Treatment time for non-surgical endodontic therapy with or without a magnifying loupe

Microbiota of Peri-Implant Healthy Tissues, Peri-Implant Mucositis, and Peri-Implantitis: A Comprehensive Review

Understanding the microbiological profiles of peri-implant conditions is crucial for developing effective preventive and therapeutic strategies. This narrative review analyzes the microbial profiles associated with healthy peri-implant sites, peri-implant mucositis, and peri-implantitis, along with related microbiological sampling and analyses. Healthy peri-implant sites are predominantly colonized by Streptococcus, Rothia, Neisseria, and Corynebacterium species, in addition to Gram-positive cocci and facultatively anaerobic rods, forming a stable community that prevents pathogenic colonization and maintains microbial balance. In contrast, peri-implant mucositis shows increased microbial diversity, including both health-associated and pathogenic bacteria such as red and orange complex bacteria, contributing to early tissue inflammation. Peri-implantitis is characterized by even greater microbial diversity and a complex pathogenic biofilm. Predominant pathogens include Porphyromonas gingivalis, Tannerella forsythia, Treponema denticola, Fusobacterium nucleatum, and unique species like Filifactor alocis and Fretibacterium fastidiosum. Additionally, less common species such as Staphylococcus and Enterobacteriaceae, contributing to disease progression through biofilm formation and increased inflammatory response, along with EBV and human cytomegalovirus with a still not defined role, and Candida albicans contribute to disease progression through biofilm formation, immune modulation, and synergistic inter-kingdom interactions. Future research should standardize diagnostic criteria, employ advanced molecular techniques, integrate microbial data with clinical factors, and highlight inter-kingdom interactions.

Influence of operator's experience on complications of root canal treatment using contemporary techniques: a retrospective study

BACKGROUND

Endodontic treatment has benefited from the development of new techniques and equipment. Few clinical studies have been published on the complications associated with root canal preparations performed by doctors with different working experiences using contemporary techniques. This study aimed to analyze the complications of endodontic treatment performed by residents and endodontic specialists in a teaching stomatology hospital using contemporary techniques.

METHODS

Cases of root canal treatment (RCT) and non-surgical root canal retreatment (ReRCT) performed by residents with 1-3 years of experience and endodontic specialists with 5-7 years of experience were collected from the electronic medical system of the Department of Endodontics, Beijing Stomatology Hospital, from September 1, 2020 to August 31, 2021. The cases were examined in terms of patient age, sex, type of tooth, diagnosis, treatment modality (RCT or ReRCT), number of appointments, whether an operating microscope was used, presence of ledges, canal transportation, perforations, missed canals, separated instruments, flare-ups and clinical incidence of second mesiobuccal (MB2) root canal in the maxillary molars.

RESULTS

In total, 859 teeth from 820 patients were included in the analysis. The overall incidence of complications in the resident group was significantly higher than that in the specialist group. More ledges and flare-ups were observed in the resident group (p < 0.05). The clinical incidence of MB2 was significantly higher in the specialist group (p < 0.05). There were no significant differences in root canal transportation, perforation, or instrument separation between the two groups (p < 0.05). Multivariate analysis showed that the incidence of root canal preparation complications was related to operator experience, tooth type and treatment modality.

CONCLUSIONS

Technical advancements could reduce the effect of working experience on RCT complications between residents and endodontic specialists in a teaching stomatology hospital.

Minimally invasive management of vital teeth requiring root canal therapy

The present study aimed to investigate the possible use of a non-instrumentation technique including blue light irradiation for root canal cleaning. Extracted human single rooted teeth were selected. Nine different groups included distilled water, NaOCl, intra-canal heated NaOCl, and NaOCl + EDTA irrigation after either instrumentation or non-instrumentation, and a laser application group following non-instrumentation technique. The chemical assessment of the root canal dentine was evaluated using energy dispersive spectroscopy (EDS) and Fourier transform infrared (FT-IR) spectroscopy. Surface microstructural analyses were performed by using scanning electron microscopy (SEM). The antimicrobial efficacy of different preparation techniques was evaluated using microbial tests. Light application didn't change the calcium/phosphorus, carbonate/phosphate and amide I/phosphate ratios of the root canal dentin. The root canal dentin preserved its original chemistry and microstructure after light application. The instrumentation decreased the carbonate/phosphate and amide I/phosphate ratios of the root canal dentin regardless of the irrigation solution or technique (p < 0.05). The application of light could not provide antibacterial efficacy to match the NaOCl irrigation. The NaOCl irrigation both in the non-instrumentation and instrumentation groups significantly reduced the number of bacteria (p < 0.05). The use of minimally invasive root canal preparation techniques where the root canal is not instrumented and is disinfected by light followed by obturation with a hydraulic cement sealer reduced the microbial load and preserved the dentin thus may be an attractive treatment option for management of vital teeth needing root canal therapy.

