Endodontics and the ageing patient

The prevalence of root canal treatment, periapical status, and coronal restorations in elderly patients in the Polish population

Objectives

The aim of this retrospective cohort study was to determine the prevalence and correlations between root canal treatment, periapical status, and coronal restoration detected using cone beam computed tomography (CBCT) in the elderly Polish population (60-79 years).

Methods

A total of 480 CBCT images were assessed. Collected data included: age, gender, the tooth location, direct restoration, decay, single crown, abutment of fixed bridge, the quality of the restoration, root canal treatment, post and core, apical periodontitis (AP), and quality of root filling.

Results

The number of teeth in the elderly patients decreased, while the number of endodontically treated teeth increased with age. More teeth were preserved in mandible, the most common group of teeth were incisors. AP was more often detected in the maxilla in general, and in mandibular molars. The over-filling was observed more frequently in maxilla, in maxillary molars and in mandibular premolars, while the short-filling in maxillary and mandibular molars. AP was significantly more often observed in short-filled root canals than in other length criteria (overfilled, adequately, lack of filling).

Conclusions

Inadequate prosthetic restoration, presence of post, pulpotomy, missed canals and root canal treated teeth were associated with increased prevalence of AP.

Clinical significance

The article indicates the need of treatment of elderly population in Poland. There is the demand to enhance the quality of endodontic and restorative treatment in this population. Additionally, CBCT examination, if indicated, should be implemented in the course of endodontic therapy to provide adequate information to clinicians.

A systematic review and meta-analysis of the prevalence and global distribution of middle mesial canals in mandibular molars identified by CBCT

OBJECTIVES

This systematic review and meta-analysis aimed to evaluate the prevalence of middle mesial canal (MMC) in permanent mandibular molars of different populations and regions based on cone-beam computed tomography (CBCT) studies.

MATERIALS AND METHODS

PubMed, Scopus, Embase, Web of Science, and Open-Grey were searched up to October 2023 according to specific keywords. A hand search was conducted on the references of the included studies and articles from three peer-reviewed journals in endodontics. The main variable of interest was the prevalence of MMC. Additional data such as the total number of included cases, age and country of the population, CBCT device information, voxel size, and field of view details were also extracted. Extracted data were analyzed qualitatively with the JBI quality assessment checklist and quantitatively with STATA software.

RESULTS

Of 32,793 studied teeth, the cumulative prevalence of MMC in both mandibular 1st and 2nd molars was 3.11% (95% CI: 2.00-4.44%). The subgroup analysis reveals a prevalence of 4.15% (95% CI: 2.69-5.89%) for mandibular 1st molars and 1.2% (95% CI: 0.2-2.83%) for mandibular 2nd molars. The highest prevalence of MMC in 1st molar was attributed to South Asia (11.24%) and Africa (6.61%).

CONCLUSIONS

The prevalence of MMC varies among regions. Clinicians should be aware of the potential prevalence of MMC, particularly in mandibular first molars, as a missed MMC could result in endodontic failure.

CLINICAL RELEVANCE

The presence of MMCs varies in different geographic regions (0% to 29.7%). Clinicians should always look for MMC when doing an endodontic treatment on mandibular molars, as the presence of this canal is not uncommon. We suggest searching for this canal as if searching for the second mesiobuccal canal of maxillary 1st molars.

Characterization of the root and canal anatomy of maxillary premolar teeth in an Iraqi subpopulation: a cone beam computed tomography study

This study aims to evaluate the number of roots and root canal morphology types of maxillary premolars in relation to a patient's gender and age in an Iraqi population using two classification systems. Cone beam computed tomography (CBCT) scans of 1116 maxillary premolars from 385 patients were evaluated for the number of roots and root canal morphology types according to Vertucci's classification and Ahmed et al. classification systems. Differences in the number of roots and root canal morphology types with regard to tooth type, patients' gender and age groups were evaluated and the degree of bilateral symmetry was determined. Chi-squared test was used for statistical analysis. About 51.1% of the 1st premolars were double rooted. The majority (87.9%) of the 2nd premolars were single rooted. The three-rooted form presented in only 1.2% and 0.7% of the 1st and 2nd premolars, respectively. Vertucci Type IV (Ahmed et al. code 2MaxP B1P1) and Vertucci Type I (Ahmed et al. code 1MaxP1) were the most common canal morphology types in the 1st and 2nd premolars, respectively. Females showed a lower number of roots and a higher prevalence of Vertucci Type I configuration (P < 0.05). Younger age groups showed a higher prevalence of Vertucci Type I configuration (P < 0.05). Bilateral symmetry was seen in more than half of the maxillary premolars. There is a considerable variation in the number of roots and root canal configurations of maxillary premolars in the studied Iraqi population, with a significant difference by gender and age groups. Ahmed et al. classification provided more accurate presentation of the root and canal anatomy in maxillary premolars compared to Vertucci's classification.

Longitudinal study of endodontic and periapical status of an adult Danish population examined in 2009, 2014, and 2019: a repeated cohort study

OBJECTIVE

To describe endodontic changes in an adult Danish population (C2;2009-2014-2019) and compare them with a similar cohort (C1;1997-2003-2008).

MATERIAL AND METHODS

A randomly selected cohort (C2) with three full-mouth radiographic examinations. The frequencies of teeth, apical periodontitis (AP), root filled teeth, and lost teeth in C2 were compared to a similar cohort (C1) using regression analyses; effect of age, cohort, and period was assessed.

