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Prognosis of root canal treatments filled with Thermafil system: A 5-year retrospective study

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Aim: The aim of this retrospective cohort study was to assess the clinical and radiographic outcome after 5 ± 1 years of root canal treatments filled with Thermafil (TF) and to evaluate if the success rate is consistent with results reported by Literature with standard techniques. Methodology: A total of 213 endodontically treated teeth filled with TF and AH Plus were retrospectively examined. Following data were collected: initial pathology, primary treatment/retreatment and root filling length. Preoperative Periapical Index (PAI) was used as scoring system. At 5-years evaluation, teeth were judged healthy (PAI ≤ 2, no symptoms), endodontically-diseased (PAI ≥ 3 and/or symptoms, extraction or reintervention for endodontic reasons) or not-endodontically-diseased (root fracture, destructive caries, periodontal abscess). Outcome was blindly assessed by two examiners. Descriptive analysis and multivariate logistic regression were performed. Results: The total survival rate was 88%. Before the end-point, 20 teeth were extracted for not-endodontic reasons. Of the 193 analyzed teeth, 85% were considered healthy and proportions were significantly higher (Chi-square; p
Content may be subject to copyright.
ORIGINAL
ARTICLE/ARTICOLO
ORIGINALE
348
CONGRESSO
NAZIONALE
BOLOGNA
2015
VINCITORE
PREMIO
RICCARDO
GARBEROGLIO
Prognosis
of
root
canal
treatments
filled
with
Thermafil
system:
a
5-year
retrospective
study
Prognosi
dei
trattamenti
endodontici
otturati
con
Thermafil:
studio
clinico
retrospettivo
a
5
anni
C.
Pirani *,
V.
Tinarelli,
M.R.
Gatto,
F.
Iacono,
M.G.
Gandolfi,
C.
Prati
School
of
Dentistry,
Endodontic
Clinical
Section,
Master
in
Clinical
Endodontology,
Department
of
Biomedical
and
Neuromotor
Sciences
(DIBINEM),
Alma
Mater
Studiorum
University
of
Bologna,
Bologna,
Italy
Received
7
March
2016;
accepted
5
April
2016
Available
online
9
May
2016
Giornale
Italiano
di
Endodonzia
(2016)
30,
46—51
KEYWORDS
Clinical
outcome;
Endodontic
prognosis;
Retrospective
clinical
study;
Root
canal
treatment;
Thermafil.
Abstract
Aim:
The
aim
of
this
retrospective
cohort
study
was
to
assess
the
clinical
and
radiographic
outcome
after
5
1
years
of
root
canal
treatments
filled
with
Thermafil
(TF)
and
to
evaluate
if
the
success
rate
is
consistent
with
results
reported
by
Literature
with
standard
techniques.
Methodology:
A
total
of
213
endodontically
treated
teeth
filled
with
TF
and
AH
Plus
were
retrospectively
examined.
Following
data
were
collected:
initial
pathology,
primary
treatment/
retreatment
and
root
filling
length.
Preoperative
Periapical
Index
(PAI)
was
used
as
scoring
system.
At
5-years
evaluation,
teeth
were
judged
healthy
(PAI
2,
no
symptoms),
endodonti-
cally-diseased
(PAI
3
and/or
symptoms,
extraction
or
reintervention
for
endodontic
reasons)
or
not-endodontically-diseased
(root
fracture,
destructive
caries,
periodontal
abscess).
Outcome
was
blindly
assessed
by
two
examiners.
Descriptive
analysis
and
multivariate
logistic
regression
were
performed.
Peer
review
under
responsibility
of
Societa
`Italiana
di
Endodonzia.
*
Corresponding
author
at:
Department
of
Biomedical
and
Neuromotor
Sciences
(DIBINEM),
School
of
Dentistry,
Endodontic
Clinical
Section,
Master
in
Clinical
Endodontology,
Alma
Mater
Studiorum
University
of
Bologna,
Via
San
Vitale
59,
40125
Bologna,
Italy.
Tel.:
+39
051
2088106;
fax:
+39
051
225208.
E-mail:
chiara.pirani4@unibo.it
(C.
Pirani).
Available
online
at
www.sciencedirect.com
ScienceDirect
j
ou
rn
al
home
pag
e:
www.
el
sevie
r.
com/l
oca
te/
g
ie
http://dx.doi.org/10.1016/j.gien.2016.04.005
1121-4171/ß
2016
Societa
`Italiana
di
Endodonzia.
Production
and
hosting
by
Elsevier
B.V.
This
is
an
open
access
article
under
the
CC
BY-NC-ND
license
(http://creativecommons.org/licenses/by-nc-nd/4.0/).
Introduction
Complete
obturation
and
long-lasting
seal
of
the
root
canal
space
represent
a
critical/fundamental
step
of
successful
root
canal
treatment.
