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Baltieri PWQ, de Araújo LP, Gomes BPFA, de Almeida JFA, Ferraz CCR, de-Jesus-Soares A. Outcome of Nonsurgical Root Canal Retreatment of Teeth with Persistent Apical Periodontitis Treated with Foraminal Enlargement and 2% Chlorhexidine Gel: A Retrospective Cohort Study. J Endod 2024:S0099-2399(24)00520-X. [PMID: 39313095 DOI: 10.1016/j.joen.2024.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2024] [Revised: 07/30/2024] [Accepted: 09/16/2024] [Indexed: 09/25/2024]
Abstract
INTRODUCTION Nonsurgical root canal retreatment (NS-RCRT) becomes necessary when primary endodontic procedures fail. This study evaluates the efficacy of NS-RCRT using 2% chlorhexidine gel and foraminal enlargement techniques, aiming to assess whether these approaches enhance periapical healing outcomes and success rates compared to traditional NS-RCRT techniques reported in the literature. METHODS This retrospective cohort study analyzed 120 teeth diagnosed with persistent apical periodontitis, from 80 patients who underwent NS-RCRT between January 2014 and December 2018 at a specialist's private practice. Data were collected following the Preferred Reporting Items for Observational Studies in Endodontics 2023 guidelines. Periapical healing was evaluated using digital periapical radiographs by three calibrated examiners. The outcome of the treatment was analyzed through descriptive statistics and bivariate analyses, including the Chi-Square and Fisher's Exact tests. Treatment outcomes were deemed successful if they showed complete or incomplete repair and unsuccessful if no repair was observed. RESULTS The average follow-up period was 30 months. Under loose criteria, 92.50% (n = 111) of the teeth were categorized as successful, and 7.5% (n = 9) as unsuccessful. Bivariate analysis indicated that the radiographic restoration of apical transportation was the only factor that significantly influenced the outcome. CONCLUSIONS NS-RCRT performed in a single visit using the foraminal enlargement technique and 2% chlorhexidine gel demonstrated high success rates and may be an effective alternative to tooth extraction. This method promoted periapical healing and could significantly improve NS-RCRT protocols. Further prospective studies are recommended to corroborate these findings.
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Affiliation(s)
- Patrick Wilson Quelis Baltieri
- Department of Restorative Dentistry, Division of Endodontics, Piracicaba Dental School, State University of Campinas (UNICAMP), Piracicaba, SP, Brazil
| | | | - Brenda P F A Gomes
- Department of Restorative Dentistry, Division of Endodontics, Piracicaba Dental School, State University of Campinas (UNICAMP), Piracicaba, SP, Brazil
| | - José Flávio Affonso de Almeida
- Department of Restorative Dentistry, Division of Endodontics, Piracicaba Dental School, State University of Campinas (UNICAMP), Piracicaba, SP, Brazil
| | - Caio Cezar Randi Ferraz
- Department of Restorative Dentistry, Division of Endodontics, Piracicaba Dental School, State University of Campinas (UNICAMP), Piracicaba, SP, Brazil
| | - Adriana de-Jesus-Soares
- Department of Restorative Dentistry, Division of Endodontics, Piracicaba Dental School, State University of Campinas (UNICAMP), Piracicaba, SP, Brazil
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Dağıstan-Çavuşoğlu B, Usta SN. Effect of different chelators on the push-out bond strength of hydraulic cements in retrograde obturation. J Dent Res Dent Clin Dent Prospects 2024; 18:204-209. [PMID: 39386123 PMCID: PMC11459082 DOI: 10.34172/joddd.41378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2024] [Accepted: 08/02/2024] [Indexed: 10/12/2024] Open
Abstract
Background This study examined the effect of ethylenediaminetetraacetic acid (EDTA) and etidronic acid (HEDP) in retrograde cavities on the bond strength of MTA Angelus and NeoPutty. Methods Sixty-six teeth with single roots and canals were decoronated and enlarged up to F3 using the ProTaper Universal file system. After removing the apical 3 mm within the scope of endodontic surgery procedures, retrograde cavities were prepared with ultrasonic tips. The teeth were divided into three main groups according to the irrigation solution used: saline, 17% EDTA, and 9% HEDP. Following the irrigation of retrograde cavities, each main group was further divided into two subgroups in terms of using MTA Angelus and NeoPutty as retrograde filling materials. Bond strength values of hydraulic cements were measured by the push-out test. Fracture modes were examined under a stereo microscope. Two dentin sections from each group were examined under scanning electron microscopy (SEM) to observe dentinal tubules. Two-way ANOVA and post hoc Tukey tests were used to analyze the data. Results Irrigation solutions similarly affected the bond strength values of hydraulic cements (P=0.115). MTA Angelus showed significantly higher values than NeoPutty in all the solution groups (P=0.34). Adhesive and cohesive fracture modes were mostly observed in the MTA Angelus and NeoPutty groups, respectively. Conclusion EDTA, HEDP, and saline had a similar effect on the bond strength of hydraulic cements. The higher bond values of MTA Angelus compared to NeoPutty could support its safe use in endodontic surgery procedures.
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Affiliation(s)
| | - Sıla Nur Usta
- Department of Endodontics, Gulhane Faculty of Dentistry, University of Health Sciences, Ankara, Turkey
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Peters OA, Rossi-Fedele G, George R, Kumar K, Timmerman A, Wright PP. Guidelines for non-surgical root canal treatment. AUST ENDOD J 2024; 50:202-214. [PMID: 38864671 DOI: 10.1111/aej.12848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2024] [Accepted: 04/04/2024] [Indexed: 06/13/2024]
Abstract
Guidelines were developed by the Australian Society of Endodontology Inc. with the intent to describe relevant aspects of contemporary evidence-based root canal treatment. The document aims to support clinicians by describing a Standard of Practice in the Australian context. The presented guidelines refer to Competence criteria and Quality standards for the main steps in root canal treatment. While the intent is not to replace individual clinical decision-making, it is envisaged that these periodically reviewable guidelines may help to improve clinical outcomes.
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Affiliation(s)
- Ove A Peters
- The University of Queensland, Brisbane, Queensland, Australia
| | | | - Roy George
- Griffith University, Gold Coast, Queensland, Australia
| | - Kiran Kumar
- The University of Queensland, Brisbane, Queensland, Australia
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Liu H, Lu L, Xu K, Shen Y. Treatment outcomes and prognostic factors of the apical barrier technique with premixed calcium silicate-based putty in necrotic permanent teeth with open apices: a retrospective cohort study with up to six years follow-up. Clin Oral Investig 2024; 28:425. [PMID: 38990402 DOI: 10.1007/s00784-024-05813-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2024] [Accepted: 06/28/2024] [Indexed: 07/12/2024]
Abstract
OBJECTIVES To evaluate treatment outcomes of the apical barrier technique with premixed calcium silicate-based putty for treating necrotic permanent teeth with open apices and to identify prognostic factors. MATERIALS AND METHODS Permanent teeth with necrotic pulps and open apices treated by the apical barrier technique with premixed calcium silicate-based putty, with a minimum follow-up of 12 months, were included. Treatment outcomes were based on clinical signs, symptoms, and radiographic evaluation. The treatment outcome was dichotomized into success or failure according to strict and loose criteria. The chi-square test (or Fisher's exact test) and multiple logistic regression analysis were used to evaluate possible prognostic factors associated with treatment outcomes. RESULTS Seventy-four teeth with a follow-up time of 12-72 months (mean, 25.74 ± 14.36 months) were included in the final evaluation. The success rate was 97.30% using the loose criteria and 66.22% using the strict criteria. Multiple logistic regression analysis indicated that the size of pre-operative periapical lesion (≥ 5 mm) (odds ratio [OR]: 18.96; P = 0.0153) and root canal underfilling (OR: 8.341; P = 0.0448) were significant predictors for treatment failure under the strict criteria. CONCLUSION The apical barrier technique with premixed calcium silicate-based putty is a highly successful procedure for treating necrotic permanent teeth with open apices after an observation period of up to 6 years. Treatment success under the strict criteria is primarily affected by the size of the pre-operative periapical lesion and the apical extent of root-filling. CLINICAL RELEVANCE Careful case selection and ensuring adequate root filling quality are essential to the successful outcome of the apical barrier technique with premixed calcium silicate-based putty.
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Affiliation(s)
- He Liu
- Division of Endodontics, Department of Oral Biological and Medical Sciences, Faculty of Dentistry, University of British Columbia, 2199 Wesbrook Mall, Vancouver, V6T 1Z3, Canada
| | - Le Lu
- Department of Endodontics, Suzhou Stomatological Hospital, No. 1366 Suzhan street, Suzhou, 215005, China.
| | - Ke Xu
- Department of Endodontics, Suzhou Stomatological Hospital, No. 1366 Suzhan street, Suzhou, 215005, China
| | - Ya Shen
- Division of Endodontics, Department of Oral Biological and Medical Sciences, Faculty of Dentistry, University of British Columbia, 2199 Wesbrook Mall, Vancouver, V6T 1Z3, Canada.
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Yoo YJ, Cho EB, Perinpanayagam H, Gu Y, Zhu Q, Noblett WC, Kum KY. Endodontic Microsurgery Outcomes over 10 Years and Associated Prognostic Factors: A Retrospective Cohort Study. J Endod 2024; 50:934-943. [PMID: 38642732 DOI: 10.1016/j.joen.2024.04.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Revised: 03/13/2024] [Accepted: 04/13/2024] [Indexed: 04/22/2024]
Abstract
INTRODUCTION This retrospective cohort study aimed to evaluate long-term healing outcomes (10-17.5 years) after contemporary endodontic microsurgery (EMS) and identify the associated prognostic factors. METHODS Clinical and radiographic data of an EMS cohort (2006-2013) from the electronic database of the dental hospital were reviewed retrospectively by 2 independent examiners to determine their survival and healing outcomes, and potential prognostic factors were analyzed by Cox proportional hazards regression and logistic regression (α = 0.05). RESULTS Through strict inclusion and exclusion criteria and 721 EMS-treated teeth in the cohort, 309 (42.9%) were included (male = 35.0%; female = 65.0%; age = 45.83 ± 15.53 years) with a mean final follow-up of 152.26 ± 26.37 months (range, 120-211 months; median = 148 months). Clinical and radiographic assessments found an 80.5% 10-year survival rate with 63.4% of success. Collectively, tooth type, tooth mobility, preoperative lesion size, clinical crown-to-root ratio, and crown restorations at follow-up were significantly associated with long-term success and survival over 10 years. CONCLUSIONS The preoperative status and condition of the tooth including its alveolar bone support and adequate full-crown restorations may be relevant prognostic determinants of success and survival after EMS over time.
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Affiliation(s)
- Yeon-Jee Yoo
- Department of Conservative Dentistry, Dental Research Institute, Seoul National University Dental Hospital, Seoul National University School of Dentistry, Seoul, Republic of Korea
| | - Eun-Bee Cho
- Department of Conservative Dentistry, Dental Research Institute, Seoul National University Dental Hospital, Seoul National University School of Dentistry, Seoul, Republic of Korea
| | - Hiran Perinpanayagam
- Division of Endodontics, Schulich School of Medicine & Dentistry, University of Western Ontario, London, Canada
| | - Yu Gu
- Department of Endodontics, School and Hospital of Stomatology, Shandong University, Jinan, Shandong Province, People's Republic of China
| | - Qiang Zhu
- Division of Endodontology, University of Connecticut School of Dental Medicine, Farmington, Connecticut
| | - W Craig Noblett
- Division of Endodontics, Department of Restorative Sciences, School of Dentistry, University of Minnesota, Minneapolis, Minnesota
| | - Kee-Yeon Kum
- Department of Conservative Dentistry, Dental Research Institute, Seoul National University Dental Hospital, Seoul National University School of Dentistry, Seoul, Republic of Korea.
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Jogezai U, Kalsi A. Long-term complications and management of dental trauma in the adult patient - Part 1: fractured teeth, pulpal complications and resorption. Br Dent J 2024; 237:95-105. [PMID: 39060587 DOI: 10.1038/s41415-024-7641-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Revised: 03/23/2024] [Accepted: 04/08/2024] [Indexed: 07/28/2024]
Abstract
Dental trauma is one of the most common injuries encountered in the younger population. This can have a long-term impact on the patient's overall quality of life as they may have to deal with the sequelae of these injuries for years to come. Young boys experience dental trauma more frequently than young girls and one of the most common outcomes of these injuries are fractured teeth. This first paper in a two-part review series aims to provide an overview of dental trauma followed by a discussion on management of fractured teeth, associated pulpal complications and resorption. These can be uncomplicated fractures involving enamel and/or dentine, or complicated fractures involving enamel, dentine and pulp. They can involve the crown, the crown and root together, or present solely as root fractures. Pulpal complications can lead to pulp necrosis or pulp canal obliteration. Resorption can be internal or external, inflammatory, or replacement type. The management of each of these injuries begins with a thorough assessment followed by initiating emergency treatment to stabilise the presenting condition. This is followed by a long-term treatment plan which aims to address the patients' aesthetic and functional requirements and provide the patient with the most suitable treatment outcome in the hope to improve their sense of wellbeing and overall quality of life.
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Affiliation(s)
- Ursala Jogezai
- Specialty Registrar in Restorative Dentistry, Royal National ENT and Eastman Dental Hospitals, UK.
| | - Amardip Kalsi
- Consultant in Restorative Dentistry, Cambridge University Hospitals, UK
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Agarwal D, Raghavendra SS. Cleaning efficacy and debris extrusion of supplementary file systems XP-endo Finisher and XP-endo Finisher R in endodontic retreatment. JOURNAL OF CONSERVATIVE DENTISTRY AND ENDODONTICS 2024; 27:498-502. [PMID: 38939537 PMCID: PMC11205175 DOI: 10.4103/jcde.jcde_90_24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/17/2024] [Revised: 03/20/2024] [Accepted: 03/27/2024] [Indexed: 06/29/2024]
Abstract
Aim To evaluate cleaning efficacy and debris extrusion of supplementary file systems XP Endo Finisher (XPEF) and XP Endo Finisher R (XPEFR) in endodontic retreatment. Materials and Methods Thirty single-rooted teeth with single canals were selected, canal preparation done till file #30 6% and obturation completed using lateral condensation technique with AH Plus sealer. The samples were stored at 37°C in a 100% humidity incubator for 7 days. The samples were distributed across the three groups according to the method of retreatment (n = 10): Group I: Neo Endo retreatment (NER) files, Group II: NER files + XPEF, and Group III: NER files + XPEFR. Removal of gutta percha using each file system according to the distributed groups was performed. The extruded debris was collected in an Eppendorf tube, dried in a hot air oven, and weighed. Teeth were sliced longitudinally using carborundum discs. Coronal, middle, and apical thirds were assessed for cleaning efficacy under a stereomicroscope. Results were tabulated and subjected to the statistical analysis using the Kruskal-Wallis H-test followed by post hoc turkey HSD test. All statistical tests were carried out at significance level P < 0.05. Results It was seen that Group II (NER files + XPEF) exhibited better cleaning efficacy than Group III (NER files + XPEFR), although the results were not statistically significant. Greater debris extrusion was seen with Group III when compared to Group II. Conclusion Supplementary files XPEF/XPEFR enhance the cleaning efficacy in endodontic retreatment, but the debris extrusion of XPEFR is more than XPEF.
