International questionnaire study on systemic antibiotics in endodontics. Part 1. Prescribing practices for endodontic diagnoses and clinical scenarios.

OBJECTIVES: Part 1 of this two-part study aims to investigate systemic antibiotics (SA) prescribing practices for various endodontic diagnoses and clinical scenarios by general practitioners, post-graduate students and endodontists in Israel and the former Soviet Union (FSU) states. MATERIALS AND METHODS: A total of 7500 dentists from Israel and FSU states were invited to fill in an online questionnaire. The questionnaire consisted the SA prescribing for endodontic diagnoses and clinical scenarios (post operative pain, post apical surgery and post avulsion). The international guidelines of the European Society of Endodontology and the American Association of Endodontists were used as the standard of correct practice. RESULTS: A total of 1310 dentists (response rate of 17.46%, 498 Israeli and 812 FSU dentists) completed the survey. The rates of prescription SA among the Israeli and the FSU respondents for non-recommended diagnoses and clinical scenarios were 24.75% and 11.42% (P>0.05), 16.57% and 16.17% (P>0.05) respectively. The rates of prescription SA among the Israeli and the FSU respondents for recommended diagnoses and clinical scenarios were 63.39% and 62.9% (P>0.05), 27.2% and 13.9% (P>0.05) respectively. CONCLUSIONS: There are gaps between the recommended protocols for prescribing SA for patients with various endodontic diagnoses and clinical scenarios and the actual practices among Israeli and FSU dentists. Continuing education of dentists must be encouraged in order to improve SA prescription practice according to international guidelines. CLINICAL RELEVANCE: When not indicated, prescription of systemic antibiotics might lead to antimicrobial resistance, while non-prescription, when required, might have negative repercussions on the patient's health. Knowledge of the prescription habits of dentists in the endodontic practice will help prevent harmful situations.

CBCT analyses of advanced cervical resorption aid in selection of treatment modalities: a retrospective analysis.

OBJECTIVES: The selection of treatment for advanced (classes 3 and 4) invasive cervical resorption (ICR) based on a two-dimensional periapical radiograph is challenging. The purpose of the present study is to describe different treatment approaches for advanced invasive cervical resorption based on cone-beam computed tomography evaluation. MATERIALS AND METHODS: All cases of advanced ICR based on CBCT evaluation in our endodontic department between 2011 and 2016 were included in the study. The dimension, circumferential, and coronal-cervical locations of the entry point of the resorption tissue into the tooth were evaluated. The selected treatment approach for each case was documented, and all the data were summarized and analyzed. RESULTS: Twenty-three cases of advanced ICR were included in the study. Approximately, 74% were diagnosed in stage 4, and 26% were diagnosed in stage 3. The narrow entry point was identified in 43% (10 cases), while in 57% (13) of cases, the entry point was wide. Circumferentially, 70% (16) were located on the proximal side. Coronal-cervically, 43% (10) were located more than 1.5 mm above the crestal bone. All narrow entry point cases were treated using a minimally invasive technique, while different treatment approaches were chosen for cases with a wide entry point. CONCLUSIONS: The present study proposes different treatment approaches for advanced ICR based on CBCT. The CBCT evaluation of the entry point may facilitate choosing the appropriate treatment approach for advanced ICR cases. CLINICAL RELEVANCE: The description of different treatment approaches for advanced invasive cervical resorption based on cone-beam computed tomography evaluation enables the clinician to choose the optimal treatment approach for each advanced ICR case.

C-shaped canals-prevalence and root canal configuration by cone beam computed tomography evaluation in first and second mandibular molars-a cross-sectional study.

OBJECTIVES: C-shaped root canal configuration is an unusual root canal morphology and one of the most often anatomical variations in root canal systems of second mandibular molars. The purpose of this study was to assess the prevalence, symmetry and configuration of C-shaped canals in first and second mandibular molars in an Israeli population using cone beam computed tomography (CBCT). MATERIALS AND METHODS: One thousand twenty Israel patients' CBCT scans were screened and evaluated. First and second mandibular molars with C-shaped canals were identified. Prevalence configuration along the root and symmetry were analyzed, and new radicular groove classification was proposed. RESULTS: Total of 1465 mandibular second molars and 1229 mandibular first molars were evaluated. The overall prevalence of C-shaped canals in first and second mandibular molars was 0.16 and 4.6%, respectively. No significant difference was found by gender or side of occurrence. The unilateral prevalence of C-shaped canals in mandibular second molars was 55%. C-shaped canal configuration changed along the root in 63% of the cases. CONCLUSIONS: The prevalence of C-shaped canals in first and second mandibular molars in the Israeli population is low in comparison to other subpopulations. Clinicians should be aware of the possible asymmetry, different configuration along the root, and the location of danger zone of this anatomic variation during clinical work. CLINICAL RELEVANCE: CBCT is an efficient three dimensional radiographic examination for evaluation of C-shape root canal configuration. CBCT may help the clinicians during clinical work for considering appropriate cleaning, shaping, and obturation technique according to the characteristic of C-shape root canal configuration.

