Survival of endodontically treated permanent teeth among children: a retrospective cohort study.

BACKGROUND: Outcome studies of nonsurgical root canal treatment (NSRCT) in permanent teeth of children are scarce. This study investigated survival and assessed the variables associated with failure of endodontically treated teeth (ETT) in 6- to 18-year-olds. METHODS: Records of subjects who received NSRCT at age 6-18 years at Boston University between 2007 and 2015 were assessed for the occurrence of untoward events. Kaplan-Meier survival curves were used to investigate the survival of ETT in the total sample. Adjusted hazard ratios (aHRs) and 95% confidence intervals (CIs) were estimated. RESULTS: The analysis included 341 patients (424 ETT). Kaplan-Meier survival curves differed according to age at treatment (log-rank P = 0.026), with survival being the lowest among the youngest age group. The estimated 5-year survival probability was 80% for 15- to 18-year-olds, 64.8% for 12- to 14-year-olds and 46.4% for 6- to 11-year-olds. Compared to age at treatment of 15-18 years, age at treatment of 6-11 years (aHR: 2.19, 95% CI 1.02-4.67) and 12-14 years (aHR: 2.02, 95% CI 1.15-3.55) was associated with an increased risk of ETT failure. In the total study sample, the estimated cumulative survival probability was 93.3% at 12 months, 88.0% at 24 months, 76.2% at 36 months, 71.0% at 48 months, and 69.1% at 60 months. CONCLUSIONS: In children, ETT are more likely to survive when NSRCTs are performed at an older age.

THE PREVALENCE OF A SECOND ROOT CANAL IN MANDIBULAR ANTERIOR TEETH VARIES BY GEOGRAPHIC REGIONS AND DEMOGRAPHIC FACTORS.

ARTICLE TITLE AND BIBLIOGRAPHIC INFORMATION: Martins JNR et al. Influence of Demographic Factors on the Prevalence of a Second Root Canal in Mandibular Anterior Teeth - A Systematic Review and Meta-Analysis of Cross-Sectional Studies Using Cone Beam Computed Tomography. Arch Oral Biol. 2020 Aug;116:104,749. doi: 10.1016/j.archoralbio.2020.104749. SOURCE OF FUNDING: No funding was obtained for this research TYPE OF STUDY/DESIGN: Systematic review with meta-analysis.

For pulp treatment in primary teeth, rotary canal instrumentation may be modestly time efficient, but otherwise similar to manual canal instrumentation.

ARTICLE TITLE AND BIBLIOGRAPHIC INFORMATION: A systematic review and meta-analysis of randomized clinical trials comparing rotary canal instrumentation techniques with manual instrumentation techniques in primary teeth. Manchanda S, Sardana D, Yiu CKY. Int Endod J. 2020;53(3):333-353. SOURCE OF FUNDING: Information not available. TYPE OF STUDY/DESIGN: Systematic review with meta-analysis of data.

Intentional Replantation of Teeth is a Viable and Cost-effective Alternative Treatment to Single-Tooth Implants.

ARTICLE TITLE AND BIBLIOGRAPHIC INFORMATION: A Systematic Review of the Survival of Teeth Intentionally Replanted with a Modern Technique and Cost-effectiveness Compared with Single-tooth Implants. Mainkar A. J Endod 2017:43(12):1963-8. SOURCE OF FUNDING: Information not available. TYPE OF STUDY/DESIGN: Systematic review/meta-analysis.

Growth and Differentiation of Dental Stem Cells of Apical Papilla on Polycaprolactone Scaffolds.

Biodegradable scaffolds are useful tools in the field of tissue engineering and regenerative medicine. The aim of this study was to test the potential of the human stem cells of apical papilla (SCAP) to attach, proliferate and differentiate on a polycaprolactone (PCL)-based scaffolds. SCAP were extracted from the root apical papillae of freshly extracted immature premolar teeth by using enzymatic digestion. Porous PCL scaffolds were fabricated using particle leaching method and NaCl or mannitol as porogens. SCAP of passage 3 were seeded on non-porous and porous PCL scaffolds for up to 14 days. For control, cells were cultured on glass coverslips. Picogreen DNA quantification was used to assay for cell proliferation. Cell differentiation and development of calcification nodules were examined using scanning electron microscopy and alizarin red staining. SCAP showed a comparable attachment, growth and proliferation patterns on PCL scaffolds and coverslips. Cell proliferation was enhanced on mannitol scaffolds at all time points. Calcification nodules were detected in all PCL scaffolds while it was not present on glass coverslips. These nodules were detected on NaCl-scaffolds by day 7 and on mannitol and non-porous scaffolds by day 14. In conclusion, SCAP were able to attach, proliferate and differentiate on PCL scaffolds without using any inductive media, indicating their potential application for dental tissue regeneration.