Warm
gutta-percha
compaction
has
been
demonstrated
as
an
efficient
technique
1
with
well-
documented
results.
2,3
However
this
technique
is
relatively
difficult
and
time
consuming
4
and
requires
a
long
training
to
be
appropriately
performed.
Among
techniques
using
thermo-plasticized
gutta-percha,
Thermafil
(TF)
coated
carrier
system
is
gaining
popularity
over
time.
It
was
firstly
described
in
1978
5
and
it
consists
of
a
plastic
carrier,
coated
with
a-phase
gutta-percha,
6
utilized
as
a
means
of
condensation.
7
This
technique
produces
a
homogeneous
mass
of
gutta-percha,
effective
for
obturating
canals
with
curved
morphology
or
difficult
access.
Available
in
vitro
laboratory
results
deemed
TF
as
an
efficient
techni-
que
able
to
ensure
a
stable
long-term
sealing,
4,8—11
compar-
able
both
to
cold
lateral
12—14
and
warm
vertical
compaction
4,8
techniques.
However,
despite
many
laboratory
studies
and
the
ever-increasing
clinical
employment
of
the
coated-carrier
systems,
to
date
there
is
little
information
about
their
clinical
and
radiological
outcome.
Few
in
vivo
reports
15—17
are
nowadays
available
concerning
the
clinical
use
of
TF
and
the
superiority
of
the
carrier-based
techniques
in
terms
of
clinical
outcome
has
not
been
reported.
The
aim
of
this
5-year
longitudinal
clinical
study
was
to
identify
factors
that
might
influence
the
prognosis
of
root
canal
treatment
in
teeth
filled
with
TF
observed
in
a
retro-
spective
cohort
of
patients
during
a
Master
Program
of
an
University
Endodontic
Department.
The
present
article
was
written
following
the
STROBE
Statement
for
observational
studies
and
respecting
the
guidelines
published
by
Dodson
in
2007.
18
Material
and
methods
Follow-up
group
The
study
population
consisted
of
patients
recruited
in
the
Dental
Clinical
School
of
DIBINEM
University
of
Bologna,
Endodontic
Department.
Four-hundred
twenty
patients
were
treated
by
graduated
attending
the
Master
program
of
PAROLE
CHIAVE
Endodonzia;
Successo
clinico;
Studio
retrospettivo;
Prognosi;
Thermafil.
Results:
The
total
survival
rate
was
88%.
Before
the
end-point,
20
teeth
were
extracted
for
not-
endodontic
reasons.
Of
the
193
analyzed
teeth,
85%
were
considered
healthy
and
proportions
were
significantly
higher
(Chi-square;
p
<
0.04)
for
teeth
without
initial
radiolucency
and
when
final
length
of
root
filling
material
was
adequate.
Logistic
regression
showed
that
the
preope-
rative
PAI
2
significantly
increased
the
healing
rate
(risk
ratio
[RR]
3.09;
95%
CI,
1.12—8.53).
Conclusions:
The
overall
healing
rate
of
the
present
investigation
was
similar
to
that
previously
reported
by
well-documented
obturation
techniques.
The
prognosis
of
endodontic
therapies
performed
with
TF
obturation
system
supports
the
clinical
use
in
a
post-graduated
Master
Program.
ß
2016
Societa
`Italiana
di
Endodonzia.
Production
and
hosting
by
Elsevier
B.V.
This
is
an
open
access
article
under
the
CC
BY-NC-ND
license
(http://creativecommons.org/licenses/by-nc-nd/
4.0/).
Riassunto
Obiettivi:
Il
presente
studio
clinico
retrospettivo
ha
valutato
il
successo
a
5
1
anni
di
trattamenti
endodontici
eseguiti
nel
Master
di
Endodonzia
e
otturati
con
tecnica
Thermafil
(TF).
Materiali
e
Metodi:
In
totale,
213
denti
trattati
endodonticamente
e
inclusi
nel
Recall-program,
sono
stati
esaminati
durante
le
visite
di
controllo.
I
canali
sono
stati
otturati
con
TF
e
cemento
AH
Plus.
I
seguenti
dati
sono
stati
registrati
e
analizzati
statisticamente:
patologia
iniziale,
tipo
di
trattamento
(primo
trattamento/ritrattamento)
e
lunghezza
dell’otturazione
canalare
(under-
filling,
adeguato,
overfilling).
L’Indice
Periapicale
(Periapical
Index-PAI)
preoperatorio
e
`stato
usato
come
scoring
system.
Dopo
5
anni
i
denti
sono
stati
classificati
come
healthy
(PAI
2,
nessun
sintomo),
endodontically-diseased
(PAI
3
e/o
sintomi;
ritrattamenti,
apicectomie
o
estrazioni
per
cause
endodontiche)
or
not-endodontically-diseased
(fratture
radicolari,
lesioni
cariose
profonde,
problemi
parodontali).
