Nonsurgical Endodontics Research Articles

Teaching of magnification in the undergraduate curriculum: A position statement from the British Endodontic Society Teachers of Endodontology Group.

This position statement on undergraduate teaching on the use of magnification in endodontics represents the consensus of the British Endodontic Society Teachers of Endodontology Group. Current clinical and scientific evidence, as well as the expertise of the committee, has been used to develop this statement. The contributors to this position statement consider, as a minimum requirement, the use of dental loupes in non-surgical endodontics at undergraduate level. It is recommended that the use of dental loupes should be integrated into endodontic clinical skills training and the performance of endodontic treatment in the undergraduate curriculum.

Use of a Penrose Drain for Decompression of a Large Periapical Lesion: A Case Report With 4.5-Year Follow-up

Managing large cyst-like periapical lesions poses significant challenges, especially when nonsurgical treatment or retreatment options are ineffective. Despite its efficacy, decompression remains an underutilized minimally invasive alternative in modern dentistry. This case report describes the use of a Penrose drain for decompression following aspiration and irrigation to manage a large periapical lesion associated with a 56-year-old man's maxillary lateral incisor. The lesion had caused thinning and perforation of the facial and palatal cortical plates, as well as the inferior border of the nasal fossa. Cone-beam computed tomography was used to evaluate the lesion preoperatively and to assess the healing progress postoperatively. Complete 3-dimensional healing was observed after a subsequent root-end surgery performed 3.5years post-decompression. This report suggests that decompression using a Penrose drain in combination with aspiration and irrigation could be a simple but effective modality for managing large cyst-like periapical lesions when nonsurgical endodontics are attempted and deemed ineffective.

Dynamic Navigation System vs. Free-Hand Approach in Microsurgical and Non-Surgical Endodontics: A Systematic Review and Meta-Analysis of Experimental Studies.

(1) Background: A Dynamic Navigation System (DNS) is an innovative tool that facilitates the management of complex endodontic cases. Despite the number of advantages and limitations of this approach, there is no evidence-based information about its efficiency in comparison with that of the traditional method in endodontics. (2) Objectives: We aimed to explore any beneficial effects of the DNS and compare the outcomes of DNS vs. free-hand (FH) approaches for non-surgical and microsurgical endodontics. (3) Methods: A literature search was conducted in August 2023 to identify randomized, experimental, non-surgical, and microsurgical endodontic studies that compared the DNS with FH approaches. The procedural time (ΔT, s), substance loss (ΔV, mm3), angular deviation (ΔAD, °), coronal/platform linear deviation (ΔLD_C, mm), and apical linear deviation (ΔLD_A, mm) were recorded and analyzed. Quality and risk of bias assessments were conducted according to the Quality Assessment Tool For In Vitro Studies. A meta-analysis was performed using mean difference and standard deviation for each outcome, and heterogeneity (I2) was estimated. p < 0.05 was considered significant. (4) Results: One-hundred and forty-six studies were identified following duplicate removal, and nine were included in the systematic review and meta-analysis. The overall risk of bias was classified as low. The DNS was found to be more accurate and efficient than the FH approach was, resulting in a significantly shorter operation time (p < 0.00001) and less angular (p ≤ 0.0001) and linear deviation (p ≤ 0.01). For substance loss, the advantage of the DNS was significant only for microsurgery (p = 0.65, and p < 0.005, for non-surgical and microsurgical procedures, respectively). A reduced risk of iatrogenic failure using the DNS was observed for both expert and novice operators. (5) Conclusions: The DNS appears beneficial for non-surgical and microsurgical endodontics, regardless of the operator's experience. However, appropriate training and experience are necessary to access the full advantages offered by the DNS.

Beyond Tradition: Non-surgical Endodontics and Vital Pulp Therapy as a Dynamic Combination.

