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Department of Endodontics, College of Dental Medicine, Nova Southeastern University, Fort Lauderdale, FL !"#!$%", US&. rosen'ergendo(adelphia.net )his in vitro study measured the effect of calcium hydro*ide root filling on the microtensile fracture strength +M)FS, of teeth. & total of -$ e*tracted human disease#free permanent ma*illary incisors .ere hand and rotary instrumented and vertically compacted .ith United States /harmacopeia +US/, calcium hydro*ide. )he teeth .ere stored in a moist environment for 0, !", and "- days. &s a control group, %$ teeth .ere vertically compacted .ith gutta percha and sealer. )he M)FS of the teeth .as measured +Mpa, using an 1nstron machine. Data .ere assessed statistically using an unpaired t#test +/ value,. )he intracanal placement of calcium hydro*ide .ea2ened the M)FS of teeth 'y % .3 Mpa per 00 days4 an average of $.%50 M/a day#%. 6et.een 0 and "- days, the M)FS of the dentin .as reduced 'y - .37. )his difference .as statistically significant +/ 8 $.$5,. & statistical difference +/ 8 $.$5, .as o'served 'et.een the mean M)FS of the calcium hydro*ide# filled dentin 'et.een 0 days +-5.0 M/a, and !" days + 5.9 M/a, and also 'et.een 0 and "- days + %." M/a,. )here .as also a significant difference +/ 8 $.$5, 'et.een the M)FS of the calcium hydro*ide#filled dentin after "- days + %." M/a, and the gutta percha#filled dentin +-%. M/a, .hen used as a control root filling material. )he .ea2ening of the dentin 'y ! #- .37 follo.ing root canal filling .ith calcium hydro*ide provides compelling evidence to re#evaluate the daily usage of this material in endodontic therapy. Dent Traumatol. 2002 Jun;18(3):134-7 ong!term calcium hydroxide as a root canal dressing may increase ris" of root fracture.
Department of :ral and Ma*illofacial Surgery, University ;ospital, <igshospitalet, Copenhagen, Denmar2. 1t has 'een proposed +Cve2 %33!, that immature teeth are .ea2ened 'y filling of the root canals .ith calcium hydro*ide dressing and gutta#percha. )he aim of the present study .as to test the hypothesis that dentin in contact .ith calcium hydro*ide .ould sho. a reduction in fracture strength after a certain period of time. 1mmature mandi'ular incisors from sheep .ere e*tracted and divided into t.o e*perimental groups. =roup %4 the pulps .ere e*tirpated via the apical foramen. )he root canals .ere then filled .ith calcium hydro*ide +Calasept, and sealed .ith 1<M+<, cement, and the teeth .ere then stored in saline at room temperature for $.5, %, !, , 9, 3, or %! months. =roup !4 the pulps .ere e*tirpated and the root canals .ere filled .ith saline and sealed .ith 1<M+<, cement. )he teeth .ere then stored in saline for ! months. 1ntact teeth served as controls and .ere tested immediately
after e*traction. &ll teeth .ere tested for fracture strength in an 1nstron testing machine at the indicated o'servation periods. )he results sho.ed a mar2edly decrease in fracture strength .ith increasing storage time for group % +calcium hydro*ide dressing,. )he results indicate that the fracture strength of calcium hydro*ide#filled immature teeth .ill 'e halved in a'out a year due to the root filling. )he finding may e*plain the fre>uent reported fractures of immature teeth filled .ith calcium hydro*ide for e*tended periods. Dent Traumatol. 2006 Jun;22(3):154-6 'om(arison of fracture resistance in root canals of immature shee( teeth after filling with calcium hydroxide or MT#.
Department of :ral and Ma*illofacial Surgery, University ;ospital of Copenhagen, Denmar2. ?ens.ove.andreasen(rh.hosp.d2 )hirty immature sheep incisor teeth .ere tested for their fracture resistance after various treatment modalities using calcium hydro*ide +C;, or a mineral trio*ide aggregate material +M)&, as a root filling. )he incisors, having appro*imately "$7 of their root gro.th completed, .ere removed from ?a.s of slaughtered sheep and divided into four e*perimental groups. )he pulps .ere e*tirpated from all the teeth through the open ape*es. +a, Saline group4 the teeth .ere preserved in saline for %$$ days at 9 degrees C. +', C; group4 the root canals .ere filled .ith C; and sealed apically .ith 1<M and stored as a'ove. +c, M)& group4 the canals .ere filled .ith M)& and stored as a'ove. +d, C;@M)& group4 the canals .ere filled .ith C; and sealed .ith 1<M. &fter $ days, the C; .as replaced .ith M)& and stored as a'ove. &t the end of the %$$#day storage period, all teeth .ere em'edded in plaster of /aris and tested for fracture strength at the cervical area in an 1nstron testing machine. )he results sho.ed a decrease in fracture resistance +a, of the incisors .ith C; in the root canals after %$$ days of storage, compared to +', teeth stored in intracanal saline and +c, teeth .ith $ days of C; and then filled .ith M)&, and +d, those filled .ith M)& in the canals. 1n conclusion, .hen C; .as 2ept in the canals of immature sheep teeth for only $ days follo.ed 'y root filling .ith M)& there .as no significant decrease in strength of the root .ithin an o'servation period of %$$ days. )his finding may 'e of importance in the decision of treatment plans for teeth .ith pulp necrosis and immature root formation. A Endod. 2005 Dec;31(12):895-7 &racture resistance of human root dentin ex(osed to intracanal calcium hydroxide.
