again endodontically treated teeth with posts and teeth without RCF (86%) and failed to find a difference regarding interproximal bone loss (Katsamakis et al. 2009). ...
Aim: The communication between the periodontium and the root canal may serve as a pathway for infectious agents, leading to attachment loss. The aim of this study was to compare the interproximal bone level on root canal filled teeth and non root canal filled teeth (KREBS project).
Materials and Methods: In a retrospective analysis, the records of patients from the school of dentistry at the University of Basel were consecutively screened during January 2009 and October 2011. The interproximal bone level at the mesial and distal aspects of root canal filled teeth and their contra-lateral non root canal filled correlates were assessed on periapical radiographs. Generalised linear mixed-effects models using the logit link were performed for comparison.
Results: The sample consisted of 72 patients comprising data from 128 pairs of teeth. The results for the mean interproximal bone level revealed 5.46 mm for root canal filled teeth and 5.44 mm for teeth without root canal filling (p = 0.89). Using the maximal distance on either the distal or the mesial tooth surface a mean distance of 5.44 mm was detected for root canal filled teeth and 5.38 mm for non-root canal filled teeth respectively (p = 0.66). The differences between the proximal bone level of root canal filled compared to non root canal filled teeth were not statistically significant in both analyses.
Conclusion: Existence of root canal fillings may not be a significant predictor for interproximal bone loss in periodontitis patients.
... At least proper RCF do not seem to affect healing after regenerative periodontal surgery (Cortellini & Tonetti 2001). Katsamakis et al. (2009) compared the radiographic bone loss at teeth with endodontic post and at contra-laterals without endodontic posts. Only a minority (14%) of these contra-laterals were endodontically treated. ...
... Only a minority (14%) of these contra-laterals were endodontically treated. However, the study failed to find a significant difference in bone loss between teeth with and without endodontic posts (Katsamakis et al. 2009). This observation contrasts with the results of Timmerman & van der Weijden (2006). ...
... This observation contrasts with the results of Timmerman & van der Weijden (2006). Katsamakis et al. (2009) failed to find a statistically significant difference between teeth with posts and teeth without posts, of which only 14% were endodontically treated. Thus, they compared, to some extent, again endodontically treated teeth with posts and teeth without RCF (86%) and failed to find a difference regarding interproximal bone loss (Katsamakis et al. 2009). ...
The purpose of this study was to test the hypothesis that teeth that are adequately endodontically treated develop more periodontal bone loss than their contra-lateral counterpart without root canal filling (RCF) in relation to the restoration margin (RM) in periodontitis patients.
In 53 periodontitis patients (26 females; 34-73 years of age), 66 pairs of radiographs were sampled. Each pair of radiographs depicted one pair of contra-lateral teeth: one with and one without RCF. All radiographs were digitized. Using a PC program the linear distances cemento-enamel junction (CEJ) or RM to the alveolar crest (AC) and CEJ/RM to bony defect (BD) were measured at the site of most pronounced bone loss. Comparisons were made according to RCF, RM, site (mesial/distal), jaw and tooth type (anterior/posterior).
The study showed statistically significant differences for the distance CEJ/RM-BD only for tooth type (anterior: 6.17 ± 3.01 mm, posterior: 5.03 ± 2.59 mm, p=0.044; without RCF: 5.14 ± 2.82 mm, RCF: 5.57 ± 2.70 mm, p=0.159; without RM: 5.67 ± 2.98 mm, RM: 5.16 ± 2.61 mm; p=0.322; mesial: 5.62 ± 2.98 mm, distal: 5.06 ± 2.24 mm; p=0.238; maxilla: 5.55 ± 3.04 mm, mandible: 5.20 ± 2.52 mm; p=0.486).
Teeth with endodontic treatment failed to exhibit more bone loss than endodontically untreated teeth.
... as been shown previously that regenerative treatment of intra-bony defects in teeth with or without RCF made no difference regarding attachment gain. However, only RCF without obvious endodontic problems were included in this study. At least proper RCF do not seem to affect healing after regenerative periodontal surgery (Cortellini & Tonetti 2001). Katsamakis et al. (2009) compared the radiographic bone loss at teeth with endodontic post and at contra-laterals without endodontic posts. Only a minority (14%) of these contra-laterals were endodontically treated. However, the study failed to find a significant difference in bone loss between teeth with and without endodontic posts (Katsamakis et al. 2009). T ...
... Only a minority (14%) of these contra-laterals were endodontically treated. However, the study failed to find a significant difference in bone loss between teeth with and without endodontic posts (Katsamakis et al. 2009). This observation contrasts with the results of Timmerman & van der Weijden (2006). ...
... at contra-laterals without endodontic posts. Only a minority (14%) of these contra-laterals were endodontically treated. However, the study failed to find a significant difference in bone loss between teeth with and without endodontic posts (Katsamakis et al. 2009). This observation contrasts with the results of Timmerman & van der Weijden (2006). Katsamakis et al. (2009) failed to find a statistically significant difference between teeth with posts and teeth without posts, of which only 14% were endodontically treated. Thus, they compared, to some extent, again endodontically treated teeth with posts and teeth without RCF (86%) and failed to find a difference regarding interproximal bone loss (Katsamaki ...
