Monitoring Nonsurgical and Surgical Root Canal Treatment of Teeth with Primary and Secondary Infections

Non-surgical root canal treatment and retreatment versus apical surgery in treating apical periodontitis: A systematic review

BACKGROUND

In addition to non-surgical root canal treatment or retreatment, apical surgery may be carried out to manage teeth with apical periodontitis. However, it is unclear which treatment option is more effective.

OBJECTIVE

To systematically review the effectiveness of apical surgery compared with non-surgical treatment or retreatment in terms of clinical and patient-related outcomes in teeth with apical periodontitis.

METHODS

A literature search of electronic databases, the grey literature, the reference lists of included articles and previous reviews, and a hand search of leading endodontic journals, was conducted. Randomised and non-randomised control trials, and longitudinal observational studies on patients undergoing surgical (treatment group) and non-surgical root canal treatment or retreatment (control group) of teeth with apical periodontitis were included. The risk of bias was appraised using the Cochrane risk-of-bias tool; ROBINS-I and the Newcastle-Ottawa Scale.

RESULTS

Five studies, consisting of two randomised clinical trials, two non-randomised clinical trials, and a retrospective cohort study, were included. The interobserver agreement was high and kappa correlation coefficient was good. In total 529 teeth were available for follow-up that varied from 6 months to 8.7 years. The overall risk of bias was high for four studies and raised some concerns in one study. Apical surgery showed seemly better results regarding periapical healing and less need for more and further intervention, although tooth survival was higher in the control group. Given the heterogeneity of the studies, meta-analysis was not possible.

DISCUSSION

Previous systematic reviews have conducted an indirect comparison by separately pooling the outcomes of studies analysing either non-surgical, or surgical, treatment. In this systematic review, only studies that compared both treatments were included. Most results of this and previous reviews were similar.

CONCLUSION

No treatment option showed clear superiority. However, to arrive at statistically supported conclusions there is a need for additional high-quality comparative trials.

REGISTRATION

PROSPERO database (Registration number CRD42021260300).

Treatment of pulpal and apical disease: The European Society of Endodontology (ESE) S3-level clinical practice guideline

BACKGROUND

The ESE previously published quality guidelines for endodontic treatment in 2006; however, there have been significant changes since not only in clinical endodontics but also in consensus and guideline development processes. In the development of the inaugural S3-level clinical practice guidelines (CPG), a comprehensive systematic and methodologically robust guideline consultation process was followed in order to produce evidence-based recommendations for the management of patients presenting with pulpal and apical disease.

AIM

To develop an S3-level CPG for the treatment of pulpal and apical disease, focusing on diagnosis and the implementation of the treatment approaches required to manage patients presenting with pulpitis and apical periodontitis (AP) with the ultimate goal of preventing tooth loss.

METHODS

This S3-level CPG was developed by the ESE, with the assistance of independent methodological guidance provided by the Association of Scientific Medical Societies in Germany and utilizing the GRADE process. A robust, rigorous and transparent process included the analysis of relevant comparative research in 14 specifically commissioned systematic reviews, prior to evaluation of the quality and strength of evidence, the formulation of specific evidence and expert-based recommendations in a structured consensus process with leading endodontic experts and a broad base of external stakeholders.

RESULTS

The S3-level CPG for the treatment of pulpal and apical disease describes in a series of clinical recommendations the effectiveness of diagnosing pulpitis and AP, prior to investigating the effectiveness of endodontic treatments in managing those diseases. Therapeutic strategies include the effectiveness of deep caries management in cases with, and without, spontaneous pain and pulp exposure, vital versus nonvital teeth, the effectiveness of root canal instrumentation, irrigation, dressing, root canal filling materials and adjunct intracanal procedures in the management of AP. Prior to treatment planning, the critical importance of history and case evaluation, aseptic techniques, appropriate training and re-evaluations during and after treatment is stressed.

CONCLUSION

The first S3-level CPG in endodontics informs clinical practice, health systems, policymakers, other stakeholders and patients on the available and most effective treatments to manage patients with pulpitis and AP in order to preserve teeth over a patient's lifetime, according to the best comparative evidence currently available.

Comparison between the rotary (Hyflex EDM®) and manual (k-file) technique for instrumentation of primary molars: a 12-month randomized clinical follow-up study

OBJECTIVES

Rotational instrumentation is an alternative for the clinical practice of pediatric dentists. However, there are few records in the literature on the clinical and radiographic aspects of treated teeth over time. Compare instrumentation time and filling quality between manual (k-file) and rotary (Hyflex EDM®) files, and clinically and radiographically follow-up the treated teeth for 12 months. Moreover, the characteristics of glass ionomer restorations and their interference in the treatment prognosis over time were evaluated.

