Risk factors associated with the survival of endodontically treated teeth: A retrospective chart review.

BACKGROUND: Studies on risk factors affecting tooth retention after endodontic treatment in dental school settings are limited. Understanding these factors is crucial for preserving teeth. The aim of this retrospective study was to evaluate patient- and tooth-level risk factors associated with the survival of endodontically treated teeth. METHODS: Electronic health records of patients who underwent endodontic treatment at the School of Dental Medicine at the University of Pennsylvania from 2017 through 2020 were analyzed. Patient-level factors included age, sex, American Society of Anesthesiologists Physical Status Classification, smoking history, diabetes status, and amoxicillin allergy. Tooth-level factors included position, presence of restorations, and periodontal conditions with preprosthetic treatments. RESULTS: The results of this study indicate that the patient-level factors significantly associated with tooth retention included age, sex, American Society of Anesthesiologists Physical Classification Status, and amoxicillin allergy. Tooth-level factors such as core buildup, full-coverage crown, healthy periodontium, and scaling and root planing were also associated with higher survival rates. Mandibular premolars had higher survival rates than mandibular molars. CONCLUSIONS: This investigation revealed that the tooth retention rate of endodontically treated teeth was 96.2% after initial root canal treatment, 92.4% for nonsurgical re-treatment, and 97.8% for surgical re-treatment. PRACTICAL IMPLICATIONS: The tooth retention of the endodontic treatment was associated with healthy periodontium, tooth structure, tooth position, tooth restoration, and the patient's overall health.

Comparison of Fracture Resistance between Different Treatment Modalities of Mutilated Endodontically Treated Teeth Using Polyether Ether Ketone.

AIM: To compare fracture resistance of multiple treatment modalities intended for mutilated teeth using polyether ether ketone (PEEK) and zirconia materials. MATERIALS AND METHODS: The study was divided into four groups according to treatment modality adopted (n = 14): fiber post (F), Nayyar core (N), endocrown (E), and Richmond crown (R). Each group was further subdivided into two groups (n = 7) according to the type of material used: zirconia (Z) and PEEK (P). Using computer-aided design/computer-aided manufacturing, restorations were constructed from both materials following tested treatment options and manufacturer direction. Finished restorations were then tried, seated, and cemented to their corresponding acrylic teeth. All specimens were tested for fracture resistance in universal testing machine with cross head speed of 0.5 mm/min speed until failure, which was confirmed by a sudden drop in the measurements of the testing machine. Results were recorded, tabulated, and statistically analyzed. Shapiro-Wilk normality tests were considered to evaluate the normality of the data distributions. One-way analysis of variance (ANOVA) followed by Tukey's post hoc analysis was conducted to analyze the fracture resistance significant differences. RESULTS: Descriptive statistics of the restoration material revealed statistically a higher mean value for PEEK material (3609 ± 188.1) than zirconia (2404 ± 425.6). One-way ANOVA revealed statistically significant differences between zirconia group (p < 0.0001). Regarding zirconia group statistical significance was detected between fiber post vs endocrown (p = 0.0299), fiber post vs Richmond crown (p < 0.0001), and Nayyar core vs Richmond crown (p = 0.0004). However, there was no statistically significant difference between PEEK group (P = 0.1614). CONCLUSION: Polyether ether ketone could present a reliable treatment option in endodontically treated teeth. CLINICAL SIGNIFICANCE: Using one-piece Richmond crowns constructed of PEEK could present a viable treatment option against conventional treatment options of root canal treatment (RCT) single-rooted teeth.

Is zirconium or stainless steel the most suitable crown material for less dentin stress in endodontically treated teeth?

BACKGROUND: Stainless steel crowns (SSCs), which have been used frequently in the treatment of first permanent molars in children until now, has become less applicable due to its poor aesthetic appearance. Zirconia crowns (ZCs) have become more popular due to their aesthetic advantage. However, stress transmission of ZCs to dental tissues under occlusal forces in endodontically treated teeth has not been described. OBJECTIVE: The aim of this study was to compare the stress distribution of different crown materials (ZCS, SSCs) and adhesive materials on dentin in endodontically treated permanent teeth and to specify the crown-adhesive model with lower stress. METHODS: Finite element analysis (FEA) was used to apply a force of 300 N from the inner part of the buccal tubercles (vertical loading) and a lingo-buccal at an angle of 30 degrees (oblique loading) of the first permanent molars (FPM) with different crown (ZCS, SSCs) and adhesive (Glass ionomer cement, Resin modified glass ionomer cement, Resin cement) materials in twelve separate models. The von Mises values obtained from the models were compared and the optimal stress values were determined by FEA. RESULTS: The lowest stress values of dentin were found in zirconia crown model with glass ionomer cement (GIC) adhesive under vertical loading (26,793 Mpa). In the zircon crown and GIC adhesive model, less von Mises stress occurred on the dentin under all conditions. CONCLUSIONS: ZCs and GIC adhesive may be recommended for teeth with a high probability of dentin fracture.

