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Dhamija R, Tewari S, Gupta A. Two- and three-dimensional healing assessment after endodontic microsurgery in through-and-through periapical lesions: 5-year follow-up from a randomized controlled trial. Int Endod J 2024; 57:1180-1199. [PMID: 38758526 DOI: 10.1111/iej.14084] [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: 02/13/2024] [Revised: 03/19/2024] [Accepted: 05/03/2024] [Indexed: 05/18/2024]
Abstract
AIM To evaluate clinical and radiographic outcome of endodontic microsurgery in through-and-through periapical lesions at 1-year and 5-year follow-up with adjunct use of platelet-rich plasma (PRP). METHODOLOGY Thirty-two patients with large through-and-through periapical lesions were randomized in platelet-rich plasma (PRP) group and control group. Two-dimensional (2D) healing was evaluated with Molven's criteria and three-dimensional (3D) healing with modified PENN 3D criteria. Healing at resection plane (R), apical area (A), buccal cortex (BC), palatal cortex (PC) and overall bone healing (B) was assessed using CBCT scans. The volume of lesion was measured using ITK-Snap software. The analysis included comparison of 1- to 5-year intragroup (Friedman test/McNemar test) and intergroup scoring (Chi-square/ Mann-Whitney test). Logistic regression analysis was performed to determine the effect of various factors on healing at 5 years. RESULTS Out of 32 patients/59 teeth evaluated after 1-year of endodontic microsurgery, 24 patients/44 teeth reported at 5 - year follow-up. Healing assessment with modified PENN 3D criteria revealed improvement in overall success rate of 66.7% at 1 year to 83.3% at 5 years, with no deterioration in any healing category. PRP group exhibited significantly better 3D healing than control group; both at 1 year (84.6% vs. 45.5%) and 5 years (100% vs. 63.6%). A significantly higher number of completely healed teeth were observed in PRP group than the control group at 5 years with respect to R, BC and B parameters. A volume reduction of 88% (91.4% PRP, 84% control) was depicted at 1 year and 94% (97.1% PRP, 91.1% control) at 5 years. None of the recorded factors including age, gender, size of lesion, preoperative swelling and sinus, histology of lesion, use of PRP, tooth location, preoperative buccal bone had significant effect on 3D healing at 5 years. CONCLUSIONS This 5-year study suggested improvement in 3D radiographic healing of large through-and-through periapical lesions from 1 to 5 years with no deterioration in any healing parameter in both control and PRP groups. The additional use of PRP led to significantly better healing in such lesions. RACB index using CBCT allows better estimation of healing at resected, apical and cortical plane over modified PENN 3D or Molven's criteria.
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Affiliation(s)
- Ritika Dhamija
- Department of Conservative Dentistry & Endodontics, Post Graduate Institute of Dental Sciences, Rohtak, Haryana, India
| | - Sanjay Tewari
- Department of Conservative Dentistry & Endodontics, Post Graduate Institute of Dental Sciences, Rohtak, Haryana, India
| | - Ambika Gupta
- Department of Oral Medicine and Radiology, Post Graduate Institute of Dental Sciences, Rohtak, Haryana, India
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Yamada M, Kasahara N, Matsunaga S, Fujii R, Miyayoshi N, Sekiya S, Ding I, McCulloch CA. Critical Factors Affecting Outcomes of Endodontic Microsurgery: A Retrospective Japanese Study. Dent J (Basel) 2024; 12:266. [PMID: 39195110 DOI: 10.3390/dj12080266] [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: 07/08/2024] [Revised: 08/16/2024] [Accepted: 08/19/2024] [Indexed: 08/29/2024] Open
Abstract
The critically important preoperative and intraoperative factors that affect the success of endodontic microsurgery (EMS) in Japanese patients are not defined. We conducted a retrospective study that analyzed treatment outcomes for 46 teeth in 46 Japanese patients. Treatment was provided between March 2013 and March 2015. All patients were evaluated after one year, the shortest time period over which treatment outcomes after apicoectomy could be evaluated and in which there were complete records for the recruited patient population. Healing was assessed on the basis of clinical symptoms and radiographs. With the use of a binary logistic regression model to quantify success, we estimated the effects of patient age, sex, dental arch, lesion size, lesion type, preoperative root canal treatment, the presence or absence of a post core, and the presence or absence of an isthmus on the surgically prepared dentine surface. The overall success for EMS was 93.5% after one year; failures comprised 6.5%. Successful outcomes were higher (p = 0.04) for maxillary teeth than for mandibular teeth. Success was higher (p = 0.019) for patients who received root canal instrumentation prior to EMS. Age, sex, lesion size, lesion type, the presence or absence of a post core, and the presence or absence of a root canal isthmus had no effect (p > 0.2) on success. We conclude that the percentage of successful outcomes after EMS treatment for Japanese patients presenting with periapical periodontitis is very high after one year and that success is influenced strongly by the dental arch and preoperative root canal instrumentation.
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Affiliation(s)
- Masashi Yamada
- Department of Endodontics, Tokyo Dental College, Kanda Misaki-cho, Chiyoda-ku, Tokyo 101-0061, Japan
| | - Norio Kasahara
- Department of Histology & Developmental Biology, Tokyo Dental College, Kanda Misaki-cho, Chiyoda-ku, Tokyo 101-0061, Japan
| | - Satoru Matsunaga
- Department of Anatomy, Tokyo Dental College, Kanda Misaki-cho, Chiyoda-ku, Tokyo 101-0061, Japan
| | - Rie Fujii
- Department of Endodontics, Tokyo Dental College, Kanda Misaki-cho, Chiyoda-ku, Tokyo 101-0061, Japan
| | - Norihito Miyayoshi
- Department of Endodontics, Tokyo Dental College, Kanda Misaki-cho, Chiyoda-ku, Tokyo 101-0061, Japan
| | - Sayo Sekiya
- Department of Anatomy, Tokyo Dental College, Kanda Misaki-cho, Chiyoda-ku, Tokyo 101-0061, Japan
| | - Isabel Ding
- Faculty of Dentistry, University of Toronto, 124 Edward St., Toronto, ON M5G 1G6, Canada
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Kaur IP, Sroa RB, Debbarma M, Pallawi S, Kumar A. Outcome Assessment of Three Different Methods of Root-end Preparation and Filling Materials in Endodontic Surgery: A Comparative Clinical Prospective Study. Contemp Clin Dent 2024; 15:77-83. [PMID: 39206245 PMCID: PMC11349068 DOI: 10.4103/ccd.ccd_570_23] [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: 12/17/2023] [Revised: 01/29/2024] [Accepted: 02/08/2024] [Indexed: 09/04/2024] Open
Abstract
Introduction The technique of endodontic surgery had evolved tremendously in the recent years with introduction of new instruments and materials. Aim This study aims to compare the clinical outcome of endodontic microsurgery using three different techniques with three different root-end filling materials for 16 months. Materials and Methods A total of 45 maxillary incisors indicated for root-end surgery were selected for the study. They were enrolled into three groups, i.e. Group A (traditional [TRS]/heat burnished gutta-percha), Group B (concave [CON]/Retroplast), and Group C (cavity/DiaRoot BioAggregate), of 15 teeth each. The clinical and radiographic outcome was recorded at 1, 6, 12, and 16 months using various criteria. Statistical Analysis The data were analyzed by one-way analysis of variance and Tukey's post hoc test using SPSS V. 21 software (IBM Corp., Somers, NY, USA). Results All patients had uneventful healing at the final follow-up. Radiological intratime analysis concluded a highly high significant (P < 0.0001) decrease in the size of radiolucency between the three groups at the third recall visit. Intertime analysis recorded no significant decrease in radiolucency between Groups A and B, a significant decrease in B and C, and a highly significant decrease between Groups A and C at 12 months. Conclusions There was no significant difference in the clinical outcome after endodontic surgery when comparing TRS/heat burnished gutta-percha, CON/Retroplast, and cavity/DiaRoot BioAggregate techniques at 16 months. However, cavity/DiaRoot BioAggregate resulted in significantly rapid and predictable healing at 12 months.
