Nonsurgical Endodontic Treatment Research Articles

Patient-related perceptions and experience measures of non-surgical endodontic treatment – A cross-sectional study

Objectives: This study assessed the outpatients’ perceptions of non-surgical root canal treatment (RCT) and compared them with their post-treatment experiences. Material and Methods: Eighty participants were selected for this cross-sectional study based on inclusion and exclusion criteria. Two surveys were conducted from October 01, 2023, to November 30, 2023 (Pretreatment survey) – one conducted before the RCT includes a survey about the patient’s past RCT experiences and demographics such as age, sex, and level of educational status. Multiple-choice questions were employed to determine patient concerns related to RCT, while modified visual analog scales (0–100) were used to assess pain and anxiety (Post-treatment survey) – done after the endodontic procedure with a root canal filling material. It outlines the patient’s experience, any discomfort experienced during treatment, the significance of tooth retention, and Re-RCT. Results: No difference was found in the demographic analysis. Out of the 80 participants, 33 participants (41.25%) presented with pretreatment anxiety, and 12 participants (15%) reported post-treatment. In the pretreatment survey, the primary concerns were pain and cost, which were reported at 27.55% and 10%, respectively. The post-treatment survey detailed that the time and the need for Re-RCT were the concerns, with reported rates of 11.25% and 10%, respectively. An absolute difference was found between anticipated and pre-operative pain and between experienced and pre-operative pain. However, no difference was found between anticipated and experienced pain 89% of the patients were willing to go for RCT again if needed. Conclusion: Treatment success is the goal for any dental procedure performed, which might be perceived differently by the patient and dentist. Consideration of patient perceptions and experiences, along with the dentist’s opinions, will help enhance endodontic treatment success.

The immune landscape in apical periodontitis: From mechanism to therapy.

Apical periodontitis (AP) is featured by a persistent inflammatory response and alveolar bone resorption initiated by microorganisms, posing risks to both dental and systemic health. Nonsurgical endodontic treatment is the recommended treatment plan for AP with a high success rate, but in some cases, periapical lesions may persist despite standard endodontic treatment. Better comprehension of the AP inflammatory microenvironment can help develop adjunct therapies to improve the outcome of endodontic treatment. This review presents an overview of the immune landscape in AP, elucidating how microbial invasion triggers host immune activation and shapes the inflammatory microenvironment, ultimately impacting bone homeostasis. The destructive effect of excessive immune activation on periapical tissues is emphasized. This review aimed to systematically discuss the immunological basis of AP, the inflammatory bone resorption and the immune cell network in AP, thereby providing insights into potential immunotherapeutic strategies such as targeted therapy, antioxidant therapy, adoptive cell therapy and cytokine therapy to mitigate AP-associated tissue destruction.

Diagnosis and endodontic treatment of odontogenic cutaneous sinus tracts: A report of two cases

Introduction: The odontogenic cutaneous sinus tract (OCST), caused by pulp necrosis, creates connections between pathological spaces and anatomical structures. Extraoral manifestations pose diagnostic challenges leading to inappropriate treatments such as multiple surgery and antibiotic therapies. Effective management requires the treatment of dental pathology through endodontic therapy or extraction. This paper presents two cases of OCST and emphasizes the importance of accurate diagnosis and successful non-surgical endodontic treatment. Observations: Case report 1: A 23-year-old male patient referred by his dermatologist with a cutaneous sinus tract on his chin that had appeared five years ago. During this period, he reported spontaneous pain and pus discharge from the chin area. The examination revealed a periapical lesion associated with tooth number 31. Cone beam computed tomography (CBCT) revealed the existence of a localized perforation on the buccal alveolar table and a second root canal of the tooth. After six months of follow-up, the cutaneous sinus tract was significantly improved by the appropriate endodontic treatment. Case report 2: A 36-year-old female patient was referred by her dentist to examine a chin lesion that had appeared a month ago. In clinical examination and radiographic assessment, periapical lesion associated with two mandibular central incisor teeth #41 and #31 was observed. After identifying the source of infection, endodontic treatment was carried out, and a good improvement in fistula was observed after one month. Conclusions: The correct diagnosis and treatment of OCST are important for healing. CBCT aids to identify odontogenic origin of the sinus tract through the detection of apical periodontitis and bone lesion. Root canal therapy is the treatment of choice for these cases and should always be attempted first. Monitoring the patients is necessary until complete healing of the disease.

