Healing after surgical retreatment at four time points: A retrospective study

Outcome of curcumin-based photodynamic therapy in endodontic microsurgery: A case report

INTRODUCTION

Persistent apical periodontitis after root canal treatment may require surgical retreatment when non-surgical options are ineffective or impractical due to anatomical challenges or iatrogenic errors. Endodontic microsurgery (EMS) is a precise technique that aims to overcome extraradicular biofilm and root morphology issues. Photodynamic therapy (PDT) is an emerging supplementary disinfection approach that utilizes a photosensitizer agent and light to eliminate microorganisms through oxidative reactions.

REPORT

A 60-year-old male with persistent apical periodontitis in a left maxillary first molar underwent non-surgical root canal retreatment followed by surgical reintervention due to anatomical complexities. During surgery, PDT was performed using a novel curcumin-based photosensitizer agent. After the procedure, the tooth was retrofilled with bioceramic cement, and photobiomodulation was applied to enhance tissue healing. One year post-surgery, the patient exhibited complete periradicular repair and remained asymptomatic.

DISCUSSION

EMS is considered a last resort to salvage an endodontically treated tooth and has shown moderate success rates. PDT has demonstrated promise in improving periapical healing and reducing microorganisms. In this case, curcumin, diluted with 2 % chlorhexidine gel, served as an effective photosensitizer agent with antimicrobial properties. Moreover, performing photobiomodulation aided in cell recovery and reduced postoperative discomfort.

CONCLUSION

The proposed EMS treatment protocol with PDT using curcumin yielded positive outcomes in this case report. Further randomized clinical trials are necessary to assess the efficacy of this approach in EMS. Additionally, further research on curcumin-based photosensitizer agents encapsulated in nanoparticles and enhanced antimicrobial agents is recommended to refine this treatment protocol for routine use.

Predictors of periapical bone healing associated with teeth having large periapical lesions following nonsurgical root canal treatment or retreatment: A cone beam computed tomography-based retrospective study

AIM

Several factors influence the condition of the periapical tissues associated with root filled teeth. The primary objective of this study was to retrospectively evaluate the extent and speed of bone healing of large periapical lesions associated with nonsurgical root canal treatment or retreatment. The secondary objective was to analyse the relationship between the time to complete healing when analysed using cone beam computed tomography (CBCT) and other possible predictors that affect healing.

METHODOLOGY

Seventy-nine patients were treated during the years 2013-2020 with large periapical lesions of endodontic origin (10-15 mm) as observed on intraoral periapical radiographs (IOPAR) were included. IOPAR and CBCT were available before treatment and during the follow-up (IOPAR every 6 months and CBCT every 12 months). The volume of periapical lesions was calculated by OsiriX Lite software. Variables such as initial volume of the lesion, age, gender, type of treatment or type of root canal filling were compared to identify the differences between healed and unhealed lesions. Pearson's Chi-square test was used for categorical variables, the t-test for age and the Wilcoxon test for initial volume of the lesion. The association between time to healing and the variables was assessed using univariate analysis and multivariate analysis. The Wilcoxon test was used to observe the association of healing time with categorical variables and the correlation index was measured with the quantitative variables.

RESULTS

Of the 79 cases analysed, 60 lesions (76%) were completely healed as verified by CBCT in a mean healing time of 19 months, of which 60% healed fully between 12 and 18 months. Increase in age of patient and larger initial volume of the lesion were associated with a significantly longer healing time (p < .001). Gender, filling material and type of treatment did not have a significant effect on the healing process (p > .05).

CONCLUSIONS

Clinicians should be aware that periapical lesions in older patients and larger areas of bone loss take longer to heal. CBCT monitoring of large periapical lesions is critical and it can help clinicians in the decision-making process.

PROBE 2023 guidelines for reporting observational studies in endodontics: Explanation and elaboration

Observational studies play a critical role in evaluating the prevalence and incidence of conditions or diseases in populations as well as in defining the benefits and potential hazards of health-related interventions. There are currently no reporting guidelines for observational studies in the field of Endodontics. The Preferred Reporting Items for study Designs in Endodontology (PRIDE) team has developed and published new reporting guidelines for observational-based studies called the 'Preferred Reporting items for OBservational studies in Endodontics (PROBE) 2023' guidelines. The PROBE 2023 guidelines were developed exclusively for the speciality of Endodontics by integrating and adapting the 'STrengthening the Reporting of OBservational studies in Epidemiology (STROBE)' checklist and the 'Clinical and Laboratory Images in Publications (CLIP)' principles. The recommendations of the Guidance for Developers of Health Research Reporting Guidelines were adhered to throughout the process of developing the guidelines. The purpose of this document is to serve as a guide for authors by providing an explanation for each of the items in the PROBE 2023 checklist along with relevant examples from the literature. The document also offers advice to authors on how they can address each item in their manuscript before submission to a journal. The PROBE 2023 checklist is freely accessible and downloadable from the PRIDE website (http://pride-endodonticguidelines.org/probe/).

REAL-TIME 3D IMAGE-GUIDED NAVIGATION SYSTEM IN ENDODONTIC MICROSURGERY - A CADAVER STUDY

INTRODUCTION

This study evaluated the accuracy and efficiency of 3D Dynamic Navigation System (3D-DNS) to perform minimally invasive osteotomy (MIO) and root-end resection (RER) in endodontic microsurgery (EMS) and investigated the viability of root-end cavity preparation (RECP) and fill (REF) in MIO.

METHODS

We divided 48 tooth roots in cadaver heads into two groups: 3D-DNS (n = 24) and freehand (n = 24). Cone beam computed tomography (CBCT) scans were taken before and after surgery. First, we verified virtual 3D-DNS accuracy using three outcome measures: 2D and 3D virtual deviations and angular deflection (AD). Second, we investigated 3D-DNS's accuracy for performing MIO in two outcome measures: Osteotomy size and volume. Third, we determined the 3D-DNS accuracy for RER in three outcomes: Resected root length, root length after resection, and resection angle. We investigated the viability of RECP and REF and measured REF depth and volume, as well, recording procedural times and number of mishaps.

RESULTS

2D and 3D virtual deviations and AD were lower in the 3D-DNS than FH (p<.05). Osteotomy height, length, and volume were all reduced when using 3D-DNS (p < .05). The resection angle was lower for the 3D-DNS (p<.05). RECP and REF were completed in 100% of the roots. The REF depth achieved was ∼ 3mm. Osteotomy time, RER time, and total procedure time were all significantly shortened using 3D-DNS (p < .05).

CONCLUSIONS

3D-DNS enabled our surgeon to perform accurate and efficient EMS with minimally invasive osteotomy and RER. The surgeon was also able to conduct RECP with adequate REF in minimally invasive osteotomy performed using 3D-DNS guidance.