Nonsurgical Root Canal Therapy Research Articles

Combined non-surgical and surgical management of misdiagnosed cutaneous sinus tract of endodontic origin – 15 months CBCT follow-up

Introduction and aim. An extraoral cutaneous sinus tract of endodontic origin represents a skin condition that appears due to an infection that could be primary or secondary to trauma accompanied by alveolar bony changes. It may be easily misdiagnosed and inappropriately treated due to lack of inadequate expertise on part of medical professionals followed by faulty treatment which can complicate the case further. Description of case. This case report intends to highlight a case of a sixteen-year-old male patient referred for an extraoral cutaneous sinus tract misdiagnosed and insufficiently treated by a general physician followed by general dentists for more than a month due to lack of proficiency in the field of endodontics. The clinical and radiographic examinations confirmed the pulpal origin due to trauma related to permanent mandibular incisors. A combination of non-surgical root canal therapy followed by periapical surgery was performed leading to a significant healing of the lesion. Conclusion. Accurate diagnosis is the key to treat draining sinus tracts of endodontic origin. Root canal treatment and endodontic surgery should be used judiciously for effectively eliminating the pathogens thus providing healing and repair mechanisms a chance to achieve the desired result.

Endodontic Competence of the New General Dentist as Conceptualized by Predoctoral Educators: A Qualitative Exploration

Introduction: Without a unified standard for what constitutes endodontic competence for the new general dentist, predoctoral endodontic directors (PEDs) are left with the great responsibility of educating their learners in a manner that they believe best serves patients. Given different influencing factors and varying amounts of resources, these PEDs must ensure the achievement of meaningful objectives utilizing conceptual frameworks of competence. It is essential for dental educators and other stakeholders to gain an understanding of what current endodontic competence means to enable more accurate needs assessments to advise future curriculum development. The purpose of this study was to explore how endodontic competence for the new general dentist is conceptualized by predoctoral endodontics directors and their respective institutions while identifying perceived facilitators and barriers to its achievement. Methods: Following the development of a semi-structured interview guide and its piloting, qualitative interviews were conducted with 10 PEDs. Interviews were transcribed and coded. The constant comparative method was utilized for data analysis. Results: Interviews were conducted until thematic saturation was achieved. Conceptualization of endodontic competency seemed to be informed by three primary themes: the existing paradigmatic approaches of PEDs and their institutions, their concerns regarding validity evidence especially as it related to assessment, and the presence of institutional and logistical barriers. Conclusion: Despite differences between their institutional definition and personal conceptualization of endodontic competence, PEDs report success at graduating new general dentists competent in endodontic diagnosis, case difficulty assessment, palliative treatment, and routine non-surgical root canal therapy on single-canal teeth of minimal difficulty.

Outcome of nonsurgical management of large cyst-like periapical lesions using a modified apical negative pressure irrigation system: a case series study

ObjectiveTo assess the effectiveness of a self-constructed modified apical negative pressure irrigation (ANPI) system employing commonly used clinical instruments in nonsurgical root canal therapy (NSRCT) for large cyst-like periapical lesions (LCPLs).MethodsFrom 2017 to 2022, 35 patients diagnosed with LCPLs (5-15 mm) via preoperative clinical and radiographic evaluations of endodontic origin underwent NSRCT combined with ANPI. These patients were subjected to postoperative clinical and radiographic follow-up at 3 months, 6 months, 1 year, 2 years, 3 years, and 4 years, with a CBCT scan specifically conducted at 6-month follow-up. Through the reconstruction of three-dimensional cone beam computed tomography (CBCT) data, an early prognosis was facilitated by monitoring changes in lesion volume. Various treatment predictors—including sex, type of treatment, lesion size, preoperative pain, jaw, type of teeth involved, sealer extrusion, and the number of root canals—were meticulously analyzed. The evaluation of post-treatment outcomes leveraged both clinical observations and radiographic data collected during the follow-up periods. The Kruskal‒Wallis test and one-way ANOVA were also conducted to determine the independent factors influencing treatment outcomes. A significance level of 5% was established.ResultsThirty-five teeth from 35 patients with a median age of 28 years (range 24–34) were treated; the median follow-up duration was 19 months (range 12–26). The overall success rate was 91.4%, with a median lesion reduction of 77.0% (range 54.2–96.4%) at 6 months. Patients under 30 years of age exhibited a significantly greater success rate than older patients did (100.0% vs. 80.0%, p = 0.037). Other factors, such as sex, jaw, treatment type, preoperative pain, cyst size, tooth location, sealer extrusion, and the number of roots, did not significantly impact treatment outcomes.ConclusionsDespite limitations related to the observational case-series study design and relatively small sample size, our findings suggest that utilizing the ANPI in the NSRCT for LCPLs may hold promise. The notably higher success rate in patients younger than 30 years is worth noting.

