Endodontic Retreatment Research Articles

The use of cone beam computed tomography in endodontic re-treatment

Radiography plays an integral role in endodontics. However, conventional radiographic techniques have limitations, such as background noise, providing only a two-dimensional representation of the image, superimposition and distortion. Cone beam computed tomography (CBCT) provides the clinician with a three-dimensional image of the structures involved in the clinical situation. When considering options for endodontic re-treatments, it is vital to identify the cause of the initial failure and here, the use of CBCT images can be beneficial. This is illustrated through an endodontic re-treatment case owing to a palatal canal missed with conventional radiographic techniques. CPD/Clinical Relevance: Cone beam computed tomography can be beneficial in cases of endodontic re-treatment.

Análise da eficácia de remoção de cimentos obturadores biocerâmicos versus cimentos convencionais: revisão sistemática e metanálise de estudos in vitro

This study aimed to carry out a systematic review to evaluate the effectiveness in removing bioceramic sealers compared to conventional sealers commonly used, evaluated through the percentage of remaining material. The electronic search was carried out in the following databases: MEDLINE (PubMed), Embase, Web of Science, Scopus, Cochrane Library, and in gray literature, at the Brazilian Digital Library of Theses and Dissertations (BDTD). Two independent researchers conducted the survey to identify the studies, without restrictions on year and language of publication, using the PICO strategy until the month of August 2020. A total of 80 titles were retrieved in the initial search, however, only 9 studies were included for the qualitative synthesis and 5 studies were included in the quantitative synthesis. The descriptive results indicated that the average time taken to remove the filling material was longer for bioceramics by approximately 67% of the studies that evaluated this condition, and with regard to the establishment of patency, no difference was detected between the sealers. It could be observed that bioceramic sealers presented a lower amount of remaining material than conventional sealers (p = 0.01) both in the overall analysis and in the analysis of subgroups. The removal of conventional sealer proved to be inferior to bioceramic sealers, with greater amounts of material remaining in the root canals after endodontic retreatment. The use of bioceramic sealers has gained space in the endodontic practice. However, it is not yet known whether these sealers affect the removal of root canal fillings during retreatments.

Resolution of Apical Periodontitis-induced Mental Nerve Paresthesia Through Nonsurgical Endodontic Retreatment: A Case Report

Paresthesia is a potential consequence of unsuccessful root canal treatment. Persistent infection resulting in apical periodontitis may enlarge sufficiently to involve the mental neurovascular bundle. The case presented in this report was referred for endodontic evaluation with a chief complaint of discomfort on mastication and persistent numbness of the lower left lip. Clinical and radiographic evaluation revealed incomplete primary endodontic treatment of the left mandibular second premolar with complex internal anatomy. The untreated root canal system resulted in the progression of apical periodontitis involving the left mental neurovascular bundle as confirmed by cone-beam computed tomography imaging. Nonsurgical root canal retreatment was performed over 2 visits. At the 3-year follow-up visit, the paresthesia had resolved with return of normal sensation. Nonsurgical endodontic retreatment may be sufficient to allow healing of large periapical lesions and resolve complications including paresthesia without the need for surgical intervention.

Combined Effect of Mineral Trioxide Aggregate and Customized Glass Fiber Post in Nonsurgical Endodontic Retreatment Teeth at Esthetic Zone: A Case Report

Combined Effect of Mineral Trioxide Aggregate and Customized Glass Fiber Post in Nonsurgical Endodontic Retreatment Teeth at Esthetic Zone: A Case Report

Success rate of orthograde endodontic retreatment after failed apicectomy - A retrospective study.

Orthograde retreatment after failed apicectomy maybe a treatment alternative to endodontic resurgery. The purpose of this study was to examine the clinical outcome of orthograde endodontic retreatment after failed apicectomy. Success was rated radiographically in 191 cases of orthograde retreatment after failed apicectomy that were treated in a private practice with a documented recall of at least 12 months. The radiographs were rated individually by two observers, in cases of disagreement a consensus was reached by joint discussion with a third observer. Success or failure were evaluated according to previously described criteria. The success rate and the median survival were calculated using the Kaplan-Meier survival analysis. The log rank test was used to evaluate the effect of prognostic factors/predictors. Hazard ratios of predictors were analysed using Univariate Cox Proportional Hazard regression analysis. The mean follow-up of the included 191 patients (124 females, 67 males) was 32.13 (±23.68) months and the median was 25 months. The overall recall rate was 54%. Cohen Kappa analysis revealed nearly perfect agreement between both observers (k = 0.81; p = 1.0). The overall percentage of success was 84.82% (complete healing 79.06%, incomplete healing 5.76%). The median survival was 86 months (95% CI: 56-86). None of the selected predictors had an influence on the treatment outcome (p > .05). Orthograde retreatment should be considered a valuable treatment option after failed apicectomy. A surgical endodontic retreatment can still be a treatment option after orthograde retreatment to obtain outcome for the patient.

