UMKC Spreadsheet Random Part 2 Flashcards by Chris Lingard

Electronic apex locator Review of EAL vs. Radiographs: Decreased radiation, improved accuracy of EAL

McDonald, 1990

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Frequency of pain following RCT Syst Rev: 5.3% of RCT treated teeth may have persistent pain

Nixdorf, Law, 2010

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Oraverse Alpha adrenergic blocker to reverse effects of anesthetic

Prasanna, 2012

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Coronal Seal Demonstrated recontamination of obturated RCS when bacteria placed in natural saliva within 30 days

Khayat, Torabinejad, 1993

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Improving IANB success in hot teeth For symptomatic irreversible pulpitis, administration of 30%-50% nitrous oxide resulted in increase in success of the IAN block compared with room air/oxygen.

Reader group, 2012

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4 Visit Endo supported 97% one step, 89% two steps

Paredes-Vieyra (2012)

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How to remove separated files Removal of separated instruments: needle sleeve tech, endo extractor, braided Hedstrom files, Masserann kit, US, Gonon post remover

Hulsmann, 1993

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Incision and Drainage Most effective treatment for abscess is obtaining drainage through I&D or through tooth via pulpectomy

Matthews, Sutherland, Basrani 2003

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Sub-epithelial external root resorption New terminology

Levine (Dental Pulp)

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Interpretating radiographs 25% agreement between the 6 examiners and 50% between 5 out of 6. Who’s reading the digital radiograph

Hartwell, 2011

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Sinus tracts Presented cases where sinus tract was tracked to adjacent teeth; ALWAYS track sinus tracts

Kelly, 1988

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NSAIDS + APAP Placebo vs. Ibuprofen 600 mg vs. Ibu 600 mg + 1 g APAP = Ibuprofen + APAP showed significantly greater pain reduction

Menhinick and Gutmann, 2004

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Immune components involved First to describe Substance P in pulp tissue

Olgart, 1988

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Ca(OH)7 IC ledermix more effective than Ca(OH)2 at decreasing pain in SAP patients

Messer, 2003

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Prognosis? Prognosis of Perio/Endo lesions depends ulitmatley on periodontal prognosis.

Hiatt, 1977

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Can Perio cause Endo problems? Found no correlation between severity of perio disease and histological status of pulp

Mazur, Massler, 1964

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How to avoid file separation No ProTapers separated when patent glide path established

Peters, 2003

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Electronic apex locator Preflaring canals increased efficacy of Root ZX

Ibarrola, Chapman, 1999

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Remove smear layer? First to describe smear layer, removed with NaOCl and REDTA

McComb, Smith, 1975

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E. faecalis Found Enterococcus in 78% of 100 failed NS RCT, bacteria in failing Endo differs from Necrotic pulp (more facultative anaerobes in failing endo)

Molander, 1998

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Invasive cervical resorption Classification and etiology (ortho, trauma, bleaching)

Heithersay, 2004

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Managing fluctuancy Vertical incisions bleed less since most vessels run parallel to long axis of tooth

Macphee, Cowley, 1981

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MTA Direct pulp cap Direct Pulp Caps = MTA (success of 78%); Ca(OH)2 (success rates of 60%)

Mente, 2010

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PAR vs. No PAR 95% w/o PAR, 85% w/PAR

Imura (2007)

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2 Visit Endo supported 81% one step, 71% two steps (all had PAR)

Peters, 2002

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Preoperative CHX Preoperative CHX reduces flora 94% immediately and 78% even after 10 days

Martin, Nind, 1987

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Frequency of pain following RCT Syst Rev: 3.4% of RCT treated teeth with persistent pain have nonodontogenic pain

Nixdorf, Law, 2010

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Perforation repair If perforation immediately repaired, favorable healing occurred

Lantz, 1967

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Methods of vitality testing Endo ice can elicit response through crown