RESULTS

C1 had 330 and C2, 170 participants (mean age, C1: 42.9; C2: 47.3 years, p < .001). The proportion of individuals with no AP was similar in C1 and C2 (p = .46). C2 had a higher proportion of individuals with no root filled teeth (p < .001) and no tooth loss (p = .02) than C1. The proportion of AP and root filled teeth increased with age in both cohorts. C2 had fewer root filled teeth and lost teeth, fewest lost teeth in the youngest age groups.

CONCLUSIONS

In C2, the prevalence of teeth with AP and root fillings increased with age, and few teeth were lost. Change in proportion of AP was similar in two cohorts; fewer root filled teeth and lost teeth in C2. The proportion of lost teeth in C2 showed cohort effect for older age groups.

Influence of operator's experience on complications of root canal treatment using contemporary techniques: a retrospective study

BACKGROUND

Endodontic treatment has benefited from the development of new techniques and equipment. Few clinical studies have been published on the complications associated with root canal preparations performed by doctors with different working experiences using contemporary techniques. This study aimed to analyze the complications of endodontic treatment performed by residents and endodontic specialists in a teaching stomatology hospital using contemporary techniques.

METHODS

Cases of root canal treatment (RCT) and non-surgical root canal retreatment (ReRCT) performed by residents with 1-3 years of experience and endodontic specialists with 5-7 years of experience were collected from the electronic medical system of the Department of Endodontics, Beijing Stomatology Hospital, from September 1, 2020 to August 31, 2021. The cases were examined in terms of patient age, sex, type of tooth, diagnosis, treatment modality (RCT or ReRCT), number of appointments, whether an operating microscope was used, presence of ledges, canal transportation, perforations, missed canals, separated instruments, flare-ups and clinical incidence of second mesiobuccal (MB2) root canal in the maxillary molars.

RESULTS

In total, 859 teeth from 820 patients were included in the analysis. The overall incidence of complications in the resident group was significantly higher than that in the specialist group. More ledges and flare-ups were observed in the resident group (p < 0.05). The clinical incidence of MB2 was significantly higher in the specialist group (p < 0.05). There were no significant differences in root canal transportation, perforation, or instrument separation between the two groups (p < 0.05). Multivariate analysis showed that the incidence of root canal preparation complications was related to operator experience, tooth type and treatment modality.

CONCLUSIONS

Technical advancements could reduce the effect of working experience on RCT complications between residents and endodontic specialists in a teaching stomatology hospital.

A literature review of local and systemic considerations for endodontic treatments in older adults

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.

CBCT and Micro-CT analysis of the mandibular first premolars with C-shaped canal system in a Chinese population author

OBJECTIVES

The purpose of this study was to survey the prevalence of C-shaped root canal system in mandibular first premolar in Chinese population by reading Cone-beam computed tomography (CBCT) images and to analyze its anatomical characteristics by CBCT and Micro-computed tomography (Micro-CT).

METHODS AND MATERIALS

The prevalence and the morphologic features of C-shaped root canal system were evaluated by observing CBCT images of 760 patients (1520 mandibular first premolars). 66 mandibular first premolars with C-shaped root canal system were scanned by Micro-CT. The morphologic features including radicular groove, C-shaped root canal categories in the cross-sections and in the 3D models, accessory and connecting canals, apical foramina and accessory foramina, were analyzed using image software.

RESULTS

C-shaped root canal system was identified in 16.9% of mandibular first premolars. The minimum mesial wall thickness most commonly occurred at the lingual site (69.7%). Regarding to the cross-sectional classification, the maximum was C2 (41.5%). In the 3D classification, the most common was S (34.8%). Accessory canals were observed in 36.4% of the samples and occurred mostly in the middle and apical regions. 42.4% samples had 1-3 variable connecting canals, and 40.9% samples had only one apical foramen.

CONCLUSIONS

The incidence of C-shaped root canal system in mandibular first premolars was 16.9% in the Chinese population. The anatomy was very complex and variable, mostly distributed in the middle and apical regions of the root canal. The mesial wall of C-shaped canal was extremely thin on the lingual side.

Age-related changes in the morphology of the root canal system of mandibular first molars: a micro-CT study

OBJECTIVE

This study aimed to evaluate changes on root canal morphology in patients with different ages using micro-CT technology.

MATERIALS AND METHODS

Mandibular first molars (n = 150) were scanned at a pixel size of 13.68 µm, categorized into 3 groups according to patient's age and analyzed regarding configuration, orifices, apical foramina, root length, canal volume, and surface area. Morphological 2D and 3D parameters were evaluated in distal roots with Type I configuration (n = 109) as well as the morphology of isthmuses Types I and III in 68 mesial roots. One-way ANOVA post hoc Tukey and Kruskal-Wallis tests were used for statistical analyses (α = 5%).

RESULTS

A great variation in the canal configuration was found. No difference was observed in roots' length (p > 0.05). Canal volume reduced with age (p < 0.05), while surface area increased (p < 0.05) in patients ≤ 30 years. There was no difference in canal/root length, area, and from foramen to the apex in distal roots with Type I configuration (p > 0.05), but 2D and 3D parameters significantly decreased with age (p < 0.05). Overall, the diameter of the isthmuses' roof reduced with age (p < 0.05). In patients ≥ 31 years with Type III isthmus the distance from the isthmus floor to the foramen of the mesiolingual canal also decreased (p < 0.05).

CONCLUSION

Overall, the internal morphology of the mesial roots of mandibular first molars was more affected by aging than distal canals. The most relevant tested parameter that significantly reduced in both roots was the volume of the root canal systems.