METHODOLOGY

In total, 40 children with pulp involvement in primary molars received treatment with Hyflex EDM® or manual rotary files, performed by an operator. Clinical and radiographic aspects were observed at different times to determine the effectiveness of each technique.

RESULTS

The rotary system reduced instrumentation time when compared to the use of manual files (p≤0.05), but there was no difference in filling quality between the groups (p≥0.05). Moreover, both types of instrumentation were effective for 12 months (p≥0.05), and restoration retention influenced the emergence of periapical lesions (p≤0.05).

CONCLUSION

Although rotary files reduce clinical time, the clinical and radiographic aspects of both techniques were similar over 12 months. Moreover, restoration retention has been shown to be related to treatment prognosis.

Retrospective clinical evaluation of root canal treatment with or without photodynamic therapy for necrotic teeth and teeth subjected to retreatment

PURPOSE

To compare the effect of photodynamic therapy (PDT) as a procedure to complement root canal treatment (RCT), for both primary treatment and retreatment.

METHODS

This was a retrospective study based on analysis of clinical records. A total of 214 teeth that had undergone RCT on either a primary or retreatment basis, with or without complementary PDT, were evaluated. For 118 teeth that met the previously established inclusion criteria, the time until healing was evaluated. Complementarily, the need for application of calcium hydroxide (CaHy) between visits and the number of visits necessary for completing the treatment were assessed. Data were analyzed using the Mann-Whitney and χ² tests with a significance level of P < 0.05.

RESULTS

Periapical radiolucency resolution was achieved at 15 ± 9.33 months in the RCT + PDT group and 20.35 ± 22.1 months in the RCT group (P = 0.07). For primary treatment, CaHy was necessary in 72.4% of the RCT cases and 16.4% of the RCT + PDT cases (P < 0.01). For retreatment cases, CaHy was used in 82.7% of the RCT cases and 17% of the RCT + PDT cases (P < 0.01). In the RCT group, more than two visits were necessary for primary treatment in 18.6% of the cases, compared with 13.10% in the RCT + PDT group (P = 0.31), whereas for retreatment, more than two visits were necessary for 64.9% and 49.1% of cases, respectively (P = 0.05).

CONCLUSION

In comparison with RCT alone, teeth receiving RCT + PDT showed less variation in the time needed for periapical lesion healing, fewer cases required CaHy, and fewer cases required more than two visits to complete the treatment.

Common Operative Procedural Errors and Clinical Factors Associated with Root Canal Treatment

Abstract Operative procedural errors must be well analyzed in order to avoid influence negatively the root canal treatment (RCT) prognosis. The successful RCT prevents tooth loss and avoids pain and apical periodontitis. This review aimed to categorize common operative procedure errors and clinical factors associated with RCT. Based on this, will be approached common errors of procedures within the clinical operative sequence: endodontic treatment planning, pulp and periapical disease diagnosis, anaesthesia, access cavity preparation, isolation with rubber dam, root canal preparation, root canal filling and retreatment, restoration of endodontically treated teeth, postoperative pain, follow up of endodontically treated teeth. The professional must remind that in each phase of RCT an operative error may have adverse implication on prognosis, and these errors characterize risk factors to failure. The knowledge of probable operative procedural errors and its consequences are essentials to avoid future problems to the tooth health.

Frequency of Root Canal Isthmi in Human Permanent Teeth Determined by Cone-beam Computed Tomography

INTRODUCTION

This study evaluated the frequency of root canal isthmi (RCIs) in human permanent teeth by using cone-beam computed tomography.

METHODS

A sample of 1400 teeth of 618 patients (394 women; mean age, 43.4 years) was selected. RCIs were detected longitudinally on 0.1-mm/0.1-mm axial slices of cone-beam computed tomography images of roots scanned from the pulp orifice to the apex, and findings were classified into 7 categories according to RCIs beginning and end: (1) both in the cervical third, (2) begin in the cervical third and end in the middle third, (3) begin in the cervical third and end in the apical third, (4) both in the middle third, (5) begin in the middle third and end in the apical third, (6) both in the apical third, or (7) no isthmus. A χ(2) test with Yates correction or the Fisher exact test was used to analyze categorical variables, described as frequencies (%). The Student t test was used to compare quantitative variables.

RESULTS

RCI is a common anatomic structure in human permanent teeth, except in maxillary anterior teeth.

CONCLUSIONS

The higher frequencies of RCIs (87.9%) were found in mandibular first molars. The frequencies of RCIs according to mean age and tooth group were not significantly different (P > .05), except in mandibular central incisors. RCIs were less frequent among older patients.