Nonsurgical Endodontic Treatment Research Articles

The 5-Year Survival Rate of Nonsurgical Endodontic Treatment: A Population-based Cohort Study in Korea

IntroductionThe purpose of the current population-based study was to analyze the 5-year survival rate of teeth that received nonsurgical endodontic treatment. Specifically, the variables affecting the 5-year survival rates of endodontically treated teeth were analyzed. MethodsThe present study included all endodontically treated teeth reported in 2010 in the National Health Insurance Cohort database of the Republic of Korea. By tracing the dental records of the sample to the end of 2015, the 5-year survival rates of the initial root canal treatment (RCT) and re-RCT were analyzed. Gender, age, institution type, diagnosis, arch type, tooth type, number of visits, and rubber dam usage were included in the analyses as confounding variables. ResultsIn total, 2,866,749 teeth received initial RCT, and 173,429 teeth received re-RCT. Five-year survival rates were 90.85% and 88.42%, respectively. The survival rate of teeth that received initial RCT was significantly higher than that of those that received re-RCT. Specifically, re-RCT showed a significantly higher rate of extraction within 12 months than during other intervals. Furthermore, the following characteristics significantly positively affected the 5-year tooth survival rate: being female, <20 years of age, hospital as the institution type, mandibular teeth, anterior teeth, initial RCT, and use of rubber dam. ConclusionsBecause of its high 5-year survival rate, endodontic treatment is an effective method for maintaining natural teeth.

Endodontic microsurgery. Part two: armamentarium and technique.

Modern endodontic microsurgery has a high reported success rate of up to 93.5%, making it a viable treatment option in the management of periapical disease when orthograde root treatment is not possible or inappropriate. This high success rate is intimately related to advanced techniques that have allowed practitioners to overcome historical barriers to the success seen in traditional surgical endodontics. When comparing traditional root-end surgery and endodontic microsurgery there are key differences when considering the flap design, access armamentarium, size of osteotomy, instruments used and root-end material. This paper highlights such key differences and advises practitioners on the techniques and instruments used to achieve high success rates, firmly establishing non-surgical endodontic treatment as an important treatment option in well-selected cases.

Effect of Low-level Laser Therapy With Different Locations of Irradiation on Postoperative Endodontic Pain in Patients With Symptomatic Irreversible Pulpitis: A Double-Blind Randomized Controlled Trial.

Introduction: This double-blind, placebo-controlled, clinical trial aimed to investigate the analgesic efficacy of low-level laser therapy (LLLT) with two different locations, and their comparison, in postoperative endodontic pain (PEP) levels in molars diagnosed with symptomatic irreversible pulpitis. Methods: Seventy-five patients with a molar tooth, diagnosed with symptomatic irreversible pulpitis, were divided into three groups of placebo, buccal only irradiation (BI), and buccal and lingual irradiation (BLI), with 25 cases being in each group. The participants received similar single-visit nonsurgical endodontic treatments. Then, a sham laser was used in the control group instead of LLLT. Individuals in BI and BLI groups received 80-second irradiation on the buccal surface and 80-second irradiation on each of the buccal and lingual surfaces respectively. A laser with an 808 nm wavelength, power of 100 mW, and a fiber diameter of 600 μm was used. PEP was assessed using a 0-100 mm VAS 4, 8, 24, and 48 hours after the treatment. Results: BLI showed a significantly higher reduction of PEP compared to placebo in all time intervals of this study. BLI was significantly more effective than BI 8 hours after the treatment. However, intragroup differences between BLI and BI groups at other time intervals and between BI and placebo groups in all time intervals were not significant. The number of taken analgesics in the BLI group was significantly lower than the placebo group and was on a statistical borderline compared to the BI group. Conclusion: LLLT with BLI was an effective measure as a supplement to oral analgesics in the reduction of PEP compared to the placebo.

An international survey on the use of calcium silicate-based sealers in non-surgical endodontic treatment.