CLINICAL RELEVANCE

A detailed evaluation of fine anatomical aspects of the root canal system of mandibular first molars of patients with different ages showed that the internal morphology of mesial roots is more affected by aging than distal canals.

Worldwide Prevalence of the Lingual Canal in Mandibular Incisors - A Multi-Center Cross-Sectional Study with Meta-Analysis

INTRODUCTION

This cross-sectional study assessed the influence of patient demographics on the worldwide prevalence of a lingual canal in mandibular incisors.

METHODS

26,400 mandibular incisors were evaluated using cone-beam computed tomography imaging by pre-calibrated observers from 44 countries. A standardized screening method was employed to collect data on the presence of a lingual canal, the anatomic configuration of the root canal, and number of roots. Patient demographic information (age, sex, and ethnicity) was also recorded. Multiple intra- and inter-rater tests assessed the reliability of the observers and groups, and a meta-analysis was used to examine differences and heterogeneities (α=5%).

RESULTS

The prevalence of the lingual canal in mandibular central and lateral incisors varied from 2.3% (0.06%-4.0%; Nigeria) to 45.3% (39.7%-51.0%; Syria) and from 2.3% (0.06%-4.0%; Nigeria) to 55.0% (49.4%-60.6%; India), respectively. Ethnicity had a significant impact on the prevalence of the lingual canal, with African, Asian, and Hispanic groups having the lowest proportions (P<.05), while Caucasians, Indians, and Arabs showed the highest (P<.05) for both incisor groups. Additionally, males had a significantly higher odds ratio for both the central (1.334) and lateral (1.178) incisors, while older patients had a lower prevalence for both tooth groups (P<.05). The side and tooth group did not influenced on the outcomes.

CONCLUSIONS

The prevalence of lingual root canals in mandibular incisors varies significantly based on geographic location, ethnicity, age, and gender. The overall prevalence was 21.9% for mandibular central incisors and 26.0% for lateral incisors.

Demographics and Oral Health Care Utilization for Older Adults

The population of older adults is projected to increase dramatically as Baby Boomers continue to reach age 65 into 2029. This article discusses key shifts in this demographic, including changes in overall health status and living arrangements, that can aid in defining older adults and their medical needs. It also highlights the changes in dental use patterns and the increase in demand for comprehensive dental services for older adults in recent years. The article focuses on the fact that oral health contributes to overall health and the dental workforce must be prepared to treat older adults in their practices.

Physiology of Aging of Older Adults: Systemic and Oral Health Considerations-2021 Update

Most oral health care providers encounter older adults in their practices and can play a critical role in supporting independence and quality of life for this aging cohort. Physiologic and structural oral cavity changes associated with normal aging may affect the presentation and oral health care of older adults. This article reviews the normative aging of dentition and oral structures and physiologic changes associated with normal aging, including cardiovascular, metabolic, and musculoskeletal changes, and how they may affect oral health. Oral health providers should be aware of normal aging processes when they plan care or schedule procedures for older adults.

In vitro study on the accuracy of sleeveless guided endodontics and treatment of a complex upper lateral incisor

PURPOSE

The present study aims to assess the accuracy of sleeveless guided endodontics for root canal treatment of severe pulp canal obliteration (PCO) in 3D printed jaws. Additionally, the treatment of a complex lateral incisor is presented to illustrate the use of sleeveless guides in a clinical situation.

METHODS

Two cone-beam computed tomography (CBCT) volumes of an upper and lower jaw were selected to design 3D printed models with PCO. Virtual planning of the access cavities was performed from right to left second premolar. Then, the models were mounted into a phantom head to simulate an actual patient. Two operators with different levels of experience in endodontics performed guided access cavities. The handpiece was guided by guiding rails placed against each other on the sides of the tooth. A post-operative CBCT scan was taken for analysis.

RESULTS

Eighty-eight guided access cavities (44 per operator) were drilled on eight 3D printed models. The mean length of the access cavities was 15.3 mm, with a mean coronal and apical deviation of 0.5 mm and 0.7 mm respectively. The mean angular deviation was 1.5^°. No statistically significant difference was found between operators for the three measured parameters.

CONCLUSIONS

This study demonstrates, within its limitations, that sleveless guides represent an accurate method for guided endodontic treatment. No statistically significant difference between operators was found when using the guide.

CLINICAL SIGNIFICANCE

This method offers a valuable alternative to conventional endodontic guides with similar accuracy results.

Current oral health services and the divergent needs of the baby boom cohorts

The two cohorts of Baby Boomers, the Early (born between 1945 and 1955) and the Late (born between 1956 and 1964), have some subtle yet distinct differences when it comes to their oral health and oral health related behaviors. Unlike their predecessors, the Baby Boomer cohorts are retaining more teeth, as there is a sharp fall in edentulous rates in this population. The oral health care community is now facing unparalleled challenges in providing and maintaining the oral health of this unique cohort who are keeping their teeth longer, have multiple comorbidities, and are living longer than previous generations. This paper draws from the latest studies, scientific data and research to describe a realistic picture of the oral health services available to and utilized by the Baby Boomers. The factors affecting utilization, their rising needs, demands, expectations, and areas where improvement is needed for the Baby Boomer are also reported here.