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Affiliation(s)
- Ibadat P. Kaur
- Department of Conservative Dentistry and Endodontics, Agartala Government Dental College and IGM Hospital, Agartala, Tripura, India
| | - Renu B. Sroa
- Department of Conservative Dentistry and Endodontics, Punjab Government Dental College and Hospital, Amritsar, Punjab, India
| | - Monalisa Debbarma
- Department of Conservative Dentistry and Endodontics, Agartala Government Dental College and IGM Hospital, Agartala, Tripura, India
| | - Sinha Pallawi
- Department of Prosthodontics, Hi-Tech Dental College and Hospital, Bhubaneswar, Odisha, India
| | - Ashok Kumar
- Department of Dentistry, AIIMS, Deoghar, Jharkhand, India
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Villa-Machado PA, Restrepo-Restrepo FA, Tobón-Arroyave SI. Dynamically guided transantral piezoelectric endodontic microsurgery: A case report with technical considerations. Int Endod J 2024; 57:490-500. [PMID: 38243920 DOI: 10.1111/iej.14026] [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: 01/20/2023] [Revised: 09/01/2023] [Accepted: 01/08/2024] [Indexed: 01/22/2024]
Abstract
AIM Endodontic microsurgery (EMS) of maxillary molars may represent a complex challenge to the clinician due to the location of the roots and the proximity of the maxillary sinus floor. This report aimed to describe the simultaneous use of a computer-assisted dynamic navigation (C-ADN) system and piezoelectric bony-window osteotomy for the transantral microsurgical approach of a maxillary left first molar with adequate root canal filling and symptomatic apical periodontitis. SUMMARY This case report highlights the importance of C-ADN to carry out a minimally invasive buccal surgical access to palatal roots affected by apical periodontitis and provides a practical example to help clinicians make treatment decisions based on the available evidence. Clinical and tomographic evaluations were performed before the surgical procedure and at 24-month follow-up. This case was treated using a C-ADN system fitted to a piezotome for the buccal approach of the buccal roots, maxillary sinus membrane lifting, and for transantral location, root-end resection, cavity preparation, and filling of the palatal root. The navigation system allowed to achieve an accurate apical canal terminus location and root-end filling of the three roots with a minimally invasive piezoelectric crypt approach. At the 24-month follow-up examination, the patient remains asymptomatic, with normal periapical structures, and regeneration of maxillary sinus walls. It was concluded that the combination of dynamic navigation with piezoelectric bony-window osteotomy offers enhanced accuracy, tissue preservation, diminished risk of iatrogenic complications, and could maximize success and survival rates in transantral EMS.
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Dong X, Su Q, Li W, Yang J, Song D, Yang J, Xu X. The outcome of combined use of iRoot BP Plus and iRoot SP for root-end filling in endodontic microsurgery: a randomized controlled trial. Clin Oral Investig 2024; 28:188. [PMID: 38430316 DOI: 10.1007/s00784-024-05569-7] [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: 11/26/2023] [Accepted: 02/20/2024] [Indexed: 03/03/2024]
Abstract
OBJECTIVES Root-end filling is important for the clinical outcome of endodontic microsurgery. Our previous study showed that combined application of iRoot BP Plus Root Repair Material (BP-RRM) and iRoot SP Injectable Root Canal Sealer (SP-RCS) in root-end filling exhibited better apical sealing as compared to the application of BP-RRM alone. The aim of this randomized controlled clinical trial was to evaluate the effect of the combined use of BP-RRM and SP-RCS on the prognosis of teeth with refractory periapical diseases after endodontic microsurgery. MATERIALS AND METHODS 240 teeth with refractory periapical diseases scheduled for endodontic microsurgery were randomly divided into BP-RRM/SP-RCS group (n = 120) and BP-RRM group (n = 120). The patients were followed up at 3 months, 6 months, and 12 months after endodontic microsurgery. Pre- and post-operative clinical and radiographic examinations were performed to evaluate the treatment outcome. The 1-year success rate of endodontic microsurgery in BP-RRM/SP-RCS and BP-RRM groups was compared by Chi-square test. Factors that might impact the prognosis were further analyzed using Chi-square test or Fisher's exact test. RESULTS A total of 221 teeth completed the 12-month follow-up. The 1-year success rates of the BP-RRM/SP-RCS and BP-RRM groups were 94.5% (104/110) and 92.8% (103/111), respectively. The combined use of BP-RRM and SP-RCS achieved a clinical outcome comparable to BP-RRM alone (P = 0.784). Tooth type (P = 0.002), through-and-through/apico-marginal lesion (P = 0.049), periodontal status (P < 0.0001), and Kim's lesion classification (P < 0.0001) were critical factors associated with the 1-year success of endodontic microsurgery. CONCLUSIONS The combined use of BP-RRM and SP-RCS is a practicable method for root-end filling in endodontic microsurgery with a satisfactory 1-year clinical outcome. CLINICAL RELEVANCE The combined application of BP-RRM and SP-RCS in EMS is an effective root-end filling method with a satisfactory 1-year clinical outcome. TRIAL REGISTRATION This study was registered in the Chinese Clinical Trial Registry (ChiCTR2100052174).
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Affiliation(s)
- Xu Dong
- Department of Cariology and Endodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, China
- Department of Stomatology, The First People's Hospital of Liangshan Yi Autonomous Prefecture, Xichang, China
| | - Qin Su
- Department of Cariology and Endodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Wen Li
- Department of Cariology and Endodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Jinbo Yang
- Department of Cariology and Endodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Dongzhe Song
- Department of Cariology and Endodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Jing Yang
- Department of Cariology and Endodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Xin Xu
- Department of Cariology and Endodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, China.
