Complications Of Root Canal Treatment Research Articles

Influence of operator’s experience on complications of root canal treatment using contemporary techniques: a retrospective study

BackgroundEndodontic treatment has benefited from the development of new techniques and equipment. Few clinical studies have been published on the complications associated with root canal preparations performed by doctors with different working experiences using contemporary techniques. This study aimed to analyze the complications of endodontic treatment performed by residents and endodontic specialists in a teaching stomatology hospital using contemporary techniques.MethodsCases of root canal treatment (RCT) and non-surgical root canal retreatment (ReRCT) performed by residents with 1–3 years of experience and endodontic specialists with 5–7 years of experience were collected from the electronic medical system of the Department of Endodontics, Beijing Stomatology Hospital, from September 1, 2020 to August 31, 2021. The cases were examined in terms of patient age, sex, type of tooth, diagnosis, treatment modality (RCT or ReRCT), number of appointments, whether an operating microscope was used, presence of ledges, canal transportation, perforations, missed canals, separated instruments, flare-ups and clinical incidence of second mesiobuccal (MB2) root canal in the maxillary molars.ResultsIn total, 859 teeth from 820 patients were included in the analysis. The overall incidence of complications in the resident group was significantly higher than that in the specialist group. More ledges and flare-ups were observed in the resident group (p < 0.05). The clinical incidence of MB2 was significantly higher in the specialist group (p < 0.05). There were no significant differences in root canal transportation, perforation, or instrument separation between the two groups (p < 0.05). Multivariate analysis showed that the incidence of root canal preparation complications was related to operator experience, tooth type and treatment modality.ConclusionsTechnical advancements could reduce the effect of working experience on RCT complications between residents and endodontic specialists in a teaching stomatology hospital.

Bleach-Induced Chemical Sinusitis and Orbital Cellulitis Following Root Canal Treatment

The authors describe an unusual case of chemical sinusitis and orbital cellulitis secondary to a sodium hypochlorite accident in a patient who had just undergone root canal treatment. The patient presented with acute, progressive symptoms of unilateral maxillary sinusitis, facial cellulitis and orbital cellulitis which began hours after root canal treatment on the ipsilateral side. He was admitted to hospital under the care of the Otorhinolaryngology team and reviewed regularly by the Ophthalmologists. He underwent Endoscopic Sinus Surgery during his hospital stay. The intraoperative findings revealed necrotic sinus mucosa and slough within the involved maxillary sinus, which were suggestive of chemical burn injury induced by the highly alkaline sodium hypochlorite solution used during root canal treatment. He was treated postoperatively with regular nasal toilet, culture-directed antibiotics and topical ocular pressure-lowering eyedrops. He displayed a slow recovery with eventually no orbital sequelae, but experienced persistent cheek numbness three months post-injury. Severe chemical sinusitis with orbital cellulitis secondary to sodium hypochlorite accident is a rare complication of root canal treatment, with potentially severe consequences. It can present with symptoms similar to complicated acute bacterial sinusitis. Otorhinolaryngologists and dental surgeons should maintain a high index of suspicion when managing a patient post-root canal treatment with symptoms of unilateral sinusitis, facial cellulitis, orbital cellulitis and even airway compromise. This would allow prompt intervention before sight or life-threatening complications set in.

Detection of the separated root canal instrument on panoramic radiograph: a comparison of LSTM and CNN deep learning methods.

