Effectiveness of root canal treatment for vital pulps compared with necrotic pulps in the presence or absence of signs of periradicular pathosis: A systematic review and meta-analysis.

BACKGROUND: Preoperative pulpal status may influence the outcomes of root canal treatment (RCTx) according to various measures used. OBJECTIVES: To compare the effectiveness of RCTx of teeth with a vital pulp versus a necrotic pulp, using a range of clinical and patient-related outcomes proposed for the development of S3-level clinical practice guidelines. METHODS: A search was conducted in the PubMed-MEDLINE, Scopus, EMBASE, Google scholar databases and available repositories, followed by hand searches, until 29 March 2022. Clinical studies published in the English language comparing the stipulated outcomes of RCTx of teeth with vital versus necrotic pulp were included. The Newcastle-Ottawa Scale was adapted to assess study quality. Effects of pulpal status were estimated and expressed as risk ratio (RR) using fixed- and random-effect meta-analyses. The quality of evidence was assessed through the Grading of Recommendations Assessment, Development and Evaluation tool. RESULTS: Twenty-eight studies published between 1961 and 2021 were included. Five studies have investigated the "tooth survival" outcome, four reported pulpal status was not a significant predictor, consistent with meta-analysis findings (RR: 1.00; 95% CI: 1.00, 1.00; n = 3). Seven studies reported pulpal status had no significant influence on postoperative pain, regardless of duration after treatment. Sixteen studies have analysed "periapical health," and 11 revealed pulpal status had no significant influence. Meta-analyses revealed the influence was not significant if preoperative periapical radiolucency was absent (RR: 0.95; 95% CI: 0.90, 1.00; n = 9) but significant if it was present (RR: 1.12; 95% CI: 1.05, 1.19; n = 11). Most studies were classified as "some concerns" (n = 17) to "low" (n = 9) risk of bias RoB. DISCUSSION: Evidence is limited and only available for three outcomes when comparing the effectiveness of RCTx in permanent teeth with vital pulp versus pulp necrosis. Nevertheless, the quality of available evidence was moderate to high. The "periapical health" data heterogeneity could be explained by preoperative radiolucency, thus RCTx was found more effective for prevention than the resolution of apical periodontitis. CONCLUSIONS: There was no significant difference in the "tooth survival," "postoperative pain" and "evidence of apical radiolucency" outcomes of RCTx in teeth with vital or necrotic pulps. REGISTRATION: PROSPERO database (CRD42021260280).

Failure of Regenerative Endodontic Procedures: Case Analysis and Subsequent Treatment Options.

INTRODUCTION: Regenerative endodontic procedures (REPs) are considered effective treatments for immature necrotic permanent teeth, with favorable outcomes. However, failed cases require subsequent treatment. This study aimed to review and analyze failed cases after REPs and suggest a treatment algorithm to aid clinical decision-making. METHODS: A total of 111 REP cases were selected that were conducted between 2015 and 2020. Clinical outcomes were assessed based on clinical and radiographic evaluations. The criteria for failure included persistence of clinical signs or symptoms and/or periapical radiolucency showing persistent apical periodontitis. Cases requiring any treatment intervention, including extraction, were also considered failures. RESULTS: Sixteen cases were included as failures. The etiology of pulpal disease was stratified into dental trauma (56%), dens evaginatus (25%), and dental caries (12.5%), with the remaining one case having an undocumented cause. The primary reasons for treatment failure were persistent infection (81.3%) and root resorption (18.7%). The identification time of failure varied, with 6 cases (37.5%) detected in less than 6 months and 10 cases (62.5%) later than 6 months after REPs. Sixteen failed cases received 5 different interventions: second REPs, apexification, conventional root canal treatment, surgical approach, and extraction. CONCLUSIONS: Interventions for failed REPs are challenging. Consideration of the treatability of the tooth, accessibility to the canal, and the presence of an apical seat might be key factors in clinical decision-making to obtain a successful outcome.

Radiographic and Clinical Findings of Single-Visit Root Canal Treatments with Apical Enlargement in Necrotic Teeth: A Retrospective Cohort Study.