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Affiliation(s)
- Divyanshi Agarwal
- Department of Conservative Dentistry and Endodontics, Dr. D. Y. Patil Dental College, Dr. D. Y. Patil Vidyapeeth, Pune, Maharashtra, India
| | - Srinidhi Surya Raghavendra
- Department of Conservative Dentistry and Endodontics, Dr. D. Y. Patil Dental College, Dr. D. Y. Patil Vidyapeeth, Pune, Maharashtra, India
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Cardoso IV, Silveira MPC, Vitali FC, Piasecki L, da Fonseca Roberti Garcia L, Bortoluzzi EA, Teixeira CS. Evaluation of changes in root canal length and accuracy of the electronic apex locator during different stages of endodontic treatment and retreatment. Odontology 2024; 112:537-545. [PMID: 37644294 DOI: 10.1007/s10266-023-00846-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 08/07/2023] [Indexed: 08/31/2023]
Abstract
This study evaluated changes in the root canal length (RCL) and the accuracy of the electronic apex locator (EAL) during the different stages of endodontic treatment and retreatment. Fifty-six mesial root canals of mandibular molars were selected. The actual root canal length (AL) of the canals was obtained by inserting a size 15 hand file up to the apical foramen, under magnification. The electronic lengths were obtained at the "APEX" mark of Root ZX II, using an alginate model. Both measurements were performed at three different stages of the initial root canal treatment-unflared, flared, and concluded-and at two stages of retreatment, after achieving patency and repreparation. Data were statistically analyzed and the significance level established was 5%. All stages produced a significant reduction in the AL (p < 0.05). The greatest variation was observed between the unflared-flared stages (0.2 mm) and between concluded-patency stages (0.09 mm), with no difference between them (p > 0.05). The accuracy of Root ZX II was negatively affected after achieving patency, presenting statistically significant difference compared to the other stages (p < 0.05). A significant reduction in the RCL was observed along the different stages of endodontic treatment and retreatment. The EAL was accurate to measure the root canals in most stages, except after achieving patency for endodontic retreatment. Determining and monitoring the RCL is an essential step towards a favorable prognosis, since it reduced along the different stages evaluated. Root ZX II was not accurate for endodontic retreatment.
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Affiliation(s)
- Ihan Vitor Cardoso
- Department of Dentistry-Endodontics Division, Health Sciences Center, Federal University of Santa Catarina, Campus João David Ferreira Lima, Trindade, Florianópolis, SC, Brazil
| | - Matheus Pompeo Caldas Silveira
- Department of Dentistry-Endodontics Division, Health Sciences Center, Federal University of Santa Catarina, Campus João David Ferreira Lima, Trindade, Florianópolis, SC, Brazil
| | - Filipe Colombo Vitali
- Department of Dentistry-Endodontics Division, Health Sciences Center, Federal University of Santa Catarina, Campus João David Ferreira Lima, Trindade, Florianópolis, SC, Brazil
| | - Lucila Piasecki
- Department of Periodontics and Endodontics, University at Buffalo, New York, NY, USA
| | - Lucas da Fonseca Roberti Garcia
- Department of Dentistry-Endodontics Division, Health Sciences Center, Federal University of Santa Catarina, Campus João David Ferreira Lima, Trindade, Florianópolis, SC, Brazil
| | - Eduardo Antunes Bortoluzzi
- Department of Diagnosis and Oral Health, School of Dentistry, University of Louisville, Louisville, KY, USA
| | - Cleonice Silveira Teixeira
- Department of Dentistry-Endodontics Division, Health Sciences Center, Federal University of Santa Catarina, Campus João David Ferreira Lima, Trindade, Florianópolis, SC, Brazil.
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Ahmed S, Jehad Hassan S, Gajdhar S, Saleh Alhazmi L, Yahya Khalifah R, Alhusain Alrifai J, Salem Aljhdali S, Sheriff Maqbul M. Prevalence of Enterococcus faecalis and Candida albicans in endodontic retreatment Cases: A comprehensive study. Saudi Dent J 2024; 36:539-545. [PMID: 38690386 PMCID: PMC11056411 DOI: 10.1016/j.sdentj.2024.01.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Revised: 01/03/2024] [Accepted: 01/08/2024] [Indexed: 05/02/2024] Open
Abstract
Introduction Endodontic treatment failures often stem from the presence of microbial pathogens, particularly Enterococcus faecalis and Candida albicans. This study systematically assesses the prevalence of E. faecalis and C. albicans in endodontic retreatment cases, aiming to explore their impact on treatment outcomes. Methods Employing a systematic sampling approach, 30 patients with a history of previous endodontic treatment were selected. Rigorous clinical and radiographic assessments were conducted, following standardized protocols for root canal sample collection. Microbiological analysis, utilizing selective culture media, was employed to identify and quantify E. faecalis and C. albicans. Statistical analyses, including chi-square and logistic regression tests, were performed. Results The study involved 30 patients undergoing endodontic retreatment, with comprehensive clinical and radiographic evaluations for cases with and without periradicular lesions. Microbiological analysis unveiled a significant prevalence of E. faecalis and C. albicans, establishing a robust association between these pathogens and retreatment failure. These findings underscore the critical need for targeted antimicrobial interventions to enhance the overall success rates of endodontic retreatment procedures. Conclusion This study highlights the substantial prevalence of E. faecalis and C. albicans in endodontic retreatment cases, emphasizing the importance of identifying and effectively managing these pathogens for successful treatment outcomes. The notable association between these microbial agents and retreatment failure underscores the imperative for tailored antimicrobial strategies to enhance the efficacy of endodontic retreatment procedures.
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Affiliation(s)
- Siddiq Ahmed
- Department of Conservative Dental Sciences, Ibn Sina national College for medical studies, Jeddah, Saudi Arabia
| | - Sami Jehad Hassan
- Department of Conservative Dental Sciences, Ibn Sina national College for medical studies, Jeddah, Saudi Arabia
| | - Shaiq Gajdhar
- Department of Prosthodontics, Ibn Sina National College for Medical Studies, Jeddah, Saudi Arabia
| | - Lama Saleh Alhazmi
- Dental interns, Ibn Sina national College for medical studies, Jeddah, Saudi Arabia
| | - Rawan Yahya Khalifah
- Dental interns, Ibn Sina national College for medical studies, Jeddah, Saudi Arabia
| | | | | | - Muazam Sheriff Maqbul
- Department of Microbiology and Immunology, Ibn Sina national College for medical studies, Jeddah, Saudi Arabia
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Terauchi Y, Torabinejad M, Wong K, Bogen G. Reprint of: The Effect of Mineral Trioxide Aggregate Obturation Levels on the Outcome of Endodontic Retreatment: An Observational Study. J Endod 2024; 50:472-482. [PMID: 38385933 DOI: 10.1016/j.joen.2024.01.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2024]
Abstract
INTRODUCTION No clinical studies have examined the effect of mineral trioxide aggregate (MTA) obturation levels on the outcome of endodontic retreatment. This retrospective study examined treatment outcomes in three cohorts that compared overfilling, flush filling, and underfilling after orthograde retreatment using MTA. METHODS Two hundred fifty patients with 264 teeth diagnosed with previously treated root canals and apical periodontitis retreated in a private endodontic practice were included. All teeth received MTA obturation and the extent of the final filling level was measured in relation to the major apical foramen. After 6-month follow-ups, all nonhealing cases were treated surgically. After 24- to 72-month reviews, the effect of preoperative lesion size and the degree of MTA obturation level were assessed. Multiple linear regression and time-to-event analysis using Stata 17 software (StataCorp LLC, College Station, TX) were used to evaluate the data. RESULTS Within the three cohorts, 99 out of 108 overfilled teeth (91.7%), 90 out of 103 flush fills (87.4%), and 10 out of 53 underfilled teeth (18.9%) healed and were successfully retreated without surgery at 48-months. When surgical outcomes were included, the combined healed proportion was 93.2%. Preoperative lesion size was found to be an important predictor for retreatment nonhealing. A 1-mm increase in lesion size at baseline resulted in an estimated 11% (95% CI 1.04, 1.18)-38% (95% CI 1.22, 1.58) increase in the risk of surgery. Compared to overfilling and flush filling, underfilling was associated with an approximately three-fold increase in requiring surgery and characterized by delayed healing. CONCLUSION MTA obturation is a viable retreatment option for teeth with nonhealing endodontic treatment. MTA overfills or flush fillings do not adversely affect healing outcomes. However, MTA underfilling increases the chances for nonhealing and surgical intervention.
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Affiliation(s)
| | - Mahmoud Torabinejad
- Department of Endodontics, School of Dentistry, Loma Linda University, Loma Linda, California
| | - Kingsley Wong
- Telethon Kids Institute, The University of Western Australia, Perth, Western Australia, Australia
| | - George Bogen
- Department of Endodontics, University of Queensland, School of Dentistry, Brisbane, Queensland, Australia.
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Sabeti M, Chung YJ, Aghamohammadi N, Khansari A, Pakzad R, Azarpazhooh A. Outcome of Contemporary Nonsurgical Endodontic Retreatment: A Systematic Review of Randomized Controlled Trials and Cohort Studies. J Endod 2024; 50:414-433. [PMID: 38280514 DOI: 10.1016/j.joen.2024.01.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Revised: 12/11/2023] [Accepted: 01/15/2024] [Indexed: 01/29/2024]
Abstract
INTRODUCTION The success rates of NS-ReTx have varied across decades of prior research. Nonetheless, recent endodontic advances have substantially enhanced case management. This systematic review aimed to identify rigorous studies on contemporary NS-ReTx, investigating both periapical healing-evaluated strictly for complete resolution or loosely for size reduction of periapical radiolucency-and success, denoting clinical normalcy combined with periapical healing. METHODS We systematically searched MEDLINE, Embase, Web of Science, the Cochrane Library, and gray literature from January 1988 to December 2022. Article selection and data extraction were independently conducted by 3 reviewers. Selected studies underwent risk of bias assessment, and evidence quality using the Grading of Recommendations, Assessment, Development, and Evaluation approach. Meta-analysis and meta-regression established pooled outcome rates, 95% confidence intervals (CIs), and significant clinical prognostic factors (P < .05). RESULTS Twenty-nine articles were included. Pooled periapical healing rates using strict and loose criteria were 78.8% (95% CI: 75.2-82.4) and 87.5% (95% CI: 83.8-91.2), respectively. Pooled success rates using strict and loose criteria were 78.0% (95% CI: 74.9-81.2) and 86.4% (95% CI: 82.6-90.1), respectively. Meta-regression analyses revealed significant influences on NS-ReTx outcomes (P < .05), including periapical status, lesion size, apical root filling extent, and follow-up duration. CONCLUSIONS Contemporary NS-ReTx shows encouraging outcomes, achieving periapical healing and success rates ranging from approximately 78% (strict criteria) to 87% (loose criteria). The absence of or smaller preoperative lesions, adequate root filling length, and extended follow-ups significantly improve NS-ReTx outcomes. Integrating these factors into treatment planning is pivotal for optimizing the outcome of NS-ReTx.
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Affiliation(s)
- M Sabeti
- Department of Preventive and Restorative Dental Sciences, Advanced Specialty Program in Endodontics, University of California, San Francisco School of Dentistry, San Francisco, California
| | - Y J Chung
- Department of Preventive and Restorative Dental Sciences, Advanced Specialty Program in Endodontics, University of California, San Francisco School of Dentistry, San Francisco, California
| | - N Aghamohammadi
- Department of Preventive and Restorative Dental Sciences, Advanced Specialty Program in Endodontics, University of California, San Francisco School of Dentistry, San Francisco, California
| | - A Khansari
- Faculty of Arts and Science, Queen's University, Kingston, Ontario
| | - R Pakzad
- Department of Epidemiology, Faculty of Health, Ilam University of Medical Sciences, Ilam, Iran
| | - A Azarpazhooh
- Faculty of Dentistry, University of Toronto, Toronto, Ontario.
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Ling D, Chen Y, Chen G, Zhang Y, Wang Y, Wang Y, He F. Outcome of nonsurgical management of large cyst-like periapical lesions using a modified apical negative pressure irrigation system: a case series study. BMC Oral Health 2024; 24:336. [PMID: 38491469 PMCID: PMC10943812 DOI: 10.1186/s12903-024-04110-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Accepted: 03/05/2024] [Indexed: 03/18/2024] Open
Abstract
OBJECTIVE To assess the effectiveness of a self-constructed modified apical negative pressure irrigation (ANPI) system employing commonly used clinical instruments in nonsurgical root canal therapy (NSRCT) for large cyst-like periapical lesions (LCPLs). METHODS From 2017 to 2022, 35 patients diagnosed with LCPLs (5-15 mm) via preoperative clinical and radiographic evaluations of endodontic origin underwent NSRCT combined with ANPI. These patients were subjected to postoperative clinical and radiographic follow-up at 3 months, 6 months, 1 year, 2 years, 3 years, and 4 years, with a CBCT scan specifically conducted at 6-month follow-up. Through the reconstruction of three-dimensional cone beam computed tomography (CBCT) data, an early prognosis was facilitated by monitoring changes in lesion volume. Various treatment predictors-including sex, type of treatment, lesion size, preoperative pain, jaw, type of teeth involved, sealer extrusion, and the number of root canals-were meticulously analyzed. The evaluation of post-treatment outcomes leveraged both clinical observations and radiographic data collected during the follow-up periods. The Kruskal‒Wallis test and one-way ANOVA were also conducted to determine the independent factors influencing treatment outcomes. A significance level of 5% was established. RESULTS Thirty-five teeth from 35 patients with a median age of 28 years (range 24-34) were treated; the median follow-up duration was 19 months (range 12-26). The overall success rate was 91.4%, with a median lesion reduction of 77.0% (range 54.2-96.4%) at 6 months. Patients under 30 years of age exhibited a significantly greater success rate than older patients did (100.0% vs. 80.0%, p = 0.037). Other factors, such as sex, jaw, treatment type, preoperative pain, cyst size, tooth location, sealer extrusion, and the number of roots, did not significantly impact treatment outcomes. CONCLUSIONS Despite limitations related to the observational case-series study design and relatively small sample size, our findings suggest that utilizing the ANPI in the NSRCT for LCPLs may hold promise. The notably higher success rate in patients younger than 30 years is worth noting.
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Affiliation(s)
- Danhua Ling
- Department of General Dentistry, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China
- Department of Prosthodontics, Stomatology Hospital, School of Stomatology, Zhejiang University School of Medicine, 166 Qiutao North Road, Shangcheng District, Hangzhou, Zhejiang Province, China
| | - Yun Chen
- School of Stomatology, Zhejiang Chinese Medical University, Hangzhou, Zhejiang Province, China
| | - Gongpei Chen
- Department of General Dentistry, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China
| | - Yanzhen Zhang
- Department of General Dentistry, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China
| | - Yanhong Wang
- Department of Comprehensive Dentistry, Jiangnan Hospital Affiliated to Zhejiang Chinese Medical University, Hangzhou, Zhejiang Province, 311221, China
| | - Ying Wang
- Department of General Dentistry, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China
| | - Fuming He
- Department of Prosthodontics, Stomatology Hospital, School of Stomatology, Zhejiang University School of Medicine, 166 Qiutao North Road, Shangcheng District, Hangzhou, Zhejiang Province, China.
