Endodontic Treatment Of Permanent Teeth Research Articles

Influence of root canal sealer composition on postoperative pain after endodontic treatment of permanent teeth: a systematic review and meta-analyses

Influence of root canal sealer composition on postoperative pain after endodontic treatment of permanent teeth: a systematic review and meta-analyses

The effect of periapical lesion size on the success rate of different endodontic treatments: a systematic review and meta-analysis

This systematic review evaluated the effect of periapical lesion (PL) size on the success rate of different endodontic treatments, including root canal treatment (RCT), non-surgical retreatment (NSR), and apical surgery (AS). Cohorts and randomized controlled trials investigating the outcomes of endodontic treatment of permanent teeth with PL and its size were identified electronically through Web of Science, MEDLINE, Scopus, and Embase databases. Two reviewers independently conducted the study selection, data extraction, and critical appraisal process. The quality of the included studies was evaluated using the Newcastle-Ottawa Scale and the 11-item Critical Appraisal Skills Program checklist for randomized controlled trials. The success rates of the endodontic treatments (small lesions and large lesions) were estimated using the rate ratios (RRs) with an associated 95% confidence interval (CI). Out of 44 included studies, 42 were cohort, and 2 were randomized controlled trials. Thirty-two studies had poor quality. For the meta-analysis, five studies in RCT, 4 in NSR, and 3 in AS were considered. The RR of the endodontic treatment success in PLs was 1.04 in RCT (95% CI, 0.99-1.07), 1.11 in NSR (95% CI, 0.99-1.24), and 1.06 in AS (95% CI, 0.97-1.16). Only sub-group analysis of long-term follow-up of RCT showed a significantly higher success rate in small lesions than in large lesions. Considering the quality of studies and variation in outcomes and size classification, our meta-analysis demonstrated that the PL size had no significant effect on the success rate of different endodontic treatments.

How does a single visit compare with multiple visits for endodontic treatment of permanent teeth?

How does a single visit compare with multiple visits for endodontic treatment of permanent teeth?

Single versus multiple visits for endodontic treatment of permanent teeth.

