Nonsurgical Root Canal Treatment Research Articles

Exploring morphometric transformations in temperature-sensitive NiTi instruments alongside real-time intracanal temperature dynamics.

This study was twofold: (i) it aimed to investigate the morphometric changes of three temperature-sensitive nickel-titanium (NiTi) instruments at different temperatures, and (ii) to conduct an invivo real-time analysis of intracanal temperature changes. Changes in the shape and length of XP-Endo Shaper, XP-Endo Finisher, and XP-Endo Finisher-R were evaluated in real time whilst heated in a temperature-controlled water bath from 22 to 45°C. Instruments were fixed to a laminated water-resistant 1 mm graph paper attached to a stone block. Instruments were imaged whilst subjected to increasing temperature using a digital camera attached to an operating microscope. From recorded videos, still frames were extracted at 10-s intervals and changes in the length and shape of each instrument were measured and changes were plotted against time. Moreover, the intracanal temperature of distal roots of lower molars was measured invivo for patients attending the clinic for non-surgical root canal treatments. The temperature was measured using a K-type thermocouple probe inserted into the mid-root level after irrigating the canal with a solution set at room temperature (22°C) or heated to 45°C. The intraoral and intracanal temperatures were recorded using a video camera for 180 s at 5-s intervals to plot the change in the intraoral and intracanal temperature, after both irrigation solution temperatures, with time. The shape transformation of XP-Endo Shaper began at 31.5 ± 2.0°C and reached its optimal transformation at 35.1 ± 1.0°C. For the Finisher and Finisher-R, shape transformations began at 29.2 ± 1.9 and 26.9 ± 2.2°C reaching the optimal transformation at 33.9 ± 1.4 and 32.7 ± 1.7°C, respectively. The average decreases in lengths of XP-Endo Shaper, Finisher, and Finisher-R after full transformation were 0.43 ± 0.23, 1.07 ± 0.22, and 1.15 ± 0.22 mm, respectively. The intracanal temperature reached 32.9 ± 0.8 and 33.2 ± 1.0°C after 3 min of application of irrigation solutions set at 22 or 45°C, respectively. The tested instruments exhibited diverse changes in their shapes and lengths at varying temperatures. Despite the temperature of the irrigation solution, the intracanal temperature consistently remained lower than the intracanal temperature once equilibrium was reached. This highlights the importance of considering the temperature of irrigation solution during invitro testing of endodontic instruments.

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.

Factors Influencing Non-Surgical Root Canal Treatment Outcomes in Mandibular Second Molars: A Retrospective Cone-Beam Computed Tomography Analysis.

Background/Objectives: This study aimed to investigate the influence of the root canal morphology and various treatment variables on the outcomes of root canal treatments (RCTs) in mandibular second molars, assessed through cone-beam computed tomography (CBCT) imaging. Methods: A total of 150 CBCT images were examined, comprising 100 cases of persistent endodontic infections and 50 of previously treated root canals with normal apices in the mandibular second molars. CBCT was utilized to evaluate the root canal configuration, the radiographic quality of coronal restorations and treated canal systems, and the presence of periapical lesions. Statistical analyses were performed to explore the correlations between these factors. Results: The presence of a C-shaped root canal configuration did not demonstrate a significant correlation with periapical lesions (p = 0.05). Factors influencing endodontic treatment outcomes included missing canals (p = 0.018), underfilling or overfilling (p = 0.045), and inadequate coronal restoration (p = 0.006). Missing a canal was identified as the variable most significantly associated with periapical lesions (OR = 3.103). Inhomogeneous root canal obturation was more commonly observed in C-shaped root canals (p < 0.001). Conclusions: Regardless of the root canal morphology of mandibular second molars, successful RCT depends on thorough disinfection to eliminate any untreated canals, precise three-dimensional filling of the canals at the correct working length, and a securely sealed coronal restoration to prevent leakage.

