A comparison of radiographically determined periapical healing and tooth survival outcomes of root canal (re)treatment performed in two care pathways within the United Kingdom Armed Forces.

AIMS: To compare radiographic periapical healing and tooth survival outcomes of root canal (re)treatment performed within two care pathways (Routine Dental Care and Referred Treatment Pathway), in the United Kingdom Armed Forces (UKAF), and determine the effects of endodontic complexity on outcomes. METHODOLOGY: This retrospective cohort study included 1466 teeth in 1252 personnel who received root canal (re)treatment between 2015 and 2020. General Dental Practitioners treated 661 teeth (573 patients) (Routine cohort), whilst Dentists with a Special Interest treated 805 teeth (678 patients) (Referred cohort). The latter group were graduates of an MSc programme in Endodontics with 4-8 years of postgraduation experience. Case complexity was retrospectively determined for each tooth using the endodontic component of Restorative Index of Treatment Need (RIOTN) guidelines. Periapical healing was determined using loose radiographic criteria. The data were analysed using chi-square tests, univariate logistic regression and Cox proportional hazards models. RESULTS: A significantly (p < 0.0001) larger proportion of cases of low complexity had undergone root canal treatment within the Routine versus Referred cohort. The odds of periapical healing was significantly higher within the Referred versus Routine cohort, regardless of analyses using pooled (OR = 1.17; 95% CI: 1.11, 1.22) or moderate complexity (OR = 4.71; 95% CI: 2.73, 8.11) data. Within the Routine cohort, anterior teeth had higher odds of periapical healing than posterior teeth (OR = 1.13; 95% CI: 1.04, 1.22). The 60-month cumulative tooth survival was lower (p = 0.03) in the Routine (90.5%) than the Referred (96.0%) cohort. Within the Routine cohort, the hazard of tooth loss was higher amongst posterior teeth (HR = 4.03; 95% CI: 1.92, 8.45) but lower if posterior teeth had cast restorations (HR = 0.36; 95% CI: 0.19, 0.70). For the Referred cohort, posterior teeth restored with cast restoration (vs not) had significantly lower risk of tooth loss (HR = 0.21; 95% CI: 0.08, 0.55). CONCLUSIONS: For UKAF patients, root canal (re)treatment provided within the Referred pathway was significantly more likely to achieve periapical healing and better tooth survival than those provided within the Routine pathway. Posterior teeth restored with an indirect restoration had a higher proportion of tooth survival. This study supported the utility of the endodontic component of RIOTN for assessing case complexity.

The development of a restorative Managed Clinical Network within the defence primary healthcare organisation.

The United Kingdom Armed Forces introduced a Managed Clinical Network to transform care provision for military patients referred with complex restorative treatment needs. This article discusses the processes that underpinned this transformation of service, from assessment of populations needs to implementation of clinical delivery.

Effect of a single course of isotretinoin therapy on bone mineral density in adolescent patients with severe, recalcitrant, nodular acne.

BACKGROUND: Adverse changes in bone have been reported for patients undergoing high-dose, long-term (several years) isotretinoin therapy for disorders of cornification. The effect of short-term (4-5 months) therapy at the lower dose recommended for acne on bone development in younger, growing adolescent (12-17 years) patients has not been well studied. OBJECTIVE: The purpose of the study was to evaluate the effect of a standard, single course of isotretinoin (Accutane) therapy on bone mineral density (BMD) of the lumbar spine and hip in adolescents ages 12 to 17 years with severe, recalcitrant, nodular acne. METHODS: In this open-label, multicenter study, 217 adolescents (81 girls) with severe, recalcitrant, nodular acne were enrolled and treated with isotretinoin twice daily with food at the recommended total dose of approximately 1 mg/kg for 16 to 20 weeks. BMD in the lumbar spine and hip was measured at baseline and at the end of therapy by dual energy radiograph absorptiometry. RESULTS: There was no clinically significant mean change in BMD measured at the lumbar spine (+1.4%, range: -4.9% to +12.3%) or total hip (-0.26%, range: -11.3% to +15.0%). Hyperostosis was not observed in any patient. Typical efficacy expected in the treatment of acne was observed. CONCLUSIONS: A 16- to 20-week course of isotretinoin treatment at the recommended dose for severe acne has no clinically significant effect on lumbar spine and total hip BMD in the adolescent (12-17 years) population.

Contemporary root canal irrigants are able to disrupt and eradicate single- and dual-species biofilms.

INTRODUCTION: Clinical/microbiological studies have consistently revealed the persistence of some bacteria after conventional root canal debridement. Although this was originally attributed to the complexity of the root canal anatomy and the difficulty of delivering antibacterial agents effectively, it has emerged that the biofilm encasement of bacterial cells may confer a further mechanism of resistance. The purpose of this study was to investigate the relative disruption and bactericidal effects of root canal irrigants on single- and dual-species biofilms of root canal isolates. METHODS: Biofilms of Streptococcus sanguinis, Enterococcus faecalis, Fusobacterium nucleatum, and Porphyromonas gingivalis were grown on nitrocellulose membranes for 72 hours and immersed in NaOCl, EDTA, chlorhexidine, and iodine for 1, 5, or 10 minutes. The number of viable and nonviable bacteria disrupted from the biofilm and those remaining adherent were determined by using a viability stain in conjunction with fluorescence microscopy. RESULTS: Gram-negative obligate anaerobe species were more susceptible to cell removal than gram-positive facultative anaerobes. The majority of cells were disrupted after the first minute of exposure; however, the extent varied according to the agent and species. The most effective agent at disrupting biofilms was NaOCl. Iodine was generally effective at bacterial killing but not disruption. CONCLUSIONS: Biofilm disruption and cell viability were influenced by the species, their coassociation in dual-species biofilms, the test agent, and the duration of exposure. The effectiveness of NaOCl as an endodontic irrigant was reinforced.