Efficacy of chlorhexidine as a final irrigant in one-visit root canal treatment: a prospective comparative study.

AIM: To evaluate postoperative pain and radiographic evidence of periapical healing in teeth with apical periodontitis treated in one visit with an additional final irrigation using 2% chlorhexidine (CHX) and to compare the results with conventional two-visit root canal treatment (RCT) with an intracanal calcium hydroxide (CH) dressing as a control group. METHODOLOGY: Ninety asymptomatic maxillary anterior teeth with periapical lesions were treated by a single operator. Root canals were prepared using the step-back technique with manual instrumentation with 2.5% NaOCl and 5% EDTA as irrigants. Half of the teeth were randomly assigned to the one-visit (OV) group and received an additional final rinse with 2% CHX before canal filling. The other teeth were treated in two visits (TV) with a CH paste made by mixing CH powder and distilled water as an interappointment dressing. All patients were recalled and investigated clinically and radiographically for 24 months. Postoperative pain at 24-48 h and changes in apical bone density indicating radiographic healing were evaluated statistically using the Mann-Whitney U-test followed by the Friedman and the Wilcoxon tests (α = 0.05). RESULTS: There were no significant differences between two groups regarding the incidence of postoperative pain at 24 h (OV group 50% no pain, 47.6% mild, 2.4% moderate pain/TV group 55% no pain, 42.5% mild, 2.5% moderate pain) and at 48 h (OV group 95% no pain, 5% mild pain/TV group 98% no pain, 2% mild pain). None of the patients reported severe postoperative pain, swelling and/or flare-ups during the follow-up period. There was no significant difference in the radiographic healing rates (OV group 97.6% PAI 1 and/or PAI 2 and 2.4% PAI 3/TV group 95% PAI 1 and/or PAI 2 and 5% PAI 3; P > 0.05). CONCLUSION: Both groups provided favourable and similar postoperative pain and periapical healing rates at 24 months. Thus, one-visit RCT with a final rinse with 2% CHX is an acceptable alternative to two-visit RCT with CH as temporary dressing in maxillary anterior teeth.

Comparison between two thermoplastic root canal obturation techniques regarding extrusion of root canal filling--a retrospective in vivo study.

OBJECTIVES: The aim of this study was to compare two different thermoplastic techniques--a core-carrier technique (Thermafil) and warm vertical compaction--in terms of overextension of root canal filling in vivo. MATERIALS AND METHODS: Flaring of 88 teeth was conducted using Pro Files .04 as finishing files, and the teeth were obturated using Thermafil. Flaring of 74 teeth was performed using Pro Files .06 as finishing files, and the teeth were obturated using warm vertical compaction. RESULTS: Seventy (80 %) of the teeth obturated using Thermafil and 31 (42 %) teeth obturated using warm vertical compaction show extruded root canal filling. In contrast to Thermafil, there is a higher rate of extruded root canal filling of teeth with more than one root canal using warm vertical compaction. CONCLUSION: Thermafil demonstrated a higher rate of extruded root canal filling compared to warm vertical compaction. Warm vertical compaction is a more predictable method of filling compared to Thermafil. CLINICAL RELEVANCE: Root canal filling extrusion will cause irritation of the surrounding tissue and impair repair processes. In the present in vivo study, there was a higher rate of root canal filling extrusion using Thermafil compared to warm vertical compaction.

Success rate of single- versus two-visit root canal treatment of teeth with apical periodontitis: a randomized controlled trial.

