Coronal Restoration Research Articles

Endocrown : from preparation to bonding : Case report /// L'endocouronne : de la préparation au collage : à propos d'un cas clinique

The restoration of endodontically treated teeth is a real challenge, particularly teeth with extensively damaged coronal tissues. The use of post-retained restorations has been discussed because of the potential tooth weakening due to the additional removal of sound dental structures. In fact, long-term prognosis of a devitalized tooth is closely related to the coronal restoration’s quality and the remaining dental structure.With the development of adhesive dentistry and minimally invasive preparation, new approaches have emerged. Among them, the endocrown which is monolithic ceramic bonded restoration, anchored to the internal portion of pulp chamber and cavity margins that have been used as an alternative to conventional post and core.

Influence of Endodontic Cavity Design on Interfacial Voids, Class II Resin Composites Sealing Ability and Tooth Fracture Resistance: An In Vitro Study.

Objective: The aim of this in vitro investigation is to study the effect of endodontic cavity design on interfacial voids, class II resin composite sealing ability, and fracture resistance in mandibular premolars. Methods: A total of 48 single-rooted mandibular premolars received compound class II preparations with either traditional flare access cavities (group A) or contracted endodontic cavity preparations (group B). Each study group was subdivided according to the coronal restoration into two sub-groups as α and β. In the α group, a microhybrid composite was used after etch-and-rinse bonding technique using an MDP-containing universal adhesive. In the β group, a self-adhesive composite was used as coronal restoration after endodontic treatment (n = 12) for each subgroup. A micro-CT analysis was performed to assess the obturation interfacial voids and tracing of class II cervical interfacial adaptation. The tooth fracture resistance testing was then performed adding an extra group of 12 sound non-prepared teeth, which were tested as the control for fracture strength testing. A one-way ANOVA and post-hoc testing were used together with descriptive statistics for an analysis of the mean values of obturation interfacial voids. A two-way ANOVA was used to assess the fracture resistance test results, and to find the influence of endodontic access design and the type of composite material on the fracture resistance testing. Chi-square testing was employed to analyze the cervical interfacial seal of the class II restorations. Results: A one-way ANOVA revealed that there were no statistically significant differences between test groups in the amount of obturation interfacial voids (p > 0.05). There were no statistically significant differences between test groups in terms of cervical interfacial sealing ability (p > 0.05). A two-way ANOVA revealed that no statistically significant differences between test groups including the control group existed in terms of the fracture resistance testing (p > 0.05). Conclusions: Although it does not improve tooth fracture resistance, the contracted endodontic access cavity does not deteriorate the quality of obturation in terms of the interfacial porosity. The self-adhesive composite does not improve the efficiency of cervical interfacial adaptation or tooth fracture resistance regardless of the endodontic access cavity shape, yet it revealed a substantial load-bearing capacity.

In-vitro comparison of fracture resistance of CAD/CAM porcelain restorations for endodontically treated molars

BackgroundThis study evaluates the fracture strength and patterns of feldspathic porcelain restorations made using CAD/CAM technology for lower first molars with extensive crown destruction. The restorations include post-core and full-contour crown, composite resin core and full-contour crown, and endocrown. This research provides insights into effective restorative options to address tooth fracture risk, supporting minimally invasive procedures and CAD/CAM integration in dental practices.MethodsThis study utilized 80 permanent mandibular first molars, which were divided into four groups: Group I (Post-Core-Full-contour crown), Group II (Core- Full-contour crown), Group III (Endocrown), and Group IV (Control). Root canal treatment was performed on all samples except for the control group. Following access cavity preparation, restorations for each tooth were fabricated using the CAD/CAM system and cemented with resin cement. The specimens were embedded in acrylic blocks. After undergoing thermomechanical aging, the samples were subjected to fracture resistance testing using a universal testing machine, which applied force until fracture occurred. The fracture patterns were subsequently analyzed, and the data were statistically evaluated using the Kruskal-Wallis and Chi-Square tests (p < 0.05).ResultsA significant difference in fracture values under axial forces was observed (p < 0.05). The control group had the highest fracture strength (1830 ± 277 N), while the Core- full-contour crown group showed the lowest (1532 ± 371 N). Failure types varied significantly among the groups (χ2 = 26.886, df = 9, p = 0.001). The most common failure type was Type-2 (33.75%), characterized by restorable fractures, while Type-3 fractures, unrestorable, were the least common (12.5%).ConclusionsThe findings underscore the significance of technological advancements in CAD/CAM for effectively restoring endodontically treated teeth with extensive crown damage. This study contributes valuable insights, emphasizing the clinical relevance of selecting appropriate restorative options to mitigate the risk of tooth fracture associated with coronal restoration failures.

