PRIDASE 2024 guidelines for reporting diagnostic accuracy studies in endodontics: A consensus-based development.

Studies investigating the accuracy of diagnostic tests should provide data on how effectively they identify or exclude disease in order to inform clinicians responsible for managing patients. This consensus-based project was undertaken to develop reporting guidelines for authors submitting manuscripts, which describe studies that have evaluated the accuracy of diagnostic tests in endodontics. These guidelines are known as the Preferred Reporting Items for Diagnostic Accuracy Studies in Endodontics (PRIDASE) 2024 guidelines. A nine-member steering committee created an initial checklist by integrating and modifying items from the Standards for Reporting of Diagnostic Accuracy (STARD) 2015 checklist and the Clinical and Laboratory Images in Publications (CLIP) principles, as well as adding a number of new items specific to the specialty of endodontics. Thereafter, the steering committee formed the PRIDASE Delphi Group (PDG) and the PRIDASE Online Meeting Group (POMG) in order to collect expert feedback on the preliminary draft checklist. Members of the Delphi group engaged in an online Delphi process to reach consensus on the clarity and suitability of the items in the checklist. The online meeting group then held an in-depth discussion on the online Delphi-generated items via the Zoom platform on 20 October 2023. According to the feedback obtained, the steering committee revised the PRIDASE checklist, which was then piloted by several authors when preparing manuscripts describing diagnostic accuracy studies in endodontics. Feedback from this process resulted in the final version of the PRIDASE 2024 checklist, which has 11 sections and 66 items. Authors are encouraged to use the PRIDASE 2024 guidelines when developing manuscripts on diagnostic accuracy in endodontics in order to improve the quality of reporting in this area. Editors of relevant journals will be invited to include these guidelines in their instructions to authors.

What is new in the 2023 European Society of Endodontology S3-level clinical practice guidelines?

BACKGROUND: The European Society of Endodontology published in 2023, the S3-level clinical practice guidelines, which supersede the Quality Guidelines for Endodontic Treatment published in 2006. OBJECTIVES: This review aims to summarize and compare the above guidelines to support their dissemination. METHOD: A narrative synthesis of the main differences alongside tabulation according to the main themes. RESULTS: Three tables were prepared according to the following themes: diagnosis of pulpal and apical condition; treatment of pulpitis; and treatment of nonvital pulp and apical periodontitis. CONCLUSIONS: A compared and simplified message regarding the most recent clinical practice guidelines has been prepared. REGISTRATION: Not applicable as a narrative review.

Clinical applications, accuracy and limitations of guided endodontics: a systematic review.

BACKGROUND: The novel concept of guided endodontics has been reported as an effective method to obtain safe and reliable results in root canal treatment. AIM: To evaluate by means of a systematic review the clinical applications, accuracy and limitations of guided endodontic treatment. DATA SOURCES: A search of the literature was performed on PubMed, Embase, Web of Science and Cochrane Library databases, until 25 April 2019. No language or year restrictions were applied. STUDY ELIGIBILITY CRITERIA: Articles that answered the research question, including case reports, in vitro and ex vivo studies were included. Data extraction was performed independently by two reviewers. STUDY APPRAISAL: Quality assessment was done using STROBE, CARE and Modified CONSORT guidelines for observational, case reports and pre-clinical studies, respectively. RESULTS: A total of 22 articles, including fifteen case reports, six pre-clinical studies (in vitro and ex vivo studies) and one observational study, were included. LIMITATIONS AND CONCLUSIONS: Even though the level of evidence is low, and the methodology described among studies heterogeneous, all articles describe guided access cavity preparation and guided surgery as being highly accurate and successful techniques when comparing the drilled path to the planned treatment. More studies with a larger number of patients are necessary to obtain significant conclusions.

European Society of Endodontology position statement: External Cervical Resorption.