Effects of irradiation, restoration and crown fracture type on the maximum load to fracture traumatized incisors: An ex vivo study.

BACKGROUND/AIMS: Radiotherapy makes teeth prone to tooth fractures. However, the relationship between radiotherapy and maximum load to fracture teeth that suffered a crown fracture is not fully understood. The aim of this study was to evaluate the influence of fracture type, radiation dose, fracture time, and their interactions on maximum load to fracture irradiated teeth. MATERIAL AND METHODS: A total of 140 permanent incisors were divided into two fracture type groups (uncomplicated and complicated) each of which included seven radiation dose subgroups (0, 10, 20, 30, 40, 50, and 60). The test groups were exposed to high-energy X-ray at 2 Gy/day, 5 days/week for a total dose of 10-60 Gy. Control groups were not irradiated. The load where the specimen started to break was obtained two different times. The 1st fracture was performed after radiation therapy, and the 2nd fracture was performed after the restoration of these samples. RESULTS: Fracture type had no effect on the maximum load to fracture. In contrast, the maximum load to fracture teeth decreased with increasing radiation doses. Maximum load to fracture the restored teeth was lower than the 1st fracture results. The general linear model procedure revealed a significant interaction between radiation dose and fracture time. Similarly, there was a significant interaction between the fracture type, radiotherapy dose, and fracture time. Maximum load values of teeth with complicated crown fractures restored with fiber posts and composite were not affected by radiation. CONCLUSION: Teeth that have been subjected to radiotherapy have an increased risk of fracture during dental trauma. However, restoration of the irradiated teeth with fiber posts and composite resin did not affect the maximum load required to fracture them.

Estudio comparativo entre coronas, endocoronas y endocoronas con ausencia de una pared axial ante fuerzas de tracción / Comparative study between crown, endocrown and endocrown without one axial wall after tensile strength

Introducción: Las alternativas de tratamiento de órganos dentales con gran destrucción en su estructura varían, no sólo por el material de restauración, sino también por el valor económico y estético. Dentro de las alternativas existe: corona convencional, endocorona cuyo objetivo principal es la elaboración de una restauradora que evita la colocación de postes intraconducto y endocorona con ausencia de una pared axial (EPA) que se realiza cuando una pared, mesial, distal, vestibular o palatina está ausente. Objetivo: Verificar si la endocorona EPA se comporta de igual manera que las coronas convencionales y endocoronas al medir su resistencia ante fuerzas de tracción. Material y métodos: Treinta premolares fueron tratados endodóncicamente, 10 fueron preparados para recibir una corona convencional (grupo A), 10 para endocorona (grupo B) y 10 para endocorona EPA (grupo C). Se realizaron fuerzas de tracción para obtener el valor máximo en el cual las coronas fallaron. Se realizó una prueba ANOVA para comparar los resultados. Resultados: Al someter a los tres tipos de coronas a fuerzas de tracción los resultados obtenidos fueron: 3.04 ± 0.55 MPa para la corona, 7.08 ± 1.6 MPa para la endocorona y 6.17 ± 1.12 MPa para la endocorona EPA. Conclusiones: No existió diferencia significativa entre la endocorona (7.08 MPa) y la EPA (6.17 MPa), convirtiéndose en una alternativa de tratamiento con buen pronóstico en la práctica diaria (AU)

Introduction: The alternatives of treatment of tooth with excessive wear vary not only by the restoration material but also by the economic and aesthetic value. Among the alternatives there is: conventional crown, endocrown whose main objective is the elaboration of a restorative that avoids the placement of intraconducting posts and endocrown without one axial wall (EPA) that is done when a wall; mesial, distal, vestibular or palatal is absent. Objective: To verify if the (EPA) behaves in the same way as the conventional crown and endocrown when measuring its resistance to tensile strength. Material and methods: 30 premolars were treated endodontically, ten were prepared to receive a conventional crown, 10 for endocrown and 10 for EPA. Tensile strength were performed to obtain the maximum value at which the crowns failed, an ANOVA test was performed to compare the results. Results: When the three types of crowns were subjected to tensile strength, the results obtained were; 3.04 ± 0.55 MPa for the crown, 7.08 ± 1.6 MPa for the endocrown and 6.17 ± 1.12 MPa for the EPA endocrown. Conclusions: There was no significant difference between the endocrown (7.08 MPa) and EPA endocrown (6.17 MPa) becoming an alternative treatment with good prognosis in daily practice (AU)