Evaluation of Marginal Adaptation of SDR Plus, Fiber-Reinforced and Nanofilled Composites in Endodontically Treated Teeth: A Scanning Electron Microscopic Study.

Endodontically treated teeth (ETT) undergo structural changes, including a reduction in water content and loss of dentin elasticity, which can compromise their mechanical properties. One critical factor influencing the long-term prognosis of a restored ETT is the marginal adaptation of the restorative material. The present study compared the marginal adaptability of Smart Dentin Replacement (SDR) Plus, fiber-reinforced, and nanofilled composites in ETT using scanning electron microscopy (SEM). Cavities were made in 30 recently extracted maxillary premolars distributed into three experimental groups depending on the restorative material used: group 1 as SDR Plus (Dentsply Sirona, Charlotte, North Carolina, USA), group 2 as fiber-reinforced composite (EverX, GC Corp., Tokyo, Japan), and supra nanofilled composite (Estelite Sigma Quick, Tokuyama Dental Corp., Tokyo, Japan). Standardized access openings were performed, and endodontic treatment was completed in all teeth. Specific composite restoration techniques were applied according to the manufacturer's instructions. After thermocycling for 30 days, the restored teeth were sectioned and viewed using SEM (Labindia Instruments Pvt. Ltd., Maharashtra, India) to measure the width of the marginal gap. The data were analyzed using statistical software. The mean marginal gap width varied significantly among the groups. Group 1 had a lower mean marginal gap of 2.99 μm, group 2 exhibited the highest mean marginal gap of 10.24 μm, and group 3 had a mean marginal gap of 5.51 μm. Overall, group 2 consistently showed significantly larger marginal gaps than the other groups. Within the limitations of this study, SDR Plus demonstrated better marginal adaptation than fiber-reinforced and supra-nanofilled resins in the coronal restoration of ETT. Fiber-reinforced composites demonstrated the maximum marginal gap, followed by nanofilled composites. Thus, SDR Plus may be recommended as a suitable restorative material to enhance the longevity and success of endodontic treatments.

Influence of Direct Coronal Restoration Materials on the Fracture Resistance of Endodontically Treated Premolars: An In Vitro Study.

(1) Background: The long-term survival of an endodontically treated tooth depends on a successful root canal treatment as well as an adequate definitive coronal restoration. This study aimed to evaluate the strength of endodontically treated premolars with mesial-occlusal-distal (MOD) cavity preparation restored with different direct coronal restoration materials but from the same manufacturer against fracture. (2) Methods: sixty intact premolars were selected and placed into five groups (n = 12): G1-intact teeth, G2-endodontic treatment and unrestored MOD cavities, G3-endodontic treatment and MOD cavities restored with Tetric PowerFlow and Tetric EvoCeram, G4-endodontic treatment and MOD cavities restored with Multicore Flow and Tetric EvoCeram, and G5-endodontic treatment and MOD cavities restored with Multicore Flow. The specimens were subjected to an axial compression load at a speed of 1.6 mm/min and optically inspected before and after with a stereomicroscope. For each premolars group, the following data were recorded: the compression resistance, the compressive strength, and the maximum force supported. The microstructure of the samples after the compression test was analyzed using scanning electron microscopy (SEM). (3) Results: statistical analysis (ANOVA and Tukey test) showed that there was a statistically significant difference between G1 and the other groups. Even though there was no statistically significant difference between the restored groups, a better mechanical behavior was registered within the G3. (4) Conclusions: this in vitro study indicated that none of the materials used can lead to a higher or at least similar fracture resistance as the intact teeth. The coronal restoration only with nano-hybrid composites may lead to a higher therapeutic benefit for the fracture-susceptible premolars.