Nonsurgical root canal treatment of an Oehlers type IIIa maxillary central incisor with dens invaginatus: a case report

Dens invaginatus has a complex anatomy, making endodontic treatment challenging. We report the case of a 11-year-old girl who presented with radiolucency at the apex of the maxillary central incisor; she was diagnosed with symptomatic apical periodontitis. Cone-beam computed tomography (CBCT) revealed dens invaginatus. The invagination and root canal were observed using a dental operating microscope, and nonsurgical root canal treatment was performed. The invagination was connected to the periodontal tissue, and the tooth was classified as Oehlers type IIIa. Root canal preparations were performed using NiTi files and an ultrasonic device. A calcium hydroxide paste was used as an intracanal dressing. The root canal was filled using a single-cone hydraulic condensation technique with a highly fluid calcium silicate-based sealer. At the 2-year follow-up, no clinical symptoms were observed, and CBCT images revealed no radiographic lesions. Nonsurgical endodontic treatment using CBCT imaging, dental microscope, effective cleaning systems, and a highly fluid sealer facilitated the successful treatment of apical periodontitis attributed to dens invaginatus. The single-cone hydraulic condensation technique using a bio-ceramic sealer is considered effective even in cases with a complex morphology and open apex.

Nonsurgical endodontic treatment of Type II dens invaginatus by removal of the internal structure of the tooth : a case report

Dens invaginatus is a developmental anomaly that occurs when the enamel organ is invaginated into the dental papilla before the process of calcification during tooth development. Dens invaginatus exhibits various anatomical variations, and these structural changes can complicate treatment. For effective management of dens invaginatus, it is crucial to accurately understand the internal structure of the tooth and to establish an appropriate treatment plan. Cone-beam computed tomography (CBCT) has proven to be a valuable tool for three-dimensional reconstruction of the tooth. This case report presents a maxillary lateral incisor with pulpal necrosis and periapical periodontitis. The case involves dens invaginatus characterized by a separate tooth structure, diagnosed using CBCT, and a treatment plan was established accordingly. For treatment, a dental microscope was used to remove the internal structure of the tooth, followed by filling with mineral trioxide aggregate (MTA).

Management of Intracanal Separated Instruments Using Ultrasonics: A Case Series

Cleaning and shaping of the root canal system is an important step in non-surgical endodontic treatment. One of the mishaps associated with this step is intracanal instrument separation. Endodontic instruments separation often results from overuse or incorrect use. Such an event impedes shaping, disinfection and subsequent filling of the canal space apical to the instrument fragment. The use of ultrasonics has shown appreciable success for management of these cases especially when supported with magnification and illumination. With adequate knowledge, suitable armamentaria, fine clinical skills, and experience successful management of such cases, without further complications, is possible. If not well managed, intracanal separated instrument fragments adversely affect the long-term treatment outcome of endodontically treated teeth. This report presents three cases with intracanal separated instruments which were successfully managed with the use of ultrasonics under magnification with dental loupes. Keywords: Instrument Separation, Retrieval, Root Canal Treatment, Ultrasonics

Surgical Endodontic Management Of Maxillary Incisors: A Case Report

In the root canal system, infection of the pulp tissue caused by caries or other pathways is the primary cause of apical periodontitis. The ultimate goal of the endodontic treatment is to create adequate conditions for periradicular tissue healing. Nonsurgical endodontic treatment is a highly predictable treatment option in most cases, but surgery may be indicated for teeth with persistent periradicular pathosis unresponsive to nonsurgical approaches. The aim of this article is to highlight the possibility of the successful outcome of surgical endodontic treatment following failed non-surgical treatment of right maxillary central incisor. With proper case selection and operator skill, periradicular surgery can be considered predictable, cost-effective alternative to tooth extraction and tooth replacement.