A Case of Respiratory Epithelium-Lined Cyst with Enriched Nociceptor Innervation

Apical lesions of endodontic origin can be classified as either granulomas or cysts. In rare cases, respiratory epithelium can proliferate and encapsulate a lesion, forming a cyst. Moreover, the innervation of apical lesions has only been previously reported in animal models of apical periodontitis. This report demonstrates an unusual case in which tooth #15 was initially treated with nonsurgical root canal therapy. Still, the patient remained in moderate to severe pain for several days following the procedure. Next, an intentional replantation was performed in which a periapical cyst was curetted from the alveolus. The patient experienced immediate pain relief following the procedure. Histological analysis revealed that the periapical cyst was lined entirely with respiratory epithelium, and immunohistochemical analysis showed it to be densely innervated. In addition, these nerve fibers expressed the LPS receptor, TLR4. This is the first demonstration of the innervation pattern of a periapical cyst. Further studies are warranted to evaluate innervation in apical lesions and its correlation with pre- and intra-operative symptoms and their participation in the pathogenesis of apical periodontitis.

Comparing the Frequency of Flare-Ups in Single vs Multiple Visit Non-Surgical Root Canal Therapy in Multi-Rooted Non Vital Teeth

<p><strong>Abstract</strong></p>
 <p><strong>Objective: </strong>The objective of the study was to make a comparison between the frequencies of flare-ups occurring in single versus multiple visit non-surgical root canal therapy in multi-rooted teeth with pulpal necrosis.</p>
 <p><strong>Materials and Methods:</strong> 360 patients with multiple-rooted Non-Vital Teeth between the ages of 20 and 60, from both genders, were selected and randomly assigned into two groups. In group A, patients underwent root canal treatment in single visit. In group B, patients underwent 2 visits for root canal treatment. On follow up, if patient complained of endodontic pain not controlled with medication with or without swelling within 24 to 48 hours postoperatively, then flare-up was noted.</p>
 <p><strong>Results: </strong>The mean age recorded in group A was 41.90 ± 10.94 years whereas in group B, it was 41.21 ± 9.25 years. 148 (41.11%) were male and 212 (58.89%) were female with male to female ratio of 1:1.4. Frequency of flare-ups was 21 (11.67%) in single visit and in 05 (2.78%) patients in multiple visit non-surgical root canal therapy in multi-rooted teeth with pulpal necrosis with p-value of 0.001.</p>
 <p><strong>Conclusion: </strong>This study concluded that frequency of flare-ups is lower after multiple visit non-surgical root canal therapy in multi-rooted teeth with pulpal necrosis as compared to single visit.</p>

Incidence of Endodontic Failure Cases in the Department of Conservative Dentistry and Endodontics, DY Patil School of Dentistry, Navi Mumbai.

Endodontic and restorative treatment goal is to restore occlusion and normal function of a tooth and provide stability to the dental arch. Root canal bacterial infection and apical periodontitis profoundly impact the management and outcome of endodontic treatments. The crucial goal of nonsurgical root canal therapy (NSRCT) is the mechanical removal of infected tissues and the chemical killing of bacteria. The present study assessed the outcomes and factors associated with the failure of primary endodontic treatment. A total of 250 teeth from 219 patients (104 male and 146 female) were examined in the Conservative Dentistry and Endodontics department, who reported symptomatic root canal-treated teeth. Data through clinical examination and radiographic examination was recorded on a proforma designed for the study of each patient regarding endodontic failure. According to the type of tooth maximum number of teeth that were reported with failure are the molars (67.6%), followed by premolar (14.0%), incisor (12.8%), and lastly, canines (5.6%). Based on the location of affected teeth, the maximum teeth that presented with failed root canal treatment were from mandibular posteriors (51.2%), followed by maxillary posteriors (31.60%), maxillary anterior (13.2%), mandibular anterior (4.0%). Endodontic failures were mostly found in underfilled root canals and poorly sealed post-endodontic coronal restoration and strong association with peri-apical radiolucency.