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Wang X, Xiao Y, Song W, Ye L, Yang C, Xing Y, Yuan Z. Clinical application of calcium silicate-based bioceramics in endodontics. J Transl Med 2023; 21:853. [PMID: 38007432 PMCID: PMC10676601 DOI: 10.1186/s12967-023-04550-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Accepted: 09/21/2023] [Indexed: 11/27/2023] Open
Abstract
Pulp treatment is extremely common in endodontics, with the main purpose of eliminating clinical symptoms and preserving tooth physiological function. However, the effect of dental pulp treatment is closely related to the methods and materials used in the process of treatment. Plenty of studies about calcium silicate-based bioceramics which are widely applied in various endodontic operations have been reported because of their significant biocompatibility and bioactivity. Although most of these materials have superior physical and chemical properties, the differences between them can also have an impact on the success rate of different clinical practices. Therefore, this review is focused on the applications of several common calcium silicate-based bioceramics, including Mineral trioxide aggregate (MTA), Biodentine, Bioaggregate, iRoot BP Plus in usual endodontic treatment, such as dental pulp capping, root perforation repair, regenerative endodontic procedures (REPs), apexification, root-end filling and root canal treatment (RCT). Besides, the efficacy of these bioceramics mentioned above in human trials is also compared, which aims to provide clinical guidance for their clinical application in endodontics.
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Affiliation(s)
- Xinyuan Wang
- Department of Stomatology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
- School of Stomatology, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
- Hubei Province Key Laboratory of Oral and Maxillofacial Development and Regeneration, Wuhan, 430022, China
| | - Yizhi Xiao
- Department of Stomatology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
- School of Stomatology, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
- Hubei Province Key Laboratory of Oral and Maxillofacial Development and Regeneration, Wuhan, 430022, China
| | - Wencheng Song
- Department of Stomatology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
- School of Stomatology, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
- Hubei Province Key Laboratory of Oral and Maxillofacial Development and Regeneration, Wuhan, 430022, China
| | - Lanxiang Ye
- Department of Stomatology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
- School of Stomatology, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
- Hubei Province Key Laboratory of Oral and Maxillofacial Development and Regeneration, Wuhan, 430022, China
| | - Chen Yang
- Department of Stomatology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
- School of Stomatology, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
- Hubei Province Key Laboratory of Oral and Maxillofacial Development and Regeneration, Wuhan, 430022, China
| | - Yuzhen Xing
- Department of Stomatology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China.
- School of Stomatology, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China.
- Hubei Province Key Laboratory of Oral and Maxillofacial Development and Regeneration, Wuhan, 430022, China.
| | - Zhenglin Yuan
- Department of Stomatology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China.
- School of Stomatology, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China.
- Hubei Province Key Laboratory of Oral and Maxillofacial Development and Regeneration, Wuhan, 430022, China.
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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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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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Outcome of Periapical Surgery in Molars: A Retrospective Analysis of 424 Teeth. J Endod 2021; 47:1703-1714. [PMID: 34499889 DOI: 10.1016/j.joen.2021.08.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 08/28/2021] [Accepted: 08/29/2021] [Indexed: 12/30/2022]
Abstract
INTRODUCTION The objective of this retrospective study was to assess the outcome of periapical surgery in a large number of molars in order to identify possible variables that might affect the outcome. METHODS The healing outcome of patients undergoing periapical surgery of molars from October 1999 to October 2019 was retrospectively evaluated. Outcome was dichotomized into "healed" and "nonhealed" using well-established clinical and radiographic healing criteria. The potential influence of patient-, tooth-, and treatment-related parameters on the healing outcome was analyzed. RESULTS A total of 424 molars in the same number of patients (45.5% male and 54.5% female) were evaluated. Three hundred seventy-two molars were classified as healed (87.7%). Three significant outcome predictors were identified: 1-year follow-up versus >1-5 years, >5-10 years, and >10 years (95.3% vs 82.2%, 76.3%, and 76.5% healed, respectively; P < .0001); root end filling material with bioceramic root repair material versus mineral trioxide aggregate (96.9% vs. 86.3% healed, respectively; P = .001); and preoperative evaluation based on cone-beam computed tomographic imaging versus 2-dimensional radiography (90.2% vs 81.4% healed, respectively; P = .02). Sex, age, tooth location, type of restoration, attachment level, presence of a post, quality of the root canal filling, technique of root end preparation, administration of antibiotics, and type of surgery had no significant impact on the healing outcome. CONCLUSIONS The healed rate for the concave (Retroplast) and cavity (mineral trioxide aggregate, SuperEBA [Staident International, Staines, UK], and bioceramic root repair material) root end preparation technique over all follow-up periods was 84% and 88.5%, respectively. The follow-up period, root end filling material, and preoperative evaluation based on cone-beam computed tomographic imaging had a significant influence on the healing outcome.
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Jabbari G, Jamali S, Nasrabadi N, Keikha F. Success Rate of Contemporary Regenerative Endodontic Therapy and the Expected Outcomes of the Endodontic Microsurgery: A Systematic Review and Meta-Analysis. PESQUISA BRASILEIRA EM ODONTOPEDIATRIA E CLÍNICA INTEGRADA 2021. [DOI: 10.1590/pboci.2021.163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Tsuboi R, Kitagawa H, Imazato S. FGF-2 release and bonding/physical properties of 4-META/MMA-based adhesive resins incorporating small FGF-2-loaded polymer particles. Dent Mater 2020; 36:1586-1594. [DOI: 10.1016/j.dental.2020.09.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Revised: 06/18/2020] [Accepted: 09/10/2020] [Indexed: 11/28/2022]
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12
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KOMABAYASHI T, COLMENAR D, CVACH N, BHAT A, PRIMUS C, IMAI Y. Comprehensive review of current endodontic sealers. Dent Mater J 2020; 39:703-720. [DOI: 10.4012/dmj.2019-288] [Citation(s) in RCA: 62] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
| | | | | | - Aparna BHAT
- University of New England College of Dental Medicine
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Pinto D, Marques A, Pereira JF, Palma PJ, Santos JM. Long-Term Prognosis of Endodontic Microsurgery-A Systematic Review and Meta-Analysis. MEDICINA (KAUNAS, LITHUANIA) 2020; 56:E447. [PMID: 32899437 PMCID: PMC7558840 DOI: 10.3390/medicina56090447] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Revised: 08/31/2020] [Accepted: 08/31/2020] [Indexed: 12/22/2022]
Abstract
Background and objectives: The long-term outcome of endodontic microsurgery (EMS) performed on root-filled teeth affected by post-treatment apical periodontitis (AP) has been a matter of debate, re-launched by the introduction of novel root-end filling materials which have been proven to improve the short-term outcome of EMS. The purpose of this systematic review and meta-analysis is to evaluate the clinical and radiographic long-term outcome of endodontic microsurgery in teeth diagnosed with secondary AP through radiographic evaluation. Materials and Methods: This systematic review and meta-analysis followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Inclusion and exclusion criteria were defined a priori to select the best longitudinal evidence. Only randomized clinical trials (RCT) and prospective clinical studies (PCS), with a follow-up ≥ 2-year, and exhibiting well-established clinical and radiographic outcome criteria, were selected. Results: A total of 573 articles were obtained, from which 10 fulfill inclusion criteria: 6 PCS and 4 RCT. Meta-analysis showed a pooled proportion of success rate of 91.3%, from an overall amount of 453 treated teeth included in RCT; from overall 839 included teeth in PCS, a pooled success rate of 78.4% was observed, with the follow-up time ranging from 2 to 13-years. Survival rate outcomes varied from 79 to 100% for the same follow-up period. Five prognostic factors with influence on the outcome were disclosed: smoking habits, tooth location and type, absence/presence of dentinal defects, interproximal bone level, and root-end filling material. Conclusions: High success rates and predictable results can be expected when EMS is performed by trained endodontists, allowing good prognosis and preservation of teeth affected by secondary AP.