Healing of Large Periapical Lesions with Non-Surgical Endodontic Treatment

Healing of Large Periapical Lesions with Non-Surgical Endodontic Treatment

CT-Assisted Management with Biodentine Obturation and Aesthetic Rehabilitation of a Geminated Maxillary Central Incisor with Mid-Root Fracture: A Rare Case Report

Gemination, a rare aberration in tooth development, results from the incomplete division of one tooth germ into two. In this case report, a true geminated permanent maxillary central incisor tooth with a horizontal mid-root fracture is successfully treated by non-surgical endodontic treatment. To elucidate the intricate root canal anatomy of this rare geminated incisor, we employed computed tomography imaging technology, enhancing our understanding of this complex case. Utilizing biodentine for obturation proved pivotal, as its capacity to accelerate reparative dentin formation facilitated prompt healing, particularly beneficial in fracture cases. This was followed by aesthetic rehabilitation to achieve a pleasing mesio-distal dimension for both the central incisors using a zirconia-reinforced porcelain crowns. Keywords: Computed Tomography (CT), Gemination, Horizontal root fracture, Biodentine Obturation

Comparing the technical quality and clinical outcomes of root canal treatment on immature permanent incisors in children: a retrospective evaluation of three bioceramic plug materials.

To assess the technical quality and clinical outcomes of non-surgical endodontic treatment of immature permanent incisor teeth with three different bioceramic plug materials and highlight variables which may influence treatment and quality outcomes. This cross-sectional analysis forms part of a retrospective service evaluation of the technical quality and clinical outcome of orthograde root canal treatment carried out in the Paediatric Dentistry Department of Charles Clifford Dental Hospital (United Kingdom). Twenty-five cases were identified chronologically, using the electronic patient record system, for three bioceramic plug materials: Mineral Trioxide Aggregate (MTA), Biodentine, and TotalFill Putty. All radiographs were analysed using standard conditions. Intra- and inter-examiner agreement was calculated using Kappa and weighted Kappa tests. Data were collected using a data collection tool, entered into Microsoft Excel, and analysed using descriptive statistics, exploratory analysis with Chi-squared tests, and multivariable analyses (logistic regression). At 12-month review, the success rate for each apexification material was MTA (84%), Biodentine (88%), and TotalFill Putty (92%). MTA had the highest frequency of post-operative coronal discolouration, with Biodentine most associated with apical extrusion. A number of variables and trends that affect the clinical outcome were identified, including the presence of pre-operative resorption, the number of operators involved in treatment, the number of appointments to complete treatment, as well as how non-use of local anaesthetic during apical plug placement had no adverse effect on technical quality or clinical outcome. MTA, Biodentine, and TotalFill Putty are highly effective apexification materials which produce excellent clinical outcomes. As such, logistical and situational factors, such as continuity of care from operators with increased levels of experience, skill and ability, rather than material choice, may be more prognostic regarding the technical quality and clinical outcome of immature endodontic treatment. Further high-quality evidence is required.