Evaluation of the clinical effect of topical subgingival application of doxycycline gel adjunctively to scaling and root planing (SRP) at furcation sites during supportive periodontal therapy (SPT).
In 39 SPT patients exhibiting at least four pockets > or m with bleeding on probing, SRP was rendered in all pockets > or m. Additionally, 14% doxycycline gel was applied subgingivally in 20 patients after random assignment (SRP&DOXY). Clinical parameters were assessed at baseline, 3, 6, and 12 months after therapy. Additional benefit of topical doxycycline was evaluated as a short-term (3 months) improvement of furcation involvement and influence on the frequency of re-instrumentation up to 12 months.
A total of 323 furcation sites (class 0: 160; class I: 101; class II: 18; and class III: 44) were treated (SRP: 165, SRP&DOXY: 158). SRP&DOXY resulted in better improvement of furcation involvement than SRP alone 3 months after treatment (p=0.041). However, SRP&DOXY failed to show a significant difference between both groups in the number of re-instrumentations.
Single subgingival application of doxycycline in addition to SRP had a short-term effect on furcation involvement. However, it failed to reduce the frequency of re-instrumentation up to 12 months at furcation sites.
... The study is limited by the fact that ETT was compared to contralateral ETT without posts or vital teeth. Katsamakis et al. investigated patterns of bone loss around ETT compared to their contralaterals in patients with periodontitis [15] and found that ETT including endodontic posts showed angular bony defects on the mesial surface more frequently. ...
Objectives
Aim was to evaluate the impact of glass fiber versus titanium endodontic posts on the interproximal bone level around severely damaged endodontically treated teeth.
Materials and methods
Thirty-eight participants of a randomized controlled trial on glass fiber (n = 18) and titanium post-endodontic restorations (n = 20) received radiographs at two different times after post placement (T0 = <12 months and T1 = 36–72 months after post placement). A total of 76 radiographs were analyzed with an image-editing software. Medians of changes in mesial and distal interproximal bone level (∆MBL, ∆DBL) were calculated and tested for statistical significance with respect to post material using Mann-Whitney U test (p < 0.05). Impact of post material on bone level changes was assessed in multilevel mixed-effect linear regression models.
Results
The mean observation period was 54 months for glass fiber and 50 months for titanium posts. Interproximal bone loss was small in both groups during the study period with no significant differences between groups (glass-fiber group, ∆MBL = − 0.03 mm and ∆DBL = − 0.06 mm; titanium group, ∆MBL = − 0.07 mm and ∆DBL = − 0.17 mm; both p > 0.05). Overall, impact of post material on bone loss was almost negligible with a nonsignificant difference between materials of 0.10 mm during the entire study period.
Conclusion
The rigidity of endodontic post material has no impact on the level of alveolar bone support of severely damaged endodontically treated teeth.
Clinical relevance
Post-endodontic restorations of severely damaged teeth can achieve steady levels of periodontal bone support as a parameter of periodontal health, irrespective of post material.
Post and cores are often required to restore a tooth after root canal treatment (Eckerbom & Magnusson 2001, Naumann et al. 2006). Numerous factors affect the biomechanical responses of a post-restored tooth. Many studies have investigated the effect of various factors on post/tooth fractures (Naumann et al. 2006, Fernandes & Dessai 2001, Theodosopoulou & Chochlidakis 2009, Fernandes et al. 2003, Standlee et al. 1972, Asmussen et al. 2005, Lin et al. 2010). These factors include post diameter (Post-D) (Okamoto et al. 2008, Du et al. 2011), post length (Post-L) (Boschian Pest et al. 2006, Nissan et al. 2008, Büttel et al. 2009), designs and materials of posts (Okamoto et al. 2008), structural integrity of tooth (Torbjörner & Fransson 2004, Zogheib et al. 2011), location (Eckerbom & Magnusson 2001), ferrule effect (Lu & Zhang 2003, Eraslan et al. 2009, Pereira et al. 2009), and periodontal support of an abutment tooth (Katsamakis et al. 2009, Naumann et al. 2006, Wang et al. 2008). However, most studies have focused only on single factors. This article is protected by copyright. All rights reserved.
This article is protected by copyright. All rights reserved.
This study was undertaken to examine the extent to which the marginal alveolar bone may be influenced by the condition of the dental pulp. A total of 115 pairs of contralateral teeth were observed in 87 patients (25 to 45 years old) in which the test tooth, but not the control tooth, was either endodontically treated or not treated but with a periapical radiolucency. The distance from the cemento-enamel junction to the marginal bone level was measured using intraoral radiographs. The condition of the endodontic filling, the periapical status, and the presence of root canal post were also assessed. With clinical parameters similar between teeth in the two groups in terms of visible plaque, bleeding on probing, probing depth, and attachment level, the results showed a somewhat (mean value 0.1 mm; SD 0.7) larger reduction of the alveolar bone support in test than control teeth. This difference was not statistically significant on a patient level. Hence, this study failed to demonstrate a correlation between a reduced marginal bone support and endodontic status.
