Epoxy vs. Calcium Silicate-Based Root Canal Sealers for Different Clinical Scenarios: A Narrative Review.

This study aimed to review the considerations for choosing a suitable sealer according to various endodontic scenarios. An electronic search of PubMed, Scopus, and the Web of Science was undertaken for the keywords of 'sealer choosing', 'appropriate sealer', 'suitable sealer', 'sealer for clinical scenario', and 'sealer for clinical situations'. However, the literature review revealed a lack of studies with practical clinical recommendations regarding the choice of appropriate endodontic root canal sealers for particular clinical situations of root canal treatment. Therefore, a narrative review was undertaken under the basis of the characteristics of an epoxy resin-based sealer (ERS) versus a calcium silicate-based sealer (CSS). Based on the evidence found through the review, the choice of an appropriate sealer in a variety of clinical scenarios was proposed. An ERS is recommended for one-visit non-vital cases, teeth with periodontal involvement, cracked teeth, and internal root resorption without root perforation. A CSS is recommended for vital or non-vital cases in multiple visits, teeth with internal root resorption with perforation or internal approach for external cervical resorption, teeth with open apices, and teeth with iatrogenic aberrations.

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.

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.

Long-term dental implications of infant oral mutilation: a case series.

Infant oral mutilation (IOM) is a ritual ceremony practised mostly in African cultures, in which the primary tooth bud of the deciduous canine is extracted. Complications and risks of IOM include pain, heavy bleeding and infection that may deteriorate to life-threating conditions. The main long-term consequence of IOM is future dental abnormalities. The scientific literature lacks in-depth analyses of the dental sequelae of this practice among adults who underwent it, and particularly of the aspect of dental treatment. Eight new cases of IOM are presented in this case series, with emphasis on dental diagnosis and treatment modalities. We describe different outcomes of this practice, such as enamel hypoplasia and crown deformations with later necrosis and infection of the root canal system, severe discolouration, immature root apex, impaction of a canine, failure of development and missing lower permanent incisors and canines, an odontoma-like structure, severe periodontal defect and root dilaceration. Familiarity with the practice of IOM is vital in order to identify its manifestations and arrive at the correct diagnosis and optimal course of treatment.

Use of Cone-beam Computed Tomography as a Critical Component in the Diagnosis of an Infected Nasopalatine Duct Cyst Mimicking Chronic Apical Abscess: A Case Report.

Nasopalatine duct cysts (NPDCs) and other nonodontogenic lesions of the oral cavity may mimic odontogenic pathoses. We present a case of a 22-year-old man with a history of dental trauma and a lesion displaying the typical clinical and radiographic signs of a chronic apical abscess- a buccal sinus tract that was traced to a radiolucent area in the periapex of a maxillary central incisor. A comprehensive diagnostic process that included a cone-beam computed tomographic scan and a histopathologic examination of the lesion after complete enucleation led to the final diagnosis of an infected NPDC. The adjacent tooth was vital at the 1-year posttreatment follow-up, and a radiograph demonstrated complete healing of the periradicular structures. This case demonstrates the ability of NPDCs to present clinical and radiographic signs similar to apical inflammatory lesions and the need for a meticulous diagnostic process in order to avoid unnecessary endodontic intervention. The article also discusses the differential diagnoses of nonodontogenic lesions in the premaxillary area.

Age-dependent root canal instrumentation techniques: a comprehensive narrative review.

The aim of this article was to review age-dependent clinical recommendations for appropriate root canal instrumentation techniques. A comprehensive narrative review of canal morphology, the structural characteristics of dentin, and endodontic outcomes at different ages was undertaken instead of a systematic review. An electronic literature search was carried out, including the Medline (Ovid), PubMed, and Web of Science databases. The searches used controlled vocabulary and free-text terms, as follows: 'age-related root canal treatment,' 'age-related instrumentation,' 'age-related chemo-mechanical preparation,' 'age-related endodontic clinical recommendations,' 'root canal instrumentation at different ages,' 'geriatric root canal treatment,' and 'pediatric root canal treatment.' Due to the lack of literature with practical age-based clinical recommendations for an appropriate root canal instrumentation technique, a narrative review was conducted to suggest a clinical algorithm for choosing the most appropriate instrumentation technique during root canal treatment. Based on the evidence found through the narrative review, an age-related clinical algorithm for choosing appropriate instrumentation during root canal treatment was proposed. Age affects the morphology of the root canal system and the structural characteristics of dentin. The clinician's awareness of root canal morphology and dentin characteristics can influence the choice of instruments for root canal treatment.

