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Shaik I, Veluru K, Sai Pranathi Gundimeda N, Jeevan Kakumanu N, Gowraram S, Pasupuleti S, Dikkala NSS. Outcomes of Regenerative Endodontic Treatment Performed Using Different Magnification Devices: A Systematic Review. JOURNAL OF PHARMACY AND BIOALLIED SCIENCES 2024; 16:S87-S89. [PMID: 38595596 PMCID: PMC11001110 DOI: 10.4103/jpbs.jpbs_555_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Revised: 08/20/2023] [Accepted: 09/01/2023] [Indexed: 04/11/2024] Open
Abstract
Aim In this systematic review, we assessed whether the effects of the usage of various devices help with magnification in endodontics and whether they resulted in any significant changes in the clinical result of treatment. Materials and Methods An exhaustive search was performed across MEDLINE and Cochrane Registers for various clinical studies, which were focused on comparing regenerative endodontic treatment based on the usage of magnification devices. Various terms were used to search these clinical trials such as microscope, regenerative endodontic surgery, apicoectomy, endoscope, and loupes. Results After scrutinizing the studies, around three clinical trials based on magnification in endodontic surgeries were included in the present review. It was observed that no statistically noteworthy betterment of treatment outcome was seen in patients treated with either of the magnification devices such as loupes and microscope. Conclusion It was evident that these magnification devices can alter the effectiveness of regenerative endodontic treatment in a very minimal way. However, we believe that more randomized clinical studies should be conducted in this area.
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Affiliation(s)
- Izaz Shaik
- Lakewood Family Dental, Bloomington, Illinios, USA
| | - Keerthini Veluru
- Government Dental College and Hospital, Hyderabad, Telangana, India, Masters in Health Informatics at University of North Texas, Texas, United States
| | | | | | - Sanjupriya Gowraram
- Chhattisgarh Dental College and Research Institute, Rajnandgaon, Chattisgarh, India
| | - Sowmya Pasupuleti
- SIBAR Institute of Dental Sciences, Takelapadu, Guntur, Andhra Pradesh, India
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Zhang MM, Fang GF, Wang ZH, Liang YH. Clinical Outcome and Predictors of Endodontic Microsurgery Using Cone-beam Computed Tomography: A Retrospective Cohort Study. J Endod 2023; 49:1464-1471. [PMID: 37633517 DOI: 10.1016/j.joen.2023.08.011] [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: 06/05/2023] [Revised: 08/16/2023] [Accepted: 08/17/2023] [Indexed: 08/28/2023]
Abstract
INTRODUCTION The aim of this retrospective cohort study was to evaluate the clinical outcomes and identify the prognostic factors of endodontic microsurgery based on cone-beam computed tomographic (CBCT) scans. METHODS Patients who underwent endodontic microsurgery in teeth with asymptomatic apical periodontitis were included. The clinical outcomes were determined based on clinical and radiographic examinations after surgery 12-48 months. Radiographic healing was assessed on CBCT images by using the modified PENN 3-dimensional criteria and classified into 4 categories: complete, limited, uncertain, and unsatisfactory healing. Multivariate logistic regression was performed to detect outcome risk factors. RESULTS Of the 204 teeth in 173 invited patients, 148 teeth of 126 patients were examined at review. On CBCT images, 88 teeth (59.5%) showed complete healing, and 42 (28.4%) teeth showed limited healing. All these 130 teeth were asymptomatic and achieved a clinical success rate of 87.8%. Uncertain healing was observed in 9 teeth, one of which was symptomatic. The remaining 9 teeth were unsatisfactory healing on CBCT scans, including 6 teeth with clinical symptoms and 3 free. Lesion type and root-end filling quality were significant outcome predictors (P < .05). The risk of treatment failure for teeth with combined endodontic-periodontal lesions was 8.6 times higher than that for teeth with isolated endodontic lesions. Adequate root-end filling quality improved the probability of success by 5.3 times. CONCLUSIONS Based on CBCT data, an adequate performed endodontic microsurgery could have predictable success in teeth without periodontal involvement.
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Affiliation(s)
- Ming-Ming Zhang
- Department of Cariology and Endodontology, Peking University School and Hospital of Stomatology & National Center for Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, Beijing, China
| | - Gao-Feng Fang
- Department of Cariology and Endodontology, Peking University School and Hospital of Stomatology & National Center for Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, Beijing, China
| | - Zu-Hua Wang
- Department of Cariology and Endodontology, Peking University School and Hospital of Stomatology & National Center for Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, Beijing, China
| | - Yu-Hong Liang
- Department of Cariology and Endodontology, Peking University School and Hospital of Stomatology & National Center for Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, Beijing, China; Department of Stomatology, Peking University International Hospital, Beijing, China.
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Setzer FC, Kratchman SI. Present Status and Future Directions - Surgical Endodontics. Int Endod J 2022; 55 Suppl 4:1020-1058. [PMID: 35670053 DOI: 10.1111/iej.13783] [Citation(s) in RCA: 30] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 05/30/2022] [Accepted: 05/31/2022] [Indexed: 11/29/2022]
Abstract
Endodontic surgery encompasses several procedures for the treatment of teeth with a history of failed root canal treatment, such as root-end surgery, crown- and root resections, surgical perforation repair, and intentional replantation. Endodontic microsurgery is the evolution of the traditional apicoectomy techniques and incorporates high magnification, ultrasonic root-end preparation and root-end filling with biocompatible filling materials. Modern endodontic surgery uses the dental operating microscope, incorporates cone-beam computed tomography (CBCT) for preoperative diagnosis and treatment planning, and has adopted piezoelectric approaches to osteotomy and root manipulation. Crown- and root resection techniques have benefitted from the same technological advances. This review focuses on the current state of root-end surgery by comparing the techniques and materials applied during endodontic microsurgery to the most widely used earlier methods and materials. The most recent additions to the clinical protocol and technical improvements are discussed, and an outlook on future directions is given. While non-surgical retreatment remains the first choice to address most cases with a history of endodontic failure, modern endodontic microsurgery has become a predictable and minimally invasive alternative for the retention of natural teeth.