Detection of Tooth Color Before and After Bleaching Using an Electronic Device.

The purpose of this article is to present a new computerized technique for evaluating tooth color before and after internal bleaching. Internal bleaching is a common and relatively safe procedure, from which results can be easily evaluated by both the dentist and the patient. Clinically, evaluation of the tooth color before, during and after internal bleaching is usually completed by using a color scale and comparing the shade to that of the tooth. However, since in some cases the bleaching results are not obvious, this method has limited value for complicated cases and especially for dental research. The case presented here demonstrates the digital color evaluation process of a tooth going through all phases of internal bleaching. The detected color is presented as the color scale numbers and can easily be saved for follow-up. Those results are presented on the device screen for the all-labial surface and also separately for the incisal, middle and cervical areas. This digital method for color detection can easily be used at every dental clinic as a validated dental record for the bleaching process. This method can also be used for dental research that evaluates the efficacy of bleaching techniques. The esthetic results can be verified easily and precisely.

Association of Nationwide Water Fluoridation, changes in dental care legislation, and caries-related treatment needs: A 9-year record-based cross-sectional study.

OBJECTIVES: The implementation of Nationwide Water Fluoridation in Israel in 2002 led to a significant reduction in caries among children. However, this practice was discontinued in 2014 due to a change in legislation. In 2010, as part of the Israeli National Health Insurance Law, free dental care for children under 10 years of age was legislated. This policy was gradually extended to include adolescents under 18 years of age in 2018. We examined the association between these efforts and changes in the caries-related treatment needs of young adults over the course of two decades. METHODS: This cross-sectional study analyzed data on the need for dental restorations, root canal therapy, and extractions that were retrieved from dental records of 34,450 soldiers recruited into military service between 2012 and 2021. These data were cross-matched with the subjects' year of birth to determine whether the implementation of water fluoridation, dental care legislation, or both were associated with changes in the need for and provision of dental care. Sociodemographic data, including sex, age, socioeconomic cluster (SEC), intellectual capability score (ICS), body mass index, and place of birth, were also extracted. RESULTS: A multivariate generalized linear model (GLM) revealed that male sex, older age, low ICS, and low SEC were significant predictors for greater caries-related treatment needs (P < 0.001). Our findings indicated that subjects exposed to fluoridated water during their childhood had significantly lower rates of caries-related treatment, regardless of access to free dental care. CONCLUSION: Mandatory water fluoridation was associated with significantly lower caries-related treatment needs while national dental health legislation providing free dental care to children and adolescents was not. Therefore, we suggest that water fluoridation should be continued to maintain the observed reduction in treatment needs. CLINICAL SIGNIFICANCE: Our findings provide support for the effectiveness of water fluoridation in preventing caries, whereas the impact of free dental care programs focused on clinical intervention remains to be determined.

Systemic antibiotics in endodontics-International questionnaire study: Choice of types, dosage, loading and duration.

The aim of the study was to investigate the systematic antibiotics (SAs) prescribing practices in the endodontic practice worldwide. 7500 general practitioners, postgraduate students and endodontists from Israel and the former Soviet Union (FSU) states were invited to fill in an online questionnaire. The first-choice SA was amoxicillin (80.12%) among the Israeli (p < 0.05) and amoxicillin + clavulanic acid (88.92%) among the FSU respondents (p < 0.05). The first-choice SA for patients with penicillin allergy was clindamycin (78.2%) among Israeli and azithromycin (35.96%) among the FSU respondents (p < 0.05). Most of the respondents from Israel as well as from the FSU reported prescribing SA for 5-7 days. Only 6.24% of the former and 2.59% of the latter reported prescribing SA until the symptoms disappeared (p > 0.05). The usage of SAs is often not in accordance with existing international guidelines and differs among different dentist's populations.

Retrograde peri-implantitis: incidence and possible co-existing factors: a retrospective analysis.