Root canal treatment (RoCT), or endodontic treatment, is a common procedure in dentistry. The main indications for RoCT are irreversible pulpitis and necrosis of the dental pulp caused by carious processes, coronal crack or fracture, or dental trauma. Successful RoCT is characterised by an absence of symptoms (i.e. pain) and clinical signs (i.e. swelling and sinus tract) in teeth without radiographic evidence of periodontal involvement (i.e. normal periodontal ligament). The success of RoCT depends on a number of variables related to the preoperative condition of the tooth, as well as the endodontic procedures. RoCT can be carried out with a single-visit approach, which involves root canal system obturation (filling and sealing) directly after instrumentation and irrigation, or with a multiple-visits approach, in which the treatment is completed in two or more sessions and obturation is performed in the last session. This review updates the previous versions published in 2007 and 2016. To evaluate the benefits and harms of completion of root canal treatment (RoCT) in a single visit compared to RoCT over two or more visits, with or without medication, in people aged over 10 years. We used standard, extensive Cochrane search methods. The latest search date was 25 April 2022. We included randomised controlled trials and quasi-randomised controlled trials in people needing RoCT comparing completion of RoCT in a single visit compared to RoCT over two or more visits. DATA COLLECTION AND ANALYSIS: We used standard Cochrane methods. Our primary outcomes were 1. tooth extraction and 2. radiological failure after at least one year (i.e. periapical radiolucency). Our secondary outcomes were 3. postoperative and postobturation pain; 4. swelling or flare-up; 5. analgesic use and 6. presence of sinus track or fistula after at least one month. We used GRADE to assess certainty of evidence for each outcome. We excluded five studies that were included in the previous version of the review because they did not meet the current standard of care (i.e. rubber dam isolation and irrigation with sodium hypochlorite). We included 47 studies with 5805 participants and 5693 teeth analysed. We judged 10 studies at low risk of bias, 17 at high risk of bias and 20 at unclear risk of bias. Only two studies reported data on tooth extraction. We found no evidence of a difference between treatment in one visit or treatment over multiple visits, but we had very low certainty about the findings (risk ratio (RR) 0.46, 95% confidence interval (CI) 0.09 to 2.50; I2 = 0%; 2 studies, 402 teeth). We found no evidence of a difference between single-visit and multiple-visit treatment in terms of radiological failure (RR 0.93, 95% CI 0.81 to 1.07; I2 = 0%; 13 studies, 1505 teeth; moderate-certainty evidence). We found evidence of a higher proportion of participants reporting pain within one week in single-visit groups compared to multiple visit groups (RR 1.55, 95% CI 1.14 to 2.09; I2 = 18%; 5 studies, 638 teeth; moderate-certainty evidence). We found no evidence of a difference in the proportion of participants reporting pain until 72 hours postobturation (RR 0.97, 95% CI 0.81 to 1.16; I2 = 70%; 12 studies, 1329 teeth; low-certainty evidence), pain intensity until 72 hours postobturation (mean difference (MD) 0.26, 95% CI -4.76 to 5.29; I2 = 98%; 12 studies, 1258 teeth; low-certainty evidence) or pain at one week postobturation (RR 1.05, 95% CI 0.67 to 1.67; I2 = 61%; 9 studies, 1139 teeth; very low-certainty evidence). We found no evidence of a difference in swelling or flare-up incidence (RR 0.56 95% CI 0.16 to 1.92; I2 = 0%; 6 studies; 605 teeth; very low-certainty evidence), analgesic use (RR 1.25 95% CI 0.75 to 2.09; I2 = 36%; 6 studies, 540 teeth; very low-certainty evidence) or sinus tract or fistula presence (RR 1.00, 95% CI 0.24 to 4.28; I2 = 0%; 5 studies, 650 teeth; very low-certainty evidence). Subgroup analysis found no differences between single-visit and multiple-visit RoCT for considered outcomes other than proportion of participants reporting post-treatment pain within one week, which was higher in the single-visit groups for vital teeth (RR 2.16, 95% CI 1.39 to 3.36; I2 = 0%; 2 studies, 316 teeth), and when instrumentation was mechanical (RR 1.80, 95% CI 1.10 to 2.92; I2 = 56%; 2 studies, 278 teeth). As in the previous two versions of the review, there is currently no evidence to suggest that one treatment regimen (single-visit or multiple-visit RoCT) is more effective than the other. Neither regimen can prevent pain and other complications in the 12-month postoperative period. There was moderate-certainty evidence of higher proportion of participants reporting pain within one week in single-visit groups compared to multiple-visit groups. In contrast to the results of the last version of the review, there was no difference in analgesic use.

Regenerative Endodontic Treatment of Permanent Teeth with Open Apex: Case Series

The purpose of these case reports is the follow-up of root development and lesions in the apical with different regenerative protocols applied to teeth with vital or vital open apex. In the first case, double antibiotic paste was used for 3 weeks to ensure disinfection, and in the second case, triple antibiotic paste was used. Regeneration treatment was applied with apical bleeding method in the first case and with PRF in the second case. After the blood clots were formed, closure was provided with MTA Plus. It was observed that the lesion area healed completely at the end of 1 year and gave a positive response to the pulp test with electricity. In the second case, it was observed that the radiolucent area in the apical region was greatly improved during the 6th month follow-up, and a positive response was obtained for the pulp test with electricity and the cold test.

