Primary Root Canal Treatment Research Articles

Healing of Apical Periodontitis in Patients with Inflammatory Bowel Diseases and under Anti–tumor Necrosis Factor Alpha Therapy

IntroductionWe evaluated healing after nonsurgical primary/secondary endodontic treatment of apical periodontitis (AP) in patients with inflammatory bowel diseases (IBDs) treated with anti–tumor necrosis factor alpha biologic medications (BMs). MethodsNineteen patients with 22 teeth affected by AP from the gastroenterology unit of the hospital with IBDs under treatment with BMs formed the study group (the IBD group). Fourteen patients with 22 teeth with AP, matched by age and sex, without systemic diseases and not taking medications formed the control group. Teeth underwent primary or secondary root canal treatments and clinical and radiographic follow-up every 3 months for 24 months. The periapical index score was recorded, and 2 trained and calibrated endodontists evaluated and compared radiographs (weighted kappa values, κ = 0.8). The Mann-Whitney, t, chi-square, Fisher, and Bruner-Langer tests and analysis of variance–type statistics were used as appropriate. ResultsThe recall rate was 100%. All teeth in the IBD patients and 81% in the control patients healed (P = .108). Initial healing was appreciable at 3 months in the IBD group and 6 months in the control group (P = .174). Overall healing was reached at 6 and 10.5 months in the IBD and control groups, respectively (P = .106). At any time of the experiment, teeth in the IBD patients showed a higher probability of healing (P < .05). Both groups exhibited a similar decrement of the periapical index (P = .291), more significant for the IBD at the 3-month follow-up (P < .05). The 2 BMs used showed a similar trend of healing (P = .628). ConclusionsThe treatment of AP in patients taking BMs had no complications; furthermore, it was associated with faster healing than the controls. These results support the possible therapeutic aid of BMs in treating AP.

Periapical Microsurgery: Do Root Canal–retreated Teeth Have More Dentinal Defects?

IntroductionThis microsurgical clinical study evaluated if teeth that have undergone endodontic retreatment are associated with more dentinal defects than primary root canal–treated teeth. MethodsOne hundred fifty-five patients who underwent periapical microsurgery treatment in a private practice setting were evaluated. The root ends were resected, and the roots were inspected for the presence of dentinal defects through the surgical operating microscope with the help of a 0.8-mm-diameter light-emitting diode probe light and methylene blue dye. The root canal treatment history (primary vs retreatment) of the teeth was documented and related to the presence or absence of dentinal defects. Bivariate analysis was performed using the chi-square test, and a multivariate analysis was performed using logistic regression to evaluate possible confounding effects of patient age, sex, and tooth location on the association between treatment and the presence of dentinal defects. ResultsOf the 155 treated teeth, 33 were excluded (3 fractured and 30 missing treatment history). Of the remaining 122 included teeth, 73 (59.8%) had undergone primary root canal treatment and 49 (40.2%) retreatment. Sixteen teeth (22.5%) of the primary root canal group versus 33 (64.7%) of the retreatment group had dentinal defects. The proportion of retreated teeth with dentinal defects compared with primary treatment was statistically significant (P < .001) with a higher proportion of retreated teeth having dentinal defects. In the multivariate analysis, only the type of treatment was statistically significant (P < .001). ConclusionsThis clinical study showed that root canal–retreated teeth are associated with more dentinal defects than primary root canal–treated teeth.

Evaluation of Antibacterial Efficiency of Different Root Canal Disinfection Techniques in Primary Teeth.

