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Treatment Outcome in Endodontics: The Toronto Study-Phase 4: Initial Treatment
Abstract
Outcome 4-6 years after initial treatment was assessed for Phase 4 (2000-2001) of the Toronto Study. Of 582 teeth treated, 430 were lost to follow-up (99 discontinuers, 331 dropouts), 15 were extracted, and 137 (32% recall minus 15 extracted teeth) were examined for outcome: healed (no apical periodontitis, signs, symptoms) or diseased. When pooled with Phases 1-3, 439 of 510 teeth (86%) were healed. Logistic regression identified 2 significant (P < or = .05) preoperative outcome predictors: radiolucency (odds ratio [OR], 2.86; confidence interval [CI], 1.56-5.24; healed: absent, 93%; present, 82%) and number of roots (OR, 2.53; CI, 1.25-5.13; healed: single, 93%; multiple, 84%). In teeth with radiolucency, intraoperative complications (OR, 2.27; CI, 1.05-4.89; healed: absent, 84%; present, 69%) and root-filling technique (OR, 1.89; CI, 1.01-3.53; healed: lateral, 77%; vertical, 87%) were additional outcome predictors. A better outcome was suggested for teeth without radiolucency, with single roots, and without mid-treatment complications. The predictive value of root-filling technique in teeth with radiolucency requires validation from randomized controlled trials.
... Of these, 255 were excluded because of being duplicates. From the analysis of the titles and abstracts of 225 eligible articles, 20 studies were selected for full-text reading [30][31][32][33][34][35][36][37][38][39][40][41][42][43][44][45][46][47][48][49]. Of these, nine studies were excluded. ...
... Four studies due to sample overlap (data used in more than one study); 2 studies for not having assessed periapical healing; 1 study for not having an experimental group; 1 study for including data on retreatments; and 1 study for not having evaluated obturation techniques [31][32][33]36,40,41,43,46,49]. Finally, 11 studies were included in the current systematic review [30,34,35,[37][38][39]42,44,45,47,48]. ...
... Reports excluded (n = ) [35,37,47]. Six studies evaluated carrier-based obturation techniques; 2 studies investigated the single-cone techniques; and 1 study also investigated the use of silver/titanium cones, or the use of Endomethasone (Septodont, Saint Maur Des Fosses, France) sealer alone, compared to the CLC [30,34,[37][38][39]42,44,45,48]. ...
Objectives
This study aimed to investigate the influence of different obturation techniques compared to cold lateral compaction on the success rate of primary non-surgical endodontic treatments.
Materials and Methods
Systematic searches were performed for studies published up to May 17th, 2022 in MEDLINE/PubMed, Cochrane Library, Web of Science, Scopus, EMBASE, and Grey Literature Reports. Randomized clinical trials and nonrandomized (nonrandomized clinical trials, prospective or retrospective) studies that evaluated the success rate of primary non-surgical endodontic treatments obturated with the cold lateral compaction (control) and other obturation techniques were included. The revised Cochrane risk of bias tools for randomized trials (RoB 2) and nonrandomized studies of interventions (ROBINS-I) were used to evaluate the risk of bias. The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) tool was used to evaluate the certainty of evidence.
Results
Eleven studies (4 randomized clinical trials (RCTs), 4 prospective, and 3 retrospectives) were included. Two RCTs were classified as having some concerns risk of bias and 2 as a low risk of bias. Two nonrandomized studies were classified as having a critical risk of bias and 5 as having a moderate risk of bias. The GRADE analysis demonstrated a very low to moderate certainty of evidence.
Conclusions
This systematic review generally evidenced no differences in the success rate of primary non-surgical endodontic treatments when the cold lateral compaction technique and other obturation techniques are performed. Further well-designed studies are still necessary.
... of apical radiolucency at 1-30 years following treatment was investigated in 19 studies (Barbakow et al., 1980a(Barbakow et al., , 1980bChugal et al., 2001;De Chevigny et al., 2008;De Quadros et al., 2005;Grahnen, 1961;Heling & Kischinovsky, 1979;Heling & Tamshe, 1970;Hoskinson et al., 2002;Jokinen et al., 1978;Nelson, 1982;Ng et al., 2011b;Oliet, 1983;Orstavik et al., 1987;Pirani et al., 2018;Ricucci et al., 2011;Salas et al., 2020;Sigurdsson et al., 2016;Sjogren et al., 1990;Smith et al., 1993). None of the included studies has reported on any of the further important outcomes including tooth function, need for further intervention, adverse effects or OHRQoL. ...
... more favourable periapical health outcome than those teeth with necrotic pulp (Table 4). Six studies (Chugal et al., 2001, Hoskinson et al., 2002, De Chevigny et al., 2008, Ng et al., 2011b, Ricucci et al., 2011, Sigurdsson et al., 2016 revealed pulpal status was not a significant prognostic factor on periapical health outcome after adjusting for periapical status using multi-variable logistic regression models. There was excellent agreement in data entry (98.8%) for the 5544 data points including qualitative comments. ...
... All disagreements were resolved through discussion. Of the 28 studies included, nine were judged as having a low RoB (Barbakow et al., 1980b;De Chevigny et al., 2008;Makanjuola et al., 2018;Ng et al., 2011aNg et al., , 2011bOginni & Udoye, 2004;Salas et al., 2020;Sigurdsson et al., 2016;Smith et al., 1993), two as high RoB (Kwak et al., 2019;Nelson, 1982) and the remaining 17 as some concerns (Chugal et al., 2001 Grahnen, 1961;Heling & Kischinovsky, 1979;Heling & Tamshe, 1970;Hoskinson et al., 2002;Jokinen et al., 1978;Kebke et al., 2021;Landys Boren et al., 2015;Oliet, 1983;Orstavik et al., 1987;Pirani et al., 2018;Prashanth et al., 2011;Ricucci et al., 2011;Sjogren et al., 1990;Wong, 2016), with the adequacy of follow up of cohort being the main domains of concern (Table 5). ...
Background:
Pre-operative pulpal status may influence the outcomes of root canal treatment (RCTx) according to various measures used.
Objectives:
To compare effectiveness of RCTx of teeth with a vital pulp versus a necrotic pulp using a range of clinical and patient-related outcomes, for the development of S3-Level clinical practice guidelines.
Methods:
A search was conducted in the PubMed-MEDLINE, Scopus, EMBASE, Google scholar databases and available repositories, followed by hand searches, until 29 March 2022. Clinical studies published in English language comparing the stipulated outcomes of RCTx of teeth with vital versus necrotic pulp were included. The Newcastle-Ottawa Scale was adapted to assess study quality. Effects of pulpal status were estimated and expressed as risk ratio (RR) using fixed- and random-effect meta-analyses. The quality of evidence was assessed through the Grading of Recommendations Assessment, Development, and Evaluation tool.
Results:
Twenty-eight studies published between 1961 and 2021 were included. Five studies have investigated the 'tooth survival' outcome, four reported pulpal status was not a significant predictor, consistent with meta-analysis finding (RR: 1.00; 95% CI: 1.00, 1.00; n=3). Seven studies reported pulpal status had no significant influence on post-operative pain, regardless of duration after treatment. Sixteen studies have analysed 'periapical health', eleven revealed pulpal status had no significant influence. Meta-analyses revealed the influence was not significant if pre-operative periapical radiolucency was absent (RR: 0.95; 95% CI: 0.90, 1.00; n=9) but significant if it was present (RR: 1.12; 95% CI: 1.05, 1.19; n=11). Most studies were classified as 'some concerns' (n=16) to 'low' (n=10) risk of bias (RoB).
Discussion:
Evidence is limited and only available for three outcomes when comparing the effectiveness of RCTx in permanent teeth with vital pulp versus pulp necrosis. Nevertheless, the quality of available evidence was moderate to high. The 'periapical health' data heterogeneity could be explained by pre-operative radiolucency, thus RCTx was found more effective for prevention than resolution of apical periodontitis.
Conclusions:
There was no significant difference in the 'tooth survival', 'post-operative pain' and 'evidence of apical radiolucency' outcomes of RCTx in teeth with vital or necrotic pulps.
... As reported by a systematic review summarizing 33 epidemiological studies, the prevalence of endodontically treated teeth is high with an average of two per patient (Pak et al., 2012). Fortunately, the success rate of primary endodontic treatment is still over 80% even after up to 10 years (Chevigny et al., 2008;Friedman et al., 2003). ...
... Several clinical studies indicate that primarily the quality of the coronal restoration determines the long-term success of endodontically treated teeth (Craveiro et al., 2015;Ray and Trope, 1995;Siqueira-Jr. et al., 2005;Thampibul et al., 2019) presence or absence of preoperative apical periodontitis (Chevigny et al., 2008;Gillen et al., 2011) or the perfection of the root canal filling. In this context, marginal leakage allows bacteria to penetrate towards the disinfected and obturated endodontic system potentially leading to apical periodontitis (Chevigny et al., 2008;Gillen et al., 2011;Siqueira-Jr. ...
... et al., 2005;Thampibul et al., 2019) presence or absence of preoperative apical periodontitis (Chevigny et al., 2008;Gillen et al., 2011) or the perfection of the root canal filling. In this context, marginal leakage allows bacteria to penetrate towards the disinfected and obturated endodontic system potentially leading to apical periodontitis (Chevigny et al., 2008;Gillen et al., 2011;Siqueira-Jr. et al., 2014). ...
Aim:
To investigate the influence of cavity cleaning and conditioning on marginal integrity of directly placed postendodontic composite class-I-restorations in vitro.
Methodology:
168 fully intact teeth without caries or fillings received preendodontic composite restorations (class-II) after their extraction. Occlusal endodontic access-cavities were prepared, root-canals were instrumented and filled with guttapercha and an epoxy-resin based sealer. Prior to postendodontic class-I-restoration, access cavities were completely contaminated with sealer, cleaned with alcohol and pretreated as follows: Cleaner only (alcohol), glycine-polishing, Al2 O3 -sandblasting, carbide bur (immediate as well as delayed restoration). A positive control (not contaminated with sealer and adhesive used) and negative control (cleaner used but no adhesive) were established. Half of the teeth from each group were subjected to thermocycling and mechanical loading (TCML). Marginal integrity of postendodontic restoration was evaluated in oro-vestibular or mesio-distal sections after AgNO3 -dye-penetration (DP) by standardized photomacroscopic imaging and expressed in percent of margin length along all segments and separately for enamel, dentine and composite, respectively. Results were analyzed non-parametrically (α=0.05).
Results:
No restorations or teeth fractured or debonded completely. Without TCML, the median DP of all segments was significantly higher for the negative control compared to all other groups in oro-vestibular cutting direction (53%; P=0.002) and in mesio-distal cutting direction (51%; P≤0.041). The other groups without TCML revealed 16-24% DP (oro-vestibular) and 12-24% DP (mesio-distal). With TCML, the median DP in oro-vestibular cutting direction for all segments ranged between 48-62% for all groups, a significant difference was only observed between glycine-polishing and carbide bur (P=0.041). In mesio-distal cutting direction, the median DP in negative control was 69% with TCML and significantly higher compared to all other groups (P=0.002). For all other groups, the median DP of all segments ranged between 28% and 40% with TCML without significant differences. Error rates method (k=7) revealed a significant influence of TCML in general on penetration of all segments in both, oro-vestibular and mesio-distal cutting directions.
Conclusion:
Additional access cavity pretreatment after alcohol cleaning did not improve the marginal integrity of postendodontic composite restorations. Thorough cleaning of the access cavity with alcohol seems to assure an acceptable marginal integrity to the tooth and restorative composite.
... The quality of root fillings was found to be a significant factor in the success rates of nonsurgical root canal treatment (NSRCT), with the highest odds ratio among numerous affecting factors (1). Various types of endodontic sealers and filling techniques have been advocated to accomplish satisfactory root filling, and until now, warm vertical compaction with the epoxy resin-based sealer AH plus has been recognized as the gold standard (2,3). Recently, a sealer-based obturation technique (SBO) using calcium silicate sealers (CSS) has become popular because it is less technique sensitive, requires less armamentarium, and is easier to perform (4). ...
... Glass ionomer-based sealer revealed the highest success rate of 94.4%, but the results were collected from only one study (1). Unlike the root canal sealers used, the root canal filling technique was reported to be a significant factor in the outcome of NSRCT (3) and vertical compaction is mostly superior or equal to lateral compaction (3,25). It should be noted that all the results regarding filling techniques and outcomes were related only to traditional sealers such as zinc oxide-or resin-based sealers, and a comparison of filling techniques using a CSS and other sealers has not been reported. ...
... We enrolled the patients when there is no or minor signs and symptoms at the next visit after canal enlargement. This is different from the time points of enrollment of other prospective studies in which patients are enrolled before treatment (3,25,26). We aimed to evaluate the effect of obturation technique and sealer and then enrolled the patients just before obturation when the other factors were standardized. ...
Introduction
This randomized controlled clinical trial compared the clinical efficacy and outcome of a sealer-based obturation technique (SBO) with calcium silicate sealers and a continuous wave of condensation technique (CWC) with a resin-based sealer.
Methods
Root canals were prepared using rotary instruments and 2.5% sodium hypochlorite. At the next visit, patients were enrolled and randomly assigned into two groups, based on the obturation protocol: CWC with AH Plus sealer (Dentsply DeTrey GmbH, Konstanz, Germany) and SBO with Endoseal TCS (Maruchi, Wonju, Korea). Patients were assessed for the level of postoperative pain using a numerical rating scale. The quality of root canal obturation was evaluated in terms of the sealer extrusion, root filling voids, and level of root filling. The participants were recalled after at least 6 months. Healing of the teeth was determined as a decrease in PAI score and resolution of symptoms. The results were statistically compared using the chi-square test or Fisher’s exact test, followed by multivariate analysis with logistic regression.
Results
A total of 74 teeth were included in the analysis (79% recalls) and the mean follow-up period was 17 months (6–29 months). Two groups expressed identical distribution of postoperative pain (P = 0.973) and similar quality of root canal obturation. The total success rates were 93.2% (CWC 92.3%, SBO 94.3%) by loose criteria and 60.8% (CWC 51.3%, SBO 71.4%) by strict criteria, with no significant differences between the two groups. The success rate by loose criteria in teeth with sealer extrusion was significantly lower than those in teeth without sealer extrusion (P = 0.049).
