Guided Access Cavity Preparation Using Cost-Effective 3D Printers.

INTRODUCTION: The purpose of this in vitro study was to evaluate the accuracy and precision of desktop 3D printers when fabricating stents for guided endodontics. METHODS: A stent was designed using planning software for guided endodontic access on a typodont model. Four different 3D printers were used to fabricate an identical stent, one per printer. Each stent was then used to gain access to the artificial endodontic canal on a typodont tooth and was repeated 10 times per stent by the same operator. Each of the accessed typodont teeth were scanned by a reference scanner and then imported into the inspection software. Inspection software used a best-fit alignment to automatically calculate absolute deviation at the base and tip of the bur. RESULTS: The mean distances between the planned and actual positions of the bur were low, ranging from 0.31 to 0.68 mm. Statistically significant differences were found among the 4 groups (F3,36 = 10.67, P < .05). Post hoc comparison revealed that Group Form2 significantly varied from Groups Form3 and Carbon (P < .05 and P < .05, respectively). Group Form3 obtained the most accurate and most precise axial deviations both coronally and apically. CONCLUSIONS: All of the printers tested produced stents for guided access that allowed for a high level of accuracy in obtaining access to the artificial endodontic canal, which would justify the trial of cost-effective 3D printers for guided endodontic access and necessitates further clinical research on teeth with pulp canal obliteration.

Long-term treatment costs for aggressive periodontitis in a German population.

AIM: This study assessed the long-term annual costs for treating aggressive periodontitis (AgP) patients. METHODS: A cohort of compliant AgP patients was retrospectively evaluated. Costs for active periodontal therapy (APT, including scaling and root planing, open flap debridement, root resections, but not pocket elimination or regenerative surgery) and supportive periodontal therapy (SPT, including also costs for restorative, endodontic, prosthetic and surgical treatments) were estimated from a mixed payer perspective in Germany. The impact of tooth- and patient-level factors on annual costs was assessed using mixed modelling. RESULTS: A total of 52 patients (mean [SD] age: 35.2/6.8 years), with 26.5 (4.0) teeth (38% with bone loss >50%) were treated. Mean follow-up (retention) time was 16.9 (5.4) years. Total treatment costs per patient and per tooth were 6,998 (3,807) and 267 (148) Euro, respectively. Approximately 87% of the costs were generated during SPT, 13% during APT. Annual patient- and tooth-level costs were 536 (209) and 20.1 (65.0) Euro, respectively. Annual tooth-level costs were significantly increased in patients aged 34 years or older, male patients, former or current smokers, teeth with furcation involvement degree II/III, and bone loss 50%-70%. CONCLUSIONS: Annual treatment costs for treating AgP patients were similar to those found for chronic periodontitis patients. Certain parameters might predict costs.

Outcome of Single- vs Multiple-visit Endodontic Therapy of Nonvital Teeth: A Meta-analysis.

INTRODUCTION: Endodontic therapy is a specialized procedure more demanded by patients within public oral health care in the country. Then, single-visit endodontic therapy may offer advantages to the health care services, to the professionals, and to the patients by reducing access barriers. MATERIALS AND METHODS: A meta-analysis was done and the variables evaluated were periapical repair, microbiological control, and postobturation pain in randomized clinical trials (RCTs) involving endodontic treatment of nonvital teeth at single- or multiple visits. RESULTS: About 17 RCTs were included. There were no differences found in periapical repair or microbiological control in single- and multiple-visit therapy. Single-visit endodontic therapy resulted in 21% less postobturation pain (relative risks = 0.79; 95%, confidence interval: 0.66-0.94). CONCLUSION: There was less postobturation pain in the single-visit endodontic therapy group. In the public dental care, this analysis favors the adoption of this one therapy because it will be possible to increase the patient access and the supply of this therapy. CLINICAL SIGNIFICANCE: It is possible to get a better cost-effectiveness for the patients and the health care service. This is very important because the reduction of the cost to the patient allows it to become a complete treatment. The health service, in turn, is able to be better used, with a greater supply of this service.

