Expert consensus on difficulty assessment of endodontic therapy.

Endodontic diseases are a kind of chronic infectious oral disease. Common endodontic treatment concepts are based on the removal of inflamed or necrotic pulp tissue and the replacement by gutta-percha. However, it is very essential for endodontic treatment to debride the root canal system and prevent the root canal system from bacterial reinfection after root canal therapy (RCT). Recent research, encompassing bacterial etiology and advanced imaging techniques, contributes to our understanding of the root canal system's anatomy intricacies and the technique sensitivity of RCT. Success in RCT hinges on factors like patients, infection severity, root canal anatomy, and treatment techniques. Therefore, improving disease management is a key issue to combat endodontic diseases and cure periapical lesions. The clinical difficulty assessment system of RCT is established based on patient conditions, tooth conditions, root canal configuration, and root canal needing retreatment, and emphasizes pre-treatment risk assessment for optimal outcomes. The findings suggest that the presence of risk factors may correlate with the challenge of achieving the high standard required for RCT. These insights contribute not only to improve education but also aid practitioners in treatment planning and referral decision-making within the field of endodontics.

Assessment of the quality of root canal fillings performed on extracted teeth by undergraduate dental students in a sample from Saudi Arabia.

BACKGROUND: The educational process in the field of endodontics commences with preclinical exercises to enhance students' proficiency in cleaning, shaping, and performing root canal fillings. Therefore, this study aimed to radiographically evaluate the technical quality of root canal fillings performed by preclinical students on extracted teeth at the College of Dentistry, University of Ha'il, Saudi Arabia. METHODS: A total of 788 extracted human teeth received root canal treatment by undergraduate students. The samples were then gathered and radiographically assessed using the three quality criteria of length, density, and taper. The category of root canal fillings was classified as either acceptable or unacceptable. The criteria for evaluating the acceptability of filling quality were defined based on the presence of adequate length, density, and taper. The effectiveness of root canal fillings was also evaluated in relation to the tooth type, sex, and treatment year. The agreement between the examiners was evaluated using Cohen's kappa test, and the relationship between the research variables was determined using the chi-squared test. The significance threshold was set at 0. 05. RESULTS: The overall quality of root filling was determined to be satisfactory in 532 (67.5%) of 788 endodontically treated extracted teeth. The majority of the research sample (88.1%) had enough length, 89.6% had adequate density, and 86.4% had acceptable taper. The quality of anterior teeth was substantially better than that of posterior teeth (p < 0.001). Our findings showed that the quality of root canals was better in 2022 than it had been in earlier years (p = 0.001). The three RCT quality criteria differed significantly when compared between sexes (p = 0.002). CONCLUSIONS: The quality of the root canal fillings completed by undergraduate students was rated as acceptable. The findings of the research suggest that the implementation of routine assessments to evaluate the technical competence of undergraduate dental students performing root canal treatments could provide significant insights into the efficacy of the curriculum requirements.

Assessment of Incidence, Management and Contributory Factors of Root Canal Instrument Separation in an Endodontics Post- Graduate Program: A Retrospective Clinical Study.

BACKGROUND: The successful outcome of nonsurgical root canal treatment (NS-RCT) is largely dependent on the technical quality of the procedure. OBJECTIVE: To investigate the incidence of separated instruments in endodontic postgraduate clinics between January 2018 and December 2021, and to determine the potential contributory factors that increase the risk of instrument separation. MATERIALS AND METHODS: A retrospective observational study was conducted in the Department of Endodontics, Faculty of Dentistry, King Abdulaziz University, Jeddah, Saudi Arabia. Data was collected to determine the incidence of separated instruments and their associated variables. Seven variables were analyzed separately: nonsurgical initial or retreatment case, tooth type, tooth arch, tooth location, canal type, root curvature, level of fracture, and file type. RESULTS: A total of 3150 cases were treated, of which 108 cases had separated instruments. The overall incidence of instrument separation was 3.4% while 53.7% of separated instruments occurred in the mandibular molars, followed by 42.6% in the maxillary molars. The highest frequency of instrument separation was recorded in the mesiobuccal canal (35.2%). The level of separation was found to be statistically significant in relation to the management (P < .001). CONCLUSION: Nickel-titanium instruments tend to separate more inside the root canal system than stainless steel instruments. However, under the limitation of this study, the incidence of instrument separation is still quite low, even with postgraduate endodontic residents with limited experience.