The Middle Mesial Canal: Combined Endodontic and Restorative Treatment Approach - A Case Report

The management of the middle mesial canal (MMC) in mandibular first molars presents considerable challenges during endodontic treatment due to its complex anatomy. Challenges may arise throughout various stages of treatment, including canal location, instrumentation, and obturation. The inability to identify and shape this canal can lead to endodontic failure and post-treatment apical periodontitis. Therefore, understanding this aberrant root canal anatomy and its clinical implications during the various stages of endodontic treatment is essential for successful management, including the selection of the optimal coronal restoration to enhance the efficacy of the obturation’s coronal seal and to ensure the restoration’s maximal longevity. This case report describes the diagnosis and successful endodontic and restorative management of an MMC in a mandibular first molar.

Assessment of Periodontitis Risk Factors in Endodontically Treated Teeth: A Cross-Sectional Study.

The aim of the study was to collect data about the prevalence and risk factors of apical periodontitis in a population of endodontically treated patients. The study group included 151 patients (52 males, 99 females; mean age 48.36 ± 15.708 yrs.) with 391 endodontically treated teeth (mean follow-up of 5.25 ± 1.759 yrs.). According to the initial tooth diagnosis, root-filled teeth were divided into Group A, root-filled teeth treated for pulpitis or for the purpose of prosthetic pulpectomies (vital pulp group), and Group B, root-filled teeth with non-vital pulp (necrotic pulp). Clinical and radiographic evaluation of the root and its periapical area were performed to establish the success/failure of endodontic therapy, the quality of the root canal fillings (length, density, taper), and coronal restoration. The presence of recurrent caries, periodontal pathology, or endo-periodontal lesions were also recorded. Univariate and multivariate analyses were used to determine the risk factors for apical periodontitis and calculate their odds ratios (ORs). For the root-filled vital pulp tooth group, the highest risks for apical periodontitis are associated with inadequate homogeneity (OR 30.938), periodontitis (OR 9.226), and over-filling (OR 8.800). For the root-filled non-vital pulp tooth group, the highest risks are associated with periodontitis (OR 4.235) and age over 60 yrs. (OR 4.875). For the necrotic pulp tooth group, multivariate analysis identified an age > 60 yrs., filled molars, intracanal posts, poor coronal restoration quality, under-filling, and periodontitis as significant combined risk factors. Inadequate root canal filling and periodontitis in both groups were risk factors associated with most cases of apical periodontitis. Other risk factors include age > 60 yrs., poor coronal restoration quality, and the presence of intracanal posts in root-filled teeth with necrotic pulp.

Fracture resistance of postendodontic restoration using self-adhesive bioactive resin and a bulk-fill composite with or without resin-impregnated glass fibers: An in vitro study.

Due to advancements in adhesive technology and the introduction of fiber reinforcement, there has been a paradigm shift towards a more minimally invasive approach in coronal restoration of endodontically treated teeth. This research aimed to evaluate and compare fracture resistance of postendodontic restoration using a self-adhesive bioactive resin and a bulk-fill composite with or without resin-impregnated glass fibers. Mesio-occlusal-distal cavities were prepared on 80 extracted human maxillary premolars. Root canal treatment was completed following standard access cavity preparation. Then, the teeth were divided into two groups based on the composite used for postendodontic restoration. Group I: Bulk-fill composite (Tetric N-Ceram). Group II: Activa BioActive. Group I and Group II were then divided into two subgroups depending on fiber incorporation (n = 20). Subgroup IA: Bulk-fill composite. Subgroup IB: Bulk-fill composite with fiber incorporation. Subgroup IIA: Activa BioActive. Subgroup IIB: Activa BioActive with fiber incorporation. The force required to fracture the teeth was recorded using the universal testing machine. Two-way ANOVA and Tukey's multiple post hoc test. Activa BioActive with fiber incorporation showed the highest mean fracture resistance (988.52N). Bulk-fill composite without fiber incorporation had the least mean fracture resistance (669.87N). Activa BioActive bulk-fill restorative material when used with the incorporation of resin-impregnated glass fibers can be a preferred material of choice for restoring endodontically treated teeth.