To gain insight on the current clinical usage of bioceramic root canal sealers (BRCS) by general dental practitioners (GDPs) and endodontic practitioners (EPs) and to determine if BRCS clinical application is in accordance with the best available evidence. An online questionnaire of 18 questions addressing BRCS was proposed to 2335 dentists via a web-based educational forum. Participants were asked about socio-demographic data, clinical practice with BRCS, and their motivation for using BRCS. Statistical analysis (chi-squared test or Fisher's exact test) was applied, as appropriate, to assess the association between the variable categories (p value < 0.05). The response rate was 28.91%. Among respondents, 94.8% knew BRCS (EPs more than GDPs, p < 0.05) and 51.70% were using BRCS. The primary reason for using BRCS was their belief of its improved properties (87.7%). Among BRCS users, single-cone technique (SCT) was the most employed obturation method (63.3%) which was more applied by GDPs (p < 0.05); EPs utilized more of the thermoplasticized obturation techniques (p < 0.05). A proportion of 38.4% of BRCS users indicated the usage of SCT with BRCS regardless of the root canal anatomy (GDPs more than EPs p < 0.05) and 55.6% considered that BRCS may influence their ability to re-establish apical patency during retreatment (GDPs more than EPs p < 0.05). This study highlights wide variation in the clinical use of BRCS which is not in accordance with the current literature. This inconsistency among EPs and GDPs on BRCS clinical application requires further clarifications to better standardize their use and improve their future evaluation.

Defining Endodontic Residents' Clinical Experiences: A National Survey.

Endodontic residency programs across the U.S. vary in the exposure they provide to residents in procedures, protocols, and equipment. Having information on the range of clinical experiences provided in programs would be useful for program directors and for applicants who are seeking the best fit for their residency. The aim of this study was to collect information from residents in U.S. endodontic residency programs about the procedures and equipment they experienced in their programs. In January 2018, a 14-question survey was emailed to all 437 endodontic residents with an email address in the 2016-17 American Association of Endodontists Membership Directory. Survey items asked about the number of endodontic procedures, techniques employed, and products used in residents' programs. A total of 133 endodontic residents responded to all or part of the survey, for a 30% response rate. The majority reported completing 151-250 nonsurgical root canals, 26-50 nonsurgical retreatments, 0-10 surgical retreatments, and 0-10 regenerative endodontic procedures during their residencies. All respondents said they used a surgical operating microscope (SOM), and 82% reported using a multi-file rotary system for nonsurgical procedures. Respondents reported that the main instruments they used were Dentsply Sirona file systems, and the most commonly used obturation technique was warm vertical compaction/condensation, reported by 92% of respondents. These endodontic residents reported being exposed to a variety of procedures, products, and protocols during their residency. Based on information they provided, prospective endodontic residency applicants can expect to use the SOM for treatment, to gain extensive experience in primary nonsurgical endodontic treatment, and to not perform endodontic surgery during their first year of postgraduate training.

Nonsurgical Endodontic Treatment of Necrotic Teeth Resolved Apical Lesions on Adjacent Implants with Retrograde/Apical Peri-implantitis: A Case Series with 2-year Follow-up

Retrograde (or apical/periapical) peri-implantitis (RPI) presents with radiographic signs of bone loss at the periapical area of endosteal implants and may also present with clinical signs of abscess formation or a sinus tract traceable to the implant periapex. The lesion may form days up to several years after the initial implant placement. In contrast to marginal peri-implantitis, which has a prevalence of 19.83%, RPI may be underreported because many clinicians are currently not aware of this type of lesion. The etiology, although not fully understood, may be attributed to endodontic infection of an adjacent tooth or residual microorganisms present after the extraction of an infected tooth at the implant site. There are several treatment modalities available for the management of RPI. Nonsurgical root canal treatment may be an option if the implant RPI etiology is suspected to be related to an adjacent endodontically involved tooth. In a previous report, surgical treatment modalities to correct RPI were described. This current case series presents 2 cases of RPI in which nonsurgical treatment of the necrotic adjacent teeth resulted in full radiographic and clinical resolution of the adjacent apical peri-implant lesions with 18-month and 2-year follow-ups, respectively. RPI may be prevented by evaluating the endodontic status of natural teeth adjacent to the implants and by addressing endodontic infections near the implant sites. Certain types of implant RPI may successfully be resolved nonsurgically by addressing adjacent endodontic infections as shown by this case series.

Postoperative pain with single- versus two-visit nonsurgical endodontic treatment

Postoperative pain with single- versus two-visit nonsurgical endodontic treatment

Cystic lesion caused by latex material.

Treatment of a maxillary second premolar with an associated cystic lesion through conventional endodontic therapy combined with decompression and cyst enucleation is reported. Although cystic lesions frequently heal simply with endodontic therapy, refractory large lesions after nonsurgical endodontic treatment may require additional diagnosis and treatment. In this case, conventional root canal treatment resulted in incomplete healing and required further surgery. Following cyst enucleation with biopsy of the lesion and apical surgery on the tooth, the cause of the refractory lesion was found to be associated with foreign latex material in the periapical tissue, which was speculated to have originated from exposure to a dental glove. At the 1-year follow-up visit, the lesion exhibited continued resolution.