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Affiliation(s)
- F C Setzer
- Department of Endodontics, School of Dental Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
| | - S I Kratchman
- Department of Endodontics, School of Dental Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
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Chao YC, Chen PH, Su WS, Yeh HW, Su CC, Wu YC, Chiang HS, Jhou HJ, Shieh YS. Effectiveness of different root-end filling materials in modern surgical endodontic treatment: A systematic review and network meta-analysis. J Dent Sci 2022; 17:1731-1743. [DOI: 10.1016/j.jds.2022.05.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 05/20/2022] [Indexed: 10/18/2022] Open
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Shah PK, El Karim IA, Duncan HF, Nagendrababu V, Chong BS. Outcomes reporting in systematic reviews on surgical endodontics: A scoping review for the development of a core outcome set. Int Endod J 2022; 55:811-832. [PMID: 35553439 DOI: 10.1111/iej.13763] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 05/10/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Evidence-informed decision-making in healthcare relies on the translation of research results to everyday clinical practice. A fundamental requirement is that the validity of any healthcare intervention must be supported by the resultant favourable treatment outcome. Unfortunately, differences in study design and the outcome measures evaluated often make it challenging to synthesise the available research evidence required for secondary research analysis and guideline development. Core outcome sets (COS) are defined as an agreed standardised set of outcomes which should be measured and reported as a minimum in all clinical trials on a specific topic. The benefits of COS include less heterogeneity, a reduction in the risk of reporting bias, ensuring all trials contribute data to facilitate meta-analyses, and given the engagement of key stakeholders, it also increases the chances that clinically-relevant outcomes are identified. The recognition of the need for COS for assessing endodontic treatment outcomes lead to the development of Core Outcome Sets for Endodontic Treatment modalities (COSET) protocol, which is registered (No. 1879) on the Core Outcome Measures in Effectiveness Trials (COMET) website. OBJECTIVES The objectives of this scoping review are to: (1) identify the outcomes assessed in studies evaluating surgical endodontic procedures; (2) report on the method of assessment used to measure the outcomes; (3) and assess selective reporting bias in the included studies. The data obtained will be used to inform the development of COS for surgical endodontics. METHODS A structured literature search of electronic databases and the grey literature was conducted to identify systematic reviews on periradicular surgery (PS), intentional replantation (IR) and tooth/root resection (RR), published between January 1990 and December 2020. Two independent reviewers were involved in the literature selection, data extraction and the appraisal of the studies identified. The type of intervention, outcomes measured, type of outcomes reported (clinician- or patient-reported), outcome measurement method, and follow-up period, were recorded using a standardised form. RESULTS Twenty-six systematic reviews consisting of 19 studies for PS, three studies for IR and four studies for RR were selected for inclusion. Outcome measures identified for PS and IR included pain, swelling, mobility and tenderness, outcomes related to periodontal/soft tissue healing (including sinus tract), periradicular healing, tooth survival, life impact (including Oral-Health-Related-Quality-of-Life), resource use and/or adverse effects. For RR, in addition to tooth survival, endodontic complications, and adverse effects, the outcome measures were primarily periodontal-related, including pocket depth reduction, attachment gain, periodontal disease, and periodontic-endodontic lesions. The majority of outcome measures for PS, IR, and RR were assessed clinically, radiologically and/or via patient history. Specific tools such as rating scales (Visual Analog Scale, Verbal rating Scale, Numerical Rating Scale, and other scales) were used for the assessment of pain, swelling, and tenderness, and validated questionnaires were used for the assessment of oral health-related quality of life. The range of follow-up periods were variable, dependent on the outcome measure and the type of intervention. CONCLUSIONS Outcome measures, method of assessment and follow-up periods for PS, IR and RR were identified and categorised to help standardise the reporting of outcomes for future research studies. Additional outcome measures that were not reported, but may be considered in the COSET consensus process include loss of root-end filling material, number of clinic visits, surgery-related dental anxiety and muco-gingival aesthetic-related measures, such as scarring, black triangles, root surface exposure, and tissue discolouration.
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Affiliation(s)
- Pratik Kamalkant Shah
- Institute of Dentistry, Faculty of Medicine & Dentistry, Queen Mary University of London, London, UK
| | - Ikhlas A El Karim
- School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, Northern Ireland, UK
| | - Henry Fergus Duncan
- Division of Restorative Dentistry & Periodontology, Dublin Dental University Hospital, Trinity College Dublin, Dublin, Ireland
| | - Venkateshbabu Nagendrababu
- Department of Preventive and Restorative Dentistry, College of Dental Medicine, University of Sharjah, Sharjah, UAE
| | - Bun San Chong
- Institute of Dentistry, Faculty of Medicine & Dentistry, Queen Mary University of London, London, UK
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Jardine AP, Rosa KFV, Matoso FB, Quintana RM, Grazziotin-Soares R, Kopper PMP. Marginal gaps and internal voids after root-end filling using three calcium silicate-based materials: A Micro-CT analysis. Braz Dent J 2021; 32:1-7. [PMID: 34787245 DOI: 10.1590/0103-6440202104096] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Accepted: 05/24/2021] [Indexed: 11/22/2022] Open
Abstract
This study evaluated the 3D quality of root-end filling, assessing the presence (volume and percentage) of marginal gaps and internal voids formed after retro-filling with three calcium silicate-based materials: MTA Angelus (Angelus Soluçoes Odontologicas, Londrina, PR, Brazil), Biodentine (Septodont Ltd., Saint Maur-des-Faussés, France) and Neo MTA Plus (Avalon Biomed Inc., Bradenton, Florida, US). Thirty human, extracted, single rooted teeth were used. Orthograde root canal treatment, root resection (3mm shorter than the apex) and retrograde cavity preparation with ultrasonic tips were performed. Teeth were divided into 3 groups (n =10 each) following a stratified randomization according to the initial volume of the root-end cavity. After retrofilling, samples were stored for 7 days. Then, two rounds of micro-CT scans were performed: soon after root-end preparation (with the cavity still empty) and 7 days after root-end filling. Marginal gaps, internal voids volume (mm3 and %), as well as, the overall defects (sum of gaps and voids) were evaluated. Statistics compared the three groups in relation to those defects. There was not statistical difference between groups regarding the marginal gaps (P≥ 0.05), the internal voids (P≥ 0.05), and the overall defects (P≥ 0.05). Median (mm3) and % of overall air-entrapment defects (gaps and/or voids) was: 0.004mm3 and 1.749% for MTA Angelus, 0.018mm3 and 6.660% for Biodentine, and 0.012mm3 and 4.079% for Neo MTA Plus. All materials had gaps and/or voids. No differences were found between MTA Angelus, Biodentine and Neo MTA Plus.