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Affiliation(s)
- Diogo Pinto
- Department of Dentistry, Faculty of Medicine, University of Coimbra, 3000-075 Coimbra, Portugal;
| | - Andréa Marques
- Rheumatology Department, Centro Hospitalar e Universitário de Coimbra, 3000-075 Coimbra, Portugal;
- Health Sciences Research Unit: Nursing, UICISA-E, 3000-075 Coimbra, Portugal
| | - Joana F. Pereira
- Institute of Endodontics, Faculty of Medicine, University of Coimbra, 3000-075 Coimbra, Portugal; (J.F.P.); (P.J.P.)
| | - Paulo J. Palma
- Institute of Endodontics, Faculty of Medicine, University of Coimbra, 3000-075 Coimbra, Portugal; (J.F.P.); (P.J.P.)
- Center for Innovation and Research in Oral Sciences (CIROS), Faculty of Medicine, University of Coimbra, 3000-075 Coimbra, Portugal
| | - João Miguel Santos
- Institute of Endodontics, Faculty of Medicine, University of Coimbra, 3000-075 Coimbra, Portugal; (J.F.P.); (P.J.P.)
- Center for Innovation and Research in Oral Sciences (CIROS), Faculty of Medicine, University of Coimbra, 3000-075 Coimbra, Portugal
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Huang S, Chen NN, Yu VS, Lim HA, Lui JN. Long-term Success and Survival of Endodontic Microsurgery. J Endod 2020; 46:149-157.e4. [DOI: 10.1016/j.joen.2019.10.022] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Revised: 10/02/2019] [Accepted: 10/25/2019] [Indexed: 12/28/2022]
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Jung J, Kim S, Kim E, Shin SJ. Volume of Voids in Retrograde Filling: Comparison between Calcium Silicate Cement Alone and Combined with a Calcium Silicate-based Sealer. J Endod 2019; 46:97-102. [PMID: 31759678 DOI: 10.1016/j.joen.2019.10.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Revised: 10/04/2019] [Accepted: 10/17/2019] [Indexed: 10/25/2022]
Abstract
INTRODUCTION The aim of this study was to compare the volume of voids between retrograde filling using calcium silicate cement alone and retrograde filling using a combination of calcium silicate cement with a calcium silicate-based sealer. METHODS Twenty single-rooted, extracted human teeth were instrumented with nickel-titanium files and obturated with gutta-percha. We resected the roots at a point 3 mm from the apex, prepared the root ends, and filled the root-end cavities with Endocem Zr (Maruchi, Wonju, Korea) or Endoseal MTA (Maruchi) plus Endocem Zr. Then, we scanned the prepared samples using micro-computed tomographic imaging and performed 3-dimensional reconstruction. The percentage volume of the gap between the canal wall and root-end filling was calculated along with the percentage volume of voids in the filling materials. All data were analyzed using the Mann-Whitney U test. Selected specimens were further observed using scanning electron microscopy. RESULTS There were no significant differences in the percentage volumes of the gaps and internal voids between the 2 groups. Both calcium silicate and the calcium silicate-based sealer exhibited good adaptation to the cavity wall. CONCLUSIONS The findings of our micro-computed tomographic and scanning electron microscopic analyses suggested that the volume of voids in retrograde filling using a combination of calcium silicate cement and calcium silicate-based sealer was comparable with that in retrograde filling using calcium silicate cement only. Calcium silicate-based sealers could be used in retrograde filling for clinical convenience without harmful effects on the quality of filling.
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Affiliation(s)
- Jaeheon Jung
- Department of Conservative Dentistry, Gangnam Severance Dental Hospital, Yonsei University College of Dentistry, Seoul, Korea
| | - Sunil Kim
- Microscope Center, Department of Conservative Dentistry and Oral Science Research Center, Yonsei University College of Dentistry, Seoul, Korea
| | - Euiseong Kim
- Microscope Center, Department of Conservative Dentistry and Oral Science Research Center, Yonsei University College of Dentistry, Seoul, Korea; Department of Electrical and Electronic Engineering, Yonsei University College of Engineering, Seoul, Korea
| | - Su-Jung Shin
- Department of Conservative Dentistry, Gangnam Severance Dental Hospital, Yonsei University College of Dentistry, Seoul, Korea.
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Safi C, Kohli MR, Kratchman SI, Setzer FC, Karabucak B. Outcome of Endodontic Microsurgery Using Mineral Trioxide Aggregate or Root Repair Material as Root-end Filling Material: A Randomized Controlled Trial with Cone-beam Computed Tomographic Evaluation. J Endod 2019; 45:831-839. [DOI: 10.1016/j.joen.2019.03.014] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Revised: 03/15/2019] [Accepted: 03/19/2019] [Indexed: 10/26/2022]
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17
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Hosoya N, Takigawa T, Horie T, Maeda H, Yamamoto Y, Momoi Y, Yamamoto K, Okiji T. A review of the literature on the efficacy of mineral trioxide aggregate in conservative dentistry. Dent Mater J 2019; 38:693-700. [PMID: 31189792 DOI: 10.4012/dmj.2018-193] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
The aim of this literature review was to assess the clinical performance of MTA to establish the evidence level for its effectiveness in vital pulp therapy, perforation repair, and retrograde root canal filling. A comprehensive literature survey was performed via electronic databases of PubMed/MEDLINE. A total of 58 papers were reviewed in this study, of which 2 were systematic reviews/meta-analysis, 9 were randomized controlled trials (RCTs), and the rest were fallen into other categories. Mineral trioxide aggregate (MTA) provided better pulp protection as a direct capping material when compared with calcium hydroxide. As perforation repair materials, MTA demonstrated an excellent sealing ability in vitro. For periodontal tissues around a perforation, MTA provided normal healing processes in clinical trials. It is therefore concluded that MTA has a high potential in repairing perforations. MTA is the most promising material when used for retrograde root canal filling demonstrating normal healing in short/long term clinical outcomes.