Johnson, Miller 2004

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Where to stop obturation? Meta-analysis shows within 2 mm of apex improved success

Ng, 2008

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Methods of vitality testing Compared cold, heat, and EPT: Cold was most reliable for positive and negative results

Petersson, 1999

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Formocresol pulpotomies Systemic distribution of formaldehyde after formocresol pulpotomies

Pashley, Myers, 1980

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Apical plug vs. obturate entire RCS Seal of 3-5 mm MTA plug is similar to completely obturated root over time; no difference in fracture resistance between the two treatments

Martin, Pashley, Tay, 2007

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Healing w/open apex? CLASSIC: immature teeth can have pulp survival and regeneration of nerve function after replantation, especially if have open apical foramen

Ohman, 1965

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Direct Pulp Cap 80% healing (uninflammed pulps)

Ravn

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Md Laterals 55% - 1 canal, 45% - 2 canals

Kartal, 1992

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How long to stabilize? After orthodontic extrusion, recommended 1 month stabilization for every 1 mm moved

Lemon, 1982

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Concerns with Hemostatic agents Rabbit: Ferric sulfate left in situ delayed healing

Lemon, Jeansonne, 1993

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Lidocaine for blocks (not articaine) Based on sales vs incidents of paresthesia - lidocaine and articaine have similar incidence, prilocaine has disproportionately high incidence

Pogrel 2007

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Concerns with Hemostatic agents Rats: Surgicel and bone wax left in situ delayed healing, complete healing with gelfoam

Ibarrola, 1985

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Problems with crowns 5.7% of vital teeth treated with full coverage crown needed RCT

Jackson, Skidmore, Rice 1992

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Temporaries Cavit - sealing properties

Parris, Kapsimalis

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Landmark Article 1st description of orthodontic vertical root exrrusion

Heithersay, 1973

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3 Visit Endo supported 75% two steps, 65% - one step

Molander, 2007

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External cervical resorption Review

Patel, 2009

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MTA F. nucleatum leakage study: 0% leakage with MTA, 44% leakage with Amalgam

Nakata, Baumgartner, 1998

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C-shaped canals Review of C shaped canals

Jafarzedeh 2007

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AH 26 AH26 cytotoxicity due to formaldehyde release from epoxy resin, NOT released from AH plus

Leyhausen, 1999

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Rate of PAR healing PARs heal at rate of 3.2 mm/mo; <12 mo.

Murphy

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Mental foramen Most common location of mental foramen inferior to crown of 2nd PM and 60% of distance from B cusp tip of that tooth to inferior border of mandible

Phillips and Kulild, 1990

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Vital vs. Necrotic 95% Vital, 88% Necrotic

Imura (2007)

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Cemental tear Report of cemental tear in endodontic literature. Case reports associated with age, trauma, and traumatic occlusion

McClanahan, 2006

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Ferrule effect 1.5-2 mm of ferrule needed

Juloski, 2012 (Syst. Rev)

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Pulpotomy Pulpotomies reduce pain regardless of use of sedative dressing

Hasselgren, 1989

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Focal Infection Theory Ignited the theory, attributed mulitude of diseases to focal infection, Mauseleums of gold?

Hunter, 1910

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Indirect Pulp Cap <50% healing (11/24 cases)

Jordan, Suzuki, Skinner

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Orthodontic considerations Endo treated teeth an be moved orthodontically without increased risk of resorption, NSD between resorption of endo and non treated teeth

Mattison, Delivanis, 1984

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Immune components involved Immune components found in pulp: T & B lymphocytes; Plasma cells; Macrophages; Dendritic cells; Cytokines & Prostaglandins

Jontell, 1998

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PDL PDL is an intraosseous injection with significant CV effects

Pashley, 1986

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Problems with crowns Endodontically treated teeth not crowned after obturation were lost at a 6.0 times greater rate than teeth crowned after obturation

Kaplan, 2002

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Flare-ups Prophylatic Pen VK reduced flareups from 2-20%

