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Pirani C, Camilleri J. Effectiveness of root canal filling materials and techniques for treatment of apical periodontitis: A systematic review. Int Endod J 2023; 56 Suppl 3:436-454. [PMID: 35735776 DOI: 10.1111/iej.13787] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 06/15/2022] [Accepted: 06/15/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Apical periodontitis (AP) is an inflammatory disease of the apical periodontium as sequelae of pulp death. It is managed by disinfection and filling of the root canal space. OBJECTIVES The aim of this systematic review was to investigate whether obturation techniques and materials used for root canal filling led to the management of AP. METHODS A systematic review protocol was written following the preferred reporting items for systematic reviews and meta-analyses (PRISMA) checklist and registered on the international prospective register of systematic reviews (PROSPERO; CRD42021260275) including two populations, interventions, comparisons, outcomes and time (PICOT) for the research questions querying the effectiveness of obturation techniques (PICOT 1) and materials (PICOT 2) for the management of AP. Electronic searches were conducted on PubMed, ScienceDirect, Scopus and Embase search engines. Searches on International Endodontic Journal, Journal of Endodontics, Clinical Oral Investigations, Journal of Dental Research and Journal of Dentistry websites were also conducted, until May 2021. Both primary (tooth survival) and secondary outcomes were evaluated. The risk of bias was assessed by Cochrane RoB2 for the randomized and ROBINS-I for the nonrandomized trials. RESULTS The search strategy identified 1652 studies, with 1600 excluded on the title and abstract screening, leaving 52 studies for full-text screening. In total, 10 studies met the inclusion criteria. The obturation technique and materials used did not affect the outcome of AP. Vertical compaction resulted in faster resolution of periapical lesions. The oral health-related quality of life of patients treated with lateral condensation exhibited poorer outcomes compared with single matched cone after 6 months of recall. DISCUSSION The inclusion and exclusion criteria used for this systematic review enabled the capture of all the literature available on the effect of obturation techniques and materials on the outcome of AP. The data were heterogenous, and a number of articles investigating obturation techniques had no information on the materials and techniques used as they looked at the quality of fill. CONCLUSIONS Included studies did not find any difference between different procedures (PICOT 1) and materials (PICOT 2). The risk of bias was high, thus the findings should be interpreted with caution. REGISTRATION PROSPERO registration number: CRD42021260275.
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Affiliation(s)
- Chiara Pirani
- Department of Biomedical and Neuromotor Sciences (DIBINEM), School of Dentistry, Endodontic Clinical Section, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Josette Camilleri
- School of Dentistry, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
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Nosrat A, Valancius M, Mehrzad S, Dianat O, Verma P, Aminoshariae A, Fouad AF. Flare-ups After Nonsurgical Retreatments: Incidence, Associated Factors, and Prediction. J Endod 2023; 49:1299-1307.e1. [PMID: 37451334 DOI: 10.1016/j.joen.2023.07.004] [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: 03/19/2023] [Revised: 06/28/2023] [Accepted: 07/05/2023] [Indexed: 07/18/2023]
Abstract
INTRODUCTION The aims of this study were to determine the incidence, associated factors, and predictability of flare-ups after nonsurgical retreatments (NSRetx). METHODS All patients (n = 3,666) who received NSRetx by 3 endodontists in 2 endodontic offices during a period of 6 years (2016-2022) were included. Demographic, diagnostic, and procedural data were collected. A flare-up was defined as moderate-severe pain with/without swelling that took place within 14 days of initiation of NSRetx and resulted in an unscheduled appointment. Bivariate analyses on the entire cohort and multivariable analyses on cases with complete dataset (n = 2,846) were performed to identify significant associations. A Random Forest algorithm was used to make a prediction model. RESULTS Incidence of flare-ups was 3.95% (n = 145). Increased risk of flare-ups was associated with diabetes (adjusted odds ratio [AOR] = 2.01; 95% confidence interval [CI], 1.01-3.97), mandibular teeth (AOR = 1.67; 95% CI, 1.11-2.52), moderate-severe preoperative pain on percussion (AOR = 2.13; 95% CI, 1.31-3.50), and pain on palpation (AOR = 1.63; 95% CI, 1.01-2.64). Lower risk of flare-up was associated with high blood pressure (AOR = 0.44; 95% CI, 0.21-0.82) (P < .05). The prediction model was not able to predict flare-ups with sufficient confidence (precision = 0.13). CONCLUSIONS Incidence of flare-ups following NSRetx was low (∼4%) and had a weak but significant association with the history of diabetes. Moderate-severe pain on percussion, pain on palpation (any intensity), and mandibular teeth had a significant association with flare-ups. The history of high blood pressure was associated with lower risk of flare-ups. Flare-ups were difficult to predict in this clinical setting.
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Affiliation(s)
- Ali Nosrat
- Division of Endodontics, Department of Advanced Oral Sciences and Therapeutics, School of Dentistry, University of Maryland Baltimore, Baltimore, Maryland; Private Practice, Centreville Endodontics, Centreville, Virginia.
| | - Michael Valancius
- Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina
| | - Sahar Mehrzad
- Bernard J. Dunn School of Pharmacy, Shenandoah University, Fairfax, Virginia
| | - Omid Dianat
- Division of Endodontics, Department of Advanced Oral Sciences and Therapeutics, School of Dentistry, University of Maryland Baltimore, Baltimore, Maryland; Private Practice, Centreville Endodontics, Centreville, Virginia
| | - Prashant Verma
- Division of Endodontics, Department of Advanced Oral Sciences and Therapeutics, School of Dentistry, University of Maryland Baltimore, Baltimore, Maryland; Private Practice, Centreville Endodontics, Centreville, Virginia; Private Practice, Capitol Endodontics, Washington, District of Columbia
| | - Anita Aminoshariae
- Department of Endodontics, School of Dental Medicine, Case Western Reserve University, Cleveland, Ohio
| | - Ashraf F Fouad
- Department of Endodontics, School of Dentistry, The University of Alabama at Birmingham, Birmingham, Alabama
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Elheeny AAH, Sermani DI, Abdelmotelb MA. Postoperative pain perception and associated risk factors in children after continuous rotation versus reciprocating kinematics: A randomised prospective clinical trial. AUST ENDOD J 2023; 49 Suppl 1:345-352. [PMID: 37026535 DOI: 10.1111/aej.12746] [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: 05/18/2022] [Revised: 02/26/2023] [Accepted: 02/27/2023] [Indexed: 04/08/2023]
Abstract
To compare the postoperative pain of continuous rotation and reciprocating movements after pulpectomy of non-vital primary molars and determine associated risk factors. 146 children aged 4-8 years with one primary molar indicated for pulpectomy were randomly assigned to two equal groups: those instrumented with continuous rotation motion (Hyflex EDM Coltene/Whaledent) and reciprocating motion (Reciproc R25 (VDW)). A 4-point pain scale was used to assess postoperative pain frequencies, which were compared at different intervals using the Chi-square test. Postoperative pain risk factors were determined using logistic regression analysis. There was no statistically significant difference between the follow-ups. Gender, pulp status, and radiographic radiolucency increased the risk of postoperative pain incidence. Postoperative pain likelihood in children with chronic apical periodontitis was 8.72 times that of children with necrotic pulps. Postoperative pain after instrumentation with both kinematics was comparable. Postoperative pain incidence is increased by preoperative pulp condition, radiographic radiolucency, and gender.
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Affiliation(s)
- Ahmad Abdel Hamid Elheeny
- Department of Paediatric and Community Dentistry, Faculty of Dentistry, Minia University, El Minia, Egypt
| | - Dania Ibrahem Sermani
- Department of Paediatric Dentistry, Faculty of Dentistry, Minia University, El Minia, Egypt
- Intern at Minia University Minia Hospital, Minia University, El Minia, Egypt
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Baaij A, Visscher CM, Jansen M, Özok AR. Incidence of interappointment emergencies in multiple-visit root canal treatments performed with or without intracanal medicament by undergraduate students. Restor Dent Endod 2023; 48:e31. [PMID: 37675442 PMCID: PMC10477423 DOI: 10.5395/rde.2023.48.e31] [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: 03/06/2023] [Revised: 04/27/2023] [Accepted: 05/07/2023] [Indexed: 09/08/2023] Open
Abstract
Objectives This retrospective cohort study examined the incidence of interappointment emergencies during multiple-visit molar root canal treatments conducted by undergraduate students. Treatments performed without the use of intracanal medicament were compared to treatments that incorporated calcium hydroxide as an intracanal medicament. Materials and Methods Interappointment emergencies, defined as instances of pain or swelling that required the patient to make an unscheduled follow-up visit, were recorded for up to 2 months after the intervention. To avoid the influence of obturation on the observed incidence of emergency visits, only unscheduled visits occurring between the start and end of the root canal treatment were included. Results Of the 719 patients included in this study, 77 (10.7%) were recorded as experiencing interappointment emergencies. Of these emergencies, 62% occurred within 2 weeks following the most recent intervention. In the group of patients who did not receive intracanal medicament, the incidence of interappointment emergencies was 11.9% (46 of 385 patients). In comparison, this rate was 9.3% (31 of 334 patients) among those who received calcium hydroxide as an intracanal medicament (odds ratio, 1.33; 95% confidence interval, 0.82-2.15; p = 0.249). Conclusions Interappointment emergencies may arise at any point during root canal treatment, but they most commonly occur within the first 2 weeks following intervention. The omission of intracanal medicament in multiple-visit molar root canal treatments, performed by undergraduate students, did not significantly increase the incidence of these emergencies.