A separated endodontic instrument is one of the challenging complications of root canal treatment. The purpose of this study was to compare two deep learning methods that are convolutional neural network (CNN) and long short-term memory (LSTM) to detect the separated endodontic instruments on dental radiographs. Panoramic radiographs from the hospital archive were retrospectively evaluated by two dentists. A total of 915 teeth, of which 417 are labeled as "separated instrument" and 498 are labeled as "healthy root canal treatment" were included. A total of six deep learning models, four of which are some varieties of CNN (Raw-CNN, Augmented-CNN, Gabor filtered-CNN, Gabor-filtered-augmented-CNN) and two of which are some varieties of LSTM model (Raw-LSTM, Augmented-LSTM) were trained based on several feature extraction methods with an applied or not applied an augmentation procedure. The diagnostic performances of the models were compared in terms of accuracy, sensitivity, specificity, positive- and negative-predictive value using 10-fold cross-validation. A McNemar's tests was employed to figure out if there is a statistically significant difference between performances of the models. Receiver operating characteristic (ROC) curves were developed to assess the quality of the performance of the most promising model (Gabor filtered-CNN model) by exploring different cut-off levels in the last decision layer of the model. The Gabor filtered-CNN model showed the highest accuracy (84.37 ± 2.79), sensitivity (81.26 ± 4.79), positive-predictive value (84.16 ± 3.35) and negative-predictive value (84.62 ± 4.56 with a confidence interval of 80.6 ± 0.0076. McNemar's tests yielded that the performance of the Gabor filtered-CNN model significantly different from both LSTM models (p < 0.01). Both CNN and LSTM models were achieved a high predictive performance on to distinguish separated endodontic instruments in radiographs. The Gabor filtered-CNN model without data augmentation gave the best predictive performance.

An Unusual Complication of Root Canal Treatment and its treatment by Laser Biostimulation

An Unusual Complication of Root Canal Treatment and its treatment by Laser Biostimulation

Postoperative Quality of Life after Single-Visit Root Canal Treatment Performed with Reciprocating Shaping Systems: An Observational Study

Postoperative pain is a frequent complication of root canal treatment. It could worse patients’ quality of life (QoL) and it may be associated to several factors, including the shaping technique. The aim of the study was to compare the impact of WaveOne Gold (WOG) and WaveOne Classic (WOC) reciprocating instrumentation on postoperative QoL after single-visit primary root canal treatment. Healthy subjects with pulp necrosis on multirooted teeth were observed. Canal shaping was performed with WaveOne Gold Primary (n = 25) or WaveOne Classic Primary (n = 29) and canal filling was completed with a carrier-based technique. Mean and maximum scores for postoperative pain were assessed through a Visual Analogue Scale (VAS) and QoL indicators were evaluated with a self-assessment questionnaire based on a Likert scale. Postoperative pain curves were similar in both groups (mean pain p = 0.43; maximum pain p = 0.27) and quality of life indicators showed no significant differences (p &gt; 0.05). There was a more favourable trend of QoL values in the WOG group, reaching statistical significance on day six posttreatment (p = 0.021). Within the limitations of the study, reciprocating instrumentation may have an impact on patients’ QoL, but the innovative geometrical and alloy properties of the WaveOne Gold seemed to induce a faster resolution of the postoperative symptoms.

Direct Pulp Capping With ProRoot MTA Alone and in Combination With Er:YAG Laser Irradiation: A Clinical Trial.

Background: Due to the complications of root canal treatment, conservative modalities to preserve pulp vitality are favorable. Direct pulp capping (DPC) refers to the coverage of the pulp tissue exposed by a biocompatible agent that can improve the prognosis of the tooth by 44% to 95%. Some recent studies have reported more predictable results (a success rate of about 90%) for DPC with laser and regenerative materials such as mineral trioxide aggregate (MTA). This study aimed to clinically compare DPC with ProRoot MTA alone and in combination with Er:YAG (erbium-doped yttrium aluminium garnet) laser irradiation (2940 nm). Methods: This clinical trial was conducted on 26 patients with a mean age of 29 years (in the range of 17 to 46 years) who required DPC following pulp exposure during deep caries removal. The teeth were divided into two groups. In the control group, the teeth underwent DPC with ProRoot MTA while in the test group, the teeth were first irradiated with a 2940 nm Er:YAG laser and then underwent DPC with ProRoot MTA. The patients were recalled at one, 3 and 6 months for the follow-up (clinical and radiographic examinations). The data were analyzed using Fisher exact test. Results: The success rate was 75% in the laser group and 93% in the control group. The groups were not significantly different (P>0.05). Conclusion: No significant difference was found in terms of the success rate of DPC with ProRoot MTA alone and in combination with Er:YAG laser irradiation.