Quantifying Radiographs in Endodontics: A Survey

Purpose: The aim of this study was to investigate the average quantity of radiographs obtained during non-surgical endodontic treatment and trends in endodontic radiography among U.S. members of the AAE. Materials & Methods: A survey was sent via e-mail to 4,269 active U.S. members of the AAE. Data were collected over a period of approximately 4 months. The number of radiographs reported for non-surgical endodontic treatment was compared across fourteen variables using Kruskal Wallace tests. Chi Square tests of Independence were also used to evaluate trends in endodontic radiography based on three primary categorical variables of interest: years of experience, professional role (PR) and use of CBCT technology. Results: 412 responses were collected (response rate ~10%). 98.3% of respondents were endodontists while the remaining 1.7% were endodontics residents. 96.1% of respondents reported the use digital radiography, 98.1% use CBCT, 87.1% of respondents reported always using an Electronic Apex Locator (EAL), and only 29.4% of respondents reported using any type of handheld x-ray system. 54.4% reported always taking intra-operative (IO) radiographs. Most respondents selected 6-7 and 8-12 radiographs to be excessive. Kruskal Wallace tests confirmed statistically significant differences between the quantity of radiographs acquired and the categorical variables (i.e., PR, years of experience, the quantity of radiographs respondents reported to be excessive, and the type of radiography used while in residency (conventional vs. digital). The average number of radiographs acquired during non-surgical endodontic treatment was 3 (anterior), 4 (premolar) and 4 (molar). Chi Squared Tests of Independence revealed significant trends in endodontic radiography based on respondents’ PR, years of experience, and use of CBCT technology. Conclusion: There were statistically significant differences in the average quantity of radiographs obtained during non-surgical endodontic treatment amongst respondents of varying PR and years of experience. The use of adjunct technology, type of radiography, and preferred positioning device did not significantly impact the number of radiographs completed. The average number of radiographs acquired during non-surgical endodontic treatment was higher for premolars and molars than anterior teeth.

Regressão de lesão periapical após tratamento não cirúrgico – Relato de caso

The present study aims to present the clinical case report regarding non-surgical endodontic treatment performed on tooth 22, with diffuse periapical lesion, suggesting chronic dento-alveolar abscess. The methodology consists of an individual descriptive study of the case report type, which includes radiographic images of a 23-year-old female patient. Clinically, in addition to swelling, it was found that there was mobility, absence of pain in the thermal test (cold) and on palpation. After a complete clinical examination, endodontic treatment, coronary opening, root canal exploration, and root canal preparation were initiated using the modified Oregon crown-apex preparation technique, associated with 2.5% sodium hypochlorite as an irrigating solution. Calcium hydroxide paste was applied as an intracanal medication for a period of 30 days and the coronary access was sealed with glass ionomer. In the following session, after verifying the absence of clinical signs and symptoms, it was decided to fill the root canal using the Tagger's Hybrid technique associated with gutta-percha and AH Plus endodontic cement. After the 24-month preservation period, tissue repair and bone neoformation of the area were observed, as well as the absence of clinical signs.

Non-surgical endodontic treatment of a type III dens invaginatus with large perirradicular radiolucency using bioceramic materials: Case report

Dens invaginatus (DI), also known as dens in dente, is an uncommon dental anomaly in humans, characterized by irregular morphological development during odontogenesis, which can manifest in various coronal and radicular anatomies. Endodontic treatment of teeth with this variation demands anatomical knowledge, detailed planning, and the use of specialized techniques and materials. The objective of this research is to detail, through a case report, the non-surgical endodontic treatment of type III dens invaginatus in the upper lateral incisor with extensive periapical lesion, using bioceramic materials. An 18-year-old female patient was referred to the referral center by an orthodontist after radiographic examination revealed an extensive periapical lesion on tooth 12. Consequently, cone beam computed tomography was requested to assess the lesion and internal/external anatomy. The endodontic treatment was performed entirely under operative microscopy, utilizing mechanized instrumentation and thermoplasticized obturation. Disinfection was enhanced through activated irrigation technique and intracanal placement of bioceramic medication, with periapical repair achieved using bioceramic sealer cement. Long-term follow-up demonstrated that conservative endodontic treatment, employing modern techniques alongside bioceramic materials, proved effective in resolving complex cases.

Management of rarely seen internal tunnelling root resorption associated with a maxillary permanent incisor

This case presents clinical techniques and materials that may be applied in the management of internal tunnelling root resorption, a rare condition which has little published literature.A 25-year-old woman was referred to a specialist centre by her general dental practitioner following an incidental finding of a radiographic radiolucency, suggestive of root resorption associated with tooth 21. A provisional diagnosis of external cervical resorption was made, and following cone beam computed tomography (CBCT), a definitive diagnosis of internal tunnelling root resorption given. Non-surgical endodontic treatment was completed using continuous wave compaction with a calcium-silicate based sealer. No further intervention has been required.A summary of the histology, aetiology, prevalence, diagnosis, management and prognosis of internal tunnelling root resorption is provided. The benefits of CBCT for diagnosing and managing internal tunnelling resorption defects and using continuous wave compaction with a calcium-silicate based sealer, compared to cold obturation techniques, are discussed.