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Affiliation(s)
- Alexander Pompermayer Jardine
- Graduate Program of School of Dentistry/Endodontics, Federal University of Rio Grande do Sul(UFRGS), Porto Alegre, RS, Brazil
| | - Ketsia Fernanda Váz Rosa
- Department of Conservative Dentistry/Endodontics, School of Dentistry, Federal University of Rio Grande do Sul(UFRGS), Porto Alegre, RS, Brazil
| | - Felipe Barros Matoso
- Graduate Program of School of Dentistry/Endodontics, Federal University of Rio Grande do Sul(UFRGS), Porto Alegre, RS, Brazil
| | - Ramiro Martins Quintana
- Graduate Program of School of Dentistry/Endodontics, Federal University of Rio Grande do Sul(UFRGS), Porto Alegre, RS, Brazil
| | | | - Patricia Maria Poli Kopper
- Graduate Program of School of Dentistry/Endodontics, Federal University of Rio Grande do Sul(UFRGS), Porto Alegre, RS, Brazil.,Department of Conservative Dentistry/Endodontics, School of Dentistry, Federal University of Rio Grande do Sul(UFRGS), Porto Alegre, RS, Brazil
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Jabbari G, Jamali S, Nasrabadi N, Keikha F. Success Rate of Contemporary Regenerative Endodontic Therapy and the Expected Outcomes of the Endodontic Microsurgery: A Systematic Review and Meta-Analysis. PESQUISA BRASILEIRA EM ODONTOPEDIATRIA E CLÍNICA INTEGRADA 2021. [DOI: 10.1590/pboci.2021.163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Khoo ST, Ode W, Lopez V, Yu VSH, Lai C, Lui JN. Factors Influencing Quality of Life after Surgical and Nonsurgical Interventions of Persistent Endodontic Disease. J Endod 2020; 46:1832-1840. [DOI: 10.1016/j.joen.2020.08.020] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 07/27/2020] [Accepted: 08/26/2020] [Indexed: 12/19/2022]
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Pinto D, Marques A, Pereira JF, Palma PJ, Santos JM. Long-Term Prognosis of Endodontic Microsurgery-A Systematic Review and Meta-Analysis. MEDICINA (KAUNAS, LITHUANIA) 2020; 56:E447. [PMID: 32899437 PMCID: PMC7558840 DOI: 10.3390/medicina56090447] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Revised: 08/31/2020] [Accepted: 08/31/2020] [Indexed: 12/22/2022]
Abstract
Background and objectives: The long-term outcome of endodontic microsurgery (EMS) performed on root-filled teeth affected by post-treatment apical periodontitis (AP) has been a matter of debate, re-launched by the introduction of novel root-end filling materials which have been proven to improve the short-term outcome of EMS. The purpose of this systematic review and meta-analysis is to evaluate the clinical and radiographic long-term outcome of endodontic microsurgery in teeth diagnosed with secondary AP through radiographic evaluation. Materials and Methods: This systematic review and meta-analysis followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Inclusion and exclusion criteria were defined a priori to select the best longitudinal evidence. Only randomized clinical trials (RCT) and prospective clinical studies (PCS), with a follow-up ≥ 2-year, and exhibiting well-established clinical and radiographic outcome criteria, were selected. Results: A total of 573 articles were obtained, from which 10 fulfill inclusion criteria: 6 PCS and 4 RCT. Meta-analysis showed a pooled proportion of success rate of 91.3%, from an overall amount of 453 treated teeth included in RCT; from overall 839 included teeth in PCS, a pooled success rate of 78.4% was observed, with the follow-up time ranging from 2 to 13-years. Survival rate outcomes varied from 79 to 100% for the same follow-up period. Five prognostic factors with influence on the outcome were disclosed: smoking habits, tooth location and type, absence/presence of dentinal defects, interproximal bone level, and root-end filling material. Conclusions: High success rates and predictable results can be expected when EMS is performed by trained endodontists, allowing good prognosis and preservation of teeth affected by secondary AP.
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Affiliation(s)
- Diogo Pinto
- Department of Dentistry, Faculty of Medicine, University of Coimbra, 3000-075 Coimbra, Portugal;
| | - Andréa Marques
- Rheumatology Department, Centro Hospitalar e Universitário de Coimbra, 3000-075 Coimbra, Portugal;
- Health Sciences Research Unit: Nursing, UICISA-E, 3000-075 Coimbra, Portugal
| | - Joana F. Pereira
- Institute of Endodontics, Faculty of Medicine, University of Coimbra, 3000-075 Coimbra, Portugal; (J.F.P.); (P.J.P.)
| | - Paulo J. Palma
- Institute of Endodontics, Faculty of Medicine, University of Coimbra, 3000-075 Coimbra, Portugal; (J.F.P.); (P.J.P.)
- Center for Innovation and Research in Oral Sciences (CIROS), Faculty of Medicine, University of Coimbra, 3000-075 Coimbra, Portugal
| | - João Miguel Santos
- Institute of Endodontics, Faculty of Medicine, University of Coimbra, 3000-075 Coimbra, Portugal; (J.F.P.); (P.J.P.)
- Center for Innovation and Research in Oral Sciences (CIROS), Faculty of Medicine, University of Coimbra, 3000-075 Coimbra, Portugal
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Yoo YJ, Kim DW, Perinpanayagam H, Baek SH, Zhu Q, Safavi K, Kum KY. Prognostic Factors of Long-Term Outcomes in Endodontic Microsurgery: A Retrospective Cohort Study over Five Years. J Clin Med 2020; 9:jcm9072210. [PMID: 32668578 PMCID: PMC7409012 DOI: 10.3390/jcm9072210] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 07/03/2020] [Accepted: 07/10/2020] [Indexed: 01/23/2023] Open
Abstract
The aim of this study was to analyze the long-term outcomes of endodontic microsurgeries in a cohort and identify their association with prognostic factors. A cohort of endodontic microsurgeries followed up periodically with complete clinical and radiographic records for at least 5 years were reviewed retrospectively. Their survival and healing status and profile characteristics were analyzed by Pearson chi-square test and logistic regression (α = 0.05) to identify prognostic factors that influenced outcomes. Of 652 cases in the cohort, 225 (34.5%) were included. The mean follow-up period was 90.4 months (range, 60–168 months). The long-term success rate was 80.5%, and the 5-year survival rate was 83.5%. Logistic regression showed higher success in anteriors compared to molars (OR = 5.405, (95% CI, 1.663–17.571; p = 0.005)) and in teeth with crown restorations (OR = 10.232, (95% CI, 3.374–31.024; p < 0.001)). Conversely, lower success was found in teeth with periodontal disease (OR = 0.170, (95% CI, 0.032–0.900; p = 0.037)) and maxillary sinus involvement (OR = 0.187, (95% CI, 0.035–0.994; p = 0.049)). Endodontic microsurgery has a highly favorable long-term outcome. Tooth position, crown restoration, periodontal disease, and maxillary sinus involvement were identified as main prognostic factors.