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Sinsareekul C, Saengthong-Aram P, Limpuangthip N. Survival, complications, and patient-reported outcomes of endodontically treated teeth versus dental implant-supported prostheses: A systematic review. J Prosthet Dent 2024:S0022-3913(24)00121-5. [PMID: 38443242 DOI: 10.1016/j.prosdent.2024.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 02/12/2024] [Accepted: 02/13/2024] [Indexed: 03/07/2024]
Abstract
STATEMENT OF PROBLEM Decision making for compromised teeth involving the choice between endodontic treatment and tooth extraction followed by an implant-supported prosthesis is challenging. However, systematic reviews examining studies using the same patients or clinical settings to provide conclusive evidence regarding the best approach are lacking. PURPOSE The purpose of this systematic review was to compare the survival rate, complications, failure, and patient-reported outcomes of endodontically treated teeth and implant-supported prostheses. MATERIAL AND METHODS After the protocol had been registered at the International Prospective Register of Systematic Reviews (PROSPERO), PubMed, Scopus, and the Cochrane Database of Systematic Reviews were searched from database inception to July 2023 with no language restriction. A manual literature search was performed. The review protocol was based on the population, intervention, comparator, outcome, and study design (PICOS) criteria and included all observational and experimental human studies that directly compared the survival, complications, and patient-reported outcomes of teeth with pulpal and periapical disease after all types of endodontic treatment and subsequent restoration and tooth extraction followed by an implant-supported prosthesis. The risk of bias of the included studies was assessed by using the modified Newcastle-Ottawa scale. RESULTS Eight observational studies were included in this systematic review: 3 retrospective cohort and 5 case-control studies. Three included studies revealed no difference in survival rate between endodontically treated teeth and implant-supported prostheses during the first 3 years, but the survival of endodontically treated teeth declined over time with a higher failure rate than implant-supported prostheses. In contrast, the other 3 included studies reported lower survival rate for implant-supported prostheses and more complications. In terms of patient-reported outcomes, patients were generally satisfied with both treatment modalities, with notable improvements in oral health-related quality of life in those receiving endodontic treatment. CONCLUSIONS Whether implant-supported prostheses or endodontically treated teeth are better in terms of survival outcome is unclear. Improved oral health-related quality of life was found after endodontic treatment.
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Affiliation(s)
- Chanakarn Sinsareekul
- Lecturer, Department of Operative Dentistry, Faculty of Dentistry, Chulalongkorn University, Bangkok, Thailand
| | | | - Nareudee Limpuangthip
- Associate Professor, Department of Prosthodontics, Faculty of Dentistry, Chulalongkorn University, Bangkok, Thailand.
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Olivieri JG, Encinas M, Nathani T, Miró Q, Duran-Sindreu F. Outcome of root canal retreatment filled with gutta-percha techniques: A systematic review and meta-analysis. J Dent 2024; 142:104809. [PMID: 38145805 DOI: 10.1016/j.jdent.2023.104809] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 12/01/2023] [Accepted: 12/15/2023] [Indexed: 12/27/2023] Open
Abstract
OBJECTIVE The present systematic review and meta-analysis aimed to evaluate the success rate of root canal retreatment filled with gutta-percha and the variables related to retreatment success. DATA The PRISMA guidelines were followed for the present review. The study protocol was registered in the International Prospective Database of Systematic Reviews (PROSPERO CRD42021283134). Risk assessment was performed using the Newcastle-Ottawa scale. Funnel plots were used to detect publication bias and asymmetry was assessed using Egger's tests. SOURCES PubMed, Scopus, ScienceDirect, Cochrane, and additional sources were searched. STUDY SELECTION Studies published until 10 December 2022. Clinical studies evaluating the success of root canal retreatment filled with gutta-percha with at least a 1-year follow-up were selected. RESULTS Ten studies and one unpublished study fulfilled the inclusion criteria for quantitative analysis. The success rate of non-surgical root canal retreatment was 71% (95% CI: 66%-76%) with strict criteria and 87% (79% - 93%) with loose criteria for 1-3 years of follow-up, and 77% (66% - 86%) with strict criteria for a 4-5 years of follow-up. Endodontically retreated teeth with periapical lesions had a lower success rate under strict criteria. The tooth type, dental arch, initial periapical index (PAI) score, and the number of visits also affected the treatment success rate under strict criteria. For the loose criteria, teeth with larger periapical lesions and higher initial PAI scores had a lower success rate. CONCLUSIONS According to the present systematic review and meta-analysis, non-surgical root canal retreatment results in favourable outcomes. The presence of a periapical radiolucency, periapical lesions >5mm, a higher initial PAI score, multiple-visit retreatments, and mandibular and molar teeth resulted in a lower success rate. CLINICAL SIGNIFICANCE Non-surgical root canal retreatment filled with gutta-percha techniques is a relatively predictable procedure with a high success rate. Several variables can affect retreatment success, mainly the presence and size of a periapical lesion and the type of tooth.
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Affiliation(s)
- Juan Gonzalo Olivieri
- Department of Endodontics, Universitat Internacional de Catalunya, Barcelona, Spain.
| | - Marc Encinas
- Department of Endodontics, Universitat Internacional de Catalunya, Barcelona, Spain
| | - Tousif Nathani
- Department of Endodontics, Universitat Internacional de Catalunya, Barcelona, Spain
| | - Queralt Miró
- Fundació Institut Universitari per a la Recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
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Alzahrani O, Komo H, Howait M. Healing and Spontaneous Realignment of Displaced Roots With Periapical Granuloma After Microsurgical Endodontic Treatment (Three Years' Follow-up): A Case Report. Cureus 2024; 16:e52020. [PMID: 38205085 PMCID: PMC10777889 DOI: 10.7759/cureus.52020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/10/2024] [Indexed: 01/12/2024] Open
Abstract
Endodontic therapy aims to treat or prevent apical periodontitis, a condition characterized by inflammation of the periapical tissues at the apex of the tooth root. This case study demonstrates the successful nonsurgical and surgical management of a large periapical lesion involving the lower central incisors with root displacement induced by a periapical granuloma. A patient was referred from the maxillofacial department for endodontic treatment due to persistent pain and swelling in the lower anterior region started two months ago. Upon arrival, a clinical examination and radiographic assessment were performed using cone-beam computed tomography (CBCT). The CBCT scan revealed a significant radiolucent area measuring (10x8) mm extending from the lower left lateral incisor to the right central incisor. The lower left central incisor was necrotic and tender to palpation and percussion. A nonsurgical root canal was performed followed by an apicectomy using mineral trioxide aggregate (MTA) to facilitate healing of the periapical lesion. Histopathological examination of the lesion confirmed the diagnosis of periapical granuloma. At follow-up 1, 2, and 3 years' visits, the periodontal assessment was performed and found to be free of pain upon percussion or palpation. No other clinical or radiological signs or symptoms were identified except for a small radiolucent area mesially adjacent to the root of the lower left central incisor. The development of materials such as MTA has significantly improved the prognosis of cases with large periapical lesions. In this case, healing and spontaneous realignment of the root were observed after three years.
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Affiliation(s)
- Omar Alzahrani
- Department of Advanced General Dentistry, Faculty of Dentistry, King Abdulaziz University Dental Hospital, Jeddah, SAU
| | - Hisham Komo
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, King Abdulaziz University Dental Hospital, Jeddah, SAU
| | - Mohammed Howait
- Department of Endodontics, Faculty of Dentistry, King Abdulaziz University, Jeddah, SAU
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Kytridou V, Gkikas I, Garcia MN, Cepeda O, Hildebolt CF. A literature review of local and systemic considerations for endodontic treatments in older adults. Gerodontology 2023; 40:410-421. [PMID: 36971290 DOI: 10.1111/ger.12679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Revised: 12/09/2022] [Accepted: 12/28/2022] [Indexed: 11/17/2023]
Abstract
OBJECTIVES The aim of this literature review was to summarise the clinical important findings on the endodontic treatment outcome in older patients (≥60 years old) with pulpal/periapical disease considering local and systemic factors from a body of knowledge that is heterogeneous in methods or disciplines. BACKGROUND Due to the increasing number of older patients in the endodontic practice, and the current trend for tooth preservation, the need for clinicians to have a better understanding of age-related implications that may influence the required endodontic treatment in older adults to retain their natural dentition is indispensable. METHODS PubMed/Medline and Embase was searched by a medical librarian using specific terms based on inclusion/exclusion criteria. The reference list was hand-seached for additional relevant publications between 2005-2020. A combination of these terms was performed uing Boolean operators and MeSH terms. RESULTS Of the 1577 publications identified manually and electronically, 25 were included to be fully reviewed by the examiners. The data was derived from three systematic reviews, one systematic and meta-analysis, three case series, four prospective and 14 retrospective cohorts. Overall, there was heterogeneity in reporting as well as limitations in most studies. CONCLUSIONS The outcome of endodontic treatment (ET) either nonsurgical or surgical or combination of these is not affected by older age. ET can be the treatment of choice in older patients wiht pulpal/periapical disease. There is no evidence that older age per se affects the outcome of any type of endodontic treatment.
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Affiliation(s)
- Vasiliki Kytridou
- Section Head of Endodontics, Department of Applied Dental Medicine, Southern Illinois University School of Dental Medicine, Alton, Illinois, USA
| | - Ioannis Gkikas
- Section of Oral and Maxillofacial Surgery, Department of Applied Dental Medicine, Southern Illinois University School of Dental Medicine, Alton, Illinois, USA
| | - Miryam Nathalia Garcia
- Applied Dental Medicine Department, Section of Periodontics, Southern Illinois University School of Dental Medicine, Alton, Illinois, USA
| | - Oscar Cepeda
- Division of Geriatric Medicine, St. Louis VA Medical Center, Washington University School of Medicine, Saint Louis, Missouri, USA
| | - Charles F Hildebolt
- Washington University School of Medicine, Saint Louis, Missouri, USA
- Southern Illinois University School of Dental Medicine, Alton, Illinois, USA
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Brochado Martins JF, Hagay S, Herbst SR, Falk S. Cost-effectiveness analysis of full versus selective root canal retreatment. Int Endod J 2023; 56:1319-1327. [PMID: 37732616 DOI: 10.1111/iej.13972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 08/22/2023] [Accepted: 08/23/2023] [Indexed: 09/22/2023]
Abstract
AIM Selective root-canal retreatment has been proposed as an alternative to full retreatment in multirooted, root-canal-filled teeth with evidence of apical pathology, where only the affected root(s) is retreated. Whilst this option may save costs initially, failures and retreatments may compensate for these initial savings. We assessed the cost-effectiveness of full versus selective root-canal retreatment using data from a recent clinical pilot study, employing a modelling approach. METHODOLOGY A Markov model was constructed to follow up a previously root-canal treated maxillary molar with apical pathology on a single root (mesio-buccal), receiving either selective or full root-canal retreatment. A private-payer perspective in Dutch health care was adopted. Permanent molar teeth with apical lesions on the mesial root were simulated over the lifetime of initially 50-year-old patients. Teeth could have endodontic complications and require interventions such as retreatment or tooth extraction and replacement. Costs were calculated based on the Dutch dental fee catalogues. Monte-Carlo microsimulations were performed to assess lifetime costs and effectiveness (measured as tooth retention time), and the resulting cost-effectiveness. Probabilistic joint uncertainty and sensitivity analyses were performed, and cost-effectiveness at different willingness-to-pay-thresholds was evaluated. RESULTS In the base-case scenario, selective retreatment was less costly (2137; 2.5%-97.5% percentiles: 1944-2340 Euro) and more effective (19.6; 18.3-20.8 Years) than full retreatment (2495; 2305-2671 Euro; 16.5; 15.2-17.9 Years) in 100% of the simulations and regardless of the willingness-to-pay threshold. Only in a worst case scenario was selective retreatment more costly, but remained more effective. CONCLUSIONS Selective retreatment, when clinically applicable, is likely to be more cost-effective than full retreatment in endodontically treated molars with persistent apical periodontitis. Our results should be interpreted with caution because the quality of the underlying data is limited.
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Affiliation(s)
- João Filipe Brochado Martins
- Department of Endodontology, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Academic Centre for Dentistry Amsterdam, University of Amsterdam, Amsterdam, The Netherlands
| | - Shemesh Hagay
- Department of Endodontology, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Academic Centre for Dentistry Amsterdam, University of Amsterdam, Amsterdam, The Netherlands
| | - Sascha Rudolf Herbst
- Department of Oral Diagnostic, Digital Health and Health Services Research, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Schwendicke Falk
- Department of Oral Diagnostic, Digital Health and Health Services Research, Charité-Universitätsmedizin Berlin, Berlin, Germany
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Gupta A, Showkat R, Singh TK. Innovative ex vivo exploration: A comparative study of novel approaches of root canal filling material removal efficiency. JOURNAL OF CONSERVATIVE DENTISTRY AND ENDODONTICS 2023; 26:713-718. [PMID: 38292747 PMCID: PMC10823978 DOI: 10.4103/jcde.jcde_162_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 10/02/2023] [Accepted: 10/06/2023] [Indexed: 02/01/2024]
Abstract
Introduction Retention of the natural tooth without any symptoms in the oral cavity is one of the prime desires of endodontic treatment. Root canal therapy usually leads to failure when treatment is not up to the mark of acceptable standards. To address these deficiencies, non-surgical endodontic retreatment is the most accepted option with the success rate ranging from 65% to 83%. Forty-five single-rooted mandibular premolars with undeviated canals (as per Schneider's criteria) were obtained and divided further into three groups with 15 specimens along with resin-based sealer solvent in each group: Group 1 - Retreatment rotary file system, Group 2 - Ultrasonics, and Group 3 - Diode laser. Specimens were then evaluated under a stereomicroscope at ×10 after cutting in two halves followed by evaluation of the remaining filling material using Hulsmann and Bluhm criteria. Context Nonsurgical retreatment. Aims The aim of the study was to evaluate and compare the efficacy of various retreatment techniques for the elimination of root canal filling material. Settings and Design The sample size was determined using the formula n = (Zα/2)2 s2/d2. The design of the study is in vitro experimental study. Subjects and Methods A sum of 45 single-rooted extracted human permanent mandibular premolars were included in this study. All teeth were biomechanically prepared and obturated followed by decoronating the samples. All specimens were randomly divided into 3 groups comprising 15 specimens along with solvent based on the technique for the filling material elimination from the root canal, i.e. Group I: retreatment rotary files, Group II: ultrasonics, and Group III: diode laser. Statistical Analysis Used The Tukey's post hoc tests and one-way analysis of variance were used for comparison of the study parameters among the groups. Results Results revealed that ultrasonics showed the least amount of remaining filling material within the root canal which had a significant difference from other groups, i.e. retreatment rotary files and diode laser. Conclusions Ultrasonics with a resin-based sealer solvent can be considered a preferred option for nonsurgical retreatment. However, none of the groups shows complete elimination of filling material inside the root canal system.