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Affiliation(s)
- Annemarie Baaij
- Department of Endodontology, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Corine Mirjam Visscher
- Department of Orofacial Pain and Dysfunction, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Manon Jansen
- Department of Endodontology, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Ahmet Rifat Özok
- Department of Endodontology, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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Sharma A, Sharma R, Sharma M, Jain S, Rai A, Gupta S. Endodontic Flare-Ups: An Update. Cureus 2023; 15:e41438. [PMID: 37546112 PMCID: PMC10403811 DOI: 10.7759/cureus.41438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/06/2023] [Indexed: 08/08/2023] Open
Abstract
Root canal treatment deals with mechanical and chemical cleaning followed by obturation that promotes healing and repair of periradicular tissues. Flare-ups can occur in between or some days after endodontic therapy leading to unscheduled visit by the patient. This complication is characterized by severe pain and/ or swelling. There is a correlation between number of appointments, intracanal medicament used and flare-ups. However, there is no sure procedure that can avoid this complication. Therefore, this review article has discussed about causes and some procedures to prevent and treat flare-ups.
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Affiliation(s)
- Anjali Sharma
- Conservative Dentistry and Endodontics, Teerthanker Mahaveer Dental College and Research Centre, Moradabad, IND
| | - Rohit Sharma
- Conservative Dentistry and Endodontics, Teerthanker Mahaveer Dental College and Research Centre, Moradabad, IND
| | - Madhurima Sharma
- Prosthodontics and Crown and Bridge, Teerthanker Mahaveer Dental College and Research Centre, Moradabad, IND
| | - Saloni Jain
- Conservative Dentistry and Endodontics, Teerthanker Mahaveer Dental College and Research Centre, Moradabad, IND
| | - Aparna Rai
- Conservative Dentistry and Endodontics, Teerthanker Mahaveer Dental College and Research Centre, Moradabad, IND
| | - Sheersh Gupta
- Conservative Dentistry and Endodontics, Teerthanker Mahaveer Dental College and Research Centre, Moradabad, IND
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Magar SS, Alfayyadh AY, Alruwaili KK, Almunahi HFF, Alsharari AHL, Magar SP. The Determination of Flare-Up Incidence and Associated Risk Factors During Endodontic Treatment: An Observational Retrospective Study. Cureus 2022; 14:e31424. [DOI: 10.7759/cureus.31424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 11/07/2022] [Indexed: 11/15/2022] Open
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Milani AS, Froughreyhani M, Taghiloo H, Nouroloyouni A, Jafarabadi MA. The effect of antibiotic use on endodontic post-operative pain and flare-up rate: a systematic review with meta-analysis. Evid Based Dent 2022:10.1038/s41432-021-0205-z. [PMID: 35165442 DOI: 10.1038/s41432-021-0205-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 05/14/2021] [Indexed: 06/14/2023]
Abstract
Aim Antibiotics are widely used to prevent flare-ups after endodontic treatment of non-vital teeth. This systematic review assessed the effect of antibiotic administration on post-endodontic treatment pain and flare-up rate.Methods Five major databases including Web of Science, Cochrane Library, PubMed, Scopus and Embase were searched to identify randomised clinical trials (RCTs) published until September 2020. Retrieved papers were critically appraised using the revised Cochrane risk of bias tool (RoB 2). To reduce the clinical heterogeneity, the included studies were divided into two groups: studies on symptomatic non-vital teeth and studies on asymptomatic non-vital teeth. The primary outcomes were 'post-operative pain' and 'flare-up rate'. The data of included studies were statistically combined through meta-analysis using random-effect model. The Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach was used to assess the quality of evidence.Results Six RCTs involving two RCTs (N = 61) on symptomatic teeth and four RCTs (N = 310) on asymptomatic teeth were included. In two RCTs on asymptomatic teeth, prophylactic antibiotic had been used, while in the remaining two RCTs, antibiotics had been administered after treatment. Quantitative synthesis of the RCTs showed that antibiotic administration following endodontic treatment of symptomatic non-vital teeth has no effect on pain severity at 24 hours following treatment (weighted mean difference [WMD] = -0.03; 95% confidence interval [CI]: -0.53 to 0.47), and the use of antibiotics before endodontic treatment of asymptomatic non-vital teeth has no effect on flare-up rate (relative risk [RR] = 0.58; 95% CI: 0.22-1.54). The GRADE approach revealed that the overall quality of evidence on the topic is low.Conclusions The antibiotic administration following endodontic treatment of symptomatic non-vital teeth has no effect on pain severity at 24 hours following treatment. Also, prophylactic antibiotics are ineffective in reducing the flare-up rate following treatment of asymptomatic non-vital teeth. However, to evaluate the effect of post-treatment antibiotics on flare-up rate in asymptomatic non-vital teeth, more high-quality RCTs are needed.
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Affiliation(s)
- Amin Salem Milani
- Associate Professor of Endodontics, Research Centre for Evidence-Based Medicine (EBM), Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran.
| | - Mohammad Froughreyhani
- Professor of Endodontics, Department of Endodontics, Faculty of Dentistry, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Hamid Taghiloo
- Assistant Professor, Department of Oral and Maxillofacial Radiology, Faculty of Dentistry, Tabriz University of Medical sciences, Tabriz, Iran
| | - Ahmad Nouroloyouni
- Assistant Professor of Endodontics, Department of Endodontics, Faculty of Dentistry, Ardebil University of Medical Sciences, Tabriz, Iran
| | - Mohammad Asghari Jafarabadi
- Department of Statistics and Epidemiology, School of Medicine, Zanjan University of Medical Sciences, Zanjan, Iran
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Chaniotis A, Ordinola Zapata R. Present status and future directions -Management of curved and calcified root canals. Int Endod J 2022; 55 Suppl 3:656-684. [PMID: 35106792 DOI: 10.1111/iej.13685] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 01/14/2022] [Accepted: 01/18/2022] [Indexed: 12/01/2022]
Abstract
Root canal curvature and calcification introduce factors that increase the risk of procedural accidents during root canal treatment. The inability to achieve patency to the apical third, asymmetrical dentine removal leading to transportation, perforation and instrument fracture inside the curved trajectories are some of the procedural problems that might jeopardize the management of intraradicular infection and result in poor treatment outcomes. In fact, curved and constricted canals introduce such complexity that total instrumentation concepts and specially designed instruments have been developed to deal with the challenge. This narrative review seeks to provide and consolidate the principles necessary for understanding the dynamics of curved and constricted canal management and to improve the understanding for future developments in this field.
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Affiliation(s)
- Antonis Chaniotis
- Private practice, National and Kapodistrian University of Athens, Dental School, Athens, Greece
| | - Ronald Ordinola Zapata
- Division of Endodontics, School of Dentistry, University of Minnesota, Minneapolis, Minnesota, USA
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Abbott PV. Present status and future directions - managing endodontic emergencies. Int Endod J 2021; 55 Suppl 3:778-803. [PMID: 34958512 DOI: 10.1111/iej.13678] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 12/20/2021] [Accepted: 12/26/2021] [Indexed: 11/28/2022]
Abstract
Endodontic emergencies are common in both general dental practices and specialist Endodontic practices. The aim of this review is to provide an overview of endodontic emergencies. Endodontic emergencies can be a result of many different conditions of the pulp, root canal and periradicular tissues. They may occur before endodontic treatment has been started, between appointments when treatment is being performed over multiple visits, or after endodontic treatment has been completed. In the latter situation, the emergency may be very soon after the treatment or it may occur many years later, in which case it is usually a new disease process as a result of the root canal system becoming infected. An emergency can be a stressful situation for both the patient and the dentist (or endodontist) as it is usually an unexpected event. It is incumbent on dental professionals to provide timely assistance to patients who have an emergency, and it is also important to allow sufficient time to manage the situation comprehensively. Management of endodontic emergencies should follow the principles of the 3D's - Diagnosis, Definitive dental treatment and Drugs - and in that sequence. An accurate diagnosis, the first "D", is essential so the appropriate treatment can be provided. Diagnosis requires a thorough understanding of the various conditions that can cause the emergency and this can be helped by having a comprehensive classification of the various conditions. The diagnosis should also direct the clinician to the appropriate definitive dental treatment, the second "D". Root canal treatment will not always be required as some cases can be managed conservatively. Other cases may require root canal re-treatment. The specific details of how the treatment is done can also vary, according to the diagnosis. The final "D" is Drugs - the use of drugs should also be dependent on the diagnosis and the dental treatment. Drugs should only be an adjunct following the treatment. The clinician must also differentiate between inflammation and infection in order to provide the appropriate treatment and to prescribe the appropriate medication for effective pain relief and resolution of other symptoms or signs such as swelling.
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Affiliation(s)
- Paul V Abbott
- UWA Dental School, The University of Western Australia, Western Australia, Australia
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Bassam S, El-Ahmar R, Salloum S, Ayoub S. Endodontic postoperative flare-up: An update. Saudi Dent J 2021; 33:386-394. [PMID: 34803278 PMCID: PMC8589595 DOI: 10.1016/j.sdentj.2021.05.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Revised: 05/13/2021] [Accepted: 05/20/2021] [Indexed: 02/03/2023] Open
Abstract
Endodontic treatment corresponds to a combined chemical and mechanical approach, followed by a three dimensional hermetic obturation, that eliminate the pulpal and periradiculare disease and boost healing and repair of periradiculare tissue. Despite the advances in the endodontic field, the inter-appointment flare up remains a true nightmare that encounters every dentist. This complication commences a few hours or days after root canal procedures and it is characterized by the development of pain and/or swelling, requiring an unscheduled appointment for emergency treatment. Different studies showed that flare-ups represent a multifactorial phenomenon including mechanical, chemical and microbial factors. In addition, a correlation was found between flare-up and age, gender, tooth type, presence of preoperative pain, tooth condition before treatment, irrigation techniques, number of visits as well as intracanal medication. Moreover, some medicine intake was proved to be efficient in controlling this postoperative pain. However, a clear procedure to avoid its occurrence is yet to be established. In this review, we summarize knowledge about the etiology of flare-up and its related factors. This could be effective in helping dentists to adapt some strategies to prevent it.