Clinical Evaluation of Metal Dental Prostheses in Captive Wild Felids.

Captive felids are prone to dental fractures, and the recommended treatment involves endodontics (root canal treatment), prosthodontics (coronal restoration), or tooth extraction. A single-unit dental prosthesis can restore the crown of a tooth whose structure has been partially or completely lost. Nine animals out of 35 captive wild felids kept under human care in 7 different Brazilian institutions were selected for the study. The animals selected included the little spotted cat (Leopardus tigrinus), ocelot (L. pardalis), margay cat (L. wiedii), pampas cat (L. colocolo), jaguarundi cat (Puma yagouaroundi), puma (P. concolor), jaguar (Panthera onca), lion (P. leo), and tiger (P. tigris). Nineteen canine prosthodontic crowns (18 full and one 3/4) were cemented using dual-cure resin cement and their feasibility was evaluated for 30 months. Fourteen (73%) remained fixed to the tooth and 5 (27%) were lost after the evaluation period. This study aimed to assess the longevity of prosthodontic crowns in the canine teeth of wild felids. Furthermore, it aimed to determine the functionality and longevity of teeth which had received prosthodontic crowns.

The prevalence of root canal treatment, periapical status, and coronal restorations in elderly patients in the Polish population

ObjectivesThe aim of this retrospective cohort study was to determine the prevalence and correlations between root canal treatment, periapical status, and coronal restoration detected using cone beam computed tomography (CBCT) in the elderly Polish population (60–79 years). MethodsA total of 480 CBCT images were assessed. Collected data included: age, gender, the tooth location, direct restoration, decay, single crown, abutment of fixed bridge, the quality of the restoration, root canal treatment, post and core, apical periodontitis (AP), and quality of root filling. ResultsThe number of teeth in the elderly patients decreased, while the number of endodontically treated teeth increased with age. More teeth were preserved in mandible, the most common group of teeth were incisors. AP was more often detected in the maxilla in general, and in mandibular molars. The over-filling was observed more frequently in maxilla, in maxillary molars and in mandibular premolars, while the short-filling in maxillary and mandibular molars. AP was significantly more often observed in short-filled root canals than in other length criteria (overfilled, adequately, lack of filling). ConclusionsInadequate prosthetic restoration, presence of post, pulpotomy, missed canals and root canal treated teeth were associated with increased prevalence of AP. Clinical significanceThe article indicates the need of treatment of elderly population in Poland. There is the demand to enhance the quality of endodontic and restorative treatment in this population. Additionally, CBCT examination, if indicated, should be implemented in the course of endodontic therapy to provide adequate information to clinicians.

Acceptability of interactive post-endodontic restoration decision making application among undergraduate dental students