Morse, Furst, 1987

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Extrusion Damage to the IAN as the result of root canal therapy, surgical debridement within 48 hrs ass. w/ resolution of symptoms (he’s an oral surgeon)

Pogrel, 2007

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Antibiotics for pain relief? Antibiotics gave no pain relief for patients with untreated irreversible pulpitis

Keenan, 2006

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Effect of Endo on tooth Previous studies believed RCT dried out teeth. This study: vital dentin = 12.4% moisture; root filled dentin = 12.1%

Papa, Messer, 1994

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Focal Infection Theory bacteremias occur in healthy patients undergoing routine toothbrushing or flossing without adverse effects

Nair

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Immunoglobulins PAR contain IgG>A>E>M for cysts and granulomas

Pulver, 1978

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Preflaring canals Preflaring canals increased efficacy of Root ZX

Ibarrola, Chapman, 1999

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Dentinal permeability Dynamics of dentinal permeability (diameter, density, etc?)

Pashley

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Non Endo Pain Craniofacial pain only complaint during ischemic episode in 6% of patients.32% reported craniofacial pain concomitant with pain in other regions.

Kreiner, Okeson, 2007

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1 vs. 2 visits? No difference in incidence of pain when treatment performed in 1 visit or 2

Mulhern, 1982

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Decoronation Described decoronation

Malmgren, 2000

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Canal walls clean? All instrumentation techniques (lightspeed, profile, GT, NiTi hand files) left 35% or more of the canals? surface area unchanged.

Peters 2001

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Why do some PARs not heal? Why some PARs don’t heal: Persistent intracanal infection, true cyst, extradicular infection, foreign body, cholesterol crystals

Nair, 1999

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Trust the Patient? ER pts can locate tooth 73% of time if PDL is not involved, 89% if PDL involved.

McClanahan, Bowles, 2010

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Membrane needed? Calcium sulfate excludes soft tissue

Pecora, 1997

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When to recall? Endodontic recall at 1 yr; peak incidence of healing is 1 yr, may take 4 years, 76% of PAR developing after NS RCT are seen at 1 y

Orstavik, 1996

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Cvek Pulpotomy 91% healing (young molars)

Mass

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Ibuprofen masking diagnosis Tested SIP/SAP teeth, found that ibuprofen taken 1 hr before diagnosis can cloud diagnosis, bite test (Asma Khan’s baby) can save you

Read, McClanahan, Bowles 2014

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Spaces of infection Spread of infection: factors include virulence of organism, host resistance, and muscle and fascial arrangements

Laskin, 1964

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Temporaries Cavit and TERM were more leakproof temporary restorations as compared with IRM

Pashley, 1988

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Gate Control Theory Gate Control Theory of Pain

Melzack, Wall, 1965

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Don’t trust radiograph Difference between apical foramen and anatomic apex can vary as much as 2 mm

O’Neil, 1974

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Necrosis with calcification? Suggested that 15-20% of teeth showing calcific metamorphosis due to trauma become necrotic

Jacobsen

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Can Perio cause Endo problems? Pulpal/Perio interactions, pulpal necrosis occurs only if apical blood supply is compromised

Langeland

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Adjust occlusion? Occlusal adjustment no difference in pain relief with symptomatic irreversible pulpitis

Parirokh, 2013

Bacteria in Tubules? Bacteria can invade upt to 150-250 um into dentinal tubules

Love, 1996

Strange morphology Dens invaginatus: infolding of dental papilla during development; Mechanism of action unknown

Hulsmann, 1997

Internal resorption Review

Patel, 2010

Pulpotomy only? No difference in pulpotomy, pulpectomy on post-endo pain

Maddox & Walton, 1978

Apical foramen anatomy Described major and minor diameters, CDJ is 0.5-0.75 mm from anatomical apical foramen (fill to radiographic apex is overextended) (Green did this too, just not as well)