"Endodontic Retreatment in the Cure of Apical Periodontitis; Lateral Canal Involvement: Report of a Case with 18 Years of Evolution"

The objectives of endodontics are the prevention and cure of periapical disease (Apical Periodontitis); which is achieved by cleaning and disinfection of the root canal system and subsequent obturation of root spaces by filling with inert materials, avoiding reinfection and persistent inflammation [1].

The Effect of Mineral Trioxide Aggregate Obturation Levels on the Outcome of Endodontic Retreatment: An Observational Study

IntroductionNo clinical studies have examined the effect of mineral trioxide aggregate (MTA) obturation levels on the outcome of endodontic retreatment. This retrospective study examined treatment outcomes in three cohorts that compared overfilling, flush filling, and underfilling after orthograde retreatment using MTA. MethodsTwo hundred fifty patients with 264 teeth diagnosed with previously treated root canals and apical periodontitis retreated in a private endodontic practice were included. All teeth received MTA obturation and the extent of the final filling level was measured in relation to the major apical foramen. After 6-month follow-ups, all nonhealing cases were treated surgically. After 24- to 72-month reviews, the effect of preoperative lesion size and the degree of MTA obturation level were assessed. Multiple linear regression and time-to-event analysis using Stata 17 software (StataCorp LLC, College Station, TX) were used to evaluate the data. ResultsWithin the three cohorts, 99 out of 108 overfilled teeth (91.7%), 90 out of 103 flush fills (87.4%), and 10 out of 53 underfilled teeth (18.9%) healed and were successfully retreated without surgery at 48-months. When surgical outcomes were included, the combined healed proportion was 93.2%. Preoperative lesion size was found to be an important predictor for retreatment nonhealing. A 1-mm increase in lesion size at baseline resulted in an estimated 11% (95% CI 1.04, 1.18)–38% (95% CI 1.22, 1.58) increase in the risk of surgery. Compared to overfilling and flush filling, underfilling was associated with an approximately three-fold increase in requiring surgery and characterized by delayed healing. ConclusionMTA obturation is a viable retreatment option for teeth with nonhealing endodontic treatment. MTA overfills or flush fillings do not adversely affect healing outcomes. However, MTA underfilling increases the chances for nonhealing and surgical intervention.

An Endodontic Forecasting Model Based on the Analysis of Preoperative Dental Radiographs: A Pilot Study on an Endodontic Predictive Deep Neural Network

IntroductionThis study aimed to evaluate the use of deep convolutional neural network (DCNN) algorithms to detect clinical features and predict the three-year outcome of endodontic treatment on preoperative periapical radiographs. MethodsA database of single-root premolars that received endodontic treatment or retreatment by endodontists with presence of three-year outcome was prepared (n = 598). We constructed a 17-layered DCNN with a self-attention layer (Periapical Radiograph Explanatory System with Self-Attention Network [PRESSAN-17]), and the model was trained, validated, and tested to 1) detect 7 clinical features, that is, full coverage restoration, presence of proximal teeth, coronal defect, root rest, canal visibility, previous root filling, and periapical radiolucency and 2) predict the three-year endodontic prognosis by analyzing preoperative periapical radiographs as an input. During the prognostication test, a conventional DCNN without a self-attention layer (residual neural network [RESNET]-18) was tested for comparison. Accuracy and area under the receiver-operating-characteristic curve were mainly evaluated for performance comparison. Gradient-weighted class activation mapping was used to visualize weighted heatmaps. ResultsPRESSAN-17 detected full coverage restoration (area under the receiver-operating-characteristic curve = 0.975), presence of proximal teeth (0.866), coronal defect (0.672), root rest (0.989), previous root filling (0.879), and periapical radiolucency (0.690) significantly, compared to the no-information rate (P < .05). Comparing the mean accuracy of 5-fold validation of 2 models, PRESSAN-17 (67.0%) showed a significant difference to RESNET-18 (63.4%, P < .05). Also, the area under average receiver-operating-characteristic of PRESSAN-17 was 0.638, which was significantly different compared to the no-information rate. Gradient-weighted class activation mapping demonstrated that PRESSAN-17 correctly identified clinical features. ConclusionsDeep convolutional neural networks can detect several clinical features in periapical radiographs accurately. Based on our findings, well-developed artificial intelligence can support clinical decisions related to endodontic treatments in dentists.