La
valutazione
del
risultato
a
5
anni
e
`stata
effettuata
in
doppio
cieco
da
due
esaminatori
esperti.
L’associazione
tra
le
variabili
e
il
risultato
finale
e
`
stata
valutata
statisticamente
mediante
analisi
univariata
e
regressione
logistica.
Risultati:
La
sopravvivenza
a
5
anni
e
`risultata
88%
e
l’85%
degli
elementi
e
`stato
classificato
come
healthy
con
valori
statisticamente
significativi
(Chi-square;
p
<
0.04)
in
assenza
di
lesione
periapicale
iniziale
e
con
un’otturazione
canalare
adeguata.
La
regressione
logistica
ha
confer-
mato
il
PAI
iniziale
2
come
fattore
prognostico
piu
`importante
(risk
ratio
[RR]
3.09;
95%
CI,
1.12—8.53).
Conclusioni:
Il
successo
delle
terapie
endodontiche
eseguite
con
tecnica
Thermafil
e
la
notevole
semplicita
`di
esecuzione,
ne
incoraggiano
l’utilizzo
clinico
all’interno
di
un
Master
di
Endodonzia.
ß
2016
Societa
`Italiana
di
Endodonzia.
Production
and
hosting
by
Elsevier
B.V.
Cet
article
est
publie
´en
Open
Access
sous
licence
CC
BY-NC-ND
(http://creativecommons.org/licenses/by-nc-
nd/4.0/)
Prognosis
of
root
canal
treatments
filled
with
Thermafil
system
47
Endodontology
from
January
2008
to
December
2010,
and
considered
eligible
for
the
present
research.
Only
patients
aged
between
18-70,
not
affected
by
systemic
disease,
not
treated
with
amino-bisphosphonates
and
with
adequate
oral
hygiene
(Plaque
Index
<
20%)
were
included
in
the
Recall
program.
Severely
damaged
teeth
requiring
periodontal
therapy
or
included
in
a
bridge
were
excluded.
All
patient
recruited
in
this
investigation
were
treated
according
with
the
principles
established
by
the
Declaration
of
Helsinki
as
modified
in
2000.
19
A
signed
informed
consent
was
obtained
from
all
patients.
Demographic
and
clinical
data
(age,
gen-
der,
medical
history,
symptomatology,
date
of
treatments)
were
extracted
from
medical
records
and
radiographic
para-
meters
(PAI
and
length
of
root
canal
filling)
were
obtained
from
preoperative
periapical
radiographs
(Table
1).
Root
canal
treatment
All
root
canal
treatments
were
strictly
standardized
and
performed
by
postgraduate
students
attending
Master
in
Endodontics
at
the
University
of
Bologna,
under
the
super-
vision
of
experienced
tutors.
A
preoperative
periapical
radio-
graph
of
the
tooth
was
taken
for
every
patient.
Each
element
isolated
with
rubber
dam
(Hygienic
Dental
Dam,
Colte
`ne
Waledent,
Cuyahoga
Falls,
OH,
USA)
before
creating
a
straight-line
access.
As
a
routine
procedure
for
treatments
and
retreatments
was
used
a
step-down
technique
20
with
Gates-Glidden
burs
(Maillefer,
Ballaigues,
Switzerland)
#4-3-
2
at
low
speed.
Coronal
third
and
apical-medium
third
was
prepared
by
using
manual
K-files
(Maillefer,
Ballaigues,
Swit-
zerland).
Apical
diameters
were
prepared
between
size
ISO
#20
and
#45,
depending
on
the
size
of
the
root.
The
working
length
was
determined
at
0.5
mm
from
the
apex
by
electro-
nic
apex
locator
(Root
ZX,
Morita,
Tokio,
Japan)
and
radio-
graphically
confirmed.
Each
canal
was
irrigated
with
5—10
ml
of
5%
NaOCl
(Niclor
5,
Ogna,
Muggio
`,
Italy)
and
1—3
ml
of
10%
EDTA
(Tubuliclean,
Ogna,
Muggio
`,
Italy).
In
case
of
root
canal
retreatment,
the
filling
material
was
removed
by
using
also
appropriate
solvents
for
gutta-percha
and
cement
(Endosolv
E
or
Endosolv
R
Septodont,
Cedex,
France)
until
the
material
was
not
detectable
at
naked
eye
and
by
radiograph.
Root
canal
filling
and
restoration
AH
Plus
sealer
(Dentsply
DeTrey
GmbH,
Konstanz,
Germany)
was
mixed
and
inserted
into
root
canal
using
a
K-file.
TF
system
(Dentsply
Maillefer
GmbH,
Konstanz,
Germany)
was
used
as
root
canal
filling
procedure
in
all
the
included
teeth.
