Diagnosis and Management of Maxillary Sinusitis of Endodontic Origin.

The anatomic proximity of maxillary posterior teeth to the maxillary sinus provides a natural conduit for the spread of dental pathology into the maxillary sinus. This diffusion results in the development of sinus disease attributable to endodontic pathology, and is termed "maxillary sinusitis of endodontic origin" (MSEO). Ultimately, suspicion of odontogenic causes of sinus disease should come as a relief to the provider and patient alike as the conditions are very treatable by noninvasive means with high expected success. This article reviews the diagnosis and management of odontogenic sinusitis with an emphasis on CBCT imaging as part of the interdisciplinary diagnostic workup. Illustrative cases documenting the treatment of MSEO are also presented.

Outcomes-Based Treatment Planning in Endodontics: Applying the Latest Evidence.

A comprehensive understanding of the factors that influence treatment outcomes is crucial in endodontic diagnosis and treatment planning. Having knowledge that takes into account dental and patient-related conditions when choosing procedures can help clinicians maximize the prognosis of natural teeth and reduce postoperative complications. That being said, the landscape of outcome studies in endodontics is continually evolving, presenting a challenge for many clinicians trying to stay current with the latest literature. This article reviews factors that influence the outcomes of the following endodontic therapies: primary root canal treatment, nonsurgical retreatment, and surgical retreatment. An emphasis is placed on the importance of considering preoperative and treatment-related factors as prognostic indicators before developing a treatment plan, with the ultimate goal of enhancing tooth durability and ensuring patient satisfaction.

Vital Pulp Therapy: Managing Deep Caries in the Permanent Dentition.

The adoption of vital pulp therapy (VPT) is a significant advancement in preserving the longevity of vital mature pulp. VPT represents a potential alternative approach to nonsurgical root canal therapy in which compromised pulp is treated such that it maintains its vitality and function. With the introduction of novel bioceramic materials, including calcium silicate cements and mineral trioxide aggregate, the prognosis for VPT in mature permanent teeth has greatly increased, and as a result, adaptation of VPT in these teeth has garnered considerable support. This article reviews evidence-based guidance for case selection and procedural methods associated with the adoption of VPT in mature permanent teeth.

Saving Cracked Teeth: The Current State of Evidence.

Treatment planning for cracked teeth can be quite challenging for clinicians, as various outcomes-related clinical parameters must be considered. Historically, extraction was recommended for cracked teeth with radicular extensions due to their poor prognosis. Recent literature, however, suggests that these teeth may be saved with careful case selection and appropriate treatment. This article closely examines Davis and Shariff's 2019 study, which demonstrated a promising prognosis for treating cracked teeth with radicular extensions following a specific treatment protocol. This literature review discusses current findings regarding cracked teeth and suggested treatment modalities to optimize outcomes.

Evidence-Based Pain Management: Dispelling Disinformation in Dentistry.

According to the American Dental Association Principles of Ethics and Code of Professional Conduct, dental professionals hold a special position of trust and privilege within society, and thus are bound to adhere to the highest standards of conduct. This code of ethics defines key tenets, including veracity, patient autonomy, beneficence, nonmaleficence, and justice. Maintaining these ethical principles goes beyond the competent delivery of operative care and requires up-to-date, evidence-based knowledge and practices on the part of clinicians.1 With pain management being a key component of endodontics practice, clinicians must maintain their knowledge on the most effective evidence-based pain management strategies to ethically care for their patients.

Incidental CBCT Findings: The Importance of Reading the Whole Image.

The use of cone-beam computed tomography (CBCT) imaging often elicits changes in both diagnostics and treatment plans when incorporated into endodontic workups. In endodontic practice, CBCT scans enable detection of periapical pathology before it is apparent on traditional 2-dimensional intraoral radiographs. The visualization provided by CBCT scans can help clinicians confirm suspected diagnoses, including but not limited to periapical pathology, traumatic tooth displacement, and vertical root fracture. This article discusses the use of CBCT imaging in the field of endodontics with an emphasis on its utilization to identify incidental findings, which can introduce complexities to a diagnosis and yield valuable information to enhance the scope of care for the patient.

Medication-Related Osteonecrosis of the Jaw (MRONJ) Mistaken for Acute Apical Abscess.