This study evaluated the long-term clinical outcomes of single-visit root canal treatments with apical enlargement on patients with necrotic pulp tissue retrospectively. A total of 137 teeth with necrotic pulp tissue which underwent single-visit root canal treatments were included. The root canals were shaped up until the apical constriction, which was determined by an apex locator. The outcomes were evaluated by two independent and calibrated endodontists clinically and radiographically. Teeth were dichotomized into healed (PAI ≤ 2, no signs or symptoms) and nonhealed (PAI > 2, with/without signs or symptoms) groups. Each patients' preoperative PAI and lesion size were recorded to evaluate the preoperative periapical status as well as several other prognostic factors. Statistical analyses were performed (p = 0.05) on ninety teeth. The mean observation time was 60 months. Out of ninety teeth, 87 (96.7%) were healed and 3 (3.3%) were nonhealed. No correlations were found between the prognostic factors and the outcomes (p > 0.05). Cohen's kappa and Gwet's agreement coefficient scores between the preoperative PAI scores and preoperative lesion sizes showed good agreements, with values of 0.834 and 0.898, respectively. Apical enlargement is a viable treatment option for single-visit root canal treatments.

Effect of Different Concentrations of Sodium Hypochlorite on Outcome of Primary Root Canal Treatment: A Randomized Controlled Trial.

INTRODUCTION: The aim of this study was to evaluate the effect of 2 different concentrations of sodium hypochlorite on healing and postoperative pain after primary endodontic treatment. METHODS: One hundred mandibular molars with pulp necrosis and chronic apical periodontitis were randomly assigned to 2 treatment groups: high-concentration (HC) 5% sodium hypochlorite and low-concentration (LC) 1% sodium hypochlorite. Root canal treatment was performed using a standardized protocol. Canals were prepared using equal volumes of respective irrigants after each instrument change. After chemomechanical preparation, the final flush was performed with 5 mL 17% EDTA solution followed by 5 mL 5% or 1% sodium hypochlorite depending on the group. All patients were asked to record the degree of pain on a visual analog scale every 24 hours for 1 week. At the second visit, canals were obturated, and the teeth were restored permanently. Clinical and radiographic evaluations were performed every 3 months for 12 months. The data collected were statistically analyzed. RESULTS: Eighty-six teeth were available for evaluation at the 1-year follow-up. The overall healing rate observed was 76.7%. Greater healing was observed in the HC (81.4%) group compared with the LC group (72.1%), but the difference was not statistically significant (P > .05). No significant differences in pain incidence and pain scores were found between the 2 groups (P >.05), with lower values reported in the LC group. CONCLUSIONS: The use of LC or HC sodium hypochlorite did not result in a significant difference in the clinical outcome.

Postoperative pain of patients with necrotic teeth with apical periodontitis following single visit endodontic treatment versus multiple visit endodontic treatment using triple antibiotic paste: a randomized clinical trial.

Background: A randomized clinical trial was conducted to compare the postoperative pain following endodontic treatment of necrotic teeth with apical periodontitis. Treatments were performed in multiple visits with application of triple antibiotic paste interappointment dressing or single visit without interappointment dressing. Methods: In total 44 participants were assigned randomly into two groups. Group A: multiple visit endodontic treatment with triple antibiotic paste interappointment dressing; group B: single visit endodontic treatment without interappointment dressing. Postoperative pain of participants was assessed after 24, 48, 72 hours and one week using numerical rating scale. Results: No statistically significant difference was found in postoperative pain after 24, 48, 72 hours and one week between the two groups. Conclusion: Triple antibiotic paste as an interappointment dressing in multiple visits endodontic treatment was not proved to reduce the postoperative pain compared to a single visit in patients with necrotic teeth with apical periodontitis who did not have an interappointment dressing. Trial registration: clinicaltrials.gov, NCT02947763. Date: 28th October 2016.

Comparison of frequency of post-obturation pain of single versus multiple visit root canal treatment of necrotic teeth with infected root canals. A Randomized Controlled Trial.