Acute endodontic pain

Dental pain is amongst the most common types of or ofacial pain, it significantly reduces quality of life in patients and is regarded as a serious public health issue in many countries, furthermore it is main reason of seeking emergency dental treatment. Usually dental pain is caused by pulp and periapical conditions and is inflammatory. The two key components of dental pain are the activity of nerve fibers and alterations in microciculation. Anatomical and neurophysiological differences affecting mentioned type of pain were presented in this paper as well as mechanisms of dental pain form ation, clinical implications of hyperalgesia, allodynia, reffered pain phenomena and therapeutic procedures. The most optimal way of preoperative pain management is implementation of causal treatment as soon as possible, which includes tooth extraction or endodontic intervention. During root canal treatment complete pulp removal is followed by exact chemomechanical preparation of the entire root-canal system with the use of instrumentation and plentiful irrigation and dense obturation. Endodontic therapy allows tooth preservation and periapical tissues healing. Intraoperative pain is controlled with the means of proper local anaesthesia, depending on clinical situation using not only first choice techniques as regional block and infiltrative anaesthesia but also additional methods like intraligammentary, intraosseus and intrapulpal injections. Postprocedural pain management starts during anaesthesia. In article additional pharmacological and non-pharmacological strategies helpful in treating these conditions, providing better effectiveness of local anaesthesia that is difficult in tissue inflammation and decreasing and even preventing development postendodontic pain – common complication of root canal treatment.

The intriguing tale of an iatrogenic perforation

INTRODUCTION: Iatrogenic perforations are one of the most exasperating complications of root canal treatment. The prognosis of the root with iatrogenic perforation depends on the location and the procedures undertaken to manage the problem. This case report gives an account of a lateral perforation on a canine tooth and the management strategy under the circumstances. It also gives an overview of some of possible approaches to prevent iatrogenic perforations. METHODS: A right maxillary canine which had an iatrogenic perforation was carefully re-treated and the defect in the bone was exposed using a full thickness mucoperiosteal flap and packed with bone graft material A clinical re-evaluation was done at the end of 3 months. RESULTS: After 3 months the tooth was asymptomatic. There was no tenderness on palpation and on percussion. CONCLUSION: A thorough knowledge of the anatomy of the tooth, combined with the use of appropriate techniques can help in reducing the complications that may occur during endodontic therapy. However, if a problem does occur, a scrupulous management would help in salvaging the involved tooth.

Evaluation of complications of root canal treatment performed by undergraduate dental students

ABSTRACTThis study evaluated the technical quality of root canal treatment (RCT) and detected iatrogenic errors in an undergraduate dental clinic at the College of Dentistry, Taibah University, Saudi Arabia. Dental records of 280 patients who received RCT between 2013 and 2016 undertaken by dental students were investigated by retrospective chart review. Root canal obturation was evaluated on the basis of the length of obturation being ≤2 mm from the radiographic apex, with uniform radiodensity and good adaptation to root canal walls. Inadequate root canal obturation included cases containing procedural errors such as furcal perforation, ledge, canal transportation, strip perforation, root perforation, instrument separation, voids in the obturation, or underfilling or overfilling of the obturation. In 193 (68.9%) teeth, RCT was adequate and without procedural errors. However, in 87 (31.1%) teeth, RCT was inadequate and contained procedural errors. The frequency of procedural errors in the entire sample was 31.1% as follows: underfilling, 49.9%; overfilling, 24.1%; voids, 12.6%; broken instruments, 9.2%; apical perforation, 2.3%; and root canal transportation, 2.3%. There were no significant differences (p > 0.05) in the type or frequency of procedural errors between the fourth- and fifth-year students. Lower molars (43.1%) and upper incisors (19.2%) exhibited the highest and lowest frequencies of procedural errors, respectively. The technical quality of RCT performed by undergraduate dental students was classified as ‘adequate’ in 68.9% of the cases. There is a need for improvement in the training of students at the preclinical and clinical levels.