Rubber Dam Clamp May Cause Cortical Necrosis: A Case Report

Tooth isolation methods used during endodontic procedures are necessary to create an aseptic field and protect the patient’s alimentary tract from irrigation and instrument insult. This case details changes that can occur in mandibular cortical bone architecture after the use of a stainless steel rubber dam clamp during an endodontic procedure. A 22-year-old, otherwise healthy woman underwent nonsurgical root canal therapy on tooth #31 (mandibular right second molar, symptomatic irreversible pulpitis and periapical periodontitis.) Cone-beam computed tomographic imaging obtained between treatments revealed irregular erosive and lytic changes of the crestal-lingual cortical bone, resulting in sequestrum formation with infection and exfoliation. Continued monitoring and 6-month post-treatment CBCT imaging revealed complete resolution without further intervention. When a stainless steel rubber dam clamp is placed onto gingiva overlying mandibular alveolar bone, bony changes can occur presenting with radiographic signs of cortical erosion and may result in necrosis of the cortical bone with sequestrum formation. Knowledge of this potential outcome improves our understanding of the normal course progression after dental procedures using a rubber dam clamp for tooth isolation.

A comparative analysis of outcomes of root canal therapy for pediatric medicaid beneficiaries from New York State.

This study investigated differences in the provision of root canal therapy and outcomes in a publicly insured cohort of children and adolescents. New York State Medicaid administrative claims from 2006 to 2018 were analyzed. Enrollees aged 6-18 were included in the study if they had initial non-surgical root canal therapy (NSRCT), in the permanent dentition, that allowed for at least 1 year of post-treatment follow-up. Descriptive analyses, multivariable logistic regression, and multivariable Cox proportional hazard models were used to examine the association between demographic variables (gender, age, race/ethnicity, and area-based factors) and dental treatment provision and outcomes. Male gender was associated with having more than one initial NSRCT (adjusted odds ratio (aOR) = 1.06; 95% confidence interval (CI) = 1.02-1.10), as was rurality (aOR = 1.15; 95% CI = 1.06-1.24). Black/African American (AA) and Hispanic children were less likely than non-Hispanic white children to have multiple NSRCTs (aOR = 0.88; 95% CI = 0.83-0.93 and aOR = 0.78; 95% CI = 0.74-0.83). Being older or female conferred a lower hazard of an untoward event (aHR = 0.93; 95% CI = 0.92-0.94 and aHR = 0.86; 95% CI = 0.81-0.91). Compared to non-Hispanic white children, Hispanic and Black/AA children had a higher risk of untoward event (aHR = 1.31; 95% CI = 1.21-1.41 and aHR = 1.55; 95% CI = 1.43-1.67) while children of Asian descent had a lower incidence after initial NSRCT (aHR = 0.79; 95% CI = 0.71-0.88). Race/ethnicity was the strongest demographic predictor of provision of initial non-surgical root canal therapy, subsequent placement of a permanent restoration and the occurrence of an untoward event after NSRCT in this cohort.

Effect of Sodium Hypochlorite in Dental Unit Waterline on Aerosolized Bacteria Generated from Endodontic Procedures