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Affiliation(s)
- Yeon-Jee Yoo
- Department of Comprehensive Treatment Center, Seoul National University Dental Hospital, Seoul 03080, Korea;
| | - Dong-Won Kim
- Department of Conservative Dentistry, Dental Research Institute, Seoul National University Dental Hospital, Seoul National University School of Dentistry, Seoul 03080, Korea; (D.-W.K.); (S.-H.B.)
| | - Hiran Perinpanayagam
- Schulich School of Medicine & Dentistry, University of Western Ontario, London, ON N6A 5C1, Canada;
| | - Seung-Ho Baek
- Department of Conservative Dentistry, Dental Research Institute, Seoul National University Dental Hospital, Seoul National University School of Dentistry, Seoul 03080, Korea; (D.-W.K.); (S.-H.B.)
| | - Qiang Zhu
- Division of Endodontology, Department of Oral Health and Diagnostic Sciences, School of Dental Medicine, University of Connecticut Health Center, Farmington, CT 06030, USA; (Q.Z.); (K.S.)
| | - Kamran Safavi
- Division of Endodontology, Department of Oral Health and Diagnostic Sciences, School of Dental Medicine, University of Connecticut Health Center, Farmington, CT 06030, USA; (Q.Z.); (K.S.)
| | - Kee-Yeon Kum
- Department of Conservative Dentistry, Dental Research Institute, Seoul National University Dental Hospital, Seoul National University School of Dentistry, Seoul 03080, Korea; (D.-W.K.); (S.-H.B.)
- National Dental Care Center for Persons with Special Needs, Seoul National University Dental Hospital for Persons with Special Needs, Seoul 03080, Korea
- Correspondence: ; Tel.: +82-2-2072-2656
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Monaghan L, Jadun S, Darcey J. Endodontic microsurgery. Part one: diagnosis, patient selection and prognoses. Br Dent J 2019; 226:940-948. [PMID: 31253911 DOI: 10.1038/s41415-019-0415-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Historically, surgical endodontics has been viewed as a treatment of last resort, mainly due to poor outcomes as a result of limitations in materials and techniques. Contemporary techniques, modern materials and better visualisation have all led to an improvement in success rates, making endodontic microsurgery a valuable treatment option to certain patients. Such advances, however, are no substitute for skill in endodontic diagnosis and treatment planning, which can often prove challenging. A variety of tools are available to test for fractures and assess both periodontal and pulpal health. More advanced techniques such as cone beam computed tomography are often invaluable in pre-surgical assessment and diagnosis. Once an accurate diagnosis has been established, a favourable prognosis is explicitly linked to careful patient selection. Orthograde treatment, or retreatment, remains the gold standard for the majority of endodontic problems. However, there are a number of indications for surgery where orthograde treatment is either impossible, or less likely to be successful. It is paramount for any clinician undertaking endodontic surgery to have a detailed understanding of the local and systemic factors associated with successful treatment. Whilst there are few absolute medical contraindications, there are a number of conditions which may influence patient management and make treatment more challenging.
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Affiliation(s)
- Liam Monaghan
- University Dental Hospital of Manchester, Orthodontic Department, Higher Cambridge Street, Manchester, UK
| | - Sarah Jadun
- University Dental Hospital of Manchester, Oral Surgery, Higher Cambridge Street, Manchester, UK
| | - James Darcey
- University Dental Hospital of Manchester, Restorative Department, Higher Cambridge Street, Manchester, UK.
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Liao WC, Lee YL, Tsai YL, Lin HJ, Chang MC, Chang SF, Chang SH, Jeng JH. Outcome assessment of apical surgery: A study of 234 teeth. J Formos Med Assoc 2019; 118:1055-1061. [DOI: 10.1016/j.jfma.2018.10.019] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Revised: 10/24/2018] [Accepted: 10/26/2018] [Indexed: 11/29/2022] Open
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Outcome of Endodontic Surgery: A Meta-analysis of the Literature-Part 3: Comparison of Endodontic Microsurgical Techniques with 2 Different Root-end Filling Materials. J Endod 2018; 44:923-931. [PMID: 29681480 DOI: 10.1016/j.joen.2018.02.021] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Revised: 02/17/2018] [Accepted: 02/19/2018] [Indexed: 12/12/2022]
Abstract
INTRODUCTION The aim of the present study was to investigate the influence of root-end preparation and filling material on endodontic surgery outcome. A systematic review and meta-analysis was conducted to determine the outcome of resin-based endodontic surgery (RES, the use of high-magnification preparation of a shallow and concave root-end cavity and bonded resin-based root-end filling material) versus endodontic microsurgery (EMS, the use of high-magnification ultrasonic root-end preparation and root-end filling with SuperEBA [Keystone Industries, Gibbstown, NJ], IRM [Dentsply Sirona, York, PA], mineral trioxide aggregate [MTA], or other calcium silicate cements). METHODS An exhaustive literature search was conducted to identify prognostic studies on the outcome of root-end surgery. Human studies conducted from 1966 to the end of December 2016 in 5 different languages (ie, English, French, German, Italian, and Spanish) were searched in 4 electronic databases (ie, Medline, Embase, PubMed, and Cochrane Library). Relevant review articles on the subject were scrutinized for cross-references. In addition, 5 dental and medical journals (Journal of Endodontics; International Endodontic Journal; Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontics; Journal of Oral and Maxillofacial Surgery; and International Journal of Oral and Maxillofacial Surgery) were hand checked dating back to 1975. All abstracts were screened by 3 independent reviewers (H.B., M.K., and F.S.). Strict inclusion-exclusion criteria were defined to identify relevant articles. Raw data were extracted from the full-text review of these selected articles independently by each of the 3 reviewers. In case of disagreement, an agreement was reached by discussion, and qualifying articles were assigned to group RES. For EMS, the same search strategy was performed for the time frame October 2009 to December 2016, whereas up to October 2009 the data were obtained from a previous systematic review with identical criteria and search strategy. Weighted pooled success rates and a relative risk assessment between RES and EMS were calculated. To make a comparison between groups, a random effects model was used. RESULTS Sixty-eight articles were eligible for full-text review. Of these, per strict inclusion exclusion criteria, 14 studies qualified, 3 for RES (n = 862) and 11 for EMS (n = 915). Weighted pooled success rates for RES were 82.20% (95% confidence interval [CI], 0.7965-0.8476) and 94.42% for EMS (95% CI, 0.9295-0.9590). This difference was statistically significant (P < .0005). CONCLUSIONS The probability for success for EMS proved to be significantly greater than the probability for success for RES, providing best available evidence on the influence of cavity preparation with ultrasonic tips and/or SuperEBA (Keystone Industries, Gibbstown, NJ), IRM (Dentsply Sirona, York, PA), MTA, or silicate cements as root-end filling material instead of a shallow cavity preparation and placement of a resin-based material. Additional large-scale randomized clinical trials are needed to assess other predictors of outcome.