This Position Statement represents the consensus of an expert committee convened by the European Society of Endodontology (ESE) on External Cervical Resorption (ECR). The statement is based on current clinical and scientific evidence as well as the expertise of the committee. The primary aim is to provide a current authoritative position on the aetiology, histopathology, clinical presentation and management of ECR, and also to highlight areas where there is minimal evidence. Previously published review articles provide more detailed background information and the basis for this position statement (International Endodontic Journal 51, 1205, 2018, International Endodontic Journal 51, 1224, 2018). It is intended that this position statement will be updated at appropriate intervals, as further evidence emerges.

European Society of Endodontology position statement: the use of antibiotics in endodontics.

This position statement represents a consensus of an expert committee convened by the European Society of Endodontology (ESE) on Antibiotics in Endodontics. The statement is based on current scientific evidence as well as the expertise of the committee. The goal is to provide dentists and other healthcare workers with evidence-based criteria for when to use antibiotics in the treatment of endodontic infections, traumatic injuries of the teeth, revascularization procedures in immature teeth with pulp necrosis, and in prophylaxis for medically compromised patients. It also highlights the role that dentists and others can play in preventing the overuse of antibiotics. A recent review article provides the basis for this position statement and more detailed background information (International Endodontic Journal, 2017, https://doi.org/10.1111/iej.12741). Given the dynamic nature of research in this area, this position statement will be updated at appropriate intervals.

European Society of Endodontology position statement: Revitalization procedures.

This position statement represents a consensus of an expert committee convened by the European Society of Endodontology (ESE) on revitalization procedures. The statement is based on current clinical and scientific evidence as well as the expertise of the committee. The goal is to provide suitably trained dentists with a protocol including procedural details for the treatment of immature teeth with pulp necrosis as well as a patient consent form. Revitalization is a biologically based treatment as an alternative to apexification in properly selected cases. Previously published review articles provide more detailed background information and the basis for this position statement (Journal of Endodontics, 39, 2013, S30; Journal of Endodontics, 39, 2013, 319; Journal of Endodontics, 40, 2014, 1045; Dental Traumatology, 31, 2015, 267; International Endodontic Journal, 2015, doi: 10.1111/iej.12606). As controlled clinical trials are lacking and new evidence is still emerging, this position statement will be updated at appropriate intervals. This might lead to changes to the protocol provided here.

Assessment of treatment failure in endodontic therapy.

There is a paucity of guidelines for the dental profession to assess failure of endodontic therapy. While a successful treatment can be well defined by the absence of apical periodontitis and clinical symptoms after a period of observation, failed treatment has escaped a distinct standing over the years. This article highlights aspects of significance and concludes that research ought to better explore the general health properties of persistent apical periodontitis on root-filled teeth and finally confirm the extent there is an association between apical periodontitis and adverse systemic health effects. Clearing this condition will determine whether clinicians should take a serious or relaxed attitude to persistent apical periodontitis subsequent to endodontic treatment.

The confidence of undergraduate dental students when performing root canal treatment and their perception of the quality of endodontic education.

AIM: This article aims to gain understanding into the perception of undergraduate dental students in terms of their confidence and competence at performing root canal treatment and their perception of the quality of endodontic education. METHODS: An online questionnaire was distributed to all 3rd, 4th and 5th year dental students at Cardiff University via their academic e-mail addresses. The questionnaire utilised both scaled response and open questions to gain an insight into undergraduate opinion. RESULTS: Out of a possible 208 students, 98 responses were obtained (response rate = 47%). Perception of competence and confidence were significantly greater amongst the more senior year groups (P < 0.01). However, 49% (n = 38) of participants did not feel competent performing root canal treatment on anterior, single-rooted teeth, whilst 74% (n = 70) did not feel competent performing root canal treatment on posterior, multirooted teeth. Free comments from participants indicated that this was due to a lack of clinical experience. Approximately, 80% of participants ranked education in endodontics at Cardiff University as ≤5 on a Likert scale (1 = inadequate to 10 = good), indicating that improvement was required. Improvements that were suggested by the students included the provision of further information within lectures, a broader range of lecturers, an increased number of shorter, more organised practical sessions, additional training equipment, greater supervision and online reference guides to root canal treatment. CONCLUSION: Enhancing undergraduate education in endodontics is necessary to increase students' perception of their confidence and competence when performing root canal treatment.

