Outcome and associated predictors for nonsurgical management of large cyst-like periapical lesions: A CBCT-based prospective cohort study.

AIM: The aim of this cone-beam computed tomography (CBCT)-based study was to evaluate the outcome of nonsurgical root canal treatment (RCT) performed for the management of large cyst-like periapical lesions (LCPL) and to identify the predictive factors affecting healing. METHODOLOGY: Fifty-four subjects (77 permanent maxillary anterior teeth) with LCPL (>10 mm) of endodontic origin were included. A single operator performed standardized multi-visit RCT. Patients were clinically and radiographically examined at 6, 12 months, and a CBCT scan was taken at 24 months. Two independent blinded evaluators measured the pre- and postoperative volume of periapical lesions on CBCT scans using ITK snap software (version 3.8.0-beta-20181028-win64). The outcome was assessed as a percentage change in lesion volume and dichotomized as success (resolved/reduced) or failure (unchanged/enlarged). Ten preoperative (gender; age; intraoral draining sinus, soft tissue swelling, tooth discoloration, pulp canal obliteration, open apex, root resorption, cortical bone defect and lesion volume) and four intraoperative (apical extent and density of root filling; number of treatment visits and type of root filling) predictive factors were observed. Bivariate and stepwise multivariable linear regression analysis was performed to identify independent predictors affecting treatment outcomes. The significance level was set at 5%. RESULTS: A recall rate of 88% was achieved. The success rate of RCT was 82.2% (8.9% resolved, 73.3% reduced). Median lesion volume reduction was 75% (IQR 61%-93%). No pre- or intra-operative factors were related to treatment failure. However, presence of preoperative cortical bone defect (palatal versus no cortical defect, ß = -51.5; 95% CI: -86.9 to -16, p = .006) and apical extent of obturation (long versus flush, ß = -27.2; 95% CI: -53.8 to -0.6, p = .04) were negatively associated with reduction in lesion volume (%). CONCLUSION: Large cyst-like periapical lesions may be successfully managed with RCT. Preoperative cortical bone defect and apical extent of obturation may negatively influence osseous healing.

Quality and accuracy of patient-oriented Web-based information regarding tooth avulsion.

BACKGROUND/AIM: Tooth avulsion (TA) is a severe form of traumatic dental injury. The tooth's prognosis depends on the immediate measures taken. First responders are often laypeople, and the Internet is a favored platform to access health-related information. The aim of this descriptive study was to evaluate the accuracy, quality, readability, and popularity of patient-oriented web information regarding the emergency management of TA. METHODS: Three search engines (Google, Bing, and Yahoo.com) were browsed with six VPNs using "knocked out tooth," "fallen out tooth," and "tooth avulsion" as keywords. The top 20 results for each were evaluated. Webpages were included if they had information oriented to caregivers. They were analyzed for accuracy (cutoff ≥95%). Quality of web pages was assessed using DISCERN and the Journal of the American Medical Association (JAMA) benchmark. Readability was evaluated using Flesch-Kincaid Grade Level (FKGL), Gunning Fog (FOG), Coleman-Liau Index (CLI), and Simple Measure of Gobbledygook (SMOG). Popularity was assessed by Alexa Popularity Rank (APR). Accurate and inaccurate webpages were compared using chi-square analysis and the Mann-Whitney U test. Spearman's correlation between the studied metrics was established. A p < .05 was considered significant. RESULTS: Seventy-two webpages were included, of which 23 (32%) were accurate. The median DISCERN ratings for accurate and inaccurate webpages were 3.0 [2.5-3.0] and 3.0 [2.0-3.0], respectively (p = .331). Ten (44%) accurate and 12 (24.5%) inaccurate webpages had high-quality JAMA (p = .089). The median readability scores for accurate webpages were FKGL (8 [6.75-9.2]), FOG (10.6 [9.55-12.3]), CLI (7 [6-7]), SMOG (6.7 [6.15-7.5]), while scores for the inaccurate webpages were FKGL (7.85 [6.275-8.525]), FOG (10.55 [8.875-11.425]), CLI (7 [7-8.25]), and SMOG (7 [6.2-7.925]), with a higher CLI score for inaccurate webpages (p = .0035). The median APRs for accurate and inaccurate webpages were 1,02,538 [26,852-14,43,755] and 7,63,190 [2,19,799-29,92,067], respectively (p = .163). Accuracy had a positive correlation with quality (DISCERN: rho = .293, p = .013; JAMA: rho = .249, p = .036), while popularity (APR) was negatively correlated with quality (DISCERN: rho = -.330, p = .013; JAMA: rho = -.287, p = .032). CONCLUSION: Relevant webpages were limited and had low accuracy. This can impact the emergency management by laypeople and adversely affect the prognosis following avulsion.