Conclusion
SBO using an endoseal TCS could be a possible alternative to CWC using AH Plus. Sealer extrusion and postoperative pain were found to negatively impact prognosis of the endodontic treatment.
... Chung et al. [24] similarly reported an 81.5% success rate using the same criteria. The current study's 90% favorable outcome rate is in accordance with the 87% rate found in a Toronto study [26] with equivalent outcome criteria. The overall drop-out rate in the current study was low (19%). ...
... Previous studies have described a positive relationship between the size of PA lesions and bacterial density and diversity inside the root canal [46,47], which could impact the treatment outcome. Teeth with small PA lesions have been demonstrated to yield higher favorable outcome rates in some studies [46][47][48], although others found no statistically significant differences between small and large PA lesions [15,26,49]. ...
This study aimed to evaluate the effect of general anesthesia (GA) on the 1-year outcome of Root Canal Treatment (RCT) performed in pediatric patients and to compare it to the outcome of RCT in pediatric patients without GA. Patients admitted for RCT in permanent dentition in a public hospital, dated 2015 to 2020, age 8–15 with a minimum of one year follow-up period, were included in the study. The sample consisted of 326 teeth from 269 patients treated by a single operator, with a recall rate of 81%. Overall, 124 teeth were treated under GA and 142 teeth were without GA. The mean follow-up time was 31.5 months. Data underwent statistical analysis and the significance threshold was set for p < 0.05. Of the total cases, 90% showed favorable outcomes. A significantly higher favorable outcome was seen in the GA group than in the non-GA group (98% and 85%, respectively, p < 0.001). The outcome was significantly affected by the type and quality of the coronal restoration, degree of root development, and lesion size (p < 0.05). According to the current study, in uncooperative pediatric patients, a more favorable outcome of root canal treatment can be obtained under GA than LA if the procedure is carried out with immediate restoration.
... Root canal treatment has been shown to be a predictable procedure with a favourable outcome in 86%-98% of cases (de Chevigny et al., 2008;Ng et al., 2011a). Despite the favourable outcomes in prospective studies, large cross-sectional studies have reported that the prevalence of post-treatment disease such as persistent, recurrent or emerging apical periodontitis (AP) can exceed 42% of all root filled teeth (Kirkevang et al., 2014;Meirinhos et al., 2020;Ng et al., 2007;Pak et al., 2012), suggesting a substantial need for further intervention. ...
... Furthermore, in patients with CBCT, information serial sets of linear and volumetric measurements could be used to provide a more objective and accurate representation of osseous changes over time (Metska et al., 2013;van der Borden et al., 2013) and improved the objectivity of outcome assessment (Patel et al., 2009;Pinsky et al., 2006). The current use of a visual comparison is however in line with many endodontic outcome studies (de Chevigny et al., 2008;Ng et al., 2011a). ...
Aim:
Selective root canal retreatment is when the treatment is limited to root(s) with radiographic evidence of periapical pathosis. The goals of this retrospective study were as follows: i) evaluate the clinical and radiographic (periapical radiographs (PR) or cone beam computerised tomographs (CBCT)) outcome of selective root canal retreatment after ≥ 12 months follow-up; ii) evaluate the periapical status of the unretreated roots; iii) assess tooth survival.
Methods:
A retrospective study (January 2018 to April 2021) was conducted to identify permanent multirooted teeth that underwent selective root canal retreatment. Clinical records, PR and CBCT were examined to ascertain variables of interest. Outcomes (per root and per tooth) were classified into "favourable" or "unfavourable" using well-established clinical and radiographic healing criteria. Treatment outcomes for the whole tooth and per root were compared as well as bivariate associations between the treatment outcome of the retreated roots and the treatment-related parameters (quality of root filling, sealer extrusion, iatrogenic mishaps, type of restoration) were analysed using Fisher's exact test (α = 0.05). Survival was recorded in months.
Results:
A total of 75 teeth (195 roots) in 75 subjects were available for outcome analysis. The favourable outcome per tooth was 86.7%. At follow-up, 92.6% of the retreated roots had a favourable outcome. From the unretreated roots, 3.5% showed radiographic signs of an emerging periapical lesion. No statistical difference was shown between the outcomes per root and per tooth between both groups. None of the treatment-related parameters had a direct influence on the outcome of the retreated roots. The survival rate at 12-48 months after retreatment was 91.5%.
Conclusions:
Selective root canal retreatment is associated with a favourable outcome in a majority of cases. Untreated roots rarely developed radiographic signs of a new periapical lesion at follow-up. Future high-quality clinical trials with larger sample sizes and longer follow-up periods are required to confirm these findings.
... Achievement of the correct WL may be compromised in the presence of an EL, resulting in a residual bacterial load in the apical root canal portion [3]. Consequently, formation of an EL can be directly linked to the development or persistence of an apical periodontitis, resulting in a negative outcome of endodontic treatment [3][4][5]. Previous studies reported that intraoperative complications such as incorrect working length is a significant outcome predictor, especially for teeth with a preoperative radiolucency [4,5]. Clinicians should try to pass the ledge in such cases, with apical surgery the only alternative where this is not possible [6]. ...
... Consequently, formation of an EL can be directly linked to the development or persistence of an apical periodontitis, resulting in a negative outcome of endodontic treatment [3][4][5]. Previous studies reported that intraoperative complications such as incorrect working length is a significant outcome predictor, especially for teeth with a preoperative radiolucency [4,5]. Clinicians should try to pass the ledge in such cases, with apical surgery the only alternative where this is not possible [6]. ...
Background
Endodontic ledge (EL) formation is the most common complication of endodontic treatment. Although various etiological factors have been identified, canal curvature is the most significant variable correlated with EL formation. The aim of this micro-computed tomographic (micro-CT) study was to evaluate EL position in the mesial canals of the lower molars in relation to the degree of canal curvature.
Methods
Forty intact mandibular first molars with independent mesial canals with 20°–40° primary mesio-distal curvature, 10°–30° buccal-lingual canal curvature and 4 < r ≤ 8 mm main curvature radius were selected. Working length was measured with a K-File #10 and a high resolution pre-operative micro-CT analysis was performed. Ledges were created at the point of maximum canal curvature using stainless steel K-Files #30–35, alternating irrigation with 5% NaOCl and 10% EDTA. A post-operative high-resolution micro-CT analysis was then completed. Pre- and post-operative images were analyzed. The angle (α) formed between the vector passing through the geometric center of the EL and the center of the original canal lumen and the line joining the centers of the mesio-buccal and mesio-lingual canal orifices was calculated, and a descriptive statistical analysis was achieved. The α angle values were analyzed in relation to canal curvature using Kruskal-Wallis and post hoc Dunn’s tests. The level of significance was set at P < 0.05.
Results
The α angles appeared inversely proportional to canal curvatures in the buccal-lingual and mesio-distal projections. The mean α angle was 36.4° (standard deviation 10.64; 95% confidence interval 34.1–40.9).
Conclusion
Within the limitations of this study, endodontic ledges develop in the opposite direction to the three-dimensional canal curvature and their position is influenced by the degree of curvature. Clinically, the α angle values may be related to the recommended direction to manage endodontic ledges.
... (Seltzer et al., 1963;Bender et al., 1964;Swartz et al., 1983;Reid et al., 1992;Smith et al., 1993;Friedman et al., 1995;Cotton et al., 2008;Ng et al., 2008). Die warme vertikale Obturation zeigte jedoch gegenüber den Kaltverfahren vereinzelt tendenziell bessere Ergebnisse (Aqrabawi, 2006;de Chevigny et al., 2008a). ...
... Teilweise wurden hier mit einer OR von 2,86 bzw. 16,6 stark voneinander abweichende Ergebnisse berichtet(de Chevigny et al., 2008a;Imura et al., 2007). In diesen beiden Arbeiten lagen die Anteile an Zähnen mit präoperativer Läsion bei 64 % und 65 %, was vergleichbar mit dem vorliegenden Ergebnis von 62,3 % ist. ...
Bei der vorliegenden Arbeit handelt es sich um eine klinische und radiologische Nachuntersuchung von insgesamt 114 Patientinnen und Patienten, die zwischen 2009 und 2012 in der Poliklinik für Zahnerhaltung und Parodontologie der Universität Würzburg von approbierten Zahnärztinnen und Zahnärzten endodontisch behandelt wurden. Dabei kamen drei verschiedene Obturationsmethoden zum Einsatz. 1. Single-Cone-Technik mit Guttapercha und AH Plus® (SCGP) 2. Single-Cone-Technik mit Guttapercha und GuttaFlow® (SCGF) 3. Adhäsive Obturation in Continuous-Wave-Technik mit Resilon® (CWR) Die Erhebung der Ausgangsvariablen (zum Behandlungszeitpunkt) erfolgte retrospektiv unter Zuhilfenahme der klinischen und radiologischen Dokumentation. Die Reevaluation des periapikalen Zustands der Zähne und die Erhebung weiterer klinischer Parameter erfolgte im Rahmen eines aktiven Patientenrecalls nach durchschnittlich 6,3 Jahren. Dabei wurden mit möglichst hoher Standardisierung postoperative Einzelzahnaufnah-men angefertigt. Diese wurden anhand der PAI-Klassifikation ausgewertet, um den pe-riapikalen Zustand der Zähne vor und nach Therapie zu bestimmen. PAI-Werte von 1 und 2 galten als Behandlungserfolg, Grad 3 bis 5 als Misserfolg. Im Hinblick auf die de-finierten Arbeitshypothesen wurden die Erfolgsraten innerhalb der Kohorten miteinander verglichen. Das vorrangige Ziel der hier vorliegenden Arbeit war, zu untersuchen, ob der endodontische Behandlungserfolg abhängig von der jeweiligen Obturationsmethode ist und ob technikspezifische Unterschiede sich einerseits auf die Qualität der Obturation und andererseits auf das Auftreten möglicher Komplikationen, wie der periapikalen Extrusion von Wurzelfüllmaterial, auswirken. Ferner sollten diese Aspekte neben weite-ren zahn- und patientenbezogenen Variablen bezüglich ihres Einflusses auf die Erfolgs-rate der endodontischen Therapie analysiert werden. Es konnten keine signifikanten Unterschiede der endodontischen Erfolgsraten zwischen den hier untersuchten Obturationsmethoden ermittelt werden (p = ,16). In der SCGP-Kohorte lag die Erfolgsrate bei 85 % (34/40) verglichen mit 68,8 % (44/64) für CWR und 80 % (8/10) für SCGF. Die Homogenität der Obturation (p = ,2) und die Extrusion von Wurzelfüllmaterial in das periapikale Gewebe (p = ,93) zeigten keine Abhängigkeit von der gewählten Obturationstechnik. Die Länge der Wurzelkanalfüllung hingegen unter-schied sich signifikant zwischen den Kohorten (p = ,04*). Die Obturation mittels SCGP-Technik erzielte den höchsten Anteil adäquater Wurzelkanalfüllungen (92,5 %, 37/40) gegenüber SCGF (80 %, 8/10) und CWR (71,88 %, 46/64). Die CWR-Methode zeigte mit 18,8 % (12/64) den höchsten Anteil an unterfüllten Obturationen (SCGP: 7,5 %, 3/40; SCGF: 0 %). Unabhängig von der Obturationsmethodik zeigte sich der endodontische Behandlungs-erfolg im Allgemeinen unbeeinflusst von der Qualität der Wurzelkanalfüllungen. Die Va-riablen Obturationslänge (p = ,12) und -homogenität (p = ,11) sowie die Extrusion von Wurzelfüllmaterial in die periapikale Region (p = 1,00) zeigten keinen signifikanten Ein-fluss auf die Erfolgsrate. Das Durchschnittsalter im Patientenkollektiv betrug 60 Jahre mit einer tendenziellen Überrepräsentation weiblicher Probandinnen (60,5 %, 69/114). 73 % (81/111, 3 Mis-sings) der Studienteilnehmer/-innen wurden ab einem PSI-Grad von 3 als parodontal erkrankt eingestuft und 23,7 % (27/114) zeigten eine positive Raucheranamnese. Der BMI betrug im Durchschnitt 26,3 kg/m2. 42,3 % (47/111, 3 Missings) der Studienteil-nehmer/-innen wurden anhand der Einnahme von Medikamenten zur Therapie bzw. Prävention von kardiovaskulären Erkrankungen und/oder oraler Antidiabetika als chro-nisch erkrankt klassifiziert (chronic disease medication, CDM). Das Recallintervall be-trug durchschnittlich 6,3 Jahre mit einem Minimum von 4,7 und einem Maximum von 8,7 Jahren. Die patientenbezogenen Variablen Alter (p = ,45), Geschlecht (p = ,67), Pa-rodontitis (p = ,08), BMI (p = ,58), CDM (p = ,19), Recallintervall (p = ,08) und Rauchen (p = ,34) zeigten keinen signifikanten Einfluss auf den endodontischen Behandlungser-folg. Unter den zahnbezogenen Variablen beeinflusste lediglich der präoperative apikale Sta-tus den endodontischen Erfolg signifikant (p = ,007*). Zähne mit präoperativer apikaler Läsion zeigten eine Erfolgsrate von 66,2 % (47/71) gegenüber 90,7 % (n = 39/43) bei Fällen ohne apikale Läsion. Die Misserfolgswahrscheinlichkeit bei Vorliegen einer präoperativen Läsion war um den Faktor 4,98 erhöht (OR = 4,98, 95 % KI: 1.60, 15,57, p = ,006*). Zwischen Kompositfüllungen, Teilkronen, Vollkronen, Teleskopkronen und Brückenversorgungen konnten keine relevanten Unterschiede in den Erfolgsraten er-mittelt werden (p = ,29). Gleiches galt für adäquate (76,6 %, 82/107) und inadäquate (57,1 %, 4/7) Restaurationen (p = ,36). Ebenso zeigten die Erfolgsraten von Wurzelka-nalrevisionen (70,5 %, 31/44) und Primärbehandlungen (78,6 %, 55/70) keine signifikan-ten Abweichungen voneinander (p = ,45). Molaren waren im Studienkollektiv mit 56,1 % (64/114) gegenüber Prämolaren und Frontzähnen mit je 21,9 % (25/114) überrepräsen-tiert. Der Zahntyp (p = ,07) und die Ausgangsdiagnose (p = ,22) stellten keine relevanten Einflussfaktoren des endodontischen Erfolgs dar.