The trend of quality of publications in endodontic surgery: a 10-year systematic survey of the literature.

OBJECTIVES: The aims of the present systematic literature analysis were to evaluate, over a 10-year period, the trend of the proportion of RCT, SR, MA published on endodontic surgery, and to investigate if the impact factor (IF) of the main endodontic Journals correlates with the proportion of RCT, SR, MA they publish. METHODS: An electronic search of the RCT, SR and MA published on the topic "endodontic surgery" from 2001 to 2010 was performed on Medline and Cochrane CENTRAL database using specific search terms combined with Boolean operators. Endodontic Journals impact factor was retrieved by the Thomson Scientific database. The proportion of each study type over the total number of articles on endodontic surgery published per year was estimated. The correlation between the number of high-evidence level studies published on the main endodontic Journals and the IF of such Journals per year was estimated. RESULTS: From a total of 900 articles published in 2001-2010 on endodontic surgery, there were 114 studies of high evidence level. A significant increase of the proportion of either RCT, SR and MA over the years was found. A modest to unclear correlation was found between the Journal IF and the number of high-evidence articles published. CONCLUSIONS: There is a positive trend over the years among researchers in performing studies of good quality in endodontic surgery. The impact factor of endodontic Journals is not consistently influenced by publication of high-evidence level articles.

Technical quality of root fillings performed by undergraduate students: a radiographic study.

AIM: The aim of this study was to evaluate the radiographic technical quality of endodontic treatment performed by undergraduate students at the School of Dentistry, Faculty of Medicine, University of Novi Sad, Serbia. MATERIALS AND METHODS: Electronic records of 220 patients treated by final-year undergraduate students during the school year 2011/2012 were examined, and the final sample consisted of 212 patients, 322 teeth, and 565 root canals. The criteria for overall radiographic adequacy of root canal fillings were defined as the presence of adequate length and density and absence of iatrogenic errors (ledge, fractured instrument, untreated canal, and apical transportation). Chi-square test was used to determine statistical significance between different parameters. RESULTS: Adequate root canal fillings were found in 74.22% of the teeth. The percentage of root fillings with adequate length and density was 89.73% and 92.6%, respectively. Fractured instruments and ledges were present in 16 root canals (2.8%), while the presence of missed canal and apical transportation was observed in 2 cases, each (0.3%). CONCLUSIONS: Overall, the technical quality of root canal fillings performed by undergraduate students was satisfactory.

Potential errors and misuse of statistics in studies on leakage in endodontics.

AIM: To assess the quality of the statistical methodology used in studies of leakage in Endodontics, and to compare the results found using appropriate versus inappropriate inferential statistical methods. METHODOLOGY: The search strategy used the descriptors 'root filling' 'microleakage', 'dye penetration', 'dye leakage', 'polymicrobial leakage' and 'fluid filtration' for the time interval 2001-2010 in journals within the categories 'Dentistry, Oral Surgery and Medicine' and 'Materials Science, Biomaterials' of the Journal Citation Report. All retrieved articles were reviewed to find potential pitfalls in statistical methodology that may be encountered during study design, data management or data analysis. RESULTS: The database included 209 papers. In all the studies reviewed, the statistical methods used were appropriate for the category attributed to the outcome variable, but in 41% of the cases, the chi-square test or parametric methods were inappropriately selected subsequently. In 2% of the papers, no statistical test was used. In 99% of cases, a statistically 'significant' or 'not significant' effect was reported as a main finding, whilst only 1% also presented an estimation of the magnitude of the effect. When the appropriate statistical methods were applied in the studies with originally inappropriate data analysis, the conclusions changed in 19% of the cases. CONCLUSIONS: Statistical deficiencies in leakage studies may affect their results and interpretation and might be one of the reasons for the poor agreement amongst the reported findings. Therefore, more effort should be made to standardize statistical methodology.