Clareamento dental interno: enfoque na questão do tampão cervical e na descrição da técnica (imediata e/ou mediata) / Internal dental whitening: focus on the cervical buffer issue and on the description of the technique (immediate and / or mediate)

Introdução: A alteração de cor dentária consiste em um dos principais aspectos que corroboram à desarmonia do sorriso. Em situações de dentes não-vitais que apresentem escurecimento, o clareamento dental interno tem sido considerado uma opção conservadora de tratamento, podendo ser efetuado por meio de diferentes técnicas (mediata, imediata e mista). Em quaisquer técnicas, é necessária a confecção de um tampão cervical previamente à aplicação do agente clareador. Objetivo: Consiste em revisar a literatura a respeito do clareamento interno, das principais técnicas pelas quais ele pode ser realizado, sobre a importância do tampão cervical para a prevenção de danos ao dente e para a execução de um tratamento seguro e eficaz. Metodologia: Realizou-se uma busca nas bases de dados eletrônicos PubMed, ScienceDirect, LILACS e SciELO; analisando as publicações entre o período de 2010-2020. Resultados: A técnica mediata consiste em uma das mais utilizadas e indicadas; a imediata, na configuração termocatalítica, encontra-se em desuso, devido à contraindicação do uso do calor. A técnica mista, sendo a combinação das duas técnicas, pode potencializar o resultado clareador. Em todas elas, deve-se efetuar um tampão cervical para evitar o extravasamento do material clareador pelos túbulos dentinários, prevenindo a reabsorção cervical externa, que constitui o principal risco do clareamento interno. Conclusão: Baseado na literatura, todas as técnicas podem ser realizadas, desde que executadas de modo apropriado, seguindo as medidas como a da não aplicação de calor e a da execução do tampão, se adequando às necessidades do paciente a fim de escolher a técnica mais indicada.

Introduction: The change in tooth color is one of the main aspects that corroborate the disharmony of the smile. In situations of non-vital teeth that suffer from darkening, internal tooth whitening has been considered a conservative treatment option and can be carried out through different techniques (mediate, immediate, and mixed). In any of these techniques, it is necessary to make a cervical tampon before the application of the bleaching agent. Objective: To review the literature regarding internal whitening, the main techniques used in this process, the importance of the cervical plug for the prevention of damage to the tooth, and the execution of safe and effective treatment. Methodology: A search was performed in the electronic databases PubMed, ScienceDirect, LILACS, and SciELO, analyzing publications from 2010 to 2020. Results: The mediated technique consists of one of the most used and indicated; the immediate, in the thermocatalytic configuration, has fallen in disuse due to the contraindication of the use of heat. The mixed technique, which is the combination of the two others, can potentiate the whitening result. In all of them, a cervical plug is necessary to avoid the extravasation of the whitening material by the dentinal tubules, preventing external cervical resorption, which is the main risk of internal whitening. Conclusion: Literature suggests all three techniques can be performed if correctly executed, following measures such as the non-application of heat and the execution of the buffer, adapting to the needs of the patient to choose the most suitable technique.

Pinos estéticos de fibra de vidro: técnicas e protocolos clínicos / Aesthetic fiberglass pins: techniques and clinical protocols

Introdução: Os pinos de fibra de vidro (PFVs) apresentam-se como uma alternativa prática e econômica capaz de reabilitar dentes endodonticamente tratados com perdas estruturais superiores a 50%. Objetivo: Realizar uma revisão de literatura sobre o protocolo clínico acerca da utilização dos PFVs, bem como explanar as diferentes técnicas que po-dem ser utilizadas para implementá-los. Materiais e métodos: Realizou-se uma revisão bibliográfica de estudos publicados entre 2000 e 2021 por meio da busca nas bases de dados: PubMED/Medline, Scielo (Scientific Eletronic Library) e Google Acadêmico. Para a pesquisa, foram utilizados os seguintes descritores: Dente não Vital (Non-vital Tooth), Pinos Dentários (Dental Pins) e Técnica para Retentor Intrarradicular (Post and Core Technique). Após criteriosa filtragem, foram selecionados 24 trabalhos para inclusão no estudo, além de 10 livros considerados relevantes para esta revisão. Resultados: Durante o diagnóstico e planejamento, é necessário avaliar determinados fatores para que se obtenha sucesso clínico, como: quantidade de estrutura dentária remanescente, posição dentária e forças oclusais recebidas e necessidades restauradoras e estéticas exigidas pelo caso e pelo paciente. Diante das particularidades de cada caso, o clínico deve selecionar entre as técnicas a mais ideal: Técnica do PFV direto/ técnica convencional; Técnica do pino de fibra de vidro anatômico; ouTécnica direta com PFV associado a pinos acessórios. Conclusão: A técnica do PFV apresenta passos clínicos simplificados e sua correta realização garante sucesso no tratamento. Diante de situações em que o PFV não apresenta correta adaptação, o clínico deve abrir mão da utilização da técnica convencional e utilizar as técnicas de personalização do PFV.