... 8 Also warm vertical compaction (WVC) with the epoxy resin-based sealer (AH Plus sealer) has been recognized as the gold standard. [9][10] Bioceramic sealers because of its physiochemical and biological properties are gaining popularity in modern endodontic therapy. 11 Bioceramic sealers have been found to be able to promote apical healing, to possess antibacterial activity, and to bond to tooth structure. ...
... 17 The presence of pre-operative radiolucency, has been found to be a significant predictor for success in various studies but in our study, we did not find the preoperative lesion to be predictor for success of treatment which is similar to the first cohort study conducted on bioceramic sealer. 9,10,[17][18][19][20] During obturation, ideally the material should be contained in the intraradicular space but inadvertent sealer extrusion into the periapical area may occur. Various studies have reported that sealer extrusion has no impact on endodontic outcomes but there is variation in tissue reaction based on the type of sealer. ...
The proper shaping and cleaning followed by well-sealed root canal system is desired for successful outcome of the endodontic treatment. With the advent of Bioceramic sealers and their beneficial biological properties, they have been widely incorporated in clinical practice. So, the purpose of this study was to find out the difference in the healing outcome of root canal treatments and retreatments carried out with either single cone obturation technique (SCO) or warm vertical compaction technique (WVC). This was observational analytical study (Cohort study), carried out in private practice. The patients were recalled at-least at six months. When association of healing with type of sealer was considered there was a statistically significant association between healing potential and type of sealer (p-value 0.03). Kaplan -Meier analysis for time to healing showed that with progress of time probability of healing was seen to be more in bioceramic sealer group. Within the limitations of this study the SCO had good healing potential and can be used as a safe alternative in obturation.
... Endodontic treatment is considered a predictable procedure; however, a multifactorial failure rate of 14-16% has been reported [1]. Endodontic retreatment is often recommended after failure of the primary non-surgical root canal treatment (NSRCT). ...
... Caution is paramount in endodontic retreatment because re-accessing the root canal system places the tooth at greater risk for iatrogenic injury [2]. Retreatments are often successful but suffer from higher failure compared to initial NSRCTs [1]. Successful retreatment requires removing the previous obturation materials, such as gutta-percha (GP) and sealer, followed by disinfection of the root canal system [3]. ...
Purpose: This study compared the removability of AH Plus and EndoSequence BC sealers using in vitro micro-computed tomography.
Methods: Ten single-canal, extracted human teeth were cleaned and shaped with ProTaper NEXT rotary files to size X5 (50/0.06) (Dentsply-Sirona). Canals were obturated with a single cone gutta-percha and either AH Plus (Dentsply-Sirona) (Group A) or EndoSequence BC (Brasseler) (Group B). ProTaper Universal Retreatment files (Dentsply-Sirona) were used to remove obturation materials after 90 days at 37oC/100% humidity. Each tooth was scanned using micro-computed tomography (SkyScan 1272; Bruker) at an isotropic resolution of 6 μm from which the percent of material removed was calculated. Two-sample t-tests and one-way ANOVA were used for analysis.
Results: The percent removal of materials in the coronal third was 92.9% ± 7.3% (Group A) and 93.2% ± 6.1% (Group B). Removal in the middle third was 94.9% ± 8.5% (Group A) and 96.5% ± 6.1% (Group B). Apical third removal was 76.2% ± 27.9% (Group A) and 70.1% ± 30.8% (Group B). No statistically significant differences were determined between the two sealers or among the sectional thirds within each group (P > 0.05).
Conclusion: AH Plus and EndoSequence BC sealers exhibit the same removability at all canal levels of 70% to 96%, with better removal coronally.
... This finding, once again, can be explained by the characteristics of the sample (progressive periodontal disease and fragility of the abutments). Endodontic failures were not associated with multirooted teeth, and this finding is in agreement with some studies 27 but not with others 6 . All complications that required tooth extraction were counted as complete failures, while 40 teeth (3.4%) experienced 41 complications that were successfully retreated. ...
... When comparing the methodology of the present study with those previously published, the following observations can be made: in studies reporting 8-year 28 to 10-year 31 follow-ups, the actual mean observation time was unknown 28 , though significantly shorter, or less than 3 years 31 . Other studies did not consider the teeth clustering effect in the same patient 6,[26][27][28][29]31,32 , and the great majority of similar studies did not give information on who performed the assessment, or on the number of and reasons for drop-out, with very few exceptions 25 . The survival rate reported in the present study (86%) is lower than the 92% reported as average in a systematic review 33 which included survival rates of four studies with a follow-up of 6 years or more. ...
PURPOSE
To evaluate the 20-year prognosis of endodontically treated/re-treated teeth in a population with multiple patient/tooth/site risk factors, and to investigate the pro-gnostic factors that could predict the long-term outcome of endodontic therapy.
MATERIALS AND METHODS
This ambispective cohort study included patients who received primary/secondary root canal therapy from 1986 to 1998 performed by a single operator in a private practice. Outcomes measures were: tooth survival; clinical and radio-graphic success, as assessed by the treating clinician and an independent outcome assessor; and complications, as evaluated 20 years after treatment. Descriptive statistics , life table and Cox regression analyses for survival were fitted.
RESULTS
Four hundred and eleven patients (59% affected by advanced periodontitis) with 1169 endodontically treated teeth were identified (703 treatment, 466 retreatment). Drop-outs at 20-year follow-up were 128 patients (31.1%) with 388 (33.2%) teeth. Forty teeth (3.4%) in 30 patients experienced endodontic complications, subsequently successfully treated. Clinical and radiographic evaluation revealed: complete clinical success in 542 teeth (69.7%), partial success in 10 (1.3%), partial failure in 75 (9.6%), and failure in 151 (19.4%) (10 extracted for endodontic reasons, 58 due to periodontitis, and 58 vertical fracture). Life table analysis revealed 86% tooth survival at 20-year follow-up. The chance of survival decreased with increasing patient age (P = 0.006). Retreated teeth had better survival than treated teeth (P = 0.024) Canines and premolars had better chances of survival than incisors (P = 0.002 and P = 0.015, respectively). Teeth treated at two sittings (with intermediate medication) had reduced chances of survival as compared to teeth treated at one sitting (P = 0.027). Teeth treated for the first time for endodontic reasons exhibited a better chance of survival than teeth treated for periodontal and prosthetic reasons (P = 0.012).
CONCLUSIONS
The 20-year prognosis of endodontically treated/re-treated teeth as part of multidisciplinary rehabilitation of patients affected by advanced periodontitis is good. Aging, two-stage endodontic treatment, and endodontic treatment for non-endodontic reasons are important predictors of failure.
... Much of the endodontic study conducted in the last 60 years has been concentrated on finding effective treatments for apical periodontitis (AP). A clinical component that centers on patient complaints and a time-dependent radiographic examination of changes in bone volume around root apices make up the two components of the monitoring of AP development [5]. ...
Introduction: Conservative endodontics advocates sparingly altering standard procedures in order to preserve tooth structure if possible. Every bit of structure that is saved is a benefit, according to conservative endodontics. As a result, conservative endodontics may be performed by both endodontists and general dentists. Aim and Objective: The comprehensive evaluation of conventional radiology employed in endodontic conservative therapy has as its primary goal the endodontic conservative therapy. Methodology: The electronic databases that underwent rigorous individual searches were Embase, Google Scholar, LILACS and MEDLINE using the Ebsco search engine, PubMed, Science Direct, Scopus, and Web of Science. Results: Conventional radiography (CR) is without a doubt the most widely used imaging method for evaluating root canals due to its availability, affordability, and convenience. Digital Radiography (DR) has gained popularity as a replacement for CR because it offers better image quality and enables the dentist to do radiographic exams with less radiation exposure. Conclusion: For root canal treatment, radiographic diagnostic value is essential. Additionally, this technique is utilized to find procedural errors, resorptive defects, and fractures. Radiographic examinations are important because they provide details on how difficult the therapy is.
... The main goals of root canal treatments (RCTs) are undoubtedly the prevention or the resolution of periapical lesions and the retention of the function of the treated teeth as much as possible [1,2]. The outcome of the primary endodontic treatment has been thoroughly assessed in several studies and reviews during the past decades, and all of them concluded that RCTs are valid and conservative options for planning oral rehabilitation [3][4][5]. ...
Since there are no data in the literature regarding the comparison of the marginal adaptation of hydraulic sealers when used with a single-cone technique or through thermomechanical compaction, this study aimed to evaluate the behavior of four different endodontic sealers used with the two above-mentioned obturation techniques by evaluating the marginal gap existing between the obturation materials and the dentinal walls through scanning electron microscopy. Given this objective, a total of 104 single-rooted, straight canal teeth were selected and divided into four subgroups according to the selected endodontic sealer ((AH) Plus Bioceramic Sealer (AHP), EndoSequence BC Sealer HiFlow (ES), C-Root SP (CR), and GuttaFlow Bioseal (GF)). Each tooth was decoronated and instrumented with the HyFlex EDM/CM systematics up to 30.04. After irrigation procedures, the teeth of each subgroup were divided into two groups and obturated according to two different obturation techniques: the single-cone technique (SC) and the thermomechanical compaction technique (TC). After the required sealer setting time, each tooth was sectioned in three parts at 3, 6, and 9 mm from the apex, and each section was observed with a scanning electron microscope. The marginal gap of each sample was measured using G* Power Software v3.1, and the statistical analysis was performed using the Kruskal–Wallis test, followed by a post hoc Dunn’s test. Results showed that there were not any statistically significant differences in terms of the marginal gap between the two different above-mentioned obturation techniques for each sealer, except for the middle third of root canals, where a statistically significant difference was found for AHP, ES, and GF sealers. In conclusion, the thermomechanical compaction of hydraulic sealers and gutta-percha guarantees better sealing than the single-cone technique when the root canal shape is not rounded.
... The current common clinical treatment involves removing the damaged dental pulp tissue, disinfecting it, and then filling it with artificial fillings (Morotomi et al., 2019). Although initial root canal treatment (RCT) has a high success rate and a predictable prognosis after treatment, the possibility of reinfection still exists (Salehrabi and Rotstein, 2004;Torabinejad et al., 2007;de Chevigny et al., 2008). Even if the treatment is successful, the vitality of the pulp is lost, and the perception and immune function completely disappear, reducing the resistance to external stimuli and weakening the teeth (Miran et al., 2016). ...
During the last decade, stem cell therapy has emerged as a potential treatment for many devastating and incurable diseases. Currently, the most commonly used human adult stem cells in research and clinical applications are hematopoietic stem cells (HSCs) and mesenchymal stem cells (MSCs). Due to their multilineage differentiation and ability to secrete various potent bioactive molecules, HSCs and MSCs have great potential to ameliorate tissue malfunction by either generating new functional cells or releasing soluble factors that reduce inflammation, increase cell viability and enhance tissue regeneration in the diseased or degenerated organs. Recently, human epidermal stem cells (EPSCs) has become an attractive cell source for skin regeneration, attributable to its high accessibility. EPSCs can give rise to differentiated epidermal cell lineages, including keratinocytes, hairs, and sebocytes, which could make up the whole skin. However, there are still several limitations associated with the use of HSCs, MSCs and EPSCs in regenerative medicine, including: (i) the insufficient amount of high quality adult stem cells that could be obtained and expanded in vitro; (ii) ineffective differentiation of adult stem cells toward desirable functional cell types; (iii) the significant variation in types and amount of soluble factors released from various sources; and (iv) the poorly defined interactions between stem cells and various microenvironmental components in the target tissues. Therefore, to fully exploit the great potentials of these adult stem cell types, the precise mechanisms underlying their temporal and spatial regulation as well as posttranslational regulation during their self-renewal and differentiation must be unraveled and the culture condition that can be effectively used to expand and regulate their differentiation toward specific lineages have to be optimized.
... 46 The majority of endodontic outcome studies do not consider pain as a criterion for failure possibly because of its subjective nature. [47][48][49][50] However, pain on tooth percussion can indicate failure of endodontic treatment as this sign is an indicator of underlying periapical inflammation that may not be captured by radiographic examination alone. 51 Pain may also play an important role in a patients" decision-making process in selecting between root canal treatment (tooth retention) versus extraction followed by an implant-supported crown. ...
Recently in oral healthcare settings, the focus of assessing treatment outcomes has shifted from the perspective of the clinician towards that of the patient. Endodontology is a specialty of dentistry concerned with the prevention and treatment of pulp and periapical diseases. Research in endodontology and its associated treatment outcomes have focused mainly on clinician-reported outcomes (CROs) and not patient-reported outcomes (PROs). As a result, there is a need to emphasize the importance and relevance of dPROs to researchers and clinicians. The aim of this review is to present an overview of dPROs and dPROMs within clinical endodontics in an attempt to create a better understanding of the patient experience, highlight the need to place the patient at the center of treatment, enhance patient care and encourage more research into dPROs. The key dPROs following endodontic treatment include pain, tenderness, tooth function, need for further intervention, adverse effects (exacerbation of symptoms, tooth discoloration) and Oral Health–Related Quality of Life. dPROs are important following endodontic treatment because they assist clinicians and patients when they discuss and select the most appropriate management options, help clinicians make decisions on pre-operative assessment, prevention and treatment, and improve the methodology and design of future clinical studies. Clinicians and researchers in endodontology should prioritize patient welfare and undertake routine analyses of dPROs using appropriate and robust measures. Due to the lack of agreement over the reporting and definition of endodontic treatment outcomes, a project to define a "Core Outcome Set for Endodontic Treatment Methods (COSET)" is currently ongoing. In the future, a new and exclusive assessment tool should be developed to reflect the viewpoints of patients receiving endodontic treatment more accurately.
