Initial Endodontic Treatment Research Articles

Ameloblastoma Suggesting Large Apical Periodontitis

This case report describes the endodontic treatment of a large apical periodontitis with well-defined margins adjacent to teeth #22–24. After the initial endodontic treatment, continued expansion of the mandible cortical bone was observed, indicating a need to surgically enucleate the lesion and submit it for histopathologic examination. The microscopic examination indicated a diagnosis of ameloblastoma. Ameloblastoma is a benign epithelial neoplasm of odontogenic origin, and depending on the stage of development, it can mimic a periapical lesion and therefore should be considered in establishing an endodontic differential diagnosis. The definitive diagnosis for some periapical lesions can only be made by a histopathologic examination.

The Outcome of Endodontic Treatment: A Retrospective Study of 2000 Cases Performed by a Specialist

The purpose of this study was to evaluate the treatment outcome of initial endodontic treatment and nonsurgical retreatment performed by an endodontic specialist in his private office. A total of 2,000 teeth were examined clinically and radiographically and the results were analyzed statistically by Pearson or Fisher's Exact test and multivariate logistic regression. The multivariate analysis evaluated joint associations among various factors, using logistic regression models. The dependent variable for this analysis was the dichotomous outcome: healed versus disease. The overall endodontic success rate was 91.45%, and the healed rate was significantly higher for initial endodontic treatments than for nonsurgical retreatments; teeth without lesion than for those with lesions; teeth treated without complications than for those with complications; recall period of 18-24 months than for other periods, and teeth with final coronal restoration than for those without. Of the 1376 teeth treated in the initial endodontic treatment sample, the success rate was 94.0%. Multivariate analysis identified the presence of procedural complications (file breakage, perforation and flare-up), as well as the absence of the restorations at follow-ups as the significant predictors of outcome, showing lower rates of success. Of the 624 teeth in the nonsurgical retreatment sample, 85.9% were successful. Stepwise logistic regression analysis revealed that preoperative radiolucency was a strong statistically significant factor to determine lower rates of success than in its absence. Two additional variables (age and tooth type) were found to have a significant influence on the outcome of the retreatment sample. A higher healed rate was observed for the 50-59 years age groups than others, while multirooted (molars) teeth revealed a significantly lower percentage of success than pre-molars and anterior teeth.

Retrospective Cross Sectional Comparison of Initial Nonsurgical Endodontic Treatment and Single-Tooth Implants

Retrospective Cross Sectional Comparison of Initial Nonsurgical Endodontic Treatment and Single-Tooth Implants

Treatment Outcome in Endodontics: The Toronto Study. Phase III: Initial Treatment

The 4- to 6-year outcome of initial endodontic treatment was assessed for phase III (1998-1999) of the Toronto Study. Of the 532 teeth treated, 248 were from discontinuers (excluded), 142 from dropouts, 10 extracted, and 132 (50% recall) examined for outcome: healed (no apical periodontitis [AP], signs, symptoms) or diseased. Phase III was analyzed alone and combined with phases I, II ( n = 373 teeth). Logistic regression performed on the combined phases I-III sample identified significant (p ≤ 0.05) outcome predictors: preoperative AP (OR = 3.5; CI 1.7-7.2; healed: absent, 93%; present, 80%), number of roots (OR = 2.2; CI 1.0-4.7; healed: 1 - 92%; ≥2 - 83%), and intraoperative complications (OR = 2.2; CI 1.1-4.5; healed: absent, 88%; present, 76%). Treatment technique (OR = 2.8; CI 1.3-6.1; healed: Schilder, 89%; alternative, 73%) was suggested as an outcome predictor in teeth with AP, requiring confirmation from randomized controlled trials.