IntroductionAerosol generation in a dental setting is a critical concern, and approaches that aim at decreasing bacterial load in aerosols are of high priority for dental professionals. The objectives of this study were to evaluate the relative effect of various endodontic procedures on the generation and dissemination of aerosols and the effect of 0.1% sodium hypochlorite (NaOCl) in dental unit waterlines (DUWLs) on the bacterial load in the generated aerosols in a clinical setting. MethodsThe study was completed in 2 phases. The classic passive sampling technique using brain-heart infusion agar plates was used. Agar plates were strategically placed throughout the operatory at predefined locations. In phase 1, to evaluate the effect of different endodontic procedures on the generation and dissemination of aerosols, we collected a total of 38 samples. After baseline collection, test samples were collected during vital pulp therapy (VPT) full pulpotomy (n = 10), nonsurgical root canal therapy (NSRCT, n = 10), surgical root canal therapy (SRCT, n = 10), and incision and drainage (n = 8) procedures. Bacterial growth was expressed as colony-forming units at 48 hours after sample collection. Data were analyzed using 1-way analysis of variance with the Tukey multiple comparison post hoc test. In phase 2, to evaluate the effect of 0.1% NaOCl in the DUWL on the bacterial load in the generated aerosols, a total of 30 samples were collected. All procedures including VPT (n = 10), NSRCT (n = 10), and SRCT (n = 10) were performed with 0.1% NaOCl in the DUWL. Bacterial growth was expressed as colony-forming units at 48 hours after sample collection. Data were analyzed using 2-way analysis of variance with the Tukey multiple comparison post hoc test. ResultsAll endodontic procedures generated aerosols at all tested locations, except incision and drainage. Aerosols were disseminated as far as 3 m from the patient's head with no significant difference between various locations (P > .05). VPT procedures generated the maximum number of aerosols compared with NSRCT and SRCT. Adding 0.1% NaOCl to DUWLs significantly reduced the bacterial load in the generated aerosols in all treatment groups compared with groups treated with untreated waterlines (P < .05). No significant difference was noted in the bacterial load between all groups with treated waterlines (P > .05). ConclusionsAll tested endodontic procedures led to the generation and dissemination of contaminated aerosols, and the addition of 0.1% NaOCl as a biocide to the DUWL led to a statistically significant reduction in the bacterial load.

Vital Pulp Therapy of Permanent Teeth with Reversible or Irreversible Pulpitis: An Overview of the Literature.

Vital pulp therapy (VPT) has been recently proposed as an alternative approach even in symptomatic mature permanent teeth with deep caries’ lesions, aiming to maintain the pulp vitality over time and/or to avoid non-surgical root canal therapy (NSRCT). However, to date, the diagnosis of reversible or irreversible pulpitis is only based on clinical pain quantity and quality, without precisely reflecting the pulp inflammation status. Therefore, the aim of the present study was to provide an overview based on the current scientific literature to demonstrate the clinical effectiveness of VPT on mature permanent teeth, validating the use of hydraulic calcium silicate-based cements and their role in pain management. VPT may be successfully applied not only in mature permanent teeth diagnosed with reversible pulpitis, but also in permanent dental elements with signs and symptoms of irreversible pulpitis. Hydraulic cements showed favorable outcomes in terms of decrease of pro-inflammatory mediators and of post-operative pain. Pain plays a central role in the chance to perform VPT in mature permanent teeth, since it may be considered as a pre-operative diagnostic criterion as well as a treatment success parameter. In addition, proper assessment of pulp inflammation and choice of appropriate materials are key factors in enhancing VPT success.

What is the best effective postoperative medication in reducing pain after non-surgical root canal treatment?