OBJECTIVE: To determine the pain of single versus multiple visit endodontic treatment after obturation in teeth with necrotic pulps and infected canals. METHODS: The randomized controlled study was conducted from January to June 2016 at Shaheed Zulfiqar Ali Bhutto Medical University, Islamabad, Pakistan. Dental patients aged 18-60 years of either gender were selected who were subjected to computer-generated randomisation. Both maxillary and mandibular single rooted teeth till second premolar were included. Single visit endodontic treatment to Group-I subjects was carried out by gaining access to canals, cleaning, shaping and obturation at same visit whereas in Group-II patients, who underwent multiple visits, cleaning and shaping was followed by placement of intra-canal medicament, while obturation was done 5 days later. Patients were recalled within 48 hours after obturation to record the pain score using visual analogue scale.. RESULTS: Of the 60 patients, 30(50%) were in each of the two groups. There was no significant difference in post-operative pain in the two groups (p=0.8). The frequency of post-operative pain was not significant either (p>0.05). The post-operative mean pain score was 2.23±1.736 in Group-I and 2.38±1.94 in Group-II (p=0.8).. CONCLUSIONS: Treatment carried out in single visit or multiple visits showed no difference in pain frequency.

Postoperative Pain Management with Oral Methylprednisolone in Symptomatic Patients with a Pulpal Diagnosis of Necrosis: A Prospective Randomized, Double-blind Study.

INTRODUCTION: The purpose of this prospective randomized, double-blind, placebo-controlled study was to evaluate postoperative pain by using an oral dose regimen of methylprednisolone in symptomatic patients with pulpal necrosis and symptomatic apical periodontitis, a periapical radiolucency, and experiencing preoperative moderate to severe pain. METHODS: One hundred twenty-five adult symptomatic patients presenting for emergency endodontic treatment with a pulpal diagnosis of necrosis and symptomatic apical periodontitis, a periapical radiolucency, and experiencing moderate to severe pain participated. All patients received complete endodontic debridement and were randomly divided into 2 groups. In a double-blind manner, the groups received either an oral regimen of methylprednisolone (96 mg immediately after treatment followed by 48 mg each day for 5 consecutive days) or a lactose placebo. All patients received 600 mg ibuprofen and an opioid-containing escape medication to take if needed. Patients completed a 7-day diary to record pain and number of analgesic medications taken each day. RESULTS: Moderate to severe pain was experienced by 40%-50% of the patients on day 1 and 31% of the patients on day 2, with the pain ratings decreasing during the next 7 days. There were no statistically significant differences in pain ratings between the methylprednisolone and placebo groups. CONCLUSIONS: When compared with a placebo, the current regimen of oral methylprednisolone did not significantly reduce postoperative pain after complete debridement of symptomatic patients presenting for emergency endodontic treatment with a pulpal diagnosis of necrosis and symptomatic apical periodontitis, periapical radiolucency, and experiencing moderate to severe pain.

Clinical comparison of Kedo-S paediatric rotary files vs manual instrumentation for root canal preparation in primary molars: a double blinded randomised clinical trial.

AIM: This was to compare and evaluate the instrumentation time and quality of obturation between paediatric rotary file (Kedo-S) and manual instrumentation techniques in primary molars. METHODS: A double blinded randomised control trial was performed that included mandibular primary molars in children of age 4-7 years with pulp necrosis. Sixty primary mandibular molars were randomly divided into two groups: 30 were instrumented with paediatric rotary files Kedo-S (experimental group) and 30 with hand K-files (control group). During the preparation of the primary root canals the instrumentation time was recorded in seconds. The quality of obturation was recorded as optimal, under filled or over filled using immediate post-operative radiographs. The instrumentation time and quality of obturation were analysed using independent t-test and Chi-square test. RESULTS: Mean instrumentation time with paediatric rotary files Kedo-S (78.53 s) was significantly less than K-files (95.46 s) (p < 0.05). There was a significant improvement in the quality of obturation (p < 0.05) with paediatric rotary files (Kedo-S). CONCLUSION: Clinical use of paediatric rotary files Kedo-S was effective during root canal preparation of primary teeth with reduction in instrumentation time and better quality of obturation.