Unique root anatomy of mandibular second premolars: clinical strategies for effective disinfection and preservation of dentine structure in root canal treatment—a case report

It is difficult to predict the outcomes of non-surgical root canal treatment (NSRCT) for mandibular second premolars with multiple root canals. In these teeth, the complicated anatomy with fin(s), or a C-shape, and possible secondary canal(s) varies unpredictably. The morphology of the root canals provides shelters for bacteria to remain, regrow, and form biofilms despite the endodontic treatment. Moreover, the prevalence of mandibular second premolars with multiple canals is extremely infrequent. Therefore, the clinical management of NSRCT in such cases is not sufficiently reported. This case report introduces two cases of NSRCT for mandibular second premolars with a radicular groove and also presents the appropriate clinical strategies and techniques. Cone-beam computed tomography (CBCT) imaging was used preoperatively. After the completion of NSRCT, CBCT was reused to review the completed procedures using the Nerve Canal tool in CS 3D Imaging v3.2.9 and v3.8.7. Five canals were obturated in case 1, and four canals in case 2 along with a C-shape morphology. Analyzing the configuration of the root canals by CBCT was critical to achieve successful NSRCT because the numbers, exits, configurations, and volumes of the secondary canals were not anticipated after reviewing 2D radiographs. Based on the interpretation, the advanced protocols of NSRCT were planned: first, augmentation of chemo-mechanical cleaning, but minimizing the loss of dentine; second, the tactile examination to locate and negotiate the orifices of the secondary canals; and lastly, the optimized plan and technique for root canal filling of the complex canal systems.

Effect of different instrumentation techniques on students' performance and outcomes of nonsurgical root canal treatment.

This study compared, retrospectively, the incidence of clinical errors and effects on treatment outcomes, when students were exposed to two different instrumentation techniques: a hybrid rotary technique (HYB), consisting of both hand instrumentation with hand stainless steel and Ni-Ti files plus the use of a rotary system (Vortex Blue, Dentsply Sirona), versus a full reciprocation instrumentation technique (WaveOne Gold [WOG], Dentsply Sirona). A total of 368 endodontic cases (n=184) in anterior and premolar teeth, completed by dental students at the University of Michigan School of Dentistry from 2013 to 2022, were used for the study. The groups were evaluated by two calibrated clinicians, observing the incidence of clinical errors: file separations, over-instrumentation, ledges and transportations. Treatment outcomes were also observed. Data were analyzed statistically by Fisher's exact test and Mann-Whitney U test (p<0.05). No significant difference in file separations, ledges, and transportation was observed between the two groups. However, the WOG Group experienced significantly more over-instrumentation than HYB group, although this did not significantly affect tooth survival or periapical index (PAI). Cases with PAI scores of 5 were found to have significantly less tooth survival compared to the other PAI scores. It can be concluded that both techniques in our study are well suited to advancing the endodontic dental education of students and novice operators, anticipating relatively successful outcomes of tooth survival, as long as the cases selected are less severe in progression preoperatively.

Incidence of Middle Mesial Canals in Mandibular Molars during Root Canal Treatment and Nonsurgical Retreatment

IntroductionLarge-scale clinical studies on the incidence of middle mesial canals (MMCs) in nonsurgical root canal treatment (RCT) and retreatment of mandibular molars are lacking. The primary aim of this observational study was to determine the incidence of MMCs in mandibular first and second molars that received RCT or nonsurgical retreatment (NSRetx). The secondary aim was to determine factors associated with incidence of MMCs. MethodsIncluded were 3018 mandibular molars that received RCT (n = 1624) or NSRetx (n = 1394) by 3 endodontists in a private practice. Demographic and procedural data were collected. Bivariate and multivariable (Poisson regression model) analyses were performed. ResultsIncidence of MMCs was 8.8% (n = 267). Although the bivariate analysis showed that NSRetx was significantly associated with incidence of MMCs, this association did not reach the threshold for statistical significance after controlling for all covariates (P = .07). Multivariable analysis on the entire cohort showed that incidence of MMCs was significantly associated with younger age (risk ratio [RR] = 1.62; 95% confidence interval [CI], 1.28–2.06), male gender (RR = 1.48; 95% CI, 1.18–1.85), preoperative cone-beam computed tomography (CBCT) (RR = 1.48; 95% CI, 1.17–1.89), and first molar (RR = 2.30; 95% CI:1.74–3.05). Subgroup multivariable analyses revealed that incidence of MMCs was associated with male gender only in the RCT group (RR = 2.26; 95% CI, 1.55–3.30) but not in the NSRetx group (RR = 1.11; 95% CI, 0.82, 1.50); and with preoperative CBCT only in the NSRetx group (RR = 1.78; 95% CI, 1.28, 2.50) but not in the RCT group (RR = 1.10; 95% CI, 0.71, 1.69). Associations with younger age and first molar remained unchanged. ConclusionsOverall incidence of MMCs was 8.8%. Incidence of MMCs was significantly higher in younger patients and in mandibular first molars but was not associated with the type of treatment.