A successful primary root canal treatment depends on effective shaping and cleaning the root canal system and finally filling it with a hermetic sealer. Clinically, roots of primary teeth are difficult to shape and the irrigation/disinfection protocol has great importance on prognosis. The present study evaluated the antibacterial efficiency of Endosafe (Orangedental GmbH & Co. KG), photo-activated disinfection (PAD; Orangedental GmbH & Co. KG), diode laser (Epic 10; Biolase, Inc.), ozone (O3, Ozonytron; Biozonix, München, Germany), and sodium hypochloride applications in primary root canals that were infected with Enterococcus faecalis after standard mechanical instrumentation. The study was conducted on roots of 100 human primary molar teeth, which were extracted due to excessive caries. The roots were divided in 5 groups with 15 roots in each root disinfection protocol. In addition, 15 samples and 10 samples served as positive and negative controls, respectively. The Shapiro-Wilk test, the Kruskal-Wallis test and then by post hoc group comparisons with the Bonferroni-adjusted Mann-Whitney U test (unpaired observations) was used. Sodium hypochlorite (NaOCl) exhibited the highest antibacterial effect (0 colony-forming units per mL). Diode laser irradiation was statistically more effective than the ozone, PAD, and Endosafe groups (p < 0.001). Endosafe, PAD, and ozone groups showed similar antibacterial effect (p > 0.05). Although not statistically significant, the Endosafe was more effective in reducing the bacterial count when compared with ozone and PAD. The five tested irrigation systems were shown to be effective in disinfection of the E. faecalis-contaminated primary root canals and best results were obtained with 2.5% NaOCl and diode laser.

Pooled analysis of 1-year recall data from three root canal treatment outcome studies undertaken using cone beam computed tomography.

To provide an estimate of the proportion of successful outcomes of primary and secondary root canal treatments (retreatments) determined by periapical radiographs and cone beam computed tomography (CBCT), a pooled analysis of the data collected from three previous prospective clinical outcome studies was undertaken. The analysis pooled the 1-year results for 354 teeth, including 123 primary treatments and 231 retreatments. All root canals were instrumented with ProTaper Universal and filled using a warm vertical condensation technique. Comparisons of favourable results between root canal treatments and retreatments and between different tooth types were made using chi-square/Fisher's exact test. The overall percentage of favourable results was 91% using periapical radiographs and 80% for CBCT (P<0.001). With CBCT, the percentage of favourable results for primary treatments (84.7%) was not significantly different (P=0.316) from that of retreatments (77.9%). When assessed by tooth group, the overall percentage of favourable results with CBCT was 75.5%, 90.6% and 91.1% for molar, premolar and anterior teeth, respectively. When CBCT is used to assess the outcome, the proportion of favourable outcomes in molars was significantly lower than that of premolars and anterior teeth (P<0.05). Teeth with root fillings terminating more than 2mm short of the radiographic apex had less favourable outcomes (73%) compared to long (83%) and adequate root filling length (84%). The proportions of favourable outcomes of primary root canal treatments and retreatments assessed with CBCT were lower when compared to periapical radiographs, and also lower than those historically reported by periapical radiograph-based outcome studies. Considering the very high favourable outcome of anterior teeth and premolars compared to molar teeth, future studies assessing the effect of new materials and techniques on the outcome of root canal treatments should be based on preoperative and postoperative CBCT images, and focus on molar teeth.

Fracture of nickel titanium rotary instrument during root canal treatment and re-treatment: a 5-year retrospective study.

To evaluate retrospectively the incidence of K3 nickel titanium rotary instrument fracture in referred cases during root canal treatment and re-treatment. Clinical and radiographic reports of 12867 endodontic cases treated at the King Abdulaziz medical city between January 2010 and November 2015 were reviewed to obtain information on intracanal fractured instruments with respect to the treatment performed, tooth type and the size and at what level the instrument fractured (coronal, middle or apical). The degree of canal curvature was classified into mild (<10° ), moderate (10-25° ) or severe (>25° ). Logistic regression was used to test the incidence of instrument fracture in relation to the root canal treatment performed and tooth type. Chi-square tests were used to analyse the fracture incidence in the treated teeth in respect to fracture level and fractured file diameter. The level of significance was set at 0.05. Root canal treatment was performed on 8946 cases, whilst re-treatment was performed on 3921 cases. The fracture incidence was higher during re-treatment cases (2.96%) than in primary root canal treatment (0.74%) (P<0.001) with a 1.41% incidence overall. There was a trend for more fractures in maxillary (1.68%) and mandibular (1.35%) molar teeth. Moreover, 56.6% of the fractured instruments occurred in severely curved canals, and the apical third of the root canal was the most common site for instrument fracture (85.7%), followed by middle (13.2%), and coronal (1.1%) thirds, mostly with file sizes 20 and 25 (59.9% and 25.27%, respectively). The fracture incidence of K3 instruments was significantly greater during root canal re-treatment than root canal treatment, mainly with small instruments and in the apical third of the canals.