This study examined the prevalence of endodontic treatment in a group of 184 Dutch adults, and determined the periapical status of all teeth using panoramic radiographs. The results indicate that in this group, 2.3% of the teeth were root-filled, and that 5.2% of all non-endodontically treated teeth showed signs of periapical pathology. Around the apices of 39.2% of the endodontically treated teeth in this survey, radiographic signs of periapical pathology were observed. Using the level of the root canal filling as a criterion for evaluating the quality of the root canal treatment, 50.6% of the endodontic treatments were qualified as inadequate. There was a significant correlation between the presence of periapical pathology and underfilling of the root canal(s). 44.6% of the patient sample had at least one tooth with radiographic signs of periapical pathology, indicating a substantial future need for endodontic treatment.
This report describes the clinical presentation of three cases of vertical root fractures in adult patients where an initial diagnosis of localized periodontitis had been considered. Loss of the affected tooth occurred in all of these patients. The effects of endodontic therapy and the provision of post-retained restorations are considered in relation to their potential effect of weakening the root and predisposing the tooth to vertical fracture. The last case presents an unrestored molar tooth with a complete vertical root fracture.
The purpose of the present investigation was to evaluate the influence of overhanging marginal restorations on periodontal status and whether any such influence is modified by the patient's oral hygiene level and degree of radiographic attachment loss. The investigation was conducted as a retrospective study on a consecutive referral population. Periodontal pockets at proximal sites with marginal overhangs were significantly deeper (0.42 mm) compared to sites with metal restorations without overhangs. This difference was larger (0.62 mm) for sites with radiographic attachment loss 6 mm, while no significant difference was found for sites with radiographic attachment loss 〈6 mm. In patients with a mean radiographic attachment loss 5 mm, an overhanging restoration margin was associated with a significantly increased loss of radiographic attachment (0.66 mm). It was concluded that the influence of a marginal overhang on pocket depth and radiographic attachment decreases with increasing loss of periodontal attachment in periodontitis-prone patients. The effect on pocket depth of a marginal overhang may act synergistically, potentiating the effect of poor oral hygiene.
The restoration of root treated teeth often requires the use of posts. Their use may affect the quality of the seal of the root canal filling. The various aspects of the relationship between root canal filling and post space preparation are discussed in this review. It is recommended that the use of posts should be avoided whenever possible. Where the preparation of post space is required, immediate removal of gutta-percha using heated instruments and small Gates Glidden drills is the method of choice.
Abstract Prosthodontic treatment of non-vital teeth following endodontic therapy faces problems originating from the fact that such teeth generally have damaged clinical crowns, necessitating retention beyond the remaining coronal portions of the teeth. Additional intraradicular retention can be obtained by means of root canal posts. The total need for retention shows wide variations. Each case, therefore, should be carefully analyzed before decisions arc made about post types, post designs and post dimensions. The need for retention is dependent upon intermaxillary relations, type of prosthetic appliance, position of tooth, and volume and shape of remaining tooth substance. At least 3 mm of well-sealed root canal should be left apically to the post preparation, but normally the post preparation should not extend into the apical one-third of the root. Sufficient additional retention through a post is usually achieved when the extention of the post into the root canal at least equals the difference between the mean height of the prepared coronal dentin and the height of an ideal crown preparation of the tooth.
Abstract Overhanging dental restorations (ODR) are a major dental health problem. An ODR is defined as an extension of restorative material beyond the confines of a cavity, preparation. They have been strongly implicated as an etiologic factor in the progression of periodontal disease and are alarmingly prevalent. In addition to promoting plaque accumulation, they change a nondestructive subgingival flora to a destructive one. There is good documentation that bleeding, gingivitis, and bone loss increase in tissues adjacent to ODR as compared to homologous teeth. Removal of ODR enhances the effectiveness of the hygienic phase of periodontal therapy. Many ODR, however, are not detected on radiographs and are evident only by use of an explorer directed subgingivally. For this reason and others, many are not removed. This literature review summarizes research concerning the prevalence, significance and removal of ODR.
Previous investigations have shown htat corrosion and other electrochemical processes occure when different alloys or metals are found together in the same mouth. In the present report, when teeth were restored using non-noble metallic posts, the metals diffused out to surrounding hard and soft connective tissues. The material consisted of extracted teeth with screw posts and surrounding discolored connective tissues. The screwposts had been cemented to the teeth 3--10 years earlier. The distribution of metal ions was determined by means of energy-dispersive X-ray microanalysis. Copper and zinc were found in both hard and soft tissues. Relatively high concentrations of copper ions were identified in areas of the teeth with blue-green discolorations. Zinc ions were detected in the dentin; they most probably originated from the screwposts and the cement, but zinc is also found in normal human dentin. Copper, zinc, silver and iron were found in the dark discolorations of the gingiva adjacent to the extracted teeth.
Six cases of vertical root fractures accompanied by vertical bone loss are presented. Possible causes for these fractures are suggested. Four vertical fractures probably resulted from the use of excessive pressure at the time of obturation of the canals. One vertical root fracture may have been caused by the cementation of a post, and another may have been caused by the cementation of an inlay in an endodontically treated tooth. All of the fractures resulted in alveolar bone loss to the apical extent of the fracture lines. The definitive treatment in each case was extraction of the tooth or root amputation. In one case successful treatment was accomplished by apically positioning the flap.
