Retrospective Assessment of Endodontically Treated Teeth Replaced by Dental Implants.

INTRODUCTION: This study investigated endodontically treated teeth that were replaced by dental implants at the University of North Carolina (UNC) at Chapel Hill School of Dentistry. The primary objective of this study was to determine the reasons leading to the extraction of endodontically treated teeth and their subsequent replacement with dental implants. The secondary objective was to evaluate the proportion of these teeth that, according to experienced endodontists, could have been preserved. METHODS: The UNC-Chapel Hill's dental electronic health records between 2004 and 2019 were probed for implant placement that replaced root canal-treated teeth. Preextraction radiographs and clinical charts were examined to ascertain the primary reason related to the extraction and to compile a profile for each case. In cases in which endodontic failure was the primary reason for extraction, radiographs and clinical findings were evaluated by 2experienced endodontists to assess potential treatment options. RESULTS: Between 2004 and 2019, 29.3% (1564 of 5229) of teeth replaced by dental implants at UNC School of Dentistry had undergone root canal treatment, with the mandibular first molar being the most commonly replaced tooth. The leading reasons for extraction were recurrent caries associated with defective restoration (26.6%), fracture of coronal structure (21.5%), vertical root fracture (20.9%), compromised periodontal condition (13.8%), and endodontic failure (2.4%). Two experienced endodontists evaluated extractions due to endodontic failure and concluded that 61.7% of them could have been candidates for endodontic retreatment. CONCLUSION: Substantial loss of tooth structure was the leading cause of extraction of root canal-treated teeth, followed by vertical root fracture and periodontal disease. Although endodontic failure constituted a minor portion of the reasons for extraction, a considerable number of teeth were extracted due to vertical root fractures following root canal treatment. A significant proportion of the extracted teeth due to endodontic failure could have been considered as potential candidates for endodontic retreatment.

Evaluation of 3D MRI for early detection of bone edema associated with apical periodontitis.

OBJECTIVES: To detect and evaluate early signs of apical periodontitis using MRI based on a 3D short-tau-inversion-recovery (STIR) sequence compared to conventional panoramic radiography (OPT) and periapical radiographs in patients with apical periodontitis. MATERIALS AND METHODS: Patients with clinical evidence of periodontal disease were enrolled prospectively and received OPT as well as MRI of the viscerocranium including a 3D-STIR sequence. The MRI sequences were assessed for the occurrence and extent of bone changes associated with apical periodontitis including bone edema, periradicular cysts, and dental granulomas. OPTs and intraoral periapical radiographs, if available, were assessed for corresponding periapical radiolucencies using the periapical index (PAI). RESULTS: In total, 232 teeth of 37 patients (mean age 62±13.9 years, 18 women) were assessed. In 69 cases reactive bone edema was detected on MRI with corresponding radiolucency according to OPT. In 105 cases edema was detected without corresponding radiolucency on OPT. The overall extent of edema measured on MRI was significantly larger compared to the radiolucency on OPT (mean: STIR 2.4±1.4 mm, dental radiograph 1.3±1.2 mm, OPT 0.8±1.1 mm, P=0.01). The overall PAI score was significantly higher on MRI compared to OPT (mean PAI: STIR 1.9±0.7, dental radiograph 1.3±0.5, OPT 1.2±0.7, P=0.02). CONCLUSION: Early detection and assessment of bone changes of apical periodontitis using MRI was feasible while the extent of bone edema measured on MRI exceeded the radiolucencies measured on OPT. CLINICAL RELEVANCE: In clinical routine, dental MRI might be useful for early detection and assessment of apical periodontitis before irreversible bone loss is detected on conventional panoramic and intraoral periapical radiographs.

Periapical Lesions and Missed Canals in Endodontically Treated Teeth: A Cone-Beam Computed Tomographic Study of a Chinese Subpopulation.