Healing of Apical Periodontitis after Nonsurgical Treatment in Patients with Type 2 Diabetes

IntroductionThe purpose of this prospective study was to compare the success of primary root canal treatment between type 2 diabetic and nondiabetic patients and to investigate the effect of periapical healing on glycated hemoglobin (HbA1c) in type 2 diabetic patients with apical periodontitis. MethodsSixty mandibular molars with necrotic pulps and apical radiolucency (size ≥ 2 mm × 2 mm) were included in the study. Based on the HbA1c levels, patients were divided into 2 groups: type 2 diabetic (HbA1c ≥6.5%) and nondiabetic (HbA1c <6.5%). Forty-six teeth were evaluated at the 12-month follow-up time period. The primary outcome measure was the change in apical bone density as determined by the periapical index. ResultsBoth the diabetic and nondiabetic group depicted a significant reduction in the periapical score after endodontic treatment at the 12-month follow-up (P < .05). Significantly less periapical healing was observed in the diabetic group (43%) compared with the nondiabetic group (80%) at the 12-month follow-up (P < .05). HbA1c levels in the diabetic group increased at each follow-up after endodontic treatment. ConclusionsDiabetes mellitus may have a negative impact on the outcome of endodontic treatment in terms of periapical healing. Nonsurgical endodontic treatment did not improve HbA1c levels in patients with type 2 diabetes.

The ability of Reciproc instruments to reach full working length without glide path preparation: a clinical retrospective study.

BackgroundReciproc instruments are the only contemporary root canal instruments where glide path preparation is no longer strictly demanded by the manufacturer. As the complete preparation of root canals is associated with success in endodontic treatment we wanted to assess the ability and find predictors for Reciproc instruments to reach full working length (RFWL) in root canals of maxillary molars in primary root canal treatment (1°RCTx) and retreatment (2°RCTx) cases.MethodsThis retrospective study evaluated 255 endodontic treatment cases of maxillary molars. 180 were 1°RCTx and 75 2°RCTx. All root canals were prepared with Reciproc instruments. The groups were compared and in a binary logistic regression model predictors for RFWL were evaluated.ResultsA total of 926 root canals were treated with Reciproc without glide path preparation. This was possible in 885 canals (95.6%). In 1°RCTx cases 625 of 649 (96.3%) canals were RFWL and in 2°RCTx cases 260 of 277 (93.9%). In second and third mesiobuccal canals (MB2/3) 90 out of 101 (89.1%) were RFWL with Reciproc in 1°RCTx and in the 2°RCTx treatment group 49 out of 51 cases (96.1%). In mesio-buccal (MB1) canals “2°RCTx” was identified as negative predictor for RFWL (OR 0.24 (CI [0.08–0.77])). In MB2/3 canals full working length was reached less often (OR 0.04 (CI [0.01–0.31])) if the tooth was constricted and more often if MB2/3 and MB1 canals were convergent (OR 4.60 (CI [1.07–19.61])).DiscussionUsing Reciproc instruments, the vast majority of root canals in primary treatment and retreatment cases can be prepared without glide path preparation.

A two-year report of a comparative randomized controlled trial on the treatment of upper central incisors with periapical lesions

