A five-year retrospective clinical study of a calcium-aluminate in retrograde endodontics. 1L. KRAFT, 2M. SAKSI, 3L. HERMANSSON, C.H. PAMEIJER4, 1CBI, Stockholm, 2Privattandläkarna Norrköping, 3 The Angstrom Laboratory, Uppsala University, and Doxa AB, Uppsala, Sweden, 4University of Connecticut, Farmington, USA Poster # 1333 At treatment After 6 months Objective: To conduct a long-term clinical study using a calcium aluminate (CA) based material as root canal sealer and as a retrograde filling material. Patient no. Diagnosis, Indications Surgical procedure Symptoms at Control Answers Group 1 11 c p o. Trauma in frontal maxilla, with swelling. Open apex. Orthograde rf. 2 and 5 years, healed No symptoms 1. No 2. Yes 3. No symptoms 2 a b c 22,21,12 all with c p o. Not fully healed after trauma and orthograde root filling treatment. Retrograde rf. 3. No 3 C p o 16. Patient with pain, difficult to diagnose. Patient informed of a dubious prognos is for her pain treatment. All three roots treated. 2 and 5 years, healed No pain resisting 3. No pain 4 36 juxtradicular, c p a, possible crack. Distal root amputation. 2 years, healed No 5 year control 1. Occasionally 2 - 5 C p o 26, mb and db roots. Retrograde rf 2 years. Symptoms remained in mb; db healed 5 years, no problems 1. Yes 3. Symptoms (2) 6 C p o 15 No x-ray control at 2 years 5 years, x-ray control, symptom free 7 Exacerbations, c p o 21, apical symptoms. 2 years, healed, no symptoms 2. No 8 Chronic perapical destruction 11 Orthograde rf med 9 C p o 11 2 years, healed. Apical parestesi remaining 5 year, no symptoms 10 C p o 21 Retrograde amalgam rf removed with ultrasonic. Repetitive retrogr. therapy. 2 And 5 years, healed 11 C p o 23 12 a d C p o 12 21 22 2,5 and 5 years x-ray. Every tooth healed. 13 C p o 13 2,5 and 5 year healed 14 C p o 21, trauma. Orthograde rf with Doxa on the apical third of the tooth 2 years healed 15 2.5 years healed 16 C p o 11, exacerbations. 17 Retrograde rf, repetitive retrograde therapy. 2.5 years x-ray. The apical radiolucency re- duced. Not completely healed, without periodontal contour. 5 years, symptom free (1) Introduction: The study was conducted on human volunteers who had signed an informed consent form. A total of 17 patients were treated who were diagnosed with either a chronic periapical lesion or who were in need of a retrograde filling in failed endodontically treated teeth. The material used in this study was a Ca-aluminate (CA) based material produced by Doxa AB. Commercially available endodontic materials are described in [1-3]. Materials and method: Materials. The CA-material exhibits compressive strength above 200 MPa, fracture toughness, KIC, of 0.7 MPam1/2, Vickers hardness, HV, of 150 Kg/mm2 and Young´s modulus of 15 GPa. The materials properties, including the chemical and the biological aspects of the CA-material are described in more details elsewhere [4-8]. Methods and Evaluation. A total of 8 orthograde treatments and 14 retrograde fillings were placed.  The orthograde root canal treatments were carried out according to standardized established techniques, using NiTi files and NaOCl. Gutta-percha cones were used in conjunction with the calcium aluminate, which was mixed in a ratio specified by the manufacturer. The retrogrades were carried out using an operating microscope. All teeth had a pre-operative, immediate post-operative and 2 and 5 year post-operative X-rays. Recall visits were scheduled after 2 and 5 years. The patients’ teeth were examined and investigated with X-ray, and three questions regarding subjective symptoms were put to the patients at recalls; 1. Have you had any persistent symptoms? 2. Do you know which tooth was treated? 3. Can you feel any symptoms at the tooth apex? Based on both the clinical examination and the subjective symptoms the results were graded into different groups related to the success of the therapy as follows; 1 = Complete healing, 2 = Incomplete healing, 3 = Uncertain and 4 = Failure. Patient no. 17 At treatment After 2.5 years Patient no. 9 At treatment After 2.5years Results: After 2 years out of 17 patients (22 teeth) treated, 16 patients (21 teeth) were examined with follow-up x-ray, and after five years 13 patients (16 teeth) were evaluated. The over-all results are shown in Table below. Score 1 or 2 is considered successful, and score 3 or 4 is considered as failure. The whole study with all patient nos. (#) is summarized in the table to the right. Over-all results Patient no. 7 (Score 1 or 2 is considered successful, and score 3 or 4 is considered as failure) CONCLUSION 1. Orthograde and retrograde endodontic treatments using an experimental calcium aluminate material were judged successful after a two and five year recall evaluation. 2. These clinical results confirm earlier biocompatibility studies. 3. However, a controlled clinical trial with more subjects should be undertaken to verify the findings in this study. This study was supported in part by Doxa Dental AB Score Nos. of teeth At 2 years At 5 years Percentage At 2 years At 5 years 1 Complete healing 2 Incomplete healing 3 Uncertain 4 Failure 18 14 3 2 1 82 87 14 13 4 Total 22 16 100 100 At treatment After treatment At 2 year control References: 1. Haumann, C.H.J. and R.M. Love, Biocompatibility of dental materials used in contemporary endodontic therapy: Int Endo J, 2003. 36: p. 147-160. 2. Niederman, R. and J.N. Theodosopoulou, A systematic review of in-vivo retrograde obturation materials. Int Endod J, 2003. 36: p. 577-585. 3. Alamo, H.L., et al., A Comparison of MTA, Super-EBA, composite and amalgam as root-end filling materials using a bacterial microleakage model. International Endodontic Journal, 1999. 32: p. 197-203. 4. Hermanssson, L. and E. Kraft L., H., Chemically Bonded Ceramics as Biomaterials,. Key Engineering materials, 2003. 247: p. 437-442. 5. Torabinejad, M., Clinical Applications of Mineral Trioxide Aggregate. J Endo, 1999. 25(3): p. 197-205. 6. Kraft, L., Calcium Aluminate Based Cement as Dental Restorative Materials. Ph D Thesis, December 2002, Uppsala University, Sweden, 2002. 7. Engqvist, H., et al., Chemical and biological integration of a mouldable bioactive ceramic material capable of forming apatite in vivo in teeth. Biomaterials, 2003. 25(17): p. 2781-27870 8. Pameijer et al, J Dental Res 82: # 380, p 73 (2004) Patient no. 14