Quality Of Root Canal Treatment Research Articles

Effect of Orthodontic Treatment on the Outcomes of Endodontically Treated Teeth: a CBCT analysis

Objective: Often there is the need of moving endodontically treated teeth. Orthodontic movement may have no effect on the prognosis of teeth with root canal treatment (RCT). To verify this subject, we evaluated the effect of orthodontic movement on the prognosis of RCT teeth using cone-beam computed tomography (CBCT) and further explored the influence of orthodontic movement on the prognosis of RCT teeth with and without apical periodontitis (AP). This retrospective study was conducted by evaluating 169 RCT teeth of 100 patients who had undergone fixed orthodontic treatment. AP was assessed and classified using the CBCT periapical index. Univariate analysis of RCT outcome was performed for the total RCT group, RCT without AP group and RCT with AP group. Multivariate logistic regression was performed for the total RCT group and RCT without AP group, respectively, but not for the RCT with AP group. Variables related to the prognosis of RCT were included, such as age, gender, tooth position, RCT quality, coronal restoration quality, periodontal condition, orthodontic traction distance, and orthodontic rotation angle. The orthodontic traction distance and rotation angle were not significantly correlated to the RCT outcomes, regardless of the presence of AP. Among the total RCT group, teeth with unqualified RCT (OR = 3.42, P = 0.004) and inadequate coronal restoration (OR = 4.40, P = 0.031) had a lower success rate. Of the 97 RCT teeth without AP, unqualified RCT was a risk factor for treatment failure (OR = 3.55, P = 0.041). Of the 72 RCT teeth with AP, the univariate analysis showed that RCT quality were significantly related to the outcome (p = 0.042). Orthodontic movement had no effect on the prognosis of RCT teeth regardless of the presence of AP.

Molar root canal treatment performed by undergraduate dental students; an observational study of procedural errors and student perception

BackgroundMolar root canal treatment (RCT) is challenging and requires training and specific skills. Rotary instrumentation (RI) reduces the time needed for instrumentation but may increase the risk of certain procedural errors. The aims of this study were to evaluate the quality of molar RCTs provided by undergraduate students, to compare the prevalence of procedural errors following manual and RI, and to assess the students’ self-perceived confidence to perform molar RCT without supervision and their preference for either manual or RI.MethodsMolar RCTs performed by the final year students were evaluated radiographically according to predefined criteria (Appendix 1). The procedural errors, treatment details, and the students’ self-perceived confidence to perform molar RCT and their preference for either manual or RI were recorded. Descriptive statistics were performed, and the Chi-squared test was used to detect any statistically significant differences.Results60.4% of RCTs were insufficient. RI resulted in more sufficient treatments compared with MI (49% vs. 30.3% respectively. X2: 7.39, p = 0.007), required fewer visits to complete (2.9 vs. 4.6 respectively. X2: 67.23, p < 0.001) and was the preferred technique by 93.1% of students. The most common procedural errors were underextension of the root canal obturation (48.4%), insufficient obturation (45.5%), and improper coronal seal (35.2%) without a significant difference between the two techniques. 26.4% of the participating students reported that they did not feel confident to perform molar RCT without supervision.ConclusionThe quality of molar RCT provided by UG students was generally insufficient. RI partially improved the technical quality of RCT compared with MI. UG students need further endodontic training and experience before they can safely and confidently practise molar RCT.

Predictors of apical periodontitis in root canal treated teeth from an adult Nepalese subpopulation: a cross-sectional study

BackgroundEndodontic literature search revealed that no study has been conducted to evaluate the prevalence of apical periodontitis (AP) in root canal treated teeth from an adult Nepalese population of Madhesh Province. Consequently, little is known about the extent and risk factors associated with it. This study aimed to determine AP prevalence in root canal treated teeth from an adult Nepalese subpopulation and to analyze the related risk factors including age, sex, tooth type, type of coronal restoration and quality of root canal treatment and coronal restoration as predictors of AP.MethodsDigital panoramic radiographs were evaluated. Periapical status of 300 root canal-treated teeth was scored by using the periapical index. The quality of root canal treatment and coronal restorations were categorized as adequate or inadequate through radiographic and clinical evaluation. The data were analyzed using univariate and multivariate logistic regression models.ResultsPrevalence of AP in the present study was 31.7%. In 45.7% of the treated teeth, quality of root canal treatment was adequate whereas 46% of the cases had adequate coronal restorations. Multivariate logistic regression analysis revealed statistically significant associations and remarkably increased risk for AP in teeth with inadequate root canal treatment (odds ratio [OR] = 7.92; 95% CI: 3.96–15.82; p < 0.001) whereas lower risk for AP was found in females (OR = 0.51; 95% CI: 0.28–0.90; p = 0.021) and in teeth restored with crown (OR = 0.22; 95% CI: 0.09–0.51; p < 0.001) and filling (OR = 0.18; 95% CI: 0.08–0.42; p < 0.001). Quality of coronal restoration, tooth type and age of the patient were not found to be the predictors of AP.ConclusionsWithin the limits of this study, a high prevalence of AP and poor overall quality of root canal treatment and coronal restoration was found in the subpopulation studied. Quality of root canal treatment, type of coronal restoration and sex of the patient are significant predictors of possible AP development in root canal treated teeth. Substantial efforts are needed to improve the endodontic treatment standards.