[The assessment of the endodontic foundation]. / De beoordeling van het endodontische fundament.

The diagnosis of an endodontic disease requires thorough research, collecting both clinical and radiographic information. The clinical examination includes history taking, visual inspection of the tooth and surrounding tissues, palpation of the soft and hard tissues, periodontal examination and percussion. The radiographic examination provides valuable information, but can never stand alone in arriving at a diagnosis. It is important to link the findings of the radiographic examination to other information. Sometimes, invasive examination is necessary, during which the coronal restoration is removed to allow better assessment of the tooth. This can provide additional information about the presence of caries, fractures, leakage of the restoration or other reasons for failure of the initial root canal treatment. A good diagnosis is essential for planning successful follow-up treatment.

Irreversible pulpitis in mature permanent teeth: a cost-effectiveness analysis of pulpotomy versus root canal treatment.

INTRODUCTION: Evidence-based dentistry suggests pulpotomy as a potential alternative to root canal treatment in mature permanent teeth with irreversible pulpitis. However, the evidence surrounding the cost-valuation and cost-efficacy of this treatment modality is not yet established. In this context, we adopted an economic modeling approach to assess the cost-effectiveness of pulpotomy versus root canal treatment, as this could aid in effective clinical decision-making. METHODS: A Markov model was constructed following a mature permanent tooth with irreversible pulpitis in an 18-year-old patient over a lifetime using TreeAge Pro Healthcare 2022. Transition probabilities were estimated based on existing literature. Costs were estimated based on the United States healthcare following a private-payer perspective and parameter uncertainties were addressed using Monte-Carlo simulations. The model was validated internally by sensitivity analyses, and face validation was performed by an experienced endodontist and health economist. RESULTS: In the base case scenario, root canal treatment was associated with additional health benefit but at an increased cost (1.08 more years with an incremental cost of 311.20 USD) over a period of an individual's lifetime. The probabilistic sensitivity analysis revealed pulpotomy to be cost-effective at lower Willingness-To-Pay (WTP) values (99.9% acceptable at 50 USD) whereas increasing the values of WTP threshold root canal treatment was a cost-effective treatment (99.9% acceptable at 550 USD). CONCLUSION: Based on current evidence, pulpotomy was a cost-effective treatment option at lower WTP values for the management of irreversible pulpitis in mature permanent teeth. However, by increasing the WTP threshold, root canal treatment became a more cost-effective treatment option over a period of lifetime of an individual.

Assessment of Apical Pressures in Single and Joining Canals - An Ex Vivo Study Based on Computational Fluid Dynamic Analysis.

OBJECTIVE: Computational fluid dynamic analysis (CFD) is claimed to be a reliable tool for analysing the fluid flow and the generated apical pressures in the simulated root canal. The current study aimed to analyse the apical pressures in extracted teeth with single and joining canals. METHODS: Forty-six freshly extracted teeth were collected for the present study. The power was set at 95%, with an effect size of 0.55 (1-ß=95%, α=0.05). Once the root canal anatomy was confirmed with cone-beam computed tomography (CBCT), they were divided into two groups: group I: mandibular second premolars with Vertucci type-I (n=23), and group II: maxillary second premolars with Vertucci type-II (n=23). The instrumentation of the specimens was carried out to a 0.04-taper using rotary instruments. A post-instrumentation CBCT was obtained, and computer-aided design models were obtained. The CFD simulations were then con- ducted with simulated 30-gauge side vented needles at 25, 50, and 75% short of the working length (WL). RESULTS: Group I recorded significantly (p<0.05) higher apical pressures at needle positions 25% short of the WL. However, no significant differences were elicited in the groups at other needle positions. CONCLUSION: Single canal specimens recorded higher apical pressures at needle positions 25% short of the WL. However, no differences were elicited between single and joining canals at higher needle positions.