Background/PurposeSelecting an appropriate coronal restoration after root canal treatment requires careful consideration, however, there is a lack of established web-based tool that is based on clear guidelines for suitable post-endodontic restorations. Hence, we aimed to design and determine the acceptability of an interactive application to aid the decision making process for post-endodontic restoration among the undergraduate dental students. Materials and methodsA web-based post-endodontic restoration decision making interactive application, (RestoSmart) was developed after a detailed review of available literature. Seventy undergraduate dental students of IMU University were recruited in the study. A validated questionnaire was given to the participants before and after the use of RestoSmart to answer the provided mock clinical scenarios. Obtained data were statistically analyzed using IBM SPSS version 26 software package. ResultsThe statistical analysis demonstrated that RestoSmart was acceptable among the undergraduate dental students (P < 0.05). Initially, participants recognized the potential benefits of designing an interactive application, 74% believing that it may enhance decision making and 76% emphasizing its user-friendliness. Additionally, close to half of the participants expressed the willingness to use interactive tools in future. Following the use of RestoSmart, there was a notable increase in favorability, with 94.2% finding it helpful in the decision making and 94.3% acknowledging its user-friendliness. Furthermore, 87.2% expressed intent to use RestoSmart in future. ConclusionRestoSmart was useful for decision making and user friendly. While overall response was positive, there exist some areas for improvement such as ease of use, updating evidence-based guidelines, and establishing its helpfulness in teaching and learning.

Comparative Evaluation of Polymethyl Methacrylate and Thermoforming Crowns as Semipermanent Crowns in Primary Molars: An In Vivo Study.

The present randomized clinical trial is aimed at evaluating clinical efficiency of two different types of esthetic crowns-polymethyl methacrylate crowns and vacuum formed thermoformed crown as an alternative to full-coverage coronal restoration for deciduous molars. A total of 45 primary molars in pediatric patients were selected using randomization and split into three groups based on the technique used for preparation of crowns: group I-polymethyl methacrylate crowns; group II-thermoformed crown; and group III-stainless steel crowns (SSC). All crowns were clinically and radiographically evaluated at baseline, 1st month, and 3rd month for gingival health, retention, marginal integrity, proximal contacts, occlusion, alignment, and staining. The data was tabulated and analyzed by Statistical Package for the Social Sciences (SPSS) Version 23.0 software. The intergroup comparison was done by Kruskal-Wallis test, analysis of variance (ANOVA), and Mann-Whitney U test for continuous data. The intragroup comparison was done by Friedman test and Wilcoxon signed-rank test for categorical data. All p-values < 0.05 were considered statistically significant. With regard to the parameters of plaque score, gingival index score, occlusion, interproximal contacts, retention, alignment, and marginal adaptation, no statistical significance was noted between the three groups. However, with regard to the discoloration (staining) when the polymethyl methacrylate acrylic (PMMA) group was compared with thermoforming group, statistical significance was noted in 1st month with p-values of 0.04 and 0.03, respectively. On intragroup comparison, statistically significant values were obtained in SSC group for plaque score and thermoforming group for gingival index score. The study concluded that the PMMA and thermoforming crowns can be used as an alternative to SSC for restoring the primary molars as they showed equivalent results to that of standard SSC. Matha N, Kumar KS, Reddy BVT, et al. Comparative Evaluation of Polymethyl Methacrylate and Thermoforming Crowns as Semipermanent Crowns in Primary Molars: An In Vivo Study. Int J Clin Pediatr Dent 2024;17(S-1):S43-S54.

A Fluorescence-based Method to Reaccess Root Canals in Endodontically Treated Teeth: A Micro–Computed Tomography Tridimensional Assessment