Are clinical decisions in endodontics influenced by the patient's fee-paying status?

OBJECTIVE: We explored whether the fee status of a UK patient influences clinical decision-making in endodontics. SUBJECTS AND METHODS: In a randomised-controlled vignette study describing either an 'NHS-funded', 'Privately-funded' or undisclosed fee-status patient, we examined the importance vocational trainer dentists placed on a series of factors normally considered when deciding whether to offer patients endodontic treatment as opposed to extracting the tooth. N = 119 experienced (M years post qualification = 20.01) dentists participated. MAIN OUTCOME MEASURES: Having read a vignette describing a hypothetical patient who could potentially be treated either endodontically or through an extraction, dentists rated a series of factors they would normally consider (for example, poor oral hygiene, the rest of their mouth is unfilled and caries-free), before recommending either endodontic treatment or an extraction. RESULTS: The patient's funding status had no influence on these dentists' clinical decision-making when considering endodontic treatment as an option (p >0.05) with the exception of a single item relating to infrequent attendance where the NHS patient was more likely than the 'undisclosed-fee' patient, to be offered extractions (F (2, 116) 3.43, p <0.04). CONCLUSIONS: We have found no strong evidence to suggest that the fee-status of a patient influences clinical decision-making in endodontic treatment by experienced dentists.

A survey for endodontists in today's economy: exploring the current state of endodontics as a profession and the relationship between endodontists and their referral base.

INTRODUCTION: The purpose of this study was to assess the perceptions, referral trends, and practice patterns of practicing endodontists in the United States and any effect the recent economy may have had on these. METHODS: A 24-question survey was formulated and sent via www.surveymonkey.com to 3255 active members of the American Association of Endodontists. Overall, 875 participants completed the survey, a response rate of 26.9%. RESULTS: The average number of treatment cases per day was 5.7. Average work hours per week were 34.3 for men and 30.7 for women (P < .05). Among all treatment cases, 46% were nonsurgical retreatment, and 7.2% were apical surgical procedures. Procedural misadventure accounted for 10.8% of all treatment cases, with the most common referral reason being unable to locate canals (75.0%) followed by separated instruments (15.3%). Of all respondents, 49.9% performed regenerative endodontic procedures, and 7.7% placed implants. Among endodontists who practice in urban areas, 69.7% believed there were too many endodontists, and 50% have delayed their retirement plans because of recent economic impact, compared with their suburban and rural counterparts at 66.1% and 38%, 25.9% and 33.1%, respectively (P < .05). Fifty-nine percent of respondents were optimistic about the future of endodontics as a specialty, but those who have practiced more than 20 years were more pessimistic than those with less experience (P < .05). CONCLUSIONS: Recent economic impacts appear to have had an effect on the perceptions of active endodontists regarding practice success, the future of the specialty, and their retirement plans. Those who have been in practice longest (>20 years), practice in urban settings, and practice in a solo environment are most significantly affected.

The 'E' factor -- evolving endodontics.

Endodontics is a constantly developing field, with new instruments, preparation techniques and sealants competing with trusted and traditional approaches to tooth restoration. Thus general dental practitioners must question and understand the significance of these developments before adopting new practices. In view of this, the aim of this article, and the associated presentation at the 2013 British Dental Conference & Exhibition, is to provide an overview of endodontic methods and constantly evolving best practice. The presentation will review current preparation techniques, comparing rotary versus reciprocation, and question current trends in restoration of the endodontically treated tooth.

The status of mineral trioxide aggregate in endodontics education in dental schools in Turkey.