Real-time guided endodontics: A case report of maxillary central incisor with calcific metamorphosis

Dental trauma results in various complications and poses an enigma to the practitioner. Calcific metamorphosis is one of the sequelae of trauma. A female patient of 35 years visited the specialty clinic of endodontics for the management of a discolored tooth. Clinically, discolored 21 was observed with no pain on palpation and percussion. The pulp sensibility test revealed a negative response. Radiographic examination revealed pulp canal obliteration with an apical radiolucency of Peri Apical Index (PAI 4). The tooth was diagnosed as necrotic pulp with asymptomatic apical periodontitis. Attempt to negotiate the canal under a Dental Operating Microscope (LABOMED, Los Angeles, CA, USA) and ultrasonics (Satelec, Acteon, France) was futile. Cone-beam computed tomography image revealed a patent canal in the apical third. Using real-time guided endodontics with a dynamic navigation system (Navident, ClaroNav, Toronto, ON, Canada), the protocol of plan, trace, and place was followed, and successful canal negotiation was achieved. After radiographic confirmation, root canal treatment was completed.

A study of mandibular premolar root and canal morphology in a Black South African population using cone-beam computed tomography and two classification systems

PURPOSE

An investigation of the configurations of mandibular premolar roots and canals in a population of Black South Africans.

METHODS

Cone-beam computed tomography analysis of 772 mandibular premolars was performed, and the premolars were classified according to the systems proposed by Vertucci and Ahmed et al. Root number, canal morphology, age, and sex were recorded. Fisher's exact test was used to determine relationships based on age and sex (P < 0.05).

RESULTS

Single roots were seen in the majority of mandibular premolars (97.1%). Single canal configurations (i.e., Vertucci Type 1/Ahmed et al. ¹MP¹) were observed in 48.5% of first and 81.3% of second mandibular premolars. Mandibular first premolars demonstrated multiple canals in more than half of the sample (51.5%), and C-shaped morphology in more than one-tenth (11.1%). A relationship between sex and the presence of radicular grooves was demonstrated (P = 0.049), males being more likely to demonstrate this feature (P = 0.051). Multiple canals in mandibular first premolars also showed a relationship with sex (P = 0.005), a male predilection being evident (P = 0.007). The Ahmed et al. system proved superior to the Vertucci classification for reporting complex configurations and anatomical variations, although a greater number of unique categories were created.

CONCLUSION

Diverse mandibular premolar root and canal morphology was observed in the studied population. Clinicians must be aware of common morphological features as well as possible anatomical variations in mandibular premolars, as failure to treat complete root canal systems may negatively impact endodontic treatment outcomes.

Root Canal Treatment Survival Analysis in National Dental PBRN Practices

Few studies have examined the longevity of endodontically treated teeth in nonacademic clinical settings where most of the population receives its care. This study aimed to quantify the longevity of teeth treated endodontically in general dentistry practices and test the hypothesis that longevity significantly differed by the patient's age, gender, dental insurance, geographic region, and placement of a crown and/or other restoration soon after root canal treatment (RCT). This retrospective study used deidentified data of patients who underwent RCT of permanent teeth through October 2015 in 99 general dentistry practices in the National Dental Practice-Based Research Network (Network). The data set included 46,702 patients and 71,283 RCT permanent teeth. The Kaplan-Meier (product limit) estimator was performed to estimate survival rate after the first RCT performed on a specific tooth. The Cox proportional hazards model was done to account for patient- and tooth-specific covariates. The overall median survival time was 11.1 y; 26% of RCT teeth survived beyond 20 y. Tooth type, presence of dental insurance any time during dental care, placement of crown and/or receiving a filling soon after RCT, and Network region were significant predictors of survival time (P < 0.0001). Gender and age were not statistically significant predictors in univariable analysis, but in multivariable analyses, gender was significant after accounting for other variables. This study of Network practices geographically distributed across the United States observed shorter longevity of endodontically treated permanent teeth than in previous community-based studies. Also, having a crown placed following an RCT was associated with 5.3 y longer median survival time. Teeth that received a filling soon after the RCT before the crown was placed had a median survival time of 20.1 y compared to RCT teeth with only a crown (11.4 y), only a filling (11.2 y), or no filling and no crown (6.5 y).

Variations of root and canal morphology of mandibular second molars in Chinese individuals: a cone-beam computed tomography study

BACKGROUND

The mandibular second molars demonstrate variations on root and canal morphology. The aim of this study was to investigate all the root canal morphology of mandibular second molars and analyze the morphological variations in patients by gender and age in a Chinese population use CBCT imaging.

METHODS

Cone-beam computed tomographic images of 1200 bilateral mandibular second molars were obtained from 600 patients (300 females and 300 males) who required a preoperative assessment for implant surgery, surgical removal of impacted teeth, orthodontic treatment, surgery of maxillofacial tumour and cysts or LeFort I osteotomy. CBCT images were divided into 5 groups according to age: "15-24 years", "25-34 years", "35-44 years", "45-54 years" and "≥ 55 years"; and 2 groups by gender: "females" and "males". The following information were recorded: the number of roots and canals and their morphology, the frequency and configuration of C-shaped canals by gender, age and position (left and right). The chi-square test was used to analyse differences between groups. P value of < 0.05 was considered statistically significant.

RESULTS

Of the 1200 teeth, 61% had two separate roots located mesiodistally, 35.6% had one C-shaped root. The 45.3% teeth had three canals in two-rooted mandibular second molars. The mesial root showed a Vertucci type II configuration in 28.9% cases followed by type IV(24.4%). While the distal root showed a significant higher prevalence of type I configuration in 95.6%. In the examined 1200 teeth, 430 teeth (35.8%) had C-shaped root canals. The prevalence of C-shaped root canal systems was significantly higher in females (42.5%) than in males (29.1%) (P = 0.000), and did not differ with age (P = 0.126). The 80.4% C-shaped canals were bilateral (P = 0.000) and did not differ with side (left and right) (P = 0.758).