Introduction: Fiberglass posts (FPs) are presented as a practical and economical alternative capable of rehabilitating endodontically treated teeth with 50% structural losses greater than 50%. Objective: To review the literature on the clinical protocol for the use of FPs, as well as explain the different techniques that can be used. Materials and methods: A literature review of studies published between 2000 and 2021 was carried out through a search on the Scielo (Scientific Electronic Library) and Google Scholar databases. The following descriptors were used for the research: Non-Vital Tooth, Dental Pins, and Technique for Intraradicular Retainer (Post and Core Technique). After careful screening, we selected 24 papers and 10 books, considered relevant for this review. Results: During planning, it is necessary to determine specific factors for clinical success, such as the amount of remaining tooth structure, the tooth position and the occlusal forces received, and restorative and esthetic needs required by the case and the patient. Given each case's particularities, the clinician must select among the most ideal techniques: the direct FP technique/convention-al technique; the Anatomical fiberglass post technique, and the direct technique with FP associated with accessory posts. Conclusion: The FP technique has simplified clinical steps and its correct performance is successful in the treatment. Faced with situations in which the FP does not present adequate adaptation, the clinician must not use the conventional technique, using techniques for personalizing the FP.

Endodontic Periapical Lesion: An Overview on the Etiology, Diagnosis and Current Treatment Modalities.

Nonsurgical and surgical endodontic treatments have a high success rate in the treatment and prevention of apical periodontitis when carried out according to standard and accepted clinical principles. Nevertheless, endodontic periapical lesions remain in some cases, and further treatment should be considered when apical periodontitis persists. Although several treatment modalities have been proposed for endodontically treated teeth with persistent apical periodontitis, there is a need for less invasive methods with more predictable outcomes. The advantages and shortcomings of existing approaches for the diagnosis and treatment of endodontic periradicular lesions are discussed in this review.

Induction of root development and apical closure in permanent mandibular molar with irreversible pulpitis through total pulpotomy with application of mineral trioxide aggregate / Inducción del termino de desarrollo radicular y cierre apical en molar mandibular permanente con pulpitis irreversible a través de pulpotomía total con aplicación de agregado de trióxido mineral

Loss of teeth vitality when root formation is incomplete, results in weaker structures leaving them prone to fractures and unfavourable long-term prognosis. Apexogenesis is currently the treatment of choice in immature teeth and is indicated in vital teeth without pulpal pathologies. The treatment aims to eliminate the causal agent of the damage, and provide the necessary conditions to preserve vitality in the tooth and induce apical root closure. A 6-year-old male patient was treated at the Endodontics Clinic, Universidad de La Frontera upon complaining of acute pain in tooth 30. The tooth presented incomplete root development due to dental caries with pulp exposure and a diagnosis of irreversible symptomatic pulpitis. Total pulpotomy was performed with the application of Mineral Trioxide Aggregate and controlled at 1, 4, 6, 7 and 12 months, achieving root development and apical closure in the permanent molar. The result was comparable with studies that support this therapy in teeth with irreversible pulpitis. This work seeks to contribute to the existing evidence on the management of immature permanent teeth with irreversible pulpitis to induce root development and apical closure, and maintain pulp vitality.