Retrospective Assessment of Endodontically Treated Teeth Replaced by Dental Implants.

INTRODUCTION: This study investigated endodontically treated teeth that were replaced by dental implants at the University of North Carolina (UNC) at Chapel Hill School of Dentistry. The primary objective of this study was to determine the reasons leading to the extraction of endodontically treated teeth and their subsequent replacement with dental implants. The secondary objective was to evaluate the proportion of these teeth that, according to experienced endodontists, could have been preserved. METHODS: The UNC-Chapel Hill's dental electronic health records between 2004 and 2019 were probed for implant placement that replaced root canal-treated teeth. Preextraction radiographs and clinical charts were examined to ascertain the primary reason related to the extraction and to compile a profile for each case. In cases in which endodontic failure was the primary reason for extraction, radiographs and clinical findings were evaluated by 2experienced endodontists to assess potential treatment options. RESULTS: Between 2004 and 2019, 29.3% (1564 of 5229) of teeth replaced by dental implants at UNC School of Dentistry had undergone root canal treatment, with the mandibular first molar being the most commonly replaced tooth. The leading reasons for extraction were recurrent caries associated with defective restoration (26.6%), fracture of coronal structure (21.5%), vertical root fracture (20.9%), compromised periodontal condition (13.8%), and endodontic failure (2.4%). Two experienced endodontists evaluated extractions due to endodontic failure and concluded that 61.7% of them could have been candidates for endodontic retreatment. CONCLUSION: Substantial loss of tooth structure was the leading cause of extraction of root canal-treated teeth, followed by vertical root fracture and periodontal disease. Although endodontic failure constituted a minor portion of the reasons for extraction, a considerable number of teeth were extracted due to vertical root fractures following root canal treatment. A significant proportion of the extracted teeth due to endodontic failure could have been considered as potential candidates for endodontic retreatment.

Precision-milled simulated curved root canals in bovine dentine for the assessment of chemo-mechanical root canal preparation.

AIM: The aim was to develop a standardized curved root canal model in bovine dentine and to assess whether that natural substrate would behave differently from the resin in standard plastic training blocks when prepared chemo-mechanically. The impact of substrate microhardness on simulated canal transportation was considered. METHODOLOGY: High-precision computer numerical control (CNC) milling was used to recreate a simulated root canal from a resin training block (Endo Training Bloc J-Shape, size 15) in longitudinally sectioned, dis- and re-assembled bovine incisor roots. Optical overlays obtained from 10 resin blocks were used to identify an average canal and program the CNC milling apparatus accordingly. Resin and dentine microhardness were measured. Simulated root canals in resin training blocks and their bovine counterparts were then instrumented at 37°C using Reciproc R25 instruments (VDW) with water or 17% EDTA (n = 10). Open-access image processing software was used to superimpose and analyse pre- and postoperative images obtained with a digital microscope. Centering ratios were averaged to indicate canal transportation. The effects of substrate and irrigant on canal transportation were assessed by two-way anova. RESULTS: Superimposed images showed that resin blocks under investigation varied considerably in terms of simulated canal length and curvature, whilst the milled canals were highly similar. The microhardness of dentine was more than three times higher than that of the resin. Conversely, canal transportation was considerably greater in dentine compared to resin, and in dentine had a tendency to be increased by EDTA. There was a strong effect of substrate on canal transportation (p < .001), no overall effect of irrigant, and a marginally significant interaction between irrigant and substrate (p = .077). CONCLUSIONS: CNC milling allows to create standardized simulated curved root canals in bovine dentine. These models may be useful to test and compare materials and concepts of chemo-mechanical root canal instrumentation. Microhardness is a bulk feature that does not predict the response to chemo-mechanical instrumentation of a composite material such as dentine.