Platelet-rich fibrin as an apical barrier for MTA placement in the treatment of teeth with open apices: a pilot study

ObjectiveThe aim of the present pilot study was to assess the effectiveness of the platelet-rich fibrin (PRF) apical barrier for the placement of MTA for the treatment of teeth with periapical lesions and open apices.MethodsA total of thirty teeth on twenty-eight patients with open apices and periapical periodontitis were enrolled and divided into two groups in the present pilot study. In the PRF group (fourteen teeth in thirteen patients), nonsurgical endodontic treatment was performed using PRF as an apical matrix, after which the apical plug of the MTA was created. For the non-PRF group (fourteen teeth in fourteen patients), nonsurgical endodontic therapy was performed using only the MTA for an apical plug with no further periapical intervention. Clinical findings and periapical digital radiographs were used for evaluating the healing progress after periodic follow-ups of 1, 3, 6, and 9 months. The horizontal dimension of the periapical lesion was gauged, and the changes in the dimensions were recorded each time. The Friedman test, Dunn-Bonferroni post hoc correction, and Mann-Whitney U test were used for statistical analysis, with P < 0.05 serving as the threshold for determining statistical significance.ResultsAll patients in both groups in the present pilot study had no clinical symptoms after 1 month, with a significant reduction in the periapical lesion after periodic appointments. The lesion width of the PRF group was significantly smaller than that of the non-PRF group in the sixth and ninth month after treatment.ConclusionsPRF is a promising apical barrier matrix when combined with MTA for the treatment of teeth with open apices and periapical periodontitis. Small number of study subjects and the short time of follow-up period limit the generalizability of these results.Trial registrationTCTR, TCTR20221109006. Registered 09 November 2022 - Retrospectively registered, https://www.thaiclinicaltrials.org/show/TCTR20221109006.

Outcomes of nonsurgical endodontic treatment under general anesthesia in special health care needs: An observational study

Background and aimThe alarming rise in the number of people with special health care needs (SHCNs) necessitates a paradigm shift in how to approach their oral health needs. General anesthesia (GA) is a valuable technique for facilitating dental procedures in patients with SHCNs who may not be able to tolerate treatment without it. The aim was to assess nonsurgical endodontic treatment and outcomes in patients with SHCNs performed under GA.MethodSeventy-eight permanent teeth in 33 patients who received nonsurgical endodontic treatment under GA were included between 2018 and 2022 in SHCNs hospital clinics. The demographic data, types of SHCNs, pulpal and periapical diagnosis, type of treatment, and material used were analyzed. All patients were recalled for clinical and radiographic examinations. Pre-treatment and recall periapical radiographs were evaluated and scored using the Periapical Index (PAI).ResultsAutism and Attention deficit hyperactivity disorder were 39.4% of patients treated. Most treatments delivered were primary nonsurgical root canal treatment (95%). Warm vertical compaction of gutta-percha for obturation accounted for 88% of cases treated. Single cone obturation technique was used in 9 cases (12%) utilizing tricalcium silicate sealer. At the recall visits, 98.7% of teeth treated had survived. Twelve teeth have pre-treatment periapical lesions, and all healed except one. Female patients were found to have higher scores of PAI compared to male patients (23.7% vs 7.5%), yet insignificant. Only 10 patients with nonsurgical root canal treatment reported recurrent caries.ConclusionThis study demonstrates a high survival rate for nonsurgical endodontic treatment performed under GA in a cohort of patients with SHCNs. Interestingly, patients with social and communication disorders received the highest proportion of treatments under GA. These findings highlight the potential of GA-facilitated endodontics for this population. However, further research is warranted to explore additional methods for optimizing oral health outcomes in SHCNs.