La pérdida de vitalidad en dientes con formación radicular incompleta trae como resultado el debilitamiento de estos, dejándolos propensos a fracturas con un desfavorable pronóstico a largo plazo. Las terapéuticas actuales de regeneración pulpar en dientes inmaduros estan principalmente indicadas en cuadros de pulpitis irreversible y buscan eliminar el agente causal de daño y brindarle al diente las condiciones y estímulos necesarios para preservar vitalidad e inducir el cierre apical radicular. Un paciente de 6 años de edad y de sexo masculino, acude a la Clínica de Especialidad de Endodoncia de la Universidad de la Frontera, consultando por un dolor agudo en diente 4.6 el cual presentaba un desarrollo radicular incompleto producto de una caries con exposición pulpar con diagnóstico de Pulpitis Irreversible Sintomática. Se realiza una pulpotomia total con aplicación de Mineral Trioxide Aggregate y se controla a los 1, 4, 6 y 7 meses obteniendo un interesante resultado comparable con estudios que avalan dicha terapeutica en dientes con pulpitis irreversible. Este trabajo busca contribuir a la evidencia existente sobre el manejo de dientes permanentes inmaduros con cuadros de pulpitis irreversible para inducir el desarrollo radicular, cierre apical y mantener vitalidad pulpar.

Direct resin composite restoration of endodontically-treated permanent molars in adolescents: bite force and patient-specific finite element analysis

Abstract Objective To evaluate the influence of three levels of dental structure loss on stress distribution and bite load in root canal-treated young molar teeth that were filled with bulk-fill resin composite, using finite element analysis (FEA) to predict clinical failure. Methodology Three first mandibular molars with extensive caries lesions were selected in teenager patients. The habitual occlusion bite force was measured using gnathodynamometer before and after endodontic/restoration procedures. The recorded bite forces were used as input for patient-specific FEA models, generated from cone-beam computed tomographic (CT) scans of the teeth before and after treatment. Loads were simulated using the contact loading of the antagonist molars selected based on the CT scans and clinical evaluation. Pre and post treatment bite forces (N) in the 3 patients were 30.1/136.6, 34.3/133.4, and 47.9/124.1. Results Bite force increased 260% (from 36.7±11.6 to 131.9±17.8 N) after endodontic and direct restoration. Before endodontic intervention, the stress concentration was located in coronal tooth structure; after rehabilitation, the stresses were located in root dentin, regardless of the level of tooth structure loss. The bite force used on molar teeth after pulp removal during endodontic treatment resulted in high stress concentrations in weakened tooth areas and at the furcation. Conclusion Extensive caries negatively affected the bite force. After pulp removal and endodontic treatment, stress and strain concentrations were higher in the weakened dental structure. Root canal treatment associated with direct resin composite restorative procedure could restore the stress-strain conditions in permanent young molar teeth.

Restauração de dentes tratados endodonticamente com resinas bulk-fill: revisão integrativa / Endodontically treated teeth restored with bulk-fill resins: integrative review

Objetivo: realizar uma revisão de literatura sobre o uso de resinas bulk-fill para restaurar dentes tratados endodonticamente. Materiais e método: a busca dos estudos, clínicos ou laboratoriais, foi realizada no portal PubMed, utilizando os descritores "bulk fill" e "endodontically treated". Os dados extraídos da literatura foram agrupados em um quadro, que apresenta as características metodológicas e os principais resultados de cada estudo. Resultados: Sete estudos foram incluídos na revisão. Dentre eles, cinco avaliaram a resistência à fratura dos dentes após a restauração, um avaliou a adaptação da resina ao assoalho da câmara pulpar, e um realizou um ensaio clínico com acompanhamento de três anos, comparando o uso de resina bulk-fill com resina convencional. Considerações finais: o desempenho das resinas bulk-fill mostrou-se semelhante ao das resinas convencionais nas características de resistência à fratura dos dentes (in vitro) e longevidade (in vivo). A economia de tempo clínico proporcionada pelas resinas bulk-fill pode justificar o seu emprego para a restauração de dentes tratados endodonticamente. (AU)

Objective: the aim of this study was to review the literature regarding the use of bulk-fill resin to restore endodontically treated teeth. Materials and method: the search was performed at PubMed, using the descriptors "bulk fill" AND "endodontically treated". Clinical and laboratorial studies were included. The extracted data was presented on a table showing the methodological features and results of each study. Results: seven studies evaluated the bulk-fill resin on direct restoration. Five of these seven evaluated the resistance to fracture, one assessed the resin adaptation to the floor chamber, and one was a randomized clinical trial comparing the bulkfill resin to conventional resin. Final considerations: the performance of bulk-fill resins was similar to the conventional resins when compared to the in vitro studies on tooth fracture resistance and in vivo study on longevity of restorations. The economy of clinical time may justify its use to restore endodontically treated teeth. (AU)

Prevalence of technical errors and periapical lesions in a sample of endodontically treated teeth: a CBCT analysis.