Microbiological profile of root canals indicated for endodontic retreatment due to secondary endodontic infections or for prosthetic reasons.

The objective of this study was to evaluate the microbiological profile of root canals indicated for endodontic retreatment due to secondary endodontic infections evidenced by the presence of chronic apical periodontitis (G1) or for prosthetic reasons, without clinical and radiographic signs of endodontic reinfection (G2). Microbiological samples were collected from thirty teeth (N=30) out of which 15 were indicated for retreatment due to the presence of chronic apical periodontitis (G1) and 15 were indicated exclusively for prosthetic reasons (G2). Samples were collected from root canals before (S1), after chemomechanical preparation (S2), and after 30 days of intracanal medication composed of calcium hydroxide and 2% chlorhexidine gel (S3). The molecular analysis was performed using Nested-PCR for the detection of 17 bacterial species. The efficacy of each stage of the retreatment in reducing the microbial load was verified by counting colony-forming units (CFU). The statistical analysis considered a significance level of 5%. The results showed that bacteria were detected in 100% of the cases in S1, in both groups, by Nested PCR. The most frequently found species in S1 in both groups were Enterococcus faecalis, Fusobacterium nucleatum, Porphyromonas gingivalis, Aggregatibacter actinomycetemcomitans, and Parvimonas micra. The microbial load of G1 was higher than G2 in the initial samples (S1). Endodontic retreatment was effective in reducing the microbial load in G1 and G2. Statistically significant associations were found between specific bacteria and clinical signs and symptoms. It was concluded that the microbial community present in the root canal of teeth indicated for endodontic retreatment is mixed and heterogeneous. G1 and G2 differ in the number of species per case and microbial load. Endodontic retreatment was effective in reducing the microbial load. Statistically significant associations were found between specific bacteria and clinical signs and symptoms.

Guided Endodontic Surgery: A Narrative Review.

Background and objectives: Endodontic surgery has evolved over the last two decades. The use of state-of-the-art guided endodontic surgical procedures produces a predictable outcome in the healing of lesions of endodontic origin. The main objective of this review paper is to define and characterize guided surgical endodontics as well as its benefits and drawbacks by reviewing the most recent relevant scientific literature. Methods: A literature search was conducted using multiple databases comprising of MEDLINE (via PubMed), EMBASE, and Web of Science. The terms used for the search were 'guided endodontics', 'surgical endodontics', and 'endodontic microsurgery'. Results: In total, 1152 articles were obtained from the analysis of the databases. Unrelated articles from the available full text of 388 articles were excluded. A total of 45 studies were finally included in the review. Conclusions: Surgical-guided endodontics is a relatively new area of study that is still maturing. It has many applications such as root canal access and localization, microsurgical endodontics, endodontic retreatment, and glass fiber post removal. Additionally, it does not matter how experienced the operator is; the procedure can be completed for the patient in less time and provides greater accuracy and safety than conventional endodontics.

Treatment outcome of surgical and non-surgical endodontic retreatment of teeth with apical periodontitis.