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Affiliation(s)
- Aakash Gupta
- Department of Dentistry, All India Institute of Medical Sciences, Bathinda, Punjab, India
| | - Rukhsar Showkat
- Department of Dentistry, All India Institute of Medical Sciences, Bathinda, Punjab, India
| | - Tarun Kumar Singh
- Department of Dentistry, All India Institute of Medical Sciences, Bathinda, Punjab, India
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Zanza A, Reda R, Testarelli L. Endodontic Orthograde Retreatments: Challenges and Solutions. Clin Cosmet Investig Dent 2023; 15:245-265. [PMID: 37899987 PMCID: PMC10612510 DOI: 10.2147/ccide.s397835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Accepted: 10/05/2023] [Indexed: 10/31/2023] Open
Abstract
Endodontic orthograde retreatments are considered one of the possible treatment options in case of post-treatment diseases considering the promising results present in the literature. Despite this, a plethora of articles have been published on this topic, and drawing conclusions could be challenging. For this reason, this review aims to summarize the crucial points on each aspect of non-surgical endodontic retreatments, discussing and comparing the current protocols, techniques, materials, and indications. Taking into consideration data from the literature, in terms of diagnosis, CBCT should be considered the first choice, since it can thoroughly affect the diagnosis and treatment plan. Regarding the procedural phases, some conclusions can be drawn: when present, coronal restoration materials such as crowns, partial prostheses, post, and core should be removed; the use of magnification devices, ultrasonic instruments, and an in-depth interpretation of radiographic images with both 2D and 3D images are strongly recommended during the orifice location; additional protocols such as irrigants activation, ultrasonic cleaning, and rotary or reciprocating instrumentation of treated canals are strongly recommended for filling materials removal and to achieve a high-quality chemo-mechanical disinfection; perforations should be treated as soon as possible, and the material of choice to treat them is the MTA or other calcium-silicate-based repair materials; the presence of ledges does not intrinsically reduce the success rate of RCRts if properly managed; in case of instrument fragments, their removal should be considered as the first treatment option, however many variables should be considered to select the proper technique or consider the option of bypassing.
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Affiliation(s)
- Alessio Zanza
- Department of Oral and Maxillo-Facial Sciences, Sapienza University of Rome, Rome, Italy
| | - Rodolfo Reda
- Department of Oral and Maxillo-Facial Sciences, Sapienza University of Rome, Rome, Italy
| | - Luca Testarelli
- Department of Oral and Maxillo-Facial Sciences, Sapienza University of Rome, Rome, Italy
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Bucchi C, Rosen E, Taschieri S. Non-surgical root canal treatment and retreatment versus apical surgery in treating apical periodontitis: A systematic review. Int Endod J 2023; 56 Suppl 3:475-486. [PMID: 35762859 DOI: 10.1111/iej.13793] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 06/24/2022] [Accepted: 06/25/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND In addition to non-surgical root canal treatment or retreatment, apical surgery may be carried out to manage teeth with apical periodontitis. However, it is unclear which treatment option is more effective. OBJECTIVE To systematically review the effectiveness of apical surgery compared with non-surgical treatment or retreatment in terms of clinical and patient-related outcomes in teeth with apical periodontitis. METHODS A literature search of electronic databases, the grey literature, the reference lists of included articles and previous reviews, and a hand search of leading endodontic journals, was conducted. Randomised and non-randomised control trials, and longitudinal observational studies on patients undergoing surgical (treatment group) and non-surgical root canal treatment or retreatment (control group) of teeth with apical periodontitis were included. The risk of bias was appraised using the Cochrane risk-of-bias tool; ROBINS-I and the Newcastle-Ottawa Scale. RESULTS Five studies, consisting of two randomised clinical trials, two non-randomised clinical trials, and a retrospective cohort study, were included. The interobserver agreement was high and kappa correlation coefficient was good. In total 529 teeth were available for follow-up that varied from 6 months to 8.7 years. The overall risk of bias was high for four studies and raised some concerns in one study. Apical surgery showed seemly better results regarding periapical healing and less need for more and further intervention, although tooth survival was higher in the control group. Given the heterogeneity of the studies, meta-analysis was not possible. DISCUSSION Previous systematic reviews have conducted an indirect comparison by separately pooling the outcomes of studies analysing either non-surgical, or surgical, treatment. In this systematic review, only studies that compared both treatments were included. Most results of this and previous reviews were similar. CONCLUSION No treatment option showed clear superiority. However, to arrive at statistically supported conclusions there is a need for additional high-quality comparative trials. REGISTRATION PROSPERO database (Registration number CRD42021260300).
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Affiliation(s)
- Cristina Bucchi
- Department of Integral Adult Dentistry, Faculty of Dentistry, Research Centre in Oral Biology, Universidad de La Frontera, Temuco, Chile
| | - Eyal Rosen
- Department of Endodontics, Maurice and Gabriela Goldschleger School of Dental Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Silvio Taschieri
- Department of Biomedical, Surgical and Dental Sciences, Università degli Studi di Milano, Milan, Italy
- IRCCS Orthopedic Institute Galeazzi, Milan, Italy
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Terauchi Y, Torabinejad M, Wong K, Bogen G. The Effect of Mineral Trioxide Aggregate Obturation Levels on the Outcome of Endodontic Retreatment: An Observational Study. J Endod 2023; 49:664-674. [PMID: 37085142 DOI: 10.1016/j.joen.2023.04.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 04/13/2023] [Accepted: 04/14/2023] [Indexed: 04/23/2023]
Abstract
INTRODUCTION No clinical studies have examined the effect of mineral trioxide aggregate (MTA) obturation levels on the outcome of endodontic retreatment. This retrospective study examined treatment outcomes in three cohorts that compared overfilling, flush filling, and underfilling after orthograde retreatment using MTA. METHODS Two hundred fifty patients with 264 teeth diagnosed with previously treated root canals and apical periodontitis retreated in a private endodontic practice were included. All teeth received MTA obturation and the extent of the final filling level was measured in relation to the major apical foramen. After 6-month follow-ups, all nonhealing cases were treated surgically. After 24- to 72-month reviews, the effect of preoperative lesion size and the degree of MTA obturation level were assessed. Multiple linear regression and time-to-event analysis using Stata 17 software (StataCorp LLC, College Station, TX) were used to evaluate the data. RESULTS Within the three cohorts, 99 out of 108 overfilled teeth (91.7%), 90 out of 103 flush fills (87.4%), and 10 out of 53 underfilled teeth (18.9%) healed and were successfully retreated without surgery at 48-months. When surgical outcomes were included, the combined healed proportion was 93.2%. Preoperative lesion size was found to be an important predictor for retreatment nonhealing. A 1-mm increase in lesion size at baseline resulted in an estimated 11% (95% CI 1.04, 1.18)-38% (95% CI 1.22, 1.58) increase in the risk of surgery. Compared to overfilling and flush filling, underfilling was associated with an approximately three-fold increase in requiring surgery and characterized by delayed healing. CONCLUSION MTA obturation is a viable retreatment option for teeth with nonhealing endodontic treatment. MTA overfills or flush fillings do not adversely affect healing outcomes. However, MTA underfilling increases the chances for nonhealing and surgical intervention.
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Affiliation(s)
| | - Mahmoud Torabinejad
- Department of Endodontics, School of Dentistry, Loma Linda University, Loma Linda, California
| | - Kingsley Wong
- Telethon Kids Institute, The University of Western Australia, Perth, Western Australia, Australia
| | - George Bogen
- Department of Endodontics, University of Queensland, School of Dentistry, Brisbane, Queensland, Australia.
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Praveen Kumar V, Sadasiva K, Raj Kumar J, Ramachandran A, Parthasarathy R, Thanikachalam Y. Current Trends in Intentional Replantation Treatment Among Endodontists and Postgraduate Students in India, the United States of America, and the United Kingdom: A Cross-Sectional Study. Cureus 2023; 15:e39742. [PMID: 37398781 PMCID: PMC10310542 DOI: 10.7759/cureus.39742] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/30/2023] [Indexed: 07/04/2023] Open
Abstract
Objective This study aimed to investigate the knowledge, attitude, and practices (KAP) of intentional replantation among postgraduate students and endodontists in India, the United States of America, and the United Kingdom. Materials and methods The sample size was estimated using G*Power. Based on the pilot study done before with 60 participants, a sample size of 928 was obtained. The survey consisted of 22 questions, which were finalized after content validation by two endodontic experts. It was circulated through multiple online social platforms such as Instagram, Facebook, WhatsApp, and other online dental communities/channels. The respondents were questioned about the case selection, extraction methods, antibiotic therapy, patient acceptance level, operator preference, prognostic indicator, and various other steps in the intentional replantation treatment modality. The data for this KAP survey were organized in an Excel sheet, and statistical analysis was done using the Chi-squared test. Analysis of descriptive and inferential statistics was conducted using SPSS version 20.0 (IBM Inc., Armonk, New York). A p-value of <0.05 was considered significant. Results A strong statistical difference was found in the KAP of the practitioners in different countries. The vast majority (72.7%) considered intentional replantation as an adjunct treatment modality rather than a last resort. A total of 76.5% of the respondents preferred replantation of the tooth into the socket within 15 minutes, and 86.4% of the participants regarded replantation as the most cost-effective treatment modality. Ultrasonics (76.8%) was most commonly chosen for retrograde preparation, and Biodentine (60.1%; Septodont, Saint-Maur-des-Fossés, France) as root-end filling material. Conclusion It can be concluded that a broad majority of practitioners in different countries view intentional replantation as an adjunct treatment modality rather than a last resort. Thus, intentional replantation seems to be a promising option for preserving the natural dentition of teeth with high survival rates and better outcomes.
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Affiliation(s)
| | - Kadandale Sadasiva
- Conservative Dentistry and Endodontics, Chettinad Dental College and Research Institute, Chennai, IND
| | - Jwaalaa Raj Kumar
- Conservative Dentistry and Endodontics, Chettinad Dental College and Research Institute, Chennai, IND
| | - Anupama Ramachandran
- Conservative Dentistry and Endodontics, Chettinad Dental College and Research Institute, Chennai, IND
| | - Revathy Parthasarathy
- Conservative Dentistry and Endodontics, Sree Balaji Dental College and Hospital, Chennai, IND
| | - Yashini Thanikachalam
- Conservative Dentistry and Endodontics, Chettinad Dental College and Research Institute, Chennai, IND
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Sharma A, Sharma R, Sharma M, Jain A. Periapical Lesion: A Single-Sitting Root Canal Treatment. Cureus 2023; 15:e37597. [PMID: 37197104 PMCID: PMC10183648 DOI: 10.7759/cureus.37597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/14/2023] [Indexed: 05/19/2023] Open
Abstract
The aim of root canal treatment is to disinfect the root canal completely and prevent the progression of any periapical infection. Surgical treatment of periapical lesions is associated with many complications and challenges. This article describes the management of a periapical lesion of the right lower premolar in a single-visit root canal procedure using Metapex. The patient was observed for one week for any incidences of flare-ups.
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Affiliation(s)
- Anjali Sharma
- Conservative Dentistry and Endodontics, Teerthanker Mahaveer Dental College and Research Centre, Moradabad, IND
| | - Rohit Sharma
- Conservative Dentistry and Endodontics, Teerthanker Mahaveer Dental College and Research Centre, Moradabad, IND
| | - Madhurima Sharma
- Prosthodontics and Crown and Bridge, Teerthanker Mahaveer Dental College and Research Centre, Moradabad, IND
| | - Anushka Jain
- Conservative Dentistry and Endodontics, Teerthanker Mahaveer Dental College and Research Centre, Moradabad, IND
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Kirkevang LL. What does epidemiology tell us about treatment outcomes in endodontics. Int Endod J 2023; 56 Suppl 2:53-61. [PMID: 36254498 DOI: 10.1111/iej.13850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 10/13/2022] [Accepted: 10/14/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Available information on endodontic treatment outcome derives from clinical studies, of which the main part is observational with no randomization and little or no control of confounding factors. Several sources of bias may hamper the interpretation of results from observational studies if the problems are not addressed properly. OBJECTIVE The purpose of this narrative review is to describe and explain the potential benefits of employing epidemiological methodology when designing, conducting and reporting on observational, clinical outcome studies. DISCUSSION Epidemiology provides methodology that can be used to reduce the impact of several types of problems related to observational studies. These problems concern, external validity, which describes the generalisability of the study findings, and internal validity, which describe data quality parameters, such as selection bias, information bias and confounding. Furthermore reporting of a study should be systematized, and to that use, several checklists have been developed. CONCLUSION It can be concluded that epidemiological methods are important for conducting and interpretation of findings from clinical, observational studies in endodontology.
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Brochado Martins JF, Guerreiro Viegas O, Cristescu R, Diogo P, Shemesh H. Outcome of selective root canal retreatment-A retrospective study. Int Endod J 2023; 56:345-355. [PMID: 36403111 PMCID: PMC10100215 DOI: 10.1111/iej.13871] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 11/12/2022] [Accepted: 11/14/2022] [Indexed: 11/21/2022]
Abstract
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 computerized tomographs [CBCT]) outcome of selective root canal retreatment after ≥12 months follow-up; (ii) evaluate the periapical status of the unretreated roots; and (iii) assess tooth survival. METHODOLOGY 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 and type of restoration) were analysed using Fisher's exact test (α = .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. Unretreated 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.
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Affiliation(s)
- João Filipe Brochado Martins
- Department of Endodontology, Academic Centre for Dentistry Amsterdam, University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | | | | | - Patrícia Diogo
- Faculty of Medicine, Institute of Endodontics, University of Coimbra, Coimbra, Portugal
| | - Hagay Shemesh
- Department of Endodontology, Academic Centre for Dentistry Amsterdam, University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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Gurusamy K, Duhan J, Tewari S, Sangwan P, Gupta A, Mittal S, Kumar V, Arora M. Patient-centric outcome assessment of endodontic microsurgery using periapical radiography versus cone beam computed tomography: A randomized clinical trial. Int Endod J 2023; 56:3-16. [PMID: 36135595 DOI: 10.1111/iej.13837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 09/16/2022] [Accepted: 09/18/2022] [Indexed: 12/13/2022]
Abstract
AIM This study aimed to evaluate whether utilizing additional cone beam computed tomography (CBCT) imaging has any effect on quality of life and healing outcome following periapical surgery compared with periapical radiographs (PR). METHODOLOGY The study was registered in ClinicalTrials.gov (NCT04333940). In this parallel group randomized controlled trial, 52 patients (88 teeth) with persistent apical periodontitis and periapical radiographic evidence of periapical lesion were randomly assigned to either PR or CBCT group. The primary predictor was the type of the imaging method (PR only or with additional CBCT). The primary outcome was patient's quality of life during the first week after periapical surgery and the secondary outcomes were duration of surgery and healing outcome at 12-month follow-up. Participants of both groups received periapical surgery based on the pre-surgical plan provided by the radiographic imaging methods. Quality of life (QoL) was assessed using Modified Shugars questionnaire. Radiographic analysis for healing was conducted using Molven's criteria and modified PENN 3D criteria. The categorical data between groups were analysed using the Chi-square test, whilst intragroup comparisons were analysed using the McNemar test. The average scores for each component of QoL (oral functions, general functions, pain, swelling and other symptoms), combined QoL scores (overall average of values of 13 variables) and analgesic usage on each day were calculated and analysed. RESULTS At 12 months of follow-up, fifty patients were evaluated. Participants in PR group reported significantly more swelling on first three days compared with CBCT group. The analgesic use was higher in the PR group on 2nd and 3rd day (Mann-Whitney U test with Bonferroni correction; p < .007). A significant difference in the limitation of general functions was observed at the second day (p < .07) with the higher values in the PR group. The combined QoL score between the two groups was found to be non-significant. However, none of the patients experienced intraoperative complications or neurovascular exposure. The mean surgical time was lesser in the CBCT group (p < .05). Radiographic healing revealed a success rate of 96.2% for the PR group and 95.8% for the CBCT group with no significant difference between the groups. CONCLUSION Participants in the CBCT group experienced substantially less early postoperative swelling and limitation in general functions, in comparison with the PR group. However, preoperative CBCT had no effect on other QoL parameters and intraoperative complications in medium-risk patients. Furthermore, CBCT did not exhibit any added advantage over periapical radiography in terms of assessing healing outcome following endodontic microsurgery. CBCT offered surgically relevant anatomic information for pre-surgical planning and ensured the treatment rendition with a significantly reduced operative time.