OBJECTIVES: To evaluate the incidence of retrograde peri-implantitis (RPI) generally and the incidence of RPI with an endodontic-treated adjacent tooth and/or a periapical radiolucency. METHOD: The retrospective case-control study included the follow-up periapical images of single dental implants. Two calibrated graduate endodontic residents evaluated simultaneously the presence of RPI and the adjacent teeth status (a previous root canal treatment (RCT) and the periapical status). RESULTS: Six hundred and eleven dental implants were included in this study. Twenty-three implants with RPI were detected (the incidence of RPI was 3.7%). Thirty-one adjacent teeth to the implants with RPI were recognized. Out of them, seven teeth had a previous RCT and periapical radiolucency or no RCT and periapical radiolucency. The odds ratios for RPI in an implant with periapical radiolucency or with RCT at the adjacent tooth are 6.67 (95% CI 2.7-16.5), P < 0.05; and 0.11 (95% CI 0.007-1.9), P > 0.05 respectively. CONCLUSIONS: Based on periapical radiographs, the RPI incidence was 3.7% in the present study. The incidence of RPI increased in cases with adjacent teeth that had periapical radiolucency. Previous RCT in teeth adjacent to implants without apical radiolucency is not correlated with RPI.

Accuracy and stability of electronic apex locator length measurements in root canals with wide apical foramen: an ex vivo study.

The aim of the current study was to determine the accuracy of electronic apex locator (EAL) measurements when using files of different sizes in roots with wide apical foramina while considering a new parameter of stability of EAL reading. Ten teeth with straight roots were subjected to a sequential widening of the apical foramen to 0.6, 0.7, and 0.8 mm. The roots were embedded after each enlargement stage in an alginate mold and subjected to EAL readings. Measurements were done using sequential K-file sizes and the self-adjusting file (SAF). Measurement stability was introduced as a new additional parameter. As the difference between the file size used and the apical diameter of the canal decreases, the results obtained were more accurate and stable. The stability and accuracy of the measurements coincided with each other in a statistically significant manner. Within the limitations of the present ex vivo study, it may be concluded that in straight canals with wide apical foramina of 0.6-0.8 mm, both SS K-files which fit snugly to the walls of apical foramen and the SAF file may offer both accurate and stable EAL measurements.

Radicular Grooves and Complex Root Morphologies of Mandibular Premolars Among Israeli Population.

INTRODUCTION: Mandibular premolars usually have one root and one root canal. Different studies found that up to 30% of mandibular premolars have more than one root canal, and up to 24% of mandibular premolars have C-shape canals. The purpose of this study was to investigate the root anatomy and the prevalence of complex root canal morphology in mandibular premolars in Israeli population. METHODS: A total of 1020 Israeli patients' cone-beam computed tomography scans were screened and evaluated. A total of 1835 mandibular first premolars and 1678 mandibular second premolars were examined. Irregular root anatomy and different root canal morphologies were recorded and analyzed. RESULTS: The overall prevalence of complex root morphology (types II-VIII) in mandibular first and second premolars was 21% and 2.8%, respectively. The bilateral prevalence of complex root morphology in mandibular first and second premolars was 46% and 29%, respectively. The prevalence of radicular grooves in mandibular first and second premolars with complex root morphology was 48% and 36%, respectively. No significant difference was found according to gender or the side of occurrence. However, complex root canal morphology was significantly found in mandibular premolars with radicular grooves. CONCLUSIONS: Complex root canal morphology frequently occurs in mandibular first premolars in the population of Israel. Radicular groove existence in mandibular first and second premolars is significantly related to complex root canal morphology.

Systemic tetracycline delays degradation of three different collagen membranes in rat calvaria.