Combined Endodontic and Surgical Management of a Maxillary Lateral Incisor with Type 3 of Dens Invaginatus

Dens invaginatus (DI) is a developmental anomaly characterized by invagination of the enamel organ into the dental papilla before calcification of the dental tissues. The etiology of this phenomenon has been related either to focal growth retardation or focal growth stimulation, or localized external pressure in certain areas of the tooth bud. In this case of upper lateral incisor showing type 3 dense invaginatus and diagnose as necrotic pulp with chronic apical abscess and treated by nonsurgical root canal treatment during follow up patient comlaing of recurrent swelling associated with treated tooth so we did surgical approach has been employed to resolve patient chief complaint. A follow up of one year is also presented to show healing.

Endodontic Retreatment of Maxillary First Molar with Three Roots and Seven Canals: A Case Report

A 25-year-old female existing with mild pain and discomfort during mastication in her right posterior maxillary tooth. On clinical examination, the maxillary first molar tooth was restored with a composite filling. The tooth did not respond to heat or cold test, and it was tender to percussion. Radiograph examination revealed poor obturation of the canals and the periodontal ligament space was broad but there was no definitive periapical radiolucency. Conservative non-surgical root canal treatment was performed; a total of seven root canals were detected and they were obturated by using the calcium-based sealer. Radiograph with RVG and CBCT also confirmed that all seven canals were properly obturated. Twelve months later, there were no clinical or radiographic changes of the treated tooth. These findings suggested that careful examination of the floor of the pulp chamber with RVG and CBCT help to find extra root canals.

СРАВНИТЕЛЬНЫЙ АНАЛИЗ ЦИТОТОКСИЧНОСТИ СИЛЕРОВ ДЛЯ ПРОВЕДЕНИЯ ПЛОМБИРОВАНИЯ КОРНЕВЫХ КАНАЛОВ (IN VITRO)

Endodontics, being a part of the discipline "Dentistry", includes sections on the study of morphology, physiology and pathology of dental pulp and human periapical tissues, as well as the prevention and treatment of diseases and injuries associated with these tissues. Its scope of application includes the diagnosis and treatment of pain of pulpar and/or periapical origin, vital pulp therapy, regenerative endodontic procedures, non-surgical root canal treatment, surgical or non-surgical re-treatment of teeth with persisting infection and intracanal teeth whitening with discoloration. Ultimately, the main goal is to preserve the natural dentition.&#x0D; Like other dental specialties, endodontics combines two inseparable parts in its practical part: art and science. The art lies in performing technical procedures during root canal treatment. The scientific part includes fundamental and clinical disciplines, studying.&#x0D; Objectives. To study the cytotoxicity of epoxy resin-based silers in laboratory conditions on human cell lines and conduct their comparative analysis.&#x0D; Methodology. The article presents an analysis of the results of in vitro cytotoxicity of silers by assessing cell viability with direct injection of the studied materials into human cell culture.&#x0D; Conclusion. It has been experimentally proven that samples 1 (AH plus, Dentsply Sirona, Germany) and 3 (Epoxidin DUO, TecnoDent, Russia) do not have cytotoxic properties, unlike 2 samples (Sealart, Dentac, Turkey).

Factors influencing the outcome of nonsurgical root canal treatment and retreatment: A retrospective study.

This study assessed the influence of diverse variables on the outcome of nonsurgical root canal treatment/retreatment. In general, 304 teeth from 218 patients were treated/retreated and the outcome evaluated by the periapical index (PAI). Teeth with apical periodontitis lesions that have not completely healed were classified as success or failure based on lenient and rigid criteria, respectively. Findings were evaluated using a logistic regression analysis. The overall success rates were 74% and 82% using the PAI-rigid and lenient success criteria, respectively. Specifically for treatment, the success rates were 73% (rigid) and 82% (lenient), while for retreatment they were 78% (rigid) and 83% (lenient). The treatment outcome was negatively affected by overextension, presence of preoperative lesion, lesion size >10 mm, and higher number of treatment visits (with no intracanal medication). Regarding retreatment, the chance of success was greater for teeth with adequate coronal restorations.

Artificial Intelligence in Endodontics: A Scoping Review.