BACKGROUND Periapical lesions (PL) are a common complication of endodontically treated teeth (ETT), which can result from a missed canal (MC). This study aimed to assess the prevalence of PL and MC in the ETT of a Chinese subpopulation and investigate potential associations between them. MATERIAL AND METHODS A total of 561 cone-beam computed tomography images were selected and analyzed. A total of 1024 endodontically treated posterior teeth excluding third molars were evaluated for the presence of PL and MC. The chi-square test or Fisher's exact test, as well as the odds ratio test, were used to determine whether there was an association and risk relationship between the incidence of PL and the occurrence of MC. RESULTS The overall prevalence of PL and MC in ETT was 56.1% and 19.0%, respectively. In endodontically treated molars, the incidence of PL and MC was 64.1% and 27.6%, whereas in premolars, it was 42.1% and 4.27%. The maxillary first molar showed the highest frequency of PL (71.5%) and MC (65.7%), with the mesiobuccal second canal being the most missed (78.8%). Teeth with an MC were found to be 3.658 times (95% confidence interval=2.541-5.301, P<0.0001) more likely to be associated with a PL. CONCLUSIONS Endodontically treated teeth with missed canals are associated with higher risks of periapical lesions. The high prevalence of these complications in a Chinese subpopulation underscores the importance of implementing enhanced diagnostic and treatment methods for root canal treatment or retreatment.

Diagnostic efficacy of cone-beam computed tomography for detection of vertical root fractures in endodontically treated teeth: a systematic review.

BACKGROUND: Vertical root fractures (VRFs) sometimes occur in endodontically treated teeth. They have a difficult diagnosis and a dismal result. The objective of this review was to evaluate the diagnostic performance of cone-beam computed tomography (CBCT) for detecting VRFs in teeth that had undergone endodontic treatment. METHODS: Literature was reviewed from Web of Science, PubMed, Cochrane Review, SCOPUS, and Embase databases between 2000 and 2022. The searched keywords included "endodontically treated teeth," "cone-beam computed tomography," "CBCT," "tooth fracture," "vertical root fracture," "VRF," "accuracy," "sensitivity," and "specificity." Only articles in the English language were included. The final analysis included 20 papers that satisfied the eligibility requirements. RESULTS: The overall mean ± SD values (%) for the diagnostic sensitivity and specificity of CBCT for detection of VRFs in endodontically treated teeth in the presence of root-filling materials without an intracanal post were 71.50 ± 22.19 and 75.64 ± 19.41, respectively. The overall mean (SD) value (%) for the sensitivity of CBCT for the detection of VRFs in the presence of root-filling materials and intracanal posts was 72.76 (18.73), while the mean (SD) specificity was 75.44 (18.26). The accuracy of CBCT (mean ± SD) was 78.47 ± 17.19% and 74.02 ± 10.64%, respectively, for teeth without intracanal posts and those with posts. CONCLUSIONS: Further clinical research is needed to validate the optimum efficiency of CBCT as a diagnostic technique for detecting VRFs in teeth that have had endodontic treatment, given the low sensitivity, significant heterogeneity of studies, and lack of in-vivo studies on the subject.

Evaluation of Er,Cr:YSGG laser technique for fiber post removal of endodontically treated teeth using micro-computed tomography.

Various clinical techniques such as removal kits, ultrasonic tips, burs, and drills, have been used for fiber post removal in endodontically treated teeth. In most clinical cases, the dental practitioners prefer to use ultrasonic tips, despite the heat generation and the formation of microcracks induced in the radicular dentin. The purpose of this study was to investigate the effectiveness of using erbium, chromium: yttrium-scandium-gallium-garnet (Er,Cr:YSGG) laser (2780 nm) as an alternative fiber post removal technique and to compare it to an ultrasonic method using micro-computed tomography (micro-CT). The operating parameters of the X-ray tube were set to 50 kVp and 300 mA. This approach allowed the generation of 2D lateral projections that were then used to reconstruct the 3D volume in DICOM format. Fiber posts were removed from 20 endodontically treated single-rooted premolars (n = 10) using an ultrasonic vibrator with diamond-coated ultrasonic tip (control method), or Er,Cr:YSGG laser irradiation protocol; average power 2.5 W, repetition rate 20 Hz, pulse duration 140 µs, 40% air and 20% water, and close-contact mode. The number of sections with newly formed microcracks, the loss of dentinal tissue, the amount of the residual resin cement, and the removal time were evaluated for both methods. The data were analyzed using paired t-test, Wilcoxon signed-rank and Mann-Whitney U tests at level of significance a = .05. In the laser-treated group the parameters regarding microcracks formation (21 ± 16) and removal time (4.7 ± 1.1 min) were advantageous compared to the ultrasonic-treated group (42 ± 27 and 9.2 ± 1.0 min, respectively), indicating that Er,Cr:YSGG laser could be an alternative fiber post removal technique.