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Affiliation(s)
- Sanaa Bassam
- Department of Endodontics, Faculty of Dental Medicine, Lebanese University, Beirut, Lebanon
| | - Rima El-Ahmar
- Department of Restorative and Esthetic Dentistry, Faculty of Dental Medicine, Lebanese University, Beirut, Lebanon
| | - Sara Salloum
- Department of Endodontics, Faculty of Dental Medicine, Lebanese University, Beirut, Lebanon
| | - Sara Ayoub
- Department of Prosthodontics, Faculty of Dental Medicine, Lebanese University, Beirut, Lebanon
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11
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Predin Djuric N, Van Der Vyver P, Vorster M, Vally ZI. Comparison of apical debris extrusion using clockwise and counter-clockwise single-file reciprocation of rotary and reciprocating systems. AUST ENDOD J 2021; 47:394-400. [PMID: 33638593 DOI: 10.1111/aej.12490] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 01/14/2021] [Accepted: 01/29/2021] [Indexed: 11/28/2022]
Abstract
The aim was to evaluate apical debris extrusion produced by a single-file system used in counter-clockwise reciprocation and compare it to rotary single-file systems used in clockwise rotation and clockwise reciprocation. A total of 100 first mandibular molars were divided into five groups (n = 20): (i) WaveOne Gold Glider and Primary instrument in counter-clockwise reciprocation; (ii) One G and One Curve file in clockwise rotation; (iii) One G and One Curve file in clockwise reciprocation; (iv) TruNatomy Glider and Prime instrument in clockwise rotation; and (v) TruNatomy Glider and Prime instrument in clockwise reciprocation. Apical debris extruded was measured after glide path preparation and canal preparation. WaveOne Gold displayed significantly higher amounts of apical debris extrusion in all the groups (P < 0.05). The lowest mean values were recorded by clockwise reciprocation groups: TruNatomy Glider, One Curve and TruNatomy Glider and Prime combined value, for glide path, canal preparation and combined mean values, respectively.
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Affiliation(s)
- Natasa Predin Djuric
- Department of Odontology, Faculty of Health Sciences, School of Dentistry, Oral and Dental Hospital, University of Pretoria, Pretoria, Gauteng, South Africa
| | - Peet Van Der Vyver
- Department of Odontology, Faculty of Health Sciences, School of Dentistry, Oral and Dental Hospital, University of Pretoria, Pretoria, Gauteng, South Africa
| | - Martin Vorster
- Department of Odontology, Faculty of Health Sciences, School of Dentistry, Oral and Dental Hospital, University of Pretoria, Pretoria, Gauteng, South Africa
| | - Zunaid Ismail Vally
- Department of Odontology, Faculty of Health Sciences, School of Dentistry, Oral and Dental Hospital, University of Pretoria, Pretoria, Gauteng, South Africa
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Natchiyar N, Asokan S, Geetha Priya PR, Yogesh Kumar TD. Comparison of Clinical and Radiographic Success of Rotary with Manual Instrumentation Techniques in Primary Teeth: A Systematic Review. Int J Clin Pediatr Dent 2021; 14:8-13. [PMID: 34326578 PMCID: PMC8311778 DOI: 10.5005/jp-journals-10005-1879] [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] [Indexed: 11/23/2022] Open
Abstract
Aim and objective A systematic review was planned to compare the clinical and radiographic success rate of pulpectomy in primary molars using a rotary system and hand files system. Study design The literature search was undertaken in electronic databases from January 2000 to December 2019 using keywords. Four hundred and forty-two studies were identified after applying limits. Three hundred and thirty-one irrelevant articles were eliminated. Among the 111 articles obtained, 90 articles were eliminated after reading the titles and abstracts. After assessing the full text, 18 articles were eliminated. Randomized controlled trials (RCTs) published in the English language on pulpectomy of primary molars, using hand files and rotary files and with a follow-up period of 12 months were included. Results Three RCTs comparing the clinical and radiographic pulpectomy success rates using rotary and hand files instrumentation were finally selected. Qualitative assessment with RoB 2.0 showed one study had a low risk of bias and two studies had a high risk of bias. Conclusion Pulpectomy procedures in primary teeth using rotary and hand files instrumentation techniques were equally effective in terms of success rates. How to cite this article Natchiyar N, Asokan S, Geetha Priya PR, et al. Comparison of Clinical and Radiographic Success of Rotary with Manual Instrumentation Techniques in Primary Teeth: A Systematic Review. Int J Clin Pediatr Dent 2021;14(1):8–13.
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Affiliation(s)
- Nambi Natchiyar
- Department of Pediatric and Preventive Dentistry, KSR Institute of Dental Science and Research, Tiruchengode, Namakkal, Tamil Nadu, India
| | - Sharath Asokan
- Department of Pediatric and Preventive Dentistry, KSR Institute of Dental Science and Research, Tiruchengode, Namakkal, Tamil Nadu, India
| | - Pollachi Ramakrishnan Geetha Priya
- Department of Pediatric and Preventive Dentistry, KSR Institute of Dental Science and Research, Tiruchengode, Namakkal, Tamil Nadu, India
| | - Thoppe Dhamodharan Yogesh Kumar
- Department of Pediatric and Preventive Dentistry, KSR Institute of Dental Science and Research, Tiruchengode, Namakkal, Tamil Nadu, India
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Mantri S, Gupta N, Paul B, Dube K, Ghosh S. Incidence of postoperative pain after single-visit and multiple-visit root canal therapy: A randomized controlled trial. J Conserv Dent 2021; 24:348-353. [PMID: 35282580 PMCID: PMC8896126 DOI: 10.4103/jcd.jcd_216_21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 08/31/2021] [Accepted: 09/01/2021] [Indexed: 11/04/2022] Open
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Nosrat A, Dianat O, Verma P, Nixdorf DR, Law AS. Postoperative Pain: An Analysis on Evolution of Research in Half-Century. J Endod 2020; 47:358-365. [PMID: 33271179 DOI: 10.1016/j.joen.2020.11.021] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Accepted: 11/23/2020] [Indexed: 01/14/2023]
Abstract
INTRODUCTION Examining the evolution of research parameters helps scientists to discover the well-developed and neglected aspects of knowledge. Pain after root canal treatment is a health problem affecting millions of patients. Research in this field has a meaningful impact on quality of lives. The aim of this study was to analyze the evolution of research on postoperative pain over the past 50 years. METHODS Electronic searches were performed in Scopus and MEDLINE databases to identify studies on pain after nonsurgical root canal treatments/retreatments. The full texts of eligible articles were reviewed to determine the study category and to extract and analyze the methodological variables. A series of statistical analyses were performed to determine the trend of publications based on the variable of interest over time. RESULTS Four hundred twenty-four articles were included. There was a positive trend for systematic reviews, studies with sample size <200, studies on single-visit treatment, and clinical trials on instrumentation and adjunct treatments (P < .05). There was a negative trend for the use of numeric rating scales, studies on multiple-visit treatments, clinical trials on medication/medicament, and studies on pain in maxillary incisors (P < .05). No trend was observed based on pulpal diagnosis or for studies with longer observation periods (>8 weeks) (P > .05). CONCLUSIONS A paradigm shift is needed toward clinical studies with larger sample sizes, longer observation periods, and more focus on pulpal diagnoses associated with higher rates of postoperative pain. There is a need to view postoperative pain as an important patient-centered outcome and to develop and disseminate standard reporting guidelines for future studies.
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Affiliation(s)
- Ali Nosrat
- Division of Endodontics, Department of Advanced Oral Sciences and Therapeutics, School of Dentistry, University of Maryland Baltimore, Maryland; Private Practice, Centreville Endodontics, Centreville, Virginia.
| | - Omid Dianat
- Division of Endodontics, Department of Advanced Oral Sciences and Therapeutics, School of Dentistry, University of Maryland Baltimore, Maryland
| | - Prashant Verma
- Division of Endodontics, Department of Advanced Oral Sciences and Therapeutics, School of Dentistry, University of Maryland Baltimore, Maryland; Private Practice, Centreville Endodontics, Centreville, Virginia; Private Practice, Capitol Endodontics, Washington, DC
| | - Donald R Nixdorf
- Division of TMD and Orofacial Pain, School of Dentistry, University of Minnesota, Minneapolis, Minnesota; Department of Neurology, Medical School, University of Minnesota, Minneapolis, Minnesota; HealthPartners Institute for Education and Research, Bloomington, Minnesota
| | - Alan S Law
- Private Practice, The Dental Specialists, Lake Elmo, Minnesota; Division of Endodontics, School of Dentistry, University of Minnesota, Minneapolis, Minnesota
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The top risk factors for endodontic flare-up: a Monte Carlo simulation. Clin Oral Investig 2020; 25:3681-3690. [PMID: 33215302 DOI: 10.1007/s00784-020-03692-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Accepted: 11/10/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVES The aim of this study was to analyze the strength of risk factors related to endodontic flare-ups and rank them in order of their importance MATERIALS AND METHODS: A systematic literature search of PubMed, Cochrane Central Register of Controlled Trials, Scopus, and ISI Web of Knowledge, and grey literature was conducted up to November 2019. One hundred ninety-eight publications were identified. Twelve records fulfilled the eligibility criteria, and eight significant risk factors for flare-up, namely, "Periapical lesion," "multiple-visit treatment," "preoperative pain," "necrotic teeth," "female gender," "retreatment," "percussion pain," and "analgesics," were selected to construct the simulation model. The final data pool was established by the integration of data of common risk factors in the included articles. Monte Carlo method was used to analyze of combined numerical data, for simulation of the risk factor impacts. Ten thousand iterations were generated in the simulation model. RESULTS The results of the simulation revealed that the risk estimates of the factors had varying ranges of influence and probability on the flare-up risk. "Periapical lesion" was found to be the most sensitive risk factor, following by "preoperative pain" which was ranked the second place. The third-ranked risk factor was "multiple-visit treatment." The least sensitive risk factors for endodontic flare-up were "retreatment," "female gender," "necrotic teeth," and "analgesics." CONCLUSIONS The present study provides better comprehension on the importance of risk factors for flare-up based on their risk estimates. CLINICAL RELEVANCE A Monte Carlo simulation was adopted to identify the most influential risk factors for endodontic flare-up with a ranking, which can be used to provide meaningful predictions and further insights into clinicians' perception of flare-up risk.