... Although primary endodontic therapy is a predictable procedure with a high degree of success, failures can occur posttreatment. 10,11 Endodontically treated teeth with persistent periapical lesion(s) can be conserved with nonsurgical retreatment or endodontic surgery, presuming the tooth is periodontally sound, and restorable and the patient desires to withhold the tooth. 12 In the current clinical case, nonsurgical retreatment was indicated because of the radiographic appearance of inadequate previous root canal therapy with evidence of periapical lesions. ...
The case demonstrates successful, nonsurgical retreatment of mandibular, central, and lateral incisors. Acute exacerbation was noted on previously root-filled mandibular incisors with periapical lesions and endodontic retreatment was arranged. Thorough root canal cleaning and shaping were done using the step back technique with hand files and obturation was completed using gutta-percha and AH plus sealer using the passive lateral compaction technique. An 18-month follow-up showed complete osseous healing.
... The technical quality of RCT, associated with root canal disinfection, might affect healing outcomes [6]. An adequate quality of lling compaction [4,35] and the absence of technical complications [43] impact healing positively, whereas under lling is frequently associated with the inability to debride the apical segment of the root canal, which may harbour persistent intracanal infection [35,44]. ...
Objectives: To evaluate the prevalence of root canal treatments (RCT) with satisfactory technical quality (TQ) and to determine the pre- and intraoperative factors associated with an unsatisfactory TQ of RCT conducted by undergraduate students.
Material and Methods: This two-centred cross-sectional observational study included periapical radiographs of primary and secondary RCT conducted by undergraduate students at two dental schools (n=462). The TQ of RCT was determined using the ESE criteria, accepting (ASE) or not accepting (NSE) unintentional sealer extrusion. A calibrated examiner analysed pre- and intraoperative variables. Bivariate and multivariate analyses were conducted to identify associations between independent variables and technical outcomes (α=5%).
Results: The TQ of RCT was satisfactory in 45.9% and 62.3% of the cases according to NSE and ASE criteria. Root canal curvature (RCC) (OR=0.95; 95% CI: 0.93, 0.98) and apical root resorption (OR=0.58; 95% CI: 0.35, 0.94) were associated with unsatisfactory TQ according to NSE, but only RCC (OR=0.95; 95% CI: 0.93, 0.97) affected outcomes according to the ASE criterion. Teeth with a RCC greater than 7º and 12º according to NSE and ASE criteria, respectively, were less likely to achieve a satisfactory TQ.
Conclusions: The prevalence of RCT with a satisfactory TQ was comparable to that found in other dental schools and greater when sealer extrusion was accepted. A 12º RCC cutoff point seems to be satisfactory for undergraduate practice. Clinical Relevance: To accept unintentional sealer extrusion increased RCT satisfactory TQ. RCC was the main factor associated with unsatisfactory TQ and might support technical difficulty determination.
... In this study, a single-cone obturation technique with iRoot SP as the sealer was used for all of the cases, and the overall success rate of all teeth was 96.8%. This result coincided with the report of Chybowski et al. [33] that they followed 307 teeth with a single-cone technique for at least 1 year and found that the overall success rate was up to 90.9% compared to the cumulative success rate of 86% in the initial treatment with the vertically compacted warm gutta-percha technique [34]. ...
Background
During the obturation procedure, sealer extrusion occurs in some cases. iRoot SP is a kind of bioceramic sealer with superior physicochemical and biological properties. This article reports the outcome of iRoot SP extrusion in root canal treatment and the potential factors associated with the outcome.
Methods
Ninety-nine patients and one hundred and eighty-five teeth treated between 2014 and 2020 were included in this retrospective study. All of the cases were filled with a single-cone technique and the iRoot SP sealer. The minimum follow-up visit period was 1 year. The outcome was evaluated by clinical examination and radiographic examination at recall and was classified as healed, healing (success), or not healed (failure).
Results
The overall success rate of all teeth was 96.8%. The success rate of adequately filled teeth was 97.3%, while that of iRoot SP extrusion was 95.8%; the difference was not statistically significant. Factors such as gender, age, tooth position, follow-up visit period, size of periapical lesion, treatment type and extruding sealer amount had no influence on the outcome of iRoot SP extruded teeth.
Conclusions
The results suggested that iRoot SP extrusion has no adverse effect on the outcome of root canal treatment, which may contribute to the endodontic treatment.
... Die zum Zeitpunkt der Literatursuche vorliegenden evidenzbasierten Studien weisen eine vergleichbare Ausheilung apikaler Läsionen nach Wurzelkanalfüllung mit kalziumsilikatbasierten und etablierten Sealern auf. Diese Ergebnisse stimmen mit jenen der Toronto-Studien überein, die nach 4−6 Jahren postoperativ kumulative Erfolgsraten für Wurzelkanalbehandlungen von 86 % feststellten 21 . ...
Kalziumsilikatbasierte Wurzelkanalsealer besitzen vielversprechende Eigenschaften: eine her vorragende Biokompatibilität, die Fähigkeit zur Induktion von Hartgewebebildung, ein gutes Abdichtungsverhalten und eine antibakterielle Wirkung. Es liegen jedoch nur wenige aussagekräftige Studien zum Einfluss dieser Wurzelkanalsealer auf die klinischen Erfolgsraten von Wurzelbehandlungen vor. Die vorliegenden Studien kommen zu der Schlussfolgerung, dass kalziumsilikatbasierte Wurzelkanalsealer in Verbindung mit der Single-Cone-Technik eine vielversprechende Alternative zu langjährig etablierten Sealern in Verbindung mit warmvertikaler Kompaktion darstellen.
... The management of patient anxiety and pain, post-operative pain, and endodontic flare-up may add another burden to undergraduate students [35]. Observation studies found that the quality of RCT and the endodontic treatment outcomes were less predictable in complex cases [35,40,44,47,48]. Therefore, it's probably best to refer these challenging cases to a specialist who can conveniently dedicate expertise, time, and resources to manage and follow these cases closely. ...
Background
Identify the objectives and the instructional design of undergraduate endodontics in dental schools in Saudi Arabia.
Methods
The online questionnaire was developed from an original survey conducted in the United Kingdom. The questionnaire was modified for purpose of the study and the region of interest. Then it was directed and emailed to the undergraduate endodontic program directors in twenty-six dental schools in Saudi Arabia. The results were analyzed using descriptive statistics and the Chi-square and Fisher’s exact tests.
Results
The response rate was 96.15%. The number of credit hours for preclinical endodontic courses was up to four credit hours (84%). Students were clinically trained to do vital pulp therapies (92%), root canal treatment (100%), and root canal retreatment (68%). The majority of dental schools define the minimum clinical requirements (92%). Practical and clinical competency exams were used to evaluate students' performance (92% and 84% respectively). The students were trained to treat cases of minimal (52%) to moderate complexity (48%). Endodontic treatment consent and difficulty assessment form were used by 32% and 60% of dental schools respectively. There was no significant difference in the instructional design between public and private dental schools (P > 0.05).
Conclusion
The endodontic undergraduate objectives were to graduate competent clinicians who acquired basic science of endodontics and who know their limitations as it is necessary for a safe general dental practice. The use of endodontic treatment consent and case difficulty assessment should be wisely considered in clinical training.
... 5,10 Independent of the technique and the materials employed in endodontic obturation, it is necessary to assess this procedure by clinical and radiographic approaches and to evaluate the absence or presence of clinical and radiographic symptoms. 11 Recently, different systems have been employed to evaluate the obturation, principally cone-beam computed tomography and others that include radiovisiography and scanner X-ray. 12 Finally, when the endodontic treatment is developed with technological tools (CBCT, micro-CT, and digital X-ray methods), it is possible to acquire better case planning, for the safety and prognosis of patients. ...
... The root canal treatment aims to eliminate bacteria from the infected root canal, prevent reinfection of the tooth and promote healing of periapical tissues (Möller et al. 1981;Cook et al. 2007). The success of endodontic treatment is multifactorial, with each distinct procedural step (mechanical: instrumentation; chemical: irrigation and obturation) playing a significant role and contributing to the overall therapeutic result (Friedman et al. 2003;de Chevigny et al. 2008). Following chemo-mechanical preparation of the dentinal walls, a root canal treatment is completed by creating a bacteria-and fluid-tight seal into the root canal system with the use of filling materials (Möller et al. 1981;Guldener 1993;Wesselink 1995;Cook et al. 2007). ...
Periapical tissue may be exposed to root canal filling materials in consequence of root canal therapy. There is scant scientific data about the biocompatibility of root canal filling materials of various chemistry on the periapical area. This study aimed to investigate the effects of different root canal sealers and their eluates on human alveolar osteoblasts in terms of cell proliferation, adhesion, morphology and gene expression in vitro. Five endodontic sealers (AH Plus®, Apexit®, Tubli-Seal®, Real Seal SE®, EndoRez®) and one gutta-percha obturation material (BeeFill®) were tested. Human alveolar osteoblasts derived from 3 different donors following incubation with sealer eluates after 24 h and 72 h were investigated by means of qPCR (gene expression). Morphological reactions of the alveolar osteoblasts were measured by culturing the cells for 3 d, and 7 d and 14 d, respectively, followed by scanning electron microscopy (morphology, adhesion) and fluorescence imaging of the actin cytoskeleton (morphology, proliferation). A repeated measures analysis was performed and p-values were adjusted by Tukey. While all sealers influenced the cell morphology and the expression of genes associated with apoptosis (Casp3), proliferation (histone H3), and inflammation (interleukin-6 and matrix metalloproteinases 1 and 3), mainly AH Plus® and Apexit® yielded a regular actin cytoskeleton and beneficial gene expression patterns. Regarding cell adhesion, only AH Plus® supported proper anchorage for alveolar osteoblasts. Our results provide evidence for the biocompatibility of epoxy resin-based endodontic sealers, i.e. AH Plus®, while other sealers proved cytotoxic for alveolar osteoblasts. Further studies are needed for understanding the bone cell reactions after endodontic treatment and the clinical decision-making regarding the sealer of choice for root canal fillings.
... The current common clinical treatment involves removing the damaged dental pulp tissue, disinfecting it, and then filling it with artificial fillings (Morotomi et al., 2019). Although initial root canal treatment (RCT) has a high success rate and a predictable prognosis after treatment, the possibility of reinfection still exists (Salehrabi and Rotstein, 2004;Torabinejad et al., 2007;de Chevigny et al., 2008). Even if the treatment is successful, the vitality of the pulp is lost, and the perception and immune function completely disappear, reducing the resistance to external stimuli and weakening the teeth (Miran et al., 2016). ...
Dental caries is a common disease that not only destroys the rigid structure of the teeth but also causes pulp necrosis in severe cases. Once pulp necrosis has occurred, the most common treatment is to remove the damaged pulp tissue, leading to a loss of tooth vitality and increased tooth fragility. Dental pulp stem cells (DPSCs) isolated from pulp tissue exhibit mesenchymal stem cell-like characteristics and are considered ideal candidates for regenerating damaged dental pulp tissue owing to their multipotency, high proliferation rate, and viability after cryopreservation. Importantly, DPSCs do not elicit an allogeneic immune response because they are non-immunogenic and exhibit potent immunosuppressive properties. Here, we provide an up-to-date review of the clinical applicability and potential of DPSCs, as well as emerging trends in the regeneration of damaged pulp tissue. In addition, we suggest the possibility of using DPSCs as a resource for allogeneic transplantation and provide a perspective for their clinical application in pulp regeneration.
... Root canal instrumentation that facilitates effective disinfection is a key objective of root canal therapy [1]. However, curved and constricted root canals pose the risk of creating iatrogenic aberrancies, such as ledges, apical canal deviations, and canal wall perforations, which may jeopardize the outcome of root canal therapy [2,3]. Nickel-titanium (NiTi) engine-driven instruments have become a widespread use since they are more flexible [4], maintain the canal curvature better [5], and offer a more favorable treatment outcome [6] than stainless steel hand instruments. ...
This study aimed to examine how downward loads influence the torque/force and shaping outcome of ProTaper NEXT (PTN) rotary instrumentation. PTN X1, X2, and X3 were used to prepare J-shaped resin canals employing a load-controlled automated instrumentation and torque/force measuring device. Depending on the torque values, the handpiece was programmed to move as follows: up and down; downward at a preset downward load of 1 N, 2 N or 3 N (Group 1N, 2N, and 3N, respectively; each n = 10); or upward. The torque/force values and instrumentation time were recorded, and the canal centering ratio was calculated. The results were analyzed using a two-way or one-way analysis of variance and the Tukey test (α = 0.05). At the apex level, Group 3N exhibited the least canal deviation among the three groups (p < 0.05). The downward force was Group 3N > Group 2N > Group 1N (p < 0.05). The upward force, representing the screw-in force, was Group 3N > Group 1N (p < 0.05). The total instrumentation time was Group 1N > Group 3N (p < 0.05). In conclusion, increasing the downward load during PTN rotary instrumentation improved the canal centering ability, reduced the instrumentation time, and increased the upward force.
... 5,6,7 Warm vertical compaction appears to be preferable to lateral compaction, according to some studies. 5,8,9 Root Canal Obturation Techniques are classified as follows: Obturation techniques are classed based on how they are used in practise 10,11 . ...
After irreversible pulpal pathosis, obturation of a root canal should result in a full closure from the coronal to the apical aspect, limiting the entrance of microorganisms and fluid and therefore eliminating the root system as a source of infection and inflammation to the apical periodontium. According to current studies, the goal of obturation is to achieve not only a fluid-tight but also an airtight closure of the root canal. For obturation, semi-solid filler materials like gutta-percha have been employed in combination with sealants for many years. Poor obturation, according to Dow and Ingle, is the root cause of endodontic treatment failure. Ingle and Beveridge (1961) found that incomplete root canal obliteration accounts for roughly 58.65 percent of root canal failures in a research done at the University of Washington on the success and failures in endodontics. As a result, several obturation procedures have been developed over time. Every approach has its own set of benefits and drawbacks. As a result, the obturation procedure differs from instance to case.