AimTo evaluate the two-year success rate of primary root canal treatment performed with two integrated shaping and filling systems on upper central incisors with chronic periapical pathosis. MethodologyThe trial enrolled 60 patients with an untreated maxillary central incisor presenting a chronic periapical lesion smaller than 5mm in diameter, who were randomly assigned to two treatment groups: G1 (n=30), Revo-S/One Step Obturator; G2 (n=30) GTX/GTX Obturator. The patients underwent single-session root canal treatments by an experienced endodontist and were followed up for two years. The clinical evaluation entailed percussion and palpation tests. Two independent examiners rated the radiographic healing on the basis of a previously described scale. Comparability between groups in terms of baseline clinical parameters was tested with a Mann-Whitney test (age, apical gauging) and χ2 test (tenderness to percussion and palpation). The comparison of clinical data and radiographic healing scores between the groups and among time points was carried out with non-parametric statistical methods (p<0.05). ResultsThe two groups were comparable in terms of baseline clinical parameters. All patients were available for the re-evaluation after two years. Only one patient per group was positive to the clinical tests at the final recall. An improvement of radiographic healing scores along the follow-up period was observed. After two years, the lesions were scored as totally healed, partially healed and not healed in 93.3%, 3.3% and 3.3% of cases in G1 and in 93.3%, 0% and 6.7% of cases in G2, without pointing out statistically significant differences between groups. ConclusionsBoth the two tested integrated shaping and filling systems proved to be effective for the treatment of upper central incisors with periapical pathosis. When monitoring the healing of periapical lesions, follow-up times longer than one year may be required to observe complete healing.

Rapid Bacterial Detection during Endodontic Treatment

Bacteria present in the root canal (RC) space following an RC treatment (RCT) can lead to persistent infections, resulting in treatment failure and the need for reintervention or extraction. Currently, there are no standardized methods in use to clinically detect bacterial presence within RC spaces. The use of paper point sampling and fluorescence staining was shown to be a rapid method, able to detect residual bacteria following treatment. The study demonstrated that Calcein acetoxymethyl (AM) proved to be a suitable dye for detecting vital bacteria within mature endodontic biofilms, with an improved sensitivity over colony-forming unit counting in a stressed biofilm model. Furthermore, in a clinical trial with primary RCTs, 53 infected teeth were sampled in vivo, and increased detection of vital cells was found when compared with colony-forming unit counting, highlighting the sensitivity of the technique in detecting low cell numbers. By combining fluorescent staining and microspectroscopy with software-based spectral analysis, successful detection of vital cells from RCs was possible after 5 min of Calcein AM incubation. Application of this technology during RCT has the potential to reduce persistent infections through vital cell detection and additional treatment. Furthermore, this technique could be applied to antimicrobial research and disinfection control in clinical settings (ClinicalTrials.gov NCT03055975).

Complex Apical Anatomy Revealed Following Endodontic Treatment of a Maxillary Molar Using the GentleWave System: A Case Report

Introduction: Primary root canal treatment success depends on a number of variables, including debridement and disinfection of the root canal system to remove all bacteria and diseased pulpal and dentinal tissues. Complex root canal anatomy, such as concealed isthmuses, apical deltas and lateral canals, hinder this objective, making instrumentation of these regions nearly impossible. Recent advancements within the endodontic space have focused on improved cleaning and disinfection techniques that will enhance cleaning and debridement, even in difficult to navigate anatomy within the apical third. Background: This case study explores the effectiveness of the GentleWave® Procedure in treating a maxillary second molar diagnosed with irreversible pulpitis and symptomatic apical periodontitis that also featured complex apical root canal anatomy that was undetected until obturation was completed. Methods: A minimally invasive endodontic protocol was utilized to maximize preservation of tooth structure. The tooth was conservatively accessed followed by minimal instrumentation to a size 25/04 for creation of a fluid path and to facilitate future placement of root canal obturation material. Multisonic Ultracleaning™ and debridement were accomplished with the GentleWave Procedure. After obturation with gutta-percha and sealer, a final radiograph revealed a clinically significant obturation with previously unseen lateral canals and an isthmus within the apical third. Results: The previously diagnosed symptomatic apical periodontitis had fully resolved by the three-week followup visit. This case report demonstrates a viable minimally invasive endodontic treatment for uncovering root canal systems with complex apical anatomy utilizing the GentleWave Procedure.

Multiple-file vs. single-file endodontics in dental practice: a study in routine care.