Artificial intelligence (AI) is transforming the diagnostic methods and treatment approaches in the constantly evolving field of endodontics. The current review discusses the recent advancements in AI; with a specific focus on convolutional and artificial neural networks. Apparently, AI models have proved to be highly beneficial in the analysis of root canal anatomy, detecting periapical lesions in early stages as well as providing accurate working-length determination. Moreover, they seem to be effective in predicting the treatment success next to identifying various conditions e.g., dental caries, pulpal inflammation, vertical root fractures, and expression of second opinions for non-surgical root canal treatments. Furthermore, AI has demonstrated an exceptional ability to recognize landmarks and lesions in cone-beam computed tomography scans with consistently high precision rates. While AI has significantly promoted the accuracy and efficiency of endodontic procedures, it is of high importance to continue validating the reliability and practicality of AI for possible widespread integration into daily clinical practice. Additionally, ethical considerations related to patient privacy, data security, and potential bias should be carefully examined to ensure the ethical and responsible implementation of AI in endodontics.

Radiographic Evaluation of a Single Visit Non-Surgical Root Canal Treatment of Infected Anterior Teeth: Report of two Cases

This case report describes the non-surgical root canal treatment (RCT) of two cases with a periapical lesion associated with maxillary and mandibular anterior teeth of male patients who complained of swelling associated with pus drainage and pain. The obturation of both maxillary and mandibular central incisors was done by using lateral condensation and epoxy resin-based sealer, followed by composite resin filling as a permanent restoration. Clinical and radiographic re-evaluations at 4 months and 7 months for maxillary and mandibular teeth respectively revealed progressing bone healing, particularly in a maxillary region. This case report shows that an appropriate diagnosis in combination with RCT as a conservative non-surgical approach can lead to the complete healing of a large lesion without invasive treatments.

Predictors of periapical bone healing associated with teeth having large periapical lesions following nonsurgical root canal treatment or retreatment: A cone beam computed tomography-based retrospective study.

Several factors influence the condition of the periapical tissues associated with root filled teeth. The primary objective of this study was to retrospectively evaluate the extent and speed of bone healing of large periapical lesions associated with nonsurgical root canal treatment or retreatment. The secondary objective was to analyse the relationship between the time to complete healing when analysed using cone beam computed tomography (CBCT) and other possible predictors that affect healing. Seventy-nine patients were treated during the years 2013-2020 with large periapical lesions of endodontic origin (10-15 mm) as observed on intraoral periapical radiographs (IOPAR) were included. IOPAR and CBCT were available before treatment and during the follow-up (IOPAR every 6 months and CBCT every 12 months). The volume of periapical lesions was calculated by OsiriX Lite software. Variables such as initial volume of the lesion, age, gender, type of treatment or type of root canal filling were compared to identify the differences between healed and unhealed lesions. Pearson's Chi-square test was used for categorical variables, the t-test for age and the Wilcoxon test for initial volume of the lesion. The association between time to healing and the variables was assessed using univariate analysis and multivariate analysis. The Wilcoxon test was used to observe the association of healing time with categorical variables and the correlation index was measured with the quantitative variables. Of the 79 cases analysed, 60 lesions (76%) were completely healed as verified by CBCT in a mean healing time of 19 months, of which 60% healed fully between 12 and 18 months. Increase in age of patient and larger initial volume of the lesion were associated with a significantly longer healing time (p < .001). Gender, filling material and type of treatment did not have a significant effect on the healing process (p > .05). Clinicians should be aware that periapical lesions in older patients and larger areas of bone loss take longer to heal. CBCT monitoring of large periapical lesions is critical and it can help clinicians in the decision-making process.

Association of root morphology of mandibular second molars on panoramic-like and axial views of cone-beam computed tomography.