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Affiliation(s)
- Keerthana Gurusamy
- Department of Conservative Dentistry & Endodontics, Postgraduate Institute of Dental Sciences (PGIDS), Rohtak, India
| | - Jigyasa Duhan
- Department of Conservative Dentistry & Endodontics, Postgraduate Institute of Dental Sciences (PGIDS), Rohtak, India
| | - Sanjay Tewari
- Department of Conservative Dentistry & Endodontics, Postgraduate Institute of Dental Sciences (PGIDS), Rohtak, India
| | - Pankaj Sangwan
- Department of Conservative Dentistry & Endodontics, Postgraduate Institute of Dental Sciences (PGIDS), Rohtak, India
| | - Ambika Gupta
- Department of Oral Medicine & Radiology, Postgraduate Institute of Dental Sciences (PGIDS), Rohtak, India
| | - Shweta Mittal
- Department of Conservative Dentistry & Endodontics, Postgraduate Institute of Dental Sciences (PGIDS), Rohtak, India
| | - Vinay Kumar
- Department of Conservative Dentistry & Endodontics, Postgraduate Institute of Dental Sciences (PGIDS), Rohtak, India
| | - Mayank Arora
- Department of Conservative Dentistry & Endodontics, Postgraduate Institute of Dental Sciences (PGIDS), Rohtak, India
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Garg M, Srivastava V, Chauhan R, Pramanik S, Khanna R. Application of platelet-rich fibrin and freeze-dried bone allograft following apicoectomy: A comparative assessment of radiographic healing. Indian J Dent Res 2023; 34:40-44. [PMID: 37417055 DOI: 10.4103/ijdr.ijdr_810_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/08/2023] Open
Abstract
Background Apicoectomy conceptualizes surgically maintaining a tooth with an endodontic lesion that cannot be resolved by conventional endodontic (re-) treatment. To achieve this, continuous improvement in surgical techniques, materials and instruments is being done to enhance the outcome of periapical endodontic surgeries. The purpose of this study was to compare, radiographically, the healing kinetics of platelet-rich fibrin (PRF) and mineralized freeze-dried bone allograft (FDBA) in patients undergoing apicoectomy. Materials and Methods Nineteen patients (aged 18-40 years) were included in the study and randomly assigned to groups A or B, where they received PRF or FDBA, respectively. Following apicoectomy, PRF gel and FDBA graft were prepared and placed in the osseous defect followed by placement of PRF membrane for graft stabilization and flap closure. Radiographic follow-up was done at the 1st, 3rd, 6th and 12th months for evaluation of healing using Molven's criteria. Statistical analysis was done with Pearson's and McNemar's Chi-square tests. Results A highly significant difference (P = 0.002) in radiographic healing was observed at 6 months. Complete healing was observed in 50% of cases in Group A whereas in Group B, none of the cases presented with complete radiographic healing. However, at the end of 12 months, complete radiographic healing was observed in both groups. Conclusion Our data suggest that PRF accelerates bone healing as compared to FDBA and is both time and cost-efficient.
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Affiliation(s)
- Madhur Garg
- Department of Conservative Dentistry and Endodontics, Vardaan Dental Clinic, Jabalpur, Madhya Pradesh, India
| | - Vipul Srivastava
- Department of Conservative Dentistry and Endodontics, 32 Pearls Multi-Speciality Dental Clinic, Lucknow, Uttar Pradesh, India
| | - Raju Chauhan
- Department of Conservative Dentistry and Endodontics, Saraswati Dental College and Hospital, Lucknow, Uttar Pradesh, India
| | - Saurabh Pramanik
- Department of Department of Pediatric and Preventive Dentistry, Awadh Dental College and Hospital, Jamshedpur, Jharkhand, India
| | - Rinee Khanna
- Department of Pediatric and Preventive Dentistry, Saraswati Dental College and Hospital, Lucknow, Uttar Pradesh, India
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Marconi DF, da Silva GS, Weissheimer T, Silva IA, Só GB, Jahnke LT, Skupien JA, Só MVR, da Rosa RA. Influence of the root canal filling technique on the success rate of primary endodontic treatments: a systematic review. Restor Dent Endod 2022; 47:e40. [PMID: 36518607 PMCID: PMC9715375 DOI: 10.5395/rde.2022.47.e40] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 07/18/2022] [Accepted: 08/10/2022] [Indexed: 12/03/2022] Open
Abstract
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.
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Affiliation(s)
- Daniel Feijolo Marconi
- Department of Conservative Dentistry, School of Dentistry, Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
| | - Giovana Siocheta da Silva
- Department of Conservative Dentistry, School of Dentistry, Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
| | - Theodoro Weissheimer
- Department of Conservative Dentistry, School of Dentistry, Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
| | - Isadora Ames Silva
- Department of Conservative Dentistry, School of Dentistry, Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
| | - Gabriel Barcelos Só
- Department of Conservative Dentistry, School of Dentistry, Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
| | - Leonardo Thomasi Jahnke
- Department of Conservative Dentistry, School of Dentistry, Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
| | - Jovito Adiel Skupien
- Health and Life Sciences Master’s and Dental School, Franciscan University (UFN), Santa Maria, RS, Brazil
| | - Marcus Vinicius Reis Só
- Department of Conservative Dentistry, School of Dentistry, Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
| | - Ricardo Abreu da Rosa
- Department of Conservative Dentistry, School of Dentistry, Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
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Petričević GK, Katić M, Anić I, Salarić I, Vražić D, Bago I. Efficacy of different Er:YAG laser-activated photoacoustic streaming modes compared to passive ultrasonic irrigation in the retreatment of curved root canals. Clin Oral Investig 2022; 26:6773-6781. [PMID: 35879623 DOI: 10.1007/s00784-022-04637-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Accepted: 07/12/2022] [Indexed: 11/03/2022]
Abstract
OBJECTIVES To evaluate the efficacy of passive ultrasonic irrigation (PUI) and super short pulse (SSP) and shock wave-enhanced emission photoacoustic streaming (SWEEPS) modes of Er:YAG laser-activated irrigation (LAI) with two different laser tips, in removing filling remnants after conventional retreatment in severely curved root canals. MATERIALS AND METHODS The study sample consisted of 40 extracted molars with curved mesiobuccal root canals. The canals were instrumented with ProTaper Next and filled with an epoxy resin-based sealer and gutta-percha using continuous wave vertical compaction and warm injection back-filling. After retreatment with ProTaper Universal Retreatment system and sodium hypochlorite (NaOCl), all samples were randomly divided into four groups (n = 10) according to the final irrigation technique: PUI, LAI/SSP, SWEEPS/flat-tip, and SWEEPS/radial-tip, using 6 mL of 3% NaOCl for an activation time of 3 × 30 s. The samples were subjected to micro-CT scans after root canal filling, retreatment, and final irrigation. The filling material volume and percentage reduction were calculated. RESULTS All tested irrigation techniques were successful in the elimination of the filling remnants after the retreatment (p < 0.001). The LAI/SSP group showed a higher reduction rate than the SWEEPS/flat-tip group (p = 0.032). No significant differences were found between the other groups (p > 0.05). CONCLUSION All tested techniques improved the removal of filling material during retreatment in curved canals. LAI/SSP showed slightly better results than other techniques. CLINICAL RELEVANCE The study highlights the need for additional activated irrigation after the retreatment of curved root canals. The choice between PUI and LAI is not decisive for success.
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Affiliation(s)
- Gabrijela Kapetanović Petričević
- Department of Endodontics and Restorative Dentistry, School of Dental Medicine, University of Zagreb, Gundulićeva 5, 10 000, Zagreb, Croatia
| | - Marko Katić
- Department of Materials, Faculty of Mechanical Engineering and Naval Architecture, University of Zagreb, Zagreb, Croatia
| | - Ivica Anić
- Department of Endodontics and Restorative Dentistry, School of Dental Medicine, University of Zagreb, Gundulićeva 5, 10 000, Zagreb, Croatia
| | - Ivan Salarić
- Department of Oral Surgery, School of Dental Medicine, University of Zagreb, Zagreb, Croatia
| | - Domagoj Vražić
- Department of Periodontology, School of Dental Medicine, University of Zagreb, Zagreb, Croatia
| | - Ivona Bago
- Department of Endodontics and Restorative Dentistry, School of Dental Medicine, University of Zagreb, Gundulićeva 5, 10 000, Zagreb, Croatia.
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Kirkevang LL, El Karim IA, Duncan HF, Nagendrababu V, Kruse C. Outcomes reporting in systematic reviews on non-surgical root canal treatment: A scoping review for the development of a core outcome set. Int Endod J 2022; 55:1128-1164. [PMID: 35969087 DOI: 10.1111/iej.13812] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 08/08/2022] [Accepted: 08/08/2022] [Indexed: 01/07/2023]
Abstract
BACKGROUND Studies related to non-surgical root canal treatment are amongst the most frequently performed clinical studies in endodontics. However, heterogeneity in reporting outcomes and lack of standardization is a significant challenge to evidence synthesis and guideline development. OBJECTIVES The aims of the present scoping review were to (a) identify outcomes reported in systematic reviews evaluating non-surgical root canal treatment; (b) identify how and when the reported outcomes were measured; (c) assess possible selective reporting bias in the included studies. The information obtained in this study should inform the development of a core outcome set (COS) for non-surgical root canal treatment. METHODOLOGY Structured literature searches were performed to identify systematic reviews on non-surgical root canal treatments published in English between January 1990 and December 2020. Two reviewers undertook study selection and data extraction. Outcomes were categorized according to a healthcare taxonomy into five core areas (survival, clinical/physiological changes, life impact, resource use, and adverse events). The outcome measurement tools and length of follow-up were recorded. RESULTS Seventy-five systematic reviews were included, of which 40 included meta-analyses. Most reviews reported on physiological and clinical outcomes, primarily pain and/or radiographic assessment of periapical status, and a variety of measurement tools and scales were used. Few reviews focused on tooth survival, life impact, resources, and adverse events. The heterogeneity amongst the reviews was large on all parameters. Less than 40% of the reviews assessed the risk of selective reporting. DISCUSSION Overall aims of the included reviews were highly heterogenic; thus, outcomes and how they were measured also varied considerably. Patient-centred outcomes and the use of resources were rarely reported on. CONCLUSIONS Most studies reported on physiological and clinical outcomes, in particular pain and/or radiographic healing. Measurement tools, scales, thresholds, and follow-up periods varied greatly within each outcome, making comparison across studies complicated. Less than 40% of the reviews assessed risk of selective reporting; thus, selective bias could not be ruled out. The presented information on reported outcomes, measurement tools and scales, and length of follow-up may guide the planning of future research and inform the development of a COS for non-surgical root canal treatment.
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Affiliation(s)
| | - Ikhlas A El Karim
- School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, UK
| | - Henry Fergus Duncan
- Division of Restorative Dentistry & Periodontology, Dublin Dental University Hospital, Trinity College Dublin, Dublin, Ireland
| | - Venkateshbabu Nagendrababu
- Department of Preventive and Restorative Dentistry, College of Dental Medicine, University of Sharjah, Sharjah, UAE
| | - Casper Kruse
- Department of Dentistry and Oral Health, Aarhus University, Aarhus, Denmark
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True cyst: An unsolved truth. J Dent Sci 2022; 18:917-918. [PMID: 37021275 PMCID: PMC10068352 DOI: 10.1016/j.jds.2022.10.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 10/13/2022] [Indexed: 11/06/2022] Open
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32
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Elkholly A, Negm M, Hassan R, Omar N. Healing Assessment of Osseous Defects after Surgical Removal of Periapical Lesions in the Presence of Hydroxyapatite, Nanohydroxyapatite, and a Combination of Nanohydroxyapatite and Platelet-rich Fibrin: A Clinical Study. Open Access Maced J Med Sci 2022. [DOI: 10.3889/oamjms.2022.10766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Abstract:
Aim: to evaluate the bone healing in failed endodontically treated teeth after surgical removal of periapical lesions and placement of hydroxyapatite (HA), nanohydroxyapatite (nHA) and a combination of nanohydroxyapatite with platelet rich fibrin (PRF) periapically. Subjects and methods: the study was conducted on twenty-four patients having periapical radiolucency in single rooted teeth. The selected teeth were divided into three groups: Group A, Group B, and Group C; of 8 teeth each. All the teeth were retreated in two visits. In the first visit the old filling was removed using Protaper retreatment files (Dentsply Sirona®) then irrigation with sodium hypochlorite 2.5% was done. All canals were dried and filled with Di-antibiotic paste (metronidazole and ciprofloxacin). In the second visit the canals were obturated with Pro Taper gutta-percha points and root canal sealer (Adseal resin sealer) followed by surgical intervention in the same day. A periapical curettage along with apicoectomy were established. In all the groups, root end cavity was prepared and filled with MTA (ProRoot MTA; DENTSPLY Tulsa Dental Specialties). In Group A, hydroxyapatite powder was packed in the curetted periapical defect. In Group B, nanohydroxyapatite powder was packed in the curetted periapical defect. In Group C, nanohydroxyapatite with PRF were mixed and packed in the curetted periapical defect. In all groups, patients recall visits were scheduled at 1, 3, and 6 months’ time intervals for clinical and radiological evaluation. Results: after one month; there was a statistically significant difference between the median percentage changes in lesions size in the three groups. Pair-wise comparisons between groups revealed that there was no statistically significant difference between group B (nHA) and group C (PRF and nHA) groups. Both showed statistically significantly higher median percentage reduction in lesions size than group A (HA group). After three as well as six months; there was no statistically significant difference between the median percentage decreases in lesions size in the three groups. Conclusion: It was concluded that nHA combination with PRF produced faster periapical healing (bone regeneration) in the first three months than nHA alone. However, HA produce periapical healing (bone regeneration) after six months.