Cone-Beam Computed Tomography Assessment of Prevalence of Procedural Errors in Maxillary Posterior Teeth.

A range of procedural errors can occur when performing endodontic treatment on posterior teeth. These errors may decrease the success rate in endodontic practice. This study assessed the prevalence of procedural errors and the quality of endodontic treatments in maxillary molars and premolars using cone-beam computed tomography (CBCT). CBCT scans from two private radiology centers were assessed retrospectively to ensure the same calculated sample size of 327 teeth for each of the four maxillary posterior tooth types (a total of 1,308 endodontically treated teeth). Image sets were evaluated for procedural errors categorized as follows: obturation length (overfilling or underfilling by >2 mm short of the root apex), missed canals, perforations, strip perforations (with extrusion of material into the furcation area), separated instruments in the root canal space, and root fracture. Data were analyzed with SPSS version 20 (SPSS Inc., Chicago, IL, USA), and frequency data was assessed using the Monte Carlo test at the 0.05 level of significance. The procedural errors most commonly reported in the present study were from most frequent to least frequent: underfilled canals (50.0%), missed canals (27.5%), overfilled canals (12.5%), apical perforations (5.0%), separated instruments (3.1%), and root fractures (1.9%). No strip perforations (with extrusion of material into the furcation area) were seen in the study (0%). Underfilled and missed root canals were the most frequent procedural errors identified in the present study. These findings underline the importance of more consideration of critical working length management during all stages of root canal treatment, greater awareness of root canal anatomy, and the use of imaging and diagnostic devices that enhance the ability to identify and treat root canals both safely and effectively.

Assessment of the root surface temperature during the use of intracanal agitation systems: In vitro study.

This study aimed to evaluate the temperature changes that the different methods of agitation of irrigants promote on the external dental root surface. Nine extracted human lower premolars were standardized by cone-beam computed tomography and used. The root canal was instrumented with a Reciproc 40.06 file. Temperature measurement was performed using K-type thermocouple sensors attached to the middle, cervical, and apical thirds of the teeth. The teeth had their roots immersed in distilled water at 37ºC, which were distributed into 3 experimental groups according to the mechanical agitation methods to be studied. US Group (n=3), Irrisonic Ultrasonic Tip activated through ultrasound; EC Group (n=3), Easyclean Tip coupled to a contra-angle low-speed handpiece; XP Group (n=3), XP-endo Finisher file coupled to an endodontic electrical motor. Temperature measurements were performed simultaneously with agitation and irrigation of intracanal irrigants. Statistical analysis was performed using SPSS software with a significance level of 5%. For multiple comparisons, the Tukey test was used. The association between mechanical agitation methods and root third was statistically significant. Regarding the temperatures recorded on the external surface of the roots, the ultrasonic tip was significantly higher than the XP-endo Finisher file and the Easyclean tip, which did not differ from each other. Regarding the ultrasonic tip, the external temperature in the middle third (39.46ºC) of the root was significantly lower than in the cervical (40.41ºC) and apical third (40.53ºC). None of the agitation methods of irrigants studied presented heating above 47ºC, and their use is safe for periodontal tissues.

Comparison of accuracy and reliability of CBCT and 3D laser scanner in the volumetric assessment of the root canal space.

