Implementation of Digital Radiography during Root Canal Treatments in Saudi Endodontic and General Dental Practice.

Objective: To report usage of full-digital-radiography (FDR) during root-canal-treatments (RCTs) in Saudi dental-practice and to explore factors and measures that obstacle/contribute to better implementation. Methods: Following a pilot study, questions on demography, types of radiographic systems used during RCTs, advantages and disadvantages of FDR, reasons of not using it and measures that increase its implementation were included. The sample size was calculated considering the total number of general dentists (GDs) in Saudi Arabia and a 50-60% expected response rate. The questionnaire was emailed to 550 GDs and all endodontists in Saudi Arabia (185). A solo a reminder was emailed two months later. Data were analyzed by the Chi-square test at P=0.05. Results: Most participants (64.9%) used FDR for RCTs (P<0.001); with all endodontists (100%) and 52% of GDs (P<0.001). While all who were working in governmental-academia (100%) used FDR, 69.2% in private-academia did so (P<0.001); with no difference between private and governmental-clinics (60.6 and 69.2%). As the weekly-performed RCTs increased and participants' experience decreased, FDR usage increased (P<0.05). While high-cost was the main FDR disadvantage, faster-workflow, better image-quality and less-radiation were the main advantages (P<0.001). The majority (76.1%) of FDR none-users were doing so because of unavailability. Participants reported lower-cost and better undergraduate-education as most effective measures that increase FDR implementation in dental-practice. Conclusion: FDR was adopted to good extent in Saudi dental-practice. Financial aspects were the main concern that should be addressed to increase FDR implementation in private practice. Endodontists showed better perception towards FDR and suggested more attention to educational aspects.

Recomendaciones de la Asociación Española de Endodoncia sobre el uso de antibióticos en endodoncia / No disponible

Las encuestas realizadas en España ponen de manifiesto que los dentistas prescriben con frecuencia antibióticos en casos donde no están indicados, tanto a nivel terapéutico (pulpitis irreversible sintomática, pulpa necrótica con absceso apical agudo, periodontitis apical asintomática, absceso apical localizado sin síntomas generales en pacientes sanos), como profilácticamente. Esto puede contribuir al desarrollo de cepas bacterianas resistentes. La Asociación Española de Endodoncia (AEDE) propone estas recomendaciones, fruto del consenso de un comité de expertos y basadas en la evidencia científica, para proporcionar a los dentistas, y a otros trabajadores de la salud, criterios científicos sobre el uso de antibióticos en el tratamiento de las infecciones endodónticas, en la profilaxis antibiótica en endodoncia, y sobre el uso de antibióticos tópicos en endodoncia. Cuando la inflamación es localizada y discreta y no existe compromiso sistémico, el objetivo principal del tratamiento endodóntico es lograr el drenaje, no siendo necesarios los antibióticos. El tratamiento antibiótico sólo está indicado en los siguientes casos: 1) Pacientes inmunodeprimidos; 2) Absceso apical agudo con sintomatología sistémica (fiebre, adenopatías...); 3) Absceso api-cal agudo que progresa y se expande, como es el caso de las celulitis cérvico-faciales; 4) Reimplante de dientes avulsionados. El antibiótico de elección es la amoxicilina, con / sin ácido clavulánico, y la clindamicina en pacientes alérgicos a las penicilinas. La mejoría clínica debe ser la guía para la duración del tratamiento (3-5 días), y cuando exista evidencia de que los signos y síntomas han remitido, el tratamiento antibiótico debe interrumpirse. Respecto a la profilaxis antibiótica en endodoncia, debe considerarse en los siguientes casos: 1) Pacientes inmunodeprimidos; 2) Pacientes con riesgo de desarrollar endocarditis bacteriana; 3) Pacientes portadores de prótesis articulares; 4) Pacientes oncológicos sometidos a radioterapia; 5) Pacientes en tratamiento con bisfosfonatos por vía intravenosa. En estos casos la pauta será amoxicilina por vía oral, 2 gr en adultos o 50 mg / kg en niños, administrada 1 hora antes de la intervención

No disponible

[Consensus recommendations from Chinese experts on the standard operation procedure of dental operative microscope in endodontics and operative dentistry].