Effect of orthodontic treatment on the periapical radiolucency of endodontically treated teeth: a CBCT analysis.

BACKGROUND: This study aimed to evaluate periapical radiolucency of endodontically treated teeth before and after orthodontic treatment using cone-beam computed tomography (CBCT). METHODS: Patients who underwent orthodontic treatment at Wonkwang University Daejeon Dental Hospital between January 2009 and June 2022 were included based on the following criteria: root canal treatment, and availability of CBCT images taken before and after orthodontic treatment with an interval of > 1 year between both scans. Patients with primary teeth or orthodontic tooth extractions were excluded. The size of the periapical radiolucency (SPR) of the endodontically treated tooth was evaluated using CBCT. Pre-orthodontic treatment CBCT images and the latest post-orthodontic treatment CBCT images were analyzed. The selected teeth were further categorized based on the orthodontic duration, CBCT interval, the patient sex and age, the tooth type and position (maxilla or mandible), and quality of root canal obturation. Statistical analyses were performed to evaluate changes in SPR using the paired t-test and multiple regression analysis. RESULTS: In total, 115 teeth (37 anterior teeth, 22 premolars and 56 molars) from 61 patients (age, 14-54 years) were included, with 39 teeth from male patients and 76 teeth from female patients. The age was ranged between 14 and 54 years old, and mean age was 25.87 years old. The mean CBCT interval and orthodontic treatment period were 43.32 months and 36.84 months, respectively. Seventy-five teeth showed good obturation quality, 80 were not used as anchors during orthodontic treatment, and 71 were maxillary. The SPR size increased after orthodontic treatment for 56 teeth and decreased for 59 cases. The average change in SPR was -0.102 mm and the difference was not significant. Significant decrease of SPR were observed between female patients (p = 0.036) and maxillary teeth (p = 0.040). CONCLUSION: Orthodontic treatment had no significant impact on the changes in the SPR in endodontically treated teeth in most categories. However, there was a significant difference among females and the maxillary teeth. In both categories, the size of radiolucency decreased significantly.

Root filled teeth in two parallel Danish cohorts: A repeated longitudinal cohort study.

AIM: The aim of the study was to compare the frequency of root filled teeth and quality of root fillings (RFs) in two parallel, Danish cohorts each examined over 10 years and to evaluate factors associated with apical periodontitis (AP) and extraction of root filled teeth. METHODOLOGY: Two randomly selected cohorts (C1, C2) from Aarhus (age: 20-64 years) were followed for approximately 10 years, with full-mouth radiographic surveys performed at 5-year intervals (C1: 1997-2003-2008; C2: 2009-2014-2019). Frequency of root filled teeth, quality of RFs and coronal restorations, periapical status and tooth extraction were registered. Logistic regression analyses compared C1 with C2 for baseline and follow-up periods and assessed variables associated with AP (PAI-based) and extraction of root filled teeth. RESULTS: C1 included 330 and C2, 170 individuals, mean age 42.9 and 47.3 years, respectively, who attended all three radiographic examinations. The relative frequency of root filled teeth was lower in C2 than C1 at baseline (C1: 4.7%, C2: 3.6%; p < .001) and after 10 years (C1: 5.7%, C2: 4.2%; p < .001). The relative frequency of new RFs was lower in C2 than in C1 (p = .02). C2 had fewer short/long RFs at baseline than C1; quality of new RFs or coronal restorations was similar in C1 and C2. The risk of tooth extraction (p = .93) and risk of AP (p = .37) at 10-year follow-up was similar between the two cohorts. For both C1 and C2, root filled teeth with AP at baseline had increased risk of having AP (p < .001) or having been extracted (p < .001) at follow-up. Risk of extraction was higher for root filled premolars (p = .01) and molars (p = .01) than anteriors. Risk of AP at follow-up was higher for root filled molars (p < .001). Furthermore, inadequate quality of RFs (p = .02) and coronal restorations (p = .04) increased the risk of AP at follow-up in C1 and C2. CONCLUSIONS: The frequency of root filled teeth and new RFs decreased and little to no change in new RFs' quality, AP, or tooth extraction was seen over time (1997-2019). Root filled molars and teeth with AP at baseline had increased risk of AP and extraction.