Single versus multiple visits for endodontic treatment of permanent teeth

BACKGROUND

Root canal treatment (RoCT), or endodontic treatment, is a common procedure in dentistry. The main indications for RoCT are irreversible pulpitis and necrosis of the dental pulp caused by carious processes, coronal crack or fracture, or dental trauma. Successful RoCT is characterised by an absence of symptoms (i.e. pain) and clinical signs (i.e. swelling and sinus tract) in teeth without radiographic evidence of periodontal involvement (i.e. normal periodontal ligament). The success of RoCT depends on a number of variables related to the preoperative condition of the tooth, as well as the endodontic procedures. RoCT can be carried out with a single-visit approach, which involves root canal system obturation (filling and sealing) directly after instrumentation and irrigation, or with a multiple-visits approach, in which the treatment is completed in two or more sessions and obturation is performed in the last session. This review updates the previous versions published in 2007 and 2016.

OBJECTIVES

To evaluate the benefits and harms of completion of root canal treatment (RoCT) in a single visit compared to RoCT over two or more visits, with or without medication, in people aged over 10 years.

SEARCH METHODS

We used standard, extensive Cochrane search methods. The latest search date was 25 April 2022.

SELECTION CRITERIA

We included randomised controlled trials and quasi-randomised controlled trials in people needing RoCT comparing completion of RoCT in a single visit compared to RoCT over two or more visits.  DATA COLLECTION AND ANALYSIS: We used standard Cochrane methods. Our primary outcomes were 1. tooth extraction and 2. radiological failure after at least one year (i.e. periapical radiolucency). Our secondary outcomes were 3. postoperative and postobturation pain; 4. swelling or flare-up; 5. analgesic use and 6. presence of sinus track or fistula after at least one month. We used GRADE to assess certainty of evidence for each outcome. We excluded five studies that were included in the previous version of the review because they did not meet the current standard of care (i.e. rubber dam isolation and irrigation with sodium hypochlorite).

MAIN RESULTS

We included 47 studies with 5805 participants and 5693 teeth analysed. We judged 10 studies at low risk of bias, 17 at high risk of bias and 20 at unclear risk of bias. Only two studies reported data on tooth extraction. We found no evidence of a difference between treatment in one visit or treatment over multiple visits, but we had very low certainty about the findings (risk ratio (RR) 0.46, 95% confidence interval (CI) 0.09 to 2.50; I2 = 0%; 2 studies, 402 teeth). We found no evidence of a difference between single-visit and multiple-visit treatment in terms of radiological failure (RR 0.93, 95% CI 0.81 to 1.07; I2 = 0%; 13 studies, 1505 teeth; moderate-certainty evidence). We found evidence of a higher proportion of participants reporting pain within one week in single-visit groups compared to multiple visit groups (RR 1.55, 95% CI 1.14 to 2.09; I2 = 18%; 5 studies, 638 teeth; moderate-certainty evidence).  We found no evidence of a difference in the proportion of participants reporting pain until 72 hours postobturation (RR 0.97, 95% CI 0.81 to 1.16; I2 = 70%; 12 studies, 1329 teeth; low-certainty evidence), pain intensity until 72 hours postobturation (mean difference (MD) 0.26, 95% CI -4.76 to 5.29; I2 = 98%; 12 studies, 1258 teeth; low-certainty evidence) or pain at one week postobturation (RR 1.05, 95% CI 0.67 to 1.67; I2 = 61%; 9 studies, 1139 teeth; very low-certainty evidence). We found no evidence of a difference in swelling or flare-up incidence (RR 0.56 95% CI 0.16 to 1.92; I2 = 0%; 6 studies; 605 teeth; very low-certainty evidence), analgesic use (RR 1.25 95% CI 0.75 to 2.09; I2 = 36%; 6 studies, 540 teeth; very low-certainty evidence) or sinus tract or fistula presence (RR 1.00, 95% CI 0.24 to 4.28; I2 = 0%; 5 studies, 650 teeth; very low-certainty evidence). Subgroup analysis found no differences between single-visit and multiple-visit RoCT for considered outcomes other than proportion of participants reporting post-treatment pain within one week, which was higher in the single-visit groups for vital teeth (RR 2.16, 95% CI 1.39 to 3.36; I2 = 0%; 2 studies, 316 teeth), and when instrumentation was mechanical (RR 1.80, 95% CI 1.10 to 2.92; I2 = 56%; 2 studies, 278 teeth).