A Micro-Computed Tomography Study of the Root Canal Morphology of Mandibular First Premolars in an Emirati Population.

OBJECTIVE: To investigate variations in the root canal morphology of mandibular first premolars in a population from the United Arab Emirates using micro-computed tomography (micro-CT) and conventional radiography. MATERIALS AND METHODS: Three-dimensional images of 50 extracted human mandibular first premolars were produced using a micro-CT scanner, and conventional radiography was also used to record the number of roots, the root canal system configuration, the presence of a C-shaped canal system and lateral canals, intercanal communications, and the number and location of apical foramina. The interpretations of micro-CT and conventional radiography were statistically analyzed using Fisher's exact test. RESULTS: Variable root canal configurations based on Vertucci's classification were observed in the teeth (i.e., types I, III, IV, V, and VII). The examined teeth exhibited the following 2 additional root canal configurations, which did not fit Vertucci's classification: type 1-2-3 and type 1-3. A C-shaped canal configuration was present in 14 (28%) cases, and lateral canals were present in 22 (44%) cases. Apical deltas were found in 25 (50%) cases, intercanal communications were seen in 6 (12%) cases, and apical loops were seen in 2 (4%) of the samples. Micro-CT and X-ray imaging identified 39 (78%) and 34 (68%) apical foramina, respectively. A single apical foramen was detected in 33 (66%) samples, and 2 or 3 apical foramina were detected in 14 (28 %) and 3 (6%) samples, respectively. In 18.5 (37%) samples the apical foramina were located centrally, and in 31 (62%) they were located laterally. CONCLUSION: A complex morphology of the mandibular first premolars was observed with a high prevalence of multiple root canal systems.

Combination Analgesics Reduce Postoperative Pain in Teeth With a Pulpal Diagnosis of Irreversible Pulpitis.

ARTICLE TITLE AND BIBLIOGRAPHIC INFORMATION: Double-blind Randomized Placebo-controlled Clinical Trial of Efficiency of Nonsteroidal Anti-inflammatory Drugs in the Control of Post-endodontic Pain. Elzaki WM, Abubakr NH, Ziada HM, Ibrahim YE. J Endod 2016;42(6):835-42. SOURCE OF FUNDING: No source of funding was identified. The study was conducted by the faculty of the Dentistry Department, University of Khartoum and the Khartoum Teaching Hospital emergency clinic TYPE OF STUDY/DESIGN: Double-blind randomized controlled trial.

Limited Evidence Suggests That Symptomatic Cracked Teeth Share Characteristics Such as Clenching, Grinding, and Molars With Distal Cracks.

ARTICLE TITLE AND BIBLIOGRAPHIC INFORMATION: Correlation between symptoms and external characteristics of cracked teeth. Hilton TJ, Funkhouser E, Ferracane JL, Gilbert GH, Baltuck C, Benjamin P, Louis D, Mungia R, Meyerowitz. JADA 2017; 148(4):246-56.e1. SOURCE OF FUNDING: National Institutes of Health grant U19-DE-22516 TYPE OF STUDY/DESIGN: Cross-sectional study.

Robot-Assisted and Haptic-Guided Endodontic Surgery: A Case Report.