Kuttler, 1955

Orthodontic considerations Orthodontic movement always causes external root resorption

Mattison

Why do some PARs not heal? Pocket cysts (he renamed from Simon’s Bay Cyst) should heal following NS RCT, Large true cysts are less likely to heal following NS RCT

Nair, 1996

Md Canines 82% - 1 canal, 5% - 2 canals

Pineda, 1972

Caries effect on pulp If thickness between caries and pulp was 1.11 mm, no significant lesion in pulp. When less than 0.5 mm acute inflammation occurs

Reeves, Stanley, 1966

NS RCT success? 91% Healed

Imura (2007)

Methods of vitality testing Cold test with cotton pellet, not q-tip because cotton pellet holds more refrigerant

Jones

Necrosis with calcification? Review of PCO: Up to 25% of traumatized anterior teeth can develop PCO; Discoloration is common w/PCO; Up to 75% with PCO are symptom-free and require no TX

McCabe, Dummer, 2012

Trephination to relieve pain? Trephination wasn’t justified because more pain occurred after pulpectomy + trephination vs. pulpectomy alone

Moos, 1996

Flare-ups No change in prognosis if flare-up occurs

Kerekes, Tronstad, 1979

Curettage all tissue? Periapical curettage: remove for visability, but need not remove all granulation tissue for healing to take place

Lin, Langland, 2007

Focal Infection Theory Great Review of focal infection theory

Pallasch, Wahl, 2000

How to avoid file separation Aqueous EDTA showed less torque and force on rotary instruments than past-type EDTA

Peters, 2005

Landmark Articles Called for endodontic instrument standardization (occurred in 1976)

Ingle, 1955

Why Chloroform? Chloroform greatly facilitated removal of thermafill carriers

Ibarrola, 1993

NaOCl accident NaOCl incidents: How to avoid, signs and symptoms

Hermann, 1989

Access Laws of finding canals: centrality, CEJ, Symmetry, Color change, Orifice location (wall and floor, fusion lines)

Krasner, Rankow, 2004

Prognostic factors Pre-operative absence of PAR, root filling with no voids, RCF within 2 mm of xray apex, satisfactory coronal restoration improved primary root canal outcome

Ng, 2007

Regendo First suggested bleeding and regenerative endodontics, (Iwaya 2001, Banchs & Trope 2004 cases)

Nygard-Ostby, 1961

Focal Infection Theory Introduced focal infection theory; human mouth is focus of infection

Miller, 1890

Crown Down Instrumentation Developed crown-down technique

Marshall

Bacteria needed for PAR Bacteria necessary for PAR formation, gnotobiotic rats

Kakehashi, Stanley, Fitzgerald 1965

C-shaped canals Classification for C shapes C1-5

Melton 1991

Prognostic factors Pre-op absence of PAR; small vs big PAR; absence of pre-op sinus tract; patency; RCF close to apex; use of EDTA then NaOCl 2?RCTx; no 2% CHX; absence of tooth/root perforation (P = 0.06); absence of interappointment flare-up (pain or swelling) (P =0.002); absence of RCF extrusion; satisfactory coronal restoration

Ng, 2011

PAR prevention P/E selectin knockout mice; showed that PMN’s and macrophages protect against PAR,

Kawashima, Stashenko, 1998

PAR vs. No PAR Teeth with PAR prior to NS RCT had lesser success rates

Kerekes, Tronstad, 1979

Sargenti Paste re-emergence of sargenti paste

Musikant et al

Methods of vitality testing Cold test with CO2 ice safe on enamel and porcelain

Peters 1983

Coronal Seal Retreatment of obturated root canals that have been exposed to the oral cavity for at least 3 months.