INTRODUCTION: The aim of this study was to evaluate the outcome of single- versus 2-visit root canal treatment of teeth with apical periodontitis after a 2-year follow-up period. METHODS: Three hundred maxillary and mandibular nonvital teeth with apical periodontitis were treated in either a single visit or 2 visits. The main inclusion criteria were radiographic evidence of apical periodontitis (minimum size ≥ 2.0 × 2.0 mm) and a diagnosis of pulpal necrosis confirmed by a negative response to hot and cold tests. Radiographically, all teeth showed small and irregular periapical radiolucencies before treatment. The canals were enlarged with LightSpeedLSX (Discus Dental, Culver City, CA) root canal instruments to a final apical preparation size #60 for anterior and premolar teeth and size #45 to #55 for molars. The EndoVac negative-pressure irrigation system (Discus Dental) was used for disinfecting irrigation, and all canals were filled by lateral compaction of gutta-percha and Sealapex sealer (SybronEndo, Orange, CA). The healing results were clinically and radiographically evaluated 2 years postoperatively. RESULTS: Of the 300 teeth treated, 18 were lost to follow-up, 9 in the 2-visit group and 9 in the 1-visit group. Of the 282 teeth studied, the randomization procedure had allocated 146 teeth to 1-visit treatment and 136 teeth to 2-visit treatment. Teeth with symptoms of persisting periapical inflammation were scored as not healed. Teeth with a reduced periapical rarefaction were judged as uncertain. Teeth with complete restitution of the periodontal contours were judged as healed. In the 1-visit group, 141 of 146 teeth (96.57%) were classified as healed as compared with 121 (88.97%) of 136 teeth in the 2-visit group. Eleven cases were classified as uncertain in the 2-visit group (8.08%) compared with 4 (2.73%) in the 1-visit group. Two of 10 teeth in the 2-visit group presented with pain before the 2-year follow-up and were classified as not healed. The hypothesis tests were conducted at the 0.05 level of significance. Statistical analysis of the healing results did not show any significant difference between the groups (P = .05). CONCLUSIONS: Several factors play an important role in the decision-making process of 1- versus 2-visit endodontics. Among these are objective factors like preoperative diagnosis, the ability to obtain infection control, root canal anatomy, procedural complications, and subjective factors like patients' signs and symptoms. This study provided evidence that with a treatment protocol with instrumentation to predefined larger apical instrumentation sizes and irrigation with a negative apical pressure system can lead to healing in cases of apical periodontitis, which is a significant finding compared with more dated studies that showed average healing of apical periodontitis cases. With the given sample size, there was no statistically significant difference between the 2 treatment modalities.

Is endodontic treatment performed under general anaesthesia technically acceptable?

OBJECTIVES: Undertaking endodontic treatment under general anaesthesia (GA) is often described as difficult and hazardous, but no study reports on safe and efficacious conditions for endodontic treatment under GA. This study aims to evaluate whether compromises made for the endodontic treatment of permanent teeth under GA are acceptable. It describes the quality of endodontic treatment undertaken in two series of consecutive patients treated either under GA or local anaesthesia (LA). MATERIALS AND METHODS: Post-operative data sheets and periapical radiographs were collected for 255 permanent teeth treated under GA during a 4-year period (GA group, 125 patients with special needs) and for 246 permanent teeth treated under local anaesthesia over 7 months (LA group, 180 healthy patients). The radiographic criteria for quality of endodontic treatment (RCQET) were considered satisfactory when (1) the root filling was within 2 mm of the apex; (2) the filling displayed no voids or defects; and (3) all the visible canals had been obturated. The type of tooth, pulpal status and periapical status were considered independent variables for RCQET. RESULTS: The proportion of satisfactory RCQET reached 63% in both groups and differed by type of tooth, being significantly lower for molars than for other teeth. CONCLUSION: From a technical point of view, compromises made for the endodontic treatment of permanent teeth under GA are acceptable. Further studies should be conducted to evaluate the long-term success of endodontic treatment performed under GA. CLINICAL RELEVANCE: This study supports the feasibility of endodontic treatment for patients treated under GA.

A prospective study of the factors affecting outcomes of nonsurgical root canal treatment: part 1: periapical health.