A digital technique for a prefabricated custom post-and-core restoration.

This technique provides a prefabricated and custom post-and-core to restore endodontically treated teeth to be delivered at the preparation appointment. Cone beam computed tomography (CBCT) is used to extract the post shape from a root canal, and a computer-aided design and computer-aided manufacturing (CAD-CAM) software program is used to design the core. The post and the core are combined and milled before post space preparation. Three-dimensional preparation guides are fabricated and used in post space preparation to ensure that the prefabricated and custom post-and-core fits after the preparation. This technique can save time and reduce the risk of perforation while preparing the root canal.

Retratamientos endodónticos: una realidad que preocupa / Endodontic retreatment: a worrying reality

Las evaluaciones radiográficas de tratamientos endodón- ticos realizadas por graduados muestran un alto porcentaje de procedimientos incorrectos. Esta circunstancia lleva a la rea- lización de un elevado número de retratamientos ortógrados y retrógrados, con los inconvenientes y desventajas que conlle- va recurrir a una reintervención endodóntica. Es responsabili- dad de los profesionales, docentes y autoridades universitarias y gubernamentales revertir esta situación que afecta a la salud bucal de la sociedad. En el presente editorial se proponen di- ferentes alternativas para intentar modificar este preocupante panorama (AU)

Radiographic evaluations of endodontic treatments per- formed by graduates show a high percentage of incorrect procedures. This circumstance leads to the performance of a high number of orthograde and retrograde retreatments, with the inconveniences and disadvantages that entails resorting to an endodontic reintervention. It is the responsibility of pro- fessionals, teachers, university and government authorities to reverse this situation that affects the oral health of society. In this editorial, different alternatives are proposed to try to modify this worrying outlook (AU)

Lesiones perirradiculares asociadas a primeros molares superiores tratados endodónticamente: estudio a través de tomografías computadas / Periradicular lesions associated with endodontically treated maxillary first molars: study through computed tomography

Objetivos: Estudiar con tomografías computadas de haz cónico (CBCT) las lesiones perirradiculares de primeros molares superiores tratados endodónticamente; evaluar la lo- calización y, en los que tenían lesión en la raíz mesiovestibu- lar (MV), evaluar la frecuencia del conducto MV2. Materiales y métodos: A partir de una muestra de 179 tomografías, que incluían primeros molares superiores, se seleccionaron y analizaron aquellas en las cuales estos ha- bían recibido un tratamiento endodóntico previo, presentaban lesiones perirradiculares y conservaban una restauración co- ronaria. Las variables analizadas fueron: la localización de áreas radiolúcidas compatibles con lesiones perirradiculares de origen endodóntico y la correlación entre diferentes loca- lizaciones y la calidad del tratamiento realizado (adecuado, defectuoso o sin tratamiento). Los datos fueron analizados mediante la prueba de chi-cuadrado y la prueba de Spearman. Resultados: De las 179 CBCT que incluían primeros molares superiores, 90 reunían las condiciones requeridas. La frecuencia de las lesiones perirradiculares fue significativa- mente mayor en la raíz MV al compararla con las raíces disto- vestibular y palatina (p<0,05). El conducto MV1 presentó un tratamiento adecuado en todos los casos. El conducto MV2 recibió un tratamiento adecuado en 4 casos (4,44%), defec- tuoso en 4 casos (4,44%) y no tratado en 82 casos (91,1%); con una diferencia estadísticamente significativa (p<0,05). Conclusiones: En la muestra analizada, la localización de lesiones perirradiculares postratamiento endodóntico en primeros molares superiores se encontró con mayor frecuencia asociada a la raíz mesiovestibular, donde en la mayoría de los casos el con- ducto MB2 no fue tratado o presentó un tratamiento defectuoso (AU)