OBJECTIVES: The aims of this study are to identify the most frequent technical errors in endodontically treated teeth and to determine which root canals were most often associated with those errors, as well as to relate endodontic technical errors and the presence of coronal restorations with periapical status by means of cone-beam computed tomography images. METHODS: Six hundred eighteen endodontically treated teeth (1146 root canals) were evaluated for the quality of their endodontic treatment and for the presence of coronal restorations and periapical lesions. Each root canal was classified according to dental groups, and the endodontic technical errors were recorded. Chi-square's test and descriptive analyses were performed. RESULTS: Six hundred eighty root canals (59.3%) had periapical lesions. Maxillary molars and anterior teeth showed higher prevalence of periapical lesions (p < 0.05). Endodontic treatment quality and coronal restoration were associated with periapical status (p < 0.05). Underfilling was the most frequent technical error in all root canals, except for the second mesiobuccal root canal of maxillary molars and the distobuccal root canal of mandibular molars, which were non-filled in 78.4 and 30% of the cases, respectively. CONCLUSIONS: There is a high prevalence of apical radiolucencies, which increased in the presence of poor coronal restorations, endodontic technical errors, and when both conditions were concomitant. Underfilling was the most frequent technical error, followed by non-homogeneous and non-filled canals. CLINICAL RELEVANCE: Evaluation of endodontic treatment quality that considers every single root canal aims on warning dental practitioners of the prevalence of technical errors that could be avoided with careful treatment planning and execution.

Long-term Evaluation of Treatment Planning Decisions for Nonhealing Endodontic Cases by Different Groups of Practitioners.

INTRODUCTION: The aim of this study was to investigate changes in treatment planning decisions among different practitioner groups over 7 years for teeth with apical periodontitis and a history of endodontic treatment. METHODS: A Web-based survey was sent to dentists in Pennsylvania in 2009 consisting of 14 cases with nonhealing periapical lesions and intact restorations without evidence of recurrent caries. Participants selected among 5 treatment options: wait and observe, nonsurgical retreatment (NSRTX), surgical retreatment (SRTX), extraction and fixed partial denture, or extraction and implant (EXIMP). In 2016, the identical survey was resent to the original 2009 participants. RESULTS: In 2009, 262 dentists participated in the survey. Two hundred one participants were general practitioners (GPs: 76.7%), 26 endodontists (ENDOs: 9.9%), and 35 other specialists (prosthodontics, periodontics, and oral surgery [SPECs]: 13.4%) (n = 262). EXIMP, NSRTX, and SRTX were fairly equally selected but with great variation between practitioner groups (χ2 = 173.49, P < .05). A subset group of 104 participants (SUB) (39.7% of the original participants) retook the survey in 2016 (69 GPs [66.3%], 15 ENDOs [14.0%], and 20 SPECs [19.7%]). Comparisons among practitioner groups were significantly different in SUB (n = 104) for 2009 (χ2 = 95.536, P < .05) and 2016 (χ2 = 109.8889, P < .05). Intragroup reliability between 2009 and 2016 revealed no significant differences between the overall treatment planning choices for all practitioners (GPs, ENDOs, or SPECs). Intrapractitioner reliability showed many treatment planning decision changes on an individual level. Chances that individuals changed their original decision were 47.8% (95% confidence interval, 45.2%-50.4%) and were significantly different among the 3 practitioner groups (GPs > SPECs > ENDOs [χ2 = 11.2792, P < .05]). No significant changes were observed in the decision for tooth saving versus replacement treatment options (P = .520). CONCLUSIONS: No significant differences were noted between current and past treatment planning decisions in regard to tooth preservation by endodontic retreatment versus tooth extraction and replacement. However, individual practitioners lacked consistency in their decision making over time.

Influence of remaining coronal thickness and height on biomechanical behavior of endodontically treated teeth: survival rates, load to fracture and finite element analysis

Abstract Objective To evaluate the effect of restorative strategy (fiber post vs cast post and core), coronal height (0 mm vs 2 mm) and thickness (higher than 1 mm vs lower than 1 mm) on survival rate, fracture resistance and stress distribution. Material and Methods Seventy-two bovine teeth were cleaned and allocated in six groups (n = 12). Twenty-four teeth were sectioned at 13 mm length (no remaining coronal structure) and forty-eight were sectioned at 15 mm (2 mm remaining coronal structure). Half of the forty-eight had remaining coronal thickness lower than 1 mm and the other half had thickness higher than 1 mm. All root canals were prepared at 10 mm (luting length), fiber posts were cemented in thirty-six specimens and cast post and core in other thirty-six. All teeth were restored with metallic crowns. Specimens were submitted to 1.5 million cycles (100 N, 45°, 10 Hz at 2 mm below incisal edge) and evaluated at each 500,000 cycles to detect failures. Specimens that survived were submitted to load to fracture test. Bidimensional (Rhinoceros® 4.0) models were obteined survival data submitted to Kaplan-Meier (α=0.05) analysis and load to fracture values submitted to ANOVA and Tukey tests (α=0.05). Results Groups without remaining coronal structure showed survival rates lower than other groups (p=0.001). ANOVA showed higher values of load to fracture for groups with coronal thickness higher than 1 mm (p=0.0043). Finite element analysis showed better stress distribution in groups with remaining coronal structure and restored with fiber post. Conclusion Specimens without remaining coronal structure have lower survival rates. Specimens with remaining structure lower than 1 mm and without coronal structure support the same load to fracture value independently of the restorative strategy.

