A web-based endodontic case difficulty assessment tool.

OBJECTIVE: To develop a web-based tool to facilitate identification, evaluation and management of teeth requiring endodontic treatment. MATERIALS AND METHODS: Following a literature search and thorough analysis of existing case difficulty assessment forms, the web-based tool was developed using an online survey builder (Qualtrics, Qualtrics Lab, UT, USA). Following feedback from a pilot study, it was refined and improved. A study was performed, using the updated version (EndoApp) on a cohort (n = 53) of dental professionals and dental students. The participants were e-mailed instructions detailing the assessment of five test cases using EndoApp, followed by completion of a structured feedback form. Analysis of the EndoApp responses was used to evaluate usage times, whereas the results of the feedback forms were used to assess user experience and relevance, other potential applications and comments on further improvement/s. RESULTS: The average usage time was 2 min 7 s; the average times needed for the last three (Cases 3-5) were significantly less than the preceding two (Cases 1 & 2) test cases. An overwhelming majority of participants expressed favourable views on user experience and relevance of the web-based case difficulty assessment tool. Only two participants (4%) were unlikely or very unlikely to use EndoApp again. The potential application of EndoApp as an 'educational tool' and for 'primary care triage' was deemed the most popular features and of greater importance than the secondary options of 'fee setting' and as a 'dento-legal justification tool'. CONCLUSIONS: Within the study limitations, owing to its ability to quantify the level of difficulty and provide guidance, EndoApp was considered user-friendly and helped facilitate endodontic case difficulty assessment. From the feedback, further improvements and the development of a Smartphone App version are in progress. CLINICAL RELEVANCE: EndoApp may facilitate treatment planning, improve treatment cost-effectiveness and reduce frequency of procedural errors by providing appropriate guidance on endodontic case management.

Treatment outcome of mineral trioxide aggregate or calcium hydroxide direct pulp capping: long-term results.

INTRODUCTION: This controlled, historic cohort study project continues a previously reported trial aiming to assess treatment outcome of direct pulp capping with mineral trioxide aggregate (MTA) versus calcium hydroxide (CH). Potential prognostic factors were re-evaluated on the basis of a larger sample size and longer follow-up periods. METHODS: Clinical and radiographic outcomes of 229 teeth treated with direct pulp capping between 2001 and 2011 were investigated 24 up to 123 months post-treatment (median = 42 months). Pre-, intra-, and postoperative information was evaluated and statistically analyzed using a logistic regression model as well as generalized estimating equation logit models. RESULTS: Two hundred five patients (229 teeth) were available for follow-up (74% recall rate). The overall success rates were 80.5% (95% confidence interval [CI], 74.5-86.5) of teeth in the MTA group (137/170) and 59% (95% CI, 46.5-71.5) of teeth in the CH group (35/59). Multivariate analyses (generalized estimating equation logit model) indicated a significantly increased risk of failure for teeth that were directly pulp capped with CH compared with MTA (odds ratio = 2.67; 95% CI, 1.36-5.25; P = .001). Teeth that were permanently restored ≥ 2 days after direct pulp capping had a significantly worse prognosis irrespective of the pulp capping material chosen (odds ratio = 3.18; 95% CI, 1.61-6.3; P = .004). CONCLUSIONS: The results of this study indicate that MTA provides better long-term results after direct pulp capping compared with CH. Placing a permanent restoration immediately after direct pulp capping is recommended.

Classification of extensively damaged teeth to evaluate prognosis.

The restoration of teeth with extensive structural damage is an important clinical procedure in dental practice. However, despite the availability of a variety of materials, techniques and studies in the scientific literature, the criteria for selection of such teeth for restoration need clarification. The approach to severely compromised teeth should be based on consistent scientific evidence to reduce dental error and improve the prognosis. If restoration is indicated, it must conserve and protect the remaining tooth structure. In this article, we develop and suggest clinical criteria and guidelines that clinicians may use to identify and classify extensively damaged teeth to help in the diagnosis, treatment plan and prognosis.

The effect of the gap between the post restoration and the remaining root canal filling on the periradicular status in a Turkish subpopulation.