The aim of this study was to assess the current status of mineral trioxide aggregate (MTA) as an educational material in dental schools in Turkey. A survey was sent to senior members of the endodontic departments of seventeen dental schools; fourteen responded. All respondents reported that they used MTA in their clinical practice, with apexification, perforations, retrograde fillings, and root resorptions being the most frequently occurring treatment procedures. All reported that information was given to students regarding MTA mainly as part of the curriculum. The third and fourth years were the periods when MTA was introduced to students in most of the schools. Twelve schools reported that students had the opportunity to observe procedures in which MTA was used, but students had the chance to use the material in a very minor proportion of the schools, mainly under the supervision of clinical instructors. Ten schools agreed that MTA should be included in the regular endodontic curriculum. Financial constraints seemed to be the predominant reason for those who answered this question negatively, followed by difficult handling properties and low radiopacity of the material. Within the limitations of this study, it can be concluded that ways should be sought to prevent financial difficulties from depriving dental students of the opportunity to receive information about contemporary methodologies such as MTA utilization.

A cost-minimization analysis of root canal treatment before and after education in nickel-titanium rotary technique in general practice.

AIM: To compare root canal treatments performed before and after education in a nickel-titanium rotary technique (NiTiR) with respect to costs for instrumentation and number of instrumentation sessions in a County Public Dental Service in Sweden. METHODOLOGY: Following education, 77% of the general dental practitioners adopted completely the NiTiR. The randomly selected sample comprised 850 root canal treatments: 425 performed after the education, mainly using the NiTiR-technique (group A) and 425 performed before, using mainly stainless steel hand instrumentation (SSI) (group B). The number of instrumentation sessions in root canal treatments in group A and B was calculated. A CMA was undertaken on the assumption that treatment outcome was identical in group A and B. Direct costs associated with SSI and NiTiR were estimated and compared. Investment costs required for implementation of NiTiR were calculated, but not included in the CMA. RESULTS: Instrumentation sessions were counted in 418 (98%) root canal treatments performed in group A and 419 (99%) in group B. The number of instrumentation sessions in group A was significantly lower; 2.38, compared with 2.82 in group B (P < 0.001). Thus, on average, for every second root canal treatment performed after the education, one instrumentation session was saved. Root canal treatments in teeth with one canal, and three or more canals, were completed in significantly fewer instrumentation sessions after the education (P < 0.001). Direct costs of instrumentation sessions were SEK 2587 (USD 411) for group A and SEK 2851 (USD 453) for group B, for teeth with one canal, and SEK 2946 (USD 468) for group A and SEK 3510 (USD 558) for group B, for teeth with three or more canals (year 2011). Root canal treatments of teeth with two canals showed no significant difference with respect to number of instrumentation sessions and costs. CONCLUSIONS: Significantly fewer instrumentation sessions were required in group A, and root canal instrumentation therefore costs less than in group B. On the assumption that treatment outcome is identical in group A and B, root canal instrumentation performed after the education was more cost-effective.

Cost-effectiveness of endodontic molar retreatment compared with fixed partial dentures and single-tooth implant alternatives.

INTRODUCTION: One of the most challenging situations in dentistry is a failed root canal treatment case. Should a failed root canal-treated tooth be retreated nonsurgically or surgically, or should the tooth be extracted and replaced with an implant-supported restoration or fixed partial denture? These four treatment alternatives were compared from the perspective of cost-effectiveness on the basis of the current best available evidence. METHODS: The costs of the four major treatment modalities were calculated using the national fee averages from the 2009 American Dental Association survey of dental fees. The outcome data of all treatment modalities were retrieved from meta-analyses after electronic and manual searches were undertaken in the database from MEDLINE, Cochrane, ISI Web of Knowledge, and Scopus up to April 2010. The treatment strategy model was built and run with TreeAge decision analysis software (TreeAge Software, Inc, Williamstown, MA). RESULTS: Endodontic microsurgery was the most cost-effective approach followed by nonsurgical retreatment and crown, then extraction and fixed partial denture, and finally extraction and single implant-supported restoration. CONCLUSIONS: The cost-effectiveness analysis showed that endodontic microsurgery was the most cost-effective among all the treatment modalities for a failed endodontically treated first molar. A single implant-supported restoration, despite its high survival rate, was shown to be the least cost-effective treatment option based on current fees.