CONCLUSIONS

The most commonly observed root morphology for the mandibular second molars was 2 separate roots with three canals.The prevalence of C-shaped root canal is 35.8% and is more higher in females than in males.

Hospitalization for Oral Health-Related Conditions of the Australian Ageing Population: Two Decades of Analysis

The burden of oral health care increases among older people, with a profound challenge in utilising dental services in primary dental care settings. This study aimed to analyse two decades of nationwide hospital separation patterns due to oral health-related conditions among older people. Ageing population data were obtained from the Australian Bureau of Statistics, including people aged 65 years and older. All principal diagnoses of oral health conditions (ICD-10-AM) were analysed in this study. The hospitalisation data included all separations of older people for the financial years 1998–1999 to 2018–2019. A total of 205,461 hospital separations were recorded for older people over a period of twenty-one years. More than 60% of these separations were collectively attributed to dental caries, disorders of teeth and supporting structures, diseases of the jaws, diseases of the pulp and periapical tissues. However, the average rate of separations per 10,000 people due to dental caries was the highest among the dental conditions (8.68). Furthermore, the remaining oral health-related conditions predict an annual percentage increase in the rate that would compromise their oral health quality of life. Dental caries and its sequela seem to be the leading cause for oral health-related hospital admissions in Australia for people aged 65 and older. This could be an indicator of the inadequacy of disease management in the primary dental care setting.

Limitations and Management of Static-guided Endodontics Failure

Endodontic treatment in severely calcified canals is always a challenging task because it can result in accidents such as deviations or perforations. Recently, guided endodontics has become an alternative approach for pulp canal calcification, facilitating the location of root canals more predictably through the combined use of cone-beam computed tomographic imaging, oral scanning, and endodontic access guides. Although several reports have shown that guided endodontics is safer, faster and can be performed without an operating microscope and by less experienced operators, the technique has limitations, and iatrogenesis may occur. This article describes the limitations of static-guided endodontics and possible causes of failures. In the present case, not fixing the guide to the bone and inaccuracies generated by manually performing mesh merger software led to root perforation. Endodontic microsurgery was effective in resolving this case and should be considered the treatment of choice when guided endodontics cannot be used safely or when it fails.

Comparing the pulp/tooth area ratio and dentin thickness of mandibular first molars in different age groups: A cone-beam computed tomography study

Context

Mandibular first molar frequently requires endodontic treatment. Understanding age-related changes in pulp-dentin complex and root canal morphologies is essential for successful endodontic and restorative treatments.

Aim

This study aimed to compare pulp/tooth area ratio (PTAR) and dentin thickness (DT) in mandibular first molars in different age groups through cone-beam computed tomography (CBCT) imaging.

Subjects and Methods

One hundred CBCT images of mandibular first molar were divided into five groups; age 20-29, 30-39, 40-49, 50-59, and 60 years old and older. Axial images were used to determine PTAR at Level A (furcation), Level B (between Levels A and C), and Level C (half distance between the furcation and apex of the root). The minimum DT of the distal wall of mesiobuccal (MB) and mesiolingual (MLi) canal and mesial wall of distal canal at 2 and 3 mm under the furcation was measured.

Statistical Analysis Used

Analysis of variance was used to determine differences among age groups.

Results

PTAR was determined to reduce as age increases, showing a significant difference among the age groups at Levels A, B, and C of both roots (P < 0.05). The minimum DT was found to increase with age, demonstrating a significant difference among the age groups of MB and MLi canal at 2 and 3 mm (P < 0.05). No statistically significant difference was observed in the mesial DT of distal canal.

Conclusions

The reduction of PTAR and the increasing DT were confirmed with advanced age.

A scoping review of four decades of outcomes in non-surgical root canal treatment, non-surgical retreatment and apexification studies. Part 1: process and general results

BACKGROUND

Despite initiatives to standardize reports, variance in study design, outcomes assessed, and tools used are persistent in literature. This review scoped existing literature on endodontic outcome studies for future development of core outcome sets.

DESIGN

Comprehensive literature search of randomized controlled trials, cohort, case-control studies, or case series (≥10 patients), published after 1980, patients aged ≥10 years, and any preoperative pulpal and periapical diagnosis in permanent teeth requiring non-surgical root canal treatment (NS-RCT), retreatment (NS-ReTx), or apexification was performed. Abstracted data were reported through descriptive statistics.

RESULTS

Of 9,957 studies screened, 354 were included. An increase in the quantity of endodontic outcome publications and levels of evidence in their study design was noted over the past four decades. Although 41% of studies included participants aged 26-50, literature including participants aged >50 has increased since 2000. Apexification and NS-ReTx were mostly provided by specialists and postgraduate students. The most common follow-up period was 2-5 years (35%), and most randomized controlled trials (58%) reported follow-up times <1 year. Multiple visit treatment was most common in apexification studies (85%). Deficiency, inconsistency and ambiguity were observed across many reports.

CONCLUSIONS

NS-ReTx and NS-RCT/NS-ReTx studies have increased over the past two decades, particularly those focusing on molars and patients >50 years old. Despite the progress in endodontic research, heterogeneity in reporting styles yield considerable limitations, particularly data standardization challenges and inconsistencies in methods and results reporting. This scoping review highlighted the state of available research and supported the development of standardized guidelines for future investigations.