The purpose of this in vitro study was to compare the incidence of incomplete root fractures occurring in teeth with and without dentin-retained posts. Eighty extracted human mandibular canines were treated as follows: 20 teeth (controls) received pulpectomies using broaches and sodium hypochlorite; 60 teeth received endodontic therapy with laterally condensed gutta percha. Of those 60 teeth, 20 teeth received Flexi-posts, 20 received Vlock dentin-retained posts, and 20 teeth had no posts placed. All teeth were stained with 5% Oil-Red-O stain for 5 days and sectioned at four levels. The sections were then examined under a stereomicroscope at x20 power. No complete fractures were found. Incomplete fractures were found in two teeth from the endodontic treatment only group, two teeth from the Flexi-post group, and two teeth from the Vlock group. None of the teeth in the control group were fractured. Based upon these results, it was concluded that: 1) Flexi-post and Vlock post placement is no more likely to cause root fracture than is conventional endodontic therapy alone; and 2) incomplete root fractures are more likely to be found in teeth with conventional endodontic therapy than in teeth not treated endodontically.
A longitudinal radiological study was carried out of 200 consecutive patients in a Swedish population. The aims of the investigation were to study the prevalences of crowned teeth, pontics and posts on two occasions with an interval of 5-7 years and, furthermore, to study apical periodontitis in connection with teeth with crowns and posts to see if such treatments affected this prevalence. 417 (mean 2.1) teeth were crowned at the first examination and 529 (mean 2.6) at the second. For pontics, the corresponding figures were 93 (mean 0.5) and 141 (mean 0.7). Crowns and pontics were more common in the upper jaw. 59.4% of the endodontically treated teeth had posts at the first examination and 64.4% at the second. 34.5% of the 255 teeth with apical periodontitis found at the first examination and 41.0% of the 268 at the second were in connection with posts. It was concluded that both crowns and pontics were common treatment procedures in the studied population. Crown therapy did not seem to impair the apical status while teeth with posts more often had apical periodontitis than other teeth and, furthermore, teeth with screw posts were lost more frequently than other teeth.
The aim of the present retrospective study was to evaluate alterations of the alveolar bone level over a 10-year period at tooth sites with "angular" and "even" patterns of bone loss, in subjects who were not exposed to systematic periodontal therapy. A further objective was to evaluate whether the presence of an angular defect can serve as a predictor of additional bone loss. 201 subjects in ages 25-70 years were examined radiographically on 2 occasions 10 years apart. 194 were dentate on the 2nd examination. The radiographic bone height at the mesial and distal aspect of all teeth was assessed by measuring the distance between the cemento-enamel junction and the bone crest. The morphologic pattern of alveolar bone loss at baseline was assessed for each tooth site. Angular defects were classified as degree 1, 2 and 3, according to increasing defect depth. The change in periodontal bone height over the 10-year period was calculated for each site. The results demonstrated an increased frequency of tooth loss among teeth showing presence of an angular bony defect at baseline; whereas 13% of the teeth with an even pattern of bone loss were lost between the 2 examinations, this proportion was 22%, 46% and 68% for teeth with an angular defect of degree 1, degree 2 and degree 3, respectively. Longitudinal bone loss of greater than or equal to 2 mm occurred more often among sites showing an angular defect when compared to sites with an even alveolar bone morphology.(ABSTRACT TRUNCATED AT 250 WORDS)
In this study, I review, clinically and radiographically, 303 patients with 460 single or multirooted endodontically treated teeth. In all teeth, the therapy was performed by me with the use of final restoration of the crown with or without post and full cast crown coverage after treatment. The teeth were functioning for at least 3 years, without having received any other type of dental work since then. I evaluated the existence of vertical root fracture, the function of the teeth, the type of root canal therapy, the type and length of the post, and the type of retention of the post used in all 460 teeth. After statistical evaluation of the results, I found that 3.69% of the teeth had had vertical root fracture. Computer analysis, simple correlation hypothesis, and distribution method with 1 degree of freedom revealed significant correlation between vertical root fracture and the technique of instrumentation and obturation of the canal (p = 0.025), the length of the post (p = 0.05), and the existence of the post (p = 0.05). On the contrary, I found no correlation between root fracture and type of retention of the prefabricated post used with respect to the method of obturation.
Heat treatment during the burnout procedure may cause corrosion of the stainless steel post. This study was undertaken to determine whether alteration of the corrosion resistance of stainless steel posts occurs as a result of various simulated burnout procedures. Stainless steel posts were divided into five groups of five posts: group 1, control; 2, gypsum-bonded investment, bench cooled; 3, gypsum-bonded investment, quenched; 4, phosphate-bonded investment, bench cooled; and 5, phosphate-bonded investment, quenched. The posts were placed in individual containers of Ringer's solution and observed at 30, 180, and 600 days. Scanning electron microscopy, energy dispersive x-ray spectroscopy, optical emission spectroscopy, and optical microscopy were used to evaluate the posts qualitatively and quantitatively. Investment and heat treatment altered the metallic structure of stainless steel posts. Prefabricated posts submitted to simulated burnout procedures had a noticeable reduction in corrosion resistance. Direct casting to stainless steel posts is contraindicated.
