Misserfolg nach Revitalisierung – Recall

Von Bonald Decker

Vor einigen Monaten hatte ich Ihnen hier einen Behandlungsfall nach erfolgloser Revitalisierungbehandlung vorgestellt. So sah der Abschluss der Behandlung seiner Zeit aus:


Misserfolg nach Revitalisierung 6 Monatsrecall.001

Abschlussaufnahme nach MTA-Apexifikation

Vor Kurzem war der junge Patient zur Nachkontrolle sechs Monate nach Behandlungsabschluss bei uns. Hier die entsprechende Aufnahme:

Misserfolg nach Revitalisierung 6 Monatsrecall.002

Radiologische Nachkontrolle 6 Monate später – es zeigt sich eine Remission der apikalen Parodontitis

Misserfolg nach Revitalisierung 6 Monatsrecall.003

Gegenüberstellung: September 2015 zu März 2016

Ich bin guter Dinge, dass diese Behandlung auch entsprechend nachhaltig sein wird. Um dies zu fördern wäre in meinen Augen weiterhin ein intrakanalär adhäsiv befestigter Glasfaserstift wünschenswert…

3 Gedanken zu „Misserfolg nach Revitalisierung – Recall

  1. Erst einmal Glückwunsch zur Heilung!
    Was wäre der Vorteil des Glasfaserstiftes, gegenüber, reinem (narürlich dentinadhäsivem) Composite-Aufbau? Gibt es dazu Studien?

    • Hallo Stephan. Hier eine kleine Auswahl.

      J Dent. 2009 Sep;37(9):652-7. doi: 10.1016/j.jdent.2009.05.026. Epub 2009 May 29.
      The restoration of permanent immature anterior teeth, root filled using MTA: a

      Desai S(1), Chandler N.

      Author information:
      (1)Department of Oral Rehabilitation, University of Otago, School of Dentistry,
      Dunedin, New Zealand.

      OBJECTIVES: Immature anterior teeth are at high risk of root fracture following
      root canal treatment. The literature was explored to determine the current status
      for post-endodontic restorative management of these teeth.
      DATA AND SOURCES: The authors explored multiple search engine databases to
      November 2008. Experiments included in the review involved simulated human or
      animal immature teeth with mineral trioxide aggregate as an apical plug. The
      experiments were designed to assess and compare the fracture strength of teeth
      restored with various materials. Studies that did not fulfil inclusion criteria
      were omitted from the review.
      STUDY SELECTION: Four in vitro studies fulfilled selection criteria and were
      systematically reviewed. All studies differed in sources of teeth, their
      simulated immature tooth model and mode of force application.
      CLINICAL IMPLICATIONS: Current evidence, mostly from laboratory studies, suggests
      the use of composite resin materials placed deep into the coronal aspect of the
      root canal to impart superior fracture resistance. Further clinical research is
      needed to assess other reinforcing materials, which include a variety of post
      systems and luting agents.

      Dent Traumatol. 2014 Oct;30(5):348-55. doi: 10.1111/edt.12103. Epub 2014 Feb 27.

      Fracture resistance of endodontically restored, weakened incisors.

      Cauwels RG(1), Lassila LV, Martens LC, Vallittu PK, Verbeeck RM.

      Author information:
      (1)Department of Paediatric Dentistry and Special Care – Paecomedis Research
      Group Research, Ghent University, Ghent, Belgium.

      OBJECTIVES: To test the fracture strength of weakened bovine incisors
      endodontically treated with mineral trioxide aggregate (MTA), calcium phosphate
      bone cement (CPBC) or fibre reinforced composite (FRC) posts, and to evaluate the
      fracture mode.
      METHODS: Weakened bovine incisors (n = 75), standardized according to the
      dentinal wall thickness at the cervical area, were randomly assigned to one
      control group and three experimental groups. Unfilled teeth were assigned to
      group 1 (n = 20) and served as control group. Group 2 (n = 17) consisted of teeth
      filled with MTA. In group 3 (n = 18), the incisors were filled with CPBC and in
      group 4 (n = 20) with FRC posts. All specimens were subjected to load at a
      cross-head speed of 60 mm min(-1) until fracture occurred. The initial (IL) and
      final fracture (FL) loads (N) were recorded, and the failure mode among the
      different groups was evaluated.
      RESULTS: anova showed a statistically significant difference in fracture load
      among the groups. Tukey’s test revealed a significant difference for the IL
      between the control group and the experimental groups with exception of the MTA
      group. The FL was not significantly different among the experimental groups. A
      high percentage of favourable fractures was seen in the FRC and CPBC groups.
      CONCLUSION: FRC posts and CPBC could be promising materials to strengthen
      non-vital structurally compromised teeth.