Deciduous Tooth Pulp Autotransplantation for the Regenerative Endodontic Treatment of Permanent Teeth With Pulp Necrosis: A Case Series

IntroductionIn young individuals, deciduous tooth pulp might be used as a natural, biologic scaffold for the regenerative endodontic treatment (RET) of young permanent teeth with necrotic pulps and apical periodontitis. The present case series demonstrates the clinical and radiographic outcomes of a novel RET using deciduous pulp autotransplantation in traumatized, necrotic young permanent incisors. MethodsFive previously traumatized maxillary incisors of four 8- to 11.5-year-old patients were treated with a RET protocol that used 2.5% NaOCl irrigation and placement of calcium hydroxide dressing in the first visit. After 4 weeks, the intracanal medication was removed, and the whole pulp tissue harvested from the neighboring maxillary deciduous canine was transplanted into the disinfected root canal without induced apical bleeding. Following placement of a mineral trioxide aggregate coronal barrier, the access cavities were restored with acid-etch resin composite. The root canals of donor primary canines were filled with calcium hydroxide-iodoform paste and were restored as with the permanent incisors. ResultsThree patients were followed-up for 24 months, and 1 patient for 12 months. All teeth demonstrated radiographic evidence of complete periapical healing, slight increase in dentinal wall thickness, and continued apical closure in the absence of clinical symptoms. A positive response to cold test was obtained in 1 incisor at 12 months and 2 at 24 months. ConclusionsBased on 12- and 24-month clinical and radiographic findings, the present cases demonstrate a favorable outcome of a RET protocol using deciduous pulp autotransplantation in young permanent incisors with pulp necrosis.

Regenerative Endodontics as the Future Treatment of Immature Permanent Teeth

The regenerative endodontic procedure (REP) is an alternative solution for endodontic treatment of permanent teeth with incomplete root apex development. It results in angiogenesis, reinnervation, and further root formation. Indications for REP include immature permanent teeth with necrotic pulp and inflammatory lesions of the periapical tissues. The main contraindications comprise significant destruction of the tooth tissues and a lack of patient cooperation. We distinguish the following stages of this procedure: disinfection of the canal, delivery of the REP components, closure of the cavity, and follow-up appointments. For effective canal disinfection, the use of both rinsing agents and intracanal medicaments is suggested. Sodium hypochlorite and triple antibiotic paste are used most commonly. Light-activated disinfection is proposed as an alternative method. The prerequisite for the regeneration process of the pulp is the supply of its essential components: stem cells, growth factors, and scaffolds to the canal lumen. Blood clotting, platelet-rich plasma, and platelet-rich fibrin are used for this purpose. For a proper course of REP, it is also necessary to close the tooth canal tightly. For this purpose, mineral trioxide aggregate (MTA), tricalcium silicate (Biodentine), or types of glass ionomer cement are employed. The patient should attend regularly scheduled follow-up appointments and each time undergo a thorough interview, physical and radiological examination. The most important indicator of a successful REP is the continued growth of the root in length and thickness and the closure of the root apex visible on X-rays. Many different proposals for a management protocol have been published; the following paper proposes the authors’ original scheme. Regenerative endodontics is the future of the endodontic treatment of immature permanent teeth; however, it still requires a lot of research to refine and standardize the treatment protocol. The application of tissue engineering methods seems to be promising, also for mature teeth treatment.

Clinical and radiographic rationale for endodontic treatment of permanent teeth with periapical destruction

In the course of the present study four endodontic treatment schemes were tested and the most effective scheme was determined through the use of calcium hydroxide-based paste being applied three times at an interval of 7-14 days with the subsequent long-term temporary obturation using calcium hydroxide with iodoform, ultrasonic activation of sodium hypochlorite in the root canal, hydrodynamic irrigation and a diode laser. During the entire treatment period, the most effective scheme has revealed a reduction in defect size by 2,57±0,17 (p>0,0001) as well as a 1,84 degree (p>0,0001) decrease in PAI score. Based on optical density data, it was concluded that the application of calcium hydroxide with iodoform in the treatment scheme leads to an 2,2-4,2% improvement in bone tissue regeneration in the periapical zone. The greatest and complete inhibition of microorganisms was determined in patients of the first and third experimental groups in which a diode laser was used. The use of a diode laser in endodontic dental treatment with periapical destruction, enhances antibacterial activity and contributes to the complete inhibition of pathogenic microflora in the root canals.