Radiographic Indications of Vertucci Type V Configuration in the Distal Root of Mandibular Molars: A Case Series

Knowledge of the prevalent root canal anatomy and potential variations is necessary before the initiation of endodontic treatment. The purpose of this study was to aid in the detection and treatment of the Vertucci type V canal configuration when present in the distal root of the mandibular molars. This case series presents 3 radiographic indications of a type V configuration in the distal roots of the mandibular molars as revealed on conventional periapical radiographs: a “ghost” apex, a fast break canal, and eccentric canal tracing. Nonsurgical endodontic treatment was performed for 5 mandibular molars with the type V distal root canal. Four cases showed posttreatment resolution of symptoms and return of normal function. One case was classified as “failed” because of persistent symptoms and clinical signs. The tooth was surgically treated and subsequently healed. These case reports show the importance of visualizing and managing the anatomic variations of the canal system in distal roots of mandibular molars and incorporating these capabilities into clinical practice to enhance the occurrence of a successful outcome. Additionally, clinical guidelines are provided that can help clinicians overcome the challenges in diagnosing and treating such complex cases.

Periapical Healing in Single-visit Endodontics under General Anesthesia in Special Needs Patients

IntroductionThe aim of this study was to determine the prognostic factors of periapical healing of teeth after single-visit nonsurgical endodontic treatment under general anesthesia in special needs patients. MethodsThis retrospective study collected 448 teeth from 241 patients (mean age = 27.4 years, standard deviation = 13.9 years). A total of 271 teeth (60.5%) with clinical and radiographic follow-up records longer than 12 months (mean [standard deviation] = 56.1 [27.9]) were included in the outcome analysis. Demographic, systemic, and dental information about the cases were compared between the healed and nonhealed groups using the Pearson chi-square test. Factors contributing to periapical healing were determined with multivariate logistic regression analysis. ResultsComplete periapical healing without clinical signs was observed in 221 teeth (81.5%), uncertain healing with decreased size of the periapical lesion was shown in 43 teeth (15.9%), and no reduction in lesion size was observed in 7 cases (2.6%). In the multivariate analysis, diet type, oral hygiene maintenance, pulp vitality, and root filling length were detected as contributing factors for complete resolution of periapical lesions (P < .05). ConclusionsSuccessful outcomes of single-visit endodontic treatment under general anesthesia were shown in special needs patients. The prognoses were influenced by the clinical circumstances of the patients and the preoperative conditions of their teeth.

Periapical bone healing following endodontic treatment on the right lower premolar

Background: Acute exacerbation represents a painful condition whereby the tooth becomes highly sensitive to percussion and bite testing, and it can be aggravated by traumatic occlusion. In general, it results from earlier acute apical periodontitis. Bone destruction can be detected via a radiographic examination, and it can be seen as a radiolucent area at the periapex. Bone resorption is caused by osteoclast activation, which results from pulp inflammation. Nonsurgical endodontic treatment is typically performed to resolve the condition. This study aimed to provide an overview of both the treatment protocol and the role of 2% chlorhexidine gluconate as an endodontic irrigant. Case Report: A 38-year-old woman presented with a major complaint regarding tenderness in her lower second right premolar. The patient reported having experienced similar pain approximately 8 months previously. Clinically, the tooth had lost 50% of its coronal structure, which indicated a Class II cavity. Radiographically, bone resorption was detected in the periapical area of the tooth. An analgesic had been consumed for approximately 3 days. The cavity was cleaned and opened, and working length measurements were performed using an electronic apex locator and conventional radiography. Biomechanical preparation was done using ProTaper NEXTTM files, until size X3. Irrigation was performed using 5.25% sodium hypochlorite at each file change and continued with 17% ethylenediaminetetraacetic acid and 2% chlorhexidine for final irrigation. Sterile Aqua Dest was used for each irrigation change to avoid interaction between irrigants. Obturation was performed by means of warm vertical compaction with an epoxy resin-based sealer. An endocrown composite was recommended for permanent restoration. Four months of follow-up revealed bone regeneration and healing. Conclusion: Bone resorption is a common finding in a diseased tooth, and it stems from the persistent inflammatory process. Osteoclasts are responsible for both bone demineralization and activated pro-inflammatory cytokines. The correct endodontic treatment protocol plays an essential role in periapical bone healing.