IntroductionThe aim of this study was to evaluate the volume of dentin removal and the volume of remnants of restorative material after the removal of an esthetic restorative coronal set and cervical barrier in endodontically treated mandibular molars with the aid of different magnification methods using 3-dimensional (3D) micro–computed tomographic (micro-CT) morphometric analysis. MethodsA sample of 30 mandibular first molars (N = 30) was used. All teeth were endodontically treated, and the specimens were initially scanned using micro-CT imaging and reconstructed. The molars were filled by a single-cone technique, and immediately the material at the initial 2-mm cervical level was removed. Cervical barriers were confected using ionomer glass cement with fluorescein 0.1%, filling the 2 mm at the cervical level of the canals and an additional 2 mm as the base. The coronal restoration set was performed using esthetic resin composites. A simulated tooth aging process was performed with 20,000 thermocycling cycles. The sample was distributed into the following 3 groups (n = 10) for the removal of the restoration set and cervical barrier with diamond burs based on the magnification aid: no magnification aid (naked eye), operative microscope aid, and REVEAL device (Design for Vision Inc, Bohemia, NY) aid. After removal, the final 3D micro-CT scanning and reconstruction were conducted with the same parameters as the initial scanning, and superposition of the final and initial scanning was performed. Morphometric analysis was conducted using CTAn software (Bruker microCT, Kontich, Belgium) to assess the volume of remnant restorative material (mm³), the volume of dentin removal (mm³), and the direction and site of dentin removal. Data were analyzed using 1-Way analysis of variance (P < .05). ResultsThe REVEAL group showed better results regarding the volume of remnant material (3.17 ± 1.65) and the percentage of dentin removal (2.56 ± 1.34). The microscope group showed no statistical difference compared with the REVEAL group regarding dentin removal (3.30 ± 1.48) and was statistically similar to the naked eye group in the volume of remnant material (9.63 ± 4.33). The naked eye group showed the worst results for the volume of remnant material (7.60 ± 2.68) and the percentage of dentin removal (6.60 ± 3.70). ConclusionsThe use of fluorescence associated with magnification was the method that presented the best results, with lower percentages of dentin removal and smaller volumes of remaining restorative material. This is an innovative technology in endodontics that shows potential to overcome the challenge of reaccessing root canals in the context of endodontic retreatment.

Comparative evaluation of marginal adaptation and fatigue resistance of endodontically treated premolars restored with direct and indirect coronal restorations: an in vitro study

BackgroundAn optimum restoration for reconstructing endodontically treated teeth should provide excellent marginal adaptation, high fracture resistance as well as maximum tooth structure conservation. The purpose of this study was to evaluate the marginal adaptation and fatigue resistance of different coronal restorations in endodontically treated premolars.MethodsThirty sound maxillary first premolars were endodontically treated and received MOD cavities. Teeth were randomly allocated into three groups (n = 10) according to the type of coronal restoration: Group R: polyethylene fibers (ribbond), fibers-reinforced composite (everX posterior) and final layer of nano-hybrid composite. Group O: indirect lithium disilicate overlay and Group C: fiber-post, resin composite restoration, and lithium disilicate crown. Marginal gap assessment was performed before and after thermocycling (5000 cycles) using stereomicroscope. Samples were subjected to stepwise-stress loading starting at 200 N, and increased by 100 N in each step until failure occurred. Statistical analysis was done by One-way ANOVA followed Tukey`s Post Hoc test for multiple comparison. Paired t test was used to compare the marginal adaptation before and after thermocycling. Survival probability was evaluated by Life table survival analysis. Failure mode analysis was performed with Chi-square test.ResultsMarginal gap was significantly the lowest in group R (37.49 ± 5.05) and (42.68 ± 2.38), while being the highest in group C (59.78 ± 5.67) and (71.52 ± 5.18) in before and after thermocycling respectively (P < 0.0001). Fatigue resistance was the highest for group O (1310.8 ± 196.7), and the lowest for group R (905.4 ± 170.51) with a significant difference between groups (P < 0.0001). Crown group had the highest percentage (80%) of catastrophic failure, while, overlay group exhibited the lowest (20%).ConclusionsDirect restoration without cuspal coverage using ribbon fibers with short FRC provided better marginal adaptation than indirect overlays and crowns, but fatigue resistance wasn’t significantly improved. Adhesive ceramic overlays showed the best fatigue performance and the least catastrophic failure rate compared to both direct fiber-reinforced composite and indirect ceramic full coverage restorations.Clinical significanceIndirect adhesive overlays are a suitable, more conservative restorative option for endodontically treated teeth than full coverage restorations, especially when tooth structure is severely compromised.

Microscopic and statistical evaluation of the marginal defects of composite restorations: in vitro studies.