Knowledge about the anatomy and morphology of the root canal system is essential for successful surgical and non-surgical root canal treatments. However, precise assessment of the root morphology and anatomy is not often possible on two-dimensional radiographs. This study aimed to investigate the association of root morphology of mandibular second molars on panoramic-like and axial views of cone-beam computed tomography (CBCT). This cross-sectional study evaluated 1,231 CBCT scans of mandibular second molars obtained between October 2018 and February 2022 that were retrieved from the archives of a private radiology clinic. Panoramic-like images were reconstructed from the CBCT scans. The root morphology of mandibular second molars was classified on panoramic-like images as type 1, 2, 3, 4, or 5. The root pattern on axial CBCT images was classified into three types of single, double and C-shaped. The association of root morphology on panoramic-like and axial CBCT views was analyzed by the Chi-square test and Fisher's exact test at 0.05 level of significance. Of all, 62.7% of mandibular second molars were type 1; out of which, 97.3% had a double-root pattern on axial CBCT images. Also, 28.6% of them were type 2; of which, 92.6% had a double-root pattern. Moreover, 3.9% were type 3; of which, 47.9% had a C-shaped pattern; 0.9% were type 4, and 45.5% of them showed a single-root pattern; 3.8% were type 5 with 76.6% of them showing a single-root pattern. The prevalence of C-shaped canals was higher in females, and most C-shaped canals had a C3 pattern. Root morphology on panoramic-like CBCT views had a strong association with the root canal pattern on axial CBCT views. According to the results, mandibular second molars with a type 3 morphology on panoramic-like CBCT images are highly probable to have a C-shaped canal.

Second Opinion for Non-Surgical Root Canal Treatment Prognosis Using Machine Learning Models.

Although the association between risk factors and non-surgical root canal treatment (NSRCT) failure has been extensively studied, methods to predict the outcomes of NSRCT are in an early stage, and dentists currently make the treatment prognosis based mainly on their clinical experience. Since this involves different sources of error, we investigated the use of machine learning (ML) models as a second opinion to support the clinical decision on whether to perform NSRCT. We undertook a retrospective study of 119 confirmed and not previously treated Apical Periodontitis cases that received the same treatment by the same specialist. For each patient, we recorded the variables from a newly proposed data collection template and defined a binary outcome: Success if the lesion clears and failure otherwise. We conducted tests for detecting the association between the variables and the outcome and selected a set of variables as the initial inputs into four ML algorithms: Logistic Regression (LR), Random Forest (RF), Naive-Bayes (NB), and K Nearest Neighbors (KNN). According to our results, RF and KNN significantly improve (p-values < 0.05) the sensitivity and accuracy of the dentist's treatment prognosis. Taking our results as a proof of concept, we conclude that future randomized clinical trials are worth designing to test the clinical utility of ML models as a second opinion for NSRCT prognosis.

Cumulative Factors Determining Endodontic Operative Pain and Persistent Apical Periodontitis Following Nonsurgical Root Canal Treatment in Permanent Teeth - A Comprehensive Literature Review

Pain and discomfort experienced during and after endodontic treatment are referred to as endodontic operative pain. The condition is complicated and multifactorial, with preoperative factors relating to the host and the affected tooth, intra-operative factors resulting from mechanical, chemical, or microbial damage to peri-radicular tissues, and postoperative factors (the success of the root canal treatment, the effectiveness of pain management techniques and the persistence of periapical inflammation). The presence of persistent apical periodontitis after unsuccessful non-surgical root canal treatment may need endodontic apical surgery. This comprehensive literature review aims to explore the etiopathogenesis of endodontic operative pain and identify the factors that can influence and aggravate it. By understanding the underlying mechanisms and potential influences, dentists can implement effective strategies to prevent or manage endodontic operative pain more efficiently. Dental practitioners must convey to the patients regarding the root canal treatment process, potential discomfort and available pain management options clearly, alleviating patients' fears and enhancing their compliance with postoperative care instructions.

The Effect of Unintentional AH-Plus Sealer Extrusion on Resolution of Apical Periodontitis After Root Canal Treatment and Retreatment—A Retrospective Case-control Study

IntroductionThis study aimed to investigate the effect of unintentional AH Plus sealer extrusion on the outcome of nonsurgical root canal treatment and retreatment in teeth with apical periodontitis (AP) compared to teeth with AP and no sealer extrusion at the 1-year follow-up. MethodsIn a retrospective case-control study conducted from September 2016 to September 2021, teeth presenting clinical and radiographic signs of AP prior to treatment were included. The study comprised 2 groups: AH Plus sealer extrusion group (n = 60): initial root canal treatment or nonsurgical retreatment with unintentional apical extrusion of AH Plus sealer; and no AH Plus sealer extrusion group (n = 60): underwent the same treatment types without sealer extrusion. Additional factors, including sex, age, tooth type, tooth location, and treatment type, were recorded as potential outcome predictors. At 1-year follow-up, teeth were evaluated clinically and radiographically, and outcomes were classified as favorable (healed/healing) or unfavorable (uncertain/non-healing). Statistical analyses, such as the χ2 test, logistic regression, and Mann-Whitney U test, were employed for data analysis. ResultsA favorable outcome was observed in 88.4% and 85% of the cases of the AH Plus sealer extrusion and no AH Plus sealer extrusion groups, respectively. There was no statistically significant difference between the groups in terms of outcomes (P > .05) when analyzed categorically or ordinally. Of independent variables, nonsurgical retreatment showed lower healing of AP in both groups. ConclusionsUnintentional AH Plus sealer extrusion did not affect the healing of AP. However, initial root canal treatment showed better healing of AP than nonsurgical retreatment in the presence of AH Plus sealer extrusion. The analyzed outcome predictors had no effect on treatment outcome.