PURPOSE: To compare the accuracy and reliability of cone-beam computed tomography (CBCT) and laser scanner in measuring minor volume changes such as the root canal space. METHODS: 35 maxillary incisors were endodontically prepared. A dimensionally stable silicone material was injected into the root canal space and scanned with CBCT. The root canal volume was measured using Romexis 3.0.1 R software. Replicas were carefully removed from the teeth and scanned using an extraoral laser scanner. These images were exported to the Rhinoceros software for volume measurement. The volume of each replica was also assessed using the gravimetric method. To determine the accuracy, the volume obtained from both devices was compared with the gravimetric method. Statistical analysis was done using a paired t-test. The reliability was assessed using the intraclass correlation coefficient. RESULTS: There was no statistically significant difference between the mean volume of CBCT 27.04 ± 7.25 mm³ and the mean volume of the gravimetric method 27.87 ± 7.17 mm³ (P< 0.05). A statistically significant difference was seen with the laser scanner at 25.31 ± 6.89 mm³ and the gravimetric method at 27.87 ± 7.17 mm³ (P< 0.05). CBCT showed a good degree of agreement (ICC 0.899), while the laser scanner showed a moderate degree of agreement (ICC 0.644) with the gravimetric method. CBCT proved accurate and reliable in measuring minor volumes like the root canal space, ideally in the range of 20-25 mm³. The laser scanner presented acceptable reliability. CLINICAL SIGNIFICANCE: The laboratory data showed satisfactory outcomes, providing an evidence-based approach and potentially motivating clinicians to integrate cone-beam computed tomography for volume analysis into clinical practice. The accuracy and reliability of laser scanners for small-volume analysis have not previously been evaluated. Consequently, the findings from this study warrant further clinical investigations.

Cone-beam computed tomography assessment of the root canal morphology of primary molars.

BACKGROUND: This study aimed to assess the root canal morphology of primary molars using cone-beam computed tomography (CBCT). METHODS: This cross-sectional study evaluated 60 maxillary and mandibular primary first and second molars on CBCT scans of patients retrieved from the archives of Hamadan School of Dentistry between 2018-2020. The teeth were evaluated regarding the number of roots and canals, canal type according to the Vertucci's classification, and root surface concavities. Data were analyzed descriptively and by independent t-test. RESULTS: The most frequent number of canals and roots in the maxillary right and left first molars was 3 canals (60%) and 3 roots (80%). These values were 4 canals (80%) and 5 canals (50%) with 3 roots in the maxillary right and left second molars, respectively, 4 canals (100%) and 2 roots (50%), and 3 canals (60%) and 2 roots (50%) in mandibular right and left first molars, respectively, and 4 canals (92.3%) and 3 roots (61.5%) in mandibular right and left second molars. Vertucci's type IV was the most common canal type in mesial and distal canals, type I was the most common in mesiobuccal, mesiolingual, distobuccal, and distolingual, and types I and II were the most common in the palatal canal. The maximum and minimum concavities were noted in the buccal (26.7%) and mesial (8.3%) surfaces, respectively. CONCLUSIONS: A wide variation exists in the number of roots and canals of maxillary and mandibular primary molars, which calls for further attention in treatment of such teeth.

Cost-effectiveness analysis: nonsurgical root canal treatment versus single-tooth implant.

BACKGROUND: Economic evaluation of nonsurgical root canal treatment (NSRCT) and single-tooth implant (STI) provides useful information for medical decision. This retrospective study aimed to evaluate the cost-effectiveness of NSRCT versus single-tooth implant (STI) after 5-year treatment in a university affiliated hospital in Beijing, China. METHODS: 211 patients who underwent NSRCT and 142 patients who had STI were included and recalled after 5-year treatment. The propensity scores were used to match the cases of two treatment modalities. At recall, outcomes were determined based on clinical and radiographical examinations. For endodontically treated cases, absence or reduction of radiolucency were defined as success. Marginal bone loss (MBL) ≤ 4 mm were determined as success for implant cases. Direct and indirect costs were calculated in China Yuan (CNY). Patients' willingness to pay (WTP) for each treatment modality was evaluated by questionnaires. A cost-effectiveness analysis was performed from the societal perspective. RESULTS: 170 patients with 120 NSRCT teeth and 96 STI were available at recall. Based on propensity score matching, 76 endodontically treated teeth were matched to 76 implants. Absence of the radiolucency was observed in 58 of 76 endodontically treated teeth (76%) and reduction of the radiolucency in 9 of 76 teeth (12%) and altogether the success rate was 88%. 100% implants were detected with marginal bone loss (MBL) ≤ 4 mm. The cost advantage of NSRCT (4,751 CNY) over STI (20,298 CNY) was more pronounced. Incremental cost effectiveness ratio (ICER) was 129,563 CNY (STI-NSRCT) per success rate gained. It exceeded the patients' willingness to pay value 7,533 CNY. CONCLUSIONS: Clinical outcomes of NSRCT and STI could be predictable after 5-year treatment. NSRCT may be more cost-effective than STI for managing endodontically diseased teeth.