Magura, 1991

NS RCT success? Washington Study (94% success)

Ingle

Transillumination Describes transillumination as a useful adjunct

Hill, 1986

1 Visit Endo supported 85% one step, 80% two steps (all had PAR)

Penesis, 2008

Ca(OH)3 Ca(OH)2 remains best IC med available to reduce microbial flora

Law, 2004

Pain relief? Systematic review: Antibiotics gave no pain relief for patients with untreated irreversible pulpitis

Keenan, 2006

Improving IANB success in hot teeth For SIP, 0.5 mol/L mannitol added to 1.9 mL lidocaine with epi resulted in higher success. the combo lido/mannitol formulation would not result in predictable pulpal anesthesia

Reader group, 2012

Apical resorption In teeth with PAR, 81% revealed apical inflammatory root resorption

Laux, 2000

Ododontoblasts Odontoblasts extend 1/3 the length of tubule

Pashley

RETX vs. primary endo 83% healing in primary and 80% healing in RETX

Ng, 2011

MTA Plug MTA Plug success rate: 85% w/PAR, 96% w/o PAR

Mente, 2013

Coronal Seal Quality of coronal seal more important than quality of endo tx for prevention of apical periodontitis; Retrospective study, 1,010 NSRCT

Ray, Trope, 1995

Immunoglobulins levels of IgG, IgA, IgM, elastase & PGE2 were higher in inflamed pulps than in normal pulps

Nakanishi, 1995

Perforation repair F/u to 2010 paper (larger sample size)

Mente, 2014

Post space Leave at least 5 mm of gutta-percha to not affect apical seal

Mattison, 1984

Intermediate cementum Zone of highly calcified tissue at junction b/t cementum and dentin, not product of cemento/dentinogenesis, has enamel matrix proteins, product of Hertwig’s epithelial root sheath

Harrison, Roda, 1995

Methods Walking bleach, recommended superoxol + Na perborate for greater efficacy, change every week

Nutting, Poe, 1963

NaOCl accident Long term paresthesia (15 months) after injection of 1% NaOCl thru buccal perforation of maxillary incisor

Reeh, Messer, 1989

Why Chloroform? Tested 5 solvents, Chloroform was best and only one which completely dissolved gutta-percha

Kaplowitz, 1990

RETX vs. S RCT RETX is preferable over S RCT, S RCT shouldn’t be considered primary tx when NS RETX can be done

Moiseiwitsch, Trope, 1998

Gutta-percha Storage of GP in referigerator and at low humidity will lengthen shelf life

Kolokruis, 1992

Pathogenesis Germ free rats showed no inflammatory resorption after replantation, Inflammatory resorption has bacterial component

Nishioka, Suda, 1998

Membrane needed? Large PAR healed more rapidly and better with GTR

Pecora, Kim, 1995

PAR in Vital Teeth? Not necessary for pulp to be completely necrotic before PAR appears, still need LA to access necrotic teeth

Mullaney, Howell, Petrich 1970

Retroprep depth Depth of root end preparation should be 3 mm for stability of material

Mattison

Perforation repair 92% healed

Kvinnsland

Temporaries Cavit better than GIC, both leak after 14 days

Hartwell, 2010

Effect of Endo on tooth Endodontic procedures have small effect on tooth stiffness (5% reduction), occlusal prep (20%), MOD (63%)

Reeh, Messer, 1989

Other bugs involved Yeast cells isolated from RCS of infected teeth

Nair, 1990

History of various methods Invented thermafill

Johnson, 1978

Bacterial progression Initially - Facultative anaerobic; Finally - obligate anaerobes

Moller, 1981

Regendo Mixture of Cipro, Metro, and Mino was 100% effective

Hoshino, 1996

Perforation repair 86% long tern follow up success with MTA

Mente, 2010

Effect of file separation on prognosis Meta-analysis - shows prognosis not significantly reduced for teeth with separated instruments during NS RCT

Panitvisai, 2010

Indirect Pulp Cap <50% healing (11/24 cases)

