Effect of the time interval of functional loading on the periapical healing of endodontically treated mandibular molar tooth with pulp necrosis and asymptomatic apical periodontitis: A split-mouth randomized clinical study.

INTRODUCTION: This prospective study evaluated the effect of immediate functional loading (IFL) of full coverage prosthesis on the clinical and radiographic outcome of nonsurgical endodontic therapy (NSET) performed on mandibular molar tooth with pulp necrosis and asymptomatic apical periodontitis. METHODS: In twenty subjects, standardized two visit NSET was performed in bilateral mandibular first molar teeth (split-mouth model) with a diagnosis of pulp necrosis and asymptomatic apical periodontitis exhibiting a radiographic periapical index (PAI) score ≥3. In each subject, the non-vital bilateral mandibular first molar teeth were randomized to either of two groups that is IFL group (immediate functional loading) or NFL group (functional loading after a time interval of six months). Provisional full coverage prostheses were provided within seven days after completion of endodontic therapy. The cases were followed up clinically and radiographically at six and twelve months. Radiographs were assessed for periapical healing based on PAI scores which were dichotomized as healed (PAI score ≤2) or non-healed (PAI score ≥3). The data was compared using Chi-square and Fischer's exact tests. RESULTS: A recall rate of 100% was achieved at the end of twelve months. All teeth in IFL group and NFL group were clinically asymptomatic. On an inter-group comparison between the proportion of teeth healed and non-healed (radiographic), there was significant difference (p<0.05). CONCLUSION: Immediate functional loading of full coverage prosthesis in endodontically treated mandibular molar tooth with pulp necrosis and asymptomatic apical periodontitis delayed periapical healing.

Comparison of Soft Tissue Volumetric Changes and Pink Esthetics After Immediate Implant Placement with Socket Shield and Conventional Techniques: A Randomized Controlled Trial.

PURPOSE: To compare volumetric changes in buccal soft tissue and pink esthetic scores after immediate implant placement performed with a socket shield technique (SST) or the conventional technique (CT). MATERIALS AND METHODS: This parallel-arm, randomized controlled trial included 22 participants requiring replacement of a single maxillary incisor with an immediate implant. Immediate implants were placed via either the SST or the CT, with patients randomly allocated to one of the two groups. All implants underwent an immediate loading protocol. Definitive crowns were placed 6 months after implant placement. Scans of casts were recorded with a digital white light scanner before implant placement and at the end of 12 months. Volumetric changes to soft tissues on the buccal aspect were assessed by superimposition of the scanned cast. Esthetic evaluation of the soft tissue was done by evaluating the pink esthetic score (PES) before implant placement and 6 and 12 months after implant placement. Statistical analysis of the data was performed using statistical software (Stata 16.0, StataCorp). RESULTS: The mean volumetric change in buccal soft tissues at the end of 12 months in the SST group was -0.1520 ± 0.86 mm, and in the CT group, it was -0.643 ± 0.35 mm. The difference was statistically significant (P = .001). Higher PES was observed in the SST group at all time intervals. The difference was statistically significant at 6 months (P = .001) and 12 months (P = .007). CONCLUSIONS: The results of this study showed less volumetric changes in buccal soft tissues and higher PES when the SST is used rather than the CT.