Dental operative microscope has been wildly used in endodontics and operative dentistry for many years. Many progresses have been made by using operative microscope in improving the outcomes of root canal therapy, endodontic surgery and operative dentistry. However, in clinical practice, improper use of the dental operative microscope is not uncommon, the reason related to which is the operator's lack of understanding and mastering not only the properties but also the standard operative procedure of the dental operative microscope. To this end, in October 2019, the vice chairman of the Society of Cariology and Endodontology, Chinese Stomatological Association, professor Liang Jingping, organized a group of professional experts in this field, convened a meeting about the standard operative procedure of dental operative microscope. Experts at the meeting had a very heated discussion and the consensuses were reached.

Determinación de la Longitud de Trabajo Mediante Localizador Electrónico de Foramen Apical y CBCT a Través del Software 3D Endo de Dentsply Sirona: Estudio Comparativo in vitro / Determination of Working Length Using Electronic Locator for Apex and CBCT with 3D Endo Dentsply Sirona Software: Comparative in vitro Study

RESUMEN: En la historia de la Endodoncia, se han utilizado distintos métodos para determinar la longitud de los canales radiculares, como sensación táctil y radiografías. Últimamente, han adquirido gran importancia los localizadores apicales electrónicos, por su gran precisión. Actualmente se ha incorporado el uso de imagenología con Cone Beam. Debido a que existen muchas formas de medir dicha longitud, es necesario ponerlos a prueba y ver si se asemejan a la técnica gold estándar definida en la literatura como el localizador electrónico de foramen apical. El propósito de esta investigación es determinar si existen diferencias estadísticamente significativas en la medida de la longitud de trabajo entre el localizador electrónico de foramen apical, y el uso de Cone Beam procesado con el software 3D endo de Dentsply Sirona. Para esto, se seleccionaron 30 premolares extraídos; se les tomó un Cone Beam para ser analizados con el software 3D endo y medir la longitud de trabajo. Una vez hecho esto, se realizó manualmente cavidad de acceso y se preparó el tercio cervical con fresas Gates Glidden 1 y 2; luego, los dientes fueron colocados en un modelo Pro Train, que asemejó las propiedades de los dientes en la cavidad oral, para permitir el uso del localizador electrónico de foramen y determinar la longitud de trabajo. Una vez obtenidos los datos, fueron comparados a través del Test de Proporciones (p=0.05 hipotético), dando como resultado p=0,2 lo que indica que no existen diferencias estadísticamente significativas en la medida de la longitud de trabajo entre ambos métodos.

ABSTRACT: Various methods have been used in the history of endodontics, to determine the length of the root canals (working length), such as tactile sensation and X-rays. Recently, apical locators have acquired importance, due to their precision. The use of Cone Beam has now also been incorporated. Because there are many ways to measure this length, it is necessary to test them and see if they resemble the standard gold measurement technique defined in the literature as the electronic apex locators. The purpose of this research is to determine whether there are statistically significant differences in the working length between the electronic apex locators, and the use of Cone Beam processed with the Software 3D Endo by Dentsply Sirona. For this, 30 extracted pre-molars were selected, for Cone Beam tomography and 3D endo Software analysis, to measure the working length. Once this was carried out, cavity preparation was performed manually, and the cervical third approached with gates glidden drills 1 and 2. Subsequently, the teeth were placed in a Pro Train model, which resembled the properties of the teeth in the oral cavity, to allow the use of the electronic apex locators to determine the working length.Once the data were obtained, they were compared through the proportions Test (p = 0.05 hypothetical), resulting in p = 0.2, indicating that there are no statistically significant differences in the working length between the two methods.

Clinical applications, accuracy and limitations of guided endodontics: a systematic review.