Assessment of the canal anatomy of the premolar teeth in a selected Turkish population: a cone-beam computed tomography study.

BACKGROUND: Teeth may have additional roots and a different number of root canals. Overlooked root canals may cause endodontic failure. The aim of this study was to investigate the prevalence of root canals and the number of roots of premolars in a selected Turkish population. MATERIALS AND METHODS: A total of 2,570 teeth from 1,438 patients were evaluated. The cone-beam computed tomography scans of 1,055 maxillary and 1,515 mandibular premolars were examined. RESULTS: Type IV root canal morphology was observed most frequently in maxillary first premolars (77%), and the rates of single and double channel formations were very similar (51% and 49%, respectively). Of the second maxillary premolars, 57.4% had Type I morphology, and 89.9% of the teeth were single-rooted, while 68.6% had a single root canal. The most common formation was Type I (85%) among mandibular first premolars, and a single root was observed in 95.6% of these teeth. In addition, 87% of the mandibular first premolars had a single root canal. The second mandibular premolars mostly had Type I (95.4%) formation, and 99.3% of the teeth were single-rooted, while 96.9% had a single root canal. CONCLUSION: According to our findings, 51% of maxillary first premolars had a single root, 79.4% had two root canals, and 77% had Type IV (77%) formation. Maxillary second premolars mostly had Type I formation. In addition, a single root and single root canal formation were most common. Mandibular first premolars generally had a single root and single root canal formation, but 13% had two root canals, and 6.4% had Type V formation. More than 95% of mandibular second premolars had Type I formation.

Pre-medical assessment of root-canal-filled teeth with asymptomatic apical periodontitis-A multifaceted balancing act.

AIM: Prior to certain medical therapies, dental assessment and treatment of oral foci of infection are recommended. The aim of the present study was to acquire a deeper understanding of the decision-making process regarding the pre-medical management of root-canal-filled teeth with asymptomatic apical periodontitis (AAP). METHODOLOGY: Hospital-affiliated dentists in Sweden were contacted for a semi-structured, in-depth interview. The absolute inclusion criterion was that the dentists had experienced and could recount at least two authentic cases involving root-canal-filled teeth with AAP-one case having resulted in pre-medical treatment, and one having resulted in expectancy. Fourteen interviews, with fourteen informants, were conducted and included in the study. During the interviews, open-ended questions and comments encouraging the informants to elaborate and clarify their experiences were offered. The interviews were digitally recorded, transcribed verbatim and analysed using Qualitative Content Analysis with an inductive approach. RESULTS: A theme describing the latent content was identified through interpretation of the collected data: A multifaceted balancing act characterized by a sometimes-difficult risk-benefit-estimation, where an increased uncertainty entails an increased reliance on external opinions. Three main categories, comprising four sub-categories, describing the manifest content were recognized: The tipping scale, The team effort and The frame of reference. CONCLUSIONS: The current interview study found pre-medical decision-making regarding root-canal-filled teeth with AAP to be a multifactorial and contextual process marked by uncertainty and collaborative measures. Further research, resulting in the development of evidence-based treatment guidelines, is suggested necessary.