To evaluate and compare the treatment outcome of root filled teeth with apical periodontitis treated either non-surgically or by endodontic microsurgery, and to assess the influence of an intra-radicular post, clinical and demographic factors. Clinical and radiological data from 1157 patients with apical periodontitis in previously root filled teeth treated by postgraduate students at the Department of Endodontics, University of Oslo, between September 2010 and January 2020 with recall data at least 11 months from completion were studied. Surgical cases were scored using the Rud/Molven criteria and grouped into success, uncertain or failure at control. Non-surgical cases were scored with the periapical index (PAI) and similarly grouped into success, uncertain or failure at control. Chi-square analyses were used for comparison of subgroups of teeth treated and logistic regression analyses for assessment of the influence of clinical variables. Non-surgical retreatment was performed on 351 teeth and 107 teeth were treated with endodontic microsurgery, with overall success rates of 65.5% and 77.6%, respectively. The difference was statistically significant. Teeth with an intra-radicular post treated non-surgically (n = 30) were successful in 73.3% of cases, whereas teeth with intra-radicular post treated with endodontic microsurgery (n = 30) had a lower, 66.7% success rate. The distribution of tooth groups (anterior, premolar and molar) differed significantly between surgical and non-surgical cases, with maxillary anterior and premolar teeth more often treated surgically. Non-surgical retreatment cases were significantly influenced by patients' age (older patients had poorer outcome) and pre-operative PAI score (negatively correlated with outcome). Surgical cases were not significantly influenced by the factors studied here. The tooth type differed significantly for teeth treated by surgical versus non-surgical methods. Microsurgical treatment with apicectomy and retrograde filling showed significantly better treatment results than non-surgical retreatment of teeth with apical periodontitis, whereas treatment outcome in teeth with posts after non-surgical treatment tended to be better than after surgical treatment. Outcome of non-surgical retreatment was negatively influenced by older age and higher pre-operative PAI score.

Rotary Systems for Root Canal Gutta-percha Removal: A Review

Gaining a predictable outcome in endodontics is complicated by handling an endodontically treated. Compared to primary root canal therapy, non-surgical endodontic retreatment typically entails the removal of previous root filling materials. This process may be necessary to enable access to contaminated canal space for recleaning and to remove obturation materials that may have been contaminated by marginal penetration of microorganisms and microbial toxins. The achievement of patency at the canal terminus and the extension of cleaning as close as possible to the apical terminus have been identified as healing prognostic criteria. Gutta-percha (GP) is the current mainstay material utilised as an endodontic filling material, capable of performing comprehensive, three-dimensional sealing of the treated root canal system in a highly effective manner with considerable physical durability. Interestingly, since its initial discovery in the 17th century, GP remains to this day the ideal obturation material used across, in essence, all dental clinics globally due to its material properties and versatility for use in conjunction with sealer compounds. The development of GP removal systems that can manage to remove GP in its entirety from root canals during non-surgical retreatment procedures is currently highly desirable for dental practices. This literature review investigated this current research niche and scrutinised two prevalently utilised rotary systems – Edgefile-XR and the XP-Endo shaper systems.

Retreatment of Oval-Shaped Root Canals – Difficulties and Treatment Approaches

The complex anatomy of oval-shaped root canals presents a major challenge for secondary endodontic retreatment. The positive outcome of the retreatment depends on the proper cleaning and reshaping of the root canal space. Despite the use of various retreatment techniques and the improvement of additional protocols, none of them has yet succeeded in cleaning the entire root canal from filling residue. The untouched irregularities of the oval-shaped canals represent a reservoir for debris and microorganisms that are the main cause of endodontic treatment failure or delayed healing process. Further research should be done to improve the retreatment protocols of oval shaped canals. The aim of this review was to observe the articles investigating the efficacy for retreatment of oval-shaped root canals in the last 10 years.

Evaluation of the efficacy of TruNatomy, ProTaper retreatment, and RaCe file systems in retreatment of moderately curved mandibular molars: An in vitro study.

Endodontic retreatment is the first line of treatment in cases of failed primary endodontic treatment. Although associated with challenges such as incomplete removal of obturating material, increased clinical time, and extrusion of apical debris, endodontic retreatment still has considerable success rate in the general population. The aim of this study was to evaluate and compare the efficacy of TruNatomy, ProTaper retreatment, and RaCe file systems to remove the obturating material, time taken to remove the obturating material, and apical extrusion of debris using cone-beam computed tomography (CBCT). In vitro study. Forty-five moderately curved mesiobuccal roots of the mandibular molars were instrumented up to #25, 4% taper and obturated with bioceramic sealer and lateral compaction technique. Teeth were divided randomly into three groups (n = 15). Teeth were retreated with TruNatomy, ProTaper retreatment, and RaCe file systems, respectively. Preretreatment and postretreatment CBCT scans were recorded and percentage of obturating material removed was calculated. Time taken to remove the obturating material and apical extrusion of debris was noted. Descriptive statistics including percentage, mean, standard deviation, Tukey's post hoc test, Kruskal-Wallis test, and Mann-Whitney Post hoc test were used. The total time needed for the removal of obturating material was comparatively shorter in the RaCe group, followed by the ProTaper retreatment group and TruNatomy group (P < 0.001). TruNatomy files were significantly better in removing the obturating material than the ProTaper retreatment files (P = 0.04). Statically, no difference between RaCe and TruNatomy files was noted. Apically extruded debris was more in the TruNatomy group than in the RaCe and ProTaper retreatment groups (P = 0.01). All tested endodontic files were effective in removal of obturating material, although none could completely remove the filling material and no system could completely eliminate apical extrusion.