Data sources Medline, Embase, CENTRAL, Cumulative Index to Nursing and Allied Health Literature and Scopus databases were searched (until July 31 2019). They searched the WHO International Clinical Trials Registry Platform and ClinicalTrials.gov databases for completed and ongoing trials, as well as ProQuest, Google Scholar (first 100 hits) and the OpenGrey database for those unpublished. In addition, abstracts of annual meetings from the American Association of Endodontists, the International Federation of Endodontic Associations and the European Society of Endodontics were searched. A manual search of references in related papers and textbooks was carried out. Any missing information was filled in by contacting the authors.Study selection All randomised clinical trials (RCT) of nonsurgical endodontic therapy with pharmaceutical treatments provided postoperatively to alleviate pain on adult subjects were eligible. Two reviewers selected the studies and extracted the data and the results were examined by a third reviewer. Any differences were settled with the help of a fourth reviewer.Data extraction and synthesis Two authors independently evaluated and retrieved data from chosen trials found through searches. Another reviewer looked at the trial selection and data extraction. They also assessed the risk of bias in each of the research they chose.The mean and standard deviation of a 0-100 (mm) visual analogue pain scale were extracted or derived from study text, graphs and tables The postoperative medications were compared using network meta-analysis in a Bayesian model. Mean differences (MDs) and 95% credible intervals (CrIs) of post-operative pain were estimated at 6-8 hours and 12, 24 and 48 hours. Two authors utilised the CINeMA web application to assess the confidence in the main results by accounting for six domains: within- and across-study bias; indirectness; imprecision; heterogeneity; and incoherence. Each domain was assigned no concerns, major concerns, or minor concerns. Each result would be assigned a confidence level of high, moderate, low, or very low. To establish an agreement, a third reviewer was consulted.Results From the initial search of 969 records, 11 RCTs matched the inclusion criteria. Five studies were rated as having a low risk of bias, five as having a moderate risk and one as having a high risk. Moderate and major heterogeneity and some inconsistencies were detected, though not statistically significant.Oral medications were classified into placebo, non-steroidal anti-inflammatory drugs (NSAIDs), opioids, acetaminophen, NSAIDs + acetaminophen, corticosteroids, NSAIDs + benzodiazepines and NSAIDs + opioids groups.With moderate confidence, NSAIDs + acetaminophen were shown to be more efficacious than placebo at 6-8 hours following nonsurgical root canal therapy (MD = 22; 95% CrI = [-38, -7.2]). With very low confidence, NSAIDs had a greater effect than placebo after 12 and 24 hours (MD = -28; 95% CrI = [-49, -7] and MD = -15; 95% CrI = [-27, -2.3], respectively). After 6 12 and 24 hours, other medications were no more effective than placebo in pain reduction. After 48 hours, no treatment was more effective than placebo. Subgroup analysis found that other medications, such as corticosteroids and acetaminophen, were no more beneficial than placebo for patients who could not use NSAIDs. Six trials provided safety data and concluded that the therapies were safe and posed no significant risks.Conclusions Very low to moderate-quality evidence suggests that postoperative administration of NSAIDs and acetaminophen, or NSAIDs alone, reduced discomfort after non-surgical root canal therapy in patients with irreversible pulpitis or pulpal necrosis. Trials have shown, however, that using these drugs does not result in major complications. We cannot, however, be confident that they are risk-free.

Multidisciplinary approach in the management of large infected periapical cystic lesion in the mandibular anterior region with platelet-rich fibrin

Periapical cysts are considered as the most prevalent odontogenic cystic lesions of the jaws. These cystic lesions are usually asymptomatic; however, once infected, they result in tumefaction of the affected region. Current noninvasive diagnostic methods such as computed tomography, magnetic resonance imaging, and cone-beam computed tomography help in accurate assessment of size and nature of these lesions, which determine proper treatment planning and prognosis of the affected tooth. Management of these cystic lesions depends upon their extent. Periapical localized cysts can be managed by nonsurgical root canal therapy, whereas large periapical cysts require multidisciplinary approach involving an endodontist and an oral surgeon. Accelerated healing of soft and hard tissues near these lesions can be done using tissue engineering scaffolds such as platelet-rich fibrin and platelet-rich plasma. This case report presents successful multidisciplinary management of a large infected periapical cyst which was associated with mandibular incisors.

EXTERNAL ROOT RESORPTION CAN BE MANAGED VERY WELL WITH BIOACTIVE ROOT CANAL SEALERS IN NON-SURGICAL ROOT CANAL THERAPY

EXTERNAL ROOT RESORPTION CAN BE MANAGED VERY WELL WITH BIOACTIVE ROOT CANAL SEALERS IN NON-SURGICAL ROOT CANAL THERAPY

Comparative clinical assessment of working length endo-motor apex locator versus radiographic method in endo-dontic therapy.

Introduction: The technological and therapeutic advancements suggests that, choosing an appropriate endodontic approach is the key parameter to mitigate over radiation exposure and locating precise root canal length.Objective: Current study aims to evaluate the comparative accuracy of working length apex locator versus radiographic apex locator in in endodontic therapy among patients belonging from Sindh, Pakistan.Methodology: Current four-month duration based cross-sectional study focusing endodontic therapeutic techniques was conducted at Bibi Aseefa Dental College Larkana Sindh Pakistan. 124 patients requiring non-surgical root canal therapy were included in the study for working length apex locator and radiographic apex locator techniques. Film positioner were used to assess the morphology and initial working length of tooth by radiographic apex locator technique. Whereas glide path and working length was achieved with #12/02 M3 – Pro Gold File (United Dental) with 00 reading in Endo-Matic apex locator. Further data analysis was achieved with SPSS Version 20 and Microsoft Office 2010 multiple tools.Results: Among 124 patients, 69 (55.6%) were males and 55 (44.4%) were females with mean age of 33.60±12.87 years. We found comparative accuracy of 77 % of working length apex locator in terms of apical limit determination. Whereas, in case of radiographic apex locators 70 % accuracy was recorded.Conclusion: Working length endomotor with built in apex locators provide satisfac-tory control of apical limit of endodontic treatment and better time saving option, however radiographic confirmations remain the confirmatory length measurement tool to identify the dimension of canal and path obtained by endodontic instru-ment.Keywords: EndoMatic, Electronic Apex Locators, Hybrid Endomotors, Radiograph, Working Length.

