Incidence of Middle Mesial Canals in Mandibular Molars during Root Canal Treatment and Nonsurgical Retreatment.

INTRODUCTION: Large-scale clinical studies on the incidence of middle mesial canals (MMCs) in nonsurgical root canal treatment (RCT) and retreatment of mandibular molars are lacking. The primary aim of this observational study was to determine the incidence of MMCs in mandibular first and second molars that received RCT or nonsurgical retreatment (NSRetx). The secondary aim was to determine factors associated with incidence of MMCs. METHODS: Included were 3018 mandibular molars that received RCT (n = 1624) or NSRetx (n = 1394) by 3 endodontists in a private practice. Demographic and procedural data were collected. Bivariate and multivariable (Poisson regression model) analyses were performed. RESULTS: Incidence of MMCs was 8.8% (n = 267). Although the bivariate analysis showed that NSRetx was significantly associated with incidence of MMCs, this association did not reach the threshold for statistical significance after controlling for all covariates (P = .07). Multivariable analysis on the entire cohort showed that incidence of MMCs was significantly associated with younger age (risk ratio [RR] = 1.62; 95% confidence interval [CI], 1.28-2.06), male gender (RR = 1.48; 95% CI, 1.18-1.85), preoperative cone-beam computed tomography (CBCT) (RR = 1.48; 95% CI, 1.17-1.89), and first molar (RR = 2.30; 95% CI:1.74-3.05). Subgroup multivariable analyses revealed that incidence of MMCs was associated with male gender only in the RCT group (RR = 2.26; 95% CI, 1.55-3.30) but not in the NSRetx group (RR = 1.11; 95% CI, 0.82, 1.50); and with preoperative CBCT only in the NSRetx group (RR = 1.78; 95% CI, 1.28, 2.50) but not in the RCT group (RR = 1.10; 95% CI, 0.71, 1.69). Associations with younger age and first molar remained unchanged. CONCLUSIONS: Overall incidence of MMCs was 8.8%. Incidence of MMCs was significantly higher in younger patients and in mandibular first molars but was not associated with the type of treatment.

Flare-ups After Nonsurgical Retreatments: Incidence, Associated Factors, and Prediction.

INTRODUCTION: The aims of this study were to determine the incidence, associated factors, and predictability of flare-ups after nonsurgical retreatments (NSRetx). METHODS: All patients (n = 3,666) who received NSRetx by 3 endodontists in 2 endodontic offices during a period of 6 years (2016-2022) were included. Demographic, diagnostic, and procedural data were collected. A flare-up was defined as moderate-severe pain with/without swelling that took place within 14 days of initiation of NSRetx and resulted in an unscheduled appointment. Bivariate analyses on the entire cohort and multivariable analyses on cases with complete dataset (n = 2,846) were performed to identify significant associations. A Random Forest algorithm was used to make a prediction model. RESULTS: Incidence of flare-ups was 3.95% (n = 145). Increased risk of flare-ups was associated with diabetes (adjusted odds ratio [AOR] = 2.01; 95% confidence interval [CI], 1.01-3.97), mandibular teeth (AOR = 1.67; 95% CI, 1.11-2.52), moderate-severe preoperative pain on percussion (AOR = 2.13; 95% CI, 1.31-3.50), and pain on palpation (AOR = 1.63; 95% CI, 1.01-2.64). Lower risk of flare-up was associated with high blood pressure (AOR = 0.44; 95% CI, 0.21-0.82) (P < .05). The prediction model was not able to predict flare-ups with sufficient confidence (precision = 0.13). CONCLUSIONS: Incidence of flare-ups following NSRetx was low (∼4%) and had a weak but significant association with the history of diabetes. Moderate-severe pain on percussion, pain on palpation (any intensity), and mandibular teeth had a significant association with flare-ups. The history of high blood pressure was associated with lower risk of flare-ups. Flare-ups were difficult to predict in this clinical setting.