3D geometric analysis of second mesiobuccal canal in permanent maxillary first molar tooth.

Cone-beam computed tomography scans exhibiting a second mesiobuccal (MB2) canal were examined. The vertical distance of the MB2 orifice from the pulp floor (depth), inter-orifice distance (IOD) of MB2 from mesiobuccal (MB) and palatal (P) orifices, the horizontal distance of the MB2 orifice from the line joining MB-P orifices [mesial deviation (MD)] and root canal configuration (RCC) were evaluated on 330 scans. The Student's t-test, ANOVA, Spearman's correlation and linear regression analysis were applied. The MB2 depth was 1.69 ± 0.86 mm. IOD (MB-MB2, MB2-P) was 2.18 ± 0.58 mm and 4.63 ± 1.06 mm, respectively. MD was 1.02 ± 0.37 mm. The predominant RCC was Vertucci's type II (75.5%). No correlation of depth with IOD of MB-MB2 (rho = 0.0367, p = 0.506) was observed. Significant correlation of depth with IOD of MB2-P (rho = 0.696, p < 0.001) and MD (rho = 0.174, p = 0.001) was established. No association of depth with age and IOD (MB-MB2) was observed on linear regression analysis. However, a significant positive association was established with IOD (MB2-P) (p < 0.001) and MD (p = 0.001).

Endodontic management of mandibular second molar fused to odontome with 12-month follow-up using cone beam computed tomography: A case report.

Fusion is a developmental anomaly characterised by the union of two adjacent teeth or tooth-like substance. Odontomes are malformation of the dental tissue which arise during normal tooth development. They are usually asymptomatic but often associated with tooth eruption disturbance. In this paper, we report a rare case of fusion involving permanent mandibular second molar with an odontome, which led to a partial eruption of the molar as well as its devitalisation. Successful endodontic management was carried out in this case with a supplementary disinfection procedure using XP Endo finisher (FKG Dentaire, La Chaux-de-Fonds, Switzerland). The use of high-end diagnostic imaging modalities such as cone beam computed tomography (CBCT) helped in making a confirmatory diagnosis; determining the treatment plan before undertaking the actual treatment; for better understanding of the fused tooth's complicated root morphology; and for its effective management and to follow up this unusual case for 12 months.

Treatment outcome of regenerative endodontic procedures in mature permanent teeth compared to nonsurgical endodontic treatment: A systematic review and meta-analysis.

