History of Endodontics aae/abe



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Dystrophic Calcification

Diffuse foci of calcification frequently found in the aging pulp; usually described as being perivascular or perineural.



Age & Pulp Stones / pulpal calcification


  1. Bernick – Age causes:

    1. Reduction in vascular supply, innervation (loss of plexus of rashkow), cellularity (odontoblasts deterioration), and pulp chamber size (due to deposition of dentin)

    2. Increase in calcified masses and collagen (relatively) within the pulp




  1. Hendricks-Klyvert – incidence of calcifications 8-90%

    1. Pulp stones – calcifications

    2. Denticles – composed of dentin


Types: Free, attached, embedded

Characteristics: Normal or Inflamed, Old or Young, Occurs in 50% pulps, Asymptomatic, No detrimental effect on pulp



What lines sinus tracts?



Baumgartner

  1. 100% of sinus tracts are lined with epithelium to the level of the rete ridges (epithelium/CT barrier)

  2. 67% had granulomatous tissue lining the tract past the rete ridges

  3. 33% had epithelium lining the entire way


Harrison/Larson

  1. 10% lined with epithelium

  2. 90% lined with granuation tissue


Gupta

  1. Overall Incidence of Sinus Tracts (Teeth with PARLs): 18%



Discuss the Cracked Tooth

  1. Cameroncoined term Cracked tooth syndrome, most commonly found in the mandibular second molar (#1- biting pain, #2-acute onset thermal sensitivity)




  1. HiattMand 2nd Molar>Mand 1st Molar>Max PMs = Max 1st Molar; 70%: non-restored or minimally restored




  1. Abou-Rass – Transillumination and Staining for diagnosis of Cracked Tooth




  1. Rivera – Classified longitudinal tooth fractures

    1. Craze lines

    2. Cuspal fracture

    3. Cracked tooth

    4. Split tooth

    5. Vertical root fracture




  1. Ehrmann – Ortho band – eval 2-4 wks  symptomatic RCT/Crown

Discuss the Cracked Tooth

  1. Krell/Rivera 200620% Reversible Pulptitis/Cracked teeth treated with full coverage crown required NSRCT by 6 mos due to IP or PN. 9.7% incidence.




  1. Berman/KuttlerFracture necrosis - 27 teeth w/ PN and M-D crack (no or shallow rest.), ext, micro CT, cracks deep onto root surface, Rec. EXT




  1. Tan 2006 – 1st longitudinal crack retrospective outcome study (49 patients) – RCT/Crown – 85.5% survival at 2 years. Sign. Outcome factors: terminal tooth, multiple cracks, pre-op probing depth; Location/extent not sign. factor.




  1. Seo/Park JOE 2012 – Characteristics of Cracked teeth: 67% No restoration/Class I; Bite test #1 diagnostic test; Staining/transillumination


  1. Abbott/Leow 2009 – Cracked Tooth Syndrome is not a “syndrome”





  1. OpdamCuspal coverage composite; Signore – Cuspal coverage amalgam

Vertical Root Fracture


**Tamse/Fuss 1999:

  1. J-shaped” lesions on PA

  2. Etiology- Intraradicular Posts, Lateral condensation

  3. #1- Max 2nd PM, #2- Mesial root Mand Molar

  4. 67% had isolated buccal perio defect; 34% sinus tract closer to g.m. than apex


Holcomb/Pitts; Meister – VRF from lateral condensation – 84% (wedging forces)
PetersVRF from occlusal loading of Posts
Rud/Omnell79.8% VRFs had isolated narrow perio pocket
Pitts/Natkin – Exploratory Sx: “Punched out” bony les. (dehisc/fenest) – granulomatous tissue; perio abscess, multiple sinus tracts (pathognomonic)


Ross
Carbon fiber, Parallel sided posts least likely to cause VRFs
Cohen/Berman 2006 – VRFs: Max PMs, Mand 1st Molars; RCT; >40 yo

Periapical Index

Orstavik 1986 – 5 categories, modeled on diagrams/histological diagnoses by Brynolf, Radiographic size of periapical lesion, 1=healthy, 2, 3 = uncertain, 4, 5 = diseased; 1=normal, 2=small changes in bone, 3=changes in bone w/mineral loss, 4=AP w/well defined RL area, 5=Severe AP w/exacerbating features
Estrella 2008 – PAI for CBCT:

0 = Intact periapical bone structures

1 = Diameter of PARL > 0.5 – 1.0 mm

2 = Diameter of PARL > 1.0 – 2.0 mm

3 = Diameter of PARL > 2.0 – 4.0 mm

4 = Diameter of PARL > 4.0 – 8.0 mm

5 = Diameter of PARL > 8.0 mm

Score + E = Expansion of periapical cortical bone

Score + D = Destruction of periapical cortical bone

Periapical Index (PAI) – Orstavik/Kerekes (1986)

Radiographic Assessment of Apical Periodontitis:
1 – Normal – No Periapical bone loss evident

2 – Small bony changes periapically, not pathognomic for AP

3 – Bony changes with Mineral Loss, characterisitic of AP

4 – AP with well defined RL area

5 – Severe AP with radiating expansion of bony changes
Cone Beam CT Periapical Index (CBCTPAI) – Estrella (2008)

CBCT Assessment of Apical Periodontitis:

0 – Normal – No Periapical bone loss evident

1 – PARL: >0.5 – 1 mm E – Expansion of Periapical cortical bone

2 – PARL: >1 – 2 mm D – Destruction of Periapical cortical bone

3 – PARL: >2 – 4 mm

4 – PARL: >4 – 8 mm

5 – PARL: >8 mm


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