APPLICATION OF BIOCERAMICS IN THE TREATMENT OF POST-TRAUMATIC PERIODONTITIES OF PERMANENT TEETH IN CHILDREN

Relevance. In children, post-traumatic complications in the teeth with incomplete formation of the root often lead to stopping the development of the root and premature loss of teeth. The instability of the results of endodontic treatment with calcium hydroxide preparations leads to the search for new treatments. Materials based on tricalcium phosphate ceramics attract attention because they contribute to the regeneration of bone tissue. Objective: to evaluate the effectiveness of endodontic treatment of post-traumatic periodontitis of permanent teeth with incomplete root formation using bioceramics based on biological hydroxyapatite "Osteopatite ceramic" brand "OK 015". Materials and methods. In children aged 9-15 years, 17 permanent teeth with post-traumatic complications were treated. In 12 cases, this was chronic granulating periodontitis. For a prolonged temporary obturation of root canals, a paste was used, which was prepared by mixing metronidazole and "OK 015" granules. The treatment was monitored every other day, 2 weeks, 1, 3, 6, 9, 12 months. Permanent root canal filling was performed after apexification. Results. In the early stages of the observation of complications of treatment was not observed. 3 months after treatment, bone structure regeneration was activated, in 1 tooth – apexification. After 6 months, the positive dynamics of bone regeneration was observed in 100 % of children. X-ray reconstruction of bone tissue was confirmed in 35,3 % of cases, apexification occurred in 41,2 %. After 9 months, bone resection was observed in 59 % of cases, apexification – in 64 % of the teeth. After 12 months, bone tissue recovery occurred in 76,5 % of cases, in 94 % – apexification. Thus, the rate of apexification is ahead of the processes of reparative osteogenesis. The formation of a mineralized barrier is not always accompanied by a complete restoration of the structure of the periapical bone. Conclusion. Material based on biological hydroxyapatite "Osteoapatite ceramic" brand "OK 015" for temporary obturation of the root canal promotes apexification and regeneration of bone tissue in the periapical region in the process of endodontic treatment of permanent teeth with unformed root in children.

How does a single visit compare with multiple visits for endodontic treatment of permanent teeth?

How does a single visit compare with multiple visits for endodontic treatment of permanent teeth?

Single versus multiple visits for endodontic treatment of permanent teeth.

