Multiple-file vs. single-file endodontics in dental practice: a study in routine care

Clinicians' perspectives, inducements, preferences, and clinical experiences regarding the use of electronic apex locator and apex locator integrated engine-driven instrumentation: a cross-sectional study

BACKGROUND

This study aimed to investigate the perspectives, preferences, and clinical experiences regarding using electronic apex locator and apex locator integrated instrumentation of dentists and endodontists.

METHODS

A web-based questionnaire consisting of 3 parts and 23 closed-ended questions to achieve the objective of the study was carried out in ethical conditions between August and October 2023. The first part of survey included demographic information, while the second part was about evaluating electronic apex locator usage. In the last part, only participants' use of apex locator-integrated instrumentation was evaluated. Data were analyzed at a significance level of p < 0.05.

RESULTS

A total of 297 clinicians, including 59 endodontists and 34 endodontic residents/Ph.D. students participated in the questionnaire. Endodontists and endodontic residents/Ph.D. students perform statistically significantly more root canal treatments per week on average (p = 0.001). For the working length determination method (multiple option question), 78.5% of participants use an electronic apex locator and 39.7% apex locator-integrated engines. However, the preference rate for electronic apex determination technique was generally 95.6%, with the full rate confirmation of endodontists and endodontic residents/Ph.D. students (100%). A total of 21 endodontists out of 59 prefer apex locator integrated engine-driven instrumentation. Although many of these specialized clinicians use this technique, they stated that they measure electronic working length passively for confirmation of the working length before (90.5%) and after the preparation (66.7%).

CONCLUSIONS

Dentists, as well as endodontists, are skeptical about apex locator-integrated engine-driven instrumentation. Using this technique as a supporter rather than a primary way for preparation within safe limits may give safer results in terms of treatment outcomes.

Fifteen years of engine-driven nickel-titanium reciprocating instruments, what do we know so far? An umbrella review

Numerous systematic reviews (SRs) have produced conflicting findings on engine-driven nickel-titanium reciprocating instruments (reciprocating instruments) since Yared's seminal study 15 years ago. This umbrella review analysed SRs examining the clinical and laboratory evidence regarding reciprocating instruments for root canal treatment. SRs that evaluated qualitatively and/or quantitatively the outcomes postoperative pain, oral health-related quality of life (OHRQoL), shaping ability, debris extrusion, microbial load, endotoxins reduction, cyclic fatigue, file fracture, dentinal cracks and root canal filling removal were included. The AMSTAR 2 tool was used to evaluate SRs quality, while the ROBIS tool to assess risk of bias (RoB). Forty SRs were included. The SRs revealed predominantly 'high' RoB and 'critically low' quality. Most focused on technical outcomes, exhibiting significant methodological and statistical heterogeneity. Findings suggest comparable efficacy between reciprocating and rotary instruments. However, due to the scarcity of high-quality evidence, future well-designed studies and reviews considering core outcome measures are needed.

A single-file endodontic treatment: A promising endodontic concept

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A critical appraisal of research methods and experimental models for studies on root canal preparation

It is the aim of this review to present a critical overview and summary on the contemporary possibilities, limitations and challenges of research related to root canal preparation. Frequently used research tools and contemporary research designs will be presented and discussed critically focussing on shortcomings and benefits with special regard to clinical relevance and scientific evidence. A plethora of experimental set-ups for assessing the shaping of root canals have been described in the endodontic literature using a considerable number of techniques and instruments. Nevertheless, it can be stated that scientific evidence demonstrating the clinical impact of many investigated topics is questionable or even missing. Instead of technical, radiographic and geometrical parameters, further research should focus on biological aspects and clinical evidence of the impact of root canal preparation on the outcome of root canal treatment.