Symptomatic irreversible pulpitis and apical periodontitis in mature permanent teeth present challenges in their management. Traditional treatment approaches, such as root canal therapy or tooth extraction, may compromise tooth structure and oral function. This review article explores the combination of non-surgical endodontic treatment and vital pulp therapy as an alternative approach for these conditions. The purpose is to examine this combined approach's effectiveness, benefits, challenges, and limitations. The objectives include reviewing the literature, evaluating clinical outcomes, discussing potential benefits, and providing recommendations for clinical practice. The combination approach aims to preserve tooth structure, promote healing, and reduce postoperative complications. The article discusses the rationale for combining the two techniques, presents evidence supporting their efficacy, and outlines the techniques and protocols involved. Clinical outcomes, case studies, potential challenges, and comparative analysis with traditional approaches are also explored. Future directions and research recommendations highlight areas for further investigation, innovations, and the development of clinical guidelines. In conclusion, the combination of non-surgical endodontic treatment and vital pulp therapy offers a valuable strategy for managing mature permanent mandibular molars with symptomatic irreversible pulpitis and apical periodontitis. Further research and advancements are needed to refine the treatment protocol and expand the evidence base, and clinicians should stay updated to provide optimal care and improve patient outcomes.

Factors governing the success of non-surgical endodontics: A review

Microorganisms are considered as the primary cause for pulpitis and periapical infection which requires endodontic treatment for pain relief and healthy tooth restoration. Root canal treatment is a sensitive process that requires proper and accurate operative steps accompanied by certain other factors affecting its success. The overall goal of root canal treatment is therefore to prevent or treat periapical disease. Non-surgical endodontic therapy should be attempted whenever feasible and is generally preferred over surgical endodontics, tooth extraction, and replacement. The present review highlights and discusses the major factors affecting the success of nonsurgical endodontic treatment. A multitude of factors has been examined impacting the clinical success of non-surgical endodontics. Some factors had a profound impact on success rates, whereas others showed a negligible effect.

Revitalizing Pulpo Perio Complex

Endodontic–periodontal combined lesions pose a treatment challenge for clinicians, especially when the lesion is persistent and does not show signs of healing after nonsurgical endodontics. This case report describes interdisciplinary management of a nonhealing combined lesion related to a periapical cyst through an integrated approach of apicoectomy and regenerative periodontics. A 51-year-old male patient presented with a sinus tract for 4 months after endodontic retreatment of the maxillary right central and lateral incisor. Surgical enucleation of the cystic lesion together with regenerative periodontics using bone graft, advanced platelet-rich fibrin plus membrane, and guided tissue regeneration membrane to treat the tunnel bony defect was done. Clinical and radiographic examination at 6 months showed resolution of lesion, reduction in probing depths, and good bone fill of the defect.

Three-dimensional printing in endodontics: A review of literature

Three-dimensional (3D) printing is a fast evolving technology and is being increasingly used in dentistry. Compared to the older and traditional (lost-wax technique) methods, 3D printing has an upper hand. A wider variety of raw materials can be utilized with 3D printing. Even though this technology has been known for over 30 years, but its assimilation into practice was slow as it relied on the availability of the right materials, which give accurate prints and have optimal biocompatibity. 3D printing technology can use Cone beam computed tomography (CBCT) data for fabrication of guides used in surgical and non-surgical endodontics. This article assesses applications of 3D printing in endodontics.

Magnification in undergraduate endodontic teaching in the UK and Ireland: a survey of teaching leads in Endodontology.

To investigate the use of magnification in undergraduate endodontic teaching in dental schools within the UK and Ireland and identify factors that may impact on levels of adoption. An electronic questionnaire was distributed to teaching leads in undergraduate endodontics in all UK and Ireland dental schools. Completed questionnaires were received from 15 of 18 course leads. The study revealed magnification is not universally embedded within the undergraduate curricula, and the majority of schools had no expectation for students to use magnification, although it was encouraged. The study provided insight into teaching staff factors, student factors and institutional factors that impact upon the adoption of magnification in undergraduate endodontic teaching. Although course leads utilized magnification in their own practice, this did not translate into institutional expectation for students to use magnification. Barriers to adoption of such an institutional expectation included cost and lack of staff training. Magnification has become viewed as an essential part of endodontic practice. The dental operating microscope has the most significant impact on endodontic visualization; however, the use of dental loupes in nonsurgical endodontics could be considered the minimum standard. The pedagogical dilemma faced by dental educators training undergraduates to behave in a manner that they themselves would not, cannot be rationalized on the basis of cost and lack of staff training. It is proposed that although significant, these barriers are not insurmountable and the use ofdental loupe should become an expectation in undergraduate training in the UK and Ireland.