OBJECTIVES: The aim of this study was to quantitatively evaluate the effect of systemic tetracycline (TTC) on the degradation of three different collagen membranes. MATERIALS AND METHODS: Collagen membranes were cut into 5 mm diameter membrane discs and labeled with aminohexanoyl-biotin-N-hydroxy-succinimide ester. One membrane disc each of a non-cross-linked [BioGide (BG)], glutaraldehyde cross-linked [BioMend Extend (BM)], and ribose cross-linked [Ossix (OS)] was implanted on the calvaria of 40 Wistar rats. Another 10 biotinylated collagen membrane discs from each membrane type were processed for histologic observation and served as baseline; half of them (five from each group) were also treated with formic acid to inspect possible interference with biotinilazation of collagen by formic acid used during the decalcification process. A 10 mg/kg dose of TTC (50% of the minimal recommended antibacterial dose) to the experimental (20 animals) and saline to the control (20 animals) group was administered intramuscularly every 3 days. From each group, block sections were retrieved in half of the animals after 14 days and in the remaining after 28 days. Decalcified tissue histology was stained with streptavidin horseradish peroxidase. A computer-assisted program measured the membranes' collagen contents. Statistical analysis consisted of analysis of variance (ANOVA) with repeated measures. RESULTS: No statistically significant differences in collagen contents were appreciated between biotinylated non-implanted membranes treated or not treated by formic acid. Systemic TTC had a different effect on the bio-degradation of the membranes: while it significantly decreased the resorption of two of the membranes (BG and BM), it had minimal influence on the ribose cross-linked membrane (OS). ANOVA with repeated measures, tests of within-subjects effects, showed a statistically significant difference between the membranes (P<0.001), within the membranes at the different time-points (P<0.001), a significant interaction between membranes and time and between the membranes and administered TTC (P<0.001). Test of between-subject effects revealed a statistically significant interaction with time and with TTC (P<0.001). CONCLUSIONS: Systemically administered TTC in sub-antibacterial doses may offer a possible treatment alternative to reduce bio-degradation and enhance bio-durability of certain collagen membranes. The findings of the present study could have clinical application in large non-self-contained bone defects, where prolonged membrane barrier functions are desirable.

External invasive resorption: Case report of a rapidly progressive process in an impacted maxillary canine during orthodontic treatment.

External invasive resorption (EIR) is a type of external resorption that can involve the coronal, middle and apical parts of the root in its advanced stages and results in progressive loss of tooth structure. Common potential predisposing factors for EIR are orthodontic treatment and trauma. The EIR progression rate has not been described previously. This case report describes rapidly progressive EIR in an impacted maxillary canine after surgical exposure and application of directional orthodontic traction over 8 months. The article discusses the etiologies of EIR, the possible reasons for EIR and its rapid progression in the presented case and proposes a new theory of the connection between EIR and tooth impaction.

Ludwig Angina after First Aid Treatment: Possible Etiologies and Prevention-Case Report.

Ludwig angina is a life-threatening type of soft tissue cellulitis involving 3 compartments on the floor of the mouth including the submental, sublingual, and submandibular spaces bilaterally. Prevention, early recognition, and treatment of Ludwig angina are critical because this is a clinical diagnosis with unpredictable progression. This article describes a rare case of Ludwig angina that evolved from an odontogenic infection and the specific microbiology and clinical course and discusses possible etiologies and prevention.

Cone-beam Computed Tomography as a Noninvasive Assistance Tool for Oral Cutaneous Sinus Tract Diagnosis: A Case Series.

An oral cutaneous sinus tract is a relatively uncommon condition that is generally associated with long-standing periapical inflammation. The traditional process of oral cutaneous sinus tract diagnosis is an invasive method based on the insertion of a lacrimal probe or wire. The present article describes the use of cone-beam computed tomographic imaging as a noninvasive assistant tool for the verification of the odontogenic origin.

External invasive resorption: Possible coexisting factors and demographic and clinical characteristics.

The purpose of this retrospective study was to identify the coexisting factors for EIR and to characterise EIR clinically and demographically. All cases of EIR that were referred to the endodontic department between 2011 to 2016 and diagnosed by an endodontist were evaluated. Demographic and clinical characteristics were collected and evaluated. Thirty-eight cases of EIR diagnosed between 2011 and 2016 were included in the study. Seventy-one percent of EIR cases were misdiagnosed by general practitioners. The most affected teeth were the maxillary central incisors (29% of cases) and mandibular molars (26%). Sixty-eight percent of EIR cases were diagnosed in teeth with clinically normal pulp. Pulp necrosis was observed mainly in the advanced stages (class 3 and class 4) of EIR (75%) and in teeth with a history of trauma (63%). Histories of previous trauma and orthodontic treatment were reported in 29% and 23% of cases, respectively.

Root Canal Morphology Evaluation of Central and Lateral Mandibular Incisors Using Cone-beam Computed Tomography in an Israeli Population.