Current options concerning the endodontically-treated teeth restoration with the adhesive approach

Abstract: Adhesive procedures have changed the way to restore endodontically treated teeth (ETT). It started with the shift from cast post-and-core to fiber post. The original focus on strength also shifted towards failure modes, revealing that catastrophic failures are still a concern when restoring endodontically-treated teeth even with fiber posts. As an alternative, postless approaches have been proposed in order to improve the chances of repair. The goal of this critical review is to present a survey of the current knowledge on adhesive approaches to restore endodontically treated teeth with and without extensive coronal tissue loss. The preservation of tooth structure of endodontically treated teeth is paramount. Partial versus full coverage of ETT, the role of the ferrule, the post type effect on catastrophic failures and postless alternatives as endocrowns and postless build-ups are reviewed. There is a consensus that the remaining tooth structure plays an important role in ETT survival, although the current literature still is contradictory on the influence of post type on root fractures as well as the benefits of avoiding a post or partially restoring a tooth. More clinical studies should be carried out with the modern postless adhesive alternatives to conventional approaches.

How biomechanics can affect the endodontic treated teeth and their restorative procedures?

Abstract: Endodontic treatment is a common dental procedure used for treating teeth which the pulp tissue has become irreversibly inflamed or necrotic as a result of the carious process or dental trauma. This procedure which involves mechanical and chemical preparation of root canal may affect several mechanical and physical properties of the tooth structure. The endodontic treatment can also influence the longevity of the rehabilitation of endodontically treated teeth and biomechanics during the oral function. For restoring endodontically treated teeth several factor and clinical decisions should be observed. The decision of the fiberglass post usage and the restorative materials are related to several factors such as the quantity and quality of remaining dental structure, presence of ferrule, post cementation length and final coronal restoration. In this review, the authors will address the effect of the endodontic treatment procedures on canal shape and mechanical properties of a tooth, and also discuss the parameters and the biomechanical principles of root canal treated teeth.

Evaluation of Stress Distribution in Endodontically Weakened Teeth Restored with Different Crown Materials: 3D-FEA Analysis

Abstract This study evaluated the stress distribution in endodontically treated teeth, weakened (W) or not weakened (NW), restored with different materials of prosthetic crown using 3D-FEA. Models of a maxillary canine were constructed based on micro-CT images and divided into the groups: G1 (control) - sound tooth; G2 to G7 - endodontically treated teeth restored with glass fiber post (GFP); which G2 to G4 simulated NW root and G5 to G7 simulated W root. For crown material the teeth were restored with: G2 and G5: metallic coping and ceramic veneering, G3 and G6: zirconia coping and ceramic veneering, G4 and G7: alumina coping and ceramic veneering. Load of 180 N was applied at the incisal third of lingual surface at 45º. Models were supported by the periodontal ligament (x=y=z=0). The von Mises stress (VMS) values were calculated. The W teeth presented higher VMS at coping when compared to NW teeth and group G1 showed lower VMS value. For crown material, for both W or NW teeth, increasing VMS was found at metallic, zirconia and alumina coping, respectively. Metallic coping showed a better performance despite its unfavorable esthetics, suggesting as an appropriate material for prosthetic restoration of endodontically treated teeth.