Endodontic applications of 3D printing.

Computer-aided design (CAD) and computer-aided manufacturing (CAM) technologies can leverage cone beam computed tomography data for production of objects used in surgical and nonsurgical endodontics and in educational settings. The aim of this article was to review all current applications of 3D printing in endodontics and to speculate upon future directions for research and clinical use within the specialty. A literature search of PubMed, Ovid and Scopus was conducted using the following terms: stereolithography, 3D printing, computer aided rapid prototyping, surgical guide, guided endodontic surgery, guided endodontic access, additive manufacturing, rapid prototyping, autotransplantation rapid prototyping, CAD, CAM. Inclusion criteria were articles in the English language documenting endodontic applications of 3D printing. Fifty-one articles met inclusion criteria and were utilized. The endodontic literature on 3D printing is generally limited to case reports and pre-clinical studies. Documented solutions to endodontic challenges include: guided access with pulp canal obliteration, applications in autotransplantation, pre-surgical planning and educational modelling and accurate location of osteotomy perforation sites. Acquisition of technical expertise and equipment within endodontic practices present formidable obstacles to widespread deployment within the endodontic specialty. As knowledge advances, endodontic postgraduate programmes should consider implementing 3D printing into their curriculums. Future research directions should include clinical outcomes assessments of treatments employing 3D printed objects.

MTAによるアピカル・バリアー・テクニックの臨床応用

MTAによるアピカル・バリアー・テクニックの臨床応用

Preparation Prerequisites for Effective Irrigation of Apical Root Canal: A Critical Review.

BackgroundIt is well recognized that disinfection of the complex root canal system at the apical root canal remains the most critical therapeutic measure to treat apical periodontitis.Material and MethodsObservational and experimental data in relation to the anatomy of the apical root canal in different tooth types and the cross sectional diameters of the apical part of the most commonly used hand and rotary files are critically reviewed.ResultsThe present data analysis confirm that the challenging issue of antibacterial efficacy of modern preparation protocols in non-surgical endodontics requires more attention to apical root canal irrigation as a balance between safety and effectiveness. Ex vivo investigations clearly indicate that a specific design of the chemo-mechanical preparation is needed at the onset of RCT, more particularly in infected teeth. Design should be based on specific anatomical parameters, and must determine the appropriate size and taper of preparation as pre-requirements for effective and safe apical irrigation.ConclusionsThe optimal irrigation protocols might be designed on the basis of technical specifications of the preparations procedures, such as the penetration depth, the type of the needle, the required time for continuous irrigant flow, the concentration of NaOCl, and the activation parameters. Key words:Endodontics, root canal treatment, instrumentation, irrigation, apical root canal.

Bilateral dens invaginatus in the mandibular premolars - Diagnosis and treatment

Dens invaginatus (DI) is a developmental anomaly that results from an infolding of the dental papilla during tooth development and simulates the appearance of a tooth within another tooth. It shows a wide spectrum of variations in morphology and usually affects the maxillary lateral incisors. This study presents an unusual case of an Oehlers’ Type I DI involving the bilateral mandibular first and second premolars, which presented as an incidental radiographic finding in the first premolars and was associated with a periapical lesion in the second premolars which was successfully treated using nonsurgical endodontics.

A systematic review of nonsurgical single-visit versus multiple-visit endodontic treatment.