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Mason J, Kirkpatrick T, Roberts HW. Dislodgement pushout resistance of five bioceramic root-end filling materials. Dent Mater J 2022; 41:843-849. [PMID: 35934803 DOI: 10.4012/dmj.2022-058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
This study evaluated the dislodgement push-out resistance of five bioceramic materials. One hundred single-rooted teeth with one canal had the apical 3 mm and crown resected to create a 14 mm standardized length. The canals were instrumented to an apical size 80 with a 3 mm root-end preparation made with ultrasonic diamonds. The prepared roots were randomly divided into 5 root-end restorative groups (n=20). ProRoot MTA, Biodentine, EndoSequence Root Repair Material, EndoSequence Fast Set Putty, and EndoSequence BC Sealer with each material placed following manufacturer's instructions and stored at 100% humidity for 2 weeks. An apical-to-coronal static testing load with the identified dislodgement force converted into MPa with mean results analyzed with Kruskal-Wallis and Dunn's post hoc tests (α=0.05). ProRoot MTA and Biodentine displayed similar push-out stress resistance and exhibited significantly greater stress resistance than the similar Endosequence materials. However, all materials failed cohesively and were not dislodged from the root canal surface.
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Affiliation(s)
| | - Timothy Kirkpatrick
- Department of Endodontics, University of Texas Health Science Center at Houston
| | - Howard W Roberts
- Dental Biomaterials Research, University of Kentucky College of Dentistry
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Anti-Inflammatory and Mineralization Effects of an ASP/PLGA-ASP/ACP/PLLA-PLGA Composite Membrane as a Dental Pulp Capping Agent. J Funct Biomater 2022; 13:jfb13030106. [PMID: 35997444 PMCID: PMC9397017 DOI: 10.3390/jfb13030106] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 07/24/2022] [Accepted: 07/26/2022] [Indexed: 02/06/2023] Open
Abstract
Dental pulp is essential for the development and long-term preservation of teeth. Dental trauma and caries often lead to pulp inflammation. Vital pulp therapy using dental pulp-capping materials is an approach to preserving the vitality of injured dental pulp. Most pulp-capping materials used in clinics have good biocompatibility to promote mineralization, but their anti-inflammatory effect is weak. Therefore, the failure rate will increase when dental pulp inflammation is severe. The present study developed an amorphous calcium phosphate/poly (L-lactic acid)-poly (lactic-co-glycolic acid) membrane compounded with aspirin (hereafter known as ASP/PLGA-ASP/ACP/PLLA-PLGA). The composite membrane, used as a pulp-capping material, effectively achieved the rapid release of high concentrations of the anti-inflammatory drug aspirin during the early stages as well as the long-term release of low concentrations of aspirin and calcium/phosphorus ions during the later stages, which could repair inflamed dental pulp and promote mineralization. Meanwhile, the composite membrane promoted the proliferation of inflamed dental pulp stem cells, downregulated the expression of inflammatory markers, upregulated the expression of mineralization-related markers, and induced the formation of stronger reparative dentin in the rat pulpitis model. These findings indicate that this material may be suitable for use as a pulp-capping material in clinical applications.
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Liang C, Liang Q, Xu X, Liu X, Gao X, Li M, Yang J, Xing X, Huang H, Tang Q, Liao L, Tian W. Bone morphogenetic protein 7 mediates stem cells migration and angiogenesis: therapeutic potential for endogenous pulp regeneration. Int J Oral Sci 2022; 14:38. [PMID: 35858911 PMCID: PMC9300630 DOI: 10.1038/s41368-022-00188-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 06/17/2022] [Accepted: 06/19/2022] [Indexed: 02/05/2023] Open
Abstract
Pulp loss is accompanied by the functional impairment of defense, sensory, and nutrition supply. The approach based on endogenous stem cells is a potential strategy for pulp regeneration. However, endogenous stem cell sources, exogenous regenerative signals, and neovascularization are major difficulties for pulp regeneration based on endogenous stem cells. Therefore, the purpose of our research is to seek an effective cytokines delivery strategy and bioactive materials to reestablish an ideal regenerative microenvironment for pulp regeneration. In in vitro study, we investigated the effects of Wnt3a, transforming growth factor-beta 1, and bone morphogenetic protein 7 (BMP7) on human dental pulp stem cells (h-DPSCs) and human umbilical vein endothelial cells. 2D and 3D culture systems based on collagen gel, matrigel, and gelatin methacryloyl were fabricated to evaluate the morphology and viability of h-DPSCs. In in vivo study, an ectopic nude mouse model and an in situ beagle dog model were established to investigate the possibility of pulp regeneration by implanting collagen gel loading BMP7. We concluded that BMP7 promoted the migration and odontogenic differentiation of h-DPSCs and vessel formation. Collagen gel maintained the cell adhesion, cell spreading, and cell viability of h-DPSCs in 2D or 3D culture. The transplantation of collagen gel loading BMP7 induced vascularized pulp-like tissue regeneration in vivo. The injectable approach based on collagen gel loading BMP7 might exert promising therapeutic application in endogenous pulp regeneration. BMP7 as a regenerative signaling molecule mediates stem cell migration and odontoblastic differentiation (a) and as a pro-angiogenic factor promotes revascularization of endothelial cells (b). Collagen gel supports cell adhesion, spreading, and viability (c). ![]()
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Affiliation(s)
- Cheng Liang
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & Engineering Research Center of Oral Translational Medicine, Ministry of Education & National Engineering Laboratory for Oral Regenerative Medicine, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Qingqing Liang
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & Engineering Research Center of Oral Translational Medicine, Ministry of Education & National Engineering Laboratory for Oral Regenerative Medicine, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Xun Xu
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & Engineering Research Center of Oral Translational Medicine, Ministry of Education & National Engineering Laboratory for Oral Regenerative Medicine, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Xiaojing Liu
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & Engineering Research Center of Oral Translational Medicine, Ministry of Education & National Engineering Laboratory for Oral Regenerative Medicine, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Xin Gao
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & Engineering Research Center of Oral Translational Medicine, Ministry of Education & National Engineering Laboratory for Oral Regenerative Medicine, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Maojiao Li
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & Engineering Research Center of Oral Translational Medicine, Ministry of Education & National Engineering Laboratory for Oral Regenerative Medicine, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Jian Yang
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & Engineering Research Center of Oral Translational Medicine, Ministry of Education & National Engineering Laboratory for Oral Regenerative Medicine, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Xiaotao Xing
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & Engineering Research Center of Oral Translational Medicine, Ministry of Education & National Engineering Laboratory for Oral Regenerative Medicine, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Haisen Huang
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & Engineering Research Center of Oral Translational Medicine, Ministry of Education & National Engineering Laboratory for Oral Regenerative Medicine, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Qi Tang
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & Engineering Research Center of Oral Translational Medicine, Ministry of Education & National Engineering Laboratory for Oral Regenerative Medicine, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Li Liao
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & Engineering Research Center of Oral Translational Medicine, Ministry of Education & National Engineering Laboratory for Oral Regenerative Medicine, West China Hospital of Stomatology, Sichuan University, Chengdu, China.
| | - Weidong Tian
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & Engineering Research Center of Oral Translational Medicine, Ministry of Education & National Engineering Laboratory for Oral Regenerative Medicine, West China Hospital of Stomatology, Sichuan University, Chengdu, China.
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Dioguardi M, Stellacci C, La Femina L, Spirito F, Sovereto D, Laneve E, Manfredonia MF, D’Alessandro A, Ballini A, Cantore S, Lo Muzio L, Troiano G. Comparison of Endodontic Failures between Nonsurgical Retreatment and Endodontic Surgery: Systematic Review and Meta-Analysis with Trial Sequential Analysis. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:894. [PMID: 35888613 PMCID: PMC9324533 DOI: 10.3390/medicina58070894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 06/13/2022] [Accepted: 06/29/2022] [Indexed: 11/16/2022]
Abstract
Background and Objectives: In the presence of a persistent endodontic lesion or endodontic failure, the alternative for the recovery of the dental element is endodontic retreatment or endodontic surgery, which consists in the surgical removal of the root apices with retrograde closure of the endodontium. The objective of this systematic review and meta-analysis was to provide an updated value of the Risk Ratio between the two types of treatment in order to offer to clinicians who propose a non-surgical endodontic retreatment or an endodontic surgery a direct comparison. Materials and Methods: The revision was performed according to PRISMA indications: three databases (PubMed, Scopus and Cochrane register) were consulted through the use of keywords relevant to the revision topic: surgical endodontic retreatment, endodontic retreatment, apicoectomy. This search produced 7568 records which, after eliminating duplicates and applying the inclusion and exclusion criteria, resulted in a total of seven included articles. The meta-analyses were conducted by applying fixed-effects models, given the low percentage of heterogeneity. In addition, trial sequency analysis (TSA) was performed for the analysis of the statistical power of the results and GRADE for the quality of the evidence. Results: The results of the meta-analyses' data report an aggregate risk ratio (RR) between non-surgical endodontic retreatment and surgical endodontic retreatment of: 1.05 [0.74, 1.47] at one year of follow-up; RR 2.22 [1.45, 3.41] at two years of follow-up; an RR 1.08 [0.73 1.62] for a follow-up period of 3-4 years; and an RR 0.92 [0.53, 1.61] for a follow-up period of 8-10 years. Conclusions: The results of the present meta-analysis show that in the long term, the risk of failure is identical for the two groups, and there is only a slightly higher risk of failure for non-surgical endodontic retreatments, when only two years of follow-up are considered.
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Affiliation(s)
- Mario Dioguardi
- Department of Clinical and Experimental Medicine, University of Foggia, Via Rovelli 50, 71122 Foggia, Italy; (C.S.); (L.L.F.); (F.S.); (D.S.); (E.L.); (M.F.M.); (A.D.); (L.L.M.); (G.T.)
| | - Camilla Stellacci
- Department of Clinical and Experimental Medicine, University of Foggia, Via Rovelli 50, 71122 Foggia, Italy; (C.S.); (L.L.F.); (F.S.); (D.S.); (E.L.); (M.F.M.); (A.D.); (L.L.M.); (G.T.)
| | - Lucia La Femina
- Department of Clinical and Experimental Medicine, University of Foggia, Via Rovelli 50, 71122 Foggia, Italy; (C.S.); (L.L.F.); (F.S.); (D.S.); (E.L.); (M.F.M.); (A.D.); (L.L.M.); (G.T.)
| | - Francesca Spirito
- Department of Clinical and Experimental Medicine, University of Foggia, Via Rovelli 50, 71122 Foggia, Italy; (C.S.); (L.L.F.); (F.S.); (D.S.); (E.L.); (M.F.M.); (A.D.); (L.L.M.); (G.T.)
| | - Diego Sovereto
- Department of Clinical and Experimental Medicine, University of Foggia, Via Rovelli 50, 71122 Foggia, Italy; (C.S.); (L.L.F.); (F.S.); (D.S.); (E.L.); (M.F.M.); (A.D.); (L.L.M.); (G.T.)
| | - Enrica Laneve
- Department of Clinical and Experimental Medicine, University of Foggia, Via Rovelli 50, 71122 Foggia, Italy; (C.S.); (L.L.F.); (F.S.); (D.S.); (E.L.); (M.F.M.); (A.D.); (L.L.M.); (G.T.)
| | - Massimo Francesco Manfredonia
- Department of Clinical and Experimental Medicine, University of Foggia, Via Rovelli 50, 71122 Foggia, Italy; (C.S.); (L.L.F.); (F.S.); (D.S.); (E.L.); (M.F.M.); (A.D.); (L.L.M.); (G.T.)
| | - Alfonso D’Alessandro
- Department of Clinical and Experimental Medicine, University of Foggia, Via Rovelli 50, 71122 Foggia, Italy; (C.S.); (L.L.F.); (F.S.); (D.S.); (E.L.); (M.F.M.); (A.D.); (L.L.M.); (G.T.)
| | - Andrea Ballini
- Department of Precision Medicine, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy;
| | | | - Lorenzo Lo Muzio
- Department of Clinical and Experimental Medicine, University of Foggia, Via Rovelli 50, 71122 Foggia, Italy; (C.S.); (L.L.F.); (F.S.); (D.S.); (E.L.); (M.F.M.); (A.D.); (L.L.M.); (G.T.)
| | - Giuseppe Troiano
- Department of Clinical and Experimental Medicine, University of Foggia, Via Rovelli 50, 71122 Foggia, Italy; (C.S.); (L.L.F.); (F.S.); (D.S.); (E.L.); (M.F.M.); (A.D.); (L.L.M.); (G.T.)
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Matsuzaki E, Hirose H, Matsumoto K, Matsumoto N, Fujimasa S, Hatakeyama J, Anan H. Effects of root-end filling materials on vascular endothelial cell proliferation and tube formation. J Dent Sci 2022; 17:1232-1237. [PMID: 35784111 PMCID: PMC9236890 DOI: 10.1016/j.jds.2021.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 12/04/2021] [Indexed: 11/25/2022] Open
Abstract
Background/purpose Regarding root-end filling materials in apical surgery, sealing ability and biocompatibility are useful for treatment. Angiogenesis, which occurs in the process of periapical wound healing, is closely related to bone formation. In this study, we investigated the effects of root-end filling materials on vascular endothelial cell proliferation and angiogenesis. Materials and methods Mineral trioxide aggregate (MTA), 4-methacryloxyethyl trimellitate anhydride/methyl methacrylate-tri-n-butyl borane (4-META/MMA-TBB) resin, Super EBA, and CS-BG-multi, bioactive glass-related materials, were used. After curing, each material was soaked in a medium for 1 or 7 days, and then cultured for 1-7 days to investigate the effects on human umbilical vein endothelial cell (HUVEC) proliferation, angiogenesis, and vascular endothelial growth factor receptors (VEGFRs) mRNA expression. Results In the 1-day soaked sample, there was significantly less proliferation in MTA and Super EBA on day 7 of culture. In the 7-day soaked sample, there was significantly less proliferation in Super EBA and CS-BG-multi on day 7 of culture. Tube formation was significantly high in MTA in both the 1-day and 7-day soaked samples, significantly high in SB in the 1-day soaked sample, and significantly low in Super EBA in both the 1-day and 7-day soaked samples. CS-BG-multi was comparable to the control. VEGFR-1 and VEGFR-2 mRNA expressions showed an upward trend in MTA, and a trend similar to the control in SB. Conclusion MTA and 4-META/MMA-TBB resin had a higher pro-angiogenic effect while Super EBA had a less pro-angiogenic effect. CS-BG-multi had low toxicity on tube formation of HUVEC.