... The unclear categorization of extractions and retreatment as failures is another limitation Wu et al. (2009) noted of previous systematic reviews on the outcome of endodontic treatment. In this review, outcomes were recorded as they were reported in the study; however, it was noted that 18 studies (Aqrabawi, 2006;Arya et al., 2017;Cotton et al., 2008;Craveiro et al., 2015;de Chevigny et al., 2008;Dorasani et al., 2013;Farzaneh et al., 2004;Friedman et al., 2003;Gill et al., 2016;Llena et al., 2020;Marquis et al., 2006;Molander et al., 2007;Penesis et al., 2008;Pirani et al., 2015;Ricucci et al., 2011;Saini et al., 2012;Siqueira et al., 2008;Zavanitti et al., 2020) excluded teeth from analysis that were extracted or required further endodontic treatment before the study endpoint, indicating that outcome rates reported in this review may be overestimated. ...
Background:
A comprehensive effort to evaluate outcomes of primary root canal treatment (RCT) between 1966 and 2002 was published by Ng et al. (2007, 2008). Changes in endodontic materials and treatment methods warrants an updated analysis of outcomes.
Objectives:
This study aimed to 1) quantify the success rates of primary RCT published between 2003 and 2020; and 2) investigate the influence of some characteristics known/ suspected to be associated with treatment outcomes.
Methods:
An electronic search was performed in the following databases (01-01-2003 to 12-31-2020): Pubmed, Embase, CINHAL, Cochrane and Web of Science. Included study designs were longitudinal clinical studies (randomized control trials, cohort studies, retrospective observational studies). Studies with at least twelve-months of post-operative review and success rates based on clinical and radiographic criteria were analyzed. The terms 'strict' (complete resolution of periapical lesion) or 'loose' (reduction in size of existing periapical lesion) were used to describe the outcome criteria. Weighted, pooled success rates were calculated. Random effects meta-regression models were used to investigate potential sources of statistical heterogeneity. The Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach was used to evaluate for quality assessment of the included studies.
Results:
Forty-two studies were included in the review. Meta-analyses showed that the weighted pooled success rates were estimated to be 92.6% (95% CI: 90.5-94.8%) under 'loose criteria' and 82.0% (95% CI: 79.3-84.8%) under 'strict' criteria. The most significant areas of study heterogeneity were year of publication and qualification of operator. The majority (64.29%) of studies were considered to be of low quality of evidence.
Discussion:
Biological factors continue to have the most significant impact on RCT outcomes. The technological method of instrumentation had no significant effect. The quality of evidence, was based primarily on study design and only randomized control trials were considered to be "high" quality of evidence.
Conclusions:
The reported success rates show improvement over time. Weighted success rates for studies with a minimum of four-year follow-up had better outcomes, compared to those with less than four years, when 'strict criteria' were used.
... Several treatment approaches have been proposed in an effort to prevent periapical diseases. Root canal treatment heals 86% of teeth, with 95% remaining asymptomatic and functional 4-6 years after root canal treatment [5]. Should root canal treatment fail, non-surgical endodontic retreatment is recommended; however, said retreatment may decrease success rates by up to 80% [6]. ...
To compare and contrast the accuracy of piezoelectric ultrasonic insert (PUI) and trephine bur (TB) osteotomy site preparation techniques for apical location. (1) Material and methods: A total of 138 osteotomy site preparations were randomly distributed into one of two study groups. Group A: TB technique (n = 69) and B: PUI technique (n = 69). A preoperative cone-beam computed tomography scan and an intraoral scan were performed and uploaded to implant-planning software to plan the virtual osteotomy site preparations for apical location. Subsequently, the osteotomy site preparations were performed in the experimental models with both osteotomy site preparation techniques and a postoperative CBCT scan was performed and uploaded into the implant-planning software and matched with the virtually planned osteotomy site preparations to measure the deviation angle and horizontal deviation as captured at the coronal entry point and apical end-point between osteotomy site preparations using Student’s t-test statistical analysis. (2) Results: The paired t-test found statistically significant differences at the coronal entry-point deviations (p = 0.0104) and apical end-point deviations (p = 0.0104) between the TB and PUI study groups; however, no statistically significant differences were found in the angular deviations (p = 0.309) between the trephine bur and piezoelectric ultrasonic insert study groups. (3) Conclusions: The results showed that the TB is more accurate than the PUI for apical location.
... 4,5 Endodontic treatment has a high success rate of up to 93%. [6][7][8] However, the lack of adequate coronal coverage significantly reduces treatment success. 9 Research has found that in the absence of coronal coverage, saliva leaked throughout the whole length of the root filling material in only a week, although the obturation was of good quality. ...
Aim:
This study aims to describe the pattern of coronal restoration use among different dental specialties after root canal obturation in two governmental hospitals in Riyadh.
Materials and methods:
Electronic dental records at King Abdul-Aziz Medical City and University Dental Hospital were reviewed. Teeth that underwent initial root canal treatment on a permanent tooth for obturation using gutta-percha between April 2019 and June 2019 were included. The collected data included the type of material used for coronal restoration after RCT, immediate post-space preparation, cotton pellet placement, the clinical title and specialty of the treating physician, and the center where treatment was performed. Excel was used for data collection. IBM SPSS was used for descriptive and interferential analyses.
Results:
A total of 763 patients were included in the study, in which the double seal technique was used in 56% of the patients, followed by Cavit, which was used in approximately 17% of the patients. Post space was prepared immediately after root canal treatment in 49 patients, and only 17 teeth received the final post, whereas post space was temporized for the rest of the prepared teeth and received the final post at the following visits. Significant relations were found between the type of material used and the clinical title of the treating physician and between the material of choice and the specialty of the dentist. The double seal was the technique of choice among endodontists and restorative dentists, whereas advanced general dentists frequently used Cavit. The least used materials were IRM, amalgam, and Ketac Silver.
Conclusion:
The double seal technique was found to be the most commonly used method to achieve a coronal seal, followed by Cavit. Other materials used after RCT, in sequential order based on the frequency of use, were GIC, temporary crowns, resin composite, RMGIC, prefabricated post with composite buildup, IRM, amalgam, and Ketac Silver.
... Initial root canal therapy has been shown to be a predictable procedure with a high degree of success [1][2][3][4], although, failures can occur after treatment. Some publications reported failure rates of 14%-16% for initial root canal treatment [1,5]. ...
The purpose of this review was to give the reader an update about the postoperative period and healing outcome after surgical endodontic retreatment. Endodontic surgery has become a standard of care for dental maintenance if conventional endodontic retreatment is not able to eliminate the infection, it is important to know how to manage the post-surgical care; due it might directly interfere in the healing outcome after the surgical procedure. Based on the results of the present review, the postoperative period after the surgery treatment is very mild, without any complications, being similar to any dental surgical discomfort, as swelling, bleeding and pain, which could be easily controlled with simple medicine. Regarding the repair after endodontic surgery, the length of follow-up time and the healing evaluation criteria affect the outcome, and 1-year follow-up periods might be insufficient to predict a long-term healing.
... International guidelines state that the tooth and rubber dam should be disinfected before access cavity preparation (European Society of Endodontology, 2006). Whilst many clinical, outcome-based studies have examined the efficacy of chemomechanical means in disinfecting the root canal space, apart from rubber dam use, they provide little information about the asepsis protocol (de Chevigny et al., 2008;Friedman et al., 2003). Notable exceptions are outcome studies including microbiological sampling, utilizing Möller's disinfection protocol (Möller, 1966), this included cleaning the field with 30% hydrogen peroxide followed by swabbing with 5% or 10% iodine (Byström et al., 1987;Kvist et al., 2004;Molander et al., 2007;Sjögren et al., 1990). ...
Aim
To evaluate the effect of an enhanced infection control protocol on root canal treatment outcomes and on microbial load within root canals after chemomechanical preparation.
Methodology
A total of 144 molar teeth from 139 healthy patients receiving primary root canal treatment were block randomised to a standard protocol (StP) and an enhanced infection control protocol (EnP). Both treatment arms adhered to current best practice recommendations, while the EnP comprised additional steps included replacing rubber dams, gloves, files, all instruments and surface barriers at the time of canal filling to reduce the chances of iatrogenic contaminations. Patients and radiographic examiners were blinded to the protocol used. Intracanal samples were taken at baseline (S1) and after completion of chemomechanical preparation (S2). Microbial 16S rDNA copy numbers were enumerated by quantitative polymerase chain reaction (qPCR). Cone beam computed tomography (CBCT) scans were taken before treatment and at one-year follow-up. The outcome was assessed clinically and radiographically using CBCT by logistic regression modelling.
Results
At one-year follow-up, 115 teeth were analysed (54 in StP and 61 in EnP). The percentage of favourable outcomes assessed by CBCT was 85.2% in the EnP and 66.7% in the StP. The odds of 12-months success was three times higher in the EnP group compared to the StP group (OR=2.89; p=0.022, CI: 1.17 – 7.15). The median bacterial reads were reduced from 8.1×10³ in S1 samples to 3.5×10³ in the StP group and from 8.6×10³ to 1.3×10³ in the EnP group. The enhanced protocol significantly reduced bacterial counts in pre-canal filling samples when compared to the standard protocol (p=0.009).
Conclusions
The implementation of a facile, enhanced infection control protocol in primary root canal treatment resulted in less detectable bacterial DNA before canal filling and significantly more successful outcomes at one year.
... The Toronto study showed a healing forecast of 82% [80] and 80% for nonsurgical retreatment of teeth with apical radiolucency [24]. In practice, 82.3-88.7% of the teeth were healed radiologically and are therefore within the range given in the literature. ...
Aim: The prognosis of the healing of an apical lesion is extremely important for the treatment decision for tooth retention or implantation. In several studies, the presence of an apical lesion was shown to be a significant factor in both primary treatment and non-surgical retreatment. The aim of the present study was the retrospective investigation of the prognosis of the healing of bony apical lesions of teeth, which were treated endodontically. The evaluation contained various clinical parameters that can influence the success of the root canal treatment. Materials and Method: 62 teeth were treated in 52 patients during the study period. The treatment was carried out by a specialist in endodontics with the aid of the dental surgical microscope and a two-stage procedure. Two certified examiners assessed the radiological results after three to 72 months. Preoperative and postoperative information related to potential prognostic factors was evaluated. Results: Results of the 62 apical lesions, 82.3% (examiner 1) - 88.75% (examiner 2) were classified as healed. Of all the prognostic factors analyzed, none showed a significant influence on the treatment success. The success rate of the present study was in the range of comparable studies. Conclusions: The apical lesion can be treated with relatively high success rates if general micro-endodontic procedures are followed.
... While differences in radiographic success were reported after one and two years [2,3], the comparable overall five-year success rates of 78% and 75% for FP and NSRCT, respectively, suggested that both might be considered as alternative treatments for permanent mature teeth with symptomatic irreversible pulpitis [4]. These findings notwithstanding, the reported 75% overall success for NSRCT [4] starkly contrasts with the well-established current best evidence for NSRCT [16][17][18] reporting 92 to 98% success two to six years after the treatment of teeth with no pre-operative apical periodontitis. This considerable discrepancy in outcomes, and a low recall rate, undermine the validity of the VPT-NSRCT comparison study [4]. ...
Background and Objectives: Symptomatic irreversible pulpitis in permanent mature teeth is a common indication for nonsurgical root canal treatment (NSRCT), but contemporary studies have reported on vital pulp therapy (VPT) applied in such teeth as a less invasive treatment. This systematic review assessed the outcomes of VPT, including partial and full pulpotomy performed with hydraulic calcium silicate cements (HCSCs) in permanent mature posterior teeth diagnosed with symptomatic irreversible pulpitis. Materials and Methods: The PRISMA guidelines were followed. The search strategy included PubMed ® , EMBASE, Cochrane library and grey literature electronic databases. The quality assessment of the identified studies followed the Cochrane Collaboration Risk of Bias, ROBINS-I and Newcastle-Ottawa Scale tools. Results: The search of primary databases identified 142 articles, of which 9 randomized controlled trials and 3 prospective cohort studies were selected for review. The risk-of-bias was assessed as 'high' or 'serious', 'fair', and 'low' for three, seven and two articles, respectively. One to five years after VPT using HCSCs, the success rates mostly ranged from 78 to 90%. Based on two articles, the outcomes of the VPT and NSRCT were comparable at one and five years. Despite the necessity for the intra-operative pulp assessment in VPT procedures, the majority of the studies did not fully report on this step or on the time needed to achieve hemostasis. Small sample sizes, of under 23 teeth, were reported in three studies. Conclusions: The reviewed 12 articles reported favorable outcomes of the VPT performed with HCSCs in permanent mature posterior teeth with symptomatic irreversible pulpitis, with radiographic success in the range of 81 to 90%. Two articles suggested comparable outcomes of the VPT and root canal treatment. Universal case selection and outcome criteria needs to be established for VPT when considered as an alternative to NSRCT. This evidence supports the need for further research comparing longer-term outcomes of both of the treatment modalities.
... Initial root canal therapy has been shown to be a predictable procedure with a high degree of success [1][2][3][4], although, failures can occur after treatment. Some publications reported failure rates of 14%-16% for initial root canal treatment [1,5]. ...
The purpose of this review was to give the reader an update about the postoperative period and healing outcome after surgical endodontic retreatment. Endodontic surgery has become a standard of care for dental maintenance if conventional endodontic retreatment is not able to eliminate the infection, it is important to know how to manage the post-surgical care; due it might directly interfere in the healing outcome after the surgical procedure. Based on the results of the present review, the postoperative period after the surgery treatment is very mild, without any complications, being similar to any dental surgical discomfort, as swelling, bleeding and pain, which could be easily controlled with simple medicine. Regarding the repair after endodontic surgery, the length of follow-up time and the healing evaluation criteria affect the outcome, and 1-year follow-up periods might be insufficient to predict a long-term healing.