When should root remnants and unrestorable broken teeth be extracted in frail older adults?

BACKGROUND

Many frail older adults have an unhealthy dentition; unrestorable broken teeth and root remnants with open root canals, commonly accompanied by periapical and periodontal inflammation, are often seen. Improving oral health in the growing group of frail older adults with remaining teeth is a considerable challenge for dental care professionals. Dentists are often uncertain how to deal with root remnants and unrestorable broken teeth in frail older adults.

METHODS

The authors aim was to provide recommendations to dentists to help in their clinical decision making about the extraction or retention of roots remnants and broken teeth in frail older adults.

CONCLUSIONS

Decisions about the extraction or retention of root remnants should made on the basis of preventing pain and oral discomfort, preventing severe inflammation, and preventing additional decline in oral health. Both root-related and patient-related factors are considered.

PRACTICAL IMPLICATIONS

Decision-making trees can help dentists decide whether to extract root remnants and unrestorable broken teeth in frail older adults.

Comparative analysis of cytokines and growth factors in the conditioned media of stem cells from the pulp of deciduous, young, and old permanent tooth

Objectives

To compare and analyze the secretome profile of stem cells obtained from the deciduous tooth (SHEDs), young (yDPSCs), and old permanent tooth (oDPSCs).

Methods

All the stem cells were assessed for mesenchymal stem cell markers. The stem cells were differentiated into osteoblasts and chondrocytes using lineage-specific differentiation media. Conditioned media was collected from growing stem cells, and a cytometric bead array was performed to estimate secreted cytokines and growth factor levels by flow cytometry. Gene expresseion levels were assessed by real-time quantitative polymerase chain reaction.

Results

Age did not affect the mesenchymal characteristics of dental stem cells from various age groups. The secretomes of SHEDs and young yDPSCs exhibit more growth factors and lesser pro-inflammatory cytokines than oDPSCs. Osteo and chondrogenic differentiation potential were higher in SHEDs and young yDPSCs than in the oDPSCs. TLR1, TLR2, TLR3 show decreased expression levels with age and TLR5, TLR6 show increased expression with age.

Conclusion

The superior regenerative potential of SHEDs and yDPSCs may be due to the higher growth factors and lower pro-inflammatory cytokine profile.

Demographics and Oral Health Care Utilization for Older Adults

The population of older adults is projected to increase dramatically as Baby Boomers continue to reach age 65 into 2029. This article discusses key shifts in this demographic, including changes in overall health status and living arrangements, that can aid in defining older adults and their medical needs. It also highlights the changes in dental use patterns and the increase in demand for comprehensive dental services for older adults in recent years. The article focuses on the fact that oral health contributes to overall health and the dental workforce must be prepared to treat older adults in their practices.

Physiology of Aging of Older Adults: Systemic and Oral Health Considerations-2021 Update

Most oral health care providers encounter older adults in their practices and can play a critical role in supporting independence and quality of life for this aging cohort. Physiologic and structural oral cavity changes associated with normal aging may affect the presentation and oral health care of older adults. This article reviews the normative aging of dentition and oral structures and physiologic changes associated with normal aging, including cardiovascular, metabolic, and musculoskeletal changes, and how they may affect oral health. Oral health providers should be aware of normal aging processes when they plan care or schedule procedures for older adults.

[Clinical and radiological assessment of the anatomical and topographic structure of the root canals of teeth in patients of different age groups]

THE AIM OF THE STUDY

Was to identify the features of the anatomical structure of the root canals of teeth according to CBCT data in patients in different age groups.

MATERIAL AND METHODS

Patients of europeoid race, both sexes, who have indications for endodontic treatment (60 people), were divided into three groups: group 1 (young) 20 people aged 18 to 44 years, group 2 (middle age) 20 people - from 45 to 60 years, group 3 (elderly) 20 people - from 61 to 75 years old. To assess the root canal anatomy, all patients underwent x-ray examination (CT) on a Vatech computed tomography and analyzed with the Ez3D plus program before beginning endodontic treatment. The object of study was the first molars of the lower jaw (distal root canal).

RESULTS

The analysis of axial, sagittal, coronal sections of the first molar of the lower jaw revealed that patients belonging to the 1^st group, the distal root canal often had an oval shape all over (95%) and over a wide apical opening, in only one case out of 20 (5%) were identified at slit-like form of the distal root canal, probably due to malocclusion or as a consequence of increased abrasion of teeth. In group 2, two independent root canals were identified in the distal root of the first lower molar (in 65%), extending from the tooth cavity to the apex.in 35% of cases, the distal root canal began with a single entrance in the oral part and bifurcated into two separate channels at about the level of 2 /3 canals, then re - joined into a single apical opening, in group 3, in 75% of cases, a slit-like form of the distal root canal was observed. The obtained CLCT data (taking into account the image error) were confirmed in the clinic at the stage of endodontic treatment using optical magnification (microscope).

CONCLUSION

CBCT and operation microscopy with x40 magnification data showed clear age-dependent variations of first lower molar distal root canal anatomy.