A 22-year follow-up cross-sectional study on periapical health in relation to the quality of root canal treatment in a Belgian population.

To investigate the prevalence of apical periodontitis (AP) and the technical standard of root canal treatment in a Belgian population, assess the association of different variables with periapical status, and compare the results to a similar study conducted 22 years previously. In this cross-sectional study, 614 panoramic radiographs of first-time adult attendees at the Dental School of the University Hospital of Ghent were examined. Recorded patient-level parameters included gender, age, number of teeth, number of root filled teeth, presence of any AP lesion, and number of implants. The following tooth-level data were collected: tooth presence, coronal status, quality of coronal restoration, post presence, type of root-filling material, length and density of root filling, root-end filling material, presence of AP, and adjacent implant. Multivariable multilevel binary logistic regression was used to explore the association between patient and tooth characteristics and AP prevalence. Risk differences and confidence intervals were calculated to compare the present with the previous study. The prevalence of AP at patient and tooth level was 46.9% and 5.6%, respectively. Fifty-one per cent of the 614 patients had at least one root filled tooth, and 5.9% of the 14 655 teeth studied were root filled. AP was found in 45% of root filled teeth. Fifty-four per cent of the root-filled teeth were rated as inadequate. Multivariable multilevel logistic regression revealed that more teeth, more implants, fewer root-filled teeth, adequate density, adequate coronal restoration, and no caries reduced the likelihood of AP. There were no statistically significant differences between the two studies regarding the prevalence of root-filled teeth or AP and the technical quality of root canal treatment. The prevalence of AP and the technical quality of root canal treatment in Belgium have not substantially changed over the last 22 years, despite the technological advancements and continuing education in the field.

Prevalence of apical periodontitis and quality of root canal treatment in an adult Kuwaiti sub-population: a cross-sectional study

Prevalence of apical periodontitis and quality of root canal treatment in an adult Kuwaiti sub-population: a cross-sectional study

Quality of post and core placement by final year undergraduate dental students.

The success of endodontic restoration of badly compromised teeth depends on the quality of post and core placement and the extra-coronal restoration. Ensuring that students place posts to acceptable quality standards is therefore essential. The aim of this study was to radiographically evaluate post placement by final year undergraduate dental students and to identify any predictors of performance. Two hundred retrospectively and randomly selected posts placed by sixth year students were evaluated radiographically. Data on student gender; number and quality of radiographs; periapical pathology; tooth location; root canal treatment quality; amount of remaining gutta percha; gap between gutta percha and post; post-to-root width; crown-to-root ratio; and types of core material and crowns were recorded. Four criteria were used to grade post placement quality: (i) amount of remaining gutta percha; (ii) gap between gutta percha and post; (iii) post width to root ratio; and (iv) crown-to-root ratio. Assessments were scored to produce final grades. Data are presented using descriptive statistics and the chi-squared test was used to investigate whether student gender or tooth location were associated with final grade. Post and core quality was acceptable in most cases (97.5% were graded as adequate), with no differences in quality between male and female students nor according to tooth location (anterior, premolar, and molar). Just over half of radiographs were adequate quality (53.5%), while just under half were assessed as less than adequate (46.5%) due to cone cutting, overlap, shortening or elongation, although this did not affect formal assessment of post quality. General outcomes of post and core placement by undergraduate students were good, with few errors that might affect the prognosis and long-term survival of treated teeth. Providing undergraduate dental students with clear guidelines on when and how to take radiographs throughout the procedure may improve the quality of post and core treatment and reduce the risk of multiple unnecessary radiographic exposures. From the clinical perspective, although dental students generally place high quality posts and cores, it remains important to monitor the quality and performance of post placement as this determines the survival of compromised teeth.

Lisans Öğrencileri Tarafından Manuel Aletlere Karşı Döner Aletler Kullanılarak Gerçekleştirilen Kök Kanal Tedavisinin Teknik Kalitesi: Bir Retrospektif Çalışma