Root canal treatment (RoCT), or endodontic treatment, is a common procedure in dentistry. The main indications for RoCT are irreversible pulpitis and necrosis of the dental pulp caused by carious processes, tooth cracks or chips, or dental trauma. Successful RoCT is characterised by an absence of symptoms (i.e. pain) and clinical signs (i.e. swelling and sinus tract) in teeth without radiographic evidence of periodontal involvement (i.e. normal periodontal ligament). The success of RoCT depends on a number of variables related to the preoperative condition of the tooth, as well as the endodontic procedures. This review updates the previous version published in 2007. To determine whether completion of root canal treatment (RoCT) in a single visit or over two or more visits, with or without medication, makes any difference in term of effectiveness or complications. We searched the following electronic databases: Cochrane Oral Health's Trials Register (to 14 June 2016), Cochrane Central Register of Controlled Trials (CENTRAL) (the Cochrane Library, 2016, Issue 5), MEDLINE Ovid (1946 to 14 June 2016), and Embase Ovid (1980 to 14 June 2016). We searched ClinicalTrials.gov and the World Health Organization International Clinical Trials Registry Platform for ongoing trials to 14 June 2016. We did not place any restrictions on the language or date of publication when searching the electronic databases. We included randomised controlled trials (RCTs) and quasi-RCTs of people needing RoCT. We excluded surgical endodontic treatment. The outcomes of interest were tooth extraction for endodontic problems; radiological failure after at least one year, i.e. periapical radiolucency; postoperative pain; swelling or flare-up; painkiller use; sinus track or fistula formation; and complications (composite outcome including any adverse event). We collected data using a specially designed extraction form. We contacted trial authors for further details where these were unclear. We assessed the risk of bias in the studies using the Cochrane tool and we assessed the quality of the body of evidence using GRADE criteria. When valid and relevant data were collected, we undertook a meta-analysis of the data using the random-effects model. For dichotomous outcomes, we calculated risk ratios (RRs) and 95% confidence intervals (CIs). For continuous data, we calculated mean differences (MDs) and 95% CIs. We examined potential sources of heterogeneity. We conducted subgroup analyses for necrotic and vital teeth. We included 25 RCTs in the review, with a total of 3780 participants, of whom we analysed 3751. We judged three studies to be at low risk of bias, 14 at high risk, and eight as unclear.Only one study reported data on tooth extraction due to endodontic problems. This study found no difference between treatment in one visit or treatment over multiple visits (1/117 single-visit participants lost a tooth versus 2/103 multiple-visit participants; odds ratio (OR) 0.44, 95% confidence interval (CI) 0.04 to 4.78; very low-quality evidence).We found no evidence of a difference between single-visit and multiple-visit treatment in terms of radiological failure (risk ratio (RR) 0.91, 95% CI 0.68 to 1.21; 1493 participants, 11 studies, I2 = 18%; low-quality evidence); immediate postoperative pain (dichotomous outcome) (RR 0.99, 95% CI 0.84 to 1.17; 1560 participants, 9 studies, I2 = 33%; moderate-quality evidence); swelling or flare-up incidence (RR 1.36, 95% CI 0.66 to 2.81; 281 participants, 4 studies, I2 = 0%; low-quality evidence); sinus tract or fistula formation (RR 0.98, 95% CI 0.15 to 6.48; 345 participants, 2 studies, I2 = 0%; low-quality evidence); or complications (RR 0.92, 95% CI 0.77 to 1.11; 1686 participants, 10 studies, I2 = 18%; moderate-quality evidence).The studies suggested people undergoing RoCT in a single visit may be more likely to experience pain in the first week than those whose RoCT was over multiple visits (RR 1.50, 95% CI 0.99 to 2.28; 1383 participants, 8 studies, I2 = 54%), though the quality of the evidence for this finding is low.Moderate-quality evidence showed people undergoing RoCT in a single visit were more likely to use painkillers than those receiving treatment over multiple visits (RR 2.35, 95% CI 1.60 to 3.45; 648 participants, 4 studies, I2 = 0%). There is no evidence to suggest that one treatment regimen (single-visit or multiple-visit root canal treatment) is better than the other. Neither can prevent all short- and long-term complications. On the basis of the available evidence, it seems likely that the benefit of a single-visit treatment, in terms of time and convenience, for both patient and dentist, has the cost of a higher frequency of late postoperative pain (and as a consequence, painkiller use).

Regenerative Endodontic Treatment of Permanent Teeth after Completion of Root Development: A Report of 2 Cases

IntroductionClinical regenerative endodontic treatment has been focused on immature necrotic teeth, but it should be extended to mature teeth as an alternative to conventional endodontic treatment. There have been no clinical reports to attempt to revascularize pulp in the entire root canals of mature necrotic teeth. The present report describes the treatment of mature, necrotic, permanent incisors with apical periodontitis by using regenerative endodontic therapy. MethodsIn this case report, modified regenerative endodontic procedures were used to enhance the probability of pulp revasuclarization in mature necrotic teeth. At the first appointment, the root canals were mechanically instrumented to the apices with a large apical size by using the step-back technique and irrigated copiously with antimicrobial solution. Intracanal medicaments (calcium hydroxide or ciprofloxacin) were placed in the root canals. At the following appointment, the root canals were irrigated with antimicrobial solution, and bleeding was induced into the root canals by passing hand files beyond apices. Collagen membranes were placed in the canals as a matrix against which mineral trioxide aggregate was placed. Glass ionomer was used to restore the teeth. The resolution of apical radiolucency and regression of clinical signs and symptoms were observed at recall appointments. ConclusionsThe present report presents modified regenerative endodontic procedures for mature necrotic permanent teeth. Further clinical studies with a large number of cases are needed to investigate the outcome of regenerative endodontic therapy for mature necrotic teeth.

Is endodontic treatment performed under general anaesthesia technically acceptable?