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Tan HSG, Lim KC, Lui JN, Lai WMC, Yu VSH. Postobturation Pain Associated with Tricalcium Silicate and Resin-based Sealer Techniques: A Randomized Clinical Trial. J Endod 2020; 47:169-177. [PMID: 33098889 DOI: 10.1016/j.joen.2020.10.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 09/10/2020] [Accepted: 10/13/2020] [Indexed: 01/02/2023]
Abstract
INTRODUCTION The incidence of immediate postobturation pain associated with 2 sealer techniques was compared and potential prognostic factors identified. METHODS Patients referred for endodontic treatment were recruited with informed consent. Root canals were debrided and teeth rendered asymptomatic before random allocation to receive TotalFill BC (FKG Dentaire SA, La Chaux-de-Fonds, Switzerland) or AH Plus sealer (Dentsply Maillefer, Ballaigues, Switzerland). Patients blinded to the sealer reported their postobturation pain experience 1, 3, and 7 days after treatment. Blinded and calibrated assessors independently reviewed treatment quality, sealer extrusion, and radiographic data under standardized conditions. RESULTS One hundred sixty eligible patients (163 teeth, 95.3%) returned their pain diary. No postobturation pain difference was found between the 2 sealers (P > .05), although the AH Plus sealer technique was significantly associated with extrusion beyond the apex (P < .05; odds ratio [OR] = 3.02; 95% confidence interval [CI], 1.39-6.57). Thirty-three (20.6%) patients reported pain on day 1 (median 1 = very mild pain), 16 (10.0%) on day 3 (median 1 = very mild pain), and 9 (5.6%) on day 7 (median 2 = mild pain). The prognostic factors were as follows: (1) moderate/severe preoperative pain (OR = 4.41; 95% CI, 1.42-13.76 on day 3 and OR = 5.16; 95% CI, 1.17-22.78 on day 7), (2) provoked preoperative pain (OR = 4.24; 95% CI, 1.40-12.78 on day 3 and OR = 5.35; 95% CI, 1.27-22.51 on day 7), (3) pulpless tooth (OR = 0.11; 95% CI, 0.02-0.57 on day 3), and (4) sonic activation during treatment (OR = 3.02; 95% CI, 1.39-6.57 on day 1 and OR = 3.01; 95% CI, 1.05-8.59 on day 3). CONCLUSIONS There was no significant difference in pain experience between teeth filled using AH Plus or TotalFill BC Sealer 1, 3, and 7 days after obturation. Patient- and treatment-related factors could influence postobturation pain.
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Affiliation(s)
| | - Kian Chong Lim
- Faculty of Dentistry, National University of Singapore, Singapore
| | - Jeen Nee Lui
- Department of Restorative Dentistry, National Dental Centre of Singapore, Singapore
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Singh A, Kumar A, Nazeer J, Singh R, Singh S. Incidence of postoperative flare-ups after single-visit and multiple-visit endodontic therapy in permanent teeth. J Indian Soc Pedod Prev Dent 2020; 38:79-83. [PMID: 32174633 DOI: 10.4103/jisppd.jisppd_354_19] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
AIM Single- and multiple-visit root canal treatment has been the subject of long-standing debate in the endodontic community, so the purpose of this study was to determine the incidence of postoperative flare-up after single- and multiple-visit endodontic therapy in permanent teeth. MATERIALS AND METHODS A total of 65 children aged >10 years who underwent root canal treatment were randomly categorized equally into two treatment groups: the first group underwent single-visit treatment, and the other group underwent multiple-visit therapy. The visual analog scale was employed to evaluate pain preoperatively and postoperatively after obturation. Recall visits were carried out after 1 week, 1 and 3, 6 and 9 months. The Statistical Package for the Social Sciences version 15.0 was employed for statistical analysis. RESULTS Except at the baseline, at all the other time intervals, the mean pain score in the multiple-visit group was higher as compared to that of the single-visit group; statistically no significant difference was found. CONCLUSION The mean pain score in the single-visit group was lower as compared to that of the multiple-visit group; however, the difference between the two groups was statistically significant (P > 0.05).
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Affiliation(s)
- Anju Singh
- Department of Dentistry, Nalanda Medical College and Hospital, Patna, Bihar, India
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- Department of Conservative Dentistry and Endodontics, Patna Dental College and Hospital, Patna, Bihar, India
| | - Abhas Kumar
- Department of Oral and Maxillofacial Surgery, Patna Dental College and Hospital, Patna, Bihar, India
| | - Jazib Nazeer
- Department of Oral Pathology and Microbiology, Patna Dental College and Hospital, Patna, Bihar, India
| | - Rohit Singh
- Department of Prosthodontics Crown Bridge and Implantology, Patna Dental College and Hospital, Patna, Bihar, India
| | - Supriya Singh
- Private Practice, Department of Oral Medicine and Radiology, Patna, Bihar, India
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Manual versus rotary instrumentation for primary molar pulpectomies- A 24 months randomized clinical trial. PEDIATRIC DENTAL JOURNAL 2018. [DOI: 10.1016/j.pdj.2018.02.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Del Fabbro M, Afrashtehfar KI, Corbella S, El-Kabbaney A, Perondi I, Taschieri S. In Vivo and In Vitro Effectiveness of Rotary Nickel-Titanium vs Manual Stainless Steel Instruments for Root Canal Therapy: Systematic Review and Meta-analysis. J Evid Based Dent Pract 2017; 18:59-69. [PMID: 29478682 DOI: 10.1016/j.jebdp.2017.08.001] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2017] [Revised: 08/05/2017] [Accepted: 08/05/2017] [Indexed: 11/28/2022]
Abstract
INTRODUCTION This systematic review evaluated the effectiveness of nickel-titanium (NiTi) rotary files compared to stainless-steel (SST) hand files. METHODS An electronic search was performed on Medline, EMBASE, CENTRAL and Scopus databases up to February 2016. An additional hand searching was performed in 13 journals. The studies were classified according to study type and the outcome variables. Two reviewers independently applied eligibility criteria, extracted data, and three reviewers independently assessed the quality of the evidence of each included study according to The Cochrane Collaboration's procedures. A meta-analysis was performed whenever it was possible. RESULTS The electronic and hand search strategies yielded 1155 references of studies after removal of duplicates. Four clinical studies (two prospective and two retrospective studies) and 18 in vitro studies (on extracted teeth) were included for the qualitative synthesis after full-text evaluation of the eligible studies. The overall level of methodological quality of the studies included can be considered inadequate. Only one clinical study was judged at low risk of bias, whereas most non-clinical studies had a low risk of bias. Three meta-analyses, based on a very limited number of studies, could be performed. Each meta-analysis contained two studies. Of these, one meta-analysis was based on clinical studies. CONCLUSIONS The results of this systematic review suggested that NiTi rotary instruments were associated with lower canal transportation and apical extrusion when compared to SST hand files, whereas both groups had similar outcomes in terms of success of therapy, amount of residual bacteria, and cleansing ability after treatment. However, due to the limited evidence available, these results should be interpreted with caution. Consequently, more randomized control trials using standardized protocols are needed in order to provide more solid recommendations.
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Affiliation(s)
- Massimo Del Fabbro
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy; Orthopedic Institute Galeazzi IRCCS, University of Milan, Milan, Italy.
| | - Kelvin Ian Afrashtehfar
- Department of Reconstructive Dentistry and Gerodontology, Faculty of Medicine, School of Dental Medicine, University of Bern, Bern, Switzerland; Division of Oral Health and Society Research, Faculty of Dentistry, McGill University, Montreal, Canada; Division of Prosthodontics and Dental Geriatrics, Faculty of Dentistry, University of British Columbia, Vancouver, Canada.
| | - Stefano Corbella
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy; Orthopedic Institute Galeazzi IRCCS, University of Milan, Milan, Italy
| | - Ahmed El-Kabbaney
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy; Conservative Dentistry and Endodontic Department, Faculty of Dentistry, Mansoura University, Mansoura, Egypt
| | - Isabella Perondi
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy; Orthopedic Institute Galeazzi IRCCS, University of Milan, Milan, Italy
| | - Silvio Taschieri
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy; Orthopedic Institute Galeazzi IRCCS, University of Milan, Milan, Italy
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Nair M, Rahul J, Devadathan A, Mathew J. Incidence of Endodontic Flare-ups and Its Related Factors: A Retrospective Study. J Int Soc Prev Community Dent 2017; 7:175-179. [PMID: 28852632 PMCID: PMC5558250 DOI: 10.4103/jispcd.jispcd_61_17] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Accepted: 06/12/2017] [Indexed: 11/17/2022] Open
Abstract
Aims and Objectives: The aim and objective of the study were to determine the incidence of flare-ups during endodontic treatment and to identify the risk factors associated with flare-ups. Subjects and Methods: A total of 1725 patients who were treated during the time period of 2009–2014 by the same endodontist were reviewed. Incidence of flare-up, patients' age, gender, status of pulp, tooth position, number of roots, and treatment provided were taken from their dental records. Relationship between these factors and flare-ups was examined. Statistical analysis was done using Pearson Chi-square test and Fisher's exact test. Results: A total of 2% incidence of endodontic flare-ups was seen out of 1725 cases. Patient's age, gender, and diagnosis had a significant effect on the development of flare-ups (P < 0.05). Tooth type, position of tooth, number of root canals, number of visits, and treatment modality had no significant effect on flare-up incidence. Conclusions: Diagnosis plays an important role in predicting the incidence of flare-ups. Patients in the age group of 40–60 years had a higher risk of developing flare-ups. Women compared to men are more prone to flare-ups.