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Affiliation(s)
- Noriyasu Hosoya
- Department of Endodontology, Tsurumi University School of Dental Medicine
| | | | - Taku Horie
- Department of Operative Dentistry, School of Dentistry, Aichi Gakuin University
| | - Hidefumi Maeda
- Department of Endodontology and Operative Dentistry, Division of Oral Rehabilitation, Faculty of Dental Science, Kyushu University
| | - Yuko Yamamoto
- Department of Endodontology, Tsurumi University School of Dental Medicine
| | - Yasuko Momoi
- Department of Operative Dentistry, Tsurumi University School of Dental Medicine
| | | | - Takashi Okiji
- Department of Pulp Biology and Endodontics, Division of Oral Health Science, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University
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Effects of root-end filling on the fractal dimension of the periapical bone after periapical surgery: retrospective study. Clin Oral Investig 2019; 23:3645-3651. [DOI: 10.1007/s00784-019-02967-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Accepted: 05/16/2019] [Indexed: 12/14/2022]
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von Arx T, Jensen SS, Janner SF, Hänni S, Bornstein MM. A 10-year Follow-up Study of 119 Teeth Treated with Apical Surgery and Root-end Filling with Mineral Trioxide Aggregate. J Endod 2019; 45:394-401. [DOI: 10.1016/j.joen.2018.12.015] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Revised: 12/04/2018] [Accepted: 12/15/2018] [Indexed: 10/27/2022]
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20
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Contemporary Digital Restorative and Minimal-Invasive Preservative Surgical Techniques in the Esthetic Zone: A Case Report. IMPLANT DENT 2018; 27:142-145. [PMID: 29271786 DOI: 10.1097/id.0000000000000716] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
When immediately temporizing an implant, relining and cementation of the provisional can be a challenging, time-consuming, and contaminating procedure. Excess resin and cement need to be carefully removed from the fresh wound. This can be overcome by digitally backward planning the treatment with subsequent production of a surgical guide to be used by both the technician and the dentist. In this report, a patient with a fractured and hopeless central incisor and an apical radiolucency at his compromised (root-canal treated, post and core build-up) contralateral counterpart was treated using guided implant installation, immediate placement of a prefabricated screw-retained provisional, and apicoectomy. Dehiscence of the buccal plate after tooth extraction resulting in the need for hard- and soft-tissue grafting and delayed surgery did not affect the clinical outcome.
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The use of Bioceramics as root-end filling materials in periradicular surgery: A literature review. Saudi Dent J 2018; 30:273-282. [PMID: 30202163 PMCID: PMC6128316 DOI: 10.1016/j.sdentj.2018.07.004] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2018] [Revised: 07/15/2018] [Accepted: 07/16/2018] [Indexed: 01/26/2023] Open
Abstract
Introduction Periradicular surgery involves the placement of a root-end filling following root-end resection, to provide an apical seal to the root canal system. Historically several materials have been used in order to achieve this seal. Recently a class of materials known as Bioceramics have been adopted. The aim of this article is to provide a review of the outcomes of periradicular surgery when Bioceramic root-end filling materials are used on human permanent teeth in comparison to "traditional" materials. Methods & results An electronic literature search was performed in the databases of Web of Science, PubMed and Google Scholar, between 2006 and 2017, to collect clinical studies where Bioceramic materials were utilised as retrograde filling materials, and to compare such materials with traditional materials. In this search, 1 systematic review and 14 clinical studies were identified. Of these, 8 reported the success rates of retrograde Bioceramics, and 6 compared treatment outcomes of mineral trioxide aggregate (MTA) and traditional cements when used as root-end filling materials. Conclusion Bioceramic root-end filling materials are shown to have success rates of 86.4-95.6% (over 1-5 years). Bioceramics has significantly higher success rates than amalgam, but they were statistically similar to intermediate restorative material (IRM) and Super ethoxybenzoic acid (Super EBA) when used as retrograde filling materials in apical surgery. However, it seems that the high success rates were not solely attributable to the type of the root-end filling materials. The surgical/microsurgical techniques and tooth prognostic factors may significantly affect treatment outcome.
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Outcome of Endodontic Surgery: A Meta-analysis of the Literature-Part 3: Comparison of Endodontic Microsurgical Techniques with 2 Different Root-end Filling Materials. J Endod 2018; 44:923-931. [PMID: 29681480 DOI: 10.1016/j.joen.2018.02.021] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Revised: 02/17/2018] [Accepted: 02/19/2018] [Indexed: 12/12/2022]
Abstract
INTRODUCTION The aim of the present study was to investigate the influence of root-end preparation and filling material on endodontic surgery outcome. A systematic review and meta-analysis was conducted to determine the outcome of resin-based endodontic surgery (RES, the use of high-magnification preparation of a shallow and concave root-end cavity and bonded resin-based root-end filling material) versus endodontic microsurgery (EMS, the use of high-magnification ultrasonic root-end preparation and root-end filling with SuperEBA [Keystone Industries, Gibbstown, NJ], IRM [Dentsply Sirona, York, PA], mineral trioxide aggregate [MTA], or other calcium silicate cements). METHODS An exhaustive literature search was conducted to identify prognostic studies on the outcome of root-end surgery. Human studies conducted from 1966 to the end of December 2016 in 5 different languages (ie, English, French, German, Italian, and Spanish) were searched in 4 electronic databases (ie, Medline, Embase, PubMed, and Cochrane Library). Relevant review articles on the subject were scrutinized for cross-references. In addition, 5 dental and medical journals (Journal of Endodontics; International Endodontic Journal; Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontics; Journal of Oral and Maxillofacial Surgery; and International Journal of Oral and Maxillofacial Surgery) were hand checked dating back to 1975. All abstracts were screened by 3 independent reviewers (H.B., M.K., and F.S.). Strict inclusion-exclusion criteria were defined to identify relevant articles. Raw data were extracted from the full-text review of these selected articles independently by each of the 3 reviewers. In case of disagreement, an agreement was reached by discussion, and qualifying articles were assigned to group RES. For EMS, the same search strategy was performed for the time frame October 2009 to December 2016, whereas up to October 2009 the data were obtained from a previous systematic review with identical criteria and search strategy. Weighted pooled success rates and a relative risk assessment between RES and EMS were calculated. To make a comparison between groups, a random effects model was used. RESULTS Sixty-eight articles were eligible for full-text review. Of these, per strict inclusion exclusion criteria, 14 studies qualified, 3 for RES (n = 862) and 11 for EMS (n = 915). Weighted pooled success rates for RES were 82.20% (95% confidence interval [CI], 0.7965-0.8476) and 94.42% for EMS (95% CI, 0.9295-0.9590). This difference was statistically significant (P < .0005). CONCLUSIONS The probability for success for EMS proved to be significantly greater than the probability for success for RES, providing best available evidence on the influence of cavity preparation with ultrasonic tips and/or SuperEBA (Keystone Industries, Gibbstown, NJ), IRM (Dentsply Sirona, York, PA), MTA, or silicate cements as root-end filling material instead of a shallow cavity preparation and placement of a resin-based material. Additional large-scale randomized clinical trials are needed to assess other predictors of outcome.