Regenerative endodontics after front tooth trauma. A case report / Regenerative endodontische Therapie nach Frontzahntrauma. Ein Fallbericht

In the context of tooth trauma, mostly the maxillary central front teeth are involved, whereby their roots are in some cases still in the developing stage (immature). Depending on the type of trauma, a necrosis of the pulp is the consequence or at least foreseeable. In order to preserve such a tooth, an endodontic therapy is inevitable. The disadvantage of conventional endodontic therapy methods of immature teeth (apexification, apexogenesis) is the root growth stop. Alternatively, the regeneration/revascularisation of the dental pulp (RP) was suggested, that allows a further root growth. The aim of this case report is to present the procedure of a RP-therapy and to suggest a step-by-step manual.

Regenerative Endodontic Treatment with Orthodontic Treatment in a Tooth with Dens Evaginatus: A Case Report with a 4-year Follow-up.

Dens evaginatus is a developmental tooth anomaly in which an extra cusp or tubercle protrudes on the occlusal surface of the tooth along with some pulpal tissue. Because of the fragile nature of the protrusion, these teeth are often at risk of pulpal exposure. When this occurs in an immature tooth, regenerative endodontic treatment may be a good treatment approach to promote root formation. There is limited literature that documents the occurrence of orthodontic treatment in teeth that have undergone regenerative endodontic therapy using triple antibiotic paste. Here we present a case of an immature premolar tooth with dens evaginatus that was diagnosed with pulp necrosis and chronic apical abscess. The tooth was treated with regenerative endodontic treatment; after which, the patient received orthodontic treatment with fixed appliances for 2 years. The tooth responded favorably to the regenerative endodontic treatment and orthodontic tooth movement. Clinically and radiographically, all the follow-up examinations revealed an asymptomatic tooth with evidence of periapical healing with stunted root development. The tooth remained asymptomatic even after 4 years. The regenerative endodontic procedure (REP) was successful in treating an immature permanent premolar with pulp necrosis and apical periodontitis with dens evaginatus. In this case, the tooth treated with an REP responded to orthodontic treatment similar to the nonendodontically treated teeth. Further studies are recommended to clarify the precise effects of orthodontic treatment on teeth treated with an REP.

Maintaining Apical Patency Does Not Increase Postoperative Pain in Molars with Necrotic Pulp and Apical Periodontitis: A Randomized Controlled Trial.

INTRODUCTION: This prospective, single-center, single-blind, randomized controlled trial aimed to evaluate whether maintaining apical patency (AP) during endodontic treatment increases postoperative pain in molar teeth with necrotic pulp and apical periodontitis. METHODS: Three hundred twenty qualified patients between 21 and 45 years of age were randomized into 1 of 2 groups (the AP group and the nonapical patency [NAP] group) using a series of random numbers in a 1:1 ratio. Qualified patients were selected from patients who had necrotic pulp and apical periodontitis in the maxillary or mandibular molar teeth. The primary outcome was to assess postoperative pain severity, and the secondary outcome was to evaluate analgesic consumption during the 7-day follow-up period using the visual analog scale (VAS). The VAS consisted of a 100-mm line. Pain severity was evaluated as no pain (0-4 mm), mild pain (5-44 mm), moderate pain (45-74 mm), and severe pain (75-100 mm). The Student t test was used to identify statistically significant differences between the study groups (P < .05). RESULTS: The mean VAS scores were significantly lower in the AP group in the first 5 postoperative days (P < .05); after which, it was nonsignificant. In the NAP group, the postoperative pain increased between 12 and 24 hours, whereas the postoperative pain decreased in the AP group during that period. At 12 and 24 hours, the mean VAS scores for the AP group were 42.90 and 37.78 mm, respectively. The mean VAS scores for the NAP group were 64.46 and 65.74 mm, respectively. None of the patients had severe postoperative pain during the follow-up period. No significant difference was found in analgesic consumption (P > .05) between the groups. CONCLUSIONS: The maintenance of AP in molar teeth with necrotic pulp and apical periodontitis was associated with less postoperative pain when compared with NAP.