Undertaking endodontic treatment under general anaesthesia (GA) is often described as difficult and hazardous, but no study reports on safe and efficacious conditions for endodontic treatment under GA. This study aims to evaluate whether compromises made for the endodontic treatment of permanent teeth under GA are acceptable. It describes the quality of endodontic treatment undertaken in two series of consecutive patients treated either under GA or local anaesthesia (LA). Post-operative data sheets and periapical radiographs were collected for 255 permanent teeth treated under GA during a 4-year period (GA group, 125 patients with special needs) and for 246 permanent teeth treated under local anaesthesia over 7months (LA group, 180 healthy patients). The radiographic criteria for quality of endodontic treatment (RCQET) were considered satisfactory when (1) the root filling was within 2mm of the apex; (2) the filling displayed no voids or defects; and (3) all the visible canals had been obturated. The type of tooth, pulpal status and periapical status were considered independent variables for RCQET. The proportion of satisfactory RCQET reached 63% in both groups and differed by type of tooth, being significantly lower for molars than for other teeth. From a technical point of view, compromises made for the endodontic treatment of permanent teeth under GA are acceptable. Further studies should be conducted to evaluate the long-term success of endodontic treatment performed under GA. This study supports the feasibility of endodontic treatment for patients treated under GA.

Single versus multiple visits for endodontic treatment of permanent teeth

Single versus multiple visits for endodontic treatment of permanent teeth

Reason for Endodontic Treatment of Permanent Teeth of Patients seen in a Nigerian Teaching Hospital

Objective: To determine the reasons for endodontic treatment. Methodology: This was a cross-sectional study of all patients aged 17years and above of both gender attending the conservative clinic for endodontic treatment during the 18 months study period. Reasons for pulp disease leading to teeth being indicated for root canal therapy were retrieved from the patients\' hospital record. Result: 323 teeth were indicated for endodontic treatment. The teeth included one hundred and two anterior teeth (31.6%), one hundred and forty one premolars (43.7%) and eighty molars (24.8%). Reasons for endodontic treatment were caries, trauma, failed restoration, tooth wear, periodontal disease and any combination of these reasons. Caries was the most common reason for endodontic treatment (50.2%), followed by trauma (20.7%) while failed restoration accounted for (16.1%).Trauma was the commonest reason for endodontic treatment among the anterior teeth studied while dental caries was the commonest reason for endodontic treatment among the posterior. Conclusion: Dental caries was found to be the commonest reason for endodontic therapy. Traumatic exposure of the pulp was the second most common reason for endodontic treatment. Premolars were the most treated teeth, followed by anterior (incisors and canines). Molars were the least treated teeth. Keywords : Endodontic Treatment, Pulpitis, Indications NQJHM Vol. 16 (2) 2006: pp. 37-40

Radiological assessment of apex formation following use of hydroxyapatite

The treatment of pulp in teeth with incomplete apex formation is still a clinical challenge. In addition to the most widely used medication for this purpose, calcium hydroxide, other materials have also been tested. Following the use of synthetic biomaterials for restoring bone tissue, and considering their recognized biocompatibility and bioconductivity, our intention was to explore the possibility of using synthetic biomaterials in the endodontic treatment of permanent teeth with incomplete apex formation. The aim of this study was to observe the effectiveness of hydroxyapatite in apexogenesis of young permanent teeth. In this study a 100 µm synthetic hydroxyapatite material, Beohap (HAP) powder, was applied to 24 teeth in 3 dogs of 5.5 months of age, after incomplete root development was established on radiographs. The treated teeth were radiographed monthly and the radiographs compared with those of the corresponding teeth on the other side of the jaw until completion of apex growth. The tested teeth were divided into three groups according to the method of treatment: the first was direct pulp capping, the second was amputation of the pulp at the enamelcement junction and the third was high amputation at the radiographically identified point of root growth. On the basis of radiographic analysis, apex formation was successful in all test groups, with no significant differences between the three groups and the controls (Fisher's and χ 2 test). Deformities of the root apex were observed in two teeth (25%) in the third group.