Radiographic evaluation of the technical quality of undergraduate endodontic 'competence' cases in the Dublin Dental University Hospital: an audit.

PURPOSE: The aim of this audit was to evaluate the technical quality of undergraduate de novo endodontic competence cases in the Dublin Dental University Hospital (DDUH) compared to European standards. MATERIALS AND METHODS: A radiographic analysis of the number of canals in student 'competence' cases (completed 2009-2010) that met the accepted technical criteria for an ideal root canal treatment was carried out. The benchmark was formulated using accepted European guidelines. Several technical factors were analysed including the apical extent of obturation (within 2mm of radiographic apex), the presence of voids, technical errors and the presence of untreated roots. One hundred and nineteen root canals were initially selected in 78 teeth; however, five teeth were excluded from analysis as the postoperative radiograph was either missing or not diagnostic. RESULTS: Single-rooted teeth demonstrated voids in 36% of root fillings, and 69% were filled to within 2mm of the apex and there were no detectable technical deficiencies. Multi-rooted teeth demonstrated voids in 38% of root fillings; 60% were filled to within 2mm and 94% of canals demonstrated no deviation from the original canal. Combined results demonstrated that 49% of all the single-rooted teeth and 17% of all the multi-rooted teeth were acceptable within the technical parameters identified in the guidelines. CONCLUSIONS: Analysis of individual technical criteria revealed areas in which the quality was acceptable and others in which it could be improved. Although the overall results appeared poor, they were similar to previous studies of the technical quality of undergraduate root canal treatment.

Evaluation of physicochemical properties of four root canal sealers.

AIM: To assess the physicochemical properties and the surface morphology of AH Plus, GuttaFlow, RoekoSeal and Activ GP root canal sealers. METHODOLOGY: Five samples of each material were evaluated for setting time, dimensional alteration, solubility and radiopacity tests, according to ANSI/ADA Specification 57. A total of 50 mL of deionized distilled water from the solubility tests were used to measure the metal solubility by atomic absorption spectrometry. The morphologies of the external surface and the cross-section of the samples were analysed by means of a scanning electron microscope (SEM). Statistical analysis was performed by using one-way anova and post hoc Tukey-Kramer tests with the null hypothesis set as 5%. RESULTS: AH Plus had the longest setting time (580.6 ± 3.05 min) (P<0.05). Activ GP did not have a mean value on the radiopacity and solubility tests (1.31 ± 0.35 mm and 11.8 ± 0.43%, respectively) in accordance with ANSI/ADA, being significantly different from the other materials (P<0.05), which had mean values for these tests in accordance with the ADA's requirements. GuttaFlow was the only sealer that conformed to the Specification 57 concerning the dimensional alteration test (0.44 ± 0.16%) (P<0.05). The spectrometry test revealed significant Ca(2+), K(+), Zn(2+) ion release from Activ GP sealer (32.57 ± 5.0, 1.57 ± 0.22 and 8.20 ± 1.74 µg mL(-1), respectively). In SEM analysis, the loss of matrix was evident and the filler particles were more distinguishable in all groups. CONCLUSIONS: The setting time of all sealers was in accordance with ANSI/ADA's requirements. Activ GP did not fulfill ANSI/ADA's protocols regarding radiopacity, dimensional alteration and solubility. GuttaFlow was the only sealer that conformed to the Specification 57 in all tests. SEM analysis revealed that the surfaces of all sealers had micromorphological changes after the solubility test.

Accreditation of postgraduate speciality training programmes in Endodontology. Minimum criteria for training Specialists in Endodontology within Europe.

