The impact of an enhanced infection control protocol on molar root canal treatment outcome - a randomized clinical trial

Evaluation of quality of root canal therapy performed by predoctoral students on endodontic outcome and quality of life of patients

This study evaluated the technical quality (TQ) of root canal therapy (RCT) performed by predoctoral students and its impact on endodontic outcome (EO) and patients' quality of life (QoL). The TQ of RCT done by predoctoral students was evaluated and follow-up visits were conducted to determine the clinical, radiographic outcome of RCT and patients' QoL. Frequency distribution, multiple regression, independent-samples t test and one-way anova were performed. A total of 226 teeth of 164 patients were clinically and radiographically examined. A satisfactory TQ was observed in 130 (57.5%), successful clinical outcomes in 155 (68.6%), successful radiographical outcomes in 206 (91%) and overall successful EO in 150 teeth (66.4%) with 80% of patients reporting a favourable QoL. A significant positive correlation was noted between EO and QoL (p = 0.002) with no significant correlation in between TQ-RCT and EO (p = 0.07) and TQ-RCT and QoL (p = 0.316). Successful EO had a positive impact on patients' QoL.

Endodontic operative field asepsis: a comparison between general dentists and specialists

OBJECTIVE

The aim was to evaluate the establishment of an aseptic endodontic operative field in general dentistry by assessing general dentists' ability to reduce the amount of contamination to a non-cultivable level, and to compare the operative field asepsis at a general dentistry clinic with that at an endodontic specialist clinic.

MATERIALS AND METHODS

A total of 353 teeth were included in the study (153 in general dentistry, 200 at the specialist clinic). After isolation, control samples were taken, the operative fields disinfected with 30% hydrogen peroxide (1 min) followed by 5% iodine tincture or .5% chlorhexidine solution. Samples were collected from the access cavity area and buccal area, placed in a fluid thioglycolate medium, incubated (37°, 7 d), evaluated for growth/non-growth.

RESULTS

Significantly more contamination was observed at the general dentistry clinic (31.6%, 95/301), than at the endodontic specialist clinic (7.0%, 27/386) (p <.001). In general dentistry, significantly more positive samples were collected in the buccal area than in the occlusal area. Significantly more positive samples were collected when the chlorhexidine protocol had been used, both in general dentistry (p <.001) and at the specialist clinic (p =.028).

CONCLUSIONS

The result from this study shows insufficient endodontic aseptic control in general dentistry. At the specialist clinic, both disinfection protocols were able to reduce the amount of microorganisms to a non-cultivable level. The observed difference between the protocols may not reflect a true difference in the effectiveness of the antimicrobial solutions, as confounding factors may have contributed to the result.

The influence of patient race on the outcome of endodontic treatments: a pooled analysis of one-year recall data from four cone beam computed tomography outcome studies

Objectives The aim of this pooled data analysis was to establish if there is an association between a patient's race and the proportion of successful outcomes of endodontic treatments, and if so, what factors may determine this association.Methodology Data collected from four prospective clinical outcome studies were pooled. Patients were recalled 12 months after the completion of the treatment. Treatment outcome was determined by clinical findings and cone beam computed tomography examination. Statistical analysis included the description of categorical and continuous variables and simple binary logistic regression models, chi-squared tests and Kruskal-Wallis tests.Results Data from 301 patients were available. Of these patients, 43 were Black (14.3%), 50 were from a Non-Black Minority Ethnic (NBME) group (16.6%) and 208 were white (69.1%). The risk of an unfavourable outcome was higher in teeth with short root canal fillings (OR = 3.36; p = 0.002), when a preoperative radiolucency was present (OR = 2.59; p = 0.019) and when an intra-operative root canal perforation was detected (OR = 5.25; p = 0.016).Multiple regression models showed that Black (OR = 2.28; p = 0.05) and NBME patients (OR = 3.07; p = 0.008) had a higher risk of an unfavourable result compared to white patients.Conclusions Black and NBME patients had a significantly higher failure rate of root canal treatments compared to white patients. All other known pre-, intra- and post-operative risk factors for root canal treatment failure were present in similar proportions in BME and white patients.

Treatment Outcome and Root Canal Preparation Techniques: 5-Year Follow-Up

OBJECTIVE

This study aims at comparing treatment outcome and tooth survival of root canal-filled teeth following manual vs rotary instrumentation techniques over a 5-year period.

METHODS

This was a single-centre study conducted as a follow-up to a short-term parallel-arm randomised controlled noninferiority trial in which root canal treatment was performed on teeth using either rotary or manual instrumentation. Patients were monitored at post 6-month, 1-year, 4-year, and 5-year review periods by blinded evaluators. Treatment outcome was categorised as favourable, uncertain, and unfavourable (employing European Society of Endodontology categorisation based on strict clinical and radiographic criteria), and 5-year tooth survival was determined by assessing whether tooth was in situ in the oral cavity or extracted. The Kaplan-Meier method and log rank test evaluated tooth survival. P value <.05 was considered statistically significant.