Jordan, Suzuki, Skinner

Cemental tear Incisors (76.1%); men (77.5%); >60 yrs old (73.2%); abscess formation (66.2%); PD >6 mm (73.2%); vital pulp (65.3%); opposing tooth (84.3%), mod-severe attrition (77.9%)

Lin, 2011

Ca(OH)5 CMCP not useful as IC med, since it clears only 67% of bacteria from RCS, compared to 97% for Ca(OH)2

Messer, 1984

Techniques First to publish an article on true crown-down instrumentation

Morgan, Montgomery

Steroids effective? Yes. IM Steroids; injectable dexamethasone better than placebo for reducing post-endo pain; Be sure pain is due to inflammation and not infection

Marshall, 1984

Sargenti Paste First discredited the Sargenti technique

Langeland, 1973

Regendo CLASSIC: immature teeth can have pulp survival and regeneration of nerve function after replantation, especially if have open apical foramen

Ohman, 1965

How to remove separated files Removal of separated instruments: US application and Hedstrom files

Krell, 1984

Cyst healing after Endo? In theory: After NS RCT, cysts heal becuase epithelium stops proliferating due to reduction in inflammatory cytokines, and apoptosis occurs

Lin, 2007

Intraosseous Buccal infiltration with 4% articaine w/ epi and IO injection with 2% lidocaine w/ epi are likely to allow pain-free TX than PDL and repeat IANB injections w/ 2% lidocaine w/ epi SIP

Kanaa, 2012

Can Perio cause Endo problems? If main blood supply remains intact, perio disease unlikely to cause endo disease

Mee-Madison, 1992

Flare-ups Rate of flare up is same for tx vs. retx (Most related factor is pre op pain)

Mattscheck, Law, Noblett, 2001

File separation Cyclic fatigue: Rotation subjects NiTi to both tensile and compressive forces in area of canal curvatures, producing destructive form of loading

Pruett, Clement, Carnes, 1997

MB root of Mx 1M 96% - 2 canals (Stropko 1999 said the more Max molars done with magnification, the more MB2s you will find)

Kulild, 1990

Status of pulp matter? Consider status of pulp prior to determining length; Necrotic teeth with PAR show more apical resorption

Malueg, Wilcox, Johnson, 1996

Direct Pulp Cap 80% healing (uninflammed pulps)

Ravn

Steroids effective? Yes. Oral Steroids; oral dexamethasone better than placebo for reducing post-endo pain

Krasner, 1986

Methods of vitality testing Place EPT on MB cusp tip for molars

Lin, 2007

Cyst or Granuloma? Can’t distinguish between cyst or granuloma radiographically

Priebe, 1954

Apical resorption with PAR, always resorption (can also reference Delzangles)

Malueg, Wilcox, Johnson, 1996

What apical size? The minimum instrumentation size needed for penetration of irrigants to apical third is #30

Khademi, 2006

Risks Bleaching factors associated with the teeth exhibiting resorption were heat with 30% hydrogen peroxide

Madison, Walton, 1990

How much resection? Resect at least 3 mm, removes 98% of apical ramifications

Kim, 2006

Steroids effective? Yes. PDL Steroids; Intraligamentary injection of slow release methylprednisolone effective reducing post-endo pain

Kaufman, 1994

Post op Pain 2 case reports of heat sensitivity after NS RCT. Missed canals. Don’t rule out Endo treated teeth as source of patient’s thermal discomfort

Kier, Walker, 1991

Perforation repair Best prognosis for perf repair is in apical or middle thirds. Contamination with oral fluids = failure.