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Affiliation(s)
- Manuja Nair
- Department of Conservative Dentistry and Endodontics, Pushpagiri College of Dental Sciences, Pathanamthitta, Kerala, India
| | - J Rahul
- Department of Conservative Dentistry and Endodontics, Pushpagiri College of Dental Sciences, Pathanamthitta, Kerala, India
| | - A Devadathan
- Department of Conservative Dentistry and Endodontics, Pushpagiri College of Dental Sciences, Pathanamthitta, Kerala, India
| | - Josey Mathew
- Department of Conservative Dentistry and Endodontics, Pushpagiri College of Dental Sciences, Pathanamthitta, Kerala, India
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Moreira MS, Anuar ASNS, Tedesco TK, dos Santos M, Morimoto S. Endodontic Treatment in Single and Multiple Visits: An Overview of Systematic Reviews. J Endod 2017; 43:864-870. [DOI: 10.1016/j.joen.2017.01.021] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Accepted: 01/15/2017] [Indexed: 11/17/2022]
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22
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Hou XM, Su Z, Hou BX. Post endodontic pain following single-visit root canal preparation with rotary vs reciprocating instruments: a meta-analysis of randomized clinical trials. BMC Oral Health 2017; 17:86. [PMID: 28545437 PMCID: PMC5445416 DOI: 10.1186/s12903-017-0355-8] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2016] [Accepted: 02/23/2017] [Indexed: 11/28/2022] Open
Abstract
Background In endodontic therapy, continuous rotary instrumentation reduced debris compared to reciprocal instrumentation, which might affect the incidence of post-endodontic pain (PP). The aim of our study was to assess whether PP incidence and levels were influenced by the choice of rotary or reciprocal instruments. Methods In this meta-analysis the Pubmed and EM databases were searched for prospective clinical randomized trials published before April 20, 2016, using combinations of the keywords: root canal preparation/instrumentation/treatment/therapy; post-operative/endodontic pain; reciprocal and rotary instruments. Results Three studies were included, involving a total of 1,317 patients, 659 treated with reciprocating instruments and 658 treated with rotary instruments. PP was reported in 139 patients in the reciprocating group and 172 in the rotary group. The PP incidence odds ratio was 1.27 with 95% confidence interval (CI) (0.25, 6.52) favoring rotary instruments. The mild, moderate and severe PP levels odds ratios were 0.31 (0.11, 0.84), 2.24 (0.66, 7.59) and 11.71 (0.63, 218.15), respectively. No evidence of publication bias was found. Conclusions Rotary instrument choice in endodontic therapy is associated with a lower incidence of PP than reciprocating instruments, while reciprocating instruments are associated with less mild PP incidence.
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Affiliation(s)
- Xiao-Mei Hou
- The Second Dental Center, Peking University School and Hospital of Stomatology, Beijing, China
| | - Zheng Su
- Department of Endodontics, Capital Medical University School of Stomatology, No. 4 Tian Tan Xi Li, Dong Cheng, Beijing, 100050, China
| | - Ben-Xiang Hou
- Department of Endodontics, Capital Medical University School of Stomatology, No. 4 Tian Tan Xi Li, Dong Cheng, Beijing, 100050, China.
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Saumya-Rajesh P, Krithikadatta J, Velmurugan N, Sooriaprakas C. Post-instrumentation pain after the use of either Mtwo or the SAF system: a randomized controlled clinical trial. Int Endod J 2016; 50:750-760. [DOI: 10.1111/iej.12702] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2016] [Accepted: 09/19/2016] [Indexed: 12/14/2022]
Affiliation(s)
- P. Saumya-Rajesh
- Department of Conservative Dentistry and Endodontics; Meenakshi Ammal Dental College and Hospital; Meenakshi University; Chennai Tamil Nadu India
| | - J. Krithikadatta
- Department of Conservative Dentistry and Endodontics; Meenakshi Ammal Dental College and Hospital; Meenakshi University; Chennai Tamil Nadu India
| | - N. Velmurugan
- Department of Conservative Dentistry and Endodontics; Meenakshi Ammal Dental College and Hospital; Meenakshi University; Chennai Tamil Nadu India
| | - C. Sooriaprakas
- Department of Conservative Dentistry and Endodontics; Meenakshi Ammal Dental College and Hospital; Meenakshi University; Chennai Tamil Nadu India
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Gomes MS, Böttcher DE, Scarparo RK, Morgental RD, Waltrick SBG, Ghisi AC, Rahde NM, Borba MG, Blomberg LC, Figueiredo JAP. Predicting pre- and postoperative pain of endodontic origin in a southern Brazilian subpopulation: an electronic database study. Int Endod J 2016; 50:729-739. [DOI: 10.1111/iej.12684] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2016] [Accepted: 08/11/2016] [Indexed: 01/19/2023]
Affiliation(s)
- M. S. Gomes
- Clinical Department; School of Dentistry; Pontifical Catholic University of Rio Grande do Sul; Porto Alegre Brazil
- Medical and Dental Center of the Military Police of Rio Grande do Sul; Porto Alegre Brazil
| | - D. E. Böttcher
- Clinical Department; School of Dentistry; Pontifical Catholic University of Rio Grande do Sul; Porto Alegre Brazil
| | - R. K. Scarparo
- Department of Conservative Dentistry; School of Dentistry; Federal University of Rio Grande do Sul; Porto Alegre Brazil
| | - R. D. Morgental
- Department of Semiology and Clinics; School of Dentistry; Federal University of Pelotas; Rio Grande do Sul Brazil
| | - S. B. G. Waltrick
- Clinical Department; School of Dentistry; Pontifical Catholic University of Rio Grande do Sul; Porto Alegre Brazil
| | - A. C. Ghisi
- Clinical Department; School of Dentistry; Pontifical Catholic University of Rio Grande do Sul; Porto Alegre Brazil
| | - N. M. Rahde
- Clinical Department; School of Dentistry; Pontifical Catholic University of Rio Grande do Sul; Porto Alegre Brazil
| | - M. G. Borba
- Clinical Department; School of Dentistry; Pontifical Catholic University of Rio Grande do Sul; Porto Alegre Brazil
| | - L. C. Blomberg
- Biomedical Informatics; Federal University of Health Sciences of Porto Alegre; Porto Alegre Brazil
| | - J. A. P. Figueiredo
- Clinical Department; School of Dentistry; Pontifical Catholic University of Rio Grande do Sul; Porto Alegre Brazil
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Azim AA, Azim KA, Abbott PV. Prevalence of inter-appointment endodontic flare-ups and host-related factors. Clin Oral Investig 2016; 21:889-894. [DOI: 10.1007/s00784-016-1839-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2015] [Accepted: 04/24/2016] [Indexed: 11/24/2022]
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Kfir A, Blau-Venezia N, Tsesis I, Goldberger T, Metzger Z. Does root canal treatment in necrotic pulp or retreatment cases with periapical lesions require anaesthesia? An in vivo clinical study. Int Endod J 2016; 50:330-338. [PMID: 26992649 DOI: 10.1111/iej.12632] [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: 12/12/2015] [Accepted: 03/15/2016] [Indexed: 11/29/2022]
Abstract
AIM To examine whether local anaesthesia is required for treating teeth with necrotic pulps (TNP) and retreatment cases (RCs) associated with periapical lesions. METHODOLOGY Root canal treatment was performed in TNP and RCs without the administration of local anaesthesia. Patients were assured that if they experienced pain, local anaesthesia would be provided. Eighty canals, 40 TNP and 40 RCs, were included in the study. Two length measurements were performed: one using an electronic apex locator (EAL), which was defined as the electronic length (EL), and the second, the length at which the patient first reported that a size 15 file was touching the periapical tissues, which was defined as the periodontal length (PL). The difference between these two measurements (Δ = PL - EL) was the parameter studied. Statistical analysis was conducted using two-way anova and paired t-tests. Working length (WL) was defined in this study as being 0.5 mm short of the EL. RESULTS EL was shorter than PL in 96% of cases. The mean difference between measurements was 0.78 (±0.11) mm in the TNP group and 0.63 (±0.15) mm in the RC group; the difference was not significant. The distances between the WL and PL were thus 1.28 and 1.13 mm, respectively. In none of the 80 canals did the patient experience any pain, either during the measurements or during the instrumentation procedures. CONCLUSIONS When EALs are used, local anaesthesia may not be required for root canal treatment in teeth with necrotic pulps and retreatment cases associated with periapical lesions.