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.

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.

A Comparison of Cone-beam Computed Tomography with Periapical Radiography in the Detection of Separated Instruments Retained in the Apical Third of Root Canal-filled Teeth.

INTRODUCTION: This study compared the diagnostic efficacies of cone-beam computed tomographic (CBCT) imaging and periapical radiography (PR) in the detection of retained separated instruments located at the apical third of filled root canals. METHODS: Sixty single-rooted extracted human teeth were instrumented to size #25 and were randomly divided to a simulated 2-mm #30 K-file (stainless steel or nickel-titanium) segment separation at the apical third of the canal (n = 40) or a control group without a separated instrument (n = 20). The canals were obturated to the separated instrument or the working length for the teeth without an instrument using gutta-percha with AH26 (Dentsply DeTrey GmbH, Konstanz, Germany) or Roth sealer (Roth International Ltd, Chicago, IL). The teeth were invested in a mandible model simulating the bone density and imaged using CBCT imaging and PR. The images were evaluated separately by 2 calibrated observers twice with an interval of 4 weeks. Cohen kappa was used to evaluate the observer agreement. Receiver operating characteristic curve analysis was used to evaluate the discrimination ability. RESULTS: The intraobserver kappa was 0.744 and 0.627, and between the observers, it was 0.593 and 0.275 for PR and CBCT imaging, respectively. Using PR, the mean sensitivity was 71.25%, and the specificity was 93.75%. Using CBCT imaging, the sensitivity and specificity were 41.25% and 71.25%, respectively. Although for PR the area under the curve values ranged between 0.75 and 0.91 (P < .05), for CBCT they ranged between 0.48 and 0.60 (P > .05), regardless of the instrument or the sealer type. CONCLUSIONS: PR performed better than CBCT imaging for the detection of retained separated instruments located at the apical third of extracted human root canal-filled teeth.

Radiographic identification of separated instruments retained in the apical third of root canal-filled teeth.

INTRODUCTION: The aim of the study was to compare the diagnostic ability to radiographically detect separated stainless steel (SS) versus nickel-titanium (NiTi) instruments located at the apical third of filled root canals with either AH 26 (Dentsply DeTrey GmbH, Konstanz, Germany) or Roth sealer (Roth International Ltd, Chicago, IL). METHODS: Sixty single-rooted extracted human teeth with 1 straight root canal were instrumented to a size 25 apical diameter. In 40 teeth, apical 2-mm segments of SS (n = 20) or NiTi (n = 20) files were intentionally fractured in the apical part of the root canal. The remaining 20 teeth without fractured files served as a control group. Subsequently, the root canals were filled using laterally condensed gutta-percha and either AH 26 sealer (AH) or Roth sealer (Roth). All teeth were radiographed using conventional Kodak film (Eastman Kodak Co, Rochester, NY) and a charge-coupled device digital sensor. The evaluation of the images for the presence of a fractured instrument was performed independently by 2 blinded observers. The data were statistically analyzed using McNemar and Fisher exact tests. RESULTS: The kappa values were 0.76 and 0.615 for the first and second observers, respectively, and 0.584 between the observers. There were no significant differences in the diagnostic ability between digital and conventional radiography or the different root canal sealers (AH vs Roth, P > .05). The sensitivity to detect fractured SS was significantly higher than NiTi (P < .05). CONCLUSIONS: It may be difficult to radiographically detect a retained separated instrument. It is easier to radiographically detect fractured SS than NiTi instruments retained at the apical third of the root canal.