Shaping ability of WaveOne Gold and OneReci by using two apical sizes: a micro-computed tomographic assessment.

Backround: OneReci (MicroMega, Besançon, France) is a recently introduced single-file reciprocating system with scarce information revealed on its shaping ability. This study aimed to compare the shaping abilities of OneReci and a well-documented single-file reciprocating system WaveOne Gold (WOG; Dentsply Maillefer, Ballaigues, Switzerland) and evaluate the effect of increased apical enlargement on the preparation quality, using micro-computed tomography (micro-CT). Methods: After an initial micro-CT scanning, twenty mesial root canals of mandibular molars were anatomically matched. The canals were assigned to two experimental groups (n = 10), using OneReci or WOG in different canals of the same root. The glide paths were created, and root canals were prepared twice, using size 25 and 35 instruments of the systems, respectively. The specimens were scanned with micro-CT after each preparation. The increase in canal volume, amount of dentin removal, unprepared root canal surface, canal transportation, centering ratio and preparation times were assessed. The data were analysed with independent sample t-tests, variance analyses, Friedman and Mann-Whitney U tests. The significance level was set at 5%. Results: Each preparation increased the canal volume and dentin removal while decreasing the unprepared root surface. The difference between the systems became significant after preparation with size 35 instruments (p < 0.05). Regarding canal transportation and centering ratio, the difference was insignificant (p > 0.05). The first preparation step (glide path + size 25 instrument) was significantly faster in the OneReci group (p < 0.05). Conclusions: Preparation with size 25 instruments of the systems appeared to be safe with similar shaping performances. Larger apical preparation promoted significantly higher dentin removal, volume increase, and prepared surface area in WOG.

A comparative analysis of public and private dental benefit payer types for the provision and outcomes of root canal therapy on permanent teeth of children and adolescents in Massachusetts.

BACKGROUND: Despite substantial increases in dental benefits and improvements in the use of dental services among children and adolescents in the United States, oral health disparities according to dental insurance payer type persist. METHODS: The authors used an all-payer claims (2013-2017) database to perform a comparative analysis of the provision and treatment outcomes of an endodontic procedure (root canal therapy) in the permanent teeth of a pediatric population aged 6 through 18 years, according to dental insurance payer type. Statistical analyses, including logistic regression, Cox proportional hazards regression, and the Kaplan-Meier method, were performed at person and tooth levels. RESULTS: Compared with privately insured children and adolescents, public-payer children and adolescent beneficiaries were more likely to have had root canal therapy (adjusted odds ratio, 1.91; 95% CI, 1.73 to 2.11) and had poorer treatment outcomes associated with the procedure (adjusted hazard ratio, 2.19; 95% CI, 1.53 to 3.14; P < .0001) during the study period. Those enrolled in private insurance were more likely to receive treatment from an endodontist (specialist in providing root canal therapy) (P < .0001). Amounts allowed and paid by the insurer were significantly higher for private payers (P < .001). CONCLUSIONS: There were significant differences in the provision and outcomes of endodontic treatment between privately and publicly insured children and adolescents. PRACTICAL IMPLICATIONS: Despite ostensibly equal access to care, differences in the provision of oral health care exist between privately and publicly insured patients. These differences may be contributing to persisting oral health disparities.

Effectiveness of endodontic complexity assessment tool (E-CAT) on the undergraduate students in an endodontic training program and its predictive capability on complications.