An unusual case of maxillary permanent 1st molar with two pulp canals with pulp necrosis; diagnosis and endodontic management.

The present case report highlights the need to identify variations in root canal anatomy as a prerequisite for effective nonsurgical root canal therapy planning. As clinicians, we need to develop our observational and clinical abilities as well as amend our understanding of the complexities of the canal anatomy. Reports describing the structure of teeth and pulp canals rarely report the presence of two pulp canals in two permanent upper 1st molars. In this case, it describes the nonsurgical root canal therapy of the upper right 1st permanent molar with two pulp canals, which was confirmed by a cone beam.

Preoperative Factors Associated with Anesthesia Failure for Patients Undergoing Nonsurgical Root Canal Therapy: A National Dental Practice-Based Research Network Study

IntroductionThe aim of this study was to identify preoperative factors associated with local anesthesia failure. MethodsThe National Dental Practice-Based Research Network (www.NationalDentalPBRN.org) data from 534 patients who received a nonsurgical root canal treatment completed in a single appointment were included in this analysis. Three methods for defining anesthesia failure were used: definition 1, patient-reported level of numbness; definition 2, provider-reported quality of anesthesia; and definition 3, provider-reported use of supplemental anesthesia. Fifty-one preoperative factors were investigated and analyzed individually against the overall failure rate for each method, and multivariate generalized estimating equation logistic models were fit with predictors chosen using stepwise model selection to evaluate factors that may interact with each other. ResultsThe overall anesthesia failure rates were 5%, 15%, and 30% for definitions 1, 2, and 3, respectively. Provider experience, diabetes, absence of sharp or aching pain, absence of smoking, and a fair expected outcome were associated with anesthesia failure (definition 1). Provider level of training, absence of a sinus tract, bite sensitivity, and stress making the pain worse were associated with anesthesia failure (definition 2). Provider level of training, pain provoked by stimulus, mandibular teeth, teeth with vital pulps, and pain interfering with daily activities were associated with the use of supplemental anesthesia (definition 3). ConclusionsWith the range of 5%–30% of anesthesia failures, a few common factors across the models assessed were elucidated. Providers with higher levels of training had significantly fewer anesthesia failures. Patient self-reported history of diabetes and preoperative pain-related interference with daily activities were associated with more anesthesia failures. Greater severity of various tooth-related pain characteristics, as a group but not individually, accounted for more anesthesia failures.

Decompression strategy for critical-sized lesions: A case series and literature review.

Critical-sized lesions are defined as the smallest sized intraosseous wound in a particular bone that will not heal spontaneously during the lifetime of that animal. These critical-sized entities pose a unique challenge in endodontics, where these lesions are most likely cystic, with dimensions extending over 10 mm. This paper describes a structured methodology to treat such cases whilst also highlighting inconsistencies and variability between practitioners regarding management of critical-sized lesions. The case series demonstrates that non-surgical root canal therapy followed by surgical decompression may be the treatment of choice for such pathosis. A 16 gauge nasogastric tube was used as a decompression device and sutured to surrounding mucosa. Healing was evaluated using both two- and three-dimensional radiographs. Decompression of critical-sized lesions would appear to be a reliable, conservative and an altogether complete procedure that may not warrant second-stage surgery.

