Revisiting Orstavik's PAI score to produce a reliable and reproducible assessment of the outcomes of endodontic treatments in routine practice

Assessment of mechanical allodynia in healthy teeth adjacent and contralateral to endodontically diseased teeth: a clinical study

Objectives

The present study investigated the prevalence of mechanical allodynia (MA) in healthy teeth adjacent and contralateral to endodontically diseased teeth.

Materials and Methods

This cross-sectional study included 114 patients with symptomatic irreversible pulpitis and apical periodontitis in permanent mandibular first molars who possessed healthy teeth adjacent and contralateral to the endodontically diseased tooth. The mechanical sensitivity of the teeth was determined by percussion testing. The presence or absence of pain on percussion in the teeth adjacent and contralateral to the endodontically diseased tooth and the tooth distal to the contralateral symmetrical tooth was recorded according to coding criteria. The prevalence of MA was computed as a percentage, and binary logistic regression analysis was done. The Fisher exact test and Mann-Whitney U test were used for binary and ordinal data.

Results

Age and sex did not influence the prevalence of MA. An increased prevalence of MA was found in patients with higher levels of spontaneous pain (p < 0.001). The prevalence of allodynia was 57% in teeth adjacent to endodontically diseased teeth and 10.5% in teeth contralateral to endodontically diseased teeth. In addition, on the ipsilateral side, there were more painful sensations distal to the diseased tooth than mesially.

Conclusions

Despite being disease-free, teeth adjacent and contralateral to endodontically diseased teeth exhibited pain on percussion. There was a direct association between the severity of the patient's pain and the presence of MA.

Periapical Healing Outcome of Endodontic Re-Treatment Using Calcium Silicates Versus Resin-Based Sealers: A Systematic Review

Aim

This systematic review was conducted with the purpose of analyzing the effects of root-end sealers in endodontic re-treatment cases and comparing calcium-based sealers with sealers, which were resin-based.

Methodology

We conducted this review based on the principles of Cochrane systematic type of studies and also based on guidelines of Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA). An exhaustive search was conducted across PubMed, Medline, and Embase databases for the studies, which were based on root end sealers in cases of endodontic re-treatments. The data were then analyzed statistically with the help of SPSS 25.0.

Results

It was seen that when comparing pain levels in post-obturation cases with these sealers after 24 hours and 48 hours, not much of statistically noteworthy differences were evident. Mean difference (MD) values at 24 hours were -0.20 with confidence intervals between -0.44 and 0.07 and P value of 0.15, whereas in case of 48 hours, MD was -0.36, CI- 0.65, and P value was 0.03. However, the results were slightly better with calcium-based sealers.

Conclusion

Calcium silicate-based root end obturation sealers had similar performance when compared to resin-based sealers when we compared variables like pain intensity, etc.

Dose-response association of smoking with delayed healing of apical periodontitis after endodontic treatment

DESIGN

A prospective cohort study aimed to assess the inhibitory effect of cigarette smoking on the rate of periapical bone healing after root canal treatment (RCT). Examination included both clinical and radiographic parameters to define healing status at baseline, 6 months, and 1 year after RCT.

OBJECTIVES

To examine and compare the healing rate of apical periodontitis (AP) after RCT between smokers and nonsmokers, and to evaluate how the intensity and duration of smoking affect AP healing up to 1-year follow-up. Study hypothesis was that smoking habits could delay or deteriorate AP healing.

METHODS

The study protocol was approved by the local ethics committee and all of the participants signed a consent form. Included were adult patients with a radiographically confirmed AP in a single tooth with a favorable periodontal prognosis and adequate coronal restoration, with no previous RCT. Excluded patients were those diagnosed with a systemic disease or on medications affecting bone metabolism, former and occasional smokers, pregnant patients, and those who refused to participate. Smokers were defined as those who consumed at least 100 cigarettes in their lifetime and currently smoke. Smoking intensity was classified according to cigarette consumption per day (CPD) into: heavy smoking (≥20 CPD) and mild smoking (˂20 CPD). Tobacco exposure over time was assessed by smoking index (=CPD ˟ duration of tobacco smoking in years) and categorized into: nonsmoker, <400, 400-799, and ≥800. The control group included healthy nonsmokers and matched the smoker group in terms of age and gender. All RCTs were performed by endodontic specialists following a standardized protocol. Clinical examination involved percussion and palpation tests, periodontal probing and examination of the coronal restoration; while the periapical healing was radiographically assessed using the periapical index (PAI) scoring.