Influence of Apical Diameter on the Outcome of Regenerative Endodontic Treatment in Teeth with Pulp Necrosis: A Review.

INTRODUCTION: The aim of this review was to evaluate whether the apical diameter of teeth with necrotic pulp affects the outcomes of regenerative endodontic treatment and to determine the minimal apical size needed to obtain proper pulp revascularization. METHODS: A literature search was performed from January 1, 2001, to November 25, 2016. Studies that satisfied the inclusion criteria were subjected to data extraction and analysis. RESULTS: In total, 14 studies with 85 patients were included. There were 10 case reports, 3 case series, and 1 prospective cohort study. The apical diameters of the teeth were divided into 3 groups: a narrow-sized group (group N), <0.5 mm (n = 10); a medium-sized group (group M), 0.5-1.0 mm (n = 25); and a wide-sized group (group W), >1.0 mm (n = 60). In group N, 1 tooth failed, 2 teeth completely healed, and 7 teeth incompletely healed. In group M, 2 teeth were excluded, and 1 tooth failed. In group W, 3 teeth were excluded, and 4 teeth failed. The clinical success rates were 90%, 95.65%, and 92.98% in groups N, M, and W, respectively. CONCLUSIONS: Within the limitations, the teeth with apical diameters <1.0 mm achieved clinical success after regenerative endodontic treatment. Meanwhile, the teeth with apical diameters of 0.5-1.0 mm attained the highest clinical success rate, which may be related to other potential factors, including patient age, pulp necrosis etiology, preoperative apical radiolucency, procedure details, follow-up period, and sample size.

Endodontic treatment of canine teeth in a cynomolgus monkey ( Macaca fascicularis).

A case of bilateral superior canine tooth pulp necrosis in an 18-year-old male Macaca fascicularis is described . A skull computed tomography scan was performed to confirm the diagnostic suspicion. A successful bilateral endodontic treatment with coronotomy was performed using rotary nickel-titanium instruments. Post-operative dental radiographs confirmed the correct positioning of the sealant. A rapid and excellent clinical recovery was obtained after each surgery. This innovative approach may contribute to improving the quality of root canal treatments provided to non-human primates.

Evaluation of Effect of Foraminal Enlargement of Necrotic Teeth on Postoperative Symptoms: A Systematic Review and Meta-analysis.

INTRODUCTION: The intentional enlargement of the apical foramen is designed to reduce the microbial load in the apical foramen, or even beyond, to levels more favorable for repair. This study provides a systematic review and meta-analysis to address the PICOS question: in adult patients who undergo endodontic treatment, does foraminal enlargement (FE) cause different postoperative symptoms in comparison with conventional endodontic treatment? METHODS: The PROSPERO registration number is CRD42017059921 and was conducted following the PRISMA statements. A broad search was conducted in the electronic databases PubMed, Web of Science, Scopus, Cochrane Library, and grey literature for articles published through May 2017. The MeSH terms "Pain," "Hyperemia," "Edema," "Hyperesthesia," "Fistula," "Root canal preparation," "Tooth apex," "Periapical periodontitis," "Dental pulp necrosis," and "Clinical study" were used. The reviewers evaluated the studies for eligibility criteria and performed data abstraction and risk of bias evaluations. A random-effects model was used for the meta-analysis. RESULTS: Five studies qualified for systematic review, and 3 studies were considered for meta-analysis. The results of the meta-analysis showed that postoperative pain is higher in the endodontic treatment with FE, with a statistically significant difference in the first, second, fourth, sixth, and seventh days. Limited data indicated that no significant difference was found in analgesic consumption, flare-up, and swelling between the groups. CONCLUSIONS: Postoperative pain was higher in the FE group compared with conventional endodontic therapy in the first days after treatment in teeth with necrosis and apical periodontitis.

Regenerative Endodontics Versus Apexification in Immature Permanent Teeth with Apical Periodontitis: A Prospective Randomized Controlled Study.