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Öğütlü F, Karaca İ. Clinical and Radiographic Outcomes of Apical Surgery: A Clinical Study. J Maxillofac Oral Surg 2018; 17:75-83. [PMID: 29382999 DOI: 10.1007/s12663-017-1008-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2016] [Accepted: 03/27/2017] [Indexed: 11/28/2022] Open
Abstract
Background Endodontic treatment is usually indicated when teeth with periapical lesions are encountered. However, sometimes root canal treatment results in failure. In that case, one of the treatment choices is retreatment by an orthograde approach. Surgical endodontic therapy is also an alternative to preserve the tooth. Various techniques have been suggested in the literature which has more predictable results. The introduction of modern surgical techniques have enhanced the results of apical surgery procedures. Operating microscopes, magnifying loupes, microinstruments, ultrasonic tips, and biologically acceptable root-end filling materials (such as MTA and SuperEBA) have been introduced to this field with the modern technique, thus the success rates of modern apical surgery has increased significantly. Objective The aim of the present study was to evaluate the clinical and radiographic outcomes and periotest values of apical surgery treatment. Methods A total of 112 teeth were included. SuperEBA and MTA were used as root-filling materials. The recorded parameters were gender, age, location of the tooth, the presence/absence of a post, coronal restoration of the tooth, previous surgical/nonsurgical treatment of the tooth, the size of periapical lesions, histopathology of periapical lesions, smoking habits. Also the periotest values were recorded. Results The overall success rate was 88.4%. With regard to the evaluated variables, only one parameter (tooth type) was found statistically significant. Although the periotest values were decreased after 6 months compared to immediately postoperative measurements, the values were still significantly higher than preoperative measurements. Conclusion In this study, apical surgery performed with the modern instruments has significantly successful results with 88.4% success rate.
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Affiliation(s)
- Faruk Öğütlü
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Gazi University, 82. Street 06510, Emek, Ankara Turkey
| | - İnci Karaca
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Gazi University, 82. Street 06510, Emek, Ankara Turkey
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Wang ZH, Zhang MM, Wang J, Jiang L, Liang YH. Outcomes of Endodontic Microsurgery Using a Microscope and Mineral Trioxide Aggregate: A Prospective Cohort Study. J Endod 2017; 43:694-698. [DOI: 10.1016/j.joen.2016.12.015] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2016] [Revised: 11/20/2016] [Accepted: 12/10/2016] [Indexed: 10/20/2022]
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Çalışkan MK, Kaval ME, Tekin U, Ünal T. Radiographic and histological evaluation of persistent periapical lesions associated with endodontic failures after apical microsurgery. Int Endod J 2015; 49:1011-1019. [PMID: 26384024 DOI: 10.1111/iej.12554] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2015] [Accepted: 09/12/2015] [Indexed: 02/01/2023]
Abstract
AIM To determine the histology of persistent periapical lesions associated with nonsurgical endodontic treatment failures and to compare radiographically the sizes of periapical lesions and the presence or absence of the radiopaque lamina with the histological findings. METHODOLOGY Ninety-three anterior teeth designated for apical microsurgery were included in the study. After taking standard radiographs of all cases using the parallel technique, the films were scanned and evaluated for the size of periapical radiolucent lesions and the presence or absence of radiopaque lamina by two calibrated observers. Biopsy specimens were obtained during apical microsurgery and examined under light microscopy by oral pathologists. Histological analysis established diagnoses of granuloma, cyst, abscess and scar tissue. Interobserver agreement was evaluated by the kappa test, and the relationship between histological diagnosis and lesion size was analysed by the Pearson's chi-square test. RESULTS The 93 specimens consisted of 72% periradicular granulomas; 21.5% radicular cysts, including two keratocysts; 4.3% abscesses; and 2.2% scar tissue. Cystic prevalence increased as the size of the periapical lesion increased; however, there was no correlation between the presence of a radiopaque lamina and histological diagnosis of cyst. CONCLUSIONS Neither radiographic size nor presence of an associated radiopaque line alone was sufficient to determine the type of lesion. Histological examination is required in order to reach to a definitive diagnosis.
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Affiliation(s)
- M K Çalışkan
- Department of Endodontology, School of Dentistry, Ege University, Izmir, Turkey
| | - M E Kaval
- Department of Endodontology, School of Dentistry, Ege University, Izmir, Turkey.
