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Open access

Zoumpoulia Mylona, Christos Gogos and Nikolaos Economides

SUMMARY

Background: Irrigation during endodontic therapy is required in order to remove debris, tissue remnants, microbes and smear layer. Sodium hypochlorite (NaOCl) and Chlorhexidine (CHX) are the most commonly used irrigants. Although they are reported to have good antimicrobial effects, both have limitations. Hence, a combination of NaOCl and CHX has been proposed to compensate for these limitations. However, this association forms a dense, orange-brown precipitate that stains walls of the pulp chamber. The aim of this study was to clarify in vitro if this precipitate affects the microleakage of endodontic sealers.

Material and Methods: Extracted human teeth were used for this study. The teeth were cut at the height of the cervix and instrumented with NiTi rotary instruments. They were then divided into 2 experimental groups. In the first group (Group A) irrigations were performed with 2ml NaOCl 1%, 1ml EDTA 17% and 1ml CHX 0.2% and in the second (Group B) with 2ml NaOCl and 2ml CHX. Following this, they were obturated with gutta-percha and roth sealer. The microleakage was determined using a fluid filtration method. The measurements were repeated a month later. All analyses were performed using Fisher exact test.

Results: Microleakage of Group A was lower than microleakage of Group B but the difference was not statistically significant.

Conclusion: The precipitate that is formed by NaOCl and CHX did not affect microleakage of endodontic sealers.

Open access

Athina Dalopoulou, Nikolaos Economides and Vasilis Evangelidis

Summary

Background: Extrusion of root canal sealers may cause damage to the surrounding anatomic structures. Clinical symptoms like pain, swelling and paresthesia or anesthesia may be present. The purpose of this presentation is to describe two cases of root canal sealer penetration into periapical tissues. A different treatment management was followed in each case.

Case reports: A 55 year-old man underwent root canal retreatment of the right mandibular first molar tooth due to a periapical lesion. Postoperative periapical radiographs revealed the presence of root canal sealer (AH26) beyond the apex in the distal root in proximity to the mandibular canal. The patient reported pain for the next 7 days. Radiographic examination after 1 year showed complete healing of the periapical area and a small absorption of the root canal sealer. A 42 year-old woman was referred complained of swelling and pain in the area of the right maxillary first incisor. Radiographic examination showed extrusion of root canal sealer in the periapical area associated with a periapical lesion. Surgical intervention was decided upon, which included removal of the sealer, apicoectomy of the tooth and retrograde filling with MTA. After 1 year, complete healing of the area was observed.

Conclusion: In conclusion, cases of root canal sealer extrusion, surgical treatment should be decided on only in association with clinical symptoms or with radiographic evidence of increasing periapical lesion.

Open access

Konstantinos Sidiropoulos, Konstantina Roussou, Lambros Intzes and Nikolaos Economides

Summary

Background/Aim: Guided tissue regeneration is widely used in endodontic surgery. The aim is to aid in the healing process and bone regeneration and provide more successful and predictable outcomes.

Case report: This case report describes the successful treatment of an endodontic-periodontal lesion (with primary endodontic involvement), including root canal retreatment and endodontic surgery with the use of GTR (collagen absorbable membrane-xenogeneic bone graft). CBCT examination was used to aid in diagnosis and in the follow-up examination after two years to provide additional confirmation of the healing process. An extensive literature review was undertaken focusing on clinical studies that assessing the added benefit of GTR in surgical endodontics. The clinical and radiographic examinations showed uneventful healing and the reconstruction of the buccal plate and periapical area. The patient remained asymptomatic throughout the entire two years period after surgical intervention. A literature review concluded that lesion type, lesion size and the selection of the biomaterial are important factors that influence the outcome of GTR in comparison control groups. A favorable outcome was found in cases of large periapical lesions (>10mm), through-through lesions and with the use of an absorbable membrane, with or without a bone graft.

Conclusions: GTR is thought to provide an added benefit in bone regeneration and the healing process in specific cases. The outcomes in the case report are consistent with the conclusions of literature review.

Open access

Zoi-Despoina Tzima, Nikolaos Economides, Christos Gogos and Ioannis Kolokouris

Summary

Background/Aim: To investigate the incidence of procedural errors with the use of a novel nickel-titanium rotary system (Hyflex CM, Coltene/Whaledent, Altstätten Switzerland), evaluate the technical quality of root canal treatments and assess a questionnaire completed by the participants themselves in an undergraduate dental clinic between 2014 and 2017 (Department of Endodontology, School of Dentistry, Aristotle University of Thessaloniki).

Material and Methods: 118 undergraduate students in their first year of clinical practice performed a root canal treatment on a patient’s molar (maxillary/mandibular). None of the participants had previous experience in rotary instrumentation. The periapical radiographs were taken with the use of the paralleling technique for standardization and were collected and evaluated by the investigator. After the root canal treatment was performed the students completed a questionnaire in order to evaluate their training on rotary instrumentation.

Results: The overall incidence of instrument separation, apical perforation, root perforation, straightening and ledges was 0.8%, 4.4%, 2.3%, 5.5% and 29% respectively on root canal level. Ledges were detected more often in mandibular mesiobuccal canals. The frequency of root canals with an ‘acceptable’ filling was 68.4%, while overfilled and underfilled canals were found to be 8.6% and 16.2% respectively. The response rate was high (94.9%), 35% of the participants encountered no difficulty in the use of rotary instrumentation and 98.2% would use it again.

Conclusions: The incidence of procedural errors was considerably low and the technical quality of the filled root canals was superior to that of similar studies. The responses of the questionnaire demonstrated a positive attitude toward rotary instrumentation.