Guided Endodontics: Use of a Sleeveless Guide System on an Upper Premolar with Pulp Canal Obliteration and Apical Periodontitis

Guided endodontics has been used for the treatment of anterior teeth with a successful outcome. This approach is not only limited to anterior teeth because it can also be used for the treatment of premolars and molars. However, in such cases, space may be a limitation because a long bur has to be used in addition to the guide being placed on top of the teeth. The aim of this case report was to present a novel guided endodontics technique using a sleeveless 3-dimensional-printed guide. This design can reduce vertical space, allowing an open view of the tooth and irrigation during drilling. A 46-year-old female patient consulted the endodontic department with intermittent pain around tooth #5. Tooth #5 presented pain upon percussion and responded negative to a cold test. The initial periapical radiograph revealed an apical radiolucency with pulp canal obliteration. Clinically, there was no sinus tract. The tooth was diagnosed with pulp necrosis and symptomatic apical periodontitis. Guided endodontic treatment was performed with a sleeveless 3-dimensional-printed guide and long neck carbide bur with a head diameter of 1 mm to drill a minimally invasive access cavity up to the root canal. A completely healed apical area of tooth #5 was visible after 1 year on periapical radiographs. This technique seems to be a promising alternative in comparison with the conventional guided endodontic guide design for the negotiation of pulp canal obliteration in cases in which vertical space is limited.

Guided Endodontic Access in a Maxillary Molar Using a Dynamic Navigation System

The treatment of calcified root canals is challenging in endodontic practice. A 63-year-old man was referred to the postgraduate endodontic clinic at the University of Maryland School of Dentistry, Baltimore, MD, for the treatment of tooth #3. Because of the patient's history of head and neck radiation and the high risk of developing osteoradionecrosis, a nonsurgical endodontic approach was found to be the most reasonable treatment option despite the questionable prognosis of the tooth. During the endodontic treatment, the distobuccal canal appeared to be partially calcified and was not possible to be located freehand even with use of the dental operating microscope and cone-beam computed tomographic approximated approach. Therefore, the dynamic navigation system using the X-Guide system (X-Nav technologies, LLC, Lansdale, PA) was used, which allowed for the successful location of the canal. Conventional endodontic treatment was completed following standardized instrumentation, irrigation, and obturation. Details on how to use the dynamic navigation system are described including its advantages, disadvantages, and limitations.

Guided Endodontic Treatment of Calcified Lower Incisors: A Case Report

A 52-year-old female patient was diagnosed with chronic periapical periodontitis associated with severely calcified lower central incisors. Radiographic examination revealed no visible root canal in the coronal-third of the root. After choosing the guided endodontic treatment, an intraoral scan (Trios, 3shape, Copenhagen, Denmark), in conjunction with a cone beam computed tomography (CBCT) scan, was taken in order to design and fabricate a printed guide. Virtual implant software was used to visualize the surgical access into the sclerosed root canals. After locating the canals, the guide was removed, and the teeth were treated under a rubber dam. The guided approach allows predictable, efficient endodontic treatment of teeth presenting calcified canals, with minimal removal of sound dentine and less risk of root perforations.

Adaptable fiberglass post after 3D guided endodontic treatment: Novel approaches in restorative dentistry

OBJECTIVE

The rehabilitation of extensively damaged teeth with great structural loss and calcified root canals represents a challenge for dentistry. Classically, this restorative procedure of endodontically treated teeth involves intraradicular post placement. Retentive function post that can closely adapt to the root canal without the excessive wear of intraradicular dentin has a fundamental importance to ensure the longevity of the restoration.

CLINICAL CONSIDERATIONS

This report presents a clinical case of 3D guided access to a severely calcified pulp canal followed by the cementation of a fiberglass post that is adaptable to the root canal and prosthetic rehabilitation with full ceramic crown.

CONCLUSIONS

3D guided access allowed conservative and safe root canal treatment. The adaptable fiberglass post meets the specific needs of the described case and has a simple technique and low cost.

CLINICAL SIGNIFICANCE

Guided endodontics is a minimally invasive approach for teeth with calcified root canals. The post used in this study meets the demands of teeth endodontically treated with conservative techniques. The professional should not need to adapt the anatomy of the root canal to the anatomical reality of the post. This one adapts itself to the shape of the canal.

Root dentine thickness of danger zone in mesial roots of mandibular first molars

BACKGROUND

Better understanding of the danger zone anatomy in mesial roots (MRs) of mandibular first molars (MFMs) may serve to decrease the risk of mishaps. This study aimed to measure the minimal distal dentine thicknesses of danger zone in MRs of MFMs in a native Chinese population using cone-beam computed tomography (CBCT).

METHODS

CBCT images of 1792 MFMs from 898 Chinese patients were analyzed. The minimal distal dentine thicknesses of the mesiobuccal (MB) and mesiolingual (ML) canals below the furcation 1, 2, 3, 4, 5 mm were measured. The association between the minimal distal dentine thicknesses and the root lengths, patient's age and gender, side were assessed.

RESULTS

The minimal distal dentine thicknesses of MB and ML canals are located 3 ∼ 4 mm below the furcation for both men and women. There are no differences between MB and ML canals, while the minimal distal dentine thicknesses of MB and ML canals were higher in men than women (P < 0.05), except at 1 and 3 mm of ML canals (P > 0.05). The minimal distal dentine thicknesses of MB and ML canals increased with age in both men and women at each location (P < 0.05). The minimum distal dentine thickness at every location were significantly different between long teeth and short teeth both in men and women (P < 0.05), with short teeth having the smallest mean values. There are no significant differences between two sides (P > 0.05).

CONCLUSIONS

The minimal distal dentine thicknesses of MRs in MSMs have close correlation with root length, patient's age and gender.

Herodontics - is there a place for maintaining the apparently hopeless tooth?

