Treatment Decision-making of Cracked Teeth: Survey of American Endodontists.

AIM: The aim of this study is to survey the opinion of endodontists in the United States regarding their approach to treatment of cracked teeth. MATERIALS AND METHODS: A survey assessing the opinions of 3,500 endodontists in the United States was administered over a 4-week period. It consisted of a hypothetical clinical case and eight different treatment scenarios. Participants were asked to select one of the two treatment options: (A) informing the patient of the presence of a crack, reinforcing the tooth, and continuing with endodontic treatment; and (B) extraction of the tooth followed by replacement with an implant supported crown or fixed partial denture. RESULTS: When the crack extended across the distal marginal ridge with no associated probing depths, 92.65% endodontists preferred to continue with endodontic treatment and reenforcing the tooth. When the crack extended across the distal marginal ridge and was associated with a probing depth of 6 mm, 80% preferred extraction of the tooth. When the crack extended across the mesial marginal ridge up to the orifice of the mesiolingual canal with no associated probing depth, 82.78% preferred to continue with the treatment. When the crack was associated with a 6-mm probing depth, 83.79% preferred tooth extraction. When the crack extended across the mesial marginal ridge and down into the mesiolingual canal with/without associated probing depth, 91.13% and 63.54% preferred tooth extraction, respectively. When the crack involved both mesial and distal marginal ridges and extended across the pulp chamber, 79.74% preferred tooth extraction. When a split tooth was presented, 98.48% preferred tooth extraction. CONCLUSION: It appears that the presence of a 6-mm periodontal pocket is considered an important factor by most American endodontists when deciding whether to preserve the cracked tooth or extract it. CLINICAL SIGNIFICANCE: There is no consensus among dentists regarding the best approach to treat cracked teeth. Conclusive studies evaluating clinical approaches of endodontists regarding treatment of cracked teeth are lacking. Therefore, surveyed opinion of endodontists in the United States regarding their approach to treatment of cracked teeth was done to try to reach the best clinical decision regarding this dilemma.

Cone-beam Computed Tomographic Usage: Survey of American Endodontists.

AIM: The aim of this study was to investigate the acceptance, accessibility, and usage of cone-beam computed tomographic (CBCT) imaging among American Association of Endodontists (AAE) members in the United States by means of an online survey. MATERIALS AND METHODS: An invitation to participate in a Web-based survey was sent to 3,000 members of the AAE. The survey consisted of 19 questions on demographics, access to CBCT machines, frequency of use for particular applications, and reasons in case CBCT was not used. RESULTS: A total of 477 endodontists responded to the survey, representing a 15.9% response rate. Around 91.8% of endodontists used CBCT imaging in their practice. Around 86% of endodontists had access to CBCT in their office, while 14% referred their patients to an outside office. Cone-beam computed tomographic units used by endodontists were Carestream (59.6%), Morita (20.8%), and Sirona (5.7%). Around 81.1% of endodontists didn't think CBCT imaging has high risk of radiation exposure; however, 10% of their patients declined CBCT imaging due to both cost and radiation exposure. Around 92.7% requested the segmental view when asking for CBCT. Endodontists' opinion was that CBCT enhances diagnosis of odontogenic pathosis, anatomical structures, treatment of iatrogenic errors, and diagnosis of nonodontogenic pathosis by 96.4%, 96.3%, 92.2%, and 88%, respectively. Around 93% of endodontists agreed that they would not consider doing CBCT for pregnant women. Majority of endodontists (74.6%) use CBCT in their practice for surgery, followed by 60.2% in nonsurgical retreatment. While 59.1% use CBCT in initial nonsurgical treatment, 44% reported that they use CBCT in endodontic recall and 9.2% use CBCT for pediatric patients. CONCLUSION: CBCT technology is becoming the imaging modality of choice for nonsurgical retreatments and presurgical treatment planning. Endodontists deal with complex cases and thus the CBCT is a necessary tool that helps save a lot of time and effort during treatment procedures, looking for canals or determining why a previous treatment failed, and in providing the most comprehensive care. CLINICAL SIGNIFICANCE: With the advancement in technology in the latest era, the three-dimensional CBCT imaging helped provide superior information over the two-dimensional periapical radiograph in making the correct diagnostic decision. This survey enlightened the usage of CBCT among endodontic practitioners in the United States. How to cite this article: Alzamzami ZT, Abulhamael AM, Talim DJ, et al. Cone-beam Computed Tomographic Usage: Survey of American Endodontists. J Contemp Dent Pract 2019;20(10):1132-1137.

Nonsurgical Management and 2-year Follow-up by means of Cone Beam Computed Tomography of an Invasive Cervical Resorption in a Molar.