BACKGROUND: The novel concept of guided endodontics has been reported as an effective method to obtain safe and reliable results in root canal treatment. AIM: To evaluate by means of a systematic review the clinical applications, accuracy and limitations of guided endodontic treatment. DATA SOURCES: A search of the literature was performed on PubMed, Embase, Web of Science and Cochrane Library databases, until 25 April 2019. No language or year restrictions were applied. STUDY ELIGIBILITY CRITERIA: Articles that answered the research question, including case reports, in vitro and ex vivo studies were included. Data extraction was performed independently by two reviewers. STUDY APPRAISAL: Quality assessment was done using STROBE, CARE and Modified CONSORT guidelines for observational, case reports and pre-clinical studies, respectively. RESULTS: A total of 22 articles, including fifteen case reports, six pre-clinical studies (in vitro and ex vivo studies) and one observational study, were included. LIMITATIONS AND CONCLUSIONS: Even though the level of evidence is low, and the methodology described among studies heterogeneous, all articles describe guided access cavity preparation and guided surgery as being highly accurate and successful techniques when comparing the drilled path to the planned treatment. More studies with a larger number of patients are necessary to obtain significant conclusions.

Assessing a training programme for primary care dental practitioners in endodontics of moderate complexity: Pilot data on skills enhancement and treatment outcomes.

Aims: To explore the impact of dedicated training to extend the skills of primary care practitioners on the quality of endodontic care, using clinical, radiographic and patient-related outcomes. Methods: The quality of endodontic treatment performed at the beginning and end of training to become dentists with extended skills (DES) in endodontics was assessed in vitro and in vivo from endo-training blocks and self-reported logbooks containing clinical notes and radiographs respectively. The quality of endodontic care delivered by DES post-training was measured using clinical and radiographic outcomes. Patient-related outcomes were assessed using a self-report questionnaire, including the Oral Health Impact Profile ­ Endodontic Outcome Measure (OHIP-EOM). Results: Data on eight dentists were examined pre-and post-training, five of whom participated in further follow-up investigations on the quality of endodontic care delivered to their patients. Significant improvements in skills were seen for all domains in vitro (p <0.05), and for all domains of the clinical treatment process, and achieving the correct working length of the root filling as seen by radiography in vivo (p <0.05). The quality of the clinical process was maintained following training. Positive patient outcome (OHIP-EOM) scores were recorded (mean score of 34.72, SD = 10.74, n = 120 pre-treatment and 25.85, SD = 7.74, n = 47 representing reduced impact at follow-up). The majority of patients reported being satisfied, or very satisfied, with the service they received (72.5%, n = 98); would use the service again (68.1%, n = 92); and would recommend the service to friends and family (74.8%, n = 101). Conclusions: Findings suggest that training for dentists working in practice can be successful in enhancing skills and changing practice, with evidence of high patient satisfaction and good clinical and patient-related outcomes. Pilot results must be interpreted with caution and further research is required.

European Society of Endodontology position statement: External Cervical Resorption.

This Position Statement represents the consensus of an expert committee convened by the European Society of Endodontology (ESE) on External Cervical Resorption (ECR). The statement is based on current clinical and scientific evidence as well as the expertise of the committee. The primary aim is to provide a current authoritative position on the aetiology, histopathology, clinical presentation and management of ECR, and also to highlight areas where there is minimal evidence. Previously published review articles provide more detailed background information and the basis for this position statement (International Endodontic Journal 51, 1205, 2018, International Endodontic Journal 51, 1224, 2018). It is intended that this position statement will be updated at appropriate intervals, as further evidence emerges.

Surgical experience, workload and learning curve vs postoperative outcome.

AIM: In this review, we look at the factor of the surgical experience and surgical workload in a variety of surgical disciplines and its effect on the intraoperative and postoperative complications rate. MATERIALS AND METHODS: An extensive systematic electronic search was carried out on the relevant databases. Two independent reviewers were engaged in selecting appropriate articles in line with the protocol. RESULTS: It was very interesting to see that only 52 studies could be identified as per the inclusion criteria and search keywords. This included studies from 1990 onwards, spanning all surgical disciplines. Six studies were identified in third molar surgery, one of the most common surgeries practiced across all surgical disciplines. Seven appropriate oral implant surgery studies were identified, covering two-stage implants and immediately loaded implants. The evidence was overwhelming that the surgeon's experience positively correlates with the level of osseointegration and implant success. An interesting study from general surgery highlighted the fact it is not unusual to see senior surgeons selected to operate on complex patients or carry out complex surgical procedures than their junior colleagues. In face, this may explain why a number of studies identified no difference in the surgical complications between seniors and juniors. CONCLUSIONS: Despite the fact that experience matters, many factors can influence the outcome of the surgery. If the surgeon, despite his/her lack of seniority, manages to utilise experience appropriately then there will be a beneficial outcome for the patient.