BackgroundLittle is known about the differences of rotary multiple file endodontic therapy and single-file reciprocating endodontic treatment under routine care conditions in dental practice. This multicenter study was performed to compare the outcome of multiple-file (MF) and single-file (SF) systems for primary root canal treatment under conditions of general dental practice regarding reduction of pain with a visual analogue scale (VAS 100), improvement of oral-health-related quality of life (OHRQoL) with the german short version of the oral health impact profile (OHIP-G-14) and the speed of root canal preparation.Materials and MethodsTen general dental practitioners (GDPs) participated in the study as practitioner-investigators (PI). In the first five-month period of the study, the GDPs treated patients with MF systems. After that, the GDPs treated the patients in the second five-month period with a SF system (WaveOne). The GDPs documented the clinical findings at the beginning and on completion of treatment. The patients documented their pain and OHRQoL before the beginning and before completion of treatment.ResultsA total of 599 patients were included in the evaluation. 280 patients were in the MF group, 319 were in the SF WaveOne group. In terms of pain reduction and improvement in OHIP-G-14, the improvement in both study groups (MF and SF) was very similar based on univariate analysis methods. Pain reduction was 34.4 (SD 33.7) VAS (MF) vs. 35.0 (SD 35.4) VAS (SF) (p = 0.840) and the improvement in OHIP-G-14 score was 9.4 (SD 10.3) (MF) vs. 8.5 (SD 10.2) (SF) (p = 0.365). The treatment time per root canal was 238.9 s (SD 206.2 s) (MF) vs. 146.8 sec. (SD 452.8 sec) (SF) (p = 0.003).DiscussionRegarding improvement of endodontic pain and OHRQoL measure with OHIP-G-14, there were no statistical significant differences between the SF und the MF systems. WaveOne-prepared root canals significantly faster than MF systems.

Precision of multi-frequency electronic apex locators

Data sourcesCochrane Central Register of Controlled Trials, Medline, Embase and Scopus databases.Study selectionStudies that reported the precision of electronic apex locators (EALs) in locating the apical constriction (AC) in primary root canal treatment of human teeth compared with a histologic evaluation of the AC were considered.Data extraction and synthesisData were extracted and quality assessed independently by two reviewers.ResultsTen studies were included, reporting on 1105 EAL measurements. Seven studies were considered to be at high risk of bias and three at low risk. Four different EALs were evaluated; Root ZX (J Morita, Tokyo, Japan), Justy II (Hager & Werken GmbH & Co, Duisburg, Germany), Endy 5000 (Loser Co, Leverkusen, Germany) and Endox (Lysis Co, Milan, Italy). Three EALs, Root ZX, Justy II and Endy 5000 were more accurate than the Endox in determining the distance between the file tip and the apical constriction. Pulp status was only available for 194 (17.55%) of the measurements. The status of the pulp (vital or necrotic) had no significant effect on precision.ConclusionsThe precision of electronic working length measurement depends on the device used and the type of irrigation and is not influenced by the status of the pulp tissue.

Modern Endodontic Principles. Part 6: Managing Complex Situations.

Clinicians are often faced with endodontic cases that are significantly more challenging than the primary root canal treatment of mature adult teeth. This paper outlines some of the common treatment modalities which can be employed in situations in which either primary treatment has failed, or there is iatrogenic damage or unusual anatomy. CPD/Clinical Relevance: This paper will provide the reader with advice and techniques for undertaking orthograde endodontic retreatment, hemisection, endodontic surgery and management of teeth with incompletely formed roots.

Antibacterial Efficacy of Calcium Hydroxide and Chlorhexidine Mixture for Treatment of Teeth with Primary Endodontic Lesions: A Randomized Clinical Trial.