In the present retrospective clinical study, 58 patients were examined 4 to 8 years (median 77 months) following the incorporation of a fixed reconstruction. No regular maintenance care had been provided during the interval period. The periodontal conditions represented by the Plaque Control Record (PCR), the Gingival Index (GI) and pocket probing depths were examined on 182 abutment teeth of 94 reconstructions. Pulpal vitality and periapical pathology were assessed clinically as well as radiographically. The periodontal parameters of the abutment teeth were compared with homologous contralateral uncrowned teeth. Significantly higher plaque prevalence, gingival indices, and pocket probing depths were found in the crowned teeth. Also, bleeding on probing was observed more frequently whenever the crown margins were located subgingivally. At the end of the interval period, 3.7% of the originally vital abutments had lost their vitality. A technical failure rate of 7.4% with no apparent differences between conventional and extension bridges was noted. This study indicates that even with precise marginal fit and in the absence of a regular maintenance program, the supragingival location of the crown margin is more favourable than the subgingival location for the maintenance of oral health.
The aim of this study was to determine the prevalence and localization of interproximal periodontal intrabony defects (IPIDs) in the total adult population of a Swedish county. On each interproximal tooth surface (third molars excluded) in 733 randomly selected dentate individuals aged 20 years and over, one examiner recorded from x5-magnified periapical radiographs, the presence or absence of IPID with a width and depth of at least 5 and 10 mm, respectively, representing 1 and 2 mm unmagnified. Intra-examiner reproducibility determined from double recordings was substantial (kappa = 0.66). Recordings of IPID were compared with those performed by 24 specialist periodontists using their own diagnostic criteria. IPIDs were recorded in 32% of the 733 examined individuals; the number of defects per individual ranged from 1 to 15. The prevalence of IPID increased with increasing age and IPID occurred more frequently in men than in women. IPID was observed more frequently on mesial than on distal tooth surfaces, whereas there was no difference between maxillary and mandibular tooth surfaces. Symmetrical localizations of IPID in relation to the sagittal plane were observed.
The present retrospective study was performed to evaluate some long-term alterations of the alveolar bone level at periodontal sites with angular and even ("horizontal") patterns of bone loss. The investigation included 48 patients who, following treatment for advanced periodontal disease, were placed in a maintenance care program which included recall appointments every 3-6 months for a period of 5 to 16 years. The material of the study comprised all teeth at which angular osseous defects (test sites) could be detected in a full-mouth series of radiographs obtained at the end of the active treatment phase. Alterations in the position of the marginal alveolar bone crest and the base of the osseous defect which took place during the maintenance period were assessed by comparing the post-treatment radiographs with a 2nd set of radiographs obtained at the final examination. In the same patients, an equal number of contralateral or neighboring teeth at which bone loss in the radiographs had an even or "horizontal" character were included as controls. The results from the assessments demonstrated that periodontal sites which, following active therapy displayed either angular or "horizontal" patterns of alveolar bone loss underwent, during a 5-16 year period of maintenance, only minor bone level alterations. Additional loss of supporting bone occurred equally frequently at sites with "horizontal" and angular patterns of bone loss. Thus, the findings reported failed to show up sites with angular bony defects as being particularly susceptible to recurrent destructive periodontitis.
The purpose of the present study was to assess by radiographic means the pattern of destructive periodontal disease within the dentition of individuals of different ages. Full-mouth series of intra-oral radiographs from 531 dentate individuals aged 25-75 years were examined with respect to number and type of remaining teeth, location of the alveolar bone in relation to the cemento-enamel junction and presence of angular bony defects. The assessments of alveolar bone levels and angular bony defects were performed at the approximal surfaces of all teeth present. The results showed that although most individuals had experienced a reduction in alveolar bone height with age, only a small number of subjects had developed advanced breakdown of the periodontium. Hence, pronounced bone loss was observed in only 11% of the subjects and was non-existent in ages below 35 years. 23% of the individuals accounted for 3/4 of the total number of sites with bone level values (bone loss) of greater than or equal to 6 mm. Out of the total number of tooth sites examined, 28% showed no bone loss, while 13% demonstrated pronounced periodontal tissue breakdown. Angular bony defects were found at 8% of all teeth examined and were most frequent at the maxillary first premolars. Teeth in the incisor regions consistently showed the highest frequency of advanced alveolar bone loss and the lowest frequency of normal tissue support, while corresponding figures for teeth in the molar regions were found to be the opposite. However, molars were the most frequently missing teeth.
Through a standardized procedure using clinical examination, interviews, and dental history, this 2-year study documents 100 cases of tooth fracture in 98 patients. For comparison, pertinent information was also recorded for more than 2,000 teeth in a randomly selected sample population. Two chief types of fracture were found: incomplete crown-root fractures and root fractures associated with earlier endodontic therapy.