Endodontic Treatment Outcome: Survey of Oral Health Care Professionals

This study assessed the opinion of oral health care professionals regarding the predictability of initial endodontic treatment, expected long-term outcome and the importance of placing a coronal coverage after completion of treatment. An eight-item questionnaire was distributed among oral health care professionals. There were 49% of participants who responded that the expected retention rate of teeth 5 to 10 yr after endodontic treatment was more than 90%, whereas 44% responded that such retention rate was between 70 to 80%. The majority of the participants also responded that the need for additional treatment, such as retreatment, apical surgery or extraction, was expected to occur within the first 3 yr after endodontic treatment if initial treatment has failed. About 87% of participants responded that placing coronal coverage after completion of endodontic treatment in premolars and molars was very important for long-term tooth retention and 92% responded that overall, endodontic treatment was a predictable procedure with long-term tooth retention rate. Statistically significant associations were found between years of experience and expected rate of retention for both the total group of respondents (p < 0.001) and for general practitioners when examined separately (p < 0.002). Statistically significant associations were only found for general practitioners between years of experience and their responses regarding the need for additional treatment (p < 0.05) and overall predictability of endodontic treatment (p < 0.02). A trend was found between the professionals’ years of experience and their opinion regarding the importance of coronal coverage. Of the group who had more than 20 yr of experience, about 87% considered coronal coverage to be very important for long-term tooth retention. In conclusion, it appears that most clinicians participating in this study consider endodontic therapy to be a predictable procedure with long-term tooth retention rate. Their opinions also reflect the variations that currently exist in the literature regarding the reported outcome of endodontic treatment.

Endodontic Treatment Outcomes in a Large Patient Population in the USA: An Epidemiological Study

Outcome assessment of endodontic treatment is critical for appropriate case selection and treatment planning. However, reports on outcomes of nonsurgical endodontic treatment vary considerably. Epidemiological studies done in a large patient population and over a long follow-up period can provide the clinician with useful tools for clinical decision-making and assessment of tooth prognosis. In this study, outcomes of initial endodontic treatment done in 1,462,936 teeth of 1,126,288 patients from 50 states across the USA was assessed over a period of 8 yr. Treatment was done by private general practitioners and endodontists participating in the Delta Dental Insurance plan that insures approximately 14 million individuals in the USA. Overall, 97% of teeth were retained in the oral cavity 8 yr after initial nonsurgical endodontic treatment. The combined incidence of untoward events such as retreatments, apical surgeries, and extractions was 3% and occurred mostly within 3 yr from completion of treatment. Analysis of the extracted teeth revealed that 85% had no full coronal coverage. A significant difference was found between covered and noncovered teeth for all tooth groups tested (p < 0.001). In conclusion, it appears that initial nonsurgical endodontic treatment is a predictable procedure with high incidence of tooth retention after 8 yr.

Treatment Outcome in Endodontics—The Toronto Study. Phase II: Initial Treatment

The 4- to 6-yr outcome of initial (first-time) endodontic treatment was assessed for Phase II of the "Toronto Study." In total, 442 teeth were treated by using flared preparation and vertical compaction of warm gutta-percha or step-back preparation and lateral compaction. With 126 teeth excluded (discontinuers: deceased and relocated patients), 163 dropouts, and 31 extracted, 122 (48% recall) were examined for outcome: "healed" (no apical periodontitis [AP], signs, symptoms) or "diseased" (AP, signs, or symptoms). Phase II was analyzed separately and combined with Phase I (n = 242), using Chi-square and Fisher's exact tests (p < or = 0.05). The healed rate (combined sample, 85%) differed significantly for preoperative AP (absent, 93%; present, 79%), treatment technique (flared preparation and vertical compaction, 90%; step-back preparation and lateral compaction, 80%), gender (females, 90%; males, 79%), number of roots (1-92%; > or = 2-81%), and root-filling length (adequate, 87%; inadequate, 77%). Logistic regression revealed increased risk of disease for preoperative AP (odds ratio = 3.3) and technique (odds ratio = 2.3). This study confirmed AP and highlighted treatment technique as the main predictors of outcome in initial treatment.

Treatment Outcome in Endodontics: The Toronto Study. Phase 1: Initial Treatment

This study assessed the 4- to 6-yr outcome of initial endodontic treatment during Phase 1 of the "Toronto Study" project. A total of 450 teeth were treated, alternating the "Schilder" technique and step-back with lateral condensation, and examined clinically and radiographically by an independent examiner. Apical periodontitis was recorded as absent (periapical index < 3) or present (periapical index > or = 3) and outcome dichotomized as "healed" (no apical periodontitis, no signs or symptoms) or "disease." Univariate, bivariate, and multivariate analyses were performed (p = 0.05) on 120 examined teeth. The "healed" rate (81% overall) was significantly higher for teeth treated without apical periodontitis (92%) than with apical periodontitis (74%). Several other factors were associated with healing rate differential of 10% or higher, but no statistical significance. This study confirmed apical periodontitis as the main prognostic factor in initial endodontic treatment. Continuation of the project will allow assessment of other prognostic factors with better power.