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Affiliation(s)
- A Kfir
- Department of Endodontology, The Goldschleger School of Dental Medicine, Tel Aviv University, Tel Aviv, Israel
| | - N Blau-Venezia
- Department of Endodontology, The Goldschleger School of Dental Medicine, Tel Aviv University, Tel Aviv, Israel
| | - I Tsesis
- Department of Endodontology, The Goldschleger School of Dental Medicine, Tel Aviv University, Tel Aviv, Israel
| | - T Goldberger
- Department of Endodontology, The Goldschleger School of Dental Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Z Metzger
- Department of Endodontology, The Goldschleger School of Dental Medicine, Tel Aviv University, Tel Aviv, Israel
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Çiçek E, Akkocan O, Furuncuoglu F. Comparison of apically extruded debris associated with several nickel-titanium systems after determining working length by apex locator. J Conserv Dent 2016; 19:68-71. [PMID: 26957797 PMCID: PMC4760018 DOI: 10.4103/0972-0707.173203] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Background/Aim: To compare apically extruded debris using ProTaper Universal (PTU), ProTaper Next (PTN), WaveOne (WO), Twisted File (TF), M-Two (MT), and Revo-S (RS) after determining the working length (WL) with root ZX. Materials and Methods: Seventy-two teeth were selected. The WL determination was performed with root ZX. The teeth were divided into six experimental groups, randomly. In groups, root canals were prepared with PTU to size F4/0.06, with PTN to size X4/0.06, with WO to size 40/0.08, with TF to size 40/0.04, with MT to size 40/0.06, and with RS to size AS40/0.06. After preparations were completed, final irrigation was performed with 2 mL distilled water, and a total of 10 mL of distilled water was used in each tooth. Tubes were stored in an incubator at 68°C for 5 days to evaporate the distilled water before weighing the dry debris. Data were analyzed by the Mann–Whitney U-test. Results: The RS group led to the highest amount of extruded debris, however, WO led to the least amount of extruded debris. There was no statistically difference among the groups (P > 0.05). Conclusions: The authors conclude that the results obtained might depend on the apex locator used to determine the WL.
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Affiliation(s)
- Ersan Çiçek
- Department of Endodontics, Faculty of Dentistry, Bülent Ecevit University, Zonguldak, Turkey
| | - Oguzhan Akkocan
- Department of Endodontics, Faculty of Dentistry, Bülent Ecevit University, Zonguldak, Turkey
| | - Fatma Furuncuoglu
- Department of Endodontics, Faculty of Dentistry, Ondokuz Mayis University, Samsun, Turkey
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Onay EO, Ungor M, Yazici AC. The evaluation of endodontic flare-ups and their relationship to various risk factors. BMC Oral Health 2015; 15:142. [PMID: 26577095 PMCID: PMC4647657 DOI: 10.1186/s12903-015-0135-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2015] [Accepted: 11/10/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To evaluate the incidence of flare-ups and identify the risk factors including age, gender, tooth type, number of root canals, initial diagnosis, the type of irrigation regimen, treatment modality and the number of visits, in patients who received root canal treatment from January 2002 to January 2008. METHODS Records of 1819 teeth belonging to 1410 patients treated by 1 endodontics specialist during 6-year period were kept. Patient, tooth, and treatment characteristics were evaluated and the relationships between these characteristics and flare-ups were studied. Statistical analysis was carried out by using Pearson Chi-square test, Fisher's Exact test, and Binary Logistic regression analyses. RESULTS The incidence of flare-ups was 59 (3.2 %) out of 1819 teeth that received endodontic therapy. Pulpal necrosis without periapical pathosis was the most common indication for flare-up (6 %) (p < 0.01). Teeth undergoing multiple visits had a higher risk of developing flare-ups compared to those with single appointments (OR: 3.14, CI: 1.414-7.009, p < 0.01). There were also no statistically significant differences in the incidence of flare-ups regarding to age, gender, tooth type, number of root canals, treatment modality, and the irrigation solutions that used during the treatment. CONCLUSIONS The incidence of flare-up is minimal when teeth are treated in one visit. Absence of a periapical lesion in necrotic teeth is a significant risk factor for flare-ups.
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Affiliation(s)
- Emel Olga Onay
- Department of Endodontics, Baskent University, School of Dentistry, 82 sok No 26, 06490, Bahcelievler, Ankara, Turkey.
| | - Mete Ungor
- Department of Endodontics, Baskent University, School of Dentistry, 82 sok No 26, 06490, Bahcelievler, Ankara, Turkey.
| | - A Canan Yazici
- Department of Biostatistics, Baskent University, School of Medicine, Ankara, Turkey.
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Akbar I. Efficacy of Prophylactic use of Antibiotics to Avoid Flare up During Root Canal Treatment of Nonvital Teeth: A Randomized Clinical Trial. J Clin Diagn Res 2015; 9:ZC08-11. [PMID: 25954695 DOI: 10.7860/jcdr/2015/12046.5620] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2014] [Accepted: 01/22/2015] [Indexed: 11/24/2022]
Abstract
OBJECTIVES Flare-up during root canal treatment of non vital teeth is a common clinical incident. The aim of the present study was to assess the effect of prophylactic use of antibiotics to avoid flare up during root canal treatment of the teeth having asymptomatic necrotic pulp. MATERIALS AND METHODS A randomized double blind clinical trial with parallel design was conducted on 100 subjects with asymptomatic non vital teeth. They were randomly divided into two groups. The first group (50 participants) was given two gram amoxicillin one hour before the first visit of root canal treatment; the second group (50 participants) did not receive any treatment (control group). In both groups, root canal treatment was performed in two visits. The flare up was assessed by the pain visual analogue scale and based on the swelling criteria. The data were processed and analyzed using SPSS statistical software 17. A p-value of 0.05 or less was considered statistically significant. RESULTS A total of 80% of participants in the experimental group had flare up while 12% of participants had flare up in the control group. Prophylactic Amoxicillin had no effect on inter-appointment flare up (p > 0.05). There was no relationship between flare up and patient's age, gender and tooth type (p > 0.05). CONCLUSION Prophylactic use of Amoxicillin in asymptomatic non vital teeth before root canal treatment had no effect on the incidence of flare-up.
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Affiliation(s)
- Iftikhar Akbar
- Assistant Professor, Department of Conservative Dentistry, College of Dentistry, Aljouf University , Sakaka, Saudi Arabia
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Pamboo J, Hans MK, Kumaraswamy BN, Chander S, Bhaskaran S. Incidence and factors associated with flare-ups in a post graduate programme in the indian population. J Clin Exp Dent 2014; 6:e514-9. [PMID: 25674318 PMCID: PMC4312678 DOI: 10.4317/jced.51578] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2014] [Accepted: 07/17/2014] [Indexed: 11/28/2022] Open
Abstract
Objectives: The study had twin objectives: to assess the incidence of flare-ups (a severe problem requiring an unscheduled visit and treatment) among patients who received endodontic treatment in the Department of Conservative Dentistry and Endodontics in Vyas Dental college and hospital, Jodhpur during a period of one year, and also to examine the correlation with pre-operative and operative variables.
Material and Methods: Data was collected from 1023 teeth from 916 patients who had received endodontic treatment over a 12- month period. Information was obtained for each patient treated, including pulp and peri-radicular diagnosis for the tooth, presence of pre-operatory pain, type of medication being used, type of instrumentation technique used and number of appointments needed to complete the root canal treatment.
Results: The results showed an incidence of 2.35% for flare-ups from 1023 endodontically treated teeth. Statistical analysis was done using the chi-square test.
Conclusions: Flare-ups were found to be affected significantly by gender of patient, presence of radiolucent lesions, patients taking pre-operative analgesic or anti-inflammatory drugs and on type of instrumentation technique. In contrast, there was no correlation between flare-ups and age, different arch/tooth groups and single or multiple visit endodontics.
Key words:Anti-inflammatory, flare-ups, instrumentation, prospective.
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Affiliation(s)
- Jaya Pamboo
- Post Graduate Student. Department of Conservative Dentistry and Endodontics, Vyas Dental College and Hospital, Jodhpur, Rajasthan, India
| | - Manoj-Kumar Hans
- Reader. Department of Conservative Dentistry and Endodontics, Vyas Dental College and Hospital, Jodhpur, Rajasthan, India
| | - Bangalore-Niranjan Kumaraswamy
- Professor. Department of Conservative Dentistry and Endodontics, Vyas Dental College and Hospital, Jodhpur, Rajasthan, India
| | - Subhash Chander
- Assistant Professor. Department of Conservative Dentistry and Endodontics, Vyas Dental College and Hospital, Jodhpur, Rajasthan, India
| | - Sajeev Bhaskaran
- Professor and Head. Department of Conservative Dentistry and Endodontics, Vyas Dental College and Hospital, Jodhpur, Rajasthan, India
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Yu VS, Khin LW, Hsu CS, Yee R, Messer HH. Risk score algorithm for treatment of persistent apical periodontitis. J Dent Res 2014; 93:1076-82. [PMID: 25190267 DOI: 10.1177/0022034514549559] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Persistent apical periodontitis related to a nonvital tooth that does not resolve following root canal treatment may be compatible with health and may not require further intervention. This research aimed to develop a Deterioration Risk Score (DRS) to differentiate lesions requiring further intervention from lesions likely to be compatible with health. In this cross-sectional study, patient records (2003-2008) were screened for root-filled teeth with periapical radiolucency visible on periapical radiographs taken at treatment and at recruitment at least 4 yr later. The final sample consisted of 228 lesions in 182 patients. Potential demographic and treatment risk factors were screened against 3 categorical outcomes (improved/unchanged/deteriorated), and a multivariate independent multinomial probit regression model was built. A 5-level DRS was constructed by summing values of adjusted regression coefficients in the model, based on predicted probabilities of deterioration. Most lesions (127, 55.7%) had improved over time, while 32 (14.0%) remained unchanged, and 69 (30.3%) had deteriorated. Significant predictors of deterioration were as follows: time since treatment (relative risk [RR]: 1.11, 95% confidence interval [CI]: 1.01-1.22, p = .030, rounded beta value = 1, for every year increase after 4 yr), current pain (RR: 3.79, 95% CI: 1.48-9.70, p = .005, rounded beta value = 13), sinus tract present (RR: 4.13, 95% CI: 1.11-15.29, p = .034, rounded beta value = 14), and lesion size (RR: 7.20, 95% CI: 3.70-14.02, p < .001, rounded beta value = 20). Persistent apical periodontitis with DRS <15 represented very low risk; 15-20, low risk; 21-30, moderate risk; 31-40, high risk; and >40, very high risk. DRS could help the clinician identify persistent apical periodontitis at low risk for deterioration, and it would not require intervention. When validated, this tool could reduce the risk of overtreatment and contribute toward targeted care and better efficiency in the timely management of disease.