All
root-
treated
teeth
were
temporized
with
Coltosol
(Colte
`ne Wha-
ledent,
Cuyahoga
Falls,
OH,
USA)
and
received
a
permanent
restoration
within
2
weeks
from
root
canal
obturation.
A
self-etching
dentinal
bonding
agents
(Clearfil
SE
BOND,
Kuraray,
Tokyo),a
flowable
composite
resin
and
a
high-filled
composite
resin
(Gradia
Direct,
GC
Corporation,
Tokyo,
Japan)
was
layered
and
photo-cured
into
the
cavity.
When
considered
necessary,
a
carbon
post
(Tech
2000
XOP,
Isasan,
Rovello
Porro,
Italy)
was
employed
with
Scotchbond
1/Relyx
Arch
(3
M
ESPE,
St.
Paul,
MN,
USA).
A
provisional
resin
crown
and
a
metal
ceramic
crown
was
considered
on
the
basis
of
the
residual
tooth
structure
and
applied
after
3—6
month
from
endodontic
therapy.
Pre,
intra,
and
post-operative
radio-
graphs
were
taken
using
the
paralleling
technique
and
only
those
with
proper
angulations
and
properly
developed
were
accepted.
The
exposure
time
of
each
tooth
type
was
stan-
dardized
to
minimize
the
radiation
dose.
Outcome
evaluation
One
operator
visited
the
patients,
took
the
follow-up
radio-
graphs
and
recorded
symptoms
and
clinical
signs
between
October
2013
and
December
2014.
Periapical
Index
(PAI)
firstly
proposed
by
Ørstavik
21
was
used
to
score
each
radiograph.
The
outcome
assessment
was
performed
by
two
examiners
with
the
same
years
of
training,
blind
to
the
preoperative
data
and
the
name
of
the
patient.
Tee t h
firstly
treated
were
divided
into
two
groups
according
to
initial
pulpal
diagnosis
and
periapical
status:
vital
teeth
treated
for
pulpitis
and
deep
carious
lesions,
necrotic
teeth
treated
for
periapical
lesion.
Retreated
teeth
were
divided
into
two
subgroups
according
to
the
absence/
presence
of
initial
signs/symptoms:
preventive
retreatments
and
therapeutic
retreatments.
Obturation
quality
was
evaluated
on
the
basis
of
length
of
root
filling
material,
classified
as
adequate
(0—2
mm
from
the
radiographic
apex),
overfilling
(overextension
of
gutta-
percha/sealer
from
the
apex),
underfilling
(>2
mm
from
the
apex).
Multi-rooted
teeth
were
scored
depending
on
the
root
with
the
worst
outcome.
If
the
tooth
had
been
extracted,
the
reason
and
the
time
of
extraction
were
recorded.
At
the
end-point
evaluation,
if
the
extraction
was
related
to
failure
of
the
root
canal
therapy
it
was
included
in
the
main
statistical
analysis
and
if
the
extraction
was
for
not-endodontic
reasons
(fractures
or
periodontal
disease)
it
was
excluded.
Remaining
teeth
were
dichotomized
22
as
healthy,
with
a
PAI
2
and
no
symptoms
or
clinical
signs
of
illness,
21,23
or
endodontically
diseased
(PAI
3,
presence
of
symptoms
or
clinical
signs
of
illness,
undergone
to
further
re-intervention
before
the
end-
point
as
orthograde
or
surgical
retreatment,
rizectomy
or
extraction
due
to
endodontic
pathology).
Statistical
analysis
Bivariate
analysis
of
the
associations
between
the
treatment
outcome
and
clinical
or
radiographic
parameters
using
Table
1
Considered
variables
are
represented.
Parameters
Categories
Pre-operative
parameters
Gender
Female,
male
Age
20—29,
30—39,
40—49,
50
Tooth
location
Maxilla,
mandible
Tooth
type
Single
rooted,
premolar,
molar
Initial
diagnosis
Pulpitis,
periapical
lesion,
preventive
retreatment,
therapeutic
retreatment
Initial
radiolucency
Absence,
presence
Type
of
treatment
First
treatment,
retreatment
Intra-operative
parameters
Root
filling
length
Adequate,
underfilling,
overfilling
48
C.
Pirani
et
al.
contingency
tables
and
x
2
-square
test
was
performed.
Unconditioned
logistic
regression
(forward
method)
was
per-
formed
aiming
to
identify
the
best
predictors
of
the
outcome
among
the
clinical
and
radiographic
parameters
examined
that
were
significantly
associated
with
the
outcome
on
the
basis
of
the
bivariate
analysis.
a-Level
was
a
priori
set
at
0.05.
Subject’s
chart
was
examined
to
establish
the
date
and
the
reason
for
extraction.