The population is ageing and people are keeping their own teeth for much longer due in part to the efforts of the dental profession in restoring teeth and reducing the number of teeth being extracted. Along with this there is now an increasing expectation by patients that they will retain their own teeth as they age and that dental practitioners will have the knowledge and skills to help them retain their own teeth. Contemporary restorative materials and techniques have increased the range of options available to assist with maintaining the dentition, and many of these procedures enable minimally invasive and cost effective management of the teeth as an alternative to complex and expensive procedures. This paper discusses the restoration of compromised and failing teeth in the ageing patient, and looks at the various issues facing the ageing dentate patient and the dilemma of when to restore or when to extract. Ultimately it is hoped that maintaining healthy teeth for life may not only improve oral function and quality of life, but may in fact reduce the impact of the physical and psychological aspects of ageing.

Root canal treatment in elderly patients: A review and clinical considerations

Life expectancy has increased as a result of advancements in health care services; thus, maintaining healthy dentition is an important factor in overall health. Furthermore, the growing desire of elderly patients to maintain their teeth has led to an increased need for the performance of complex dental treatment in elderly patients. Root canal therapy is an essential phase of such treatments. Elderly patients may exhibit one or more systemic conditions that require special care, in addition to other changes that occur within the dentition and oral mucosa as a result of aging. These make root canal treatment in elderly patients a great challenge. The aim of this review was to characterize pathologic and physiologic changes in elderly patients that can interfere with root canal treatment procedures, as well as attitudes of elderly patients toward such treatment, guidelines and clinical considerations for management of root canal treatment in elderly patients.

Changes in periapical status, quality of root fillings and estimated endodontic treatment need in a similar urban German population 20 years later

OBJECTIVES

The study aimed at assessing, as primary objective, the periapical status and quality of root fillings, and, as secondary objective, the endodontic treatment need of a German urban population in a cross-sectional study 20 years after the first one.

MATERIALS AND METHODS

Clinical and radiographic data of 353 patients were evaluated. Descriptive and regression analyses were performed and the endodontic treatment need was calculated. Results were compared with data from the year 1993.

RESULTS

A total of 9269 teeth were examined (26.2 teeth per patient; 1993, 24.4), of which 337 teeth were root filled (3.6%; 1993, 2.7%). Prevalence of apical periodontitis in root-filled teeth was 34% (1993, 61%). Quality of root fillings was adequate in 117 cases (35%; 1993, 14%). Minimum endodontic treatment need was estimated with 1.6% (1993, 2.3%), including teeth with clinical symptoms. Considering symptomless teeth with apical periodontitis and poor quality of root filling, the treatment need was 2.9% (1993, 3.7%). Regression analysis identified quality of root filling as a significant factor for periapical health (p = 0.01, odds ratio 3.4×, 95% CI 1.9-6.3×), likewise the type of instrumentation. Teeth treated with rotary files had a significantly better outcome (p = 0.02, odds ratio 2.0×, 95% CI 1.1-3.7×).

CONCLUSIONS

Quality of root fillings and the periapical status have improved over the last 20 years in Germany. However, there is still a need for an increase in quality of root canal treatment.

Novel navigation technique for the endodontic treatment of a molar with pulp canal calcification and apical pathology

Apical periodontitis, the inflammation of periapical tissue, commonly requires root canal treatment to achieve apical healing. However, if it is accompanied by pulp canal calcification, the treatment becomes complicated, and locating the root canal can be challenging. This case report describes a novel approach for treating a molar with pulp canal calcification and apical pathology. Due to the risk of perforation during treatment, a digitally printed template was used to assist in accurately locating the root canal. After six months, the patient was asymptomatic and the periradicular radiolucency was gradually reducing in size.

Glass-ceramics bonding in geriatric patients: comparison with young teeth

OBJECTIVE

The aim of the study was to assess whether in geriatric patients, the shear bond strength (SBS) of glass-ceramics differed when compared to young controls.

BACKGROUND

In the need of aesthetic restorations for geriatric patients, reliable bonding of glass-ceramics should be accomplished; however, glass-ceramics bonding on aged tooth structures is still unclear.

MATERIALS AND METHODS

Sixty extracted molars from young and geriatric patients [18-25 (Y), and 65-80 (O)] were cut buccolingually to prepare enamel (E) and dentin (D) surfaces. Both surfaces were randomly divided into three groups according to the resin cements: Variolink II (V); Superbond (S); and Clearfil Esthetic Cement (C) (n = 10). Disc-shaped glass-ceramics (IPS E-max Press) (n = 120) were prepared. Specimens were bonded and subjected to thermocycling. SBS test was performed using a universal testing machine (0.5 mm/min). After debonding, the surfaces were examined using stereomicroscope and scanning electron microscope. Data were statistically analysed with Kolmogorov-Smirnov, Levene, anova and Bonferroni tests (p = 0.05).

RESULTS

There were no significant differences between the old and young teeth surfaces. V showed the highest SBS [MPa(SD)] on both enamel and dentin [36.7 (6.5) (YE), 23.2 (13.2) (YD), 32.1 (16.2) (OE), 25.5 (8.6) (OD), respectively]. Significant differences were observed between resin cements (p < 0.05). The failure types were 43% adhesive between tooth and cement, 48% mix, 9% adhesive between cement and ceramic, regardless of cement type.

CONCLUSION

In geriatric patients, the shear bond strength of glass-ceramics did not differ when compared to that of young controls. On the dentin surface, etch-rinse resin cements appear to be more appropriate for glass-ceramics bonding.