This paper undertakes a broad and comprehensive synthesis of relevant clinical, biological, biomechanical, technical and healthcare services data to understand the factors affecting outcomes of periapical healing after root canal (re)treatment. The medical and dental evidence‐based era (1980‐present) is contextualised with the earlier evidence drive in endodontics (1911‐present) triggered by the focal infection era. The current evidence‐based approach has a sharper focus on evidence quality and derivation of practice guidelines. Contrary views question whether guideline‐driven, or expertise‐development‐driven endeavours would best serve outcome improvement in society. The endodontic discipline functions in a broad healthcare framework and sustains industrial, economic and trend pressures that may be deemed to influence outcomes. The nature of root canal treatment and the challenges in determining the factors that affect its outcomes is discussed. The factors potentially affecting periapical healing after root canal treatment are classified into pre‐operative, intra‐operative and post‐operative groups. These categories subsume multiple elements with interactive influences, creating a complex picture, further confounded by some apparently surprising, counter‐intuitive and contradictory findings. The technical versus biological conundrum in root canal treatment continues to cause cognitive dissonance. However, due reflection and cross‐discipline‐synthesis resolve the apparent data conflicts into a very simple, consistent and plausible picture of how root canal treatment works and the key factors that affect periapical healing. Root canal retreatment is considered mainly in the context of its differences from primary treatment as the majority of factors influencing outcomes are common to both. The exceptional difference is that retreatments have a proportionately reduced probability of healing by virtue of compromised apical root canal ramification access or modified host/infection interactions. Root canal (re)treatment outcomes are dominantly influenced by the nature of prior dynamic host/infection interaction (pre‐operative patient factors) and how the direction of this dynamic is influenced by two factors: 1) the active efficacy of the operators’ root canal treatment protocol to sustain a microbial ecological shift (intra‐operative treatment factors); and 2) the passive ability of the functional tooth (and its restoration margin) to maintain its integrity to resist infection reversal (post‐operative restorative factors).
NeoMTA is a commercially available tricalcium silicate‐based cement intended for contact with pulp and periradicular tissues. The purpose of this study was to retrospectively evaluate the outcomes of non‐surgical root canal treatments with NeoMTA obturations. Patients were treated in a private endodontic practice between 2015 and 2018. All cases, including initial treatments and retreatments, were either fully obturated with NeoMTA, or using gutta‐percha with NeoMTA as an endodontic sealer. Outcomes were assessed using follow‐up examination data with digital periapical radiographs with a minimum of a 1‐year recall. Teeth were classified based on the clinical examination as: healed/healing (success), or non‐healed (failure). 265 teeth were included with an average follow‐up time of 1.3 years. The overall success rate was 91.7%. Only the presence of a pre‐operative periapical radiolucency was found to significantly affect success. Comparison of obturation techniques demonstrated no effect on outcomes. NeoMTA is suitable for endodontic obturation.
This study aims to evaluate the ability of Raypex 6, Propex Pixi, Dentaport ZX, Apex ID, Propex II and Dr.'s Finder NEO to detect minimum root canal perforation diameter. One hundred single‐rooted, extracted human teeth were artificially perforated by 5 burs in different diameters (0.25–1.25 mm) in 5 mm above the apex. Twenty teeth were assigned to each group. The actual canal lengths (AL) were measured under stereomicroscope followed by a measurement of electronic canal length (EL) using each electronic apex locator (EAL). None of the EALs were able to detect the perforation at diameters of 0.50 and 0.25 mm. Although all EALs used in our study were unable to detect perforations at diameters of 0.5 mm and 0.25 mm, they were highly successful in the determination of simulated root perforations at diameters of 1.25, 1 and 0.75 mm.
Objectives: This study aimed to identify disease-related markers in persistent apical periodontitis (PAP) biopsies and examine whether these were associated with comorbidities.
Materials and method: The levels of the cytokines GM-CSF, IFN-γ, IL-2, IL-6, IL-9, IL-10, IL-13, IL-15, IL-17E/IL-25, IL-21, IL-23, IL-27, IL-28A/IFN -λ2, IL-33, MIP-3α/CCL20 and TNF-α were determined in lesions from patients with persistent apical periodontitis (n = 20) and compared to healthy bone samples (n = 20).
Results: We identified eleven cytokines to be differently expressed, and among them, IL-2, IL-6, IL-17E, IL-21, and IL-27 appeared to drive the discrepancy between the disease and healthy groups. The levels of T follicular helper (Tfh) cell promoting cytokines (IL-21, IL-6, IL-27) were enhanced while T helper (Th) 1 cell promoting cytokine (IL-2), Th2 cell promoting cytokine (IL-13), and Th17 cell promoting cytokine (IL-17E) were reduced in the PAP group. The data also indicate that Tfh cell differentiation (IL-21), along with Th1 (GM-CSF, IFNγ), Th2 (IL-13), and Th17 (GM-CSF) cell differentiation, might be increased in the subpopulation of patients suffering from rheumatoid arthritis, whereas no differences were found in patients with cardiovascular diseases.
Conclusions: A cluster of potential cellular markers for PAP was identified. The lesions contained additional factors that might be associated with differentiation of various T cell populations.
Clinical Relevance: Molecular analyses of PAP may result in identification of prognostic markers.
Hovedbudskap
Tannleger i Den offentlige tannhelsetjenesten i to Vestlandsfylker følger stort sett de gjeldende retningslinjer for endodontisk behandling.
Yngre tannleger utfører oftere trinnvis ekskavering og behandler mer dyp karies i melketenner enn de mer erfarne tannlegene.
يهدف البحث إلى تقييم أثر اختلاف ثخانة العاج في ارتفاع درجة حرارة السطح الخارجي للجذر في أثناء استخدام تقنيات حشو متعددة بالتلدين الحراري. تضمنت عينة البحث 60 ضاحك سفلي وحيد الجذر تم قصه بطول 12 ملم وتحضيره آلياً حتى قياس 30 بمبارد Revo-sو تحديد نقاط عند الذروة و قبل الذروة ب5 ملم ليتم قياس درجة الحرارة عندها بمقياس حرارة رقمي يعتمد على المجسات ,ثم توزيعها إلى خمس مجموعات رئيسية متساوية وفقاً لتقنية الحشو المستخدمة (1-حشو حراري بجهاز EQ-V،2-حشو حراري بجهاز HEROFILL، 3-حشو حراري باستخدام مكثفات الكوتا، 4-حشو حراري بطريقة التكثيف العمودي الحراري التقليدية، 5-حشو بطريقة التكثيف الجانبي (مجموعة شاهدة))، وتم تسجيل القراءات كل عشر ثوان وقياس ثخانة العاج عند نفس نقطة قياس درجة الحرارة قبل الذروة ب 5ملم بتقنية الCBCT . وتبين أنً ارتفاع درجة حرارة السطح الخارجي للجذر كان مرتبط عكسياً مع قيم ثخانة العاج الجذري أي يجب توخي الحذر أثناء استخدام تقنيات الحشو بالتلدين الحراري في الأسنان ذات الجدران العاجية رقيقة الثخانة.
Tooth extraction is a risk factor for the development of osteonecrosis of the jaw following treatment with antiresorptive drugs (ARDs), but not all extraction sites develop this pathology. Therefore, we aimed to identify local radiographic predictors of Medication-Related Osteonecrosis of the Jaw (MRONJ) in panoramic images of oncologic patients undergoing tooth extraction. Based on a retrospective longitudinal cohort study design, patients were included if undergoing one or more tooth extraction, with at least one administration of ARDs, and presence of pre- and post-operative panoramic radiographs. After data collection, blinded and independent observations were performed. Eleven distinct imaging-related parameters were assessed preoperatively and five postoperatively, at each extraction site. A case–control and subgroup analysis assessing MRONJ development was performed. Significance level is set to 0.05 (5%). A total of 77 oncologic patients were selected, undergoing 218 tooth extractions, from which 63 teeth (29%) in 39 patients (51%) developed MRONJ. Results showed that patients developed significantly more MRONJ with longer ARD treatment (p = 0.057), teeth with absent and incomplete endodontic fillings with caries, widened periodontal ligament space and/or periapical lesions (p = 0.005), and sclerotic and heterogenous bone patterns (p = 0.005). In conclusion, tooth extraction sites presenting with infections and bone sclerosis are at higher risk to develop MRONJ.
Introduction
The retrievability of calcium silicate-based sealers (CSS) during non-surgical retreatment has been equivocal. This study compared the retrievability of three different CSS using one of three different solutions or no solution.
Methods
130 extracted teeth with a straight canal were decoronated to a standardized root length. The canals were instrumented to 35/.04 and divided into three groups (BC: EndoSequence BC sealer™; EBC: EdgeBioceramic™; NEO: NeoSEALER™Flo), and each group was further divided into four subgroups (6% sodium hypochlorite; 5% acetic acid; carbonated water; no solution). After sealer placement, each master gutta-percha cone was placed intentionally 2 mm short of the working length (WL) to ensure the apical 2mm was filled only with sealer. After storage for 21 days at 37°C and 100% humidity, retreatment was performed until apical patency (AP) was obtained. The operator was blinded to the CSS and solution used. Data was analyzed using ANOVA to compare AP rates and the mock chair-times.
Results
Overall success rates for AP in BC, EBC, and NEO were 63.64%, 69.77%, and 100%, respectively. There was significantly higher AP rate in NEO than BC and EBC. The chair-time for NEO was significantly shorter than BC (P < .05) and EBC sealer (P < .001). There was no significant difference in the chair-time between BC and EBC sealer groups.
Conclusion
BC, EBC, and NEO sealers in a straight canal were consistently retrievable when no solution was used. Compared to no solution, the retrievability of BC, EBC, and NEO decreased when solutions were used.
A wide range of accidents might happen during the treatment of the root canal system, where the instrument breakage is one of the most unpleasant occurrences. Several techniques have been developed to facilitate the removal of the broken instruments. The aim of this article is to present the surgical removal of a broken endodontic file from the periapical region of the palatal root of a maxillary first molar depicting importance of radiographs.
The purpose of this review was to give the reader an update about the postoperative period and healing outcome after surgical endodontic retreatment. Endodontic surgery has become a standard of care for dental maintenance if conventional endodontic retreatment is not able to eliminate the infection, it is important to know how to manage the post-surgical care, due it might directly interfere in the healing outcome after the surgical procedure. An electronic search of the relevant English-language literature was conducted in the MEDLINE/ PubMed database using the following key-words combinations: Postoperative care; apical surgery; apicoectomy; wound healing. Articles from 1980 to 2011 were included. Based on the results of this present review, the postoperative period after the surgery treatment is very mild, without any complications, being similar to any dental surgical discomfort, as swelling, bleeding and pain, which could be easily controlled with simple medicine. Regarding the repair after endodontic surgery, the length of follow-up time and the healing evaluation criteria affect the outcome, and 1-year follow-up periods might be insufficient to predict a long-term healing.
Background:
Despite initiatives to standardize and improve reporting of rapidly growing endodontic outcome research studies, issues related to missing and ambiguous information are still of great concern. In this paper, we propose a framework for standardized data collection and a compiled checklist for reporting of various study designs on endodontic outcome.
Method:
A comprehensive search was carried out to locate randomized controlled trials, cohorts, case-control studies, or case series of >100 patients which reported on endodontic outcomes. We reviewed these articles to develop a Data Collection Template and compiled a checklist for reporting of future endodontic outcome research.
Results:
Out of 354 eligible articles previously reported in our scoping review on endodontic outcome studies, 109 papers were selected and screened for study variables or levels of categorization. Our complied Data Collection Template was developed in 19 domains to highlight important demographic, preoperative, intraoperative, and postoperative variables. Given the specific needs for endodontic outcome literature, we also proposed a compiled checklist (consisting of 4 main domains) to facilitate the reporting of various study designs on endodontic outcome studies. This checklist included simple descriptions of the required items and examples on reporting from published endodontic studies.
Conclusions:
By facilitating the collection and reporting of relevant research data by investigators in private practice and academia, we hope that the proposed Data Collection Template and reporting guideline can highlight the importance of standardization amongst clinicians and researchers while producing valid scientific information that will support evidence-based treatment decisions.
Introduction:
The purpose of this study was to assess the accuracy of Root ZX (J. Morita USA, Inc., Irvine, CA, USA), Raypex 6 (VDW, Munich, Germany) and i-Root (S-Denti Co. Ltd Seoul, Korea) electronic apex locators (EALs) in detecting strip root perforations in dry condition, and in presence of 0.9% saline (NaCl), 2.5% sodium hypochlorite (NaOCl), 2% chlorhexidine (CHX), 17% ethylenediaminetetraacetic acid (EDTA) and blood.
Methods and materials:
This ex vivo study evaluated 30 extracted human mandibular first molars. After mesiobuccal canal preparation, strip perforation was artificially created in the coronal third of the canal. The actual length (AL) of the canal to the perforation site was measured using a # 70 K-file under a stereomicroscope under 20× magnification. The teeth were then mounted in an alginate mold. The electronic length (EL) of the canal to the perforation site was measured by each apex locator in different environments. The difference between the EL and AL was calculated for each tooth. Statistical analyses were performed using the Friedman and post hoc Dunn tests at P<0.05 level of significance.
Results:
Most accurate measurements were seen in CHX environment for all three EALs. Root ZX mini in CHX environment showed most accurate reading but no significant difference was observed in three EALs in CHX environment. There was no significant difference between different environment in Root ZX mini (P>0.05). The most difference between the EL and AL were observed in NaOCl environment in Raypex and iRoot (P>0.05).
Conclusion:
Based on this ex-vivo study, the most accurate measurements were seen for all three EALs in CHX medium. The presence of irrigation solution affected the accuracy of all EALs. Root ZX showed better results compared to other EALs in determining the location of perforation in different environments, but this difference was not significant.
The objective of this study was to assess the resistance to fatigue fracture of conventional nickel–titanium files after undergoing shot peening. Forty NITIFLEX endodontic files, number 30, were divided into two groups; one was submitted to shot peening treatment and the other was not. All instruments were tested for fatigue fracture in simulated canals with a TRI-AUTO ZX endodontic motor. One file of each group was subjected to a residual stress analysis by XRD. Finally, the fractured surface was observed and elemental analysis performed by means of SEM and EDX. Roughness analysis was made by focal variation microscope. The shot peening group showed greater resistance to fatigue fracture; there was no difference in the length of the fractured fragments. XRD results showed the presence of residual compression stresses in the file submitted to shot peening, a decrease in the interplanar spacing, and an increase in the full-width-at-half-maximum and the microstrains. SEM and EDX showed a ductile fracture with zones of fatigue and an equiatomic ratio between the nickel and titanium. Surface roughness increased after the file was subjected to the shot peening procedure. In conclusion, shot peening increases the resistance to fatigue fracture due to the presence of residual compression stresses in files manufactured from a conventional nickel–titanium alloy.