This study aimed to evaluate the quality of dental restorations using laboratory microscopic techniques, focusing on the positioning of restorations relative to cavity edges and identifying common errors, such as incomplete or excessive coronal restorations. A total of 41 extracted lateral teeth, previously treated in vivo with Class I or II composites, were analyzed. Thirty-three of these teeth were sectioned medio-distally or buccal-orally and examined under a research laboratory microscope. Marginal areas were measured using eyepieces with a graduated scale and calibration slide, and a frequency statistical analysis was conducted. The analysis revealed that the teeth had fractious edges, deficient marginal closure, excess composite, incorrectly restored occlusal cusps, and marginal adaptation errors, with approximately half of these errors involving excess material. It was observed that restoration procedures in distal areas are particularly challenging, and clinical errors with excess material occur more frequently than those with a deficit. These findings underscore the need for improved techniques and precision in dental restorations to minimize such errors.

Effect of Orthodontic Treatment on the Outcomes of Endodontically Treated Teeth: A Cone-Beam Computed Tomography Analysis

IntroductionOften there is the need of moving endodontically treated teeth. Orthodontic movement may have no effect on the prognosis of teeth with root canal treatment (RCT). To verify this subject, we evaluated the effect of orthodontic movement on the prognosis of RCT teeth using cone-beam computed tomography (CBCT) and further explored the influence of orthodontic movement on the prognosis of RCT teeth with and without apical periodontitis (AP). MethodsThis retrospective study was conducted by evaluating 169 RCT teeth of 100 patients who had undergone fixed orthodontic treatment. AP was assessed and classified using the CBCT periapical index. Univariate analysis of RCT outcome was performed for the total RCT group, RCT without AP group and RCT with AP group. Multivariate logistic regression was performed for the total RCT group and RCT without AP group, respectively, but not for the RCT with AP group. Variables related to the prognosis of RCT were included, such as age, gender, tooth position, RCT quality, coronal restoration quality, periodontal condition, orthodontic traction distance, and orthodontic rotation angle. ResultsThe orthodontic traction distance and rotation angle were not significantly correlated to the RCT outcomes, regardless of the presence of AP. Among the total RCT group, teeth with unqualified RCT (odds ratio = 3.42, P = .004) and inadequate coronal restoration (odds ratio = 4.40, P = .031) had a lower success rate. Of the 97 RCT teeth without AP, unqualified RCT was a risk factor for treatment failure (odds ratio = 3.55, P = .041). Of the 72 RCT teeth with AP, the univariate analysis showed that RCT quality were significantly related to the outcome (P = .042). ConclusionsOrthodontic movement had no effect on the prognosis of RCT teeth regardless of the presence of AP.

Factors Influencing Non-Surgical Root Canal Treatment Outcomes in Mandibular Second Molars: A Retrospective Cone-Beam Computed Tomography Analysis.

Background/Objectives: This study aimed to investigate the influence of the root canal morphology and various treatment variables on the outcomes of root canal treatments (RCTs) in mandibular second molars, assessed through cone-beam computed tomography (CBCT) imaging. Methods: A total of 150 CBCT images were examined, comprising 100 cases of persistent endodontic infections and 50 of previously treated root canals with normal apices in the mandibular second molars. CBCT was utilized to evaluate the root canal configuration, the radiographic quality of coronal restorations and treated canal systems, and the presence of periapical lesions. Statistical analyses were performed to explore the correlations between these factors. Results: The presence of a C-shaped root canal configuration did not demonstrate a significant correlation with periapical lesions (p = 0.05). Factors influencing endodontic treatment outcomes included missing canals (p = 0.018), underfilling or overfilling (p = 0.045), and inadequate coronal restoration (p = 0.006). Missing a canal was identified as the variable most significantly associated with periapical lesions (OR = 3.103). Inhomogeneous root canal obturation was more commonly observed in C-shaped root canals (p < 0.001). Conclusions: Regardless of the root canal morphology of mandibular second molars, successful RCT depends on thorough disinfection to eliminate any untreated canals, precise three-dimensional filling of the canals at the correct working length, and a securely sealed coronal restoration to prevent leakage.