Foreign material in a maxillary sinus as a complication of root canal treatment: a case report

Endodontic infections of posterior maxillary teeth sometimes spread to the maxillary sinus, generating severe complications.[1] In some cases, the roots of the posterior maxillary teeth come into close contact with maxillary sinuses. They may contact with only the cortical wall of the floor of sinuses, or even project into the maxillary sinus so that teeth apices are only covered by Schneiderian membrane. Such anatomic variations can lead to the establishment of an oro-antral communication during root canal treatment. As a result, possible complications such as displacement of endodontic materials into the maxillary sinus may develop.[2] In this case report, we present a patient complaining about the pain and swelling in her right maxillary sinus area. Radiographic examination showed a dense foreign material in maxillary sinus and the patient history revealed previous endodontic theraphy and extraction of the tooth #15 because of the discomfort and pain. Those findings were compatible with the scenario of iatrogenic complication of the root canal treatment; displacement of the filling material into the maxillary sinuses. Case report 26 year-old-female patient visited our department complaining about the pain on the right side on the face and on the tooth #15. The patient reported that these symptoms had started after the related tooth had undergone endodontic theraphy. Panoramic and periapical radiographs were taken as a part of dental examination and it showed a radiodense foreign material in the right maxillary sinus (Fig. 1a and b). The foreign material was observed to have spread to maxillary sinus wall away from the region of the previously extracted tooth 15. The patient was told about the results of examination and the need for additional surgical treatment. The foreign material was removed through an antrostomy in the lateral sinus wall (Fig. 2a and b). The sinus was irrigated with a physiological saline solution. The flap was then sutured into its original position. The surgical site was uneventful in postoperative 10 day and any signs for oro-antral communication or sinus infection were seen. The roots of maxillary teeth proximity to maxillary sinuses can lead to overfilling of endodontic materials to maxillary sinuses accidentally. In some cases, overfilling of endodontic materials require surgical procedures. Foreign endodontic material within the maxillary sinus after endodontic treatment on extracted tooth #15 is presented in this case report. Foreign material inside the maxillary sinus was removed successfully by Caldwell-Luc operation. Postoperative healing was uneventfully.

Comparison of Manual and Rotary Instrumentation on Postoperative Pain in Teeth with Asymptomatic Irreversible Pulpitis: A Randomized Clinical Trial.

Introduction:One of the most common complications of root canal treatment is postoperative pain. The aim of the present clinical trial was to compare the severity of postoperative pain after root canal preparation with RaCe rotary system and hand K-Flexofile. Methods and Materials:A total of 96 mandibular first and second molars were divided into two groups (n=48) based on root canal preparation technique. The teeth in both groups underwent one-session root canal treatment and the severity of postoperative pain was evaluated using visual analog scale (VAS) at 4-, 8-, 12-, 24- and 48-h and 1-week intervals. In addition, the type and dosage of analgesics were recorded. Data were analyzed with repeated-measures ANOVA. Statistical significance was set at 0.05. Results:The difference between the two groups during this period and at subsequent intervals were not significant (P>0.05). There were no significant differences between the two groups in type and the number of analgesics in pain-free subjects (P=0.12 and P=0.61, respectively). Conclusion:There were no statistically significant differences in pain severity between the two groups at any intervals.

Treatment of a Vertical Root Fracture Using Dual-Curing Resin Cement: A Case Report

Introduction. Vertical root fracture (VRF) is one of the most frustrating complications of root canal treatment. The prognosis of the root with VRF is poor therefore tooth extraction and root amputation are usually the only treatment options. However, bonding of the fracture line with adhesive resin cement during the intentional replantation procedure was recently suggested as an alternative to tooth extraction. Methods. A vertically fractured left maxillary incisor was carefully extracted, fracture line was treated with adhesive resin cement, a retrograde cavity was produced and filled with calcium-enriched mixture (CEM) cement, and tooth was replanted. Results. After 12 months the tooth was asymptomatic. The size of periapical radiolucency was noticeably reduced and there was no clinical sign of ankylosis. Conclusion. Using adhesive resin cement to bond the fracture lines extraorally in roots with VRF and intentional replantation of the reconstructed teeth could be considered as an alternative to tooth extraction, especially for anterior teeth.