[Dental and oral health services research in Germany]

In den letzten 8 Jahren wurde in Deutschland nicht nur „mehr Versorgungsforschung in der Zahnmedizin“ gefordert, sondern auch geleistet. Insgesamt finden sich an 12 Medizinischen Fakultäten themenbezogene Aktivitäten der Zahn‑, Mund- und Kieferheilkunde in der Versorgungsforschung; deutschlandweit werden 9 Großprojekte verortet, die vom Bundesministerium für Bildung und Forschung oder vom Innovationsfonds gefördert werden. Gleichwohl ist der Bedarf an Versorgungsforschung größer als die jetzige Leistungsfähigkeit der universitären und außeruniversitären Zahnmedizin: Um eine nachhaltige, bedarfsgerechte und zukunftssichere zahnärztliche Versorgung aller Menschen in Deutschland gewährleisten zu können, bedarf es strukturierter, methodisch versierter und in die Versorgung hinein vernetzter Verbünde, die das wissenschaftliche Fundament für erwartete Versorgungsumbrüche legen können.

Der vorliegende Beitrag soll den Stand der Versorgungsforschung in der Zahn‑, Mund- und Kieferheilkunde in Deutschland beschreiben. Die wesentlichen Herausforderungen werden adressiert: Methodenkompetenz, Zugang zu Daten und deren Nutzung sowie die langfristige Perspektive dieses Forschungsbereichs. Derzeitige Forschungsaktivitäten und Infrastruktur inklusive Förder- und Fortbildungsinstrumente werden dargestellt.

Die Erkenntnisse aus der zahnärztlichen Versorgungsforschung in Deutschland können auch für andere Länder richtungsweisend sein; umgekehrt kann Versorgungsforschung Ansätze aus anderen Ländern sinnvoll in das deutsche Gesundheitssystem übertragen. Versorgungsforschende sollten sich professionalisieren und vernetzen. Nachhaltige Strukturen (Professuren, Mittelbau) und Rahmenbedingungen (Datennutzung, Förderung) sollten geschaffen und Forschungsergebnisse zeitnah verwertet werden.

Debris Extrusion Using Reciproc Blue and XP Endo Shaper Systems in Root Canal Retreatment

This study aimed at assessing the performance of Reciproc Blue (RB) and XP Endo Shaper (XPS), used for canal retreatment on extracted teeth, in terms of debris extrusion and obturating materials removal. Thirty mandibular premolars were prepared to ProTaper X2 file, obturated using warm vertical compaction, and then incubated for 28 days at 100% humidity at 37°C. Teeth were randomly assigned into two groups, according to the system used for retreatment (RB and XPS). During retreatment, debris extruded beyond the apex was collected in preweighed Eppendorf tubes, and the retreatment time was measured. Afterward, the teeth were longitudinally sectioned to assess the remaining obturating materials. Data were statistically analyzed using the Mann-Whitney test and chi-square test at a 95% confidence level. All the samples had extruded debris at varying weights ranging from 0.125 mg to 3.680 mg. XPS extruded less debris than RB, but no difference was detected (Mann-Whitney test; P > 0.05). RB and XPS required 54.9 ± 17.9 and 22.3 ± 9.3 seconds to perform retreatment procedures, respectively (Mann-Whitney test; P < 0.05). The sealer was found in all the samples. Compared to the RB group, fewer samples with remaining gutta-percha were found in the XPS group (Chi-square test; P < 0.05). None of the files fractured during the retreatment procedure. The tested files appear to extrude debris beyond the apex. Although XPS was able to remove the gutta-percha completely from the majority of the canals, it was unable to remove the sealer.

A retrospective assessment of different endodontic treatment protocols

Background

The aim of this study was to assess the clinical impact of non-surgical root canal treatments (NSRCT) performed with different treatment protocols on the probability of tooth survival without untoward events and to identify predictors influencing the outcome.

Methods

During the period from July 1999 to October 2016, 5,858 patients were identified in which 9,967 NSRCTs were performed. The treatments were followed up and divided into three groups. In Group 1 root canal treatment was performed with hand instruments, in Group 2 with multiple file rotary instruments and passive ultrasonic irrigation (PUI), and Group 3 was treated with Reciproc instruments and PUI. Untoward events were defined as orthograde retreatment, apicoectomy or extraction of the tooth after initial treatment. Weibull regression was used to analyse the data.