INTRODUCTION: Dental students face a number of challenges when it comes to performing root canal treatments (RCTs). The Endodontic Complexity Assessment Tool (E-CAT) was developed to assist dental practitioners in assessing the complexity of RCTs before beginning treatment. MATERIALS AND METHODS: The E-CAT was filled out independently by both the educator and the student. To allow educators to record scores and complexity classes, they transferred their and students' forms to the website https://www.e-cat.uk/. Students began endodontic treatment after learning about the complexity level of the case. The educators were responsible for recording any complications encountered in every case from the outset to 1 month after treatment. RESULTS: A total of 70 students, 33 in fourth and 37 in fifth-grade, were included in the study. In the cases with higher E-CAT scores, complications such as misdiagnosed, faulty access cavity, furca or coronal third perforation, insufficient root canal instrumentation, working length loss, canal blockage, overpreparation, incomplete root canal filling and overfilling were experienced significantly more often compared to the cases with lower E-CAT scores (p < .05). The number of complications (r = .40, p < .001), treatment sessions (r = .44, p < .001), and teacher support (r = .24, p < .001) positively correlated with E-CAT score (p < .05). CONCLUSION: The E-CAT is an effective tool for assisting dental students in understanding technical challenges, such as complex root canal anatomy and possible complications during treatment. Educators can also use e-CAT to pre-select clinical cases and standardise student training by offering cases of equal complexity.

Preoperative risk assessment does not allow to predict root filling length using machine learning: A longitudinal study.

OBJECTIVES: First we aimed to identify significant associations between preoperative risk factors and achieving optimal root filling length (RFL) during orthograde root canal treatments (RCT) and second to predict successful RFL using machine learning. METHODS: Teeth receiving RCT at one university clinic from 2016-2020 with complete documentation were included. Successful RFL was defined to be 0-2mm of the apex, suboptimal RFL >2mm or beyond the apex. Logistic regression (logR) was used for association analyses; logR and more advanced machine learning (random forest (RF), support vector machine (SVM), decision tree (DT), gradient boosting machine (GBM) and extreme gradient boosting (XGB)) were employed for predictive modeling. RESULTS: 555 completed RCT (343 patients, female/male 32.1/67.9%) were included. In our association analysis (involving the full dataset), unsuccessful RFL was more likely in undergraduate students (US): OR 2.74, 95% CI [1.61, 4.75], p < 0.001), teeth with indistinct canal paths (OR 11.04, [2.87, 44.88], p < 0.001), root canals reduced in size (OR 2.56, [1.49, 4.46], p < 0.01), retreatments (OR 3.13, [1.6, 6.41], p < 0.001). Subgroup analyses revealed that dentists were more successful in mitigating risks than undergraduate students. Prediction of RFL on a separate testset was limitedly possible regardless of the machine learning approach. CONCLUSIONS: Achieving RFL is depending on the operator and several risk factors. The predictive performance on the technical outcome of a root canal treatment utilizing ML algorithms was insufficient. CLINICAL SIGNIFICANCE: Preoperative risk assessment is a relevant step in endodontic treatment planning. Single radiographic risk factors were significantly associated with achieving (or not achieving) optimal RFL and showed higher predictive value than a more complex risk assessment form.

Health economic evaluation of endodontic therapies.

Healthcare is an expensive endeavour, and it is likely that costs for endodontic treatment will grow over the next decade. The assessment of costs and, in most cases, health outcomes, and the comparison of the cost-health ratio of interventions, is at the heart of health economics. The present review aims to introduce the main concepts of health economic analysis, to systematically review the existing economic endodontic literature, and to deduce further action for the community. Overall, the identified body of evidence on the health economics of endodontic therapies is heterogenous and has several limitations: Not all studies identified robust data to inform their analyses and many relied on a wide range of assumptions, which were only explored for their impact in a limited way. However, a number of themes were identified from the review: (1) Maintaining pulpal vitality is preferable over root canal treatment if possible when it comes to cost-effectiveness. (2) Retaining teeth is usually more cost-effective than removing and replacing them. (3) Endodontic retreatment may be clinically indicated, but not always cost-effective, and should hence be considered carefully. In conclusion, the general sparsity of economic analyses is a concern, as decision makers such as commissioners or those funding dental care increasingly rely on them. The endodontic community is called to action to improve the competency of both researchers to conduct such analyses and consider them when planning research, but also clinicians who should factor in health economics when assigning interventions. Health economics should become an accepted pillar of endodontic research.