Aim: To study with cone-beam computed tomography (CBCT) the periradicular lesions of maxillary first molars with endodontical treatment; to evaluate its localization and, in those with a mesiobuccal root (MB) injury, assess the fre- quency of the MB2 root canal. Materials and methods: From a sample of 179 tomog- raphies (CBCT) that included maxillary first molars, those in which they had received previous endodontic treatment, pre- sented periradicular lesions and had a coronary restoration were selected and analyzed. The analyzed variables were: localization of radiolucent areas compatible with periradic- ular lesions of endodontic origin and the correlation between different localizations and quality of the performed treatment (adequate, defective, or untreated). Data were analyzed by the chi-square test and the Spearman test. Results: Of the 179 CBCT that included maxillary first molars, 90 met the required conditions. The frequency of periradicular lesions was significantly higher in the MB root when compared with distobuccal and palatal roots (P<0,05). The MB1 canal presented an adequate treatment in all cas- es. The MB2 canal received adequate treatment in 4 cases (4.44%), a defective one in 4 cases (4.44%) and was untreated in 82 cases (91.1%). The differences among these frequencies were statistically significant (P<0.05). Conclusions: In the analyzed sample, the localization of periradicular lesions after endodontic treatment in maxillary first molars was associated more frequently with the mesio- buccal root in which in the majority of cases the MB2 canal was untreated or presented a defective treatment

Minimal Detectable Width of Tooth Fractures Using Magnetic Resonance Imaging and Method to Measure.

INTRODUCTION: Vertical root fracture (VRF) in root canal-treated (RCT) teeth is a common cause of pain, bone resorption, and tooth loss. VRF is also difficult to diagnose and measure. Magnetic resonance imaging (MRI) has the potential to identify VRF due to beneficial partial volume averaging, without using ionizing radiation. This investigation aimed to describe the narrowest VRFs detectable based on MRI, using micro-computed tomography (microCT) as the reference standard and proposes a method using profile integrals to measure the widths of small VRFs. METHODS: VRFs were induced in 62 RCT tooth root samples. All samples were imaged in a phantom using MRI and reference imaging was obtained using microCT. The stacks of 3-dimensional axial MRIs were assessed by 3 board-certified endodontists. Evaluators determined the most coronal slice within the stack that was discernible as the extent of the VRF. This slice was measured on correlated microCT sections to determine the minimum VRF width (µm) detectable using a profile integral-based method to measure small fractures and negate the effects of the point spread function. RESULTS: Using profile integrals to measure VRF width was repeatable and resulted in estimates that were on average 1 µm smaller than known reference widths. Adjusted median VRF width detected using MRI was 45 µm (first quartile: 26 µm, third quartile: 64 µm). CONCLUSION: Using profile integrals is a valid way to estimate small VRF width. The MRI approach demonstrated ability to repeatedly detect VRFs as small as 26 µm.

The effect of a deep-learning tool on dentists' performances in detecting apical radiolucencies on periapical radiographs.

OBJECTIVES: To determine the efficacy of a deep-learning (DL) tool in assisting dentists in detecting apical radiolucencies on periapical radiographs. METHODS: Sixty-eight intraoral periapical radiographs with CBCT-proven presence or absence of apical radiolucencies were selected to serve as the testing subset. Eight readers examined the subset, denoted the positions of apical radiolucencies, and used a 5-point confidence scale to score each radiolucency. The same subset was assessed by readers under two conditions: with and without Denti.AI DL tool predictions. For the two sessions, the performance of the readers was compared. The comparison was performed with the alternate free response receiver operating characteristic (AFROC) methodology. RESULTS: Localization of lesion accuracy (AFROC-AUC), specificity and sensitivity (by lesion) detection demonstrated improvements in the DL aided session in comparison with the unaided reading session. Subgroup performance analysis revealed an increase in sensitivity for small radiolucencies and in radiolucencies located apical to endodontically treated teeth.. CONCLUSION: The study revealed that the DL technology (Denti.AI) enhances dental professionals' abilities to detect apical radiolucencies on intraoral radiographs. ADVANCES IN KNOWLEDGE: DL tools have the potential to improve diagnostic efficacy of dentists in identifying apical radiolucencies on periapical radiographs.

Root Surface Changes in Endodontically Treated Teeth following Orthodontic Movement.