This consensus statement from the European Society of Endodontology (ESE) sets out the minimum criteria for training Specialists in Endodontology within Europe. The case is made for recognizing Endodontology as a distinctive dental discipline throughout Europe. Guidelines are presented on the requirements of a specialist and of a specialist training programme in Endodontology. The aims, objectives and curriculum content of a specialist training pathway are outlined, with guidelines on trainee appraisal, and the expectations of faculty and institutional commitment. In publishing these guidelines, the ESE is responding to a public and professional need for consistently high standards of training and specialist clinical service within Europe.

Magnification in modern endodontic practice.

The use of magnification devices in endodontics is becoming more and more common, with the aim of improving the quality of treatment. The common magnification systems used in modern endodontics are the surgical operation microscope, fiber-optic endoscope, and surgical loupes. The benefits of using magnification devices for conventional endodontic treatment include the increased visualization of the treatment field, enhanced possibilities in locating canals, aid in the removal of separated instruments, diagnosis of root and tooth fractures, perforation repair, and case documentation. In endodontic surgery, the use of magnification improves the ability to locate, clean, and fill the root canal system, thus achieving a predictable outcome. Further evidence-based research might better clarify the advantages and limitations of using magnification in endodontic practice.

[Consensus recommendations from Chinese experts on the standard operation procedure of dental operative microscope in endodontics and operative dentistry].

Dental operative microscope has been wildly used in endodontics and operative dentistry for many years. Many progresses have been made by using operative microscope in improving the outcomes of root canal therapy, endodontic surgery and operative dentistry. However, in clinical practice, improper use of the dental operative microscope is not uncommon, the reason related to which is the operator's lack of understanding and mastering not only the properties but also the standard operative procedure of the dental operative microscope. To this end, in October 2019, the vice chairman of the Society of Cariology and Endodontology, Chinese Stomatological Association, professor Liang Jingping, organized a group of professional experts in this field, convened a meeting about the standard operative procedure of dental operative microscope. Experts at the meeting had a very heated discussion and the consensuses were reached.

Implementation of Digital Radiography during Root Canal Treatments in Saudi Endodontic and General Dental Practice.

Objective: To report usage of full-digital-radiography (FDR) during root-canal-treatments (RCTs) in Saudi dental-practice and to explore factors and measures that obstacle/contribute to better implementation. Methods: Following a pilot study, questions on demography, types of radiographic systems used during RCTs, advantages and disadvantages of FDR, reasons of not using it and measures that increase its implementation were included. The sample size was calculated considering the total number of general dentists (GDs) in Saudi Arabia and a 50-60% expected response rate. The questionnaire was emailed to 550 GDs and all endodontists in Saudi Arabia (185). A solo a reminder was emailed two months later. Data were analyzed by the Chi-square test at P=0.05. Results: Most participants (64.9%) used FDR for RCTs (P<0.001); with all endodontists (100%) and 52% of GDs (P<0.001). While all who were working in governmental-academia (100%) used FDR, 69.2% in private-academia did so (P<0.001); with no difference between private and governmental-clinics (60.6 and 69.2%). As the weekly-performed RCTs increased and participants' experience decreased, FDR usage increased (P<0.05). While high-cost was the main FDR disadvantage, faster-workflow, better image-quality and less-radiation were the main advantages (P<0.001). The majority (76.1%) of FDR none-users were doing so because of unavailability. Participants reported lower-cost and better undergraduate-education as most effective measures that increase FDR implementation in dental-practice. Conclusion: FDR was adopted to good extent in Saudi dental-practice. Financial aspects were the main concern that should be addressed to increase FDR implementation in private practice. Endodontists showed better perception towards FDR and suggested more attention to educational aspects.

Australian endodontists' perceptions of single and multiple visit root canal treatment.