Results
A
total
of
213
teeth
from
94
patients
(48
females,
46
males;
mean
age:
48
13
years)
responding
to
all
the
inclusion
criteria
were
collected
and
analyzed:
107
maxillary
elements
(50%)
and
106
mandibular
elements
(50%)
divided
in
40
incisors
and
canines
(19%),
65
premolars
(30%),
108
molars
(51%).
The
total
5-year
survival
rate
was
88%.
Twenty-six
teeth
were
extracted
before
5-years
after
treatment,.
Six
teeth
(3%)
were
extracted
for
endodontic
reasons
(recurrent
abscesses);
20
teeth
(9%)
were
lost
for
not-endodontic
rea-
sons
(periodontal
reasons
with
pocket
depth,
periodontal
abscesses
or
traumatic
root-fractures)
and
excluded
from
the
logistic
regression
analysis.
A
total
of
193
teeth
have
been
followed
up
for
5
years.
All
the
parameters
listed
in
Table
1
were
correlated
with
the
final
outcome
(healthy/diseased).
The
overall
healing
rate
was
85%
and
the
percentage
of
diseased
teeth
after
5
1
years
was
15%.
The
success
rate
was
not
significantly
associated
(
p
>
0.05)
with
gender,
age,
tooth
type,
maxillary
and
mandibular
teeth
nor
with
coronal
restorations
(Tabl e
2).
Healthy
proportions
were
significantly
higher
for
teeth
with
initial
diagnosis
of
pulpitis
and
preventively
retreated
(
p
=
0.0001),
in
absence
of
radiolucency
(
p
=
0.0001),
when
final
length
of
root
filling
material
was
adequate
(
p
=
0.02).
Teet h
primarily
treated
presented
a
success
rate
of
87%,
higher
than
retreated
teeth
(80%),
however
the
statistical
significance
was
not
reached.
Multivariate
logistic
regression
identified,
among
the
explicative
variables
significantly
associated
with
the
out-
come,
initial
radiolucency
(RR
3.09;
95%
CI
1.12—8.53)
as
predictor
of
healing.
Absence
of
radiolucency
increased
the
healing
rate
of
almost
3
times
in
comparison
with
presence
of
radiolucency.
Discussion
Success
of
root-canal
treatment
has
been
defined
as
the
prevention/elimination
of
periapical
radiolucency
and
symp-
toms
of
endodontic
origins.
The
presence
of
signs
and
symp-
toms
of
infection
and
the
appearance/persistence
of
a
lesion
after
the
4-year
assessment
period,
is
identified
with
post-
treatment
disease.
24
Nevertheless,
it
is
extremely
arduous
to
always
define
and
categorize
the
outcomes
of
root
canal
treatments
in
terms
of
success
or
failure
because
clinical
and
radiographic
signs
can
frequently
appear
unfocused.
This
clinical
study
assessed
the
5-year
clinical
outcome
of
endodontic
therapies
filled
with
TF
by
post-graduated
Master
students
and
evaluated
if
the
success
rate
is
comparable
with
gold
standard
techniques
reported
by
Literature.
The
obser-
vation
period
of
5
1
years
was
decided
according
to
the
Quality
Guidelines
for
endodontic
treatment
by
the
European
Society
of
Endodontology.
24
In
fact
a
minimum
period
of
4
years
is
suggested
as
a
cut
off
point
for
a
dichotomous
outcome
assessment.
Retrospective
investigations
have
been
frequently
used
as
the
basis
for
further
prospective
studies.
In
the
present
clinical
investigation,
every
root
canal
treatment
was
per-
formed
by
trained
postgraduates
following
well
standardized
and
precise
protocols.
Chair-side
time
required
for
the
obturation
technique
and
the
ease
of
manipulation
of
a
material
are
fundamental
factors
that
support
the
choice
of
TF
technique
in
a
Master
of
Endodontology.
Selection
of
TF
was
also
correlated
with
the
operator
experience
and
with
the
time
required
for
filling
procedure.
In
fact,
TF
has
been
shown
to
be
an
efficient
technique,
effective
in
obturing
lateral
canals
25
and
results
simple,
fast
and
predictable
especially
in
small
or
curved
canals.
26
AH-Plus
(Dentsply
Maillefer,
Ballaigues,
Switzerland)
is
an
epoxy-based
endo-
dontic
sealer
that
in
vitro
provides
a
stable
apical
seal.
27
Gagliani
et
al.
15
on
122
teeth
obtured
with
TF,
outlined
a
percentage
of
success
of
95%
in
teeth
without
periapical
lesion
and
of
48%
with
periapical
radiolucency
at
24
months.
Chu
et
al.
16
examined
71
teeth
after
3—4
years,
finding
similar
treatment
outcomes
when
TF
was
compared
with
cold
lateral
condensation
of
gutta-percha
and
reported
the
TF
root
canal
filling
requires
significantly
less
operative
time
then
lateral
compaction.