| | - U Tekin
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Ege University, Izmir, Turkey
| | - T Ünal
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Ege University, Izmir, Turkey
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Lui JN, Khin MM, Krishnaswamy G, Chen NN. Prognostic Factors Relating to the Outcome of Endodontic Microsurgery. J Endod 2014; 40:1071-6. [DOI: 10.1016/j.joen.2014.04.005] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2013] [Revised: 04/09/2014] [Accepted: 04/11/2014] [Indexed: 11/26/2022]
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18
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Song M, Nam T, Shin SJ, Kim E. Comparison of Clinical Outcomes of Endodontic Microsurgery: 1 Year versus Long-term Follow-up. J Endod 2014; 40:490-4. [DOI: 10.1016/j.joen.2013.10.034] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2013] [Revised: 10/23/2013] [Accepted: 10/23/2013] [Indexed: 10/25/2022]
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Evaluation of Microsurgery with SuperEBA as Root-end Filling Material for Treating Post-treatment Endodontic Disease: A 2-year Retrospective Study. J Endod 2014; 40:345-50. [DOI: 10.1016/j.joen.2013.11.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2013] [Revised: 10/27/2013] [Accepted: 11/03/2013] [Indexed: 11/17/2022]
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20
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Treatment Decisions in 330 Cases Referred for Apical Surgery. J Endod 2014; 40:187-91. [DOI: 10.1016/j.joen.2013.10.024] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2013] [Revised: 10/15/2013] [Accepted: 10/19/2013] [Indexed: 11/18/2022]
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Song M, Kim SG, Lee SJ, Kim B, Kim E. Prognostic Factors of Clinical Outcomes in Endodontic Microsurgery: A Prospective Study. J Endod 2013; 39:1491-7. [DOI: 10.1016/j.joen.2013.08.026] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2013] [Accepted: 08/27/2013] [Indexed: 11/25/2022]
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Setzer FC, Kim S. Comparison of long-term survival of implants and endodontically treated teeth. J Dent Res 2013; 93:19-26. [PMID: 24065635 DOI: 10.1177/0022034513504782] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The outcomes of both dental implants and endodontically treated teeth have been extensively studied. However, there is still a great controversy over when to keep a natural tooth and when to extract it for a dental implant. This article reviews the benefits and disadvantages of both treatment options and discusses success vs. survival outcomes, as well as the impact of technical advances for modern endodontics and endodontic microsurgery on the long-term prognosis of tooth retention.
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Affiliation(s)
- F C Setzer
- University of Pennsylvania, Philadelphia, PA, USA
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Villa‐Machado PA, Botero‐Ramírez X, Tobón‐Arroyave SI. Retrospective follow‐up assessment of prognostic variables associated with the outcome of periradicular surgery. Int Endod J 2013; 46:1063-76. [DOI: 10.1111/iej.12100] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2012] [Accepted: 02/18/2013] [Indexed: 11/30/2022]
Affiliation(s)
- P. A. Villa‐Machado
- POPCAD Research Group Laboratory of Immunodetection and Bioanalysis Faculty of Dentistry University of Antioquia Medellín Colombia
| | - X. Botero‐Ramírez
- POPCAD Research Group Laboratory of Immunodetection and Bioanalysis Faculty of Dentistry University of Antioquia Medellín Colombia
| | - S. I. Tobón‐Arroyave
- POPCAD Research Group Laboratory of Immunodetection and Bioanalysis Faculty of Dentistry University of Antioquia Medellín Colombia
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Sadowsky SJ, Bedrossian E. Evidenced-Based Criteria for Differential Treatment Planning of Implant Restorations for the Partially Edentulous Patient. J Prosthodont 2013; 22:319-29. [DOI: 10.1111/jopr.12014] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/26/2012] [Indexed: 11/30/2022] Open
Affiliation(s)
- Steven J. Sadowsky
- Department of Integrated Reconstructive Dental Sciences; University of the Pacific Arthur A. Dugoni School of Dentistry; San Francisco CA
| | - Edmond Bedrossian
- Department of Oral Surgery; University of the Pacific Arthur A. Dugoni School of Dentistry; San Francisco CA
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von Arx T, Jensen SS, Hänni S, Friedman S. Five-Year Longitudinal Assessment of the Prognosis of Apical Microsurgery. J Endod 2012; 38:570-9. [DOI: 10.1016/j.joen.2012.02.002] [Citation(s) in RCA: 101] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2012] [Accepted: 02/06/2012] [Indexed: 11/27/2022]
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26
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Setzer FC, Kohli MR, Shah SB, Karabucak B, Kim S. Outcome of endodontic surgery: a meta-analysis of the literature--Part 2: Comparison of endodontic microsurgical techniques with and without the use of higher magnification. J Endod 2011; 38:1-10. [PMID: 22152611 DOI: 10.1016/j.joen.2011.09.021] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2011] [Revised: 09/26/2011] [Accepted: 09/30/2011] [Indexed: 02/02/2023]
Abstract
INTRODUCTION The aim of this study was to investigate the outcome of root-end surgery. It identifies the effect of the surgical operating microscope or the endoscope on the prognosis of endodontic surgery. The specific outcomes of contemporary root-end surgery techniques with microinstruments but only loupes or no visualization aids (contemporary root-end surgery [CRS]) were compared with endodontic microsurgery using the same instruments and materials but with high-power magnification as provided by the surgical operating microscope or the endoscope (endodontic microsurgery [EMS]). The probabilities of success for a comparison of the 2 techniques were determined by means of a meta-analysis and systematic review of the literature. The influence of the tooth type on the outcome was investigated. METHODS A comprehensive literature search for longitudinal studies on the outcome of root-end surgery was conducted. Three electronic databases (ie, Medline, Embase, and PubMed) were searched to identify human studies from 1966 up to October 2009 in 5 different languages (ie, English, French, German, Italian, and Spanish). Review articles and relevant articles were searched for cross-references. In addition, 5 dental and medical journals (ie, Journal of Endodontics, International Endodontic Journal, Oral Surgery Oral Medicine Oral Pathology Oral Radiology and Endodontics, Journal of Oral and Maxillofacial Surgery, and International Journal of Oral and Maxillofacial Surgery) dating back to 1975 were hand searched. Following predefined inclusion and exclusion criteria, all articles were screened by 3 independent reviewers (S.B.S., M.R.K., and F.C.S.). Relevant articles were obtained in full-text form, and raw data were extracted independently by each reviewer. After agreement among the reviewers, articles that qualified were assigned to group CRS. Articles belonging to group EMS had already been obtained for part 1 of this meta-analysis. Weighted pooled success rates and a relative risk assessment between CRS and EMS overall as well as for molars, premolars, and anteriors were calculated. A random-effects model was used for a comparison between the groups. RESULTS One hundred one articles were identified and obtained for final analysis. In total, 14 studies qualified according to the inclusion and exclusion criteria, 2 being represented in both groups (7 for CRS [n = 610] and 9 for EMS [n = 699]). Weighted pooled success rates calculated from extracted raw data showed an 88% positive outcome for CRS (95% confidence interval, 0.8455-0.9164) and 94% for EMS (95% confidence interval, 0.8889-0.9816). This difference was statistically significant (P < .0005). Relative risk ratio analysis showed that the probability of success for EMS was 1.07 times the probability of success for CRS. Seven studies provided information on the individual tooth type (4 for CRS [n = 457] and 3 for EMS [n = 222]). The difference in probability of success between the groups was statistically significant for molars (n = 193, P = .011). No significant difference was found for the premolar or anterior group (premolar [n = 169], P = .404; anterior [n = 277], P = .715). CONCLUSIONS The probability for success for EMS proved to be significantly greater than the probability for success for CRS, providing best available evidence on the influence of high-power magnification rendered by the dental operating microscope or the endoscope. Large-scale randomized clinical trials for statistically valid conclusions for current endodontic questions are needed to make informed decisions for clinical practice.