INTRODUCTION: Central and lateral mandibular incisors usually have 1 root canal. The purpose of this study was to investigate the prevalence of additional root canals in central and lateral mandibular incisors and to investigate the prevalence of oval and long oval canals in the cervical, middle, and apical thirds of cases with 1 root canal. METHODS: A total of 1016 Israeli patients' cone-beam computed tomography scans were screened and evaluated. A total of 1472 central mandibular incisors and 1508 lateral mandibular incisors were examined. The root canal morphology and cross-sectional shape were recorded and analyzed. RESULTS: The overall prevalence of more than 1 root canal in mandibular central and mandibular lateral respectively was 40.5% and 37.9%. The bilateral incidence of more than 1 root canal in mandibular central and mandibular lateral respectively was 69.8% and 68.7%. The root canal separation in type II to type V central and lateral mandibular incisors was found in the middle third of the root in 81.5% and 79.0%, respectively. The septum was smaller than 1 mm in 37% of central mandibular incisors and one-third of lateral mandibular incisors. In central and lateral incisors with 1 root canal, long oval canals were found in the middle third of the root of central and lateral mandibular incisors in 36.8% and 48.9%, respectively. CONCLUSION: The occurrence of more than 1 root canal in central and lateral mandibular incisors is approximately 40% (type III was the predominant canal type). In central and lateral incisors with 1 root canal, long oval canals are common.

Minimally Invasive Treatment of Class 4 Invasive Cervical Resorption with Internal Approach: A Case Series.

Invasive cervical resorption (ICR) is a type of external resorption that can involve the coronal, middle, and apical parts of the root in its advanced stages. The diagnosis and treatment of ICR depend on the extent of the resorption into the dentin. The treatment of advanced ICR is challenging, and these teeth have poor prognoses. This article describes 4 cases of class 4 ICR diagnosed by using cone-beam computed tomography and treated with a minimally invasive internal approach with sodium hypochlorite irrigation and calcium hydroxide dressing. All cases were followed for at least 3 years.

Successful orthograde treatment of dens invaginatus Type 3 with a main C-shaped canal based on cone-beam computed tomography evaluation.

Dens invaginatus is a rare anatomic variation that is found primarily in maxillary lateral incisors. The management of dens invaginatus is challenging for clinicians; diagnosing the type of malformation, choosing the most appropriate treatment, and carrying out treatment are complicated by the intricate root system of these teeth. The following case report describes the diagnosis and treatment planning of dens invaginatus Type 3 after cone-beam computed tomography evaluation.

Use of Cone-beam Computed Tomography during Retreatment of a 2-rooted Maxillary Central Incisor: Case Report of a Complex Diagnosis and Treatment.

A double-rooted maxillary incisor is an extremely rare anatomic variation. Only a few case reports describe this abnormal anatomy. In recent decades, cone-beam computed tomographic (CBCT) imaging has become more common for endodontic purposes. This case report describes the retreatment of double-rooted maxillary central incisors using CBCT imaging. In 2012, a 20-year-old man was referred to our department because of asymptomatic periapical lesions in teeth #8, #9, and #10. During the evaluation of a periapical radiograph, a rare anatomic variation, in the form of an additional root of tooth #9, was detected, and it was impossible to decide about the source of the lesion between teeth #9 and #10. During retreatment, after gutta-percha removal, CBCT imaging was performed; this allowed proper treatment of the additional root and a final diagnosis of normal periapical tissue of tooth #10 with no treatment needed. The 18-month follow-up revealed a healing lesion in tooth #9 and normal periapical tissue in tooth #10. During the treatment of teeth with an anatomic variation, CBCT imaging can serve as an auxiliary tool for 3-dimensional evaluation that influences treatment steps and techniques. CBCT scanning can be very useful in assessing the actual location of a periapical lesion, which influences diagnosis and treatment planning.

Prevalence of 3- and 4-rooted first and second mandibular molars in the Israeli population.

INTRODUCTION: Three-rooted mandibular molars are 1 of the anatomic variations of mandibular molars. The location of the additional root is distolingual (radix entomolaris) or mesiobuccal (radix paramolaris). The purpose of this retrospective study was to assess the prevalence of 3- and 4-rooted mandibular first and second molars in the Israeli population and to classify them according to dimension, curvature, and location of separation from the main root. METHODS: A total of 1020 Israel patients' cone-beam computed tomographic scans were screened and evaluated. The incidence of 3- and 4-rooted first and second mandibular molars were recorded and analyzed. One thousand four hundred sixty-five mandibular second molars and 1,229 mandibular first molars were evaluated. RESULTS: The overall incidence of patients with 3-rooted mandibular first and second molars was 2.6% and 1.78%, respectively. The bilateral incidence of 3-rooted mandibular first and second molars was 26%. The incidence of 4-rooted mandibular second molar was 0.55%. No significant difference was found regarding sex or side of occurrence. CONCLUSIONS: The occurrence of 3-rooted mandibular first molars in the Israeli population was rare, but clinicians should be aware of the special characteristic of this anatomic variation to modify accordingly the form of pulp chamber opening and choose appropriate instrumentation.