Evaluation of volumetric substance loss and precision in targeted endodontic re-treatment with guided versus conventional access cavity preparations: An in vitro study.

Root canal retreatment is typically viewed as an "all or nothing" approach. Whether there is periapical pathosis or not, it is advised that all restorative and obturation materials be removed from all roots. Selective root retreatment, a new therapeutic strategy, allows retreatment to be restricted to a single root or multiple roots exhibiting periapical pathosis. To address the issues, "guided endodontics," a unique guided technique for the preparation of apically extended access cavities, was introduced. In this in vitro experimental study, 22 freshly extracted two-rooted maxillary first premolars were selected and divided into two groups (n = 11). Pretreatment cone-beam computed tomography imaging of all teeth was performed. Root canal treatment was performed for all samples followed by postendodontic composite restorations with the occlusal stamp technique. Then targeted endodontic retreatment (TER) was done with the conventional method and guided method respectively. The tooth substance loss was measured and evaluated using Ez3D-i-3D-software (VATECH) and work precision was determined by calculating the dentinal loss. Statistical data analysis was done by Independent t-test for substance loss measurement and Chi-square test was used to measure the dentinal loss. TER with conventional method showed significantly higher substance loss with t = 4.591 (P < 0.05) and significantly higher dentinal loss measured in conventional method (P < 0.05). In comparison to traditional TER, TER using a customized bur and three dimensions (3D)-guide results in much less substance loss. The dentinal loss was much lower in 3D-guided approach.

Endodontic retreatment decision-making: The influence of the framing effect.

The aim of this study was to explore the influence of a framing effect in retreatment decision-making of a root-filled tooth with asymptomatic apical periodontitis (AP). Two variants of a questionnaire were created in which the factual information about a root filled with AP was identical. The options in the first variant were framed in favor to wait and see (FW) and those in the other variant were framed in favor of retreatment (FR) Two hundred and forty-eight volunteers were by chance given one of the two versions and were asked to choose between having retreatment or to wait and see. Of the 125 participants given the FW version, 69 (55.2%) chose to wait and see while out of the 123 participants who were given the FR version, 38 (30.9%) made the alike choice (p = .0002). A framing effect is likely to play an essential role in endodontic retreatment decision-making of root-filled teeth with asymptomatic apical periodontitis.

Comparative Evaluation Of Amount Of Apically Extruded Debris In Endodontic Retreatment Procedures Using Four Different File Systems- An Invitro Study

Objective(s): To compare the amount of apical debris extruded during endodontic retreatment procedures performed using H files, R-Endo Retreatment files, GPR files and ProTaper Universal Retreatment files.&#x0D; Materials and Methods: The conventional coronal access cavity was prepared for 40 extracted Mandibular Premolars. The root canals were prepared with ProTaper Next Rotary files till X1. Obturation was done by combination of Lateral and Vertical Compaction technique. All the samples were later attached to Eppendorf tubes. The samples were then divided into four groups each containing 10 samples on the basis of different retreatment files to be used. After complete removal of root canal filling material, the debris and the root filling material remnants adhered was collected in preattached Eppendorf tubes. For final weight computation and comparison, the weight of empty tube was deducted from the weight of tube accommodating the debris. ANOVA and Tukey test were applied for statistical analysis.&#x0D; Results: The R-Endo retreatment files showed minimum apical extrusion of debris than all the other examined files in the study. The apical extrusion of debris for R Endo min to max was -0.045 to 0.009. However, there was no statistically significant difference in amount of apical extrusion of debris by different files system (p&gt;0.005).&#x0D; Conclusion(s): There was no significant difference between the groups in apical extrusion of debris. Also rotary retreatment files showed lesser apical of debris than Hedstrom hand files. R Endo extruded less debris apically in this study.&#x0D; Keywords: Apical extrusion of debris; Gutta-percha; Retreatment files.