The objective of this case study is to report on the diagnosis and treatment of medication-related osteonecrosis of the jaw (MRONJ), which was originally misdiagnosed and mistreated as endodontic disease. A patient was referred for worsening odontalgia despite root canal therapy on tooth No. 19 and a course of oral antibiotics. Examination demonstrated slight buccal swelling and tenderness in the left masseter and a 7-mm diameter area of exposed bone on the mandibular left lingual torus. Further history-taking revealed prior bisphosphonate therapy for metastatic breast cancer. MRONJ was identified as the likely diagnosis, and the patient was appropriately referred to oral and maxillofacial surgery where the diagnosis was confirmed and surgical debridement performed. The case study demonstrates how the symptomatology and presentation of MRONJ can resemble endodontic disease and that timely and appropriate treatment requires eliciting an in-depth medical history, reaching a complete pulpal and periapical diagnosis, and remaining attentive to the presence of exposed bone on examination.

Cementoblastoma Mimicking Pathology of Endodontic Origin: A Case Report.

Interdisciplinary care in the management of complex pathology is critical to ensure patients receive predictable, evidence-based treatment. The authors report the unique case of a healthy 38-year-old female patient who presented to a private endodontics practice with a radiopaque lesion associated with the root of tooth No. 20. The patient experienced mild and occasional palpation tenderness associated with the tooth. Extraoral examination and intraoral soft tissues presented without any abnormalities. Intraoral radiographs revealed a radiopacity overlying the apex of tooth No. 20. A cone-beam computed tomography scan of the region revealed a well-delineated bulbous radiopaque lesion attached to the lingual aspect of the apical third of the root of tooth No. 20. The lesion could not be distinguished from the root outline and presented with a radiolucent halo along its periphery. The differential diagnosis at the time consisted of cementoblastoma, condensing osteitis, hypercementosis, and periapical cemento-osseous dysplasia. The patient was referred to an oral and maxillofacial surgeon for evaluation and treatment. Tooth No. 20 was subsequently treated with an excisional biopsy and concurrent extraction of the tooth. Histologic examination of the lesion supported the diagnosis of cementoblastoma.

Managing Endodontic Complications: The Pathophysiology and Treatment of Flare-ups.

At its core, endodontics is a specialty centered on saving patients' teeth. Nonsurgical root canal therapy and nonsurgical retreatment, arguably the "bread and butter" of endodontics, not only facilitate the preservation of the natural dentition, but in many cases, alleviate pain. Most patients arrive for endodontic treatment expecting symptom relief. A small percentage of these patients, however, experience just the opposite. Within 48 to 72 hours, these select patients experience worsening symptoms, including swelling and pain, and may wonder what mishaps may have occurred during their treatment. These symptom exacerbations are referred to as endodontic flare-ups and are well-documented in the literature. In most cases their occurrence does not reflect a lack of practitioner judgment or skill, but rather a biologic event resulting from a shift in the delicate balance of the bacterial communities and inflammatory events at the periapex. This article reviews the pathophysiology and treatment of endodontic flare-ups, thereby informing patient communication strategies surrounding these events, to preserve both the teeth in question as well as patient relationships.

Pain Management and Endodontics: Rapidly Evolving Science Benefits Patient Care.

Pain management and endodontics represent two separate but very much interrelated disciplines. Advances in both fields have resulted in significant improvements in the predictable and comfortable delivery of patient care. From the utilization of cone-beam computed tomography (CBCT) imaging, the use of biomaterials, and enhanced irrigation in endodontics, to greater understanding of pain physiology and treatment, providers and patients alike are benefiting from rapidly evolving science. These two interrelated disciplines are among the most exciting in dentistry for both clinicians and researchers. The science and practice of clinical endodontics progresses quickly. Resultantly, virtually every clinician providing endodontic care gets to experience real changes in methodologies and technologies during their career. These advances have enhanced outcomes in both nonsurgical and surgical endodontics. Similarly, seismic shifts in pain management continue to occur, and significant advances in the understanding of pain physiology, as well as drugs and devices for the prevention and treatment of pain, have greatly improved patient care.

The Diagnostic Dilemma of Unseparated Fractures.