There has been a significant increase in robot-assisted dental procedures in the past decade, particularly in the area of robot-assisted implant placement. The objective of this case report was to assess the initial use of the Yomi Robot's assistance and haptic guidance during endodontic microsurgery. The robot was used during the osteotomy and root-end resection of the first and second upper left premolars. The report aims to inform clinicians of the initial implementation of this cutting-edge technology in endodontics and its potential to enhance endodontic microsurgery. The Yomi Robot was used in performing osteotomy and root-end resection during apical surgery in a patient presenting with symptomatic upper left first and second premolars. The treatment procedure was decided after clinical examination, chart data, and radiographic examinations, which showed periapical lesions on both premolars, taking into consideration the failed endodontic retreatment on the first premolar, the post and ceramic coronal restorations on both teeth, and the desire of the patient to save them. The Yomi Robot system provides auditory, visual, and physical guidance to clinicians during surgery while using a cone-beam computed tomography scan for precision planning with greater accuracy and minimized potential for human error. Further studies are needed to prepare a protocol for robotic-guided procedures in endodontics.

Enhancement of Antimicrobial Effect of Endodontic Sealers Using Nanoparticles: A Systematic Review.

INTRODUCTION: The elimination of biofilms during root canal therapy continues to pose a challenge due to complex anatomies and uninstrumented portions of the root canal system. The incorporation of nanoparticles in endodontic sealers is an area of interest for potentially enhancing antimicrobial activity and improving treatment outcomes. This systematic review evaluated the antimicrobial effects of various nanoparticles in endodontic sealers. METHODS: Comprehensive literature review was conducted using the electronic Embase, Web of Science, and PubMed databases followed by citation searching for articles eligible per the inclusion criteria. RESULTS: A total of 1845 citations were screened, of which 13 articles met the inclusion criteria and were included in this review. All included articles were in vitro studies with low-to-moderate quality assessment scores. The incorporation of select nanoparticles was associated with significant enhancement of antibacterial effects in planktonic and/or biofilm forms, whereas other nanoparticles were not. CONCLUSIONS: The incorporation of certain types and concentrations of nanoparticles into endodontic sealers displayed antimicrobial effects in vitro. The need for well-designed clinical studies translating in vitro findings into clinical practice is warranted. The incorporation of nanoparticles may enhance the antimicrobial properties of endodontic sealers and may improve treatment outcomes.

Factors Related to the Outcomes of Cracked Teeth after Endodontic Treatment.

INTRODUCTION: Cracked teeth are a common clinical finding; however, their presence renders diagnosis and prognosis unreliable. The purpose of this research was to assess the correlations of multiple factors on the prognosis of cracked teeth that had undergone endodontic treatment. METHODS: A total of 3680 patients who received endodontic treatment by an advanced postdoctoral education program in endodontics with follow-up records of at least 1 year were assessed. From this sample, 62 patients met the inclusion criteria and were included in the final analysis. The factors being evaluated included demographics, clinical symptoms and signs, radiographic findings, and restoration type. Statistical analysis was then completed using the chi-square and Fisher exact tests. RESULTS: The mean follow-up period was 23.3 months, with an overall tooth success rate of 75.8%. The success rates differed significantly when the patient had an existing preoperative periapical lesion, lacked a proper permanent restoration on the treated tooth, or had a post placed after root canal treatment. Data analysis showed that restoring the tooth after endodontic treatment was the single most important factor for prognosis. In fact, the endodontically treated teeth with definitive full-coverage restorations had a 2-year success rate of 93.6%. CONCLUSION: Full-coverage restorations should be considered an important part of the treatment plan for cracked teeth treated endodontically.

The Recommendation of Cone-beam Computed Tomography and Its Effect on Endodontic Diagnosis and Treatment Planning.

INTRODUCTION: Although intraoral radiographs are foundational for diagnosis and planning treatment in dentistry, the resulting 2-dimensional image varies in interpretation requiring judgment. Cone-beam computed tomographic imaging provides a more detailed 3-dimensional image that may affect treatment recommendations. This study aimed to determine the basis for CBCT recommendations and the effect on diagnosis and treatment planning. METHODS: The study involved a sample of 45 cases that presented for endodontic treatment, 30 with a CBCT scan on record and 15 without. For phase 1, all 45 cases were reviewed by 3 examiners without access to the CBCT scans. For phase 2, 4 months later, the 3 examiners reanalyzed the 30 cases, this time with the associated CBCT scan. Intra- and interexaminer agreements were recorded and analyzed. Also, the recommendations for CBCT were compared with the American Association of Endodontists/American Academy of Oral and Maxillofacial Radiology joint statement. RESULTS: Interexaminer agreement in phases 1 and 2 was 65% and 72%, respectively. For endodontic diagnoses, there was a 19% change in the pulpal diagnosis category when CBCT imaging was added, whereas there was a 30% change in the apical category. The selections changed in 55% of the cases when determining etiology and in 49% of the cases when making recommendations. CBCT imaging was recommended 78.8% of the time when the case had a CBCT on record versus 33% of the time in cases without. CONCLUSIONS: CBCT imaging has a significant effect in determining the etiology of endodontic pathoses and in recommending treatment. Furthermore, CBCT imaging is not overprescribed in the endodontic department, and the faculty members adhere to the American Association of Endodontists/American Academy of Oral and Maxillofacial Radiology recommendations.