A
more
recent
clinical
study
17
verified
the
results
of
71
primary
endodontic
treatments
filled
with
lateral
compaction
or
carrier-based
obturation,
finding
that
the
tooth
type
significantly
affected
outcome,
irrespective
to
the
used
obturation
technique.
Table
2
The
association
between
primary
outcomes
and
recorded
variables
is
represented.
Variables
n
Healthy
n
%
p
value
Pre-operative
parameters
Tooth
location
0.462
Maxilla
101
84
83
Mandible
92
80
87
Tooth
type
0.15
Single-rooted
40
32
80
Premolar
63
58
92
Molar
90
74
82
Initial
diagnosis
0.0001
Pulpitis
89
82
92
Periapical
Lesion
54
42
78
Preventive
retreatment
22
22
100
Therapeutic
retreatment
28
18
64
Initial
radiolucency
0.0001
Absence
111
104
94
Presence
82
60
73
Type
of
treatment
0.253
First
treatment
143
124
87
Retreatment
50
40
80
Intra-operative
parameters
Root
filling
length
0.02
Adequate
117
106
91
Overfilling
55
41
75
Underfilling
21
17
81
Total
193
164
85
Prognosis
of
root
canal
treatments
filled
with
Thermafil
system
49
Intricate
anatomies
and
complex
operative
procedures
make
challenging
the
treatment
of
multi-rooted
teeth.
Whilst
technology
has
improved
instruments
and
materials
to
achieve
rising
outcomes
in
root
canal
therapies,
it
is
astonishing
that
the
reported
success
rates
have
failed
to
increase
over
the
last
four
or
five
decades.
28
A
possible
explanation
could
be
the
selection
of
more
complex
cases
supported
by
confidence
in
better
skills
of
specialized
clin-
icians
and
by
the
tendency
in
preserving
natural
teeth.
The
overall
healing
rate
of
the
present
investigation
was
85%:
it
should
be
emphasized
that
those
findings
are
similar
to
that
previously
reported
by
using
well-documented
obturation
techniques.
3,29—32
Among
analyzed
pre-
and
intra-operative
factors,
the
following
variables
resulted
to
significantly
affect
the
out-
come:
initial
diagnosis,
presence/absence
of
pre-operative
radiolucency
and
length
of
root
filling
material.
As
expected,
the
present
research
confirmed
that
teeth
without
preopera-
tive
radiolucency
resulted
in
a
favourable
percentage
of
healing
(94%).
Concerning
initial
diagnosis,
only
8%
out
of
vital
teeth
were
classified
as
‘failure’’,
revealing
the
onset
of
a
periapical
lesion
after
5
years.
The
outcome
was
lower
in
teeth
with
pre-operative
radiolucency,
thus
confirming
2
this
condition
as
an
important
factor
enhancing
the
healing
rate
of
root
canal
treatments.
A
relevant
percentage
(27%)
of
teeth
with
initial
periapical
lesion
were
classified
as
endo-
dontically-diseased
at
the
end
point:
6
out
of
these
were
extracted
because
resulted
not
re-treatable
and
antibiotic
not-sensitive.
In
the
present
study,
the
concurrence
of
over-
filling
and
pre-operative
periapical
lesion
did
not
statistically
diminish
the
chance
of
healing.
Those
data
are
in
contrast
with
Tennert
et
al.
33
who
demonstrated
that
the
use
of
TF
increases
root
canal
filling
extrusion
and
hypothesized
nega-
tive
effects
of
overextension.
Although
bivariate
analysis
showed
a
negative
effect
of
preoperative
conditions
(initial
diagnosis,
pre-operative
radiolucency)
and
a
post-operative
factor
(length
of
root
filling
material),
in
the
logistic
regression
only
the
presence
of
a
preoperative
periapical
lesion
had
significant
effect.
Periapical
lesions
are
concomitant
with
the
presence
of
bacteria
population
that
harbours
the
entire
canal
sys-
tems
30,34,35
insisting
on
the
periapical
tissue.
36
Conclusions
TF
system
with
AH
Plus
cement
can
be
deemed
as
an
ulti-
mate/suitable
obturation
method
in
a
post-graduate
Master
Program.
It
was
appealing
to
notice
that
the
healing
rate
was
similar
than
those
reported
by
Literature.
This
observation
encourages
the
clinical
use
of
TF.
Conflict
of
interest
The
authors
deny
any
conflict
of
interest
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root
canal
lumen
of
patients
with
primary
and
secondary
endodontic
lesions.
New
Microbiol
2008;31:235—40.