Introduction:This study compared the root canal microbial count of necrotic teeth after irrigation with 6% sodium hypochlorite (NaOCl) (single session treatment) and two-session root canal treatment with two-week application of calcium hydroxide (CH) mixed with 0.2% chlorhexidine (CHX) as intracanal medicament. Methods and Materials:In this randomized clinical trial, single-rooted necrotic teeth were divided into two groups. Root canal was irrigated with 2 mL of 6% NaOCl in one group, and a mixture of 0.2% CHX and CH powder as an intracanal medicament for two weeks, in the other group. Root canal samples were obtained before and after the intervention and number of colony forming units (CFUs) was counted in each phase. Results: The reduction of Enterococcus faecalis CFU was not significantly different between the two groups (P=0.233) but the CFU of aerobic and anaerobic bacteria was significantly lower in CH+CHX group (P<0.001). Conclusion:Two-week application of CH+CHX caused significant reduced the aerobic, anaerobic and E. faecalis colony counts. Thus, it may be beneficial to carry out primary root canal treatment of necrotic teeth with endodontic lesions in two sessions with intracanal medicaments to achieve predictable results.

Ethnicity and Pathways of Fear in Endodontics

IntroductionCultural competencies in multicultural societies with different ethnic perceptions pose a challenge during the management and treatment of patients with dental fear and anxiety. This study aimed to identify the most common and relevant pathways of fear and anxiety related to root canal treatment in different ethnic groups. MethodsAll participants visiting the Griffith University Dental Clinics, Gold Coast, Australia, were invited to participate if they had undergone primary root canal treatment or were scheduled to undergo the same. Patients with mental disabilities, those with no history of root canal treatment, those who only had surgical root canal treatment, and those below 20 years old were excluded. All participants completed the “My Endodontic Fear questionnaire.” ResultsEight hundred seventy-nine patients (20–90 years old) who had root canal treatment or were scheduled to have one consented to participate in this study. White (54.5%) and Arab/African respondents (30.9%) were more likely (P < .001) to use the conditioning pathway compared with East Asian (10.5%) or Aboriginal/Pacific Islander groups (3.9%). Age was a significant factor for all ethnicities (P < .05); 40-year-old and 65+-year-old groups showed less fear compared with the 20- to 39-year old groups. Female sex was significantly related to the use of the informative (P < .001) and parental (P = .002) pathways. ConclusionsThe present study showed that different pathways appear to be adopted by different ethnic groups, indicating the importance of customizing strategies in a multicultural society to manage fear and anxiety related to root canal treatment.

Effect of maintaining apical patency on endodontic pain in posterior teeth with pulp necrosis and apical periodontitis: a randomized controlled trial.

To evaluate the association between apical patency and post-operative pain in posterior teeth with pulp necrosis and apical periodontitis. Sixty-eight patients requiring primary root canal treatment in mandibular first molars with necrotic pulps and apical periodontitis were included. The patients were randomly allocated to one of two groups: patency (n = 34) and nonpatency (n = 34). After administering local anaesthesia, root canal preparation was completed using ProTaper rotary instruments. A size 10 K-file was used as a patency file and carried 1 mm beyond the working length (WL) between each instrument change in the patency group, while it was carried up to WL in the nonpatency group. Patients were asked to record their pain experience on a pain chart daily for 7 days. Three patients (two in the patency group, one in the nonpatency group) did not return with completed pain charts on the subsequent visit, resulting in a total of 65 patients for the final analysis (patency, n = 32; nonpatency, n = 33). Data was analysed using Chi Square test, t-test, Mann-Whitney test and Wilcoxon Signed Ranks test. Overall, 43% of the patients experienced post-operative pain. The patency group had less incidence of pain (34%) as compared to the nonpatency group (52%), but the difference was not significant (P = 0.163). Maintenance of apical patency during chemomechanical preparation had no significant influence on post-operative pain in posterior teeth with necrotic pulps and apical periodontitis.

Outcome of Orthograde Retreatment after Failed Apicoectomy: Use of a Mineral Trioxide Aggregate Apical Plug