The role of apical size determination and enlargement in the reduction of intracanal bacteria.

The master apical preparation size in root canal therapy is debatable despite considerable research. The present study compared file sizes that bind at the apex before and during crown-down preparation and assessed the relation between apical size and extent of intracanal bacterial load. There were 100 single-rooted teeth biomechanically prepared after inoculation with Enterococcus faecalis. Canals were preflared, and apical size was ascertained by the first file to bind (FAB) at the working length (WL). During crown-down preparation, the first crown-down file to reach the apex during instrumentation was noted (CDF). Teeth were then divided into three master apical file size groups of CDF + 1, CDF + 2, and CDF + 3. Positive controls were inoculated postinstrumentation, whereas negative controls were instrumented without inoculation (n = 5). The samples were then cultured for intracanal bacterial counts. Fifteen samples and four controls were analyzed under SEM. The data were analyzed using ANOVA, Student's t-test, and chi(2) tests. The CDF was demonstrated to be an average of four file sizes larger than the FAB (p < 0.05). There was a significant increase in the number of samples with negative cultures from CDF + 1 to CDF + 3. SEM observation revealed bacteria on dentinal walls and in tubules even in most negative canal cultures.

A correlation study of occlusal and pulp chamber anatomy: the maxillary first molar.

The success of endodontic therapy is based on a number of criteria, particularly the conservation of tooth structure. This principle requires a systematic approach to pulp chamber access. By correlating the occlusal anatomy with the location of the root canal orifice, a dentist may find a number of guidelines for improving access design. In this in vitro study, the authors evaluated 29 human maxillary first molars. Digital radiographs and digital occlusal photographs were taken of each specimen before and after decoronation at the cementoenamel junction (CEJ). The three images were superimposed on one another and evaluated for occlusal and pulpal patterns. The thickness of the pulp chamber walls of the CEJ varied, based on the circumference of individual teeth. In addition, the canal orifices at the pulp chamber floor exhibited a consistent pattern relative to the cusp tips, which may assist in access design.

A correlation study of occlusal and pulp chamber anatomy: the mandibular first molar.

Many parameters must be addressed for endodontic therapy to succeed. Because conservation of tooth structure is vital, the pulp chamber and root canal orifices should be located by using a method that is consistent yet accurate. The correlation of occlusal anatomy with the locations of the root canal orifice may aid dentists with access design. This study sought to determine if a correlation existed between occlusal surface anatomy, pulp chamber location, and root canal orifice location. This in vitro study utilized 21 human mandibular first molars. For each specimen, amalgam restorations were placed in the respective cusp tips, with gutta-percha placed in each canal at the level of the furcation. The authors made digital radiographs and occlusal photographs of each complete specimen. The samples were sectioned horizontally at the level of the cementoenamel junction (CEJ). Using a digital software program, the radiographs were superimposed with the digital photographs and correlations of pulp chamber to locate the canal orifice and occlusal surface anatomy. The authors found that the pulp chamber of the mandibular first molar lies more lingual at the level of the CEJ. In addition, the orifices were consistent in their location relative to cusp tip anatomy, a discovery that may assist dentists with the access design.

Intracanal assessment of mineral trioxide aggregate setting and sealing properties.