BACKGROUND: Invasive cervical resorption (ICR) is a relatively uncommon form of external tooth resorption, characterized by an invasive nature. It is usually painless and detection of lesions is often made incidentally. Three-dimensional imaging techniques, such as cone beam computed tomography (CBCT), are useful in the diagnosis and management of ICR as the true extent of the defect cannot always be estimated using conventional radiographs. AIM: The aim of this article is to report on the successful treatment of ICR in mandibular first molar by nonsurgical approach and follow-up by means of CBCT. CASE REPORT: An 18-year-old patient was referred with a complaint of unusual radiolucency in the mesial cervical area of tooth #19 with unknown etiology. Cone beam computed tomography was performed to assess the extent of the lesion in three spatial levels and diagnosis of Heithersay class III ICR was made. This case presented with ICR (Heithersay class III) on tooth #19. Nonsurgical root canal treatment and removal of the lesion from the coronal access was performed; the resorptive defect was filled with dual-cure, self-adhesive, resin-modified glass ionomer cement (RMGIC); 6-month follow-up X-ray film showed no changes at the lesion site and tooth was asymptomatic; 1-year follow-up X-ray film showed slight mesial bone loss and a probing depth of 3 mm; finally, 2-year follow-up CBCT images showed no recurrence and no further bone destruction at the lesion site. CONCLUSION: The intraoral radiographs revealed the resorptive changes in two dimensions; therefore, the actual extent and location of the lesions are not fully understood. On the contrary, CBCT is a very useful tool to achieve a proper diagnosis; it detects the extent of the defect more accurately and hence, improves the treatment outcomes of ICR. CLINICAL SIGNIFICANCE: The ICR is usually seen as a late complication to traumatic injuries of the teeth; it is essential, therefore, that the patients who were exposed to situations that can damage the integrity of periodontal tissue need to have careful periodic recalls and X-ray examinations.

Prevalence of Vertical Root Fractures in a University Endodontics Program versus a Private Endodontics Office.

Introduction: Vertical root fractures (VRFs) typically have a poor prognosis with an extraction or occasionally root amputation as the preferred treatment. VRFs have been considered an epidemic, motivating changes in the access openings, as well as in the preparation and disinfection protocols of endodontic treatment. Hence, we aimed to evaluate the prevalence of VRFs by tracking cases in both a University Endodontic Program (UEP) and a private endodontics practice (PP). We also evaluated changes in prevalence during COVID-19 along with the alterations in the frequency of cases diagnosed by clinical and radiographic signs which were later confirmed by direct visualization compared to those in which the suspicion was based on clinical and radiographic signs alone. Methods and Materials: This retrospective study looked at the prevalence of VRF in patient records at UEP and a PP. Data for the pre-COVID-19 and COVID-19 time periods were extracted from patient records and referral letters then compared. Data for suspected and confirmed prevalence were compared. Results: The UEP group included 21,156 patients while the PP group comprised 7,209 patients. The prevalence of VRFs in the former cohort was 1.80%, while 2.62% of the latter cohort exhibited VRFs with a combined total of 2.01%. The combined total prevalence of VRFs pre-COVID-19 was 1.72%, increasing from 2.1% to 3.82% during COVID-19 (p < 0.0001). The same applied to suspected cases for both clinical settings. The increase in confirmed cases between the two periods was statistically significant for the UEP group (p=0.0202) but it was insignificant for the PP group (p=0.0721). Conclusion: The combined prevalence for VRFs was 2.01% for all years denying the claim that VRF is a pandemic phenomenon. COVID-19 period saw almost a double increase in the prevalence of VRF compared to pre-COVID-19 era. This was consequently associated with a significant increase in the number of suspected VRF cases.

The incidence and severity of dental trauma in intercollegiate athletes.

BACKGROUND: The use of protective devices such as mouthguards during participation in contact sports may be effective in reducing the incidence or severity of dental injuries. METHODS: Dental injuries reported to the athletic department at the University of Southern California, Los Angeles, were recorded from 1996 through 2005. The authors classified each injury and determined the severity of the injury. Severity was defined in relation to the treatment required and the prognosis of the teeth and supporting tissues involved. RESULTS: Fifty-one traumatic dental injuries were reported. Basketball was the sport with the highest injury rate; it had an incidence rate (IR) of 10.6 injuries per 100 athlete-seasons among men, and an IR of 5.0 injuries per 100 athlete-seasons among women. The IR for men's basketball players was five times higher than that for football players for whom mouthguard use is mandatory. CONCLUSIONS: Given the relatively high incidence of dental injury in basketball and the potential of mouthguard use to reduce the incidence and severity of the trauma, mandatory use of mouthguards among collegiate basketball players should be considered. CLINICAL IMPLICATIONS: Dental professionals have a responsibility to educate patients and the public about the importance of using mouth-guard protection in contact sports.