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Affiliation(s)
- V S Yu
- Faculty of Dentistry, National University of Singapore, Singapore
| | - L W Khin
- Dean's Office Medicine Investigational Medicine Unit, Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - C S Hsu
- Faculty of Dentistry, National University of Singapore, Singapore
| | - R Yee
- Faculty of Dentistry, National University of Singapore, Singapore
| | - H H Messer
- Melbourne Dental School, University of Melbourne, Melbourne, Australia
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Song M, Liu K, Abromitis R, Schleyer TL. Reusing electronic patient data for dental clinical research: a review of current status. J Dent 2013; 41:1148-63. [PMID: 23603087 PMCID: PMC4141471 DOI: 10.1016/j.jdent.2013.04.006] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2013] [Revised: 04/04/2013] [Accepted: 04/10/2013] [Indexed: 01/07/2023] Open
Abstract
OBJECTIVES The reuse of electronic patient data collected during clinical care has received increased attention as a way to increase our evidence base. The purpose of this paper was to review studies reusing electronic patient data for dental research. DATA SOURCES 1527 citations obtained by searching MEDLINE and Embase databases, hand-searching seven dental and informatics journals, and snowball sampling. STUDY SELECTION We included studies reusing electronic patient data for research on dental and craniofacial topics, alone or in combination with medical conditions, medications and outcomes. Studies using administrative or research databases and systematic reviews were excluded. Three reviewers extracted data independently and performed analysis jointly RESULTS The 60 studies reviewed covered epidemiological (32 studies), outcomes (16), health services research (10) and other (2) topics; were primarily retrospective (58 studies); varied significantly in sample size (9-153,619 patients) and follow-up period (1-12 years); often drew on other data sources in addition to electronic ones (25); but rarely tapped electronic dental record (EDR) data in private practices (3). Type of research was not associated with data sources used, but research topics/questions were. The most commonly reported advantages of reusing electronic data were being able to study large samples and saving time, while data quality and the inability to capture study-specific data were identified as major limitations. CONCLUSIONS Dental research reusing electronic patient data is nascent but accelerating. Future EDR design should focus on enhancing data quality, begin to integrate research data collection and implement interoperability with electronic medical records to facilitate oral-systemic investigations. CLINICAL SIGNIFICANCE Measuring and improving the quality of dental care requires that we begin to reuse electronic patient data collected in practice for clinical research. Practice data can potentially serve as a useful complement to data collected in traditional research studies.
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Affiliation(s)
- Mei Song
- Center for Dental Informatics, Department of Dental Public Health, University of Pittsburgh School of Dental Medicine, Pittsburgh, PA 15261, United States.
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Bürklein S, Schäfer E. Critical evaluation of root canal transportation by instrumentation. ACTA ACUST UNITED AC 2013. [DOI: 10.1111/etp.12043] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Tanalp J, Sunay H, Bayirli G. Cross-sectional evaluation of post-operative pain and flare-ups in endodontic treatments using a type of rotary instruments. Acta Odontol Scand 2013; 71:733-9. [PMID: 22905970 DOI: 10.3109/00016357.2012.715199] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
AIM The purpose of this clinical study was to evaluate the general incidence of post-operative pain and flare-ups in patients who were endodontically treated by two endodontics specialists using rotary instruments (Hero 642, Micro Mega, France) with the same treatment protocol. METHODS Records of 382 teeth belonging to 268 patients treated by two endodontics specialists during a 6-month period were kept and evaluated. Post-operative pain between treatment visits was categorized using a pre-established scoring system. Ninety-five patients were males, whereas 173 were females. RESULTS Pulpal necrosis without periapical pathosis was determined as the most common indication for endodontic treatment (21.7%) followed by irreversible pulpitis and re-treatment without periapical lesions (18.3%, 18.3%, respectively). The general prevalence of post-operative pain and flare-ups was determined as 8.1%, whereas cases that could be classified as real flare-ups which were severe and required an unscheduled visit (scores 2 and 3) comprised 3.4% of the cases. No statistically significant correlation was determined between gender and post-operative pain and flare-up (p = 0.05). There was a significant correlation between number of appointments and the presence of pain and flare-ups. Teeth undergoing multiple visits had a higher risk of developing post-operative pain and flare-ups compared to those with single appointments with a statistical significance (p = 0.03). CONCLUSIONS Teeth with pre-operative pain were more prone to developing post-operative pain and discomfort with a statistically significant difference (p = 0.02). While no significant correlation was determined between tooth vitality and pain and flare-ups (p = 0.5), a statistically significant relationship existed between the presence of a periapical pathosis and post-operative pain and flare-ups. Cases with a periapical lesion had a higher risk of developing pain and flare-ups compared to those with no periapical involvement (p = 0.0001). Future studies may focus on the influence of rotary instrumentation systems in more specific groups of cases. Meanwhile; microbiological as well as psychological aspects of flare-ups are topics that warrant further investigation.
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Affiliation(s)
- Jale Tanalp
- Faculty of Dentistry, Department of Endodontics, Yeditepe University, Bagdat Caddesi 238, Göztepe, Istanbul, 34728, Turkey.
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Lu Y, Wang R, Zhang L, Li HL, Zheng QH, Zhou XD, Huang DM. Apically extruded debris and irrigant with two Ni-Ti systems and hand files when removing root fillings: a laboratory study. Int Endod J 2013; 46:1125-30. [PMID: 23566178 DOI: 10.1111/iej.12104] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2012] [Accepted: 03/10/2013] [Indexed: 02/05/2023]
Abstract
AIM To compare the amount of apically extruded debris and irrigant produced by two Ni-Ti instruments and hand files when removing root fillings, and to compare two experimental models. METHODOLOGY Sixty single straight root canals in human mandibular premolars were prepared with K-files and filled with gutta-percha and AH Plus sealer. The teeth were randomly divided into three groups of 20 for removal of the root filling material with Reciproc files (Group 1, RP), Mtwo retreatment files (Group 2, MR) or hand files (Group 3, H). Each group was then equally divided into experimental subgroups: A, with 1.5% agar gel model (AG); B, with empty tube model (ET). Apically extruded debris and irrigant was quantified by subtracting the initial weight of the test apparatus without a tooth from its weight after the root canal retreatment. Comparative analysis of the amount of apically extruded debris and irrigant for each of the instruments and the experimental models was performed. Time for gutta-percha removal was recorded. Data were statistically analysed using one-way analysis of variance. RESULTS Removal of root fillings with two Ni-Ti instruments produced less apically extruded debris and irrigant than hand files in both experimental models (P < 0.05). More apically extruded debris and irrigant was produced with Reciproc files than Mtwo retreatment files using the 1.5% agar gel model (P > 0.05). Significantly more apically extruded debris and irrigant was produced with Reciproc files than Mtwo retreatment files using the empty tube model (P < 0.05). The time required to remove the root fillings followed Reciproc<Mtwo R<hand files (P < 0.05). CONCLUSIONS All the instruments produced apically extruded debris and irrigant. The two Ni-Ti instruments produced less apically extruded debris and irrigant than hand files. A 1.5% agar gel can provide resistance to apically extruded debris and irrigant and may represent the clinical situation better than the empty tube model.
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Affiliation(s)
- Y Lu
- State Key Laboratory of Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu
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Hamedy R, Shakiba B, Fayazi S, Pak JG, White SN. Patient-centered endodontic outcomes: a narrative review. IRANIAN ENDODONTIC JOURNAL 2013; 8:197-204. [PMID: 24171029 PMCID: PMC3808681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/01/2013] [Revised: 08/01/2013] [Accepted: 08/01/2013] [Indexed: 11/22/2022]
Abstract
INTRODUCTION Root canal treatment (RCT) success criteria inform us of the path to bony healing and of prognostic factors, but tell little about how the patient perceives, feels, or values RCT. Patients choose, undergo, and pay for RCT, they live with the result, and inform their community. The purpose of this narrative review was to appraise patient-centered outcomes of initial non-surgical RCT and nonsurgical retreatment, in adults. MATERIALS AND METHODS Patient-centered RCT outcome themes were identified in the extant literature: quality of life, satisfaction, anxiety, fear, pain, tooth survival and cost. Narrative review was applied because the disparate themes and data were unsuited to systematic review or meta-analysis. RESULTS Application of the Oral Health Impact Profile (OHIP) demonstrated that disease of pulpal origin affects quality of life with moderate severity, primarily through physical pain and psychological discomfort, and that RCT results in broad improvement of quality of life. Satisfaction with RCT is extremely high, but cost is the primary reason for dissatisfaction. Anxiety and fear affect RCT patients, profoundly influencing their behaviors, including treatment avoidance, and their pain experience. Fear of pain is "fair" to "very much" prior to RCT. Pain is widely feared, disliked, and remembered; however, disease of pulpal origin generally produces moderate, but not severe pain. RCT causes a dramatic decrease in pain prevalence and severity over the week following treatment. Survival rates of teeth after RCT are very high; complication rates are low. Cost is a barrier to RCT, but initial costs, lifetime costs, cost effectiveness, cost utility, and cost benefit all compare extremely well to the alternatives involving replacement using implants or fixed prostheses. CONCLUSION Dentists must strive to reduce anxiety, fear, experienced and remembered pain, and to accurately inform and educate their patients with respect to technical, practical and psychosocial aspects of RCT.