Quality Assessment of Randomized Clinical Trials Reporting in Endodontic Journals: An Observational Study from 2012 to 2017.

INTRODUCTION: Reports on randomized clinical trials (RCTs) are of critical importance because readers of research often do not access the full text. This study aimed to assess the reporting quality of RCTs in 2 leading endodontic journals. METHODS: Issues of 2 endodontic journals, the Journal of Endodontics and the International Journal of Endodontics, dated from 2012 to 2017 were hand searched to identify RCT reports. A 37-item checklist based on the Consolidated Standards of Reporting Trials statement was used to examine the completeness of RCT reporting. RESULTS: One hundred nine RCT reports were included in this study. The majority were published in the Journal of Endodontics (82%). The mean overall reporting quality score was 65.0% (95% confidence interval, 77.3-66.5). Most (80%-100%) RCTs clearly reported the author/contact details, trial design, participant characteristics, number of participants, and recruitment status as well as the study's intervention(s), objective(s), outcome(s), and conclusions. Conversely, only 56 of the 109 articles (51%) satisfactorily reported all 5 items related to the randomization method. Registration of reviews was not reported in any of the included abstracts. Most of the studies included in this analysis did not report their RCT registration (22%), funding (35%), or protocols (23%). CONCLUSIONS: The results of this study suggest that the reporting quality of RCTs in endodontic journals requires further improvement. Better reporting of RCTs is particularly important for ensuring the reliability of research findings and ultimately promoting the practice of evidence-based dentistry. Optimal RCT reporting should be encouraged, preferably by complying with the Consolidated Standards of Reporting Trials guidelines.

Methodological and Reporting Quality of Systematic Reviews and Meta-analyses in Endodontics.

INTRODUCTION: The aim of this systematic review (SR) was to evaluate the quality of SRs and meta-analyses (MAs) in endodontics. METHODS: A comprehensive literature search was conducted to identify relevant articles in the electronic databases from January 2000 to June 2017. Two reviewers independently assessed the articles for eligibility and data extraction. SRs and MAs on interventional studies with a minimum of 2 therapeutic strategies in endodontics were included in this SR. Methodologic and reporting quality were assessed using A Measurement Tool to Assess Systematic Reviews (AMSTAR) and Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA), respectively. The interobserver reliability was calculated using the Cohen kappa statistic. Statistical analysis with the level of significance at P < .05 was performed using Kruskal-Wallis tests and simple linear regression analysis. RESULTS: A total of 30 articles were selected for the current SR. Using AMSTAR, the item related to the scientific quality of studies used in conclusion was adhered by less than 40% of studies. Using PRISMA, 3 items were reported by less than 40% of studies, which were on objectives, protocol registration, and funding. No association was evident comparing the number of authors and country with quality. Statistical significance was observed when quality was compared among journals, with studies published as Cochrane reviews superior to those published in other journals. AMSTAR and PRISMA scores were significantly related. CONCLUSIONS: SRs in endodontics showed variability in both methodologic and reporting quality.

Root Canal Irrigants and Medicaments in Endodontic Malpractice Cases: A Nationwide Longitudinal Observation.