Background: Regenerative endodontic procedures (REP) have the advantage of restoring root canal's native defense ability by re-establishing vital pulp-like tissue. This review aims to determine the overall clinical and/or radiographic success rate (O) of REP (I) in mature permanent teeth (P) and to compare it (C) with nonsurgical endodontic treatment (NSET). Materials and Methods: Sources: PubMed, Web of Science, Embase, EBSCO, Cochrane Central Register of Controlled trials, ClinicalTrials.gov, Clinical Trials Registry-India and OpenGrey. Inclusion: Randomized clinical trials and single-arm prospective studies evaluating the treatment outcomes of REP in mature permanent teeth. Exclusion: Incomplete trials/studies, in vitro studies, animal studies, case reports/series, conference proceedings. Cochrane ROB2.0 and ROBINS-I tools were used to assess the risk of bias. Risk difference (R.D.) between NSET and REP was determined by meta-analysis of the randomized clinical trials. The overall success rate of REP was calculated using data from both randomized clinical trials and single-arm prospective studies. Sensitivity analysis and subgroup analysis were performed. Results: Ten studies (n = 552) were included. R.D between REP and NSET was 0.032 (95% C.I: 0.023-0.087; P = 0.258). Overall success rate of REP was 96.0% (95% confidence interval: 94%-98%). No significant difference was found in sensitivity analysis (P = 0.551), or any of the subgroup analysis (P > 0.05). Discussion: A limited number of randomized clinical trials were available, and only two of them had a low risk of bias. Consistent results were obtained in both types of included studies. Conclusion: Based on a limited number of comparative studies, REP has a similar success rate to NSET in mature permanent teeth. Other: Funding: Nil. Registration: PROSPERO (CRD42020204882).

Evaluation of apical extrusion and cone-beam computed tomography assessment of irrigant penetration in oval-shaped canals, using XP Endo Finisher and EndoActivator.

BACKGROUND: Thorough cleaning of the pulp space is a challenging task. The mechanical instrumentation alone is usually not sufficient to completely debride the canals, and therefore, it requires the chemical action of irrigants also to disinfect the difficult to reach areas. AIM: The purpose of this study was to determine apical extrusion and assess irrigant penetration through cone-beam computed tomography (CBCT) for EndoActivator (EA) and XP Endo Finisher (XP). MATERIALS AND METHODS: Sixty single-rooted mandibular premolars with oval-shaped canals were equally divided into three groups after instrumentation, based on the final irrigation: Group-1 syringe needle (30G Max-I-probe), Group-2 EA, and Group-3 XP. After the final irrigation, the weight of the extruded sodium hypochlorite was calculated. The prepared canals were then irrigated with a radiopaque contrast medium, which was activated according to the group of the sample (Group-1, 2, or 3). The volume of irrigant filled in the canal, especially in the apical third was determined through special tools in CBCT imaging. STATISTICS: One-way ANOVA test was used to compare the different groups. RESULTS AND CONCLUSION: Significantly more apical extrusion was seen in XP (P < 0.001). Both XP and EA have shown complete penetration of irrigant in the canal (100%).

Influence of Final Apical Width on Smear Layer Removal Efficacy of Xp Endo Finisher and Endodontic Needle: An Ex Vivo Study.

Objective: Chemical disinfection along with mechanical instrumentation, is required to achieve debridement, especially in apical third of root canal. Thus, this study aimed to compare the influence of final apical width on the smear layer removal efficacy of XP Endo Finisher and Endodontic Needle, in mandibular premolars. Methods: 40 single-rooted mandibular premolars were included in the study, prepared using K3 XF rotary files (SybronEndo, Orange, CA). The samples were equally divided into 4 groups: Group 1: Master apical file 30/0.06 taper, final irrigation with endodontic needle (30G Max I probe, Dentsply International, York PA); Group 2: Master apical file 40/0.06 taper, final irrigation with endodontic needle; Group 3: Master apical file 30/0.06 taper, final irrigation with XP-Endo Finisher (FKG Dentaire, La Chaux-de-Fonds, Switzerland); Group 4: Master apical file 40/0.06 taper, final irrigation with XP-Endo Finisher. Smear layer and debris scores were given using SEM. Results: Group 3 and 4 performed significantly better than group 1 & 2 (P<0.05). No significant difference was observed in Group 1&2 (P>0.05); and Group 3&4 (P>0.05). Significantly higher scores were observed in the apical third, as compared to other sections of the root canal, in all the 4 groups. Conclusion: Increase in the final apical width did not significantly improve root canal cleanliness for both XP Endo Finisher and endodontic needle. However, XP endo finisher proved to be significantly better than the endodontic needle.