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Affiliation(s)
- Frank C Setzer
- Department of Endodontics, School of Dental Medicine, University of Pennsylvania, Philadelphia, Pennsylvania 19104, USA.
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Song M, Jung IY, Lee SJ, Lee CY, Kim E. Prognostic Factors for Clinical Outcomes in Endodontic Microsurgery: A Retrospective Study. J Endod 2011; 37:927-33. [DOI: 10.1016/j.joen.2011.04.005] [Citation(s) in RCA: 75] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2011] [Revised: 04/05/2011] [Accepted: 04/10/2011] [Indexed: 11/17/2022]
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Symptoms Before Periapical Surgery Related to Histologic Diagnosis and Postoperative Healing at 12 Months for 178 Periapical Lesions. J Oral Maxillofac Surg 2011; 69:e31-7. [DOI: 10.1016/j.joms.2010.07.044] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2010] [Revised: 06/21/2010] [Accepted: 07/03/2010] [Indexed: 11/17/2022]
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Bornstein MM, Lauber R, Sendi P, von Arx T. Comparison of Periapical Radiography and Limited Cone-Beam Computed Tomography in Mandibular Molars for Analysis of Anatomical Landmarks before Apical Surgery. J Endod 2011; 37:151-7. [DOI: 10.1016/j.joen.2010.11.014] [Citation(s) in RCA: 122] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2010] [Revised: 11/11/2010] [Accepted: 11/12/2010] [Indexed: 11/25/2022]
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Affiliation(s)
- Minju Song
- Department of Conservative Dentistry, Microscope Center, Yonsei University College of Dentistry, Seoul, Korea
| | - Euiseong Kim
- Department of Conservative Dentistry, Microscope Center, Yonsei University College of Dentistry, Seoul, Korea
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Zitzmann NU, Krastl G, Hecker H, Walter C, Waltimo T, Weiger R. Strategic considerations in treatment planning: deciding when to treat, extract, or replace a questionable tooth. J Prosthet Dent 2010; 104:80-91. [PMID: 20654764 DOI: 10.1016/s0022-3913(10)60096-0] [Citation(s) in RCA: 67] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Prosthodontists face the difficult task of judging the influence and significance of multiple risk factors of periodontal, endodontic, or prosthetic origin that can affect the prognosis of an abutment tooth. The purpose of this review is to summarize the critical factors involved in deciding whether a questionable tooth should be treated and maintained, or extracted and possibly replaced by dental implants. A MEDLINE (PubMed) search of the English, peer-reviewed literature published from 1966 to August 2009 was conducted using different keyword combinations including treatment planning, in addition to decision making, periodontics, endodontics, dental implants, or prosthodontics. Further, bibliographies of all relevant papers and previous review articles were hand searched. Tooth maintenance and the acceptance of risks are suitable when: the tooth is not extensively diseased; the tooth has a high strategic value, particularly in patients with implant contraindications; the tooth is located in an intact arch; and the preservation of gingival structures is paramount. When complete-mouth restorations are planned, the strategic use of dental implants and smaller units (short-span fixed dental prostheses), either tooth- or implant-supported, as well as natural tooth abutments with good prognoses for long-span FDPs, is recommended to minimize the risk of failure of the entire restoration.
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Affiliation(s)
- Nicola U Zitzmann
- Clinic for Periodontology, Endodontology and Cariology, Dental School, University of Basel, Basel, Switzerland.
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Balto K. How common is tooth pain after root canal treatment? Evid Based Dent 2010; 11:114. [PMID: 21170014 DOI: 10.1038/sj.ebd.6400758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
DATA SOURCES Medline, the Cochrane Library, TRIP database and Google Scholar, hand searching of articles, reviews and textbooks. STUDY SELECTION Articles in any language about endodontic procedures, (initial treatment or retreatment and surgical or nonsurgical but not pulpotomy, partial pulpectomy or pulp capping) in permanent teeth that reported on pain at a minimum of six months were included. The main outcome was the presence of all-cause pain, with no differentiation on the basis of aetiologies. The outcome of all-cause pain was considered positive if reported by either the patient or the practitioner. Pain could be spontaneous or provoked by biting, palpation or percussion. DATA EXTRACTION AND SYNTHESIS Data were extracted independently by two reviewers and STROBE criteria (www.strobe-statement.org) used to assess quality. A summary estimate of persistent all-cause pain frequency was established by using a random-effects meta-analysis. The influence of treatment approach (surgical/nonsurgical), longitudinal study design (prospective/retrospective), follow-up rate and duration, initial treatment versus retreatment, and quality of reporting on the pain frequency estimate was assessed in subgroup analyses. RESULTS 26 studies that included 5777 teeth with 2996 (51.9%) having follow-up pain information met the inclusion criteria. 168 teeth with pain were identified giving a frequency of 5.3% (95% confidence interval, 3.5%-7.2%, p < 0.001) for persistent all-cause pain. High and statistically significant heterogeneity among studies (I(2) = 80%) was present. In subgroup analysis, prospective studies had a higher pain frequency (7.6%) than retrospectives studies (0.9%). Quality of study reporting was identified as the most influential reason for study heterogeneity. CONCLUSIONS The frequency of all-cause persistent pain after endodontic procedures was estimated to be 5.3%, with higher report quality studies suggesting >7%.
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Affiliation(s)
- Khaled Balto
- Faculty of Dentistry, King Abdulaziz University, Jeddah, Saudi Arabia
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Zitzmann NU, Krastl G, Hecker H, Walter C, Weiger R. Endodontics or implants? A review of decisive criteria and guidelines for single tooth restorations and full arch reconstructions. Int Endod J 2009; 42:757-74. [PMID: 19548936 DOI: 10.1111/j.1365-2591.2009.01561.x] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- N U Zitzmann
- Clinic for Periodontology, Endodontology and Cariology, University of Basel, Basel, Switzerland.