INTRODUCTION: Orthodontically induced external root resorption has been labeled an unavoidable consequence of orthodontic tooth movement (OTM). The objective of this study was to investigate the change in surface area (mm2) and volume (mm3) of endodontically treated teeth (ETT) compared with contralateral teeth with a vital pulp (VPT) after OTM. METHODS: Seventy-six teeth were included in this retrospective analysis: ETT (n = 38) and VPT (n = 38). All teeth were evaluated using cone-beam computed tomographic imaging at 2 time periods: before OTM (T1) and after OTM (T2). Study teeth were segmented to include all areas contained within the lamina dura and then were converted into a mesh model for data calculation. The surface area (mm2) and volume (mm3) of each tooth were calculated at T1 and T2 based on the number of cubic voxels present within the mesh model. Statistical analysis was performed using a linear mixed-effects model. RESULTS: The average change in surface area after OTM in ETT was 13.01 mm2 and 19.95 mm2 in VPT (P < .05). The average percent change in surface area after OTM in ETT was 2.09% and 3.38% in VPT (P < .05). The average change in volume after OTM in ETT was 22.48 mm3 and 32.44 mm3 in VPT (P < .05). The average percent change in volume after OTM in ETT was 2.62% and 4.10% in VPT (P < .05). CONCLUSIONS: The results from this study suggest that ETT are less susceptible to root resorption after OTM than their vital counterparts.

Radiological Assessment of Prevalance and Quality of Periapical Status of Endodontic Treatments.

BACKGROUND The aim of this study was to determine the current prevalence and quality of endodontic treatments and investigate the relationship of various factors with posttreatment endodontic disease (PTED) in a Turkish subpopulation. MATERIAL AND METHODS The cone beam computed tomography (CBCT) images of 1069 patients (male, 50.9%; female, 49.1%; mean age, 45.32±13.50 years) were retrospectively analyzed. A total of 20 646 teeth were examined; 1604 had undergone root canal. Periapical status was assessed using a modified CBCT periapical index. The relationship between periapical status and quality of root canal fillings (RCFs) was analyzed statistically using the chi-square test. Multivariate logistic regression was performed to evaluate the effect of individual parameters by adjusting them for other variables. RESULTS A total of 7.8% of all teeth had RCF. The prevalence of poor filling (having at least 1 procedural error) was 54.1%; the prevalence of PTED was 56.8%. The prevalence of PTED was 44.3% in teeth with short RCF, 10.8% with overextended RCF, 35.7% with nonhomogeneous RCF, and 15.5% in teeth with untreated root canals. The rate of RCF teeth with procedural errors associated with PTED was 76.2%. There was no significant difference between sexes in apical periodontitis (P>0.05), which developed more frequently in teeth with procedural errors. CONCLUSIONS The overall prevalence of poor fillings (having at least 1 procedural error) among RCF teeth was high (54.1%) in this subpopulation. There is a substantial need to improve the technical quality of endodontic treatment.

Evaluation of endodontically treated teeth and related apical periodontitis using periapical and endodontic status scale: Retrospective cone-beam computed tomography study.

The purpose of this study was to evaluate the technical treatment quality and the status of apical pathology of endodontically treated teeth, as well as apical periodontitis (AP) prevalence, in a Turkish population using cone-beam computed tomography (CBCT). The CBCT images obtained between January 2018 and April 2020 were retrospectively examined. The quality of the endodontic treatments and the related periapical inflammatory lesions were classified according to the periapical and endodontic status scale (PESS). The data were statistically analysed using logistic regression, crosstabs and chi-square tests. AP was detected in 41% of 429 endodontically treated teeth. The prevalence of AP was significantly higher in teeth with inadequate root canal treatment compared with those with adequate treatment, 70.8% and 29.3%, respectively. Inadequate canal length and homogeneity, and complications were significantly associated with the prognostic periapical status scores of higher risk.

Radiographic outcomes and prognostic factors in nonvital immature permanent teeth after apexification with modified calcium hydroxide paste: a retrospective study.