Prognosis
of
root
canal
treatments
filled
with
Thermafil
system
51
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This study investigated the long-term clinical outcome of root canal treatment. 240 root-treated teeth (n = 61 patients) were initially classified on the basis of radiographic presence/absence of initial apical periodontitis (IAP) and clinical data. The final outcome measure was the periapical healing (healed/disease). The outcome at 6-9 months was correlated with the outcome at 10 years following treatment. Prognostic factors for the periapical healing were assessed. Extraction data were recorded. Univariate and multivariate logistic regression analysis was used to identify risk indicators for apical periodontitis (AP) development. Chi-square analysis was performed to evaluate a possible relationship between the 6-9 months outcome and the final outcome related to IAP. Mean observation time was 14 ± 3.7 years. Survival rate was 84.6 % and healing rate was 79 % (10-19 years). Predictors of outcome (p < .05) were considered statistically significant. Multivariate logistic regression analysis showed that initial pulpal and periapical status and the quality of root canal filling as assessed two-dimensionally were independent predictors of outcome. The 6-9 months evaluation appears to be an indicator for the final outcome of primary root canal treatment both in the presence and in the absence of IAP. An initial radiolucency associated with an unsatisfactory quality and extent of root canal filling significantly diminishes the possibility of achieving long-term radiographic success. For those with uncertain healing at 6-9 months (91 %), clinicians should consider the high healing rate when estimating the prognosis and adjust the decision making accordingly.
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This in vitro study sought to evaluate the sealing ability of 3 root canal obturator systems after immersion in simulated body fluid for 1 year. The coronal sections of 30 single-rooted teeth were removed at the cementoenamel junction at 12 mm (±1 mm), and roots were instrumented with nickel titanium instruments. Specimens were divided into 3 groups (n = 10) according to the obturation manufacturer-specified system and immersed in simulated body fluid. A digital fluid flow-meter was used to detect the flow rate at 1 week, 1 month, and 12 months after immersion. This study demonstrated that the tested endodontic obturation systems were unable to keep their sealing ability stable during the first year. At 12 months, all root filling systems showed increased flow rates (P < 0.0001).
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Objective The objective of this study was to investigate the outcome of conventional root canal treatment in a general practice setting within the Royal Air Force dental service.Design Retrospective review.Methods Teeth that had been root-filled for 12 months or more by Royal Air Force dental practitioners in patients attending a large Royal Air Force dental centre were included in the study. Following clinical and radiographic review the root fillings were classified as 'definitely successful', 'probably successful' or 'failed'. The effect on success of several variables on the outcome was investigated.Results Out of a total of 406 teeth, 59% were maxillary teeth and 41% were mandibular teeth. Sixty-nine per cent of the total sample had pre-existing periapical radiolucencies. Cold lateral condensation of gutta-percha was the most widely used filling technique (64% of all cases). Fifty per cent of the teeth had root fillings within 2 mm of the radiographic apex, 32% were greater than 2 mm from the radiographic apex and 18% were overfilled. Cold lateral condensation was the most successful (92% overall) filling technique. Maxillary anterior teeth had a better success rate (96%) than other tooth types. Teeth with pre-existing periapical radiolucencies had a higher success rate (87%) than those cases where there was no pre-existing periapical radiolucency (80%). Root fillings that were less than 2 mm from the radiographic apex of the tooth had a higher success rate (88% overall) than those that were greater than 2 mm from the radiographic apex (77% overall). Of the 406 cases, 57% (n=231) were classified as definitely successful, 28% (n=114) were classified as probably successful and 15% (n=62) were classified as failures. Thus, the overall success rate combining definitely successful and probably successful root fillings was 85% (n=344).Conclusions Root fillings placed using cold lateral condensation of gutta-percha to within 2 mm of the radiographic apex of the tooth were associated with the best outcome.
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The purpose of this retrospective study was to compare the outcome of primary endodontic treatment using a standardized cleaning and shaping technique and obturation with either lateral compaction or carrier-based obturation. Patients received primary endodontic treatment in the predoctoral dental clinic using a standardized cleaning and shaping protocol. All root canals were obturated using AH Plus(TM) sealer with lateral compaction of gutta-percha (LC) or carrier-based obturation (CBO). A total of 205 cases met the inclusion criteria. 71 teeth in 60 patients were recalled after 2 years and evaluated both clinically and radiographically by two independent examiners. Success was defined as a lack of clinical symptoms and a normal periodontal ligament space or reduction in size of a previously existing periapical radiolucency. Chi-square and logistic regression were used for statistical analysis with a significance level of P < 0.05. There was no difference in success rates between cases obturated with LC or CBO (P = 0.802); overall success rate was 83%. Molars had a significantly lower success rate (53%) than premolar and anterior teeth (89%) (P = 0.005), irrespective of the obturation technique used. When a standardized cleaning and shaping protocol was used by predoctoral dental students in a controlled university setting, there was no difference in success rates between cases obturated with LC or CBO.