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Affiliation(s)
| | | | | | | | - Shane N White
- Section of Endodontics, UCLA School of Dentistry, Los Angeles, CA, USA,Corresponding author: Shane N White, Section of Endodontics, UCLA School of Dentistry, Los Angeles, CA, USA. Tel: +1-310 206 3644 (5), Fax: +1-310 794 4900 (6), E-mail:
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Martín-González J, Echevarría-Pérez M, Sánchez-Domínguez B, Tarilonte-Delgado ML, Castellanos-Cosano L, López-Frías FJ, Segura-Egea JJ. Influence of root canal instrumentation and obturation techniques on intra-operative pain during endodontic therapy. Med Oral Patol Oral Cir Bucal 2012; 17:e912-8. [PMID: 22549694 PMCID: PMC3482542 DOI: 10.4317/medoral.18234] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2012] [Accepted: 03/25/2012] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE To analyse the influence of root canal instrumentation and obturation techniques on intra-operative pain experienced by patients during endodontic therapy. METHOD AND MATERIALS A descriptive cross-sectional study was carried out in Ponferrada and Sevilla, Spain, including 80 patients (46 men and 34 women), with ages ranged from 10 to 74 years, randomly recruited. Patient gender and age, affected tooth, pulpal diagnosis, periapical status, previous NSAID or antibiotic (AB) treatment, and root canal instrumentation and obturation techniques were recorded. After root canal treatment (RCT), patients completed a 10-cm visual analogue scale (VAS) that ranked the level of pain. Results were analysed statistically using the Chi-square and ANOVA tests and logistic regression analysis. RESULTS The mean pain level during root canal treatment was 2.9±3.0 (median=2) in a VAS between 0 and 10. Forty percent of patients experienced no pain. Gender, age, arch, previous NSAIDs or AB treatment and anaesthetic type did not influence significantly the pain level (p>0.05). Pain during root canal treatment was significantly greater in molar teeth (OR=10.1; 95% C.I.=1.6-63.5; p=0.013). Root canal instrumentation and obturation techniques did not affect significantly patients' pain during root canal treatment (p>0.05). CONCLUSION Patients feel more pain when RCT is carried out on molar teeth. The root canal instrumentation and obturation techniques do not affect significantly the patients' pain during RCT.
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Affiliation(s)
- Jenifer Martín-González
- Department of Endodontics, School of Dentistry, University of Sevilla, Facultad de Odontología, C/ Avicena s/n, 41009-Seville, Spain
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Schäfer E, Bürklein S. Impact of nickel–titanium instrumentation of the root canal on clinical outcomes: a focused review. Odontology 2012; 100:130-6. [DOI: 10.1007/s10266-012-0066-1] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2012] [Accepted: 04/02/2012] [Indexed: 01/31/2023]
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Postoperative pain after root canal treatment: a prospective cohort study. Int J Dent 2012; 2012:310467. [PMID: 22505897 PMCID: PMC3312224 DOI: 10.1155/2012/310467] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2011] [Revised: 11/10/2011] [Accepted: 01/09/2012] [Indexed: 11/18/2022] Open
Abstract
Aim. To evaluate the incidence and severity of postendodontic treatment pain (PEP) subsequent to root canal treatment (RCT) in vital and necrotic pulps and after retreatment. Methodology. A prospective study. Participants were all patients (n = 274) who underwent RCT in teeth with vital pulp, necrotic pulp, or vital pulp that had been treated for symptomatic irreversible pulpitis or who received root canal retreatment, by one clinician, during an eight-month period. Exclusion criteria were swelling, purulence, and antibiotic use during initial treatment. A structured questionnaire accessed age, gender, tooth location, and pulpal diagnosis. Within 24 h of treatment, patients were asked to grade their pain at 6 and 18 hours posttreatment, using a 1–5 point scale. Results. RCT of teeth with vital pulp induced a significantly higher incidence and severity of PEP (63.8%; 2.46 ± 1.4, resp.) than RCT of teeth with necrotic pulp (38.5%; 1.78 ± 1.2, resp.) or of retreated teeth (48.8%; 1.89 ± 1.1, resp.). No statistical relation was found between type of pain (spontaneous or stimulated) and pulp condition. Conclusion. RCT of teeth with vital pulp induced a significantly higher incidence and intensity of PEP compared to teeth with necrotic pulp or retreated teeth.
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Incidence and Impact of Painful Exacerbations in a Cohort with Post-treatment Persistent Endodontic Lesions. J Endod 2012; 38:41-6. [DOI: 10.1016/j.joen.2011.10.006] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2011] [Revised: 10/14/2011] [Accepted: 10/16/2011] [Indexed: 11/21/2022]
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Abstract
The aim of this paper is to present the contemporary developments in root canal treatment, restoration of the endodontically treated tooth, and advanced endodontic procedures, such as root canal retreatment and surgical endodontics.
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Pasqualini D, Mollo L, Scotti N, Cantatore G, Castellucci A, Migliaretti G, Berutti E. Postoperative pain after manual and mechanical glide path: a randomized clinical trial. J Endod 2011; 38:32-6. [PMID: 22152616 DOI: 10.1016/j.joen.2011.09.017] [Citation(s) in RCA: 73] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2011] [Revised: 09/06/2011] [Accepted: 09/19/2011] [Indexed: 10/15/2022]
Abstract
INTRODUCTION This prospective randomized clinical trial evaluated the incidence of postoperative pain after glide path performed with PathFile (PF) (Dentsply Maillefer, Ballaigues, Switzerland) versus stainless-steel K-file (KF). METHODS In 149 subjects, the mechanical glide path was performed with nickel-titanium (NiTi) rotary PF; in 146 subjects, the manual glide path was performed with stainless-steel KFs. Postoperative pain, analgesics consumption, and the number of days to complete pain resolution were evaluated in the following 7 days. An analysis of variance model for repeated measures was used to compare the variation of pain-scale values (P < .05). The Student's t test for continuous variables normally distributed, the nonparametric Mann-Whitney U test for the nonnormally distributed variables, and the chi-square test for dichotomous variables were used (P < .05). Despite homogeneous baseline conditions at diagnosis, tooth type, pain prevalence, and scores, the postoperative pain prevalence curves in PF group evidenced a more favorable trend in terms of time to pain resolution compared with the KF group (P = .004). The difference was also evident in the model adjusted for analgesics consumption in both groups (P = .012). The mean analgesics intake per subject was significantly higher in the KF group (3.7 ± 2.2) compared with the PF group (2 ± 1.7) (P < .001). Mean pain stop values were also significantly higher in the KF group (2.7) compared with the PF group (1.7) (P = .001). CONCLUSIONS The glide path with NiTi Rotary PF leads to less postoperative pain and faster symptom resolution.
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Affiliation(s)
- Damiano Pasqualini
- Department of Endodontics, University of Turin Dental School, Turin, Italy.
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Pain Prevalence and Severity before, during, and after Root Canal Treatment: A Systematic Review. J Endod 2011; 37:429-38. [DOI: 10.1016/j.joen.2010.12.016] [Citation(s) in RCA: 199] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2010] [Revised: 12/10/2010] [Accepted: 12/20/2010] [Indexed: 11/18/2022]
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Udoye CI, Jafarzadeh H, Aguwa EN, Habibi M. Flare-up incidence and related factors in Nigerian adults. J Contemp Dent Pract 2011; 12:120-3. [PMID: 22186755 DOI: 10.5005/jp-journals-10024-1020] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
AIM To determine the incidence of flare-up and the effect of age, gender, visit type, treatment duration, preoperative pain and intraoperative pain on flare-up in Nigerian adults. MATERIALS AND METHODS A total of 175 participants, aged 18 to 60 years with a necrotic central incisor, with or without preoperative pain, participated. They received postoperative paracetamol tablets and were asked to report back if unbearable pain/swelling developed. RESULTS A 10% flare-up rate was recorded, while none of the studied factors had a significant relationship with flare-up. CONCLUSION The relationships between flare-up and studied related factors were not proven. CLINICAL SIGNIFICANCE Age, gender, visit type, treatment duration, preoperative pain and intraoperative pain have no effect on flare-up incidence.
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Affiliation(s)
- Christopher I Udoye
- Endodontic Unit, Department of RestorativeDentistry, Faculty of Dentistry, College of Medicine, University of Nigeria, Nigeria
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Alves VDO. Endodontic flare-ups: a prospective study. ACTA ACUST UNITED AC 2010; 110:e68-72. [DOI: 10.1016/j.tripleo.2010.05.014] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2009] [Revised: 05/05/2010] [Accepted: 05/15/2010] [Indexed: 11/25/2022]
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