RESULTS

Ninety of 120 treated teeth were assessed in 37 men and 40 women with mean age of 30.6 ± 10.99 years. Treatment outcome was significantly more favourable in the rotary group compared to the manual group at post 6-month (P = .021) and 1-year (P = .043) review periods. The differences in favourable outcome (P = .498) and tooth survival (P = .296) between the 2 groups were, however, not significant at the 5-year review period.

CONCLUSIONS

The rotary instrumentation technique was shown to be more effective in resolving clinical symptoms and promoting periapical healing after the post 6-month and 1-year review compared to the manual instrumentation technique; however, both groups had similar favourable outcomes and survival rates after an extended 5-year review period.

The impact of an enhanced infection control protocol on the microbial community profile in molar root canal treatment-an in vivo NGS molecular study

INTRODUCTION

Recent findings demonstrated that one-year CBCT-based outcomes of molar root canal treatment were improved through an Enhanced infection protocol (EnP), when compared to a current best-practice standard infection control protocol (StP). The EnP comprised measures to reduce iatrogenic contamination from direct and indirect contact surfaces, including the replacement of the rubber dams, gloves, files, all instruments, and surface barriers before root canal obturation. The aim of this study was to investigate the effect of such an enhanced infection control protocol on resident microbiome present after chemomechanical instrumentation and the protocol ability in reducing iatrogenic contamination in molar teeth during root canal treatment.

METHODS

Molar teeth were block-randomized to receive either treatment under EnP or StP. To compare the differential effect of the protocol on the identity of bacteria present, one hundred and fifty, matched DNA extracts from 75 molar teeth samples (StP, n=39; EnP, n=36), were evaluated. Samples were taken before (S1) and after (S2) chemomechanical preparation and were subjected to next-generation sequencing of the V3-V4 region of the 16S rRNA gene, prior to bioinformatical identification using the HOMD oral microbiome database and downstream taxonomic processing, providing measures of richness and diversity of bacteria and significant bacterial taxa during chemomechanical instrumentation and the effect of the two treatment groups.

RESULTS

88 microbial taxa were significantly more abundant in StP S2 samples, including endodontically relevant contaminants taxa as Actinomyces, Cutibacterium, and Haemophilus. The S2 samples demonstrated fewer residual bacterial species in the EnP group, with 26.8 observed species compared to 38.3 in the StP. Reduced diversity and richness measures were noted in the EnP pre-obturation samples compared to the StP in OTU, Chao1 and ACE indices (p≤0.05). Differential microbial identities between S1 and S2 samples and protocols demonstrated that the previously observed increased effectiveness of the EnP protocol was likely to prevent recontamination or de novo contamination of the root canal space during treatment.

CONCLUSIONS

The implemented enhanced infection control protocol resulted in a specific reduction of microbial taxa often associated with recontamination or iatrogenic contamination, suggesting the basis for improved infection control measures during root canal treatment.

Radioimaging in the Evaluation of the Therapeutic Effect of the Vegetable Extract Obtained from Epilobium Parviflorum Schreb

For years, apical microleakage has been considered the main factor in endodontic failure therapy. Sealing abilities and antibacterial properties of root canal sealers and intracanal medicaments between appointments have been recognized as important factors for the success of endodontic treatment. Background: Apical periodontitis (AP) is an inflammatory disease around the apex of a tooth root. The microorganisms reach the pulp by dentinal tubules especially when there is an open cavity after a coronal fracture and the pulp is in contact with the septic oral environment. The aim of the study was to evaluate the dynamics of healing by recording periapical index (PAI), after two appointment endodontic procedure with commercial or experimental intracanal medicament. Methods: A total of 40 patients with primary chronic apical periodontitis requiring root canal treatment were assigned randomly into four groups according to the teeth medicated with dehydrated plant extract, calcium hydroxide, calcium hydroxide mixed with chlorhexidine (CHX) gel 2%, Walkhoff paste and obturated on a second visit, 7 days later. Patients were recalled at intervals of 3, 6, and 12 months to evaluate the treated teeth both clinically and radiographically for periapical healing. A 5-score scale PAI was used to evaluate stages of the periapical healing on a periapical radiography using a Kodak Dental imaging software provided by the radio-imagistic center. Results: Radiological evaluation revealed that the experimental intracanal medicament had a cumulative positive healing capacity by reducing the PAI as well as all resorbable pastes used in endodontic conventional therapy. Conclusions: The results suggest that the vegetable dry extract obtained from Epilobium parviflorum Schreb can be used as an inter-appointment medication among with the root canal filling for the positive effect on apical healing quantified by reducing the PAI.