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Küçükkaya Eren S, Parashos P. Adaptation of mineral trioxide aggregate to dentine walls compared with other root-end filling materials: A systematic review. AUST ENDOD J 2018; 45:111-121. [PMID: 29450937 DOI: 10.1111/aej.12259] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/12/2018] [Indexed: 11/29/2022]
Abstract
This systematic review analysed the literature comparing marginal adaptation of mineral trioxide aggregate (MTA) with other filling materials in root-end cavities. The PubMed, Ovid, Web of Science, SCOPUS, and Cochrane library databases were searched using appropriate keywords related to root-end filling materials and adaptation. Of 38 articles assessed, 20 met the inclusion criteria. No in vivo study was identified. In 10 studies, MTA gave the best marginal adaptation results, but no significant differences were found between MTA and any of the tested filling materials in seven studies. There was great variability in the study designs including analysed surface, unit of gap measurement and magnification amount during analysis. On the basis of available evidence, MTA presented good marginal adaptation to dentine walls. This review identified the need for the development of standardised methods to evaluate the adaptation property of root-end filling materials in ex vivo studies as well as in clinical studies evaluating outcome.
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Affiliation(s)
- Selen Küçükkaya Eren
- Department of Endodontics, Faculty of Dentistry, Hacettepe University, Ankara, Turkey
| | - Peter Parashos
- Melbourne Dental School, Faculty of Medicine Dentistry and Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia
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Torabinejad M, Parirokh M, Dummer PMH. Mineral trioxide aggregate and other bioactive endodontic cements: an updated overview - part II: other clinical applications and complications. Int Endod J 2017; 51:284-317. [PMID: 28846134 DOI: 10.1111/iej.12843] [Citation(s) in RCA: 201] [Impact Index Per Article: 28.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Accepted: 08/22/2017] [Indexed: 12/16/2022]
Abstract
Mineral trioxide aggregate (MTA) is a dental material used extensively for vital pulp therapies (VPT), protecting scaffolds during regenerative endodontic procedures, apical barriers in teeth with necrotic pulps and open apices, perforation repairs as well as root canal filling and root-end filling during surgical endodontics. A number of bioactive endodontic cements (BECs) have recently been introduced to the market. Most of these materials have calcium and silicate in their compositions; however, bioactivity is a common property of these cements. These materials include the following: BioAggregate, Biodentine, BioRoot RCS, calcium-enriched mixture cement, Endo-CPM, Endocem, EndoSequence, EndoBinder, EndoSeal MTA, iRoot, MicroMega MTA, MTA Bio, MTA Fillapex, MTA Plus, Neo MTA Plus, Ortho MTA, Quick-Set, Retro MTA, Tech Biosealer, and TheraCal LC. It has been claimed that these materials have properties similar to those of MTA but without the drawbacks. In Part I of this review, the available information on the chemical composition of the materials listed above was reviewed and their applications for VPT was discussed. In this article, the clinical applications of MTA and other BECs will be reviewed for apexification, regenerative endodontics, perforation repair, root canal filling, root-end filling, restorative procedures, periodontal defects and treatment of vertical and horizontal root fractures. In addition, the literature regarding the possible drawbacks of these materials following their clinical applications is reviewed. These drawbacks include their discolouration potential, systemic effects and retreatability following use as a root filling material. Based on selected keywords, all publications were searched regarding the use of MTA as well as BECs for the relevant clinical applications. Numerous publications were found regarding the use of BECs for various endodontic applications. The majority of these investigations compared BECs with MTA. Despite promising results for some materials, the number of publications using BECs for various clinical applications was limited. Furthermore, most studies had several methodological shortcomings and low levels of evidence.
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Affiliation(s)
- M Torabinejad
- Department of Endodontics, School of Dentistry, Loma Linda University, Loma Linda, CA, USA
| | - M Parirokh
- Endodontology Research Center, School of Dentistry, Kerman University of Medical Sciences, Kerman, Iran
| | - P M H Dummer
- School of Dentistry, College of Biomedical and Life Sciences, Cardiff University, Cardiff, UK
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von Arx T, Antonini L, Salvi GE, Bornstein MM. Changes of Periodontal Parameters after Apical Surgery: Correlation of Clinical and Cone-beam Computed Tomographic Data. J Endod 2017; 43:876-884. [PMID: 28416313 DOI: 10.1016/j.joen.2017.01.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2016] [Revised: 01/06/2017] [Accepted: 01/09/2017] [Indexed: 10/19/2022]
Abstract
INTRODUCTION The purpose of this study was to evaluate the changes of the marginal periodontium 1 year after apical surgery. METHODS Clinical and radiographic (cone-beam computed tomographic) examinations of 54 teeth treated with buccal access flaps for apical surgery were performed at baseline and after 1 year. Clinical assessment included measurements of probing pocket depth, the level of gingival margin (GM), and the width of keratinized tissue. Subsequently, the clinical attachment level (CAL) and the width of the attached gingiva were calculated. On bucco-oral cone-beam computed tomographic sections, the height and thickness of the crestal bone and the thickness of the alveolar bone were measured at different levels. RESULTS In general, the calculated mean changes of periodontal tissue and crestal/alveolar bone were only minimal. Significant mean changes included only GM and CAL on midoral aspects and the distance from the cementoenamel junction or restoration margin on midbuccal sites. CAL was further correlated with the thickness of the alveolar bone at 3 mm below the cementoenamel junction or restoration margin. None of the clinically and radiographically calculated mean changes were correlated with sex, biotype, or incision techniques. With regard to age, older patients showed significantly more gingival recession on the buccal aspect compared with younger individuals. Furthermore, mean changes of the midbuccal width of the attached gingiva were positively correlated with the healing outcome, whereas mean changes of the midoral GM and CAL were negatively correlated with the healing outcome. CONCLUSIONS Within an observation period of 1 year, the marginal periodontium and its underlying bone structures did not suffer from significant changes after apical surgery.