INTRODUCTION: The aim of the study was to compare the outcomes of regenerative endodontic treatment (RET) and apexification on immature permanent teeth with pulp necrosis and apical periodontitis. METHODS: A total of 118 patients (118 teeth) were recruited and randomly assigned to either RET or apexification treatment. Each treatment group was divided into 2 subgroups according to the etiology: dens evaginatus or trauma. Clinical symptoms and complications were recorded, and cone-beam computed tomographic imaging with a limited field of view was used to measure the change of root length, root thickness, and apical foramen size at the 12-month follow-up. The t test/rank sum test and Fisher exact test were applied to compare the change of root morphology between RET and apexification. RESULTS: One hundred three of 118 cases were completed at the 12-month follow-up. The survival rate was 100% for both treatment groups. All cases were asymptomatic with apical healing. The RET group showed a significant increase in root length and root thickness compared with the apexification group (P < .05). In the RET group, the cases caused by dens evaginatus achieved increased root length and root thickness compared with those caused by trauma (P < .05). CONCLUSIONS: RET and apexification achieved a comparable outcome in regard to the resolution of symptoms and apical healing. RET showed a better outcome than apexification regarding increased root thickness and root length. The etiology had an impact on the outcome of RET. Dens evaginatus cases showed better prognoses than trauma cases after RET.

Regenerative Endodontic Treatment or Mineral Trioxide Aggregate Apical Plug in Teeth with Necrotic Pulps and Open Apices: A Systematic Review and Meta-analysis.

INTRODUCTION: A mineral trioxide aggregate (MTA) apical plug (MAP) and regenerative endodontic treatment (RET) have shown acceptable clinical outcomes. However, comparative studies are scarce. The aims of this study were to examine the level of evidence for both treatments, conduct a systematic review of the literature on MAP and RET, and run a meta-analysis on the survival and success rates of teeth treated with these procedures. METHODS: Electronic searches were performed in MEDLINE, Web of Science, and the Cochrane Library. Two authors independently screened the titles and abstracts for eligibility. Subgroup analyses were performed on the clinical outcomes (ie, survival and success) of the procedures. RESULTS: In all, 750 studies were identified, and 144 studies were subjected to qualitative synthesis. Ten randomized clinical trials were included in subgroup analyses. Most of the studies in both groups were case reports and case series (72% and 86% in MAP and RET, respectively). The overall level of evidence in both groups was low. The pooled survival rates were 97.1% (95% confidence interval [CI], 93.7-100) and 97.8% (95% CI, 94.8-100) for MAP and RET, respectively. The pooled success rates were 94.6% (95% CI, 90.2-99.1) and 91.3% (95% CI, 84.5-98.2) for MAP and RET, respectively. Very little heterogeneity was observed among the studies regarding survival and success rates (I2 < 50%, P > .10). There was no significant difference between the 2 groups regarding survival (P = 1.00) or success rates (P = .58). CONCLUSIONS: The existing literature lacks high-quality studies with a direct comparison of outcomes of MAP and RET. Randomized multicenter clinical trials with large sample sizes and long-term follow-ups are needed to address this gap in knowledge.

Clinical Evidence for Regenerative Endodontic Procedures: Immediate versus Delayed Induction?

Clinicians face many challenges when treating immature permanent teeth in young patients. Immediate blood clot induction can be a successful option as described by some case reports. No experimental studies or clinical trials have addressed this question. We have designed a clinical trial in which we hypothesized that there is no difference in success between immediate or delayed induction protocols. After confirmation of pulpal necrosis, patients were randomized. In the delayed group, 15 teeth were treated following the American Association of Endodontists guidelines, and calcium hydroxide was used as the intracanal medication. In the immediate group, 13 teeth had a blood clot inducted at the first appointment. The teeth were evaluated after 1, 3, and 12 months. Three independent evaluators assessed the periapical healing. The Pearson chi-square test or the Fisher exact test was used to compare the success rates between the 2 groups. Currently, of the 25 recruited patients (28 teeth), 19 have completed their 12-month follow-up. The group with delayed induction had a 71% success rate, and the group with immediate induction had a 33% success rate. In most cases (79%), trauma was the etiology. All successful cases started at stage 9 of root development (Nolla), and the majority showed healing type 2. Determination of the stage of root formation and etiology are possible critical factors for any therapeutic decision. In summary, it is early to conclude or suggest any of the protocols. Clearly, much more data are needed before sample size requirements can be met.