Unseparated fractures in teeth without a history of prior endodontic treatment represent a common presentation in clinical practice. Historic heterogeneity in diagnostic terminology and treatment recommendations have produced considerable uncertainty among clinicians regarding how to best treat these teeth. That said, a current review of the literature can provide clinicians with an evidence-grounded framework for managing unseparated fractures. This article reviews the current literature with regard to the epidemiology, diagnosis, and treatment of unseparated fractures.

Cracked teeth: Distribution and survival at 6 months, 1 year and 2 years after treatment.

BACKGROUND/PURPOSE: The unpredictable condition of cracked teeth warrants further investigation and clinical experiences. The purpose of this study was to collect and record data on demographics, clinical characteristics, different treatment modalities and survival of cracked teeth at 6-month, 1-year and 2-year recalls. METHODS: 77 cracked teeth from 65 patients were included. Data on demographics, clinical parameters, treatment modalities and recall were collected. Binomial, multinomial and chi square tests were used for statistical analysis. RESULTS: Most cracked teeth occurred in patients greater than 40 years old (p < 0.01). Cracked teeth themselves were most often molars (79.22%; p < 0.01), a non-terminal tooth in the arch (62.34%; p < 0.05) and nonendodontically-treated teeth (94.81%; p < 0.01). Cracked teeth exhibited pain to percussion (63.64%, p < 0.05) or biting (74.03%; p < 0.01), and no or only positive mobility (76.62%; p < 0.01). Cracks were most often oriented in the mesiodistal direction (68.83%; p < 0.01). Higher survival rates were noted in cracked teeth lacking pre-operative pain to palpation or spontaneous pain, and with no or only positive mobility at 6-month and 1-year recalls. In vital cracked teeth, higher survival rates were noted in teeth lacking pre-operative pain to palpation and with no or only positive mobility at 2-year recalls. CONCLUSION: The absence of pre-operative palpation discomfort, spontaneous pain and minimal mobility, as well as the presence of pulp vitality were associated with higher survival rates of cracked teeth at all recall times. Results are useful for diagnosis and outcomes-based treatment planning of cracked teeth.

The Use of Selective Anesthesia in Endodontic Diagnosis.

Foundational to the diagnosis of endodontic disease is the ability for clinicians to replicate a patient's pain via clinical testing. Patients experiencing degenerative pulp diseases, like an acutely symptomatic irreversible pulpitis,may present with poorly localized pain that cannot be clinically replicated. Selective anesthesia techniques can aid clinicians in the accurate diagnosis of these patients' symptoms. This article reviews the application of selective anesthesia and presents cases in which these techniques were used to facilitate the accurate diagnosis of endodontic disease.

Endosseous implants versus nonsurgical root canal therapy: a systematic review of the literature.

For this article, the authors identified and reviewed the current literature, addressing two treatment options for endodontically involved teeth: root canal therapy and restoration versus extraction and the placement of a dental implant. The literature was evaluated as a basis for making treatment decisions. PubMed was queried for all studies that compared nonsurgical root canal therapy (NSRCT) and restoration with the extraction of teeth and placement of a dental implant. This search was supplemented by searching the bibliographies of these studies to ensure that all relevant studies were included. A total of 38 studies were found that directly compared NSRCT and restoration with extraction and placement of a dental implant. The literature is discussed in terms of outcomes for both treatment options, considerations in treatment plan decision-making, or the opinions of the authors.

Periodontal disease among adult, new-immigrant, Chinese Americans in Boston with and without diabetes -- a brief communication.

OBJECTIVES: We compared the periodontal disease levels in a population of low socioeconomic status (SES), urban, adult, Chinese American immigrants with and without type 2 diabetes. METHODS: Dental records of 51 diabetic adults were compared with 102 nondiabetic controls from South Cove Community Health Center, Boston, MA, cross-matched by age and gender. RESULTS: Our results showed that the proportion of sites with bone loss greater than 5 mm in the mesial areas of teeth was significantly correlated with higher glycosylated hemoglobin (HbA1c) (r = 0.35, P-value = 0.01). The number of teeth with mesial bone loss of greater than 5 mm was correlated to increasing HbA1c (r = 0.37, P-value = 0.01). CONCLUSIONS: Our preliminary data showed that mesial bone loss greater than 5 mm was correlated with inadequate control of diabetes. The implications and recommendations for the dental care of immigrant Chinese Americans with diabetes were discussed.