AUTHORS' CONCLUSIONS

As in the previous two versions of the review, there is currently no evidence to suggest that one treatment regimen (single-visit or multiple-visit RoCT) is more effective than the other. Neither regimen can prevent pain and other complications in the 12-month postoperative period. There was moderate-certainty evidence of higher proportion of participants reporting pain within one week in single-visit groups compared to multiple-visit groups. In contrast to the results of the last version of the review, there was no difference in analgesic use.

Impact of endodontic case difficulty on operating time of single visit nonsurgical endodontic treatment under general anesthesia

Background

A Case Difficulty Assessment Form was designed for use in endodontic curricula, and to assist practitioners with treatment planning, referral and recording. The aim of this study was to determine how endodontic case difficulty factors influence the operating time of single-visit nonsurgical endodontic treatments under general anesthesia.

Methods

Data on 198 single-visit endodontic treatments (80 anterior teeth, 43 premolars, and 75 molars) performed under general anesthesia by a specialized practitioner were obtained from 119 special needs patients (mean [SD] age = 30.7 [14.7] years). Total duration of operation was analyzed with relation to demographic and dental factors and American Association of Endodontists (AAE) Case Difficulty Assessment factors. Mann–Whitney U test, t-test, and Kruskal–Wallis test were used to assess relationships between operating time and confounding factors (p < 0.05).

Results

High difficulty cases required significantly longer time to complete operations than treatments of minimal-to-moderate difficulty regardless of tooth type (p < 0.05). Demographic factors of the patients rarely influenced operating time length. Among variables included in the AAE Case Difficulty Assessment Form, tooth position, crown morphology, root morphology, canal appearance, and periodontal condition were significantly associated with increased operating time (p < 0.05).

Conclusions

A higher level of case difficulty contributed to increased duration of endodontic treatment under general anesthesia indicating that Endodontic Case Difficulty Assessment Form is useful for predicting the duration of nonsurgical endodontic treatment. Among many factors, complicated anatomic features of the treated teeth increased case complexity and extended operating time.

Structural, fluoride release, and 3D interfacial adhesion analysis of bioactive endodontic sealers

The experimental bioactive sealers were synthesized by incorporating fluoridated-nano-bioactive glass (F-nBG; 2.5 and 5wt%) in AH Plus^® (Dentsply DeTrey, Konstanz, Germany) sealer and denoted as AH-FBG2.5 and AH-FBG5, respectively. Structural pattern, setting time, flowability, and water sorption analysis were performed. The fluoride release behavior was evaluated periodically over the course of 40 days using inductively coupled plasma optical emission spectroscopy. For sealing ability, post-extraction single-rooted teeth were obturated with sealers. The percentage of voids and sealing ability were evaluated periodically using micro-computed tomography (micro-CT) followed by push-out bond strength. The Fourier transform infrared spectra showed a change in peak height with an increase in the concentration of fillers. The setting time, flowability, and water sorption of experimental groups were within the acceptable clinical range. The fluoride release, sealing ability, and bond strength of experimental sealers were significantly high. The experimental sealers have potential to overcome sealing ability issues of sealers.

Magnification in endodontics: A review of its application and acceptance among dental practitioners

The application of magnification devices in endodontics is mainly meant for visual enhancement and improved ergonomics. This is crucial especially when long hours are spent in a narrow operating space to treat obscure microanatomy. Nevertheless, application of magnification in endodontics has yet to be introduced into the mainstream practice due to various influences in behavioral patterns. By conducting an extensive literature search in the PubMed database, this narrative review paper depicts the present state of magnification devices, their applications within the endodontic practice, factors that influence their usage, the advantages, and shortcomings, as well as the significances of magnification in the field of endodontics. This review paper will encourage clinicians to employ magnification in their practice for improved outcome.