Effectiveness in the Removal of Endotoxins and Microbiological Profile in Primary Endodontic Infections Using 3 Different Instrumentation Systems: A Randomized Clinical Study.

INTRODUCTION: This clinical study was conducted to correlate the microbiological profile and levels of endotoxins found in primary endodontic infection with the presence of clinical features and to evaluate the removal of microorganisms and endotoxins using rotary, reciprocating, and hybrid systems for biomechanical preparation. METHODS: Thirty single root canals with primary endodontic infection were evaluated with signs and symptoms and were randomly divided into 3 groups according to the instrumentation system used (n = 10) as follows: rotary Mtwo instruments (VDW, Munich, Germany) with 8 files, the reciprocating Reciproc system (VDW) with a single file, and Genius hybrid instruments with 3 files (1 rotary and 2 reciprocating files) with irrigation using 24 mL 2.5% sodium hypochlorite. Samples were collected before (S1) and after instrumentation (S2) before being submitted to microbiological culture (colony-forming units/mL) and the checkerboard DNA-DNA hybridization test. Endotoxins were quantified using the limulus amebocyte lysate assay. RESULTS: Microbiological culture showed statistical differences in the reduction of colony-forming units/mL with all systems tested (P < .05), but no statistical difference was found among the groups. The most frequently detected species were Capnocytophaga ochracea (53%) and Fusobacterium nucleatum (53%) at S1 and F. nucleatum (50%) and Leptotrichia buccalis (50%) at S2. As for the reduction of endotoxins at S2, Mtwo presented the best results (95.05%) followed by the Genius (91.85%) and Reciproc (64.68%) groups, but no statistical difference was found among the groups. Previous pain, tenderness to percussion, and presence of a sinus tract were associated with specific microorganisms (P < .05). CONCLUSIONS: Signs and symptoms were correlated with microorganisms. Endodontic treatment was effective in reducing bacteria and endotoxins but was not capable of completely removing them from the root canal.

Are there any differences between first and second primary molar pulpectomy prognoses? A retrospective clinical study.

AIM: To determine if there are any significant differences between the prognoses of pulpectomies done on first and second primary molars of the upper and lower dental arch. MATERIALS AND METHODS: Study Design: The clinical study included 55 children who had undergone 86 pulpectomy treatments, 41 on the first molars and 45 on the second molars. The root canal filling material consisted of a paste based on Walkhoff formula, containing Kri-1, calcium hydroxide and meta-cresol formaldehyde. The same clinician carried out all pulpectomies. RESULTS: After the analysis there were a total of 7 treatment failures (3 in the upper arch and 4 in the lower). Four of the 7 failures were first primary molars and three were second primary molars. STATISTICS: There were no significant differences in the prognoses of the different kinds of primary molars. CONCLUSION: The anatomy of the primary molars changes considerably. Significant differences were not observed in the prognosis of different types of primary molars after pulpectomy.

Traumatic periapical lesion only identified through cone beam computed tomography: a case report.

This case report describes the diagnosis of a traumatic periapical lesion, caused by parafunctional habits (bruxism) and associated with bone rarefaction, that had not been identified by periapical radiography. Slight edema was observed clinically at the apical region of the maxillary left canine; however, the tooth demonstrated only physiologic mobility, and the results of a pulpal sensitivity test were inconclusive. A cone beam computed tomogram (CBCT) showed the presence of a periapical lesion. After preparation of the root canal, intracanal medication (calcium hydroxide and paramonochlorophenol) was placed and changed once a month for 2 months. After 60 days (at the time of the second medication change), the edema at the apical region was no longer visible. The root canal was filled, and CBCTs obtained 30 days and 24 months after completion of treatment showed that the lesion had regressed with bone repair. Although it is an expensive procedure, CBCT is important in the examination and diagnosis of periapical lesions that may not be seen in periapical radiographs.