Efficacy of electronic apex locators in comparison with intraoral radiographs in working length determination- a systematic review and meta-analysis.

BACKGROUND: Successful endodontic treatment needs accurate determination of working length (WL). Electronic apex locators (EALs) were presented as an alternative to radiographic methods; and since then, they have evolved and gained popularity in the determination of WL. However, there is insufficient evidence on the post-operative pain, adequacy, and accuracy of EALs in determining WL. OBJECTIVE: The systematic review and meta-analysis aims to gather evidence regarding the effectiveness of EALs for WL determination when compared to different imaging techniques along with postoperative pain associated with WL determination, the number of radiographs taken during the procedure, the time taken, and the adverse effects. METHODS: For the review, clinical studies with cross-over and parallel-arm randomized controlled trials (RCTs) were searched in seven electronic databases, followed by cross-referencing of the selected studies and related research synthesis. Risk of bias (RoB) assessment was carried out with Cochrane's RoB tool and a random-effects model was used. The meta-analysis was performed with the RevMan software 5.4.1. RESULTS: Eleven eligible RCTs were incorporated into the review and eight RCTs into the meta-analysis, of which five had high RoB and the remaining six had unclear RoB. Following meta-analysis, no significant difference in postoperative pain was found among the EAL and radiograph groups (SMD 0.00, CI .29 to .28, 354 participants; P value = 0.98). Radiograph group showed better WL accuracy (SMD 0.55, CI .11 to .99, 254 participants; P value = 0.02), while the EAL group had 10% better WL adequacy (RR 1.10, CI 1.03-1.18, 573 participants; P value = 0.006). CONCLUSION: We found very low-certainty evidence to support the efficacy of different types of EAL compared to radiography for the outcomes tested. We were unable to reach any conclusions about the superiority of any type of EAL. Well-planned RCTs need to be conducted by standardizing the outcomes and outcome measurement methods.

Analysis of Shaping Abilities of Rotary File Systems in Oval Canals with Moderate Root Curvature: A Randomized Controlled Ex Vivo Study.

AIM: The purpose of this study was to evaluate and compare the canal transportation tendencies and centering ability of the TruNatomy shaper (TN) and XP-endo shaper (XPS) rotary systems in oval-shaped canals with moderate root curvature (15°-25°), using cone-beam computed tomography (CBCT) imaging. MATERIALS AND METHODS: Sixty single-rooted permanent human teeth were chosen after considering the inclusion and exclusion criteria. The teeth were divided into two groups (n = 30). The test group was instrumented with TN files and the other with XPS according to manufacturer's instructions. CBCT images were taken before and after instrumentation to record the root canal distances from mesial, distal, buccal, and lingual borders of the root at 3, 5, and 7 mm distances from the root apex using a specific formula. Statistical analysis was done using the Statistical Package for the Social Sciences software program, version 20.0. The data were analyzed using the unpaired t test. RESULTS: Both TN and XPS were safe for use in oval-shaped canals with moderate root curvature. However, the XPS showed higher buccolingual transportation as compared with TN at 3 mm from the apex and higher mesiodistal transportation at 3 and 5 mm levels from the apex as compared with TN. CONCLUSION: Canal transportation has been detected in both systems; however, the values obtained were within the safe range (<0.3 mm). Overall, no significant difference was observed between TN and XPS (p > 0.05) in their canal transportation tendencies and centering ability. CLINICAL SIGNIFICANCE: The study assesses the canal centering and transportation tendencies of the recently launched TN rotary system in extracted teeth with a combination of morphologies. The findings of the study are significant clinically as minimum transportation of the canal, minimal dentin removal, efficient disinfection, and three-dimensional obturation of the root canal are considered important factors in deciding the prognosis of endodontic therapy.

A survey assessing the knowledge and perception of dental practitioners on the need for prophylactic endodontic treatment in abutment teeth for fixed partial dentures.

Background: Tooth preparation for fixed prosthodontic procedures often induces enough thermal or mechanical stresses on the pulp. The extent of pulpal injury and ability to repair depends on factors like amount of remaining dentin, extent of heat produced, and permeability of dentinal tubules. However, there is no infallible method to predict the pulpal response and so the treatment outcome. Aim: This survey tries to assess the knowledge and perception among dental practitioners on the need for prophylactic endodontic therapy in abutment teeth for fixed partial denture (FPD). Setting and Design: Questionnaire-based survey. Methodology: An observational study was then conducted among 303 dental practitioners in the state of Tamil Nadu and 250 participants responded. Statistical Analysis Used: Descriptive statistics and multiple linear regression analysis. Results and Conclusion: The survey further imparts light on the clinical outcomes that help minimize the incidence of biological failure underneath a FPD.