OBJECTIVE: The aim of this study was to evaluate whether the gap between the post restoration and the remaining root canal filling had an impact on the periapical health of endodontically treated teeth in a Turkish subpopulation. STUDY DESIGN: Digital panoramic radiographs, evaluated for this cross-sectional study, were randomly selected from files of patients who attended to Yeditepe University, Faculty of Dentistry, between June 2007 and December 2008. The total number of teeth with endodontic posts and crowns was 407. Two observers assessed the radiographs and evaluated the quality of root canal filling and the gap between the root canal filling and the post restoration. Periapical status of the teeth was assessed by the Periapical Index (PAI) scores. Only the teeth with a minimum of 5 mm apical root canal filling that was classified as "good endodontic treatment" were included in the study. Teeth that had no root canal filling, poor endodontic treatment, or less than 5 mm remaining root canal filling beyond post restoration were not assessed. Chi-square test was used for statistical analysis and significance level was established at 5%. RESULTS: In cases with good endodontic treatment, there were 207 teeth that had no gap between the remaining root canal filling and the post restoration. In this group, 135 (65%) teeth had healthy periapex and 72 (35%) teeth showed signs of apical periodontitis. There were 81 teeth that had a gap between the remaining root canal filling and the post restoration. Of these teeth, 69 (85%) had periapical pathosis; however, only 12 (15%) teeth had healthy periapex. CONCLUSION: Statistical analysis revealed that the success rate of good endodontic treatment was significantly affected by the gap between the post restoration and remaining root canal filling (P < .001).

[Risk assessment in root canal therapy]. / Risico-inventarisatie van endodontische behandelingen.

The aim of endodontic therapy is the prevention or treatment of apical periodontitis. Some years ago, 2 endodontic classification systems, the Dutch Endodontic Treatment Index (DETI) and the Endodontic Treatment Classification (ETC), were introduced in the Netherlands. These systems differentiate between complicated and uncomplicated endodontic cases. Before treatment, the systems may help in assessing the difficulties and risks of performing an endodontic treatment and in deciding whether to carry out treatment or refer the patient to an endodontist. Root canal therapy may involve considerable risks. This is illustrated with three clinical cases, which show the sort of complications that may be prevented using the 2 classification systems.

Evaluation of a system for grading the complexity of root canal treatment.

AIM: To evaluate the reproducibility of the Restorative Index of Treatment Need (RIOTN) system for grading the complexity of root canal treatment. METHODOLOGY: The RIOTN system of grading the complexity of root canal treatment was applied to all endodontic referrals to a department of restorative dentistry in a district general hospital within a period of one year. Grading was repeated in 60 randomly selected teeth and weighted kappa analysis was used to test for intra-observer as well as inter-observer agreement with a consultant in restorative dentistry and a vocational trainee (VT). RESULTS: In all, 152 patients were referred for root canal treatment of 186 teeth within the period of study. Weighted kappa for intra-observer agreement when categorising complexity was 0.636. Weighted kappa for inter-observer agreement with the consultant was 0.570 and that for agreement with the VT was 0.223. CONCLUSION: The RIOTN system of grading the complexity of root canal treatment was incomplete; with moderate to poor reproducibility.

Endodontics: Part 2 Diagnosis and treatment planning.

As with all dental treatment, a detailed treatment plan can only be drawn up when a correct and accurate diagnosis has been made. It is essential that a full medical, dental and demographic history be obtained, together with a thorough extra-oral and intra-oral examination. This part considers the classification of diseases of the dental pulp, together with various diagnostic aids to help in determining which condition is present, and the appropriate therapy.

The outcome of endodontic retreatment: a 2-yr follow-up.

Retreatment is common in endodontics. The purpose of this article was to classify the different clinical situations encountered in retreatment cases and relate them to the outcome after an observation period of 24 months. A total of 425 patients (452 teeth) from 451 patients, consecutively admitted for root-canal retreatment, were monitored during a 24-month period. All teeth (254 molars, 107 premolars, and 91 single-root anterior teeth) were divided into two major categories: teeth with modified anatomy from previous endodontic treatment (root-canal-morphology altered) and teeth in which no significant anatomical changes were made by the former endodontic treatment (root-canal-morphology respected). Although the overall success was 69.03%, the success in the root-canal-morphology-respected group was 86.8% and in the root-canal-morphology-altered group 47% (Mann-Whitney U test p < 0.0001). The clinical success of an endodontic retreatment seems to depend on whether alterations in the natural course of the root canals were caused by previous root-canal treatment.

An evaluation of the usefulness of two endodontic case assessment forms by general dentists.

AIM: To evaluate the use of two forms to assess the risks and difficulty of root-canal treatment. METHODOLOGY: Two criterion-based forms, containing 15 and 16 items, respectively, were distributed to 83 general dentists to evaluate the potential difficulty of root-canal treatment. The participants were asked to assess the difficulty of 15 endodontic cases using the Dutch Endodontic Treatment Index (DETI) and the Endodontic Treatment Classification (ETC) forms. A questionnaire was also provided to evaluate the time needed to complete the two forms, their ease of use, the clarity and/or appropriateness of the criteria and any other comments. The outcomes of the assessment were compared with the assessment of each case as carried out by the authors. RESULTS: The response rate was 53%. The DETI was an easy and rapid way to differentiate between uncomplicated and complicated cases. In 13 of the 15 cases, 88-100% of the dentists scored the cases in agreement with the authors. Use of the ETC form was more complicated, as a result of the larger number of variables. However, most respondents recognized the complicated cases, and 91% found the ETC form valuable to help in assessing the difficulty of endodontic cases. CONCLUSIONS: These two forms may help general practitioners to assess the difficulty of endodontic problems and to decide whether to treat the case or to refer it to a specialist.