Conventional endodontic treatment used to require multiple visits, but some clinicians have suggested that single-visit treatment is superior. Single-visit endodontic treatment and multiple-visit endodontic treatment both have their advantages and disadvantages. This paper is a literature review of the research on nonsurgical single-visit versus multiple-visit endodontic treatment. The PubMed database was searched using the keywords (endodontic treatment OR endodontic therapy OR root canal treatment OR root canal therapy) AND (single-visit OR one-visit OR 1-visit). Review papers, case reports, data studies, and irrelevant reports were excluded, and 47 papers on clinical trials were reviewed. The studies generally had small sample sizes, and the endodontic procedures varied among the studies. Meta-analysis on the selected studies was performed, and the results showed that the postoperative complications of the single-visit and multiple-visit endodontic treatment were similar. Furthermore, neither single-visit endodontic treatment nor multiple-visit treatment had superior results over the other in terms of healing or success rate. Results of limited studies on disinfection of the root canals using low-energy laser photodynamic therapy is inconclusive, and further studies are necessary to show whether laser should be used in endodontic treatment. This review also found that that neither single-visit endodontic treatment nor multiple-visit treatment could guarantee the absence of postoperative pain. Since the study design of many studies displayed significant limitation and the materials and equipment used in endodontic treatment have dramatically changed in recent years, prospective randomized clinical trials are needed to further verify the postoperative pain and success rates of single-visit versus multiple-visit endodontic treatment.

Recent Advances in Endodontic Visualization: A Review

Advances in endodontics in the past two decades have given endodontists important new tools save natural dentition. By providing both intense focused light as well as a high degree of magnification, the endoscope, orascope, dental loupes and operating microscopes has become an important part of the armamentarium for many endodontists. Each instrument has inherent advantages and disadvantages. Here, we describe the recent advances as well as the traditional magnification tools in field of endodontics. The art of dentistry is based on precision. The human naked eye is capable of distinguishing fine detail, but it is no match for what can be accomplished when an image is sharpened and enlarged. The microscope and other forms of magnification fill that need, especially for accomplishing endodontic procedures. (1)Enhanced magnification and illumination opened the eyes of endodontic surgeons the intricate and complex root canal system. This advancement resulted in miniaturization of the endodontist's armamentarium. (2) Todays innovative and high-tech optical systems can deliver amazing depths-of-field and wide fields of view that enable the dentist view a complete oral cavity in focus without having move. (3)The use of optical magnification instruments such as endoscopes, orascopes, loupes and microscopes enables the endodontist magnify a specified treatment field beyond that perceived by the naked eye. (4) II. Endoscopes The term endoscopy is derived from the Greek language and is literally translated as endon (within) and skopion (to see), hence the meaning, to see within. Early endoscopists such as Hippocrates in 377 BC used primitive tube-like instruments for endoscopy. (5) With major advances in the field of medicine, a breakthrough in optical quality was achieved in 1960 by an English physician, Hopkins, who created a rod lens series that led important advancements in the field of view, magnification, and focal length of the endoscope, resulting in a clearer image.(6) The field of endoscopy has expanded further with the introduction of the dental endoscope. The use of rod-lens endoscope in endodontics was first reported in literature in 1979. (7) It was helpful in diagnosing dental fractures. The traditional endoscope used in medical procedures consists of rigid glass rods and can be used in apical surgery and non-surgical endodontics. The flexible and semi-flexible endoscopes can be very valuable addition the armamentarium. The endoscope is flexible due special nitinol coating (Figure. 1). The optical part which is 0.9 mm of diameter, is a piece of equipment that enables the practitioner a magnification of up 20X with clear picture with wide angle. A 2.7mm lens diameter, a 70o angulation, and a 3 cm long rod-lens are recommended for surgical endodontic visualization and a 4mm lens diameter, a 30o angulation, a 4 cm long rod-lens are recommended for non-surgical visualization through an occlusal access opening. (Figure.2a & 2b) (8) The rod-lens endoscope provides clinicians greater magnification, greater clarity as compared the microscopes and the loupes and the non-fixed field of vision. Non fixed field of vision is the ability view treatment field at various angles and distances without losing depth of field and focus. (9) The Modular endoscope system (Sialotechnology Ltd., Ashkelon, Israel) being based on modern technology of microendoscopes is used in small channel organs (salivary gland ductal system, tear canals) and is designed enable the practitioner work inside the root canal with magnification and instrument access. The system includes three parts:  endoscopic compact system,  optical part that includes ocular part and the endoscope, and  handpiece with a disposable part. (Figure. 3) (10)