Outcomes of nonsurgical endodontic treatment in teeth with large periapical lesion

Aim: Present study aimed to evaluate the long-term clinical and radiographical outcomes of non-surgical root canal therapy using calcium hydroxide in anterior teeth with large periapical lesions. Material and Methods: Clinical and radiographical records of 57 mandibular and 32 maxillary anterior teeth of 74 patients were included in the study. A total of 89 anterior teeth with large periapical lesions ranging in size from 6 to 20 mm were treated endodontically with calcium hydroxide as the intracanal medicament. Teeth were evaluated in two parts as lesion diameters between 6-10 mm and 11-20 mm. All cases were followed up for 24 months and assessed in three categories as complete healing, incomplete healing or no healing (failure). Results: Complete healing was observed in 74 (83.1%), incomplete healing in 7 (7.9%) and failure in 8 (9%) teeth in all cases at the end of 24-month assessment. There was no positive correlation between the outcome of the therapy and the size of the periapical lesions (p>0.05). Conclusion: Obtained results suggested that non-surgical endodontic treatment was greatly successful in the treatment of teeth with large periapical lesions and it should be considered before surgical procedure.

Acute odontogenic maxillary sinusitis treated endodontically – two case reports and 15-day CBCT outcome

Patients presented acute recurrences from Otorhinolaryngology treatments with unilateral symptoms compatible with maxillary sinusitis with a dental origin (MSDO). Cone beam computed tomography (CBCT) showed sinus extensive membrane thickening that was not visible at periapical exam associated to the maxillary molar infection in both cases. Respiratory structures assessment was possible using a 6-inches field of view CBCT. Non-surgical endodontic treatment (case 1) performed and retreatment (case 2) showed a fast symptoms relief. Recall examination after 15 days revealed healthy soft tissues with normal periodontal probing and no dental mobility. In addition, 15-day CBCTs revealed initial maxillary sinus membrane recovery after the endodontic approaches in the reported cases. No additional medical intervention nor antibiotics administration were necessary in these MSDO cases management. Long-term follow-up in such cases is advisable to exclude other potential dental or respiratory issues. Diagnose and follow-up using CBCT presented significant sinus membrane thick reduction with no symptom’s recurrence after the endodontic treatment.

Revisión de desobturación de gutapercha con limas manuales, Xilol y Reciproc

Nonsurgical endodontic treatment is the first choice in case of endodontic failure. The first step of retreatment is root canal opening, which will enable the biomechanical preparation of the root canal with proper irrigation and disinfection. The obturation removal protocol includes manual files, solvents and Reciproc, a single-use reciprocating file. This review of the scientific literature addresses the specific characteristics of manufacture, kinematics and function of the instruments and chemical products used in this protocol. We found that the choice of manual files, xylol and Reciproc would allow for a simple, safe and effective opening of the root canal

Cone-beam computed tomography investigation of the anatomy of permanent mandibular premolars in a cohort of Caucasians.

The aim of the present study was to evaluate the number of roots and the anatomy of root canal systems of permanent mandibular premolars using images derived from cone-beam computed tomography (CBCT) scans. Mandibular CBCT scans of a cohort of Caucasians (Italians) were evaluated using a dedicated software. The number of roots and the anatomy of root canal systems (following the classification by Vertucci) were recorded, and the prevalence of each type was calculated. In total, 112 mandibular scans were evaluated accounting for 97 first premolars and 88 second premolars; 94.2% of first premolars and 96.6% of second premolars had one single root. The most common root canal system configuration was type I for both first premolars (79.2%) and second premolars (95.5%). Moreover, a large variability was observed. Based on the results, mandibular premolars show a significant heterogeneity in root canal system anatomy that could complicate non-surgical endodontic treatment.