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Radiographic Morphometric Study of 37 Periapical Lesions in 30 Patients: Validation of Success Criteria. J Oral Maxillofac Surg 2009; 67:846-9. [DOI: 10.1016/j.joms.2008.08.039] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2008] [Revised: 07/15/2008] [Accepted: 08/27/2008] [Indexed: 11/22/2022]
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Distance Between Periapical Lesion and Mandibular Canal as a Factor in Periapical Surgery in Mandibular Molars. J Oral Maxillofac Surg 2008; 66:2461-6. [DOI: 10.1016/j.joms.2008.06.033] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2007] [Revised: 04/10/2008] [Accepted: 06/17/2008] [Indexed: 11/20/2022]
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Relationship Between Histological Diagnosis and Evolution of 70 Periapical Lesions at 12 Months, Treated by Periapical Surgery. J Oral Maxillofac Surg 2008; 66:1606-9. [DOI: 10.1016/j.joms.2007.12.014] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2007] [Revised: 10/19/2007] [Accepted: 12/11/2007] [Indexed: 11/23/2022]
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Periapical surgery in maxillary premolars and molars: analysis in terms of the distance between the lesion and the maxillary sinus. J Oral Maxillofac Surg 2008; 66:1212-7. [PMID: 18486786 DOI: 10.1016/j.joms.2008.01.015] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2007] [Revised: 11/12/2007] [Accepted: 01/04/2008] [Indexed: 11/22/2022]
Abstract
PURPOSE This study compares periapical surgery (PS) of the maxillary premolars and molars in close proximity to the maxillary sinus with those not in close proximity, and assesses postoperative morbidity and prognosis. PATIENTS AND METHODS A prospective follow-up study was carried out on clinical cases of PS using the ultrasound technique. Only patients undergoing PS in maxillary premolars and molars were included in this study; minimum follow-up was set at 12 months. The cases were classified into 2 different groups in function of the proximity of the periapical lesion to the maxillary sinus: group 1, when the distance was less than 2 mm; group 2, when the distance was greater than or equal to 2 mm. Postoperative morbidity was measured, as well as a clinical and radiographic follow-up evaluating the overall mid- and long-term success rate using von Arx and Kurt criteria. SPSS 12 was used for the statistical analysis. All measures of estimated association were then tested for statistical significance, and declared significant for P less than .05. RESULTS PS was carried out on 92 patients, 106 teeth, and 129 periapical lesions. Group 1 was composed of 43 maxillary premolars and molars with 59 lesions, and group 2 of 63 teeth and 70 lesions. Maximum pain occurred during the first 6 hours and swelling reached its peak on the second day. The overall healing in maxillary premolars and molars was 75% success, 10% improvement, and 15% failure at 1-year follow-up. There were no significant differences between the 2 groups regarding postoperative pain, swelling, and outcome (P > .05). CONCLUSIONS The success of PS in maxillary premolars and molars at 12 months follow-up was 75%. Failure rates in premolars and molars in close proximity to the maxillary sinus were higher than unrelated premolars and molars, but the differences were not significant statistically.
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de Chevigny C, Dao TT, Basrani BR, Marquis V, Farzaneh M, Abitbol S, Friedman S. Treatment Outcome in Endodontics: The Toronto Study—Phases 3 and 4: Orthograde Retreatment. J Endod 2008; 34:131-7. [DOI: 10.1016/j.joen.2007.11.003] [Citation(s) in RCA: 120] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2007] [Revised: 10/29/2007] [Accepted: 11/07/2007] [Indexed: 11/28/2022]
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Abstract
An assessment of whether to rehabilitate a tooth requiring endodontic treatment or to replace it with a dental implant can often involve a challenging and complex decision-making process. This paper reviews the literature pertaining to both treatment modalities and identifies key issues that need careful consideration in planning the most appropriate course of care in a given clinical situation. A need to appreciate advances across both disciplines is highlighted, allowing the development of effective interdisciplinary evidence-based treatment strategies to maximize treatment outcome.
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Affiliation(s)
- V John
- School of Dental Science, The University of Melbourne, Victoria
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Yazdi PM, Schou S, Jensen SS, Stoltze K, Kenrad B, Sewerin I. Dentine-bonded resin composite (Retroplast) for root-end filling: a prospective clinical and radiographic study with a mean follow-up period of 8 years. Int Endod J 2007; 40:493-503. [PMID: 17451454 DOI: 10.1111/j.1365-2591.2007.01242.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
AIM To evaluate treatment outcome after using a resin composite (Retroplast, RP) in combination with a dentine-bonding agent (GLUMA) as root-end filling material after 1 year as well as after more than 5 years (final examination). Also, the influence of various pre-, intra- and postoperative factors on the treatment outcome was studied. METHODOLOGY All patients (87) undergoing root-end resection consecutively treated by root-end filling with RP on an incisor, canine, pre-molar, or first molar (87 teeth, 118 roots) were initially enrolled in the study. RP was applied on the entire resected surface that was prepared to a slightly concave shape and after conditioning with EDTA and GLUMA. The treatment outcome involving subjective, clinical and radiographic parameters was evaluated after 1 year and at the final examination. A total of 27 patients (36 roots) were excluded from the study because of unavailability of follow-up (19) and extraction of the operated tooth for reasons other than failed surgery (8). Consequently, 60 patients (82 roots) were included in the final material. The mean follow-up period at the final examination was 8 years (range: 6.5-9 years). RESULTS The radiographic evaluation at the final examination revealed that 77%, 5%, 7% and 11% of the treated roots were characterized by complete, incomplete, uncertain and unsatisfactory healing, respectively. A total of 95% of the roots classified as completely healed at the 1-year control were also completely healed at the final examination. Two roots (5%) showing complete healing at the 1-year control revealed unsatisfactory healing at the final examination because of displaced or lost RP-filling. Moreover, 60% of the roots with uncertain healing at the 1-year control demonstrated complete or incomplete healing at the final examination. The classification according to subjective, clinical and radiographic parameters revealed that 78% of the teeth were characterized by a successful treatment outcome at the final examination. Evaluation of the influence of various pre-, intra- and postoperative factors on the treatment outcome revealed that the radiographic classification at the final examination was exclusively influenced by the radiographic classification at the 1-year control (P < 0.001). CONCLUSIONS The present long-term study indicates that RP can be used for root-end filling with a successful treatment outcome.
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Affiliation(s)
- P M Yazdi
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark.
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