To do a "root canal".

Endodontic treatment is often referred to as "a root canal". This article discusses the need to be more refined and descriptive in the selection of treatment alternatives. The pathological involvement of teeth needing endodontic treatment varies significantly from superficial pulp inflammation to pulp necrosis and infection, often complicated with a periradicular osteolytic process. This diversity should lead to a variety of treatment modalities based on the severity of the disease. Failure to do so and use a one-size-fits-all approach--"a root canal"--is an oversimplification and a disservice to the patient and the profession.

Private practicing endodontists: production of endodontic services and implications for workforce policy.

The methods and techniques used by private practicing endodontists to provide patient care are at the core of endodontic workforce policy. Productivity influences both the amount of care provided and the required number of practicing endodontists in the future. Data was collected from practicing endodontists in order to characterize the technical methods of producing endodontic services. This data was then used to develop a statistical model for use in assessing the national endodontic workforce conditions in the United States. A survey was mailed to a random sample of 2,075 private practicing endodontists in the United States based on membership files from the American Association of Endodontists and the American Dental Association. The overall survey consisted of three means of data collection: (1) a survey about the endodontic practice as a whole; (2) a survey about the endodontist; and (3) patient encounter forms used when collecting detailed endodontic procedure data for a single day in the practice. The model was used to obtain a projection of 4,016 endodontists in the year 2005 and 4,671 practicing endodontists in 2010 required to meet the projected demand for endodontic care. The model and survey data provide valuable information to practicing endodontists for use in identifying critical elements used to render care, how the elements are combined in the practice of endodontics, and the minimum number of endodontists required to provide a given volume of endodontic care.

Use of dental services: an analysis of visits, procedures and providers, 1996.

BACKGROUND: While many studies have provided data on Americans' access to dental care, few have provided a detailed understanding of what specific treatments patients receive. This article provides detailed information about the types of dental services that Americans receive and the types of providers who render them. METHODS: The authors provide national estimates for the U.S. civilian noninstitutionalized population in several socioeconomic and demographic categories regarding dental visits, procedures performed and the types of providers who performed them, using household data from the 1996 Medical Expenditure Panel Survey, or MEPS. RESULTS: Data show that while the combination of diagnostic and preventive services adds up to 65 percent of all dental procedures, the combination of periodontal and endodontic procedures represents only 3 percent. Additionally, while 81 percent of all dental visits were reported as visits to general dentists, approximately 7 percent and 5 percent of respondents who had had a dental visit reported having visited orthodontists or oral surgeons, respectively. CONCLUSION: MEPS data show the magnitude and nature of dental visits in aggregate and for each of several demographic and socioeconomic categories. This information establishes a nationally representative baseline for the U.S. population in terms of rates of utilization, number and types of procedures and variations in types of providers performing the procedures. These nationally representative estimates include data elements that describe specific dental visits, dental procedures and type of provider, and they offer details that are useful, important and not found elsewhere. PRACTICE IMPLICATIONS: By understanding these analyses, U.S. dentists will be better positioned to provide care and better meet the dental care needs of all Americans.

Influence of coronal restorations on the periapical health of endodontically treated teeth.

The purpose of the study was to evaluate a possible relationship between the quality of the coronal restoration, the root canal obturation and the periapical status of endodontically treated teeth. Full mouth series of radiographs from randomly selected patient charts at the Dental Faculty, University of Oslo were examined. A total of 1001 endodontically treated teeth restored with a permanent restoration were evaluated independently by two examiners. According to a predetermined set of radiographic criteria, the technical quality of the root filling of each tooth was scored as either good (GE) or poor (PE), and the technical quality of the coronal restoration was scored as good (GR) or poor (PR). The root and the surrounding structures were then evaluated and according to the periradicular findings, the treatment was categorized as success or failure. The success rate for all endodontically treated teeth was 67.4% (n = 1001). Teeth with root canal posts had a success rate of 70.7% (n = 527) and teeth without posts had a success rate of 63.6% (n = 472). The two groups with technically good endodontics had the highest success rates. In combination with technically good restorations the success rate was 81% (GE + GR, 81%) and combined with technically poor restorations the success rate was 71% (GE + PR, 71%). The two groups with technically poor endodontics combined with either good restorations or poor restorations had significantly lower success rates (PE + GR, 56% and PE + PR, 57%). The technical quality of the endodontic treatment as judged radiographically was significantly more important than the technical quality of the coronal restoration when the periapical status of endodontically treated teeth was evaluated.