The main aim of root canal treatment is to disinfect and shape the root canal system and seal it in three dimensions to prevent reinfection of the tooth. Lack of healing is due to persistent intraradicular infection residing in previously uninstrumented canals, dentinal tubules or in the complex irregularities of the root canal system. Root canal system anatomy plays a significant role in endodontic success and failure. It contains branches that communicate with the periodontal attachment apparatus furcally and laterally, and often terminate apically into multiple portals of exit. There can be various causes for endodontic failures such as: missed canals, pathological or iatrogenic perforations, and inadequate obturations. The aim of retreatment is to perform an endodontic treatment that can render the treated tooth functional and comfortable again, allowing complete repair of the supporting structures. Retreatment is classified into two major groups: non‐surgical or conventional retreatment, and surgical retreatment.
This retrospective study evaluated the outcome of the endodontic treatment/retreatment of teeth with intraoral sinus tracts. Seventy‐two teeth from 70 individuals were included. One operator treated all teeth over about 20 years. Time for the sinus tract to heal was recorded. Treatment outcome was evaluated after at least 1 year and classified as healed, healing or diseased. The overall healed rate of periradicular lesions was 73.6% (74.1% for treatment and 72.2% for retreatment). In 6 (8.3%) teeth, lesions were healing. Thirteen teeth (18.1%) exhibited persistent disease. In 68/72 (94.4%) cases, the sinus tract healed in less than 1 month. No preoperative/intraoperative variable affected the outcome (P > 0.05). Missing restorations had a negative impact (P < 0.05). Healing of both the sinus tract quickly after treatment and the periradicular lesion later were usually achieved. Closure of the sinus tract in the first month was a good predictor of lesion healing.
This study investigated the role of infection on the prognosis of endodontic therapy by following-up teeth that had had their canals cleaned and obturated during a single appointment. The root canals of 55 single-rooted teeth with apical periodontitis were thoroughly instrumented and irrigated with sodium hypochlorite solution. Using advanced anaerobic bacteriological techniques, post-instrumentation samples were taken and the teeth were then root-filled during the same appointment. All teeth were initially infected; after instrumentation low numbers of bacteria were detected in 22 of 55 root canals. Periapical healing was followed-up for 5 years. Complete periapical healing occurred in 94% of cases that yielded a negative culture. Where the samples were positive prior to root filling, the success rate of treatment was just 68%--a statistically significant difference. Further investigation of three failures revealed the presence of Actinomyces species in each case; no other specific bacteria were implicated in failure cases. These findings emphasize the importance of completely eliminating bacteria from the root canal system before obturation. This objective cannot be reliably achieved in a one-visit treatment because it is not possible to eradicate all infection from the root canal without the support of an inter-appointment antimicrobial dressing.
Current, relevant knowledge on the outcome of endodontic therapy is key to clinical decision making, particularly when endodontic treatment is weighed against tooth extraction and replacement. Inherent to reviewing the outcome is a definition of "success" in relation to the goals of therapy. As the specific goal set out by the individual patient may either be healing/prevention of disease (apical periodontitis) or just functional retention of the tooth, the potential for both healing and functionality is reviewed. Based on selected follow-up studies that offer the best evidence, the chance of teeth without apical periodontitis to remain free of disease after initial treatment or orthograde retreatment is 92 percent to 98 percent. The chance of teeth with apical periodontitis to completely heal after initial treatment or retreatment is 74 percent to 86 percent, and their chance to be functional over time is 91 percent to 97 percent. Thus there does not appear to be a systematic difference in outcome between initial treatment and orthograde retreatment. The outcome of apical surgery is less consistent than that of the nonsurgical treatment. The chance of teeth with apical periodontitis to completely heal after apical surgery is 37 percent to 85 percent, with a weighted average of approximately 70 percent. However, even with the lower chance of complete healing, the chance for the teeth to be functional over time is 86 percent to 92 percent. Considering the favorable outcome, conservative endodontic therapy, both nonsurgical and surgical, is definitely justified and should be attempted when a good restorative and periodontal prognosis is projected, unless the patient is not motivated to retain the tooth.
OBJECTIVES: This retrospective study (1) compared the outcome of root canal treatment performed by an endodontist using 1 of 2 different protocols and (2) evaluated the influence of factors affecting outcome. STUDY DESIGN: A total of 200 teeth and 489 roots (Protocol A, 83 teeth/200 roots; Protocol B, 117 teeth/289 roots) treated nonsurgically with root canal 4 to 5 years previously were examined clinically and radiographically according to strict criteria. Generalized estimating equations were used to perform logistic regression to analyze data. RESULTS: The rate of complete healing for Protocol A (78%) was similar to that of Protocol B (76%). The pulpal status (odds ratio = 2.399, P =.040) and presence (odds ratio = 1.696, P = 0.015) and size (odds ratio = 0.823, P <.001) of periapical lesion were the only factors significantly affecting treatment outcome. CONCLUSION: The preoperative status of the pulp and the presence and extent of periapical periodontitis were important prognostic determinants of treatment outcome in this study.
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.
Abstract In this study 3 commonly used sealers were evaluated. The materials tested were Proco-Sol, a zinc oxide-eugenol-based sealer, AH26, an epoxy resin, and Klorperka NØ, a resin-gutta-percha-chloroform sealer. The healing of periapical lesions was followed for a period of 3 years. While the response to Kloroperka NØ seemed slightly inferior to the 2 others, no statistically significant differences among the groups could be demonstrated.
Abstract Using a careful anaerobic bacteriological technique, bacteria were shown to be eliminated from infected root canals before the endodontic treatment was finished by root filling. Healing of the periapical lesions of the teeth was followed for 2–5 yr. The majority of the 79 lesions healed completely or decreased in size in such a way that they could be expected to heal. In 5 cases there was no or only an insignificant decrease in the size of the lesions. Two of these lesions were shown to contain bacteria of the species Actinomyces or Arachnid. In another case there were dentin chips in the periapical tissue. Periapical lesions which fail to heal in spite of careful bacteriological monitoring of the endodontic treatment may in some cases be due to an establishment of the bacteria outside the root canal in the periapical tissue. In these sites, the bacteria are inaccessible to conventional endodontic treatment.
Dear Colleagues
I feel honoured and excited to participate in Endodontic Topics, the new review journal focusing on all aspects of the science and art of endodontics, and I hope you will join me in celebrating this first issue, wherever you are! In contrast to future issues, which will focus on one area each, this issue covers different areas, all reviewed by my fellow Associate Editors. I selected the following review for this issue because it touches on several topics that have been assigned to me to cover in the future. In this review, you will find reference to endodontic treatment outcome criteria, concepts of endodontic health and disease, decision-making, treatment outcome of apical surgery and orthograde re-treatment, post-operative pain associated with the aforementioned procedures, removal of crowns and posts, as well as broken instruments, perforation repair, retrograde re-treatment and more. All of these topics are dealt with in this article in the context of case selection in the management of post-treatment disease. In the future, however, you will see the focus shifting to examining each of these topics on their own, with many of them being reviewed in greater detail by those researchers and clinicians quoted in this review. So, to my mind, this review is not just a review but a sign of things to come.
I look forward to working with many knowledgeable colleagues in the future to develop good quality, comprehensive and critical reviews for your benefit. I hope you find these reviews exciting and useful.
The long-term results of endodontic treatment according to Ingle's standardized technique performed by undergraduate students in Oslo during 1971 were assessed. An adequate seal was found in 97% of the roots. Overfilling of the canal with excess of material greater than 1 mm was observed in 3% of the roots. The overall success rate was 91% with no statistically significant difference between the results in anterior teeth, premolars, or molars. Roots without periradicular radiolucencies showed better results than roots with radiolucencies (statistically significant). It was concluded that the standardized endodontic technique led to an improvement in the technical standard of the root fillings, and that the technique may be used regularly in all groups of teeth.
This paper presents a general statistical methodology for the analysis of multivariate categorical data arising from observer reliability studies. The procedure essentially involves the construction of functions of the observed proportions which are directed at the extent to which the observers agree among themselves and the construction of test statistics for hypotheses involving these functions. Tests for interobserver bias are presented in terms of first-order marginal homogeneity and measures of interobserver agreement are developed as generalized kappa-type statistics. These procedures are illustrated with a clinical diagnosis example from the epidemiological literature.
The influence of various factors that may affect the outcome of root canal therapy was evaluated in 356 patients 8 to 10 yr after the treatment. The results of treatment were directly dependent on the preoperative status of the pulp and periapical tissues. The rate of success for cases with vital or nonvital pulps but having no periapical radiolucency exceeded 96%, whereas only 86% of the cases with pulp necrosis and periapical radiolucency showed apical healing. The possibility of instrumenting the root canal to its full length and the level of root filling significantly affected the outcome of treatment. Of all of the periapical lesions present on previously root-filled teeth, only 62% healed after retreatment. The predictability from clinical and radiographic signs of the treatment-outcome in individual cases with preoperative periapical lesions cases was found to be low. Thus, factors which were not measured or identified may be critical to the outcome of endodontic treatment.
The clinical performance of three endodontic sealers, AH 26®, Kloroperka N-Ø® and ProcoSol®, was assessed in a prospective study of endodontic treatment in 810 roots. The roots were treated by undergraduate students according to a standardized procedure, and were filled with laterally condensed gutta-percha and sealer. The sealer was randomly selected just prior to filling. The patients were recalled yearly for 4 years for a clinical and radiographic control examination, and the radiographs were scored using the periapical index (PAI) scoring system. Ridit analysis provided optimal discrimination between subgroups of roots with regard to the radiographic status of the periapical tissues as a measure of the clinical performance of the materials. The periapical status of roots filled with AH 26® or ProcoSol® was better than that of roots filled with Kloroperka®. The difference was significant after 1 year and persisted through the 4-year observation period. The difference was also evident after stratification of the material with regard to preoperative pulpal and periapical diagnoses. It is concluded that the choice of sealer may influence the outcome of endodontic treatment, and that the perapical index is a useful discriminatory tool for assessment of treatment results in endodontics.
Roots with and without preoperative chronic apical periodontitis were root canal treated and followed clinically and radiographically yearly for up to 4 years. Of 732 roots treated, 599 (82%) were available for evaluation at one or several recalls. Chronic apical periodontitis (CAP) was recorded with the periapical index scoring system. CAP developed in 29 of 473 (6%) of teeth without preoperative signs of disease, whereas 111 of 126 (88%) initially diseased roots showed signs of healing. The rate of healing CAP and the rate of emerging CAP were calculated, and analyses of event occurrence each year of observation were performed. Peak incidence of healing or emerging CAP was at 1 year in both instances. Risk assessments at 2, 3, and 4 years did not indicate an added risk of filled roots developing CAP during this period. Complete healing of preoperative CAP in some instances required 4 years for completion, while signs of initiated, but incomplete, healing were visible in at least 89% of all healing roots after 1 year. Risk analyses may provide relevant information in addition to or in substitution for success/failure analyses.
This study was performed to evaluate radiographic healing of teeth with apical periodontitis, treated in one visit or in two visits (a) with or (b) without calcium hydroxide as an intracanal disinfecting medicament. The patients were assigned one of the three treatment groups by the throwing of a die. The Periapical Index (PAI) Scoring Method was used to compare differences in periapical status from the beginning of treatment to a 52-wk follow-up evaluation. Overall, the periapical status of the treated teeth improved significantly after 52 wk (p < 0.0001). A PAI score of 1 or 2 was considered as representing a "good" periapical status while 3, 4, or 5 was a "bad" status. When base line PAI scores were controlled for, the calcium hydroxide group showed the most improvement in PAI score (3, 4, or 5 to 1 or 2), followed by the one-step group (74% vs. 64%). The teeth that were left empty between visits had clearly inferior healing results. Power statistics were conducted to determine the numbers required for significant differences between the groups, and it was shown that large experimental groups on the order of hundreds of patients would be required to show significant differences.
This prospective clinical study explored the influence of calcium hydroxide as an interappointment dressing on the healing of periapical lesions associated with pulpless teeth that had not been endodontically treated previously. This was achieved by comparing the prognosis after a two-visit root canal treatment with that following a one-visit treatment.
Seventy-three patients were recruited having one tooth with an endodontically induced lesion. Of these patients, 67 could be re-examined. Calcium hydroxide was placed in the instrumented root canals of 31 teeth for at least one week and the treatment finished at the second visit. Thirty-six teeth were root canal treated at one visit. The criteria for success were the absence of signs and symptoms indicating an acute phase of periapical periodontitis and radiographically a periodontal ligament space of normal width. Methods for event time analysis were used to evaluate and compare the prognosis of both treatment approaches.
The probability that complete periapical healing will take place increased continuously with the length of the observation period. In both treatment groups the likelihood that the root canal treatment yields a success within an observation time of five years exceeded 90%. A statistically significant difference between the two treatment groups could not be detected.
From a microbiological perspective, one-visit root canal treatment created favourable environmental conditions for periapical repair similar to the two-visit therapy when calcium hydroxide was used as antimicrobial dressing. One-visit root canal treatment is an acceptable alternative to two-visit treatment for pulpless teeth associated with an endodontically induced lesion.
Previous papers in this series on evidence-based dentistry have discussed the first 2 steps in seeking answers to clinical problems formulating a clear question and strategically searching for evidence. The next step, critical appraisal of the evidence, is made easier if one understands the basic concepts of clinical research design. The strongest design, especially for questions related to therapeutic or preventive interventions, is the randomized, controlled trial. Questions relating to diagnosis, prognosis and causation are often studied with observational, rather than experimental, research designs. The strongest study design should be used whenever possible. Rules have been established to grade research evidence. This paper, the fourth in the series, presents an overview of research methodology most commonly used in the dental literature.
This retrospective study (1) compared the outcome of root canal treatment performed by an endodontist using 1 of 2 different protocols and (2) evaluated the influence of factors affecting outcome.
A total of 200 teeth and 489 roots (Protocol A, 83 teeth/200 roots; Protocol B, 117 teeth/289 roots) treated nonsurgically with root canal 4 to 5 years previously were examined clinically and radiographically according to strict criteria. Generalized estimating equations were used to perform logistic regression to analyze data.