Process-related Factors Are as Important as Outcomes for Patients Undergoing Nonsurgical Root Canal Treatment, Nonsurgical Root Canal Retreatment, and Endodontic Microsurgery

IntroductionThere is considerable variation in the reporting of treatment outcomes in endodontics. Patient-centered outcomes are often inadequately reported in endodontic outcome studies. This paper explores patients’ expectations and reported outcomes in nonsurgical root canal treatment (NS-RCT), nonsurgical root canal retreatment (NS-ReTx), and endodontic microsurgery (EMS). MethodsWe used a qualitative description approach and conducted telephone and virtual semi-structured interviews with participants who had the following treatments within the preceding 3–12 months: NS-RCT (n = 10), NS-ReTx (n = 10), or EMS (n = 10). Half of these treatments were performed by senior endodontic residents in an academic setting and the other half by a community-based endodontist at a private practice. ResultsParticipants identified several outcomes that were important to them and integral to treatment success, such as tooth survival, resolution of symptoms, aesthetics, and radiographic healing. Process-related factors were as important as treatment outcomes for participants. Communicating with and educating patients during treatment increased participants’ satisfaction and lowered their stress. Dissatisfaction was linked to the lack of a comprehensive treatment and follow-up plan. Thorough planning ensured that patients were fully informed and had a structured approach to achieving their desired outcomes. ConclusionsThis study provides a list of outcomes that are important for patients undergoing NS-RCT, NS-ReTx, and EMS. These outcomes should be considered when developing a core outcome set related to endodontic treatments. Additionally, this study reports patients’ expectations regarding process-related factors that are essential for providing patient-centered care and improving patient experience.

Cost-effectiveness analysis: nonsurgical root canal treatment versus single-tooth implant

BackgroundEconomic evaluation of nonsurgical root canal treatment (NSRCT) and single-tooth implant (STI) provides useful information for medical decision. This retrospective study aimed to evaluate the cost-effectiveness of NSRCT versus single-tooth implant (STI) after 5-year treatment in a university affiliated hospital in Beijing, China.Methods211 patients who underwent NSRCT and 142 patients who had STI were included and recalled after 5-year treatment. The propensity scores were used to match the cases of two treatment modalities. At recall, outcomes were determined based on clinical and radiographical examinations. For endodontically treated cases, absence or reduction of radiolucency were defined as success. Marginal bone loss (MBL) ≤ 4 mm were determined as success for implant cases. Direct and indirect costs were calculated in China Yuan (CNY). Patients’ willingness to pay (WTP) for each treatment modality was evaluated by questionnaires. A cost-effectiveness analysis was performed from the societal perspective.Results170 patients with 120 NSRCT teeth and 96 STI were available at recall. Based on propensity score matching, 76 endodontically treated teeth were matched to 76 implants. Absence of the radiolucency was observed in 58 of 76 endodontically treated teeth (76%) and reduction of the radiolucency in 9 of 76 teeth (12%) and altogether the success rate was 88%. 100% implants were detected with marginal bone loss (MBL) ≤ 4 mm. The cost advantage of NSRCT (4,751 CNY) over STI (20,298 CNY) was more pronounced. Incremental cost effectiveness ratio (ICER) was 129,563 CNY (STI-NSRCT) per success rate gained. It exceeded the patients’ willingness to pay value 7,533 CNY.ConclusionsClinical outcomes of NSRCT and STI could be predictable after 5-year treatment. NSRCT may be more cost-effective than STI for managing endodontically diseased teeth.

Successful Non-Surgical Root Canal Treatment on Auto- Transplanted Maxillary Premolar with Apical Periodontitis

Successful Non-Surgical Root Canal Treatment on Auto- Transplanted Maxillary Premolar with Apical Periodontitis