Missed canal as a factor affecting the periapical status

Aim. To identify the relationship between the presence of a "missed" root canal and the periapical status.Materials and methods. 500 CBCT images of patients of both sexes were studied: 2915 teeth after endodontic treatment, of which 1549 were multicanal. Profile diagnostic criteria were used to identify the "missed" canal.Results. 518 "missed" root canals were revealed, which accounted for 33.4% of the number of multi-canal teeth. In 228 cases, changes in periapical tissues were noted, including 1 case of widening of periodontal ligament space, which accounted for 44% of the total number of "missed" canals. It was noted that the risk of developing apical periodontitis is higher for cases with "missed" canals (p &lt; 0.001). The relationship between the untreated canal and the periapical status is statistically assessed as medium or relatively strong, which confirms the relevance of accurate diagnosis of the anatomy and topography of the root canal system at all stages and by all available methods.Conclusions. In case of sufficient duration of observation, absence of symptoms, absence of periapical changes (radiologically) – repeated treatment for the purpose of endodontic treatment of the "missed" root canal is not justified. If there are changes in the periapical tissues, repeated endodontic intervention should be performed. In this case, preference should be given to endodontic re-treatment using a microscope.

Maxillary anterior teeth with extensive root resorption treated with multidisciplinary approach: A case report

Invasive cervical resorption is a type of external resorption, which is generally located in the cervical region of the tooth. The resorptive process can be caused by physiological, pathological, hormonal, and trauma factors. The present study aimed to report a case of invasive cervical resorption in tooth 12 identified as an incidental finding, in which all available clinical resources were used, as well as a combined multidisciplinary treatment of endodontics, orthodontics, surgery, and prosthesis. At the initial consultation, the tooth presented with Heithersay’s class II resorption, undergoing endodontic treatment and traction for subsequent cavity sealing. After completion of orthodontics, an increase in the resorptive pocket was observed (Class III of Heithersay), which led to endodontic retreatment and subsequent surgical intervention to remove the granulation tissue and fill it with bioceramic material. The preparation of the coronal remnant and fabrication of a prosthetic restoration were performed, with the aim of shielding the endodontic cavity and functionally restoring the tooth. With the case presented, it was possible to conclude that incidental findings are part of the endodontist’s daily life, requiring a constant search both for early diagnosis and effective multidisciplinary treatment, which contributes to the restoration of aesthetics and function, contributing to the tooth longevity.

Effect of EDDY and manual dynamic activation techniques on postoperative pain in non-surgical retreatment: a randomized controlled trial

BackgroundDuring non-surgical retreatment process, the products such as dentin debris, root canal fillings, irrigation solutions, microorganisms and remaining pulp tissues can extrude to the apical area and can cause the postoperative pain and flare-up. Thus, the aim of this study was to evaluatethe effect of EDDY and manual dynamic activation (MDA) techniques on postoperative pain (PP) associated with retreatment.MethodsNinety patients scheduled for retreatment were treated at a single visit. Non-vital mandibular premolar teeth diagnosed with asymptomatic apical periodontitis were included in this study. The patients were divided into two groups (n = 45) on the basis of the need for additional irrigation activation procedures (EDDY and MDA). The patients’ post-treatment pain levels were asked to rate the intensity of their pain on a 10-point numerical rating scale (NRS) at the 12th, 24th, 48th, and 72nd h and 7 days.The data were analyzed using the chi-square and Wilcoxon signed-rank test was used for within-group comparisons and Mann Whitney U test was used to compare the groups by time period.ResultsThe difference in postoperative pain intensity between two groups was statistically significant at 12, 24, 48, and 72 h (p < 0.05). There was no significant difference at 7 days. Moreover, no statistically significant difference was found between the two groups in terms of gender and analgesic medication intake (p > 0.05). Pain intensity after the treatment was lesser in the MDA groupthanin the EDDY group at 12, 24, 48, and 72 h.ConclusionThis study could lead us to conclude that the two activation systems can be used during endodontic retreatment with no difference at PP 7 days later. However, a comparison of the groups indicated that the EDDY resulted in significantly more PP at 12, 24, 48, and 72 h.Trial registration ClinicalTrials.gov Identifier: NCT04726670.