Department of Endodontics and /eriodontics, University of Maryland Dental School, 6altimore, Maryland, US&. gedoyon(hotmail.com
)he purpose of the present study .as to determine if e*posure to intracanal calcium hydro*ide BCa+:;!,C alters the fracture resistance of human root dentin. :ne hundred and t.o freshly e*tracted single rooted human teeth divided into three groups of - teeth each. Coronal access and endodontic instrumentation using round 'urs, stainless steel files, and /rofile =) rotary files .ere completed for each tooth. )he prepared root canal system of each tooth .as filled .ith saline solution +group %,, US/ Ca+:;,! +group !,, or Metapaste +group ,. )he apicies and access openings .ere sealed .ith composite resin and the teeth .ere immersed in saline. &fter $ days, the roots of %0 teeth from each group .ere sectioned horiDontally into %#mm thic2 dis2s and each dis2 .as loaded to fracture at !.5 mmEmin .ith a S&)EC universal#testing machine. &fter %"$ days the same procedure .as performed on the remaining %0 teeth in each of the groups. )he pea2 load at fracture .as measured for each dentin dis2. Data .ere analyDed using one#.ay &N:F& and a post hoc Student#Ne.man#Geuls test. &fter $ days e*posure to the test solution, there .as no difference in the pea2 load at fracture for the three groups of teeth. ;o.ever, after %"$ days, the roots of the teeth e*posed to US/ Ca+:;,! sho.ed a significant decrease in pea2 load at fracture .hen compared to the $#day groups and the %"$#day groups e*posed to saline or Metapaste.
From ROOTS, May 11, 2007 As I promised, here is the private communiqu !ith "r# A$$ott !hich I post !ith his prior permission# I admire %au& tremendous&y#####his c&ear cut &ine o' thin(in) and his 'antastic sty&e o' teachin)# %&ease read his tit&es and responsi$i&ities under his si)nature# *e is quite a $usy man######yet in the &ast + years, he has ,-.-R 'ai&ed to ans!er anythin) I have as(ed him in private or pu$&ic# Teachers &i(e "r# A$$ott, Fred /# and /en Schein are treasures and sad&y, some o' the 'e! remainin) )ood 0dinosaurs0 roamin) the &andscapes o' endodontics ###11 "r# Ahmad Tehrani *i Ahmad, Than(s 'or your messa)e# I !as not at the AA- meetin) in %hi&ade&phia this year due to other internationa& &ecturin) commitments as !e&& as !or( $ac( home# *o!ever, I !i&& $e at the IF-A 2or&d 3on)ress in .ancouver in Au)ust this year, and then the -S- meetin) in Tur(ey in Septem$er# *ope'u&&y !e can meet up at one o' those meetin)s instead# I encoura)e you to come a&on) to the IF-A 3on)ress especia&&y as it promises to $e a )reat scienti'ic meetin)# I am happy 'or my comments to $e posted on Roots 4 and I !ou&d $e interested in seein) any comments that my thou)hts )enerate 'rom your co&&ea)ues# The issue o' !hether 3a1O*52 !ea(ens endodontica&&y4treated teeth is an interestin) topic $ut one !hich I thin( has yet to $e 'u&&y investi)ated# In particu&ar, the question in my mind is !hether the !ea(enin) sho!n in some studies 1e#)## immature sheep teeth5 is re&evant 'rom a human c&inica& perspective !ith respect to the tooth that I am a$out to treat !hich has an open ape6, an in'ected root cana& system and apica& periodontitis#
The studies that have investi)ated this topic have not app&ied 'orces to the teeth in the same !ay as !ou&d occur in the mouth 4 typica&&y, !e are ta&(in) a$out anterior teeth and trauma 'orces# These 'orces are typica&&y an 0impact $&o!0 or a 0catastrophic 'orce0 1i#e# sudden, severe, quic(, very short app&ication time5 and they are usua&&y app&ied 'rom a &a$ia& direction and not as a continuous 'orce such as that app&ied $y Instron testin) machines 4 these machines typica&&y app&y a &oad at one point 1dependin) on the set up used5 and the &oad is then )radua&&y increased 1the rate o' increase can $e varied5 unti& the tooth 'ractures# That is, it is not typica&&y an impact 'orce as in trauma# These studies have a&so used di''erent teeth 4 sheep, humans, etc# They have