The Accuracy of Cone Beam Computed Tomography Scans in Determining the Working Length in Teeth Requiring Non-surgical Endodontic Treatment: A Retrospective Clinical Study

The Accuracy of Cone Beam Computed Tomography Scans in Determining the Working Length in Teeth Requiring Non-surgical Endodontic Treatment: A Retrospective Clinical Study

Nonsurgical Minimally Invasive Endodontic Treatment of Large Periapical Lesions: A Report of Three Cases

Introduction Periapical lesions develop as a result of microorganisms from necrotic pulp tissue or retained foreign bodies in the periapical tissue, leading to acute or chronic inflammation. It has been proven that the majority of inflammatory periapical lesions can be effectively treated using nonsurgical endodontic management. However, the selection between surgical and nonsurgical endodontic treatment for managing large periapical lesions remains a controversial issue. This report aims to reveal the effectiveness of nonsurgical, minimally invasive endodontic treatment for large periapical lesions in conjunction with lesion decompression and aspiration. Case Presentation This article presents three cases with large periapical lesions related to severe bone destruction with different causes that were managed with nonsurgical endodontic treatment, involving multiple visits for intracanal medication with calcium hydroxide. In all three cases, the long-term clinical assessments and CBCT scans consistently showed complete healing. The follow-up period ranged from 24 to 48 months. Conclusion The successful results demonstrated the efficacy of nonsurgical endodontic management, which is a minimally invasive approach when addressing large inflammatory periapical lesions with diverse causes.

40-Year Outcome of Old-School, Non-Surgical Endodontic Treatment: Practice-Based Retrospective Evaluation.

(1) Background: Non-surgical endodontic treatment has been shown to be clinically successful; however, clinical long-term data are scarce. This practice-based retrospective clinical investigation evaluated endodontic outcomes over 40 years and identified relevant clinical co-factors. (2) Methods: Two experienced dental practitioners in two different private dental practices treated 174 patients with 245 teeth from 1969 to 1993. After root canal obturation, either a new direct restoration (amalgam, resin composite, or glass-ionomer cement) or the re-cementation of a pre-existing prosthetic restoration or renewal of prosthetic restoration followed. Metal posts (operator A) or metal screws (operator B) were inserted when coronal substance loss was significant. The primary outcome (i.e., tooth survival) was achieved when the endodontically treated tooth was, in situ, painless and had full function at the end of the observation period. A secondary outcome, the impact of different prognostic factors on survival rate, was evaluated. (3) Results: The overall mean survival was 56.1% of all treated teeth after 40 years of clinical service, resulting in an annual failure rate of 1.1%. Most investigated clinical co-factors (jaw, tooth position, intracanal dressings, post/screw placement, and gender) showed no significant influence on survival. (4) Conclusions: Even with materials and techniques from the 1970s and 1980s, successful root canal treatment was achievable. Except for post-endodontic restorations, most of the evaluated factors had no significant influence on the clinical long-term survival of root canal-treated teeth.

Repair of perirradicular tissues in non-surgical endodontic treatment. A review

Non-surgical endodontic treatment aims to prevent apical periodontitis, achieved with the disinfection of the root canal system. Additionally, there are pathologies where the toxic content of the canal goes to the periradicular tissues, causing osteolysis or lesions of the bone tissue that are radiographically observed as radiolucent images. When the endodontic treatment is successful, the repair of these lesions occurs over time. To analyze the periradicular repair process of non-surgical endodontic treatment and the factors that affect it. An electronic search was carried out using the search engines PUBMED, Scopus, Google Academic, and Scielo with the words "Non-Surgical Endodontic Treatment," "Periapical Tissues," "Biological Repair," "Apical Repair." Factors such as incomplete texts, PDF texts, and publication date of the article were considered, including data from the last five (05) years. The information reviewed comprised 236 articles analyzed with the inclusion and exclusion criteria, and only 42 articles met these criteria. The success of endodontic treatment lies in the absence of clinical and radiographic signs and symptoms of infection; this is achieved with a good application of clinical protocols and procedures focused on the disinfection of the root canal system, from diagnosis, biomechanical preparation, and disinfection of the root canal system with irrigating substances and filling, including coronal rehabilitation from an aesthetic and/or prosthetic point of view.