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Azerbaycan Saytlari

 »  Home  »  Endodontic Articles 8  »  Periapical healing of endodontically treated teeth in one and two visits obturated in the presence or absence of detectable microorganisms
Periapical healing of endodontically treated teeth in one and two visits obturated in the presence or absence of detectable microorganisms
Introduction.



L. B. Peters & P. R.Wesselink
Department of Cardiology Endodontology Pedodontology, Amsterdam Academic Centre for Dentistry, Amsterdam, Netherlands.

Introduction.
Root-canal treatment aims to eliminate bacteria from the infected root-canal system to create an environment that is most favourable for healing. Several studies have shown that it is impossible to achieve a bacteria free root-canal space in all cases, even after thorough cleaning, shaping and irrigation with disinfectants or antiseptics (Bystrom & Sundqvist 1981, Bystrom et al. 1985, Orstavik et al.1991, Sjogren et al. 1997, Peters et al. 2002).Therefore, concern exists as to the fate and consequences of the remaining microorganisms in the canal. They may multiply rapidly, in some cases, to almost the initial numbers in 2-4 days, if the canal is left empty (Bystrom & Sundqvist1981).
It is generally believed that the remaining bacteria can be eliminated or be prevented from repopulating the root-canal space by introducing an interappointment dressing such as calcium hydroxide in the root canal  (Bystrom et al.1985, Chong & Pitt Ford1992). However, it has been shown that calcium hydroxide fails to consistently produce sterile root canals and even allows regrowth in some cases (Reit & Dahle. n 1988, Orstavik et al.1991, Peters et al.2002). It is unclear in which cases failure occurs, because the root-canal treatment with an interappointment calcium hydroxide dressing or a negative culture before obturation gives no guarantee of healing in all cases (Sjogren et al. 1990, Nair et al. 1990, Sjogren et al. 1997, Trope et al. 1999, Weiger et al. 2000).
Another approach is to eliminate the remaining microorganisms or to render them harmless by entombing them by complete obturation immediately after preparing and irrigating the canal space at the same visit. This way, the remaining microorganisms may be killed by the antimicrobial activity of the sealer or the Zn2ю ions of gutta-percha (Moorer & Genet1982, Kaplan et al. 1999, Fuss et al. 2000, Siqueira et al. 2000) or may be deprived of nutrition and space to multiply (Soltanoff 1978, Oliet1983,Weiger et al. 2000).
The healing potential for teeth that are treated in one or two visits with placement of an intracanal disinfectant appears similar (Trope et al. 1999, Weiger et al. 2000). Some studies report the presence of remaining microorganisms after cleaning and shaping and dressing with calcium hydroxide, but do not relate this to healing (Bystrom1986,Yared & Bou Dagher1994, Shuping et al. 2000). One study (Sjogren et al.1997) has compared the healing rate (after 5 years) between the canals that were obturated in the presence or absence of cultivable microorganisms after instrumentation and irrigation. A lower healing rate was found for teeth that harboured microorganism sat the time of root-canal obturation compared to those that had a negative culture at the time of obturation (68% vs.94%).
The purpose of this study is to evaluate the healing of periapical lesions of teeth with positive and negative canal cultures at the time of obturation and to evaluate periapical healing of teeth treated in one visit (without) or two visits with an interappointment dressing of calcium hydroxide.