Interproximal subgingival marginal discrepancies of full coverage restorations were compared with adjacent crevicular fluid flow and percentage radiographic periodontal bone loss. A total of 88 patients with 116 premolar crowns were evaluated. Patients were selected at random from student treatment records, Institute of Dental Prosthetics, Royal Dental College, Copenhagen, Denmark. Crevicular fluid collected on filter paper strips from the interproximal area was stained with 0.2% ninhydrin solution and the length of the area measured. Marginal fit was determined by measuring the marginal excess or deficit recorded in a polyether impression. The amount of bone around each crowned tooth was measured on five times magnified prints of radiographs. Percentage bone loss was calculated by dividing the distance from the alveolar crest to the most coronal level at which the periodontal space retained its normal width by the distance from the alveolar crest to the root apex. Correlating marginal fit with crevicular fluid within gingival index scores showed r = 0.32 (G.I.1) and r = 0.42 (G.I.2). Fit vs percentage bone loss showed r = 0.68 and r = 0.59, respectively (P less than or equal to 0.001). Differentiation was further made within the 0.0-0.2 mm range discrepancy by categorizing the data in four groups. Comparing fit relative to crevicular fluid and bone loss, most of these groups were significantly different when analyzed statistically using the Mann-Whitney U-Test. Small defects less than or equal to 0.050 mm were associated with significantly less fluid flow and bone loss than defects exceeding this value.
Three hundred and sixteen fixed partial dentures made in 1975-1976 by 112 general practitioners in Malmö, Sweden, were selected for a questionnaire study of the technical failure rates after 6-7 years. Cariologic, periodontal, endodontic, and esthetic complications were also identified, as were those appearing in the stomatognathic system. The total material consisted of three groups with an approximately equal number of reconstructions. One group consisted of fixed partial dentures with distal abutment teeth, another was formed of fixed prostheses with single cantilever pontic/pontics, and a third consisted of double cantilever pontics. Excluding the 26 reconstructions, which had been made for patients who died (24) or emigrated (2) during the observation period, data was obtained for 97% of the selected restorations. The results showed high rates of cariologic (18-31%), endodontic (5-23%), periodontal (7-12%), esthetic (10-16%), and technical (8-34%) complications. Differences were noted between the groups. For all types of technical failures (fractures and loss of retention) higher frequencies were related to the extent of cantilevering. Direct relationships were found between the technical failure rate and the time in service, the sum of all cantilever extension pontics in the reconstructions, and the state of the pulps of the distal abutments. No relationship was found between the technical failure rate and the status of the dentition in the opposing jaw. The clinical significance of the results obtained is discussed.
Endodontically treated teeth were restored by 8 different methods. Copper rings were filled with commercial hard setting cement and the teeth were placed into the cement to the level of the cemento-enamel junction. The teeth were grouped according to restorative methods, mounted in an Instron T.T. machine and subjected to a slowly increasing compressive force until fracture occurred. The force of fracture for each tooth was recorded and the results in the various groups compared. All teeth fractured in a similar manner, irrespective of restorative method used. Preparation of a post space in the roots significantly weakened the teeth. Cementation of a steel parapost with zinc oxyphosphate cement did not significantly strengthen the teeth. Filling the post space and the access cavity with a composite resin following acid etching of the root canal and cavity walls strengthened the teeth more than other methods used to restore them. This finding may be of clinical importance, for instance in the restoration of endodontically treated young teeth with incomplete root formation and wide root canals.
For a long time the major emphasis in prosthetic dentistry was placed on the technical and mechanical aspects of the different procedures and material used. The relationship between the prosthetic treatment and the periodontal tissues received less attention. As a consequence early results of epidemiological studies were not encouraging since they revealed that prosthetic treatment may be an important contributory factor in the aetiology of periodontal diseases. Research during the last two decades into the aetiology and pathogenesis of these diseases has revealed major principles and finer details relating to the mechanisms of their initiation and progression. Recent research has shown that cooperation between the prosthodontist and the periodontist, based upon agreed fundamental concepts, may give encouraging results in the prosthetic replacement of lost teeth. The study reported here assesses the effects upon the periodontal tissues of fixed bridges over a six and twelve year period.
A rationale has been presented for cast post and core construction based on both endodontic and fixed prosthodontic principles.
Dentin stresses from simulated functional loads to post-reinforced tooth models with four levels of periodontal support were calculated using finite element analysis. As bone levels diminished, stresses were found to increase dramatically and to concentrate in the small amount of dentin remaining near the post apex.
Apical leakage was analyzed quantitatively in extracted teeth with varied levels of remaining gutta-percha. The effect of the method of gutta-percha removal on the apical seal was also evaluated. Ninety teeth were prepared so that 30 teeth had 3 mm of gutta-percha, 30 teeth had 5 mm, and 30 teeth had 7 mm. An additional 75 teeth were divided into three groups of 25 each. A different method of gutta-percha removal was used for each group: hot instrument, mechanical rotary instrument, and chemical solvent. An electrochemical method was used to analyze apical microleakage. Measurements of leakage of each sample were obtained at 24-hour intervals for 30 days. The data suggest that the mechanical method is the most desirable for gutta-percha removal in post preparation. As the level of gutta-percha increased to 7 mm the degree of leakage decreased. At least 5 mm of gutta-percha is necessary for an adequate apical seal.
The close association between restorations with overhanging margins and chronic destructive periodontitis has been known for many years. However, the mechanisms by which overhanging restorations will interact in the pathogenesis of periodontal disease are still unknown. Generally it is accepted that overhanging restorations contribute to the promotion of the disease process by virtue of their capacity to retain bacterial plaque. The purpose of the present study was to determine if the placement of subgingival restorations with overhanging margins results in changes in the subgingival microflora.