Results

A total of 9,938 cases could be included into the analyses. The results showed 5-years predicted survival rates without untoward events of 73.9% (95% CI [71.7%–76.1%]), 75.1% (95% CI [71.7%–78.0%]) and 78.4% (95% CI [75.1%–81.4%]) for study group 1 (N = 5,580), 2 (N = 1,700) and 3 (N = 2,658), respectively. The differences between Group 1 and 3 were statistically significant (p < 0.006). Higher age of the patient (per year increase) and number of earlier NSRCTs (per unit increase) reduce the survival without untoward events statistically significant (both p < 0.02), while treatment of premolars had a statistically significant lower hazard ratio [0.89 (95% CI [0.79–0.99]; p = 0.030)] compared to treatment of molars and anterior teeth. A higher number of supportive periodontal treatments (per unit increase) improved tooth survival without untoward events highly significant (p < 0.0001).

Discussion

More recent endodontic treatment protocols involving reciprocating instruments and PUI appear to be associated with higher tooth survival rates without untoward events compared to hand instruments.

Oral health-related quality of life (OHRQoL) before and after endodontic treatment: a systematic review

OBJECTIVES

This systematic review was undertaken to determine the oral health-related quality of life (OHRQoL) before and after endodontic treatment.

MATERIALS AND METHODS

Based on the PRISMA guidelines, electronic databases (n = 7) were searched and from 1038 citations, 16 papers were included in this review. Information on study design, sample size, intervention/treatment modality, methods of assessing OHRQoL, and the key findings were extracted and analyzed.

RESULTS

Among the 16 studies, 3 were cross-sectional surveys, 9 were longitudinal studies, and 4 were randomized clinical trials. The cross-sectional studies reported improvements in OHRQoL following root canal treatment. Comparative longitudinal studies did not identify a significant association between improvements in OHRQoL and the method of root canal instrumentation or number of instruments used. Clinical trials found that improvements in OHRQoL were significantly associated with instrumentation technique, surgical-incision approach, and the application of platelet-concentrate during surgery. Several methods of assessing OHRQoL were employed with the most common being the Oral Health Impact Profile (OHIP), albeit using different versions.

CONCLUSIONS

The results of this systematic review indicate that the QoL of patients improved after endodontic treatment. Nevertheless, these results are limited to patients who seek endodontic treatment and cannot be generalized. The lack of well-designed observational studies with standardized assessment approaches, coupled with heterogeneity of study design and interventions, precluded quantitative synthesis.

CLINICAL RELEVANCE

Pragmatic clinical trials are more meaningful to understand patient-centered outcomes of treatment. This review shows that endodontic treatment does improve the QoL. However, future studies should use standardized tools and data reporting, which are critical to make meta-analyses possible.

Single versus Multiple Sitting Endodontic Treatment: Incidence of Postoperative Pain - A Randomized Controlled Trial

AIMS AND OBJECTIVES

The aim of the study is to assess any considerable differences in the incidence and severity of postobturation pain after single- and multiple-visit root canal treatment.

MATERIALS AND METHODS

We carried our study on 400 successive patients who needed root canal treatment. They were randomly categorized into two groups of 200 each. First group underwent single-visit treatment and the other group underwent multiple-visit therapy. Visual analog scale was employed to evaluate pain preoperatively and postoperatively at 6, 12, 24, and 48 h after obturation. The Statistical Package for the Social Sciences version 20 was employed for analysis.

RESULTS

There was a male predominance (235; 60.26%). Of 390 cases, 167 were vital and 223 were nonvital. There was an insignificant difference between the preoperative and postoperative pain levels of vital and nonvital teeth of both the groups at different time intervals.

CONCLUSION

There was a less incidence of pain in multiple visit group than single-visit one, which was statistically significant.