Jew, Weine, 1982

Techniques Step back (telescopic technique) - Apical stop at #25, step back incrementally while increasing file size; recapitulate with 25; Coronal flare with GG

Mullaney, 1979

Response of EPT to necrotic teeth 72% of necrotic teeth correctly identified by EPT as necrotic

Peters, Baumgartner, et al 1994

Pulp Chamber Floor Law of symmetry, law of centricity, law of color change, laws of orifice location

Krasner and Rankow 2004

AH 27 AH 26 least toxic after set, best sealer causing no or mild inflammation in 3 yr follow up on monkeys

Pascon, Spangberg, 1988

Is Chloroform safe? Chloroform is safe in dental operatory, measured room air chloroform levels during endo well below OSHA limits (8 hr limit = 2 ppm)

McDonald, 1992

RETX 86% healed

Imura (2007)

Trephination to relieve pain? No need to prophylactically trephinate since incidence of post-endo pain is low

Peters, 1980

Formocresol pulpotomies MTA pulpotomies significantly better than ferric sulfate or formocresol

Ng, 2008

Mx 2P 54% - 1 canal; 45% 2 canals

Pineda, Kuttler

Review of Sensibility Testing Review of sensibility testing

Jafarzedeh, Abbott, 2010

Ca(OH)2 Introduced Ca (OH)2 to dentistry; Showed that Ca(OH)2 could stimulate dentin bridge following direct pulp cap

Hermann, 1928

Pulp microcirculation Dynamics of blood flow and neuropeptide inf luence

Kim, 1985,89

VRF causes Vertical root fractures: Diagnosis and causes, 85% reported occurred as result of excessive force in lateral compaction

Meister, 1980

Ultrasonic activation Among the first to propose use of ultrasonics with irrigation, showing better success in canal cleanliness

Martin, Cunningham, 1982

Access Remove cervical ledges over canal orifice to enhance straight-line access

Leeb, 1983

Why do some PARs not heal? Pathogenesis of apical periodontitis, Types of apical periodontits (cysts, etc.) and why some PARs don’t heal

Nair, 2004

Extrusion induced resorption Resorption as a result of extrusion is rare

Malmgren, 1991

Avulsion PDL vitality important for success of replantation, replant quickly without damaging PDL, PDL is tissue to save, so do Endo after replantation

Loe, 1961

Obturation technique Warm GP has a higher rate of overextension than CL; Post-op pain, long-term outcomes, and obturation quality are similar between the two

Peng, 2007

NaOCl NaOCl has pH of 11, hypochlorus acid is active antibacterial property, disrupts oxidative phosphorylation

Hurst, 2001

Necrosis with calcification? Only 7% of teeth with calcific metamorphosis develop problems, so no prophylactic tx is indicated

Holcomb, Gregory, 1967

Methods of vitality testing No relationship between EPT value and pulp pathology

Mumford, 1968

Cvek Pulpotomy 91% healing (young molars)

Mass

E. faecalis E. faecalis may just be innocent opportunistic bystander, found it in only 12% of failing RCT’s

Kaufman, 2005

Sealer puff okay? Endodontic filling materials can induce periapical inflammation

Hollan, 1996

PAI Proposed use of PAI (periapical index) to evaluate radiographic success by comparison to 5 standard images

Orstavik, 1986

Bacteria needed for PAR Monkey, Bacteria etiologic factor for apical periodontitis, no evidence that necrotic tissue per se induces lesions, need bugs (mostly obligate anaerobes)

Moller, 1981

Nerves of pulp 28% of nerves = myelinated A fibers; 72% of nerves = unmyelinated C fibers

Reader, 1981

PAR in Vital Teeth? PAR in vital teeth, 11 of 24 healed with indirect pulp cap

Jordon, 1978

2nd surgery? showed that success rate of 2nd surgery performed on same tooth is 35.7% (Old-school technique)

Petersen, Gutmann 2001

2nd S RCT 36% healed; 26% uncertain

Peterson & Guttmann

Endo vs. Implants No significant difference - meta-analysis

Iqbal, Kim, 2007

Biologic Width Biologic width = CT attachment (1.07 mm) + Epi. attachment (0.97 mm); sulcus =- 0.69 mm; margin should be at least 3 mm coronal to alveolar crest to permit healing and proper restoration

Ingber, 1977

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