Infection Control in Teeth with Apical Periodontitis Using a Triple Antibiotic Solution or Calcium Hydroxide with Chlorhexidine: A Randomized Clinical Trial

IntroductionThis randomized clinical study compared the antibacterial effectiveness of treatment protocols using either a triple antibiotic solution (1 mg/mL) or calcium hydroxide/chlorhexidine paste as interappointment medication in infected canals of teeth with primary apical periodontitis. MethodsThe root canals of single-rooted teeth with apical periodontitis were prepared by using a reciprocating single-instrument technique with 2.5% sodium hypochlorite irrigation and then medicated for 1 week with either a triple antibiotic solution (minocycline, metronidazole, and ciprofloxacin) at 1 mg/mL (n = 24) or a calcium hydroxide paste in 2% chlorhexidine gluconate (n = 23). Samples were taken from the canal at the baseline (S1), after chemomechanical preparation (S2), and after intracanal medication (S3). DNA extracts from clinical samples were evaluated for total bacterial reduction using a 16S ribosomal RNA gene-based quantitative polymerase chain reaction assay. ResultsAll S1 samples were positive for the presence of bacteria, and counts were substantially reduced after treatment procedures (P < .01). Bacterial levels in S2 and S3 samples did not significantly differ between groups (P > .05). S2 to S3 reduction was 97% in the antibiotic group and 39% in the calcium hydroxide/chlorhexidine group; only the former reached statistical significance (P < .01). There were significantly more quantitative polymerase chain reaction–negative S3 samples in the antibiotic group than in the calcium hydroxide group (P < .05). ConclusionsInterappointment medication with a triple antibiotic solution at the concentration of 1 mg/mL significantly improved root canal disinfection, and its effects were at least comparable with the calcium hydroxide/chlorhexidine paste. Effectiveness and easy delivery of the antibiotic solution make it an appropriate medicament as part of a disinfecting protocol for conventional nonsurgical endodontic treatment and possibly regenerative endodontic procedures.

Surgical Resection of Odontogenic Inflammatory Maxillary Cyst: Case Report and Review of Literature

Background Odontogenic inflammatory maxillary cysts constitute pathology for which clinical, radiological and evolutionary aspects are considerably polymorphic. For small cystic lesions non-surgical endodontic treatment is used. Larger lesions, however, have a natural tendency to grow and weaken the bone (as well as an inflammatory risk) may be treated by surgery. Case presentation We present a case report of surgical resection of a large maxillary cyst on a patient who previously had multiple dental extractions until complete edentation. Conclusion Great cystic maxillary lesions are relatively rare. A definitive diagnosis cannot be determined based on the history, clinical and radiographic evaluation. A correct pre-operative diagnosis is very difficult and can only be possible after histological examination. Keywords: Dental-radicular cyst, Radiolucency, Maxilla, Enucleation

Effect of immediate periodontal surgical treatment on periodontal healing in combined endodontic–periodontal lesions with communication—A randomized clinical trial

Background and objectiveManagement of combined endodontic–periodontal lesions needs more clinical investigations. The aim of this prospective randomized clinical trial was to evaluate the effect oftime interval between the non-surgical endodontic treatment (ET) and open flap debridement (OFD) on periodontal healing in combined endodontic periodontal lesions with apical communication. MethodsForty patients were randomly allocated to two treatment protocols. Group 1(immediate periodontal surgery): OFD was performed at 21days of initiation of ET and SRP, and Group 2(delayed periodontal surgery): OFD was performed after 3 months of initiation of ET and SRP. The primary parameters included probing pocket depth (PPD), relative attachment level (RAL) and bleeding on probing (BOP) and tooth mobility (TM). ResultsSignificantly more reduction in PPD, TM and gain in RAL was observed in Group 1 at 3 months of OFD. (P<0.05) Whereas at 6 months follow up of OFD (6 and 9 months of ET in Group1 and Group 2, respectively), intergroup analysis showed statistically comparable reduction in BOP (%), PPD, TM and gain in RAL (P>0.05) in both the groups. ConclusionImmediate periodontal surgery may not affect the outcome of the treatment of combined endo-perio lesions with apical communication.

Delayed core or post and crown placement after nonsurgical endodontic treatment resulted in a very small decrease in the survival of the treated teeth in a privately insured population

Delayed core or post and crown placement after nonsurgical endodontic treatment resulted in a very small decrease in the survival of the treated teeth in a privately insured population

Non-surgical endodontic treatment of maxillary first molar with large size and curved canal: a case report

The teeth are subjected to considerable variation for the number, size, form and structure of dental tissues. In this rare case report, a 30-year-old male patient was referred for root canal treatment of his right maxillary first molar because of deep caries in this tooth. During radiographic examination for determining the working length of this tooth, the peri-apical radiographs revealed the unfamiliar size of the maxillary first molar, in addition to severe curvature in mesiobuccal root. To achieve a successful treatment instrumentation of the canals completed with a crown-down technique, and obturation was done with lateral condensation technique.