AIM: To investigate the probability of and factors influencing periapical status of teeth following primary (1°RCTx) or secondary (2°RCTx) root canal treatment. METHODOLOGY: This prospective study involved annual clinical and radiographic follow-up of 1°RCTx (1170 roots, 702 teeth and 534 patients) or 2°RCTx (1314 roots, 750 teeth and 559 patients) carried out by Endodontic postgraduate students for 2-4 (50%) years. Pre-, intra- and postoperative data were collected prospectively on customized forms. The proportion of roots with complete periapical healing was estimated, and prognostic factors were investigated using multiple logistic regression models. Clustering effects within patients were adjusted in all models using robust standard error. RESULTS: proportion of roots with complete periapical healing after 1°RCTx (83%; 95% CI: 81%, 85%) or 2°RCTx (80%; 95% CI: 78%, 82%) were similar. Eleven prognostic factors were identified. The conditions that were found to improve periapical healing significantly were: the preoperative absence of a periapical lesion (P = 0.003); in presence of a periapical lesion, the smaller its size (P ≤ 0.001), the better the treatment prognosis; the absence of a preoperative sinus tract (P = 0.001); achievement of patency at the canal terminus (P = 0.001); extension of canal cleaning as close as possible to its apical terminus (P = 0.001); the use of ethylene-diamine-tetra-acetic acid (EDTA) solution as a penultimate wash followed by final rinse with NaOCl solution in 2°RCTx cases (P = 0.002); abstaining from using 2% chlorexidine as an adjunct irrigant to NaOCl solution (P = 0.01); absence of tooth/root perforation (P = 0.06); absence of interappointment flare-up (pain or swelling) (P =0.002); absence of root-filling extrusion (P ≤ 0.001); and presence of a satisfactory coronal restoration (P ≤ 0.001). CONCLUSIONS: Success based on periapical health associated with roots following 1°RCTx (83%) or 2°RCTx (80%) was similar, with 10 factors having a common effect on both, whilst the 11th factor 'EDTA as an additional irrigant' had different effects on the two treatments.

Vital pulpotomy in the primary dentition: attitudes and practices of community dental staff in Wales.

OBJECTIVE: The International Agency for Research on Cancer (IARC) has classified formaldehyde as carcinogenic to humans, leaving the dental profession to look for viable substitutes to formocresol in the vital pulpotomy technique. This study was designed to examine the attitudes and practices of Community Dental Service (CDS) staff in Wales in relation to vital pulpotomy for primary molars 18 months following the IARC's press release. METHODS: The study employed a postal questionnaire. RESULTS: Questionnaires were returned by 79 (78.2%) of the CDS staff surveyed, yielding a sample of 65 dentists practising the technique. The most commonly used pulpotomy agents were formocresol, paraformaldehyde and ferric sulphate. Twenty-seven (41.5%) dentists expressed concern regarding their preferred pulpotomy agent and 17 (26.2%) were considering changing their technique. Only one respondent (1.5% of the sample) routinely took preoperative radiographs; follow-up radiographs were routinely taken by only three dentists (4.6%). Only 44 respondents (67.7%) always used local anaesthesia for this form of treatment. Amalgam was the most commonly used restorative material. Twenty-two respondents (33.8%) stated that they would pulp treat a primary molar on more than one occasion. CONCLUSIONS: The results of this study suggest that there is need for relevant continuing professional development courses for CDS staff in Wales.

A radiographic study of the effect of various retrograde fillings on periapical healing after replantation.

An effective retrograde sealing procedure places great demands upon both technique and materials. Prevention of micro-leakage, biocompatibility and stability of the material in the apical tissues are very important. To evaluate potential retrograde filling materials, a replantation model has been developed in which extracted permanent molars were replanted in monkeys after apicectomy of each root, preparation of a 2-mm deep retrograde cavity and its sealing with various dental materials. Prior to retro-filling the remaining pulp was exposed to saliva. Apicected molars which were infected and did not receive retrograde fillings served as positive controls. Periapical healing was evaluated radiographically after 8 weeks based on planimetric measurements of the size of the periapical radiolucency. The following dental materials were tested: amalgam, glass ionomer cement, calcium-hydroxide lining cement, AH 26 root canal sealer, various zinc oxide-eugenol cements, Cavit, and gutta-percha with various sealers. The materials which were associated with better apical healing than the infected controls were glass ionomer cement, Cavit, and the zinc oxide-eugenol cements. When plain zinc oxide-eugenol or IRM were combined with a gutta-percha core, healing was best and not statistically different from normal apices. It was concluded that radiographic assessment at 8 weeks of molar teeth retrograde filled prior to replantation could be a valuable method for discrimination of potentially useful materials in vivo.