Second Mesiobuccal Canal Evaluation Features with Cone-Beam Computed Tomography

Aim

The aim of the study is to evaluate the difference in MB2 prevalence with different slice thicknesses in maxillary first molars.

Materials and Methods

Two hundred nonfilled MB2 canals in maxillary first molars of 156 people (75 females and 81 males) aged from 20 to 73 years old were evaluated with CBCT with different slice thicknesses: 0.5 mm, 1 mm, 3 mm, and 10 mm. A general analysis was performed out, as well as in the age groups and on gender groups.

Results

Visualization with 0.5 mm and 1 mm slice thicknesses was 100% and generally equal, in both the male and the female group. General MB2 visualization with 3 mm slice thickness was 42% and 29% for the male group and 27% for the female group. No canals were visualized with 10 mm slice thickness. The study did not demonstrate a statistical difference in the MB2 prevalence between gender and age groups with the 3 mm slice thickness.

Conclusion

The most valuable way to evaluate the root canal system in first maxillary molars with CBCT is using 1 mm slice thickness for both genders and every age group.

Quantification by SIFT-MS of volatile compounds produced by the action of sodium hypochlorite on a model system of infected root canal content

Root canal irrigation with sodium hypochlorite (NaOCl) is an indispensable part of the chemomechanical preparation of infected root canals in Endodontology. However, there is limited information on the emergence of toxic or hazardous volatile compounds (VOCs) from the interaction of NaOCl with the infected content of tooth biomaterials. The aim of this study was to assess the formation of VOCs and disinfection by-products (DBPs) following the interaction of NaOCl 2.5% v/v with a model system of different sources of natural organic matter (NOM) present in infected root canals, including dentine powder, planktonic multi-microbial suspensions (Propionibacterium acnes, Staphylococcus epidermidis, Actinomyces radicidentis, Streptococcus mitis and Enterococcus faecalis strain OMGS3202), bovine serum albumin 4%w/v and their combination. NaOCl was obtained from a stock solution with iodometric titration. Ultrapure water served as negative control. Samples were stirred at 37°C in aerobic and anaerobic conditions for 30min to approximate a clinically realistic time. Centrifugation was performed and the supernatants were collected and stored at -80⁰ C until analysis. The reaction products were analysed in real time by selected ion flow tube mass spectrometry (SIFT-MS) in triplicates. SIFT-MS analysis showed that the released VOCs included chlorinated hydrocarbons, particularly chloroform, together with unexpected higher levels of some nitrogenous compounds, especially acetonitrile. No difference was observed between aerobic and anaerobic conditions. The chemical interaction of NaOCl with NOM resulted in the formation of toxic chlorinated VOCs and DBPs. SIFT-MS analysis proved to be an effective analytical method. The risks from the rise of toxic compounds require further consideration in dentistry.

Clinical studies on core-carrier obturation: a systematic review and meta-analysis

BACKGROUND

This systematic review aimed to evaluate the clinical performance of core-carrier obturation in endodontic treatment.

METHODS

Keywords of "(core carrier OR Thermafil) OR (cold lateral condensation OR lateral condensation) OR (warm vertical condensation OR vertical condensation) AND (obturation OR root canal filling) AND clinical study" were searched for all obtainable publications up to year 2017 in the databases of PubMed, ScienceDirect, EMBASE, Scopus and Web of Science. The success rate, short-term postoperative pain, overfilling and adaptation of core-carrier obturation from clinical studies were selected. Reviews, laboratory studies, animal studies and irrelevant reports were excluded.

RESULTS

1349 relevant articles were identified with 149 duplicated articles removed and 1173 irrelevant articles were excluded after screening. The titles and abstracts of the 19 identified articles were screened in the systematic review. The full texts of remaining articles were retrieved with data extracted for meta-analysis on the success rate, postoperative pain, overfilling and adaptation of obturation. The pooled success rate of core-carrier obturation was 83% (95% CI: 69%-91%). The pooled incidence of 1-day and 7-day short-term postoperative pain were 35% (95% CI: 15%-62%) and 6% (95% CI: 1-35%). The pooled proportion of teeth with overfilling and adequate adaptation of the obturation material were 31% (95% CI: 18%-50%) and 85% (95% CI: 75%-91%), respectively.