Comparative Evaluation of Stress developed on Rotary Retreatment Instruments during Retrieval of Gutta-percha.

AIM: The aim of the study is to compare the maximum stress distribution on the rotary retreatment instruments within the root canal at cervical, middle, and the apical one-third during retreatment of gutta-percha. MATERIALS AND METHODS: A human mandibular premolar was scanned, and three-dimensional geometry of the root was reconstructed using finite element analysis (FEA) software package (ANSYS). The basic model was kept unchanged; tooth models were created using the same dimensions and divided into two groups as follows: Group I: ProTaper Universal retreatment system and group II: Mtwo rotary retreatment system. The stress distribution on the surface and within the retreatment files was analyzed numerically in the FEA package (ANSYS). RESULTS: The FEA analysis revealed that the retreatment instruments received the greatest stress in the cervical third, followed by the apical third and the middle third. The stress generated on the ProTaper Universal retreatment system was less when compared with the Mtwo retreatment files. CONCLUSION: The study concludes that the retreatment instruments undergo higher stress in the cervical third region, and further in vivo and in vitro studies are necessary to evaluate the relationship between instrument designs, stress distribution, residual stresses after use, and the torsional fracture of the retreatment instrument. CLINICAL SIGNIFICANCE: The stress developed on the rotary retreatment instruments during retrieval of gutta-percha makes the instrument to get separated. There is no instrument system, i.e., suitable for all clinical situations and it is important to understand how the structural characteristics could influence the magnitude of stresses on the instrument to prevent its fracture in use.

Endodontic Management of Teeth Juxtaposed to Haemangioma.

Vascular anomalies are localized defects in the vasculature that may or may not be present at birth. There are many types of vascular anomalies with different aetiology and clinical picture and, therefore, require the combined expertise of medical, radiological, and surgical specialities for its diagnosis and management. The term "haemangioma" is used as a common generic label to incorporate all types of vascular malformations. In this report, we describe a case of two maxillary premolars, requiring endodontic therapy, in close proximity to a haemangioma. The challenges encountered in the diagnosis and management of the case are discussed.

Resection and Regeneration - A Novel Approach in Treating a Perio-endo Lesion.

The pulp and the periodontium are invariably anatomically and functionally related to each other. Lesions involving both the periodontium and the pulp complicate diagnosis, treatment planning and prognosis. An emerging approach to periodontal therapy is the concept of regeneration. In this case report, a novel combination therapy of a blend of platelet rich fibrin with bone graft and guided tissue regeneration membrane was used in the treatment of a perio-endo lesion of a multirooted tooth. A successful outcome in alleviating patient's symptoms and regeneration was seen.

Comparative evaluation of canal isthmus debridement efficacy of modified EndoVac technique with different irrigation systems.

INTRODUCTION: The purpose of this study was to evaluate the canal isthmus debridement efficacy of a new modified EndoVac (Discus Dental, Culver City, CA) irrigation protocol in comparison with EndoVac, passive ultrasonic irrigation (PUI), and conventional needle irrigation in mesial roots of mandibular molars. METHODS: The mesial roots of 64 extracted mandibular molars mounted in resin using Kuttler's endodontic cube, sectioned at 2 and 4 mm from the working length, were randomly divided into 4 groups (n = 16): group 1: Max-I-Probe (Dentsply Tulsa Dental, York, PA), group 2: EndoVac (EVI), group 3: modified EndoVac, and group 4: PUI. The specimens were reassembled and instrumented. A standard irrigation protocol was used during cleaning and shaping and final irrigation with the 4 irrigation/agitation techniques. Images of the isthmus region were taken before and after cleaning and shaping and after final irrigation. The percentage reduction of debris in the isthmus region was calculated by using the software program Image J (v1.43; National Institutes of Health, Bethesda, MD). Intergroup analysis was performed using the Kruskal Wallis and Mann-Whitney U tests. Intragroup analysis was performed using Friedman and Wilcoxon signed rank tests. The level of significance was set at P < .05. RESULTS: Intragroup analysis revealed a statistically significant difference in the percentage reduction of debris after cleaning and shaping and after final irrigation protocol in all the groups (P < .001). The final irrigation protocol produced significantly cleaner canal isthmuses in all the groups (P < .001). On intergroup analysis, the modified EVI group performed significantly better than the other groups. The EVI and PUI groups performed better than the Max-I-Probe group. There was no statistical significance between the EVI and PUI groups. CONCLUSIONS: Canal isthmuses were significantly cleaner with the modified EndoVac irrigation technique when compared with the cleanliness seen with the other irrigation systems.