used di''erent 'orms o' 3a1O*52 and this may a''ect the resu&ts# 7ens Andreasen !as visitin) our Schoo& in %erth, Austra&ia in Fe$ruary this year and !e discussed this in detai&# *e to&d me that a study is $ein) done to &oo( at di''erent 'ormu&ations o' 3a1O*52 and it &oo(s &i(e this may $e a 'actor 4 $ut these resu&ts have not $een pu$&ished any!here yet 4 hope'u&&y !e !i&& see them soon# 3ertain&y my o!n c&inica& e6perience !ou&d su))est to me that any !ea(enin) 1i' it does occur5 is very minima& since I have had on&y a$out 849 patients 1at &east that I remem$er5 !ho have returned to see me !ith 'ractures o' the teeth 'o&&o!in) &on)4term 3a1O*52 treatment o' !ide cana&s# In every one o' these cases, the 'racture has occurred as a resu&t o' 'urther trauma to the teeth 4 I do not reca&& any o' these teeth 'racturin) 0spontaneous&y0 or durin) norma& che!in) $itin) or 'unction# -ach tooth !as quite immature !hen the ori)ina& ape6i'ication treatment !as commenced and the on&y 2 options avai&a$&e 'or the patients at that time !ere to do the ape6i'ication or to e6tract the tooth# Retention o' the tooth !as in the $est interests o' the patients, as I suspect !ou&d $e the usua& scenario 'or most youn) patients !ith trauma to their anterior teeth at such a youn) a)e# The &iterature does te&& us that some chi&dren:peop&e are 0accident prone0 and so 'urther trauma to a tooth is a&!ays possi$&e# I $e&ieve it !as the 'urther trauma to the teeth that &ed to the 'racture rather than the 'act that I used 3a1O*52 in the cana&s# I' the 'urther trauma had not occurred then it is &i(e&y that the teeth !ou&d not have 'ractured# It cou&d a&so $e ar)ued the other !ay 4 that is, the 3a1O*52 &ed to the 'racture 4 $ut i' so, !hy did the 'racture not occur sooner and !hy on&y !hen the tooth !as (noc(ed a)ain; I accept that the 3a1O*52 may have !ea(ened the tooth !hich may have meant that it !as more &i(e&y to 'racture !hen (noc(ed $ut !hat is there to say that the tooth !ou&d not have 'ractured any!ay once (noc(ed a)ain; At this point in time, I do not thin( !e have an idea& rep&acement 'ro 3a1O*52 as a medicament 4 'rom $oth an anti$acteria& point o' vie! and as a 0hard tissue stimu&ant0 'or ape6i'ication# Some c&inicians are suin) MTA as an apica& $arrier $ut this is not an easy materia& to p&ace accurate&y and I !orry a$out ine6perienced )enera& dentists attemptin) this on <ust the occasiona& $asis# I have seen a num$er o' such attempts !hich have required sur)ery due to )ross e6trusion o' the MTA throu)h the apica& 'oramen and
then causin) 'orei)n $ody reactions# *ence, much caution is needed, I $e&ieve, in promotin) such techniques that have yet to $e proven scienti'ica&&y to $e advanta)eous## The options 'or the tooth have to $e considered on a case $y case $asis# In most situations, I !ou&d sti&& pre'er to use 3a1O*52 as it is predicta$&e in most respects# I' a 'racture does occur &ater, then so $e it 4 and I reco)nise:accept that this is a sma&& ris( and one that can not $e avoided i' 'urther trauma occurs# 2e need to $e a!are o' the potentia& that this may occur $ut !e shou&d not 0'ear0 that it !i&& occur in the occasiona& case# The occurrence o' such 'ractures 1a)ain in my o!n e6perience and !ithout scienti'ic eva&uation5 is too rare to !arrant chan)in) !hat I current&y do# I a&so accept that nothin) &asts 'orever in dentistry and other treatment may $e required &ater# A&& treatment !e do is a compromise to the tooth 4 $ut the rea& compromise has a&ready occurred to the tooth $e'ore the patient came to see me 1i#e# the caries, the in'ection, the trauma, etc that &ed to the need 'or the endodontic treatment5# *ope this he&ps and that it stimu&ates some comments# 3heers, %au& %ro'# %au& .# A$$ott %ro'essor o' 3&inica& "entistry *ead 4 Schoo& o' "entistry "irector 4 Ora& *ea&th 3entre o' 2A "eputy "ean 4 Facu&ty o' Medicine, "entistry = *ea&th Sciences >niversity o' 2estern Austra&ia 17 Monash Avenue ,-"?A,"S 2A +00@ Austra&ia