ENDO, 04/2009

The present study evaluated gingival recession 1 year following apical surgery of 70 maxillary anterior teeth (central and lateral incisors, canines, and first premolars). A visual assessment of the midfacial aspect of the gingival level and of papillary heights of treated teeth was carried out using photographs taken at pre-treatment and 1-year follow-up appointments. In addition, changes in the gingival margin (GM) and clinical attachment levels (CAL) were calculated with the use of clinical measurements, that is, pre-treatment and 1-year follow-up pocket probing depth and level of gingival margin. Changes in GM and CAL were then correlated with patient-, tooth- and surgeryrelated parameters. The following parameters were found to significantly influence changes in GM and CAL over time: gingival biotype (P< 0.05), with thin biotype exhibiting more gingival recession than thick biotype; pre-treatment pocket probing depth (PPD) (P< 0.03), with cases of pre-treatment PPD < 2.5 mm demonstrating more attachment loss than cases of PPD >= 2.5 mm; and type of incision (P< 0.01), with the submarginal incision showing considerably less gingival recession compared with the intrasulcular incision, papilla-base incision or papilla-saving incision. The visual assessment using pre-treatment and 1-year follow-up photographs did not demonstrate significant changes in gingival level or papillary height after apical surgery. In conclusion, gingival biotype, pre-treatment PPD, and type of incision may significantly influence changes in GM and CAL following apical surgery in maxillary anterior teeth. Keywords: aesthetics, apical surgery, follow-up study, gingival recession, periodontal parameters

Chronic pain that arises or persists after endodontic treatment is an undesirable condition that requires proper diagnosis in order to be adequately approached. Some so-called 'mysterious' cases are usually related to limited knowledge or clinical inexperience, but inadequacies of diagnostic tools can also lead to misdiagnosis and confusion. The main causes of chronic post-treatment pain not always promptly recognised are outlined in this paper and include: i) persistent/secondary intraradicular infection; ii) persistent inflammation-undetected lesion; iii) unnoticed overfilling; iv) missed canals; v) vertical root fracture or crack; vi) wrong tooth; vii) non-odontogenic pain; and viii) central sensitisation (risk factors: preoperative pain, previous painful treatment). By having all of these possible causes in mind, clinicians may create a checklist for the possible reason(s) for pain in difficult individual cases and act proactively to offer the best therapeutic solution. Keywords: apical periodontitis, cone-beam computed tomography, endodontic treatment, persistent infection, post-treatment pain, secondary infection

Traumatic injuries in the oral cavity are a common phenomenon. Crown and crown-root fractures of anterior teeth account for a majority of these injuries. Usually, treatment of such cases requires an interdisciplinary approach for complete rehabilitation. Crown-root and/or root fracture in anterior teeth, especially in the cervical region, with fracture line below the gingival attachment or alveolar bone crest presents restorative difficulties. They are the most clinically challenging cases and present the clinician with dilemmas, as there is no single well-defined treatment protocol for such cases. Re-establishment of proper aesthetics and function in the anterior teeth is quite important, and orthodontic extrusion can be a suitable treatment option for fractures below the gingival attachment or alveolar bone crest. The following case reports describe the interdisciplinary management of subgingival tooth fractures, emphasising the importance and role of orthodontic extrusion in restoring and rehabilitating the teeth to their normal aesthetics and function. Keywords: biological width, crown-root fractures, gingival fiberotomy, orthodontic extrusion, prefabricated posts, relapse

Apical patency remains one of the main controversies in contemporary endodontics. This paper reviews some problems, advantages and shortcomings of current patency techniques to assist the readers in developing their own strategies on the basis of current scientific knowledge. Keywords: apical patency, apical foramen, over-instrumentation, under-instrumentation