Frequency, impact, and predictors of persistent pain after root canal treatment: a national dental PBRN study.

Root canal treatment (RCT) is commonly performed surgery and persistent pain is known to occur, but little is known about how these patients are affected by this pain. Although biopsychosocial mechanisms are thought to be associated with the development of such pain, similar to persistent pain after surgery in other body sites, little is known about the baseline predictors for persistent pain. We assessed the frequency of persistent pain 6 months after RCT, measured the impact this pain had on patients, and determined predictive factors for persistent tooth pain in a multicenter prospective cohort study conducted within the National Dental Practice-Based Research Network. Of 708 patients enrolled, 651 (91.9%) provided follow-up data, with 65 (10.0%) meeting criteria for pain 6 months after RCT. On average, these patients reported their pain as mild to moderate in intensity, present for approximately 10 days in the preceding month, and minimally interfered with daily activities. After adjusting for the type of dental practitioner and patient age, gender, and household income, pain duration over the week before RCT significantly increased the risk of developing persistent pain (odds ratio = 1.19 per 1 day increase in pain duration, 95% confidence interval: 1.07-1.33), whereas optimism about the procedure reduced the risk (odds ratio = 0.39, 95% confidence interval: 0.22-0.67). Our data suggest that persistent pain 6 months after RCT is fairly common, but generally does not have a large impact on those experiencing it. Furthermore, patient age and gender did not predict persistent pain, whereas preoperative pain duration and the patient's expectation did.

A quantitative and qualitative analysis of ultrasonic versus sonic endodontic systems on canal cleanliness and obturation.

OBJECTIVE: The purpose of this study was to compare 2 irrigation techniques by evaluating canal cleanliness and obturation of lateral/accessory canals. STUDY DESIGN: Seventy-five extracted canines were instrumented to a size #40/0.06 taper. The EndoActivator (EA) was compared with an ultrasonic unit for final irrigation. Each unit was used for 1 minute each with 6.15% NaOCl and 17% EDTA. A control group received syringe irrigation. Thirty teeth were sectioned and evaluated for debris removal and open dentinal tubules at 3/5 mm from the apical foramen with a scanning electron microscope. Forty-five teeth were examined for obturation of lateral canals. RESULTS: The EA was significantly better in removing debris at all levels when compared with other treatment groups (P < .05) and resulted in obturation of significantly more numbers of lateral canals (P < .01.) CONCLUSIONS: The EA provided better obturation of lateral and accessory canals and resulted in less remaining debris.

Florid cemento-osseous dysplasia mimicking multiple periapical pathology--an endodontic dilemma.

A case of florid cemento-osseous dysplasia (COD) mimicking periapical pathology is presented. The fact that the patient's lesion failed to resolve three years after root canal therapy, in addition to the presence of a mixed radiolucency with discreet radiopacities, mandated a biopsy which (along with radiographic co-relation) confirmed the diagnosis of cemento-osseous dysplasia. This case report illustrates the point that periapical radiolucencies may represent benign fibro-osseous lesions that may be overlooked or result in unnecessary endodontic treatment.