Factors Associated with Incomplete Endodontic Care

IntroductionIncomplete endodontic treatment has been associated with detrimental health outcomes. MethodsThis retrospective study reviewed charts of patients receiving endodontic care over a 1-year period at the Postgraduate Endodontic Clinic at Rutgers School of Dental Medicine, Newark, NJ, to assess whether factors such as receipt of palliative endodontic care and demographic factors were associated with completion, or noncompletion, of initial nonsurgical root canal therapy (RCT). ResultsA total of 1806 patient charts met the study inclusion criteria. With descriptive statistics and bivariate analysis, the variables of palliative care, Medicaid recipient, age group, and distance from the clinic were significantly associated with RCT completion (P < .05). In the binary logistic regression with all independent variables, palliative care and age group variables were the significant factors (P < .05). Patients who had no palliative care had 8.5 times the odds of completing RCT than patients who had received palliative care. The age group of 18–35 years had 0.59 times the odds of complete RCT than the age group <18 years. ConclusionsIncomplete nonsurgical endodontic treatment is highly associated with the receipt of prior palliative care. Further research is indicated to investigate additional factors that may influence patient completion of endodontic care and opportunities to improve public health care program design to obtain optimal patient-centered outcomes.

Endodontic procedures produce bacterial droplet contamination - but what about viruses?

Research question The study aims to investigate spread, distance and spatial distribution of aerosolised microorganisms generated through various endodontic procedures.Study design A case-control study carried out at the University of Maryland, US in 2020. The study investigated the aerosolised microorganisms produced during three endodontic treatments: emergency pulpotomy, emergency pulpectomy and non-surgical root canal therapy (NSRCT), with 15 participants in each group (n = 45). Patients diagnosed with symptomatic apical periodontitis were included. The use of settle plates for passive air sampling was employed, in a 4 x 4 m room with closed doors. The number of colony-forming units (CFUs) and composition of bacterial species were analysed. Variables within the study included: distance of plate to patient's mouth (0.5 m or 2 m), positioning of plate (directly in front of or diagonal to the participant's mouth), type of endodontic treatment performed and the duration of treatment. A baseline sample was collected (room at rest) as a control. All dental treatment was carried out under rubber dam, after patients had undergone a pre-operative 0.12% chlorhexidine digluconate mouth rinse for 60 seconds. An extraoral suction system (ADS EOS Dental System Inc; Ontario, CA, USA) was also placed directly in front of the patient's mouth throughout treatment.Results A significantly greater number of CFUs were recorded after endodontic treatments (all treatments), compared to negative control. CFUs were lower in the emergency pulpotomy group compared to the other two groups. There was a significantly lower number of CFUs found at plates situated 0.5 m, compared to 2 m, away from the patient. There was a positive correlation between the procedure duration and CFU count. The main bacterial species detected were Staphylococcus aureus (48.8%), Staphlococcus epidermidis (42.2%) and oral streptococci (33.1%). Pseudomonas aeruginosa and fungi were not detected.Conclusion Emergency pulpectomy and NSRCT created greater microbial contamination than an emergency pulpotomy. Greater numbers of microorganisms were found after longer treatment times and closer to the patient's mouth.

Maxillary Anterior Teeth With Extensive Root Resorption Treated With Low-level Light-activated Engineered Chitosan Nanoparticles

IntroductionPhotoactivated chitosan-based nanoparticles can eliminate bacterial biofilm, inactivate endotoxins, improve resistance to biological degradation (resorption), and promote bone regeneration. This case is the first documentation to highlight the successful healing of teeth with extensive inflammatory root resorption (IRR) with periapical lesions using a combined surgical and nonsurgical root canal therapy using rose bengal functionalized chitosan nanoparticles (CSRBnp). MethodsA 17-year-old boy with extensive IRR of maxillary right canine (teeth #6), maxillary right lateral incisor (#7), maxillary right central incisor (#8), and maxillary left central incisor (#9) was treated with photoactivated CSRBnp, both intracanal as well as topically on resorptive defects and periapical lesions. The larger external resorptive defects on the root surfaces were restored with Biodentine, whereas the through-and-through periapical lesions were packed with sticky bone for Guided Bone Regeneration. ResultsAt 26 months of follow-up, the clinical, 2-dimensional (intraoral periapical radiographs) and 3-dimensional (cone-beam computed tomography) images showed absence of clinical symptoms, teeth mobility, arrested IRR, and significant osseous healing of the periradicular region. Postoperatively, the patient retraumatized thrice in relation to #7 resulting in horizontal root fracture, which showed type I pattern of root fracture healing in the follow-up. ConclusionsPhotoactivated chitosan-based nanoparticles can be a viable therapeutic option to hinder root resorption while enhancing healing outcomes in cases of severe IRR.