RESULTS

A total of 110 patients (55 smokers and 55 nonsmokers) were included. The two groups were comparable regarding age, gender, tooth type, socioeconomics, and periapical index scores at the baseline. The mean CPD among smokers was 12.22, and most of them were "mild smokers". At 12-month follow-up, nonsmokers showed a significantly higher healing rate compared to smokers (90.9% vs. 58.2%; χ2 = 13.846; p < 0.001). Conversely, smokers had significantly higher PAI when compared to the control group (p = 0.024). Regression analysis demonstrated that the risk of AP persistence increases with an increase in the smoking index [OR = 7.66; 95% CI: 2.51-23.28; p < 0.001, for smoking index <400 and (OR = 9.65; 95% CI: 1.45-64.14; p = 0.019, for smoking index 400-799].

CONCLUSION

Smoking was significantly associated with delayed AP healing after RCT. The likelihood of AP persistence rises as smoking exposure increases. These results could impact clinical decisions and guidelines concerning smokers.

Full Pulpotomy as a Treatment for Irreversible Pulpitis in Permanent Teeth: A Systematic Review of the Literature Based on Case Reports

The objective of this systematic review was to evaluate the current evidence of case reports where the treatment for permanent teeth with a diagnosis of irreversible pulpitis was a full pulpotomy. This study was carried out by two reviewers following the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. A systematic electronic search was carried out in the PubMed, Google Scholar, and Scopus databases until the year 2022 to find articles in English where the treatment for irreversible pulpitis in permanent teeth was a full pulpotomy. Literature reviews, in vitro or animal studies, abstracts, and unpublished data were excluded. The intervention, control, and outcome parameters were selected following the "Population, Interventions, Control, and Outcome" (PICO) guidelines. A total of 636 articles were found, and 14 articles were selected to be included in this review. The selected articles describe cases of full pulpotomies in mature permanent teeth with a diagnosis of irreversible pulpitis with a total of 34 (100%) successful cases, where 18 were men and 16 were women, with an average age of 19.20 ± 10.59 years and an average follow-up of 35.82 ± 26.39 months, with 12 months being the minimum follow-up time. The material used most frequently for obturation of the full pulpotomy was mineral trioxide aggregate in 16 cases (47.06%). Within the limitations of this review, full pulpotomy presents a high success rate regardless of the tooth, age, or sex as a treatment for teeth diagnosed with irreversible pulpitis.

A Systematic Review on Comparison of Periapical Healing and Post-Operative Pain between Bioceramic and Epoxy Resin Based Sealers

To compare the incidence of postoperative discomfort and periapical healing in endodontically treated teeth following the use of resin-based or bioceramic sealers. In vivo, clinical trials were included in the study. The selection criteria, data extraction, and analysis were performed to evaluate the quality and publication bias of the selected studies. The primary outcome measure was the comparison of postoperative discomfort between the two sealer types. Seven studies were included in the systematic review, with a modest level of evidence found in the quality assessment. There are no significant differences in the postoperative discomfort levels between resin-based and bioceramic sealers. However, the overall quality of the clinical trials was moderate, highlighting the need for further well-designed clinical trials with appropriate measures of randomization, allocation concealment, and blinding to establish a definitive conclusion on the incidence of Postoperative discomfort associated with the use of these sealers.

Assessing the Sealing Performance and Clinical Outcomes of Endodontic Treatment in Patients with Chronic Apical Periodontitis Using Epoxy Resin and Calcium Salicylate Seals

Background and Objectives: Recognizing the significance of a hermetic apical seal for successful root canal treatment, the present investigation aimed to evaluate two sealing materials through an in vitro analysis, as well as to ascertain the clinical outcomes of patients treated with these two sealers in an in vivo setting. Materials and Methods: For the in vitro part of the study, two control groups of thirty monoradicular teeth were obturated with two sealers. Then, the sealers' performance was tested based on a predefined protocol. Group A included 30 patients treated with an epoxy oligomer resin-based sealer (Adseal, MetaBiomed), while Group S comprised 30 patients treated with a polymeric calcium salicylate-based sealer (Sealapex, Kerr). Samples were sectioned and evaluated under the microscope to determine the sealer's tightness by measuring the dye penetration into the root canal filling. For the in vivo part, a prospective study was designed to include 60 patients with chronic apical periodontitis in two endodontic treatment groups, using the same two sealers. Results: The in vitro analysis found that dye penetration in Group A was 0.82 mm (±0.428), while in Group S, the dye penetration was statistically significantly deeper, being 1.23 mm (±0.353). In the in vivo part of the study, the periapical index (PAI) significantly decreased 6 months after endodontic treatment, with 80.0% of patients in Group A having a PAI score of 2 compared to only 56.7% in Group S (p-value = 0.018). Similarly, tooth mobility scores significantly decreased after treatment, but with no difference between groups. The marginal bone loss decreased significantly more in the Adseal group compared to the Sealapex group (23.3% vs. 50.0%, p-value = 0.032). At the same time, 40.0% of patients in Group S had failed tooth healing compared to only 13.3% in Group A (p-value = 0.048). Conclusions: The in vitro study showed that Adseal had a better sealing capacity and a lower degree of dye penetration compared to Sealapex. However, on clinical evaluation in the in vivo study, both patient groups exhibited significant improvements in periapical index, tooth mobility scores, and pain reduction following endodontic treatment. Nevertheless, patients treated with Adseal showed a significantly greater improvement in PAI values, tooth mobility, and teeth healing after treatment. Overall, Adseal, as an endodontic sealer, may provide better sealing capabilities and enhanced clinical outcomes in the treatment of chronic apical periodontitis.