The need and reasons for referrals to specialists among Lithuanian general dentists.

OBJECTIVE: To analyze the need for referral to a specialist and to identify the reasons of referrals among Lithuanian general dental practitioners. MATERIAL AND METHODS: Questionnaires were sent to all 2879 Lithuanian dental practitioners registered on the Lithuanian Dental Chamber license registry. The questionnaire was made with multiple-choice answers. Respondents were asked to choose only one category of answer that best fitted their clinical attitude. Questions included in the questionnaire concerned general and specific information regarding the need and main reasons for endodontic referral. RESULTS: Of the 2879 questionnaires mailed, 1532 questionnaires containing useful information were returned. The response rate was 53.2%. Of the 1532 respondents, 1431 were general dental practitioners. Majority (72.1%) of the respondents performed complicated root canal treatment by themselves. Almost half (49.6%) of them would like to refer patients to an endodontist. Two of the reasons, which restricted their decision, were the shortage of endodontists and high cost of the procedures in the specialized clinics. Approximately 19% of the respondents referred patients to an endodontist. The main reasons for referral were fractured instruments (86.6%), dental trauma (83.6%), difficulties in diagnostics (79%) followed by persistent symptoms (78.1%). CONCLUSION: The findings of the present study suggest that the need for referral of patients to an endodontist among Lithuanian dental practitioners exists. The main reasons for referrals were complications of endodontic treatment, traumatic injuries, difficulties in diagnostic procedures, and persistent symptoms.

Update on imbalanced distribution of endodontists: 1995-2006.

INTRODUCTION: Past studies on the number of endodontists in the United States indicated an imbalanced distribution of private practice endodontic practitioners in most regions, states, counties, and zip code areas of the country. The availability of more recent studies by the American Dental Association (ADA) provides an opportunity to follow up on these previous studies. METHODS: The 2006 and past ADA surveys on the Distribution of Dentists in the United States, Advanced Dental Education, and Dental Practice were used to evaluate the number of graduates from advanced education programs in endodontics, the changing number and distribution of endodontists, full-time and part-time work patterns, and the income of private practicing endodontists. RESULTS: A gradual increase in the number of graduates from advanced education programs in endodontics is reflected in a continuing increase in the overall number of private practicing endodontists, but with ongoing differences in endodontists-to-population ratios at the regional and state levels. CONCLUSION: The findings follow previous study results confirming the increasing numbers of endodontists and continuing differences in the endodontists-to-population ratios at both the regional and state levels. Concerns about the distribution of endodontists in the future need to be considered in terms of evolving dental disease patterns, changing demands for services, evolving third-party mechanisms, and the increased number of female practitioners (with fewer reported working hours than their male counterparts).

[Endodontic treatment or dental implant treatment?]. / Leczenie endodontyczne czy implantologiczne?

INTRODUCTION: The main purpose of today's dental treatment is the longest possible retention of teeth with all its functional and esthetic aspects. Thanks to modern endodontic techniques and microsurgical procedures, it is possible today to treat and keep teeth that would have had to be extracted before. On the other hand, the latest development of forms and surfaces of dental implants, improved operation techniques and precision in preparing superstructures have determined a significant increase of percentage of successful implantations and survival rate of the implants, widening the range of possibilities of prosthetic reconstructions. The aim of this study is to present current, often ambiguous view on the problem of long-term effects of endodontic treatment and its impact on teeth retention compared with effects of dental implant treatment and to try to answer the question: extirpation or implantation? MATERIALS AND METHODS: The comparative research was based on studies published within two databases: PubMed and Medline. RESULTS: Studies from a 10 years' period show similar percentage of surviving teeth after endodontic treatment and surviving implants: between 86 and 94 per cent with slight advantage of the implants. Esthetic problems, the time needed for implantation procedures and high costs of implant treatment make implantation less attractive and accessible. However, anatomical limitations ofmultirooted teeth, extensive periapical granulomatic lesions or considerable crown and root destruction are all indications for implant treatment. The lack of clear-cut evaluation criteria regarding both endodontic and implant treatment success makes statistic analysis impossible.