Infection-related mental and inferior alveolar nerve paresthesia: Literature review and presentation of two cases

A review of the literature on infection-related mental and inferior alveolar nerve paresthesia is given. This is followed by 2 case reports. The first case is of a mandibular left second molar in which a chloropercha overfill puff occurred in the vicinity of the inferior alveolar canal. The tooth remained asymptomatic until 2 and 1/2 yr later, when the periapical lesion enlarged and swelling, pain, and paresthesia developed. The paresthesia resolved 2 weeks following periapical surgery. The second case is of a mandibular right first premolar in which paresthesia began 1 day after the initial endodontic treatment. The intracanal medication was formocresol on a cotton pellet that was squeezed dry. The paresthesia was treated by irrigation, antibiotics, and dexamethasone. The paresthesia lasted 7 weeks, and when it resolved the root canal was filled with gutta-percha/eucapercha. Almost 9 months later, the tooth remained asymptomatic.

Prevalence and quality of endodontic treatment in an elderly urban population of Switzerland

Little oral health data on the elderly are available in Switzerland. This study assessed endodontic findings in 66-yr-old residents of the city of Zurich using intraoral radiographs. Of the 143 volunteers having a total of 2004 natural teeth, 78% had at least one endodontically treated tooth. Twenty percent of all teeth were root filled, two thirds of them being in the upper jaw. Sixty-four percent of the root fillings were judged insufficient and 8.5% of all teeth showed periapical radiolucencies, most of the latter (73%) being associated with insufficient root canal treatments. Ninety-eight percent of the root-filled teeth had intracanal retentive devices. Fifty-two percent of the teeth with insufficient root fillings were judged not to need revision, 37% needed revision, 9% needed apicectomy, and 2% were ready for extraction. The considerable endodontic treatment needs of the elderly can only be reduced by an improvement of quality of initial endodontic treatment.

Management of posttreatment endodontic pain with oral dexamethasone: A double-blind study

In a double-blind study, twenty-five subjects who received oral dexamethasone and twenty-five placebo subjects rated their postoperative pain 8 and 24 hours following initial endodontic treatment. The subjects who received dexamethasone reported statistically significantly less postoperative pain than the subjects who received the placebos. The question is raised as to whether oral corticosteroids are appropriate for routine management of posttreatment endodontic pain.

Stress, relaxation and saliva: a follow-up study involving clinical endodontic patients.

Dentally induced stress and relaxation-induced anxiety reduction recently have been correlated with salivary changes in private patients treated by a solo endodontist. Hypnosis was shown to be more effective than local anesthesia in anxiety reduction. Dental students and clinic patients were employed in this study in an attempt to replicate the previous findings. One additional salivary variable (pH) was examined. Twenty-nine endodontic clinic patients were treated, each by a different dental student. The patients completed dental anxiety questionnaires and had salivary samples taken prior to, and at the conclusion of, their initial endodontic treatments. Pain and anxiety were managed using local anesthesia, hypnosis, or nitrous oxide-oxygen, either alone or in combination. There were significant anxiety-reduction changes by the conclusion of the visits (p less than 0.001) as measured by increased salivary volume, increased salivary translucency, reduced salivary protein, increased salivary pH and reduced questionnaire-determined anxiety level. Hypnosis and nitrous oxide-oxygen were significantly more effective (p less than 0.05) than local anesthesia in anxiety reduction as measured by salivary changes and questionnaires. It can be concluded that saliva is an easily obtained fluid that can be used to determine levels of stress and relaxation.

Stress, relaxation, and saliva: A pilot study involving endodontic patients

Thirty-four endodontic patients completed dental anxiety questionnaires and had saliva samples taken prior to and at the conclusion of their initial endodontic treatment. Pain and anxiety were managed with local anesthesia, nitrous oxide—oxygen psychosedation, hypnosis, and mediation, either alone or in combination. For most patients, by the conclusion of the treatment, anxiety had decreased, salivary volume had increased, and salivary protein was reduced. Meditation and hypnosis, either alone or in combination with local anesthesia, were most effective in anxiety reduction as measured by questionnaire and/or salivary changes.