Endodontic Microbial Communities in Apical Periodontitis

INTRODUCTION

Apical periodontitis (AP) represents an inflammatory condition of peri-radicular tissues due to invasion and colonization of bacteria in the root canals. Primary apical periodontitis (PAP) is associated with untreated necrotic root canal and can be efficiently treated with endodontic treatment to remove bacteria. Persistent/secondary apical periodontitis (SAP) is a perpetual periapical lesion due to unsuccessfully treated root canals after an initial apparent healing of the tooth. The aim of the study was evaluating the microbial communities associated with root canals using Nanopore sequencing.

METHODS

Seventeen samples from the root canals of 15 patients with AP were Polymerase Chain Reaction-amplified for 16s ribosomal DNA gene and sequenced. Information regarding the presence or absence of AP symptoms, PAP and SAP, and periapical index of patients were recorded.

RESULTS

Firmicutes, Bacteroidetes, and Actinobacteria were the most abundant phyla detected and Phocaeicola, Pseudomonas, Rothia, and Prevotella were the most prominent genera. In samples of patients with AP symptoms, the most frequent detected genera were Cutibacterium, Lactobacillus, Pseudomonas, Dialister, Prevotella, and Staphylococcus. In PAP samples, the most represented genera were Cutibacterium, Lactobacillus, Pseudomonas, and Prevotella, whilst in SAP cases were Cutibacterium, Prevotella, Atopobium, Capnocytophaga, Fusobacterium, Pseudomonas, Solobacterium, and Streptococcus.

CONCLUSIONS

The results provide additional information on the microbiota of root-canals. These data evidence the complexity of the microbiota and the relationship with many clinical and endodontic conditions. Future studies must evaluate these conditions and identify their role in inducing bone damage and local and systemic disease, aiming to better elucidate the relationship between microbes and endodontic pathologies.

Periapical Healing following Root Canal Treatment Using Different Endodontic Sealers: A Systematic Review

The healing of the periapical tissues is crucial to the success of root canal treatment. The review studies effectively examine various endodontic root canal sealants in terms of periapical healing. This systematic review was formulated following the PRISMA 2020 guidelines and registered in the international prospective register of systematic reviews (PROSPERO) number-CRD42021239192. To find relevant articles, PubMed Central and Medline databases (until February 2022) were searched. Studies that evaluated healing following the application of different endodontic sealers were analysed. A primary outcome measure was the resolution of periapical lesions following the endodontic treatment. In vivo studies comparing radiographic treatment outcomes and articles with a minimum of 6-month follow-up were included. A total of 9 clinical trial studies that met all the inclusion criteria were included in the analysis. The overall risk of bias was high in four studies out of nine studies. Periapical lesions showed significant healing after endodontic treatment regardless of sealer type, although bioceramic and bioactive sealers had shown better results.

Comparison of Clinical-related Characteristics of Endodontic Patients Before and During the COVID-19 Pandemic

Objective: To compare patient-related and clinical-related characteristics of endodontic patients, before and during the COVID-19 pandemic. Methods: The study population comprised 506 patients (teeth: n=674) aged 13–81 years who attended undergraduate dental clinics in the Endodontics Department of the Faculty of Dentistry at Biruni University for endodontic treatment. Patient-related and clinical-related data were compared at two time intervals: before the first COVID-19 case was reported in Turkey and after the first COVID-19 case was reported in Turkey Results: There were no significant differences in terms of age and sex of the patients attending the clinics before versus during the pandemic. The incidence of reported pain before the pandemic was significantly lower than that reported during the pandemic (p=0.041). Periapical health before the pandemic was significantly better than that during the pandemic (p