OBJECTIVE: To assess the radiographic outcomes and prognostic factors in nonvital immature permanent teeth after apexification with modified calcium hydroxide paste. MATERIALS AND METHODS: Clinical and radiographic data were collected from 115 necrotic immature permanent teeth (71 caused by trauma and 44 caused by dens evaginatus) treated with apexification using a modified calcium hydroxide. Postoperative root morphology and changes in radiographic root area (RRA) on periapical radiographs were determined and statistically evaluated. Regression analysis was performed to identify factors associated with the outcomes of apexification. RESULTS: The average time for a calcified barrier formation was 10.66 ± 6.37 months. The root morphology after apexification with calcium hydroxide + iodoform paste was similar to that previously described after calcium hydroxide apexification. Compared with the trauma cases, the dens evaginatus cases revealed more type I (40.91% vs 16.9%) and less type II morphology (45.45% vs 67.61%). Although the changes in RRA were limited, the dens evaginatus cases showed greater increment of RRA than the trauma cases (4.12% ± 5.58% vs 0.70% ± 5.21%, P < 0.001). A significant association was found between the preoperative stage of root development and postoperative percentage change in RRA (P < 0.001). CONCLUSIONS: Teeth caused by dens evaginatus had better outcomes after apexification than teeth caused by trauma. Early stages of root development were associated with superior radiographic outcomes. CLINICAL RELEVANCE: Apexification provided reliable outcomes in the treatment of immature teeth with pulp necrosis and apical periodontitis, even though the root development is limited. Treatment decision should be made with comprehensive evaluation of prognostic factors.

Evaluación radiográfica de 5000 tratamientos endodónticos realizados en premolares y molares mandibulares y maxilares en una población en Argentina / Radiographic evaluation of 5000 endodontic treatments performed on mandibular and maxillary premolars and molars in a population in Argentina

Objetivo: Evaluar radiográficamente tratamientos en- dodónticos del sector posterior de la cavidad bucal y com- parar la frecuencia de aceptabilidad en cada pieza dentaria involucrada. Materiales y métodos: Se evaluaron 5000 radiogra- fías de archivo de tratamientos endodónticos realizados apro- ximadamente entre 2005 y 2019 en premolares y molares mandibulares y maxilares en Argentina. Se consideraron tratamientos correctos e incorrectos de acuerdo con: 1) con- formación de la preparación quirúrgica; 2) límite apical de la obturación; 3) homogeneidad de la obturación. Se obtuvo la fre- cuencia absoluta y relativa de correctos e incorrectos. El aná- lisis entre frecuencias y pieza dentaria se realizó con la prueba de chi cuadrado y el cálculo del coeficiente V de Cramer. Para la comparación entre grupos de piezas dentarias se utilizó la partición del valor de chi cuadrado obtenido en los corres- pondientes grados de libertad. Nivel de significación P <0.05. Resultados: La partición del valor de chi cuadrado no mostró diferencias significativas entre primeros y segundos premolares mandibulares. Las otras comparaciones exhibie- ron diferencias significativas. Conclusiones: Un alto porcentaje de los tratamientos endodónticos de la población estudiada tiene por lo menos una condición que permite categorizarlos como incorrectos según el criterio establecido en este trabajo. Este porcentaje es más preponderante en anatomías complejas (AU)

Aim: To evaluate radiographically endodontic treat- ments performed in the posterior area of the oral cavity and compare the frequency of acceptability in each tooth involved. Materials and methods: 5,000 archival radiographs of endodontic treatments performed between 2005 and 2019 on mandibular and maxillary premolars and molars in Argentina were evaluated. The percentages of correct and incorrect treatments were considered according to 1) shaping of the preparation; 2) apical limit of the obturation; 3) homogeneity of the obturation. The absolute and relative frequencies of correct and incorrect treatments were calcu- lated. The association between these frequencies and tooth type was analyzed using the chi-square test and Cramer's V coefficient. For the comparison between groups of teeth, the partition of the chi-square value obtained in the corre- sponding degrees of freedom was used. Level of significance was P <0.05. Results: The partition of the chi-square value did not show a significant difference between the first and second lower premolars. The differences were significant in the other comparisons. Conclusions: A high percentage of the endodontic treat- ments in the study population have at least one condition war- ranting their classification as incorrect according to the crite- ria established in this study. This percentage is more prevalent in complex anatomies (AU)

Endodontic mishaps during root canal treatment performed by undergraduate dental students: An observational study.