CONCLUSIONS

The success rate of endodontic treatment using core-carrier obturation was 83%. Short-term postoperative pain was not uncommon (24%). Most teeth (85%) had adequate adaptation using core-carrier obturation material, but a considerable amount of teeth (31%) had overfilling.

No evidence that magnification devices improve the success of endodontic therapy

Data sourcesCochrane Oral Health group Trials Register, the Cochrane Central Register of Controlled Trials, Medline, US National Institutes of Health Trials Register, WHO-Clinical Trials Registry Platform for ongoing trials.Study selectionOnly randomised and quasi-randomised studies were pursued. No restrictions were placed on language or date of publication. The primary outcome sought was treatment success (complete healing or incomplete healing), uncertain healing and failure after one year of treatment, between one and four years and more than four years after treatment. Secondary outcomes considered for the inclusion criteria included outcomes related to the advantage of using a given magnification device in the clinical procedure such as; greater accuracy, the ease of removing broken instruments from the canal, quality of visualisation, quality of root end filling for the retrograde treatment, quality of perforation repair and the total time required for completing the clinical procedure.Data extraction and synthesisData would have been extracted by two review authors independently using a standardised data extraction form, and any disagreement would have been resolved by discussion and a third reviewer would have been consulted. Two review authors would have independently undertaken an assessment of the risk of bias.ResultsThe searches retrieved 1,234 studies. None of these satisfied the selection criteria, therefore no analysis was completed.ConclusionsNo article was identified in the current literature for the review that satisfied the inclusion criteria. It is unknown if and how the type of magnification device affects the treatment outcome considering the high number of factors that may have a significant impact on the success of endodontic therapy.

Treatment outcomes of single-visit versus multiple-visit non-surgical endodontic therapy: a randomised clinical trial

BACKGROUND

Clincians have been providing single-visit and multiple-visit endodontic treatments for their patients. This study aims to compare the success rate, prevalence of postoperative pain and chairside time of single-visit and multiple-visit endodontic treatments.

METHOD

Patients who required primary endodontic treatment in a university dental clinic were randomly allocated to two general dentists for single-visit or multiple-visit treatments using the same materials and procedures. Ni-Ti rotary files were used to prepare the root canals, which were subsequently obturated with a core-carrier technique. The chairside time was recorded. The treated teeth were followed up every 6 months on clinically signs and symptoms including pain, tenderness to percussion, sinus tract, mobility and abscess. Periapical radiographs were taken to assess periapical pathology. Successful treatments were neither clinical signs/symptoms noted nor radiographic periapical pathology found postoperatively.

RESULTS

A total of 220 teeth from patients aged 46.4 ± 14.1 were followed up for at least 18 months. The mean (±SD) follow-up period was 29.4 ± 9.3 months. The success rates of single-visit and multiple-visit treatments were 88.9 and 87.4 %, respectively (p = 0.729, effect size odds ratio = 1.156). Maxillary teeth had odds ratios of 3.16 (95 % CI: 1.33 to 7.46; p = 0.009) and absence of preoperative apical periodontitis had odds ratios of 4.35 (95 % CI: 1.43 to 13.24; p = 0.010) were identified from logistic regression as having a higher success rate. The average chairside times of single-visit and multiple-visit treatments were 62.0 and 92.9 min, respectively (mean difference = -30.9, 95 % CI: -39.4 to -22.4, p < 0.001, effect size odds ratio = -0.996). Single-visit and multiple-visit treatment had no significant difference in the prevalence of postoperative pain within 7 days (21 and 12 %, p = 0.055, effect size odds ratio = 2.061) and after at least 18 months (0.9 and 1.0 %, p > 0.999, effect size odds ratio = 0.879).

CONCLUSIONS

The success rate and prevalence of postoperative pain of single-visit or multiple-visit treatment had no significant difference. The chairside time for single-visit treatment was shorter than multiple-visit treatment.

TRIAL REGISTRATION

Clinical Trials (WHO) ChiCTR-IOR-15006117 registered on 20 March 2015.