When and how do endodontic specialists use cone-beam computed tomography?

This study investigated the use of cone-beam computed tomography (CBCT) by endodontists in Germany and Switzerland. Sixty-eight German endodontic specialists (G-ES), 22 Swiss endodontic specialists (CH-ES) and 95 dentists with a German Master of Science in endodontics (MSc) were invited to participate. Data on the timing of diagnostic assessments, endodontic case difficulty and indications for CBCT use were collected by questionnaire. The frequencies of pre-, intra- and postoperative use of periapical radiography and CBCT were analysed by case difficulty level. In high difficulty cases, access to a CBCT device was significantly associated with the frequency of both pre- and intraoperative CBCT use. The type of endodontic qualification had a significant impact on the rate of preoperative CBCT use in high difficulty cases. German endodontic specialists used preoperative CBCT more frequently than CH-ES and MSc. Our findings show that CBCT is a valuable imaging tool for endodontists, particularly in high difficulty cases.

Treatment of calcified root canals in elderly people: a clinical study about the accessibility, the time needed and the outcome with a three-year follow-up.

OBJECTIVE: Determination of accessibility, time needed and outcome of endodontic treatment of teeth with calcified root canals in a sample of elderly participants in a private practice limited to endodontics. BACKGROUND: Due to demographic changes, gerodontology is becoming more and more important, also in the field of endodontology. Elderly patients can show up with severe calcifications of root canals. Root canal treatment, when needed, can be very challenging in these cases. Only few data exist about the treatment of calcified root canals and its outcome, especially in an elderly population. MATERIALS AND METHODS: Forty-one participants (median age: 72 years) needing a root canal treatment were included. The total number of treated teeth was 41 with 114 negotiated root canals. A specialist limited to endodontics performed the treatment in a private practice. Outcome was assessed by applying the periapical index score on the basis of recall radiographs provided by the referring dentists. Likewise, time required to localise the root canals was measured. RESULTS: All root canals have been detected using the operating microscope, and full working length could be established in 90% of the cases. Success rate was 80% after an observation time of 3 years. In three of five teeth, root canals could be localised within 15 min. CONCLUSION: Calcified root canals of older people treated in this study were all accessible within a maximum of 60 min. The success rate after a follow-up of 3 years was 80%.

Homogeneity and adaptation of endodontic fillings in root canals with enlarged apical preparation.

OBJECTIVE: The aim was to compare the homogeneity and adaptation of endodontic fillings placed in root canals with wide apical preparation. STUDY DESIGN: One hundred twenty root canals were prepared under simulated clinical conditions. The range of apical preparation size was 45 (narrow canals) to 60 (wide canals). The canals were filled using 4 techniques: Thermafil, GuttaFlow, apical cone, and vertical compaction. The root canals were sectioned at 5 levels. The adaptation and homogeneity of the filling were evaluated and statistically analyzed. RESULTS: The percentage of canal outline in contact with the filling in the Thermafil group (91.3% [95% confidence interval (CI) 88.8%-93.6%]) was statistically significantly lower than in the other groups. No statistically significant differences were found between GuttaFlow (96.6% [95% CI 95.7%-97.5%]), apical cone (98.6% [95% CI 98.0%-99.3%]), and vertical compaction (98.1% [95% CI 96.5%-99.7%]). Similarly, the percentage of void area in Thermafil group (4.0% [95% CI 2.6%-5.3%]) was statistically significantly higher than in the other groups (GuttaFlow 1.4% [95% CI 0.1%-1.8%], apical cone 1.6% [95% CI 0.7%-2.4%], and vertical compaction 0.1% [95% CI 0.1%-1.8%]). CONCLUSIONS: The tested filling techniques/materials provided similar high values for the homogeneity and adaptation to root canal walls after enlarged apical preparation, except for Thermafil at the most apical level.