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Affiliation(s)
- Etsuko Matsuzaki
- Section of Operative Dentistry and Endodontology, Department of Odontology, Fukuoka Dental College, Fukuoka, Japan
- Oral Medicine Research Center, Fukuoka Dental College, Fukuoka, Japan
| | - Haruna Hirose
- Section of Operative Dentistry and Endodontology, Department of Odontology, Fukuoka Dental College, Fukuoka, Japan
| | - Kazuma Matsumoto
- Section of Operative Dentistry and Endodontology, Department of Odontology, Fukuoka Dental College, Fukuoka, Japan
| | - Noriyoshi Matsumoto
- Section of Operative Dentistry and Endodontology, Department of Odontology, Fukuoka Dental College, Fukuoka, Japan
| | - Seishiro Fujimasa
- Section of Operative Dentistry and Endodontology, Department of Odontology, Fukuoka Dental College, Fukuoka, Japan
| | - Junko Hatakeyama
- Section of General Dentistry, Department of General Dentistry, Fukuoka Dental College, Fukuoka, Japan
| | - Hisashi Anan
- Section of Operative Dentistry and Endodontology, Department of Odontology, Fukuoka Dental College, Fukuoka, Japan
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Tandon J, Yadav RK, Tikku AP, Shakya VK, Singh SK. Comparative evaluation of different irrigating and irrigant activation system in removal of gutta-percha/sealer during retreatment: An in vitro Micro-CT study. J Oral Biol Craniofac Res 2022; 12:444-448. [PMID: 35664952 PMCID: PMC9160468 DOI: 10.1016/j.jobcr.2022.05.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 05/05/2022] [Accepted: 05/11/2022] [Indexed: 11/22/2022] Open
Abstract
Background The aim of the study was to compare the efficacy of different irrigation and irrigant activation system used as an adjuvant to retreatment rotary files in removal of gutta-percha and sealer from endodontic retreatment using Micro-CT. Method 64 extracted permanent maxillary central incisor teeth with single canal, were collected and decoronated to standard length of 16 mm. Instrumentation was done using rotary files and obturation was performed using GuttaCore and AH plus sealer. After setting of sealer, initial removal of filling material was performed using ProTaper universal retreatment files (D1, D2, D3). All 64 sample were randomised into four groups (n = 16) Group1: Endodontic syringe irrigation, Group 2: Passive Ultasonic Irrigation (PUI), Group 3: EndoActivator, and Group 4: EndoVac. Micro-CT scanning was performed after obturation, initial removal of filling material by retreatment file and after using experimental protocols of each group, and volume of remaining filling material was calculated using Dolphin software. Statistical analysis performed with one-way ANOVA followed by Tukey's post hoc. Results A significant reduction in the volume of residual obturation material were found between each group. PUI was superior to the sonic (EndoActivator), negative pressure irrigation technique (EndoVac) and positive pressure irrigation at the coronal, middle third and apical third of the root canal. However, none of the supplementary techniques were able to completely remove the residual obturation material. Conclusion PUI and EndoActivator were found better in remaining filling material removal, demonstrating clinically useful as supplementary technique in removing remaining obturation material during endodontic retreatment.
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Affiliation(s)
- Jyoti Tandon
- Conservative Dentistry and Endodontics, King George's Medical University, Lucknow, India
| | - Rakesh Kumar Yadav
- Conservative Dentistry and Endodontics, King George's Medical University, Lucknow, India
| | - Aseem Prakash Tikku
- Conservative Dentistry and Endodontics, King George's Medical University, Lucknow, India
| | - Vijay Kumar Shakya
- Conservative Dentistry and Endodontics, King George's Medical University, Lucknow, India
| | - Satyendra Kumar Singh
- Stem Cell and Cell Culture Unit, Centre For Advanced Research (CFAR), King George's Medical University, U.P, Lucknow, India
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Chao YC, Chen PH, Su WS, Yeh HW, Su CC, Wu YC, Chiang HS, Jhou HJ, Shieh YS. Effectiveness of different root-end filling materials in modern surgical endodontic treatment: A systematic review and network meta-analysis. J Dent Sci 2022; 17:1731-1743. [DOI: 10.1016/j.jds.2022.05.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 05/20/2022] [Indexed: 10/18/2022] Open
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Shah PK, El Karim IA, Duncan HF, Nagendrababu V, Chong BS. Outcomes reporting in systematic reviews on surgical endodontics: A scoping review for the development of a core outcome set. Int Endod J 2022; 55:811-832. [PMID: 35553439 DOI: 10.1111/iej.13763] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 05/10/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Evidence-informed decision-making in healthcare relies on the translation of research results to everyday clinical practice. A fundamental requirement is that the validity of any healthcare intervention must be supported by the resultant favourable treatment outcome. Unfortunately, differences in study design and the outcome measures evaluated often make it challenging to synthesise the available research evidence required for secondary research analysis and guideline development. Core outcome sets (COS) are defined as an agreed standardised set of outcomes which should be measured and reported as a minimum in all clinical trials on a specific topic. The benefits of COS include less heterogeneity, a reduction in the risk of reporting bias, ensuring all trials contribute data to facilitate meta-analyses, and given the engagement of key stakeholders, it also increases the chances that clinically-relevant outcomes are identified. The recognition of the need for COS for assessing endodontic treatment outcomes lead to the development of Core Outcome Sets for Endodontic Treatment modalities (COSET) protocol, which is registered (No. 1879) on the Core Outcome Measures in Effectiveness Trials (COMET) website. OBJECTIVES The objectives of this scoping review are to: (1) identify the outcomes assessed in studies evaluating surgical endodontic procedures; (2) report on the method of assessment used to measure the outcomes; (3) and assess selective reporting bias in the included studies. The data obtained will be used to inform the development of COS for surgical endodontics. METHODS A structured literature search of electronic databases and the grey literature was conducted to identify systematic reviews on periradicular surgery (PS), intentional replantation (IR) and tooth/root resection (RR), published between January 1990 and December 2020. Two independent reviewers were involved in the literature selection, data extraction and the appraisal of the studies identified. The type of intervention, outcomes measured, type of outcomes reported (clinician- or patient-reported), outcome measurement method, and follow-up period, were recorded using a standardised form. RESULTS Twenty-six systematic reviews consisting of 19 studies for PS, three studies for IR and four studies for RR were selected for inclusion. Outcome measures identified for PS and IR included pain, swelling, mobility and tenderness, outcomes related to periodontal/soft tissue healing (including sinus tract), periradicular healing, tooth survival, life impact (including Oral-Health-Related-Quality-of-Life), resource use and/or adverse effects. For RR, in addition to tooth survival, endodontic complications, and adverse effects, the outcome measures were primarily periodontal-related, including pocket depth reduction, attachment gain, periodontal disease, and periodontic-endodontic lesions. The majority of outcome measures for PS, IR, and RR were assessed clinically, radiologically and/or via patient history. Specific tools such as rating scales (Visual Analog Scale, Verbal rating Scale, Numerical Rating Scale, and other scales) were used for the assessment of pain, swelling, and tenderness, and validated questionnaires were used for the assessment of oral health-related quality of life. The range of follow-up periods were variable, dependent on the outcome measure and the type of intervention. CONCLUSIONS Outcome measures, method of assessment and follow-up periods for PS, IR and RR were identified and categorised to help standardise the reporting of outcomes for future research studies. Additional outcome measures that were not reported, but may be considered in the COSET consensus process include loss of root-end filling material, number of clinic visits, surgery-related dental anxiety and muco-gingival aesthetic-related measures, such as scarring, black triangles, root surface exposure, and tissue discolouration.
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Affiliation(s)
- Pratik Kamalkant Shah
- Institute of Dentistry, Faculty of Medicine & Dentistry, Queen Mary University of London, London, UK
| | - Ikhlas A El Karim
- School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, Northern Ireland, UK
| | - Henry Fergus Duncan
- Division of Restorative Dentistry & Periodontology, Dublin Dental University Hospital, Trinity College Dublin, Dublin, Ireland
| | - Venkateshbabu Nagendrababu
- Department of Preventive and Restorative Dentistry, College of Dental Medicine, University of Sharjah, Sharjah, UAE
| | - Bun San Chong
- Institute of Dentistry, Faculty of Medicine & Dentistry, Queen Mary University of London, London, UK
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Simões LP, dos Reis-Prado AH, Bueno CRE, Viana ACD, Duarte MAH, Cintra LTA, Lemos CAA, Benetti F. Effectiveness and safety of rotary and reciprocating kinematics for retreatment of curved root canals: a systematic review of in vitro studies. Restor Dent Endod 2022; 47:e22. [PMID: 35692221 PMCID: PMC9160764 DOI: 10.5395/rde.2022.47.e22] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 09/07/2021] [Accepted: 10/17/2021] [Indexed: 11/21/2022] Open
Abstract
Objectives This systematic review (register-osf.io/wg7ba) compared the efficacy and safety of rotary and reciprocating kinematics in the removal of filling material from curved root canals. Materials and Methods Only in vitro studies evaluating both kinematics during retreatment were included. A systematic search (PubMed/MEDLINE, Scopus, and other databases, until January 2021), data extraction, and risk of bias analysis (Joanna Briggs Institute checklist) were performed. Efficacy in filling removal was the primary outcome. Results The search resulted in 2,795 studies, of which 15 were included. Efficacy was measured in terms of the remaining filling material and the time required for this. Nine studies evaluated filling material removal, of which 7 found no significant differences between rotary and reciprocating kinematics. Regarding the time for filling removal, 5 studies showed no difference between both kinematics, 2 studies showed faster results with rotary systems, and other 2 showed the opposite. No significant differences were found in apical transportation, centering ability, instrument failure, dentin removed and extruded debris. A low risk of bias was observed. Conclusions This review suggests that the choice of rotary or reciprocating kinematics does not influence the efficacy of filling removal from curved root canals. Further studies are needed to compare the kinematics safety in curved root canals.
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Affiliation(s)
- Lucas Pinho Simões
- Department of Restorative Dentistry, Universidade Federal de Minas Gerais (UFMG), School of Dentistry, Belo Horizonte, MG, Brazil
| | | | | | - Ana Cecília Diniz Viana
- Department of Restorative Dentistry, Universidade Federal de Minas Gerais (UFMG), School of Dentistry, Belo Horizonte, MG, Brazil
| | - Marco Antônio Húngaro Duarte
- Department of Dentistry, Endodontics and Dental Materials, University of São Paulo (USP), School of Dentistry, Bauru, SP, Brazil
| | | | - Cleidiel Aparecido Araújo Lemos
- Department of Dentistry, Federal University of Juiz de Fora, Campus GV (UFJF-GV), School of Dentistry, Governador Valadares, MG, Brazil
| | - Francine Benetti
- Department of Restorative Dentistry, Universidade Federal de Minas Gerais (UFMG), School of Dentistry, Belo Horizonte, MG, Brazil
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Karaoğlan F, Miçooğulları Kurt S, Çalışkan MK. Outcome of single-visit- versus two-visit root canal retreatment in teeth with periapical lesions: a randomized clinical trial. Int Endod J 2022; 55:833-843. [PMID: 35488883 DOI: 10.1111/iej.13758] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 03/29/2022] [Accepted: 04/26/2022] [Indexed: 11/30/2022]
Abstract
AIM To evaluate the clinical and radiographic outcome of single-visit root canal retreatment and to compare the results with conventional two-visit root canal retreatment as control group. METHODOLOGY One hundred root canal-treated, single-rooted asymptomatic teeth with periapical lesion were retreated by one operator. Fifty of the teeth were randomly assigned to the single-visit group and the others were treated in two-visits. In both groups, root canal filling material was removed, and re-instrumentation of the root canal was performed using step-back technique with hand files using 2.5% NaOCl and 5% EDTA as irrigants. In the single-visit group 5 ml 2% chlorhexidine (CHX) were applied as the final irrigation and in the two-visit group, calcium hydroxide paste was placed into the root canal as an interappointment dressing. All root canal obturations were performed with lateral compaction. All patients were followed up for 24 months. Success was determined depending on both healed and healing cases. The chi-square or Fisher's Exact test was used to analyse the differences between the groups for success rates and the factors affecting the outcome. RESULTS The recall rate was 89 (89%). At 24 months, 39 teeth (88.6%) were considered as healed, 3 teeth (6.8%) as healing, and 2 teeth (4.5%) were identified as failed in the single-visit group, while in the two-visit group 39 teeth (86.7%) had healed, 2 teeth (4.4%) were scored as healing, and 4 teeth (8.9%) as failed. There was no statistically significant difference in the success rates between the two groups (P > 0.05). Size of the lesion and the preoperative length of root canal filling had a statistically significant impact on the outcome (P < 0.05). CONCLUSION No statistically significant difference was observed in terms of healing in 24-month follow-up of retreatments completed in single-visit or two-visits in asymptomatic teeth with periapical lesions. Size of the periapical lesion and initial apical level of root canal filling have affected the outcome of root canal retreatment.
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Affiliation(s)
- Fulya Karaoğlan
- Ege University, Faculty of Dentistry, Department of Endodontics, Bornova, İzmir, Turkey
| | | | - Mehmet Kemal Çalışkan
- Ege University, Faculty of Dentistry, Department of Endodontics, Bornova, İzmir, Turkey
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Matsuzaki E, Hirose H, Fujimasa S, Yoshimoto S, Yanagi T, Matsumoto K, Nikaido M, Minakami M, Matsumoto N, Anan H. Sphingosine-1-phosphate receptor 2 agonist induces bone formation in rat apicoectomy and alveolar bone defect model. J Dent Sci 2022; 17:787-794. [PMID: 35756763 PMCID: PMC9201516 DOI: 10.1016/j.jds.2021.10.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 10/04/2021] [Indexed: 01/01/2023] Open
Affiliation(s)
- Etsuko Matsuzaki
- Section of Operative Dentistry and Endodontology, Department of Odontology, Fukuoka Dental College, Fukuoka, Japan
- Oral Medicine Research Center, Fukuoka Dental College, Fukuoka, Japan
- Corresponding author. Section of Operative Dentistry and Endodontology, Department of Odontology, Fukuoka Dental College, 2-15-1 Tamura, Sawara-ku, Fukuoka, 814-0193, Japan.