9 dental students with clean teeth and clinically healthy gingivae (GI < 0.1) gave their consent to participate in the study. 5 MOD cast gold onlays with 1 mm proximal overhanging margins were placed in mandibular molars for 19–27 weeks. They were replaced in a cross‐over design by 5 similar onlays with clinically perfect margins which served as controls. Another 5 onlays were placed in reverse order in the remaining patients.
Prior to and every 2–3 weeks after insertion, subgingival microbiological samples were obtained by inserting a fine sterile paper point for 30 sec into the gingival sulcus subjacent to the restoration. The predominant cultivable flora was determined using continuous anaerobic culturing techniques. Following the placement of restorations with overhanging margins, a subgingival flora was detected which closely resembled that of chronic periodontitis. Increased proportions of Gram‐negative anaerobic bacteria black‐pigmented Bacteroides and an increased anaerobe: facultative ratio were noted. Following the placement of the restorations with clinically perfect margins, a microflora characteristic for gingival health or initial gingivitis was observed.
Black‐pigmented Bacteroides were detected in very low proportions (1.6–3.8%). These changes in the subgingival microflora were obvious irrespective of whether the restorations with the overhanging margins were placed in the first period of the experiment or following the cross‐over. Clinically, increasing gingival indices were detected at the sites where overhanging margins were placed. Bleeding on gentle probing always preceded the peak level of black‐pigmented Bacteroides , Loss of attachment was not detected in any site. Changes in the subgingival microflora after the placement of restorations with overhanging margins document a potential mechanism for the initiation of periodontal disease associated with iatrogenic factors.
Fractured roots were examined histologically, using different stains, to study the morphological fracture patterns and to identify potential irritants. Fractures were usually, but not always, complete and extended from a surface to include the root canal. The potential irritants identified in both the fracture space and communicating canal were bacteria, necrotic tissue, food debris, and unidentifiable amorphous substances. Soft tissues on the root surface adjacent to the fracture were inflamed with occasional ingrowth into the fracture space. The nature of the fractures and irritants demonstrated why vertical root fractures often cause marked tissue destruction.
The interproximal distance between adjacent root surfaces and the presence of intrabony pockets (IBP) facing these surfaces, was measured and recorded during 114 gingival flap procedures in 81 patients. Measurements were carried out in 344 interproximal areas and 117 IBP were detected at these sites. The correlation between the interproximal distance and the presence of IBP was positive and statistically significant (r = 0.81; P less than 0.001). The frequency of IBP increased with increasing interdental distance (slope (s) = 5.723). When interdental distances between 2.1 and 4.5 mm were analyzed, the correlation and slope were high (r = 0.96; P less than 0.01; s = 19.87). No significant correlation (r = 0.36; P greater than 0.4) existed when interproximal distances greater than 4.6 mm were analyzed separately. Intrabony pockets were frequently associated with interproximal distances greater than 2.6 mm (20-57.1%). They were less common (5-20%) when the interproximal distances were less than 2.6 mm. Two IBP in the same interdental areas were present only when these areas were greater than 3.1 mm. Based upon the present data, it seems that the frequency of IBP increased as the distance between adjacent teeth increased. However, when this distance was 4.6 mm or more, no further increase in the percentage frequency of IBP was noted.
Thirty-two cases of vertical fractures were studied in an attempt to identify the causes and diagnostic signs normally present. In all of the patients except two, osseous defects were present and could be probed. The majortiy (65.63 percent) had only mild pain or a dull discomfort. Seventy-five percent showed diffuse widening of the periodontal ligament space. This study suggests that excessive force during lateral condensation of the gutta-percha caused 84.38 percent of the fractures. A secondary cause was the forcing or tapping of inlays or dowels into place. The majority (78.13 percent) of the patients were over the age of 40. In all but nine of the cases, treatment consisted of the extraction of the involved teeth.
Dental root posts of gold-plated brass and German silver caused injury of human gingival fibroblasts in vitro. Posts made of stainless steel, titanium and gold alloys showed no discernible effects of cell morphology of apparent metabolic activity during the two-week period of observation.
A theoretical investigation has utilized the finite element technique to analyze mechanical stress patterns in a reconstructed maxillary central incisor. A series of designs for endodontic dowel posts incorporated into prosthesis has been comparatively evaluated. For the load condition considered, the results show that minor changes in the stress patterns are produced by the post diameter, length, and taper variations considered. 1. In general, larger post diameters decrease the maximum stresses for both the cylindrical and tapered designs. Variation of diameters over a 15% range produced stress variations of about 8%. 2. The effect of post length on the highest stresses in bending was less than the diameter changes. The real effect of the length changes was to change the location of the stress concentrations that occurred at the post apex in all cases. 3. The effect of taper was found to be slight if the local tapered-post diameter was comparable to the cylindrical post diameter in the high-stress region. 4. For the load considered in this study, the tapered-post design experienced slightly higher tensile and slightly lower shear stresses than the cylindrical post. 5. Using the peak stresses in the dentin and at the dentin-post interface as a criterion, the cylindrical post with the largest diameter is the best design among those examined.