      Int Endod J. 2014 Oct;47(10):958-66. doi: 10.1111/iej.12241. Epub 2014 Feb 1.

      Fracture resistance and stress distribution of simulated immature teeth after
      apexification with mineral trioxide aggregate.

      Brito-Júnior M(1), Pereira RD, Veríssimo C, Soares CJ, Faria-e-Silva AL, Camilo
      CC, Sousa-Neto MD.

      Author information:
      (1)Interinstitutional PhD program, State University of Montes Claros, Montes
      Claros, Brazil; Department of Restorative Dentistry, Faculty of Dentistry,
      University of São Paulo, Ribeirão Preto, Brazil.

      AIM: To evaluate the effect of adhesive restorations on fracture resistance and
      stress distribution in teeth with simulated immature apices and apical plugs of
      mineral trioxide aggregate (MTA).
      METHODOLOGY: Sixty bovine incisors were sectioned 8 mm above and 12 mm below the
      cemento-enamel junction (CEJ). The root canal was enlarged using a diamond bur,
      resulting in remaining root canal walls with 0.1-0.2 mm of thickness. A 5-mm
      apical plug of MTA was placed and the teeth were restored according to the
      following groups: GP–the root canal was filled with gutta-percha and endodontic
      sealer; CR–the root canal was filled with light-cured composite resin inserted
      incrementally; FP–a fibre post was cemented into the root canal; and RFP–the
      fibre post was relined with composite resin prior to the cementation into the
      root canal. A load was applied on the crown of all teeth at 135° to their long
      axis until fracture. Data was analysed by one-way anova and SNK tests (α = 0.05),
      whilst the fracture pattern was evaluated according to the position of the
      fracture. Stress distributions in the restored teeth were verified by finite
      element analysis.
      RESULTS: Teeth restored with fibre posts and relined fibre posts were associated
      with the highest fracture resistance, whilst the GP group had the lowest values.
      GP and RC groups had similar fracture resistance values (P = 0.109). All
      fractures types involved the cervical and middle thirds of roots. The GP model
      had high levels of stress concentration in the cervical and middle thirds of
      roots. No difference was found amongst the stress concentration in the RC, FP and
      RFP models.
      CONCLUSION: Restorative protocols alter the fracture resistance and stress
      distribution of immature teeth after placement of MTA apical plugs.

      Dent Traumatol. 2014 Feb;30(1):49-54. doi: 10.1111/edt.12034. Epub 2013 Feb 4.

      Investigation of the effect of different prefabricated intracanal posts on
      fracture resistance of simulated immature teeth.

      Dikbas I(1), Tanalp J, Koksal T, Yalnız A, Güngör T.

      Author information:
      (1)Faculty of Dentistry, Department of Prosthodontics, Yeditepe University,
      Istanbul, Turkey.

      AIM: The aim of this study was to assess fracture resistances of simulated
      immature single-rooted teeth whose roots have been backfilled using 3 different
      post systems after a 4 mm apical mineral trioxide aggregate (MTA) placement.
      MATERIALS AND METHODS: Forty-eight maxillary anterior teeth were assigned into
      four groups. The lengths of each root were standardized by cutting off the
      coronal and apical portions to obtain 13 ± 1 mm samples and root canals were
      enlarged. The #6 Peeso reamers were allowed to protrude 1 mm beyond apex to
      simulate immature teeth. Apical 4 mm of each tooth was filled using MTA. The
      remaining portions were treated as follows: Group 1 (Control): AH
      Plus + Gutta-percha cold lateral compaction. Group 2: Glass fiber posts (FRC
      Postec Plus post) cemented using self-adhesive resin cement. Group 3: Quartz
      fiber posts (D.T. Light post) cemented using self-adhesive resin cement. Group 4:
      Zirconia posts (Cosmopost) were placed using self-adhesive resin cement.
      Specimens were embedded in self-curing acrylic. A compressive load was applied
      lingually at a crosshead speed of 1 mm/min at an angle of 45º until fracture in a
      universal testing machine.
      RESULTS: The mean fracture resistances were 823.17 ± 188.80, 1155.50 ± 190.37,
      1208.00 ± 254.32, and 1153.25 ± 195.71 Newtons for Groups 1, 2, 3, and 4,
      respectively. All experimental groups had significantly higher fracture
      resistance compared with the control group (P 0.05).
      CONCLUSIONS: All post systems exerted a similar reinforcing effect to a simulated
      immature tooth and may be preferred specifically in situations which require
      additional reinforcement.

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