The rate of complete healing for Protocol A (78%) was similar to that of Protocol B (76%). The pulpal status (odds ratio = 2.399, P =.040) and presence (odds ratio = 1.696, P = 0.015) and size (odds ratio = 0.823, P <.001) of periapical lesion were the only factors significantly affecting treatment outcome.
The preoperative status of the pulp and the presence and extent of periapical periodontitis were important prognostic determinants of treatment outcome in this study.
The purpose of the present 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 the periapical healing of teeth treated in one visit (without) or in two visits with an interappointment dressing of calcium hydroxide.
Thirty-nine patients received root-canal treatment. In the first visit, teeth were instrumented, and 18 of these teeth were filled (after microbiological sampling) with calcium hydroxide in sterile saline. The other 21 teeth were obturated with gutta-percha and AH-26 sealer after microbiological sampling. Four weeks later, the teeth with calcium hydroxide were accessed again and after microbiological sampling they were obturated with gutta-percha and AH-26 sealer. Healing of periapical radiolucency was recorded over a period up to 4.5 years.
In both the treatment groups, the size of the periapical lesions reduced significantly during the follow-up period. Complete radiographic healing was observed in 81% of the cases in the one-visit group, and in 71% of the cases in the two-visit group. The probability of success increased continuously over time for both treatment groups. Seven out of eight cases (87.5%) that showed a positive root-canal culture at the time of obturation healed. The number of colony forming units (CFU) in six out of eight positive canals was <10(2) CFU mL(-1).
Within the limitations of this study, no significant differences in healing of periapical radiolucency was observed between teeth that were treated in one visit (without) and two visits with inclusion of calcium hydroxide for 4 weeks. The presence of a positive bacterial culture (CFU<10(2)) at the time of filling did not influence the outcome of treatment.
To assess the treatment results up to 1 year after endodontic treatment of apical periodontitis using a silicone-based sealer in comparison with Grossman's sealer, and to compare the results at 3 months after treatment with the 12-month follow-up to assess the prognostic value of a 3-month control.
A total of 199 teeth were treated at three centres. The sealer was randomly chosen at the time of filling. Treatment results were evaluated clinically and radiographically 3 and 12 months after root-canal filling. The periapical status was evaluated using the periapical index (PAI).
Average PAI scores decreased from 3.43 at start to 2.21 at 12 months for Grossman's sealer and from 3.40 to 2.26 for the silicon-based material. No significant difference between the groups at start or any of the follow ups was seen. The 3-month control was adequate in establishing significant healing in both groups. The improvement of the periapical condition continued at the 12-month examination.
This study assessed the 4- to 6-yr outcome of initial endodontic treatment during Phase 1 of the "Toronto Study" project. A total of 450 teeth were treated, alternating the "Schilder" technique and step-back with lateral condensation, and examined clinically and radiographically by an independent examiner. Apical periodontitis was recorded as absent (periapical index < 3) or present (periapical index > or = 3) and outcome dichotomized as "healed" (no apical periodontitis, no signs or symptoms) or "disease." Univariate, bivariate, and multivariate analyses were performed (p = 0.05) on 120 examined teeth. The "healed" rate (81% overall) was significantly higher for teeth treated without apical periodontitis (92%) than with apical periodontitis (74%). Several other factors were associated with healing rate differential of 10% or higher, but no statistical significance. This study confirmed apical periodontitis as the main prognostic factor in initial endodontic treatment. Continuation of the project will allow assessment of other prognostic factors with better power.
The 4- to 6-yr outcome of initial (first-time) endodontic treatment was assessed for Phase II of the "Toronto Study." In total, 442 teeth were treated by using flared preparation and vertical compaction of warm gutta-percha or step-back preparation and lateral compaction. With 126 teeth excluded (discontinuers: deceased and relocated patients), 163 dropouts, and 31 extracted, 122 (48% recall) were examined for outcome: "healed" (no apical periodontitis [AP], signs, symptoms) or "diseased" (AP, signs, or symptoms). Phase II was analyzed separately and combined with Phase I (n = 242), using Chi-square and Fisher's exact tests (p < or = 0.05). The healed rate (combined sample, 85%) differed significantly for preoperative AP (absent, 93%; present, 79%), treatment technique (flared preparation and vertical compaction, 90%; step-back preparation and lateral compaction, 80%), gender (females, 90%; males, 79%), number of roots (1-92%; > or = 2-81%), and root-filling length (adequate, 87%; inadequate, 77%). Logistic regression revealed increased risk of disease for preoperative AP (odds ratio = 3.3) and technique (odds ratio = 2.3). This study confirmed AP and highlighted treatment technique as the main predictors of outcome in initial treatment.
In the present study, multivariate analyses were performed on clinical and treatment variables that may influence the outcome of endodontic treatment. Data collected in a previous clinical-radiographic follow-up study were used. Of 810 treated, 675 roots in 498 teeth were followed for 6 months to 4 yr. Of these, 192 (the CAP group) had pre-existing, chronic apical periodontitis and 483 (the NAP group) had not. Root canal treatment followed a standard procedure with one of three sealers chosen at random. Demographic, clinical and radiographic variables were recorded at the start of, and during treatment. The periapical index (PAI) score was used to record the outcome of treatment, and applied in two different endpoint modes (END1 and END2) as the dependent variable for multivariate statistical analyses using logistic regression and the general model. The modes reflected increasing PAI scores (END1) and conventional success/failure assessment (END2). Dropouts were largely similar to the cases followed up. A total of 10 preoperative and peroperative variables were found to be significantly associated with treatment outcome by the multivariate analyses of either the total material or the NAP or CAP subgroups. Several of these were not significant in univariate analyses (e.g. the effect of sealer). Conventional success/failure analyses (END2) identified fewer of the influential variables and had low explanatory power, whereas PAI scores on an ordinal scale (END1) were most sensitive in identifying variables of influence on the treatment outcome.
The 4- to 6-year outcome of orthograde retreatment was assessed for Phases I and II of the Toronto Study. In total, 523 teeth in 444 patients were retreated. With 395 teeth lost to follow-up and 25 extracted, 103 teeth (34% recall) were examined by two independent, blinded, calibrated examiners for outcome: "healed" (absence of apical periodontitis, signs, or symptoms) or "diseased" (presence of apical periodontitis, signs, or symptoms). The "healed" rate (81%) differed significantly for preoperative apical periodontitis (absent, 97%; present, 78%) and perforation (absent, 89%; present, 42%). Logistic regression revealed an increased risk of disease for preoperative perforation and adequate root filling quality, and postoperative lack of definitive restoration (odds ratios = 26.5, 6.6, and 14.0, respectively). Without perforation, inadequate intraoperative root filling length was also identified (odds ratio = 6.8). This study suggested that apical periodontitis, although a strong predictor, was secondary to preoperative perforation and root filling quality, and to postoperative restoration, in predicting the outcome of retreatment.
This study prospectively assessed the 4 to 8 yr outcome of apical surgery performed by graduate students in phases I and II of the Toronto Study. The study cohort included 155 teeth in 138 patients. Outcome was assessed by a blinded and calibrated examiner. Clinical and radiographic measures were used for a dichotomous outcome: healed (no signs and symptoms, Periapical Index score </= 2 or scar), or diseased (presence of signs and symptoms, or Periapical Index score >/= 3). The recall rate was 85% and the overall healed rate 74%. Healed rate was significantly higher for teeth with small (</= 5 mm) than larger preoperative lesions (chi, p = 0.02). Logistic Regression revealed an increased odds of disease persistence for teeth with larger preoperative lesions (OR = 3.81, CI = 1.2-12.1), and preoperative root-filling of adequate length (OR = 3.7, CI = 1.1-11.1). Preoperative lesion size and root-filling length were significant predictors of outcome of apical surgery.
To investigate clinical results of root canal treatment performed with the aid of nickel-titanium (NiTi) rotary instruments.
A total of 179 patients underwent root canal treatment with either (A) Lightspeed, or (B) ProFile .04 or (C) ProFile .04 and .06 or GT rotary instruments to create tapered preparations. In groups A and B, laterally condensed gutta-percha and AH Plus were used. Canals in group C were obturated with System B, Obtura II and Roth's 801 sealer. Initial and recall radiographs were assessed using the periapical index (PAI). Outcomes were analysed using chi-square tests, event-time analyses and logistic regression models. Two hundred and thirty-three teeth were radiographically assessed after a mean interval of 25.4 +/- 11.8 months. Favourable outcome of treatment, defined as PAI < 3 at recall was 86.7%. Logistic regression analysis and univariate analyses indicated that teeth with preoperative PAI scores >2 and retreated teeth had a significantly lower chance of healing compared with periapically healthy teeth and primary treatments, respectively. Preparation technique, length of fill and the type of sealer did not significantly affect healing rates.
Root canal treatment with NiTi root canal instrumentation systems renders favourable outcomes in more than 86% of the cases. Outcome is significantly affected by preoperative diagnoses but not by the specific choice of instrumentation system.
The goal of this study was to weigh the impact of patient-related, tooth-related, and treatment-related factors on therapy outcome in a series of consecutive patients.
Eighty-four patients were included. Of these, 66 (79%) were available for recall after > or = 30 months (mean = 46 months). Root canal treatments were performed using a standard protocol. At recall, teeth were scored by means of the periapical index (PAI), which was the dependent variable (dichotomized to sound/ unsound). Explanatory variables were patient age, integrity of the nonspecific immune system, smoking status, dichotomized PAI score before treatment, initial treatment versus retreatment, prior exposition of the root canal to saliva, stainless-steel hand versus NiTi rotary instrumentation, and quality of root filling. Unit of observation was the patient-individual. Data were analyzed using univariate tests and backward stepwise logistic regression analysis.
After 5 steps with elimination of the least significant independent variable, status of the immune system (P = .05), initial PAI (P = .04), and root filling quality (P = .01) were found to be the indispensable predictors for treatment outcome. Using these 3 explanatory variables, the logistic regression model had a predictive value of 87%, compared to 91% with all 8 variables. Success rate at recall (PAI < or = 2 without symptoms) was 88% (95% CI = 78, 94).
The integrity of a patient's nonspecific immune system, which has been neglected in earlier investigations, is a significant predictor for endodontic treatment outcome, and should receive more attention in future studies.
The aim of the present study was to identify periapical changes 20-27 years after root-canal treatment.
The periapical condition of 265 roots filled by undergraduate students was evaluated in two series of intraoral radiographs taken 10-17 and 20-27 years after treatment. Roots (72) not recorded with a normal periapical situation on both occasions by two observers, were re-evaluated by other two examiners, separately and jointly. Final decisions about diagnoses were made by all four examiners. A strict definition was used for the identification of cases with an unfavourable outcome.
Favourable outcomes were observed in 6.4% of the roots that had radiolucencies at the 10-17-year follow-up. Periapical radiolucencies after 20-27 years appeared in 1.5% of all other roots. The radiographic failure frequency for the total material was 4.9%. The percentage of cases with normal periapical findings at the final follow-up was 86.4%, whilst 8.7% were recorded with increased width of the apical periodontal space. Delayed healing owing to surplus root-filling material explained nearly all of the cases with favourable outcome assessed many years after treatment.
Late periapical changes, with more successes than failures, were recorded when a 10-17-year follow-up period after root-canal treatment was extended for another 10 years.
Outcome of pulpectomy in 2 treatment sessions with calcium hydroxide as an intracanal dressing was compared to a procedure comprising instrumentation and root-filling in 1 session.
Subjects with a vital pulp condition (N = 256) were recruited to a randomized clinical trial. Outcome parameters included radiographic signs of apical periodontitis and painful symptoms at clinical follow-ups 1 week and 1-3 years after treatment.
Of 244 subjects available for final recall, 17 presented with periapical radiolucency. Lesions were evenly distributed among the 2 treatment groups. Postoperative pain recorded 1 week after permanent filling was significantly associated with overfilling (P = .001), with no difference between treatment groups. There was no association with presence of overfilling and radiographic lesion at end point of recall.
Study confirms that pulpectomy may be carried out at a high rate of success if due attention is given to aseptic operating procedures, proper instrumentation and filling. Under these conditions an interappointment dressing with calcium hydroxide does not seem to influence outcome.
The 4- to 6-year outcome of initial endodontic treatment was assessed for phase III (1998-1999) of the Toronto Study. Of the 532 teeth treated, 248 were from discontinuers (excluded), 142 from dropouts, 10 extracted, and 132 (50% recall) examined for outcome: healed (no apical periodontitis [AP], signs, symptoms) or diseased. Phase III was analyzed alone and combined with phases I, II (n = 373 teeth). Logistic regression performed on the combined phases I-III sample identified significant (p < or = 0.05) outcome predictors: preoperative AP (OR = 3.5; CI 1.7-7.2; healed: absent, 93%; present, 80%), number of roots (OR = 2.2; CI 1.0-4.7; healed: 1 - 92%; > or =2 - 83%), and intraoperative complications (OR = 2.2; CI 1.1-4.5; healed: absent, 88%; present, 76%). Treatment technique (OR = 2.8; CI 1.3-6.1; healed: Schilder, 89%; alternative, 73%) was suggested as an outcome predictor in teeth with AP, requiring confirmation from randomized controlled trials.
Apicalperiodontitis:microbialinfectionandhostresponsesEssentialEndodontology:preventionandtreatment of apical periodontitis
- Ørstavikd
- Pittfordtr
ØrstavikD,PittFordTR.Apicalperiodontitis:microbialinfectionandhostresponses. In:ØrstavikD,PittFordTR,eds.EssentialEndodontology:preventionandtreatment of apical periodontitis. Oxford: Blackwell Science, 1998:1–8.
Essential Endodontology: prevention and treatment of apical periodontitis
- D Ørstavik
- Pitt Ford
Ørstavik D, Pitt Ford TR. Apical periodontitis: microbial infection and host responses.
In: Ørstavik D, Pitt Ford TR, eds. Essential Endodontology: prevention and treatment
of apical periodontitis. Oxford: Blackwell Science, 1998:1-8.
Healing of apical periodontitis after endodontic treatment using three different root canal sealers