Resumo Este estudo avaliou a distribuição de tensão em dentes tratados endodonticamente, fragilizados (F) ou não fragilizados (NF), restaurados com diferentes materiais para a coroa protética utilizando 3D-FEA. Modelos de um canino maxilar foram construídos baseados em imagens de micro-CT e divididos em grupos: G1 (controle) - dente hígido; G2 a G7 - dentes tratados endodonticamente com pino de fibra de vidro (PFV), sendo que G2 a G4 simularam raízes NF e G5 a G7 simularam raízes F. Para o material das coroas os dentes foram restaurados com: G2 e G5: coping metálico e revestimento cerâmico, G3 e G6: coping de zirconia e revestimento cerâmico, G4 e G7: coping de alumina e revestimento cerâmico. Carregamento de 180 N foi aplicado na superfície lingual em seu terço incisal com 45 graus de inclinação. Os modelos foram suportados pelo ligamento periodontal (x=y=z=0). Os valores da tensão de von Mises (VMS) foram calculados. Os dentes F apresentaram maiores valores VMS para o coping quando comparados aos dentes NF, sendo que o G1 apresentou menores valores VMS. Para o material das coroas, ambos F ou NF aumentaram VMS no coping metálico, zirconia e alumina, respectivamente. Copings metálicos apresentaram melhor comportamento mecânico apesar de não favorecerem a estética, o que sugere ser um material apropriado para a restauração de dentes tratados endodonticamente.

Factors affecting the periapical healing process of endodontically treated teeth

Abstract Tissue repair is an essential process that reestablishes tissue integrity and regular function. Nevertheless, different therapeutic factors and clinical conditions may interfere in this process of periapical healing. This review aims to discuss the important therapeutic factors associated with the clinical protocol used during root canal treatment and to highlight the systemic conditions associated with the periapical healing process of endodontically treated teeth. The antibacterial strategies indicated in the conventional treatment of an inflamed and infected pulp and the modulation of the host's immune response may assist in tissue repair, if wound healing has been hindered by infection. Systemic conditions, such as diabetes mellitus and hypertension, can also inhibit wound healing. The success of root canal treatment is affected by the correct choice of clinical protocol. These factors are dependent on the sanitization process (instrumentation, irrigant solution, irrigating strategies, and intracanal dressing), the apical limit of the root canal preparation and obturation, and the quality of the sealer. The challenges affecting the healing process of endodontically treated teeth include control of the inflammation of pulp or infectious processes and simultaneous neutralization of unpredictable provocations to the periapical tissue. Along with these factors, one must understand the local and general clinical conditions (systemic health of the patient) that affect the outcome of root canal treatment prediction.

The Influence of Periodontal Status on Endodontically Treated Teeth: 9-year Survival Analysis.

INTRODUCTION: The aim of this study was to investigate the effect of periodontal status at the time of nonsurgical root canal treatment (NSRCT) on the survival rate of endodontically treated teeth (ETT). METHODS: In this retrospective investigation, molars that received NSRCT in an advanced specialty education program in endodontics from 2009 through 2017 were initially recruited. After the application of inclusion and exclusion criteria, 315 teeth were included in the study. Inclusion criteria were ETT with an acceptable quality of NSRCT; ETT that received an adequate crown within 3 months after NSRCT; and ETT with complete periodontal charting before NSRCT including pocket depths, clinical attachment loss, and bone loss. The periodontal status of all included teeth was assessed based on American Academy of Periodontology guidelines. All included ETT were divided into 3 groups as follows: healthy group, mild periodontitis, and moderate periodontitis. The survival rate of ETT was analyzed using univariate Kaplan-Meier and log-rank tests for differences between groups (P < .05). A Cox regression model was used to assess the effect of independent variables on the survival rate. RESULTS: Teeth that were diagnosed with mild periodontitis were almost 2 times more likely to be extracted compared with ETT diagnosed with normal periodontium at the time of NSRCT (odds ratio [OR] = 1.9, P < .05). This increased risk of tooth loss was 3.1 (OR = 3.1, P < .05) for ETT diagnosed with moderate periodontitis. Smokers were twice as likely to have tooth loss compared with nonsmokers (OR = 2.2, P < .05). CONCLUSIONS: Patients' periodontal health, being 1 of the prognostic determinants of the outcome of NSRCT, requires attention before and subsequent to NSRCT. This may improve the survival of ETT and help patients maintain their natural dentition.

www crownorfill com, un sitio que proporciona acceso instantáneo a la información basada en evidencia sobre restauraciones dentales posteriores: [Carta al Editor] / www.crownorfill. com Is the online tool that provides instant accessto evidence-based literature on dental restorations:[Letter to the Editor]

Crown-or-Fill© es una aplicación en un sitio web que resume la literaturabasada en la evidencia sobre los resultados del tratamiento para restauraciones en dientes posteriores en función de condiciones preexistentes. Los datos presentados se recogieron en dos revisionessistemáticas publicadas.

Crown-or-Fill© It is an application on a website that summarizes evidence based literature on treatment outcomes for restorations on posterior teeth as a function of pre-existing conditions. The data presented was collected in two published systematic reviews.