| | - Haruna Hirose
- Section of Operative Dentistry and Endodontology, Department of Odontology, Fukuoka Dental College, Fukuoka, Japan
| | - Seishiro Fujimasa
- Section of Operative Dentistry and Endodontology, Department of Odontology, Fukuoka Dental College, Fukuoka, Japan
| | - Shohei Yoshimoto
- Oral Medicine Research Center, Fukuoka Dental College, Fukuoka, Japan
- Section of Pathology, Department of Morphological Biology, Division of Biomedical Sciences, Fukuoka Dental College, Fukuoka, Japan
| | - Tsukasa Yanagi
- Section of Oral Implantology, Department of Oral Rehabilitation, Fukuoka Dental College, Fukuoka, Japan
| | - Kazuma Matsumoto
- Section of Operative Dentistry and Endodontology, Department of Odontology, Fukuoka Dental College, Fukuoka, Japan
| | - Misaki Nikaido
- Section of Operative Dentistry and Endodontology, Department of Odontology, Fukuoka Dental College, Fukuoka, Japan
| | - Masahiko Minakami
- Section of Operative Dentistry and Endodontology, Department of Odontology, Fukuoka Dental College, Fukuoka, Japan
| | - Noriyoshi Matsumoto
- Section of Operative Dentistry and Endodontology, Department of Odontology, Fukuoka Dental College, Fukuoka, Japan
| | - Hisashi Anan
- Section of Operative Dentistry and Endodontology, Department of Odontology, Fukuoka Dental College, Fukuoka, Japan
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Schwendicke F, Mertens S, Cantu AG, Chaurasia A, Meyer-Lueckel H, Krois J. Cost-effectiveness of AI for Caries Detection: Randomized Trial. J Dent 2022; 119:104080. [PMID: 35245626 DOI: 10.1016/j.jdent.2022.104080] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 02/25/2022] [Accepted: 02/28/2022] [Indexed: 10/19/2022] Open
Abstract
OBJECTIVES We assessed the cost-effectiveness of AI-supported detection of proximal caries in a randomized controlled clustered cross-over superiority trial. METHODS Twenty-three dentists were sampled to assess 20 bitewings; 10 were randomly evaluated supported by an AI-based software (dentalXrai Pro 1.0.4, dentalXrai Ltd, Berlin, Germany) and the other 10 without AI support. The reference test had been established by four independent experts and an additional review. We evaluated the proportion of true and false positive and negative detections and the treatment decisions assigned to each detection (non-invasive, micro-invasive, invasive). Cost-effectiveness was assessed using a mixed public-private-payer perspective in German healthcare. Using the accuracy and treatment decision data from the trial, a Markov simulation model was populated and posterior permanent teeth in initially 31-years old individuals followed over their lifetime. The model allowed extrapolation from the initial detection and therapy to treatment success, re-treatments and, eventually, tooth loss and replacement, capturing long-term effectiveness (tooth retention) and costs (cumulative in Euro). Costs were estimated using the German public and private fee catalogues. Monte-Carlo microsimulations were used and incremental cost-effectiveness at different willingness-to-pay ceiling thresholds assessed. RESULTS In the trial, AI-supported detection was significantly more sensitive than detection without AI. However, in the AI group, lesions were more often treated invasively. As a result, AI and no AI showed identical effectiveness (tooth retention for a mean (2.5-97.5%) 49 (48-51)) and nearly identical costs (AI: 330 (250-409) Euro, no AI: 330 (248-410) Euro). 41% simulations found AI and 43% no AI to be more cost-effective. The resulting cost-effectiveness remained uncertain regardless of a payer's willingness-to-pay. CONCLUSIONS Higher accuracy of AI did not lead to higher cost-effectiveness, as more invasive treatment approaches generated costs and diminished possible effectiveness advantages. CLINICAL SIGNIFICANCE The cost-effectiveness of AI could be improved by supporting not only caries detection, but also subsequent management.
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Affiliation(s)
- Falk Schwendicke
- Department of Oral Diagnostics, Digital Health and Health Services Research, Charité - Universitätsmedizin Berlin, Germany.
| | - Sarah Mertens
- Department of Oral Diagnostics, Digital Health and Health Services Research, Charité - Universitätsmedizin Berlin, Germany
| | - Anselmo Garcia Cantu
- Department of Oral Diagnostics, Digital Health and Health Services Research, Charité - Universitätsmedizin Berlin, Germany
| | | | | | - Joachim Krois
- Department of Oral Diagnostics, Digital Health and Health Services Research, Charité - Universitätsmedizin Berlin, Germany
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Gomez Rossi J, Rojas-Perilla N, Krois J, Schwendicke F. Cost-effectiveness of Artificial Intelligence as a Decision-Support System Applied to the Detection and Grading of Melanoma, Dental Caries, and Diabetic Retinopathy. JAMA Netw Open 2022; 5:e220269. [PMID: 35289862 PMCID: PMC8924723 DOI: 10.1001/jamanetworkopen.2022.0269] [Citation(s) in RCA: 32] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE To assess the cost-effectiveness of artificial intelligence (AI) for supporting clinicians in detecting and grading diseases in dermatology, dentistry, and ophthalmology. IMPORTANCE AI has been referred to as a facilitator for more precise, personalized, and safer health care, and AI algorithms have been reported to have diagnostic accuracies at or above the average physician in dermatology, dentistry, and ophthalmology. DESIGN, SETTING, AND PARTICIPANTS This economic evaluation analyzed data from 3 Markov models used in previous cost-effectiveness studies that were adapted to compare AI vs standard of care to detect melanoma on skin photographs, dental caries on radiographs, and diabetic retinopathy on retina fundus imaging. The general US and German population aged 50 and 12 years, respectively, as well as individuals with diabetes in Brazil aged 40 years were modeled over their lifetime. Monte Carlo microsimulations and sensitivity analyses were used to capture lifetime efficacy and costs. An annual cycle length was chosen. Data were analyzed between February 2021 and August 2021. EXPOSURE AI vs standard of care. MAIN OUTCOMES AND MEASURES Association of AI with tooth retention-years for dentistry and quality-adjusted life-years (QALYs) for individuals in dermatology and ophthalmology; diagnostic costs. RESULTS In 1000 microsimulations with 1000 random samples, AI as a diagnostic-support system showed limited cost-savings and gains in tooth retention-years and QALYs. In dermatology, AI showed mean costs of $750 (95% CI, $608-$970) and was associated with 86.5 QALYs (95% CI, 84.9-87.9 QALYs), while the control showed higher costs $759 (95% CI, $618-$970) with similar QALY outcome. In dentistry, AI accumulated costs of €320 (95% CI, €299-€341) (purchasing power parity [PPP] conversion, $429 [95% CI, $400-$458]) with 62.4 years per tooth retention (95% CI, 60.7-65.1 years). The control was associated with higher cost, €342 (95% CI, €318-€368) (PPP, $458; 95% CI, $426-$493) and fewer tooth retention-years (60.9 years; 95% CI, 60.5-63.1 years). In ophthalmology, AI accrued costs of R $1321 (95% CI, R $1283-R $1364) (PPP, $559; 95% CI, $543-$577) at 8.4 QALYs (95% CI, 8.0-8.7 QALYs), while the control was less expensive (R $1260; 95% CI, R $1222-R $1303) (PPP, $533; 95% CI, $517-$551) and associated with similar QALYs. Dominance in favor of AI was dependent on small differences in the fee paid for the service and the treatment assumed after diagnosis. The fee paid for AI was a factor in patient preferences in cost-effectiveness between strategies. CONCLUSIONS AND RELEVANCE The findings of this study suggest that marginal improvements in diagnostic accuracy when using AI may translate into a marginal improvement in outcomes. The current evidence supporting AI as decision support from a cost-effectiveness perspective is limited; AI should be evaluated on a case-specific basis to capture not only differences in costs and payment mechanisms but also treatment after diagnosis.
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Affiliation(s)
- Jesus Gomez Rossi
- Department of Oral Diagnostics, Digital Health and Health Services Research, Charité–Universitätsmedizin Berlin, Berlin, Germany
| | - Natalia Rojas-Perilla
- Department of Economics, Freie Universität Berlin, Germany
- Department of Analytics in the Digital Era, United Arab Emirates University, Al Ain, United Arab Emirates
| | - Joachim Krois
- Department of Oral Diagnostics, Digital Health and Health Services Research, Charité–Universitätsmedizin Berlin, Berlin, Germany
| | - Falk Schwendicke
- Department of Oral Diagnostics, Digital Health and Health Services Research, Charité–Universitätsmedizin Berlin, Berlin, Germany
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Lee C, Preston A, Tran D, James J, Makins SR, Gajjar D, Weltman R. A long‐term retrospective analysis of single tooth implants and endodontic therapies in a university setting. J Periodontol 2022; 93:1510-1524. [DOI: 10.1002/jper.21-0390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 09/21/2021] [Accepted: 10/12/2021] [Indexed: 11/06/2022]
Affiliation(s)
- Chun‐Teh Lee
- The University of Texas Health Science Center at Houston School of Dentistry Department of Periodontics and Dental Hygiene Houston Texas United States
| | - Alfred Preston
- The University of Texas Health Science Center at Houston School of Dentistry Department of Periodontics and Dental Hygiene Houston Texas United States
- Private practice McKinney Texas United States
| | - Duong Tran
- Tufts University School of Dental Medicine Department of Public Health & Community Service Boston MA United States
| | - Jennifer James
- The University of Texas Health Science Center at Houston School of Dentistry Department of Periodontics and Dental Hygiene Houston Texas United States
- Private practice Pearland Texas United States
| | - Scott R. Makins
- The University of Texas Health Science Center at Houston School of Dentistry Department of Endodontics Houston Texas United States
| | - Devanshi Gajjar
- Richard L. Roudebush Veterans Affairs Hospital Indianapolis Indiana United States
| | - Robin Weltman
- The University of Texas Health Science Center at Houston School of Dentistry Department of Periodontics and Dental Hygiene Houston Texas United States
- University of Nevada School of Dental Medicine Department of Clinical Sciences Las Vegas Nevada United States
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Khoo ST, Lopez V, Ode W, Yu VSH, Lui JN. Psycho-social perspectives of nonsurgical versus surgical endodontic interventions in persistent endodontic disease. Int Endod J 2022; 55:467-479. [PMID: 35141909 DOI: 10.1111/iej.13691] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 01/19/2022] [Accepted: 01/20/2022] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Patients' experiences related to dental treatment could influence care-seeking behaviour and engender personal bias. Although endodontic retreatment and apical surgery are procedures often performed to manage previously treated teeth with persistent disease, there is lack of information regarding psycho-social perspectives of patients who undergo these treatments. Our aim was to compare experiences of patients who received these two treatment modalities using a qualitative approach. METHODS A purposive sample of patients was taken from our previous study utilizing the Oral Health Impact Profile to compare oral health-related quality of life of 150 patients who received retreatment and apical surgery. Patients who reported impact and no impact were invited to participate in focus group discussions (FGDs). Eighteen patients from the retreatment group and 15 patients from the surgical group participated in six FGDs. Thematic analysis was conducted to identify key themes. RESULTS Four themes emerged: (1) psycho-social disability associated with dental procedures, (2) physical disability associated with dental problems, (3) reliance on dentist's advice for treatment and (4) self-management to preserve treated teeth. Patients undergoing endodontic retreatment reported significant time loss from work and were less informed of alternative treatment options. However, they were pleased with the aesthetics of their teeth, especially if new crowns were made. Patients undergoing surgery experienced anxiety related to loss of control during surgery and apprehension on visualizing the wound post-surgery. They reported more impact on their diet, social interaction and sleep quality and some felt self-conscious due to post-treatment gingival recession. Patients in both groups placed great trust in professional advice and expressed a clear desire to maintain their natural dentition. There was low awareness regarding long-term care and future sequelae of their treated tooth. CONCLUSIONS Patients reported different psycho-social and physical impacts following endodontic retreatment and apical surgery. Patients undergoing endodontic retreatment were more satisfied with aesthetic outcomes but experienced greater impact related to complexities and length of time taken for treatment. Patients undergoing surgery were better informed of treatment options but experienced greater physical and psycho-social disability during the recovery phase. Clinicians could consider incorporating findings from this study into the patient-dentist discussion.
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Affiliation(s)
- Shi Tien Khoo
- Department of Restorative Dentistry, National Dental Centre Singapore, Singapore, Singapore
| | - Violeta Lopez
- School of Nursing, Midwifery and Social Sciences, Central Queensland University, Rockhampton, Queensland, Australia
| | - Wataru Ode
- Faculty of Dentistry, National University of Singapore, Singapore, Singapore
| | | | - Jeen-Nee Lui
- Department of Restorative Dentistry, National Dental Centre Singapore, Singapore, Singapore
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Noorani T, Lin GS, Leong J, Chong W, Chee MK, Lee C, Maqbool M. Evolving trend of systematic reviews and meta-analyses in endodontics: A bibliometric study. SAUDI ENDODONTIC JOURNAL 2022. [DOI: 10.4103/sej.sej_209_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Matsuzaki E, Matsumoto K, Taniguchi Y, Anan H. Surgical endodontic treatment for odontogenic maxillary sinusitis caused by radicular cyst of maxillary anterior teeth: A case report. J Dent Sci 2022; 17:1048-1049. [PMID: 35756785 PMCID: PMC9201661 DOI: 10.1016/j.jds.2021.12.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Indexed: 11/24/2022] Open
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Tietz L, Furlan RD, da Rosa RA, Duarte MAH, Alcalde MP, Vivan RR, Weissheimer T, Só MVR. Efficacy of reciprocating instruments and final irrigant activation protocols on retreatment of mesiobuccal roots of maxillary molars: a micro-CT analysis. Restor Dent Endod 2022; 47:e13. [PMID: 35284326 PMCID: PMC8891472 DOI: 10.5395/rde.2022.47.e13] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 08/22/2021] [Accepted: 09/07/2021] [Indexed: 11/20/2022] Open
Abstract
Objectives This study evaluated the efficacy of 3 reciprocating systems and the effects of 2 instruments for irrigant activation on filling material removal. Materials and Methods Forty mesiobuccal roots of maxillary molars were prepared up to size 25.06 and obturated. Micro-computed tomography (micro-CT) examination #1 was performed. Teeth were then divided into 4 groups (n = 10), according to the retreatment protocol: (1) manual, (2) Reciproc Blue, (3) WaveOne Gold, and (4) X1 Blue. Micro-CT examinations #2 and #3 were performed after filling removal and repreparation, respectively. Next, all teeth were divided into 2 new groups (n = 20) according to the irrigant activation protocol: XP Clean (XP Clean size 25.02) and Flatsonic (Flatsonic ultrasonic tip). Micro-CT examination #4 was performed after irrigant activation. Statistical analysis was performed with a significance level set at 5%. Results WaveOne Gold removed a significantly greater amount of filling material than the manual group (p < 0.05). The time to reach the WL was similar for all reciprocating systems (p > 0.05). X1 Blue was faster than the manual group (p < 0.05). Only manual group improved the filling material removal after the repreparation stage (p < 0.05). Both activation protocols significantly improved the filling material removal (p < 0.05), without differences between them (p > 0.05). Conclusions None of the tested instruments completely removed the filling material. X1 Blue size 25.06 reached the working length in the shortest time. XP Clean and Flatsonic improved the filling material removal.
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Affiliation(s)
- Lilian Tietz
- Department of Conservative Dentistry, Federal University of Rio Grande do Sul - UFRGS, Porto Alegre, Brazil
| | - Renan Diego Furlan
- Department of Operative Dentistry, Endodontics and Dental Materials, Bauru School of Dentistry/University of São Paulo - FOB/USP, Bauru, Brazil
| | - Ricardo Abreu da Rosa
- Department of Conservative Dentistry, Federal University of Rio Grande do Sul - UFRGS, Porto Alegre, Brazil
| | - Marco Antonio Hungaro Duarte
- Department of Operative Dentistry, Endodontics and Dental Materials, Bauru School of Dentistry/University of São Paulo - FOB/USP, Bauru, Brazil
| | | | - Rodrigo Ricci Vivan
- Department of Operative Dentistry, Endodontics and Dental Materials, Bauru School of Dentistry/University of São Paulo - FOB/USP, Bauru, Brazil
| | - Theodoro Weissheimer
- Department of Conservative Dentistry, Federal University of Rio Grande do Sul - UFRGS, Porto Alegre, Brazil
| | - Marcus Vinicius Reis Só
- Department of Conservative Dentistry, Federal University of Rio Grande do Sul - UFRGS, Porto Alegre, Brazil
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