Interventions in root‐filled teeth identified in general dental practice: A 6‐year longitudinal observational study

AbstractAimTo investigate what happens to cross‐sectionally identified root‐filled teeth over a 6‐year period, regardless of the time that elapsed since primary root canal treatment, in a cohort of adult patients regularly attending a Public Dental Service. A secondary aim was to investigate how the cumulative events affecting root‐filled teeth over the same time were associated with variables obtained from a baseline examination.MethodologyAdult patients with ≥1 previously root‐filled tooth and regularly attending the Public Dental Service in Örebro County were enrolled for study participation in 2015. General dental practitioners examined all identified root‐filled teeth in this cohort at baseline using a standardized protocol and were also responsible for further decision‐making and treatments. After six years, information on events of the root‐filled teeth was collected from dental records. The highest rating (most invasive treatment) on a 5‐point ordinal scale was used in the analyses. Regression analyses with stepwise selection were performed for associations between patient‐ and tooth‐related factors and events.ResultsA total of 445 patients with 1007 root‐filled teeth were followed the entire observation time. Twenty (2.0%) of the root‐filled teeth had endodontic retreatment and 150 (14.9%) were extracted over six years. Among teeth with periapical radiolucency or pain, the majority did not undergo retreatment or extraction; however, the multivariate analysis demonstrated that retreatment or extraction was associated with baseline recordings of teeth with periapical radiolucency (p &lt; .0001), tenderness to percussion (p &lt; .0001), and poor coronal restoration (p &lt; .0001).ConclusionsThis study corroborates the notion that in general dentistry, root‐filled teeth with radiological signs of apical disease often remain untreated over time. Furthermore, it also reveals that root‐filled teeth presenting with mild pain do not necessarily receive any intervention. However, teeth with baseline signs of apical periodontitis, pain, or inadequate coronal restoration were more likely to have received intervention during the six‐year period.

Digital and Conventional Workflow for Endocrown Fabrication in Pulpotomy Permanent Tooth: Case Report

A higher chance of carrying out a successful full pulpotomy is dependent on the coronal restoration. Preservation of healthy dental structure is essential for providing mechanical stabilization of tooth-restoration integrity and increasing the number of suitable surfaces for adhesion. In this case, endocrown was a suitable restoration due to large coronal destruction. However, the preparation design and material selection affect the manufacturing technique. As shown in this case, the CAD/CAM technique demonstrated technical errors such as marginal chipping and overmilling, for these reasons changing to conventional technique for lithium disilicate endocrown fabrication was adopted. After one week of permanent cementation, the restoration was in good condition and abutment was normal with good gingival health.

Endodontic treatment of severely curved root canals – A case series

Background: It is not uncommon for a dentist to encounter endodontic cases of severely curved root canals. Performing endodontic treatment on severely curved root canals can be a daunting task due to the notable risk of creating an iatrogenic error including ledge, perforation, or even instrument separation. Therefore, radiograph image analysis, proper endodontic treatment planning, selection of appropriate instruments and technique is essential to ensure success in endodontic treatment of severely curved root canals. Purpose: This case series aims to elaborate the instruments and technique to safely negotiate, clean, shape, and seal root canals with severe curvature. Cases: Three patients came to Universitas Airlangga Dental Hospital due to a severe toothache. After anamnesis and examination, diagnosis was established, and endodontic treatment was deemed necessary. During radiographic image analysis, it is visible that the root canal had a severe curvature. Case Managements: Access opening was performed to allow a straight-line access, orifices were preflared, root canals were negotiated, and glide path was established. Then, shaping, cleaning, and sealing can be performed conveniently until the root canal terminus. Subsequently, coronal restoration was fabricated to restore function and esthetics. Conclusion: With proper knowledge, case analysis, appropriate instruments and techniques, severely curved root canals can be safely and predictably negotiated, cleaned, shaped, and sealed.