Article
The assurance of the quality of a service rendered by a member of the dental profession is an essential feature of any system of peer review in dentistry. This document addresses two essential elements: (i) appropriateness of treatment modality and (ii) quality or level of treatment rendered. In revising these guidelines the European Society of Endodontology is responding to a public and professional need. In receiving care of a specialized nature such as endodontic treatment, patients need and deserve treatment that meets the standard of care generally given by competent practitioners. The European Society of Endodontology has the expertise and professional responsibility necessary to assist the dental profession by instituting guidelines on the standard of care in the special area of Endodontics. In accepting this responsibility the European Society of Endodontology formulated treatment guidelines that are intended to represent current good practice. This document is the revised version of an earlier consensus report [International Endodontic Journal (1994) 27, 115-24]. As there is not one single way of performing treatment, these guidelines have been formulated in broad terms.
Article
Aim: To investigate nondestructively the percentage of 3D voids and marginal gaps in a pre-defined interface volume of interest (VOI) within root fillings produced by Thermafil Obturators with either a hydrophobic epoxy-resin-based sealer (AH Plus) or a hydrophilic flowable calcium-silicate sealer [mineral trioxide aggregate (MTA) Flow]. Methodology: Sixteen single root canals from extracted premolar teeth were prepared with ProTaper rotary instruments, randomly allocated into two groups (n = 8) and filled with size 30 Thermafil Obturators in association with AH Plus or MTA Flow sealers. The filled roots were stored at 37 °C in 5 mL of Hank's balanced salt solution (HBSS) used to represent body fluids and scanned after 7 days and 6 months using a high-resolution micro-CT. From each root, images of 3000 sections were analysed in 3D and binarized using a high-resolution micro-CT (4-μ resolution). The 3D distribution of voids (porosity and marginal gaps) at the gutta-percha-sealer-dentine interface was detected through a threshold grey level and expressed as percentage of the 40-μ-thick pre-defined interface VOI (20 μ of interface dentine and 20 μ of gutta-percha/sealer). A method of analysis based on the root canal segmentation was used, and coronal, middle and apical thirds considered separately. The percentage of 3D void volume was compared statistically using one-way anova (significance for P < 0.05). Environmental Scanning Electron Microscope with Energy Dispersive X-ray (ESEM-EDX) analysis was performed on the surface of both sealers after soaking in HBSS. Results: Micro-CT detected gaps at the dentine-sealer interface in both groups. Void volumes wider than 10.21 μm(3) with 1.35 μm diameter were detected. Cul-de-sac-type voids (blind pores) and through-and-through voids (continuous pores) were discriminated. The apical thirds had a significantly lower 3D void volume (P < 0.05) than the middle and coronal thirds. The 3D void volume reduced significantly (P < 0.05) over time. ESEM-EDX analysis revealed that MTA Flow sealer created a dense apatite layer after 7 days of immersion in HBSS, whilst only sparse calcium phosphate deposits were detected on AH Plus even after 28 days. Conclusions: Micro-CT proved to be a powerful nondestructive 3D analysis tool for visualizing the porous internal microstructure of dental/endodontic materials at the interface with dentine. The proportion of voids was least in the apical third of root canals. Voids reduced over time in the presence of simulated body fluid.
Article
Abstract A scoring system for registration of apical periodontitis in radiographs is presented. The system is termed the periapical index (PAI) and provides an ordinal scale of 5 scores ranging from 1 (healthy) to 5 (severe periodontitis with exacerbating features). Its validity is based on the use of reference radiographs of teeth with verified histological diagnoses. Results from studies involving 11 observers and 47 selected radiographs document that the PAI system is reasonably accurate, reproducible and able to discriminate between sub-populations. It may also allow for results from different researchers to be compared. The system may be suitable for the analysis of periapical radiographs in epidemiological studies, in clinical trials and in retrospective analyses of treatment results in endodontics.
Article
Objectives The aim of this study was to compare two different thermoplastic techniques—a core-carrier technique (Thermafil) and warm vertical compaction—in terms of overextension of root canal filling in vivo. Materials and methods Flaring of 88 teeth was conducted using Pro Files .04 as finishing files, and the teeth were obturated using Thermafil. Flaring of 74 teeth was performed using Pro Files .06 as finishing files, and the teeth were obturated using warm vertical compaction. Results Seventy (80 %) of the teeth obturated using Thermafil and 31 (42 %) teeth obturated using warm vertical compaction show extruded root canal filling. In contrast to Thermafil, there is a higher rate of extruded root canal filling of teeth with more than one root canal using warm vertical compaction. Conclusion Thermafil demonstrated a higher rate of extruded root canal filling compared to warm vertical compaction. Warm vertical compaction is a more predictable method of filling compared to Thermafil. Clinical relevance Root canal filling extrusion will cause irritation of the surrounding tissue and impair repair processes. In the present in vivo study, there was a higher rate of root canal filling extrusion using Thermafil compared to warm vertical compaction.