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Affiliation(s)
- Thomas von Arx
- Department of Oral Surgery and Stomatology, School of Dental Medicine, University of Bern, Bern, Switzerland.
| | - Linda Antonini
- Department of Oral Surgery and Stomatology, School of Dental Medicine, University of Bern, Bern, Switzerland; Department of Reconstructive Dentistry and Gerodontology, School of Dental Medicine, University of Bern, Bern, Switzerland
| | - Giovanni E Salvi
- Department of Periodontology, School of Dental Medicine, University of Bern, Bern, Switzerland
| | - Michael M Bornstein
- Department of Oral Surgery and Stomatology, School of Dental Medicine, University of Bern, Bern, Switzerland; Applied Oral Sciences, Faculty of Dentistry, The University of Hong Kong, Prince Philip Dental Hospital, Sai Ying Pun, Hong Kong SAR, China
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Torabinejad M, Moazzami SM, Moaddel H, Hawkins J, Gustefson C, Faras H, Wright K, Shabahang S. Effect of MTA particle size on periapical healing. Int Endod J 2017; 50 Suppl 2:e3-e8. [PMID: 27977855 DOI: 10.1111/iej.12738] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2015] [Accepted: 12/08/2016] [Indexed: 12/01/2022]
Abstract
AIM To examine the effect of reduction in MTA particle size on dento-alveolar and osseous healing in dogs. METHODOLOGY Root canals of 24 mandibular premolars in four 2-year-old beagles were prepared and filled with gutta-percha and sealer. Two to four weeks later, during periapical surgery, the root-end cavity preparations in these teeth were filled with either grey ProRoot MTA or modified (reduced particle sizes with faster setting time) MTA. The animals were sacrificed 4 months later. Degrees of inflammation, type of inflammatory cells, fibrous connective tissue adjacent to the root-end filling materials, cementum formation over the resected roots and root-end filling materials and bone healing were examined. Data were analysed using the McNemar test. RESULTS No significant differences in healing of periapical tissues were found when comparing ProRoot MTA to a modified MTA containing reduced particle sizes. CONCLUSION Reducing the particle sizes of MTA did not impact its biological properties.
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Affiliation(s)
- M Torabinejad
- Department of Endodontics, Loma Linda University, Loma Linda, CA, USA
| | - S M Moazzami
- Department of Endodontics, Mashad University, Mashad, Iran
| | - H Moaddel
- Department of Endodontics, Loma Linda University, Loma Linda, CA, USA
| | - J Hawkins
- Private Practice, Kennewick, WA, USA
| | | | - H Faras
- Department of Endodontics, Kuwait University, Kuwait City, Kuwait
| | - K Wright
- Department of Anatomy, Loma Linda University, Loma Linda, CA, USA
| | - S Shabahang
- Department of Endodontics, Loma Linda University, Loma Linda, CA, USA
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Kim S, Song M, Shin SJ, Kim E. A Randomized Controlled Study of Mineral Trioxide Aggregate and Super Ethoxybenzoic Acid as Root-end Filling Materials in Endodontic Microsurgery: Long-term Outcomes. J Endod 2016; 42:997-1002. [DOI: 10.1016/j.joen.2016.04.008] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2015] [Revised: 01/28/2016] [Accepted: 04/13/2016] [Indexed: 11/16/2022]
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Cho SY, Lee Y, Shin SJ, Kim E, Jung IY, Friedman S, Lee SJ. Retention and Healing Outcomes after Intentional Replantation. J Endod 2016; 42:909-15. [DOI: 10.1016/j.joen.2016.03.006] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2016] [Revised: 03/08/2016] [Accepted: 03/08/2016] [Indexed: 01/30/2023]
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29
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Periapical Bone Healing after Apicectomy with and without Retrograde Root Filling with Mineral Trioxide Aggregate: A 6-year Follow-up of a Randomized Controlled Trial. J Endod 2016; 42:533-7. [DOI: 10.1016/j.joen.2016.01.011] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2015] [Revised: 01/11/2016] [Accepted: 01/12/2016] [Indexed: 01/26/2023]
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von Arx T, Janner SF, Hänni S, Bornstein MM. Evaluation of New Cone-beam Computed Tomographic Criteria for Radiographic Healing Evaluation after Apical Surgery: Assessment of Repeatability and Reproducibility. J Endod 2016; 42:236-42. [DOI: 10.1016/j.joen.2015.11.018] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2015] [Accepted: 11/22/2015] [Indexed: 10/22/2022]
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von Arx T, Janner SFM, Hänni S, Bornstein MM. Agreement between 2D and 3D radiographic outcome assessment one year after periapical surgery. Int Endod J 2015; 49:915-25. [PMID: 26356580 DOI: 10.1111/iej.12548] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2015] [Accepted: 09/06/2015] [Indexed: 11/30/2022]
Abstract
AIM To compare 2D with 3D radiography in assessing the treatment outcome 1 year after periapical surgery. METHODOLOGY In this prospective study, periapical radiographs (PA) and cone beam computed tomography (CBCT) were performed 1 year after periapical surgery. Three calibrated observers independently evaluated the radiographs for the presence and type of periapical radiolucencies. Ratings in PA were compared to those in bucco-lingual and mesio-distal CBCT images (coronal and sagittal planes), and the ratings of the latter two were also compared between each other. Further, maximum size diameters of radiolucencies were measured on CBCT scans, and the calculated means were correlated with the types of radiolucency. Statistical analysis was completed using Friedman rank sum tests, the Wilcoxon signed rank test and the Pearson correlation coefficient. RESULTS A total of 61 roots in 54 patients were eligible for the final assessment. On average, the intra-observer ratings were identical in 59.6% when comparing PA and CBCT (kappa 0.112 to 0.192). A very high intra-observer agreement (93.4%) was noted when comparing bucco-lingual and mesio-distal CBCT ratings (kappa 0.797 to 1). Interobserver agreement was higher for PA (68.8%) than for CBCT (bucco-lingual 45.9%, mesio-distal 47.5%), but without reaching significant differences. The calculated mean size of persistent radiolucencies in CBCT scans correlated well with the assigned types of radiolucency. CONCLUSION CBCT images showed in nearly a third of the evaluated cases a worse situation than PA. There is a need to define criteria to assess the 'radiographic healing' in CBCT following periapical surgery.
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Affiliation(s)
- T von Arx
- Department of Oral Surgery and Stomatology, School of Dental Medicine, University of Bern, Bern, Switzerland.