INTRODUCTION: The aim of this study was to assess the role of root canal irrigants and medicaments in endodontic injuries verified in Finland and to estimate the rate of such events over time. METHODS: The study material comprised all endodontic injuries verified by the Patient Insurance Centre in 2002 to 2006 (n = 521) and 2011 to 2013 (n = 449). The data, based on patient documents scrutinized by 2 specialists in endodontics, included patients' and dentists' sex and age and the service sector. We recorded the use of root canal irrigants and medicaments, each as a dichotomy. Furthermore, we dichotomized the injuries as those related to root canal irrigants/medicaments and any other injuries. The injuries were also dichotomized as avoidable (could have been avoided by following good clinical practice) or unavoidable (normal treatment-related risks). Statistical evaluation used chi-square tests and t tests; logistic regression produced odds ratios (ORs). RESULTS: The verified injuries (N = 970) comprised 635 (65%) avoidable and 335 (35%) unavoidable injuries. The number of irrigant-/medicament-related injuries was 69, accounting for 7.1% of all verified injuries; all resulted from sodium hypochlorite and calcium hydroxide, and 87% were avoidable. The overall rate of sodium hypochlorite/calcium hydroxide injuries was 4.3 cases per 100,000 endodontic patients per year. Compared with other injuries, sodium hypochlorite/calcium hydroxide injuries were more likely avoidable (OR = 3.8) and more than 5-fold likely in 2011 to 2013 than in 2002 to 2006 (OR = 5.6). CONCLUSIONS: Extreme care is needed when applying sodium hypochlorite and calcium hydroxide into root canals to avoid increasing harmful consequences.

European Society of Endodontology position statement: the use of antibiotics in endodontics.

This position statement represents a consensus of an expert committee convened by the European Society of Endodontology (ESE) on Antibiotics in Endodontics. The statement is based on current scientific evidence as well as the expertise of the committee. The goal is to provide dentists and other healthcare workers with evidence-based criteria for when to use antibiotics in the treatment of endodontic infections, traumatic injuries of the teeth, revascularization procedures in immature teeth with pulp necrosis, and in prophylaxis for medically compromised patients. It also highlights the role that dentists and others can play in preventing the overuse of antibiotics. A recent review article provides the basis for this position statement and more detailed background information (International Endodontic Journal, 2017, https://doi.org/10.1111/iej.12741). Given the dynamic nature of research in this area, this position statement will be updated at appropriate intervals.

Endodontic Board Certification: A Review of Factors Affecting the Certification Rate.

INTRODUCTION: Board certification identifies clinicians who possess advanced proficiency and expertise within their field. Only 23% of endodontists are board certified (the lowest among all dental specialties). The aim of this study was to determine the factors that influence endodontists' decisions regarding the completion of board certification. METHODS: A 16-question survey was e-mailed to 5073 US endodontists and residents who are American Association of Endodontists members. RESULTS: A total of 1603 endodontists and residents responded, corresponding to an overall response rate of 31.6%. Of those respondents, 73.8% felt board certification was important. Among endodontists, 32% were board certified, 24.4% had plans of becoming board certified, and 43.6% had no plans to become board certified. The most common reasons for not pursuing board certification were "graduated too long ago," "don't have time," "process is too long," and "not required to become an endodontist." Board-certified endodontists were more likely to believe board certification was important compared with their non-board-certified counterparts (97.5% vs 60.3%, P < .0001), and were more likely to have received training at programs that encouraged and provided assistance in completion of the certification process. Residents were more likely to plan on becoming certified compared with non-board-certified endodontists (89.6% vs 35.9%). CONCLUSIONS: Despite widespread agreement regarding the importance of board certification, a strikingly low percentage of endodontists are board certified. Views provided by endodontists and endodontic residents provide insight that may be used to guide changes that will effectively increase the percentage of board-certified endodontists.

A Retrospective, Radiographic Outcomes Assessment of 1960 Initial Posterior Root Canal Treatments Performed by Endodontists and Dentists.

