Apical limit of root canal instrumentation and obturation, part 2. A histological study

By Ricucci D, Langeland K

Date: 12/1999
Journal: JOE

Summary: 

Purpose: to describe histologically and clinically the effect of different obturation levels on prognosis.

N= 41 human teeth .

Materials/Methods:

•10 teeth were instrumented, Ca(OH)2 placed  and observed over 7-48 days .

•In the rest of the teeth (around half were necrotic, others were vital). Complete endodontic treatment was done using 1% NaoCl irrigation. In vital cases endo done in 1 visit, necrotic in 2 or 3 visits with Ca(OH)2 as used as an intracanal medicament .  After a recall period of  18 days to 10 y and 8 months. Either tooth was extracted due to ortho or prostho reasons, or biopsy was taken from root end and periapical area

. •Serial sectioning (5 µm). Stained by H&E, brown and Brenn stain.

Most highlighted Results:

•In the Ca(OH)2 group: cases with PA lesion showed chronic and acute inflammatory cells. Cases with no PA lesion showed vital pulp stump in the periapical area.

•In cases where procedure were confined to root canal: 19 were successful on RG and histologically ;vital pulp stump with chronic inflammatory cells and healthy PDL (Fig. 7c).

•Failed cases on RG showed sever inflammatory infiltrate in periapical tissue (clinically NO pain).

•Overfilled cases showed sever inflammatory infiltrate and necrosis in tissue near extruded sealer (Fig3 c,d)

•Overfilling had the worst prognosis followed by obturation 2 mm shorter that apical constriction.

•Apical constriction is often located more that 1 mm from foramen.

Clinical significance:

Although overfilled cases resulted in no pain, all had  sever inflammatory response.