The purpose of the present investigation was to evaluate the influence of overhanging marginal restorations on periodontal status and whether any such influence is modified by the patient's oral hygiene level and degree of radiographic attachment loss. The investigation was conducted as a retrospective study on a consecutive referral population. Periodontal pockets at proximal sites with marginal overhangs were significantly deeper (0.42 mm) compared to sites with metal restorations without overhangs. This difference was larger (0.62 mm) for sites with radiographic attachment loss < or = 6 mm, while no significant difference was found for sites with radiographic attachment loss > 6 mm. In patients with a mean radiographic attachment loss < or = 5 mm, an overhanging restoration margin was associated with a significantly increased loss of radiographic attachment (0.66 mm). It was concluded that the influence of a marginal overhang on pocket depth and radiographic attachment decreases with increasing loss of periodontal attachment in periodontitis-prone patients. The effect on pocket depth of a marginal overhang may act synergistically, potentiating the effect of poor oral hygiene.
The purpose of the present investigation was to explore possible relationships between clinical periodontal status in periodontally involved teeth with and without endodontic infection. The investigation was conducted as a retrospective study on a consecutive referral population. The periapical conditions in endodontically-involved single-rooted teeth from a selected patient sample were evaluated and correlated to their periodontal status. There was a significant correlation between periapical pathology and vertical bony destructions. An intra-individual comparison between pocket depth in teeth with and without periapical pathology showed that periapical pathology was significantly correlated to an increased pocket depth in the absence of a vertical bony destruction. It was concluded that an endodontic infection, evident as a periapical radiolucency, promotes periodontal pocket-formation on an instrumented marginal root surface and, consequently, should be regarded as a risk factor in periodontitis progression and be given appropriate consideration in periodontal treatment planning.
The restoration of root treated teeth often requires the use of posts. Their use may affect the quality of the seal of the root canal filling. The various aspects of the relationship between root canal filling and post space preparation are discussed in this review. It is recommended that the use of posts should be avoided whenever possible. Where the preparation of post space is required, immediate removal of gutta-percha using heated instruments and small Gates Glidden drills is the method of choice.
A clinical study was done on 36 original cases of vertical root fractures along with the data gathered from 32 cases published previously in the literature. Vertical root fractures most frequently occur in posterior teeth in patients between 45 and 60 yr of age. The average elapsed time between the endodontic treatment and the subsequent diagnosis of vertical fracture was found to be approximately 10 yr. The evidence and symptoms most often found are mild pain in the area of the fractured tooth often accompanied by swelling and fistula, along with a deep pocket in just one area of the attachment surrounding the tooth. The sign most often revealed by X-ray is a radiolucent periradicular band.
Periodontal bone loss was compared in teeth with metal posts and contralateral teeth without metal posts by means of intraoral radiographs. 250 subjects with a high standard of dental awareness and a great number of teeth retained were included in the study. The periodontal bone loss was calculated from the ratio of the distance from bone margin to apex (bone height) and the distance from crown tip to apex (tooth length). Intra-individual differences between experimental and control teeth were statistically analyzed with the Student paired t-test. 96 subjects (38%) had > or = 1 teeth with root posts. In all, 172 teeth with posts were found, i.e., on average 1.8 teeth per subject. The means +/- SEM of the ratio bone height to tooth length in experimental and control teeth were 0.52 +/- 0.007 and 0.56 +/- 0.006, respectively. The difference was statistically highly significant (P < 0.001). Statistically significant differences were found for incisors, premolars and molars. Regression analysis indicated more severe bone loss for teeth with longer posts. The results suggest that the periodontal bone support of teeth with metal posts is inferior to that of teeth without metal posts.
This study was conducted to 1) measure the sensitivity of human and mouse macrophages to metal ions which are released from dental biomaterials, 2) compare these sensitivities with those of other cell types in the oral cavity, and 3) determine if metal ions alter the metabolism and synthetic processes of these cells at lower concentrations than are required to lyse the cells. This information will help define the biological risks associated with the release of metal ions into the oral cavity.
Macrophages were exposed to a range of concentrations of Ag1+, Au3+, Cu2+, Hg2+, Ni2+, Pd2+, Pt4+, and Zn2+ for 24 h in cell culture. The concentrations which caused a 50% decrease in succinic dehydrogenase (SDH) activity, protein production, and lactate dehydrogenase (LDH) release were measured and compared with these values for fibroblasts and osteoblasts.
Most metal ions caused alteration in SDH activity and protein production at lower concentrations than were required to induce LDH release. There were exceptions to this trend, and the differences were not always statistically significant. Furthermore, although the macrophages sometimes had statistically different sensitivities to metal ions than fibroblasts or osteoblasts, these differences were less than one order of magnitude. Macrophage response to the metal ions was highly dependent on the metal ion and the species of macrophage.
Macrophages react adversely to metal ions at similar concentrations as other cell types found in the oral cavity. Furthermore, the concentrations which affect cell metabolism and protein production are generally lower than those which lyse the cells. Thus, non-lethal concentrations of metal ions may alter the secretion of protein inflammatory mediators such as cytokines which direct the inflammatory response in tissues.