Dental microscope in Nonsurgical Endodontics

Modern endodontics has essentially changed following the introduction of the dental microscope since 1990's. One of main advantage of using dental microscope in nonsurgical endodontic treatment is enhancing clinician's ability and quality of treatment through illumination and magnification. Scopes of dental microscope in nonsurgical endodontics are finding a missed or additional root canal and a tooth crack, management of procedural errors, and others. These improvements in technology will result in greater confidence in treatment and better success in clinical practice.

Non-surgical endodontics in retreatment of periapical lesions - two representative case reports

This article reports non-surgical endodontic retreatment of two patients with persistent or recurrent periapical lesions, who had previously undergone surgical and non-surgical endodontic therapy respectively. It further discusses and reviews the relevance of classification of periapical lesions, the explanation behind healing of periapical lesions by endodontic therapy alone, causes of persistence of periapical lesions, choice of treatment modalities (whether surgical or non – surgical) and materials such as intracanal medicaments and irrigants for optimal healing. Key words:Non-surgical, retreatment, periapical, calcium hydroxide, chlorhexidine irrigation.

Root amputation and bone grafting of failed apicoectomy of mesiobuccal root of maxillary first molar

Root amputation is an option available to extend the function of a molar tooth when there is a persistent endodontic failure. This case report of a 52-year-old male provides an overview of the feasibility of mesiobuccal root amputation and bone grafting with calcium sulfate of maxillary right first molar after failed non-surgical and surgical endodontics due to root fracture. A 2 year follow-up showed successful clinical and radiographic results. In specific situations, root amputation is a viable treatment to retain a functional portion of the tooth.

The role of the dental nurse in contemporary endodontics

The efficacy of endodontic treatment depends on good diagnosis, an excellent understanding of the anatomy of the root canal system and good clinical skills. This article looks at the dental nurse's role in non-surgical endodontics, i.e. preparation of instruments and assisting during clinical procedures

Toothache or Trigeminal Neuralgia: Treatment Dilemmas

A 61-year-old woman presented to her general dentist with a complaint of pain associated with the maxillary left first premolar. The patient described a sharp, lancinating pain that was triggered by stimulation of the tooth in question. She also reported 2 specific episodes in which she experienced severe, shooting electrical shock-like pain followed by a hot sensation in the same area. One of these episodes was triggered by a cool breeze on her face and the other occurred while washing her face. Examination and radiographic assessment revealed a periapical osseous lesion resulting in a diagnosis of acute apical periodontitis. Nonsurgical endodontics was completed with no undue effects.

A Nonsurgical Endodontics Relational Research Database: The Initial Six Years of Experience

The purpose of this study was to report results of the initial six years of experience utilizing a nonsurgical root canal treatment (NSRCT) database; to compare patient characteristics, operative procedures, and patient outcomes observed in the database to those observed in other studies; and to discuss the potential benefits of a clinical endodontic database. A total of 7,372 NSRCT cases performed by endodontic residents at the University of Pennsylvania from 2000 to 2006 were evaluated. The odds ratio (OR) for caries and trauma being causative agents for NSRCT in <or=22 year-olds was 1.4 and 6.7 times, respectively, greater than similar odds in 51+ year-olds. The odds for younger patients presenting with the diagnosis of symptomatic irreversible pulpitis were two times greater than for their older counterparts, who were more likely to present with a diagnosis of pulp necrosis. The reasons necessitating NSRCT were most often caries (57.8 percent) and, second, inadequate prior root canal treatment (22.8 percent). The tooth most commonly treated was the mandibular first molar (20.1 percent). Procedural errors were found in 6.1 percent of cases and were more likely to occur in mandibular molars vs. maxillary molars.