INTRODUCTION: The Air Force Dental Service has established evidence-based treatment standards for endodontics, including 3-dimensional filling of the canal system, cuspal coverage restoration of endodontically treated posterior teeth, and use of rubber dam. The purpose of this retrospective study was to determine the effect of these standards on outcomes of initial posterior root canal treatments (RCTs) completed by Air Force (AF) and civilian dentists with and without accredited postgraduate training. METHODS: Treatment and follow-up radiographs of AF members who had an initial posterior RCT completed in 2011 were evaluated. A survey of all radiographs was performed to determine the (1) RCT obturation quality, (2) healing of periapical pathosis, and (3) presence and quality of cuspal coverage restorations. RESULTS: A total of 2262 RCTs were examined, with 1960 RCTs meeting inclusion criteria for at least 1 evaluation category. For RCT obturation quality, 1810 RCTs were evaluated, and 96.0% were considered adequate. For cuspal coverage restorations, 1856 RCTs were evaluated, and of these 2.7% were inadequately restored. Healing of periapical pathosis was 91.5% and 85.7% for AF and referred civilian providers, respectively. Survivability was 94.4% for endodontists, 95.3% for AF general dentists with additional training, 87.9% for AF general dentists without additional training, and 78.4% for civilian general dentists. Overall, survivability was 94.1% for a follow-up period ranging up to 47 months, with a mean of 27 months. CONCLUSIONS: In this retrospective, radiographic analysis, evidence-based practices as followed in the Air Force Dental Service and accredited postgraduate training resulted in improved treatment outcomes.

Improving the quality of endodontic record keeping through clinical audit.

Introduction Record keeping is an essential part of day-to-day practice and plays an important role in treatment, audit and dento-legal procedures. Creating effective endodontic records is challenging due to the scope of information required for comprehensive notes. Two audits were performed to assess the standards of endodontic record keeping by dentists in a restorative dentistry department and students on an endodontic MSc course.Methods Fifty sets of departmental records and 10 sets of student records were retrospectively evaluated against the European Society of Endodontology 2006 guidelines. Results of the first cycle of both audits were presented to departmental staff and MSc students, alongside an educational session. Additionally, departmental guidelines, consent leaflets and endodontic record keeping forms were developed. Both audits were repeated using the same number of records, thus completing both audit cycles.Results The most commonly absent records included consent, anaesthetic details, rubber dam method, working length reference point, irrigation details and obturation technique. Almost all areas of record keeping improved following the second audit cycle, with some areas reaching 100% compliance when record keeping forms were used. Statistically significant improvements were seen in 24 of the 29 areas in the departmental audit and 14 of the 29 areas in the MSc audit (P = 0.05).Conclusions Significant improvements in endodontic record keeping can be achieved through the provision of education, departmental guidelines, consent leaflets and endodontic record keeping forms.

Diagnóstico diferencial da sinusite de origem odontológica por meio da tomografia computadorizada / Differential diagnosis of dental sinusitis with the aid of computed tomography

O objetivo do presente artigo é apresentar três casos clínicos com diagnóstico de sinusite de origem odontológica, ou síndrome endo-antral, um quadro inflamatório infeccioso de origem endodôntica que acomete dos tecidos e mucosa do seio maxilar adjacentes aos ápices radiculares.Os casos apresentados chamam a atenção para a dificuldade do diagnóstico apenas coma radiografia periapical e a importância da tomografia computadorizada como recurso auxiliar.

The aim of the current article is to report three clinical cases diagnosed as sinusitis of dental origin, or endo-antral syndrome, an inflammatory condition of endodontic infection origin that affects the tissues and mucosa of the adjacent maxillary sinus up to the root apex. The presented cases draw attention to the difficulty of diagnosis only with periapical radiography and the importance of computed tomography as an auxiliary resource.

Assessment of treatment failure in endodontic therapy.

There is a paucity of guidelines for the dental profession to assess failure of endodontic therapy. While a successful treatment can be well defined by the absence of apical periodontitis and clinical symptoms after a period of observation, failed treatment has escaped a distinct standing over the years. This article highlights aspects of significance and concludes that research ought to better explore the general health properties of persistent apical periodontitis on root-filled teeth and finally confirm the extent there is an association between apical periodontitis and adverse systemic health effects. Clearing this condition will determine whether clinicians should take a serious or relaxed attitude to persistent apical periodontitis subsequent to endodontic treatment.

[Formulation of guidelines for microscopic endodontics suitable for the situation of China].

In order to promote the use of dental operating microscope in endodontics, Society of Cariology and Endodontology of Chinese Stomatological Association formulated these guidelines, after extensive consultation with related authorities and careful reference to the available published materials and literatures. It is hoped that these guidelines will be useful for dental practitioners embarking on microscopic endodontics.