Root canal treatment in a population-based adult sample: differences in patient factors and types of teeth treated between endodontists and general dentists.

OBJECTIVE: The purpose of this study was to identify in a population-based study the differences between general dentists and endodontists with regard to types of teeth treated, fees, and patient characteristics. BASIC RESEARCH DESIGN: The "Florida Dental Care Study" was a prospective cohort study using a representative baseline sample of 873 dentate adults. In-person interviews and clinical examinations were conducted at baseline, 24 months, and 48 months, with 6-monthly telephone interviews between those times. Dental record information was abstracted afterward. RESULTS: A total of 100 root canals were performed in participants during the study period. While generalists performed the majority of endodontic procedures in all teeth, the percentage of molars treated by endodontists was significantly higher than the percentage of anterior teeth and bicuspids treated by endodontists. Data on fees were available in 85 of the cases. The trend was for endodontists fees to be higher, but the difference in fees was statistically significant only for molars. There were no statistically significant differences between generalist and specialist patients with regard to income, fear of pain, and frustration from previous dental care. However, a significantly higher percentage of patients treated by endodontists had dental insurance. CONCLUSIONS: Although the number of teeth ultimately treated in this representative sample of a dentate population was small, results do suggest that endodontists' fees were higher, they performed a higher percentage of molar root canals, and their patients were more likely to have dental insurance, as compared to general dentists who did root canals.

The dental care pathway of welfare recipients in Quebec.

IN Quebec (Canada), the utilization of dental care services varies greatly from one social class to another: whereas the well-to-do visit the dentist often for check-ups, those most in need demonstrate a "wait-and-see" attitude. The objective of our research was to describe the dental care pathway of the underprivileged when confronted with symptoms, and to understand how this pathway might be interrupted and possibly lead to tooth extractions. We arranged 16 one-on-one interviews with adult Montrealers who had experienced a dental problem during the 12 months preceding the interview. These participants, 9 women and 7 men aged between 30 and 48, lived in great poverty: all were welfare recipients, and as such, enjoyed the benefits of a government programme that entitled them to free basic dental care. During the interviews, the interviewers asked the participants to describe their latest dental problem and their subsequent behaviour. The dental care pathway of our participants was characterized by a strategy of adapting to the symptoms. This process of adapting, which can last several months, is essentially an individual process in which the individuals often resort to self-medication to soothe their pain. They decide to visit a dentist when the pain is too great and self-medication is no longer effective. Once this decision is made, their dental care pathway may nevertheless be interrupted in two ways: first, in the failure to find a dentist, and second, later, in the failure to complete treatments that are not covered by the welfare program, such as endodontic treatment. The fragmented character of these dental care pathways refers us to two features of accessibility: financial accessibility and acceptability. With regard to financial accessibility, our study shows that the public coverage intended for welfare recipients presents major gaps. As for acceptability, our participants are strongly critical of the dental profession, and develop a culture of rejection of it.

Endodontics and new graduates: Part I, Practice vs training.

Surveys have demonstrated that many dentists, even the recently qualified, do not carry out endodontics using currently recommended materials and techniques. To assess the scale and nature of this finding among young graduates, a questionnaire was sent to all graduates from the mainland United Kingdom dental schools qualified for either one or four years. Widespread reduction in the number of radiographs taken and rubber dam use was found. A minority had adopted techniques and materials without published guidelines. It is suggested that alterations are required in undergraduate teaching, vocational training and the United Kingdom National Health Service remuneration system in order to improve the standard of endodontics in general practice.