IntroductionThis controlled, single-center historic cohort study project evaluates treatment outcomes of a nonsurgical treatment approach after failed apicoectomy. MethodsThe treatment outcomes of nonsurgical retreatment after a failed apicoectomy were evaluated clinically and radiographically. The study cohort consisted of teeth that had received primary root canal treatment and subsequent apicoectomy elsewhere before the patients presented with post-treatment disease. Orthograde retreatment and obturation using an apical mineral trioxide aggregate plug was performed by postgraduate students and endodontic specialists in 25 cases between 2004 and 2012. Pre-, intra-, and postoperative information and the potential effect on the retreatment outcome were evaluated and statistically analyzed using the chi-square test. ResultsTwenty-two patients with 23 teeth attended the follow-up examinations (recall rate = 92%). The follow-up periods ranged from 12 to 102 months (median = 35 months). Twenty teeth (87%) were classified as “success,” and 3 teeth were considered (17%) “failure.” The chi-square test confirmed that the preoperative factor “number of roots” had a statistically significant effect on treatment outcome (odds ratio = 0.08; 95% confidence interval, 0–1.76; P = .03). The factor “tooth location” was of borderline significance (odds ratio = 0.1; 95% confidence interval, 0–2.14; P = .05). ConclusionsThe results of the present study suggest that orthograde retreatment combined with orthograde placement of an apical mineral trioxide aggregate plug is a promising long-term treatment option for teeth with postsurgical pathosis. The success rates were higher for single-rooted teeth. The use of cone-beam computed tomographic imaging in cases of inconclusive periapical radiographs is recommended to minimize the risk of misinterpretation when assessing treatment outcome.

Long-term outcome of non-surgical root canal treatment: a retrospective analysis

This study investigated the long-term clinical outcome of root canal treatment. 240 root-treated teeth (n = 61 patients) were initially classified on the basis of radiographic presence/absence of initial apical periodontitis (IAP) and clinical data. The final outcome measure was the periapical healing (healed/disease). The outcome at 6-9 months was correlated with the outcome at 10 years following treatment. Prognostic factors for the periapical healing were assessed. Extraction data were recorded. Univariate and multivariate logistic regression analysis was used to identify risk indicators for apical periodontitis (AP) development. Chi-square analysis was performed to evaluate a possible relationship between the 6-9 months outcome and the final outcome related to IAP. Mean observation time was 14 ± 3.7 years. Survival rate was 84.6% and healing rate was 79% (10-19 years). Predictors of outcome (p < .05) were considered statistically significant. Multivariate logistic regression analysis showed that initial pulpal and periapical status and the quality of root canal filling as assessed two-dimensionally were independent predictors of outcome. The 6-9 months evaluation appears to be an indicator for the final outcome of primary root canal treatment both in the presence and in the absence of IAP. An initial radiolucency associated with an unsatisfactory quality and extent of root canal filling significantly diminishes the possibility of achieving long-term radiographic success. For those with uncertain healing at 6-9 months (91%), clinicians should consider the high healing rate when estimating the prognosis and adjust the decision making accordingly.

The survival of indirect composite resin onlays for the restoration of root filled teeth: a retrospective medium‐term study

To investigate the outcomes of root filled posterior teeth restored with indirect composite resin onlays using tooth and restoration survival as well as the quality of restoration as outcome measures. All patients were treated by the same clinician with indirect composite onlays for the restoration of root filled posterior teeth between January 2008 and February 2010 in a single clinic setting. Primary root canal treatment was performed and onlays fabricated with the indirect method using indirect composite resin. Patients were seen every 4-6months for maintenance visits according to standard clinic protocols and each patient's individualized maintenance schedule. Tooth and restoration survival were calculated, and the onlays were evaluated in accordance with the modified US Public Health Service (USPHS) criteria. Thirty-one premolars and one hundred and fifty-eight molars (n=189) of 153 patients were included. The observation period ranged from 24 to 52months with a median follow-up time of 37months. Tooth survival was found to be 100%, whilst the restoration survival was 96.8% and the functional restoration survival 98.9% at the end of the follow-up period. According to modified USPHS criteria, the A rating had a range of 83.1-100% for all evaluation criteria. Onlay restorations fabricated with indirect resin can be a viable option for the restoration of root filled teeth.

Süt dişi kanal dolgu materyalleri

Pulp therapy for primary teeth continues to havechallenge for dentists. The aim of the researches isto use the biocompatible material during and afterthe primary root canal treatment which has positiveeffects on treatment. The aim of this literatureupdate is to describe the advantages anddisadvantages of the filling materials for primaryteeth.