Outcome of root canal retreatment filled with gutta-percha techniques: A systematic review and meta-analysis.

OBJECTIVE: The present systematic review and meta-analysis aimed to evaluate the success rate of root canal retreatment filled with gutta-percha and the variables related to retreatment success. DATA: The PRISMA guidelines were followed for the present review. The study protocol was registered in the International Prospective Database of Systematic Reviews (PROSPERO CRD42021283134). Risk assessment was performed using the Newcastle-Ottawa scale. Funnel plots were used to detect publication bias and asymmetry was assessed using Egger's tests. SOURCES: PubMed, Scopus, ScienceDirect, Cochrane, and additional sources were searched. STUDY SELECTION: Studies published until 10 December 2022. Clinical studies evaluating the success of root canal retreatment filled with gutta-percha with at least a 1-year follow-up were selected. RESULTS: Ten studies and one unpublished study fulfilled the inclusion criteria for quantitative analysis. The success rate of non-surgical root canal retreatment was 71% (95% CI: 66%-76%) with strict criteria and 87% (79% - 93%) with loose criteria for 1-3 years of follow-up, and 77% (66% - 86%) with strict criteria for a 4-5 years of follow-up. Endodontically retreated teeth with periapical lesions had a lower success rate under strict criteria. The tooth type, dental arch, initial periapical index (PAI) score, and the number of visits also affected the treatment success rate under strict criteria. For the loose criteria, teeth with larger periapical lesions and higher initial PAI scores had a lower success rate. CONCLUSIONS: According to the present systematic review and meta-analysis, non-surgical root canal retreatment results in favourable outcomes. The presence of a periapical radiolucency, periapical lesions >5mm, a higher initial PAI score, multiple-visit retreatments, and mandibular and molar teeth resulted in a lower success rate. CLINICAL SIGNIFICANCE: Non-surgical root canal retreatment filled with gutta-percha techniques is a relatively predictable procedure with a high success rate. Several variables can affect retreatment success, mainly the presence and size of a periapical lesion and the type of tooth.

General Anxiety in Dental Staff and Hemodynamic Changes over Endodontists' Workday during the Coronavirus Disease 2019 Pandemic: A Prospective Longitudinal Study.

INTRODUCTION: The aim of this study was to assess general anxiety levels in endodontists and dental assistants related to different conditions during the pandemic and lockdown and to evaluate hemodynamic changes in endodontists' heart rate (HR), blood pressure, and blood oxygenation during their workday. METHODS: Anxiety levels in endodontists and dental assistants were recorded weekly during the state of alarm declared because of the coronavirus disease 2019 pandemic. Hemodynamic parameters were monitored using a sphygmomanometer for HR and blood pressure and a pulse oximeter for oxygen saturation. Measurements were taken before and after each root canal treatment as well as on arrival at the clinic and at the end of the working day. Rest data, recorded every Saturday, served as a control. Data analysis was performed using chi-square, paired t, Mann-Whitney, and analysis of variance tests (P < .05). RESULTS: General anxiety decreased over the weeks, with significant differences between weeks 1 and 4 (P < .05). Endodontists perceived higher anxiety levels of anxiety during anesthesia inoculation and dental assistants during the dental unit's disinfection and equipment material (P < .05). There was a significant increase in the cardiovascular response in all endodontists in the clinic registrations compared with rest data (P < .05). Values were higher in the strict confinement period and significant for HR when arriving at the clinic (P < .05). CONCLUSIONS: Levels of general anxiety were higher during the first weeks. The chief perceived factors related to anxiety in endodontists and dental assistants were the risk of contagion and protection measures. Higher HR and blood pressure levels were registered during the workday, especially when arriving at the clinic.

Dental Anxiety, Fear, and Root Canal Treatment Monitoring of Heart Rate and Oxygen Saturation in Patients Treated during the Coronavirus Disease 2019 Pandemic: An Observational Clinical Study.