AIM: To ascertain endodontist's point of view (treatment philosophy, rationale and preference) regarding single- and multiple-visit root canal treatment. To identify the basis on which the choice is made and how the information necessary for the choice is acquired. METHODOLOGY: Endodontists registered with the dental practice board of every state in Australia were contacted, and if they agreed to participate, they were interviewed either face to face or by telephone. The following topics were addressed in an interview lasting 15 to 20 min: demographics, current clinical procedures, treatment rationales and preference. A hypothetical scenario was posed to investigate which treatment regimen they would prefer to deliver if biological concerns were eliminated from consideration. RESULTS: Fifty-two endodontists (71% of all Australian endodontists) agreed to participate in the study. Almost all (51/52) participants had performed single-visit root canal treatment, but very few routinely performed it. A majority of participants were willing to provide single-visit treatment where patients had time constraints, and in vital cases (including elective endodontics). The most powerful factor of influencing practice change was interpersonal contact with colleagues. Publications in academic journals have a weak influence in practice change. CONCLUSIONS: Australian endodontists strongly prefer multiple-visit over single-visit root canal treatment even in cases where biological concerns are not an issue. Operator preference rather than biological or patient considerations appear to be the primary determinant of treatment choice.

Pre-clinical endodontics: a survey amongst German dental schools.

AIM: To evaluate the state and level of pre-clinical endodontic education in German dental schools and to evaluate differences with regard to intensity and extent of teaching, time devoted to teaching pre-clinical endodontics, personnel resources in teaching and technical equipment. METHODOLOGY: Twenty-eight questionnaires were e-mailed to those in charge of pre-clinical endodontic education in German dental schools. The extent of education, the student-teacher ratio, the teaching content as well as the application of teaching materials and technologies were asked. If, after 4 weeks, no response had been received, the questionnaire was sent out by e-mail again. In the absence of a reply, a phone call was made to the corresponding university to conduct the survey by phone. RESULTS: With feedback from 27 of 28 dental schools, the response rate was 96%. Pre-clinical endodontic education at German universities varied considerably. Theory classes ranged from 5 to 30 h (13.3 h mean), practical classes from 12.5 to 60 h (45.4 h mean). The student to staff ratio varied between 9 : 1 and 30 : 1 (16 : 1 mean). Forty-eight per cent of the universities had a specialist in endodontics or a teacher with a special interest. A dental microscope was available for pre-clinical teaching purposes in 38% of the universities. The majority (63%) of universities taught root canal preparation with rotary nickel titanium instruments. CONCLUSION: Pre-clinical endodontic education varied considerably between German universities because of differences in programme design, staff and course content.

Methodological and Reporting Quality of Systematic Reviews and Meta-analyses in Endodontics.

INTRODUCTION: The aim of this systematic review (SR) was to evaluate the quality of SRs and meta-analyses (MAs) in endodontics. METHODS: A comprehensive literature search was conducted to identify relevant articles in the electronic databases from January 2000 to June 2017. Two reviewers independently assessed the articles for eligibility and data extraction. SRs and MAs on interventional studies with a minimum of 2 therapeutic strategies in endodontics were included in this SR. Methodologic and reporting quality were assessed using A Measurement Tool to Assess Systematic Reviews (AMSTAR) and Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA), respectively. The interobserver reliability was calculated using the Cohen kappa statistic. Statistical analysis with the level of significance at P < .05 was performed using Kruskal-Wallis tests and simple linear regression analysis. RESULTS: A total of 30 articles were selected for the current SR. Using AMSTAR, the item related to the scientific quality of studies used in conclusion was adhered by less than 40% of studies. Using PRISMA, 3 items were reported by less than 40% of studies, which were on objectives, protocol registration, and funding. No association was evident comparing the number of authors and country with quality. Statistical significance was observed when quality was compared among journals, with studies published as Cochrane reviews superior to those published in other journals. AMSTAR and PRISMA scores were significantly related. CONCLUSIONS: SRs in endodontics showed variability in both methodologic and reporting quality.