| | - S F M Janner
- Department of Oral Surgery and Stomatology, School of Dental Medicine, University of Bern, Bern, Switzerland
| | - S Hänni
- Department of Preventive, Pediatric and Restorative Dentistry, School of Dental Medicine, University of Bern and Private Practice limited to Endodontology, Bern, Switzerland
| | - M M Bornstein
- Department of Oral Surgery and Stomatology, School of Dental Medicine, University of Bern, Bern, Switzerland.,Department of Ambulatory Care and Community Medicine, University of Lausanne, Lausanne, Switzerland
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Karygianni L, Proksch S, Schneider S, Vach K, Hellwig E, Steinberg T, Schulz SD, Tchorz JP, Altenburger MJ. The effects of various mixing solutions on the biocompatibility of mineral trioxide aggregate. Int Endod J 2015; 49:561-73. [DOI: 10.1111/iej.12483] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2015] [Accepted: 06/10/2015] [Indexed: 12/19/2022]
Affiliation(s)
- L. Karygianni
- Department of Operative Dentistry and Periodontology; Center for Dental Medicine; University of Freiburg; Freiburg Germany
| | - S. Proksch
- Department of Operative Dentistry and Periodontology; Center for Dental Medicine; University of Freiburg; Freiburg Germany
| | - S. Schneider
- Department of Operative Dentistry and Periodontology; Center for Dental Medicine; University of Freiburg; Freiburg Germany
| | - K. Vach
- Institute for Medical Biometry and Statistics; Center for Medical Biometry and Medical Informatics; University of Freiburg; Freiburg Germany
| | - E. Hellwig
- Department of Operative Dentistry and Periodontology; Center for Dental Medicine; University of Freiburg; Freiburg Germany
| | - T. Steinberg
- Department of Oral Biotechnology; Center for Dental Medicine; University of Freiburg; Freiburg Germany
| | - S. D. Schulz
- Department of Oral Biotechnology; Center for Dental Medicine; University of Freiburg; Freiburg Germany
| | - J. P. Tchorz
- Department of Operative Dentistry and Periodontology; Center for Dental Medicine; University of Freiburg; Freiburg Germany
| | - M. J. Altenburger
- Department of Operative Dentistry and Periodontology; Center for Dental Medicine; University of Freiburg; Freiburg Germany
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von Arx T, Jensen SS, Bornstein MM. Changes of Root Length and Root-to-Crown Ratio after Apical Surgery: An Analysis by Using Cone-beam Computed Tomography. J Endod 2015; 41:1424-9. [PMID: 25958177 DOI: 10.1016/j.joen.2015.04.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2015] [Revised: 03/30/2015] [Accepted: 04/01/2015] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Apical surgery is an important treatment option for teeth with post-treatment periodontitis. Although apical surgery involves root-end resection, no morphometric data are yet available about root-end resection and its impact on the root-to-crown ratio (RCR). The present study assessed the length of apicectomy and calculated the loss of root length and changes of RCR after apical surgery. METHODS In a prospective clinical study, cone-beam computed tomography scans were taken preoperatively and postoperatively. From these images, the crown and root lengths of 61 roots (54 teeth in 47 patients) were measured before and after apical surgery. Data were collected relative to the cementoenamel junction (CEJ) as well as to the crestal bone level (CBL). One observer took all measurements twice (to calculate the intraobserver variability), and the means were used for further analysis. The following parameters were assessed for all treated teeth as well as for specific tooth groups: length of root-end resection and percentage change of root length, preoperative and postoperative RCRs, and percentage change of RCR after apical surgery. RESULTS The mean length of root-end resection was 3.58 ± 1.43 mm (relative to the CBL). This amounted to a loss of 33.2% of clinical and 26% of anatomic root length. There was an overall significant difference between the tooth groups (P < .05). There was also a statistically significant difference comparing mandibular and maxillary teeth (P < .05), but not for incisors/canines versus premolars/molars (P = .125). The mean preoperative and postoperative RCRs (relative to CEJ) were 1.83 and 1.35, respectively (P < .001). With regard to the CBL reference, the mean preoperative and postoperative RCRs were 1.08 and 0.71 (CBL), respectively (P < .001). The calculated changes of RCR after apical surgery were 24.8% relative to CEJ and 33.3% relative to CBL (P < .001). Across the different tooth groups, the mean RCR was not significantly different (P = .244 for CEJ and 0.114 for CBL). CONCLUSIONS This CBCT-based study demonstrated that the RCR is significantly changed after root-end resection in apical surgery irrespective of the clinical (CBL) or anatomic (CEJ) reference levels. The lowest, and thus clinically most critical, postoperative RCR was observed in maxillary incisors. Future clinical studies need to show the impact of resection length and RCR changes on the outcome of apical surgery.
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Affiliation(s)
- Thomas von Arx
- Department of Oral Surgery and Stomatology, School of Dental Medicine, University of Bern, Bern, Switzerland.
| | - Simon S Jensen
- Department of Oral Surgery and Stomatology, School of Dental Medicine, University of Bern, Bern, Switzerland; Department of Oral and Maxillofacial Surgery, Copenhagen University Hospital, Copenhagen, Denmark
| | - Michael M Bornstein
- Department of Oral Surgery and Stomatology, School of Dental Medicine, University of Bern, Bern, Switzerland; Center for Oral Medicine and Community Dentistry, Department of Ambulatory Care and Community Medicine, University of Lausanne, Lausanne, Switzerland
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Mente J, Leo M, Michel A, Gehrig H, Saure D, Pfefferle T. Outcome of Orthograde Retreatment after Failed Apicoectomy: Use of a Mineral Trioxide Aggregate Apical Plug. J Endod 2015; 41:613-20. [DOI: 10.1016/j.joen.2015.01.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2014] [Revised: 01/02/2015] [Accepted: 01/04/2015] [Indexed: 11/28/2022]
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Çalışkan MK, Tekin U, Kaval ME, Solmaz MC. The outcome of apical microsurgery using MTA as the root-end filling material: 2- to 6-year follow-up study. Int Endod J 2015; 49:245-54. [PMID: 25819748 DOI: 10.1111/iej.12451] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2014] [Accepted: 03/23/2015] [Indexed: 11/29/2022]
Abstract
AIM To evaluate the influence of various predictors on the healing outcome 2-6 years after apical microsurgery (AMS) using MTA as the root-end filling material. METHODOLOGY A total of 90 anterior teeth with asymptomatic persistent periradicular periodontitis of strictly endodontic origin that failed after either nonsurgical or surgical treatment were included. Surgery was completed under local anaesthesia using a standardized clinical protocol. Clinical and radiographic measures as well as the follow-up period were used to determine the healing outcome. For statistical analysis of the predictors, the outcome was dichotomized into healed cases and nonhealed cases. Odds ratios were calculated, and Pearson chi-square or Fisher's exact tests were used to analyse the data. RESULTS Clinical and radiographic assessment of AMS revealed that 80% were healed, 14.4% were nonhealed, whilst 5.6% were judged to be uncertain. None of the various predictors investigated had a significant influence on the outcome of AMS. CONCLUSIONS The results of this clinical study demonstrated that 80% of cases that received apical microsurgery healed when using MTA as the root-end filling material.
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Affiliation(s)
- M K Çalışkan
- Department of Endodontology, School of Dentistry, Ege University, Izmir, Turkey
| | - U Tekin
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Ege University, Izmir, Turkey
| | - M E Kaval
- Department of Endodontology, School of Dentistry, Ege University, Izmir, Turkey
| | - M C Solmaz
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Ege University, Izmir, Turkey
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Calcium silicate bioactive cements: Biological perspectives and clinical applications. Dent Mater 2015; 31:351-70. [DOI: 10.1016/j.dental.2015.01.004] [Citation(s) in RCA: 272] [Impact Index Per Article: 30.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2014] [Revised: 12/23/2014] [Accepted: 01/07/2015] [Indexed: 01/25/2023]
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Influence of Apical Root Resection on the Biomechanical Response of a Single-rooted Tooth—Part 2: Apical Root Resection Combined with Periodontal Bone Loss. J Endod 2015; 41:412-6. [DOI: 10.1016/j.joen.2014.11.011] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2014] [Revised: 11/03/2014] [Accepted: 11/08/2014] [Indexed: 11/18/2022]
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