ABSTRACT: Endodontic mishaps during root canal treatment (RCT) are considered to be one of the most commonly encountered errors, which affect the quality of treatment and may have dangerous health implications for patients.The present study was conducted to assess the frequency and types of endodontic mishaps in root canal-treated teeth performed by undergraduate dental students.A total 404 endodontically treated teeth were performed by undergraduate dental students of King Khalid University College of Dentistry, Abha, Kingdom of Saudi Arabia. The radiographs of the endodontically treated teeth were studied for a period of 6 months, and the related demographic data were collected from patient files.The most commonly identified mishaps were related to obturation, where the maximum number of cases (68.1%) had under-obturated root canals. More endodontic mishaps were performed by students in level 9 education. The upper left 2nd molar teeth had a higher frequency of mishaps, and molars were found to have more access-related mishaps. Lastly, access-related and instrument-related mishaps had a low frequency of occurrence.The majority of endodontic mishaps found in the study sample were related to root canal obturation. The undergraduate students at level 9 were less proficient in conducting RCTs with many endodontic mishaps when compared to the cases performed by students at higher levels. The study suggests relevant guidance for dental students while performing RCTs, especially during obturation of the root canals.

Accelerated healing of endodontically treated teeth with a periapical lesion as a result of orthodontic extrusion: evaluation and rationale.

Resolution of a periapical periodontal lesion as determined by radiographic examination may take a year or longer. Orthodontic movement is known to have a positive effect on the bone topography and morphology. The literature presents no information about the effect of orthodontic movement on the rate of periapical endodontic healing following a root canal treatment. The aim of this report was to present the use of orthodontic root extrusion in cases with a periapical lesion, where other options are ruled out. Three case reports involving endodontically treated teeth with a periapical lesion are presented. In each case, the performed orthodontic extrusion resulted with healing of the periapical environment towards a predictable crown fabrication or replacing a hopeless tooth more safely with an implant-supported crown. In all cases presented, signs of radiographic healing were demonstrated in a relatively shorter time than is considered acceptable, following the extrusive orthodontic movement, with no clinical sensitivity to percussion or periodontal pockets. In conclusion, orthodontic extrusion of endodontically treated teeth with periapical lesions presented positive radiographic healing signs along with no clinical symptoms of pain and mobility and a positive effect on marginal bone level and soft tissues, at a faster rate than was expected. This report may assist in supporting a clinical decision to apply vertical extrusive forces on compromised endodontically treated teeth presenting with a periapical lesion. Healing signs may be observed within a shorter time period, which may allow better prediction for the prosthetic phase.

The Development of Large Radicular Cysts in Endodontically Versus Non-Endodontically Treated Maxillary Teeth.

Background and Objectives: Large radicular cysts of the maxilla present a clinical challenge, as they may cause recurrent infection, severe alveolar bone loss and disruption of the nasal and maxillary sinus floors. The aim of this study was to evaluate the effect of previous root canal treatment on the clinical presentation of large maxillary radicular cysts. Materials and Methods: All cases of radicular cysts treated at the Oral and Maxillofacial Surgery Department of a tertiary public hospital over a period of six years (2012-2018) were evaluated. Histologically confirmed radicular cysts of the maxilla with a maximal dimension of over 15 mm were included. Demographic data of the patients, clinical presentation and radiographic features of the lesions were analyzed. Results: A total of 211 inflammatory cysts were treated in the study period, of these 54 histologically diagnosed radicular cysts in the maxilla were found to have a maximal dimension of over 15 mm. The mean age of patients with large maxillary radicular cysts was 43.3 years, 57.6% of which were male and 42.4% female. The lateral incisor was the most common tooth affected (46.3%). The mean size of the large radicular cysts was 25 mm. Then, 83.8% of the cysts were observed in teeth with previous endodontic treatment. Teeth without endodontic treatment presented clinically with significantly fewer acute symptoms in comparison to teeth with previous endodontic treatment. Conclusions: the vast majority (83.8%) of large maxillary radicular cysts were associated with endodontically treated teeth. Previous endodontic treatment was correlated to increased frequency of clinical symptoms.