INTRODUCTION: The present study aimed to evaluate anxiety in patients and to monitor their heart rate (HR) and blood oxygenation (SpO2) before, during, and after a root canal treatment (RCT) during the state of alarm in 2 different periods of strict and partial confinement. METHODS: The patients who required a primary RCT were selected. Demographic, preoperative, and postoperative variables were registered, including perceived dental anxiety, fear, HR, and SpO2. Spearman correlation, chi-square, Mann-Whitney, and Kruskal-Wallis tests were used for frequency distribution and variable interaction, and Wilcoxon and Mann-Whitney tests were used to compare HR and SpO2 between groups and different treatment points. RESULTS: Ninety-six patients were included. The median Modified Dental Anxiety Scale scores were 8 (interquartile range [IQR], 6-9.25) and 6 (IQR, 5.5-8) in patients treated during the strict and partial confinement periods. The median fear scores were 2 (IQR, 0-5) and 3 (IQR, 1-5), respectively. Having a previous dental bad experience resulted in higher dental anxiety and fear (P < .05). HR was increased in patients with higher MDAS and fear scores and in those treated during the strict confinement (P < .05). In treatment time points T6 (x-ray taking), and T7 (post-treatment), HR decreased compared with the other evaluated treatment time points (P < .05). No clinical differences were found regarding SpO2. CONCLUSIONS: Self-perception on dental anxiety and fear was similar to other studies in a nonpandemic context. Patients with higher levels of dental anxiety and those treated in the strict confinement period presented an elevated HR. However, it can be stated that RCT performed by endodontists does not result in a significant alteration in patients.

Manejo ortógrado de perforaciones radiculares: a propósito de dos casos / Orthograde management of root canal perforations: two case reports

Las perforaciones radiculares son complicaciones no deseadas que pueden ocurrir durante el tratamiento de conductos. Los principales factores que afectan el pronóstico de un diente que presenta una perforación son la localización y el tamaño de esta, el tiempo transcurrido hasta su reparación, el grado de contaminación previa, y la presencia de una radiolucidez adyacente. La aparición de materiales biocompatibles como el agregado de trióxido mineral (MTA) incrementó de forma sustancial el pronóstico de estos dientes alcanzando tasas de éxito de alrededor del 90%. El objetivo de este artículo es describir el manejo ortógrado de dos casos con perforaciones radiculares laterales en los que se utilizaron materiales y técnicas distintas para su sellado. En ambos casos, previamente al sellado ortógrado de las perforaciones, se realizó una desinfección abundante con hipoclorito de sodio (NaOCl) al 2,5%. En el primer caso, se realizó la obturación del tercio apical del conducto usando una técnica de condensación vertical con gutapercha caliente, y posteriormente se obturó el resto del conducto, incluida la perforación, mediante MTA blanco (Angelus, Londrina, PR, Brasil). En el segundo caso, que además presentaba la dificultad añadida de un instrumento fracturado, se utilizó Biodentine (Septodont, Saint-Maur-des-Fosses, Francia) en toda la longitud del conducto radicular donde se encontraba la perforación. La ausencia de signos y síntomas clínicos y la curación radiográfica en progreso revelan unos resultados satisfactorios en las revaluaciones postoperatorias a los 6 y 18 meses

Root perforations are undesired complications that can occur during root canal treatments. The prognosis of teeth with root perforations could be affected by several factors described in the literature, such as location, size, immediacy in the repair, previous microbial contamination and the presence of a radiolucency adjacent to perforation. However, the introduction of mineral trioxide aggregate (MTA) resulted in an improved prognosis and higher success rates. The purpose of this case report was to describe two nonsurgical endodontic retreatments with lateral root perforations using two different materials and techniques for filling. A disinfection with 2,5% sodium hypochlorite was carried out in both root canals with root perforation. In the first case, the apical third of the canal was filled with vertically compacted warm gutta-percha, while the rest of the canal was sealed with white MTA (Angelus, Londrina, PR, Brazil) for proper sealing of the perforation. In the second case, in addition to presenting the added difficulty of a separated instrument, the complete root canal filling with perforation was performed using Biodentine (Septodont, Saint-Maur-des-Fosses, France). The absence of clinical signs and symptoms and the radiographic healing in progress revealed satisfactory results after 6 and 18 months of follow-up