This study sought to assess setting time and sealing properties of intracanal mineral trioxide aggregate (MTA). Eighty-three extracted single-rooted human teeth were decoronated and instrumented using the crown-down technique. The apical 3.0 mm of each tooth was resected. After MTA was placed, the coronal openings of the canals were sealed with moist cotton pellets. Root samples were divided into three groups according to setting time periods of four hours, two days, or one week. Within each group, 15 samples were kept in wet gauze to provide a moist apical environment (WA) while the remaining 10 were kept in a dry apical environment (DA). After respective incubation periods, 20 samples per group (10 WA, 10 DA) were mounted in an apical broth turbidity determination chamber and incubated for 30 days. The remaining five teeth per group (WA-h) were sectioned into 3.0 mm slices and compared for MTA setting hardness using the Shore-D Hardness test. Remaining teeth served as negative and positive controls. Each sample was inoculated coronally with Enterococcus faecalis and checked daily for turbidity in apical broth. Microbial leakage was reduced significantly as setting time increased from four hours to two days or one week. There was no significant reduction in leakage when setting time was increased from two days to one week. Over the first 20 days, the DA samples showed a higher rate of leakage compared to the WA samples. The Shore-D hardness test correlated with leakage results; 93% of total setting hardness was reported at two days and one week compared to only 75% for the four-hour group. Results suggest that apical moisture may affect MTA setting time or sealing ability initially and that intracanal MTA may take up to two days to set completely.

An analysis of current analgesic preferences for endodontic pain management.

A descriptive, cross sectional survey was developed to determine the preferences of endodontists when prescribing analgesics. Eleven clinical scenarios describing common endodontic diagnoses or procedures with specified severity of pain were provided. A survey was sent to 310 AAE members and 63 responded, providing a 20% response rate. Respondents were given various choices for analgesic prescription including various dosages of ibuprofen or acetaminophen (APAP), or combination narcotic medications. Data were analyzed by chi2 tests. Non-narcotics were preferred over narcotics for all clinical situations. Significantly more respondents selected ibuprofen 600 mg (4x a day) regardless of the severity of preoperative or postoperative pain (p<0.001). Educators and board-certified AAE members were less likely than nonboard certified AAE members to manage their patient's perceived severe pain with narcotic analgesics.

Electric pulp tester conductance through various interface media.

A conducting media is necessary when using an electric pulp tester (EPT). The objective of this study was to observe differences in conductance through various media. We hypothesized that variations in current conductance through different media exist. The pulp chamber of a freshly extracted premolar was exposed, and the cathode of a voltmeter was inserted into the pulpal tissue. The anode was coupled to the EPT handpiece. The measurement taken during dry (no interface media) EPT tip-to-tooth contact was 0 V, which served as negative control. EPT tip directly touching the cathode measured 3.9V and served as positive control. A number of media readily available in the dental office were tested. Data was analyzed using single factor ANOVA. Listerine (3.3) conducted the most voltage (p<0.5). Of nonliquids, K-Y Brand UltraGel and Crest Baking Soda & Peroxide Whitening Tartar Control toothpaste recorded significantly (p<0.05) higher voltage readings (1.4 V).

A conservative approach for the management of a crown-root fracture.

Subgingival crown-root fractures are major complications that jeopardize tooth survival and require the clinician to adopt a multidisciplinary approach combining different dental specialties to effectively treat the teeth and ensure long-term survival. Fragment reattachment is a conservative therapeutic option for uncomplicated crown-root fractures. However, biologic width involvement must be carefully evaluated and addressed. This article describes a case of restoration of a crown-root fracture by means of periodontal surgical exposure of the fracture, crown and root recontouring, and fragment reattachment.

An in vitro assessment of iodoform gutta-percha.

The purpose of this study was to test the ability of a commercially available iodoform gutta-percha, to delay infiltration of Enterococcus faecalis using a microleakage model. Seventy extracted single-rooted teeth were decoronated and biomechanically prepared using hand and rotary instruments. Thirty roots were obturated laterally with iodoform gutta-percha and another 30 with regular gutta-percha. Both groups were suspended in sterile BHI broth. An inoculum of E. faecalis suspension was placed at the coronal end of each root, incubated and replenished daily. The apical broth was observed for turbidity, indicating bacterial microleakage. Samples were observed for 32 days, and data was analyzed to compare microleakage between the two groups. The results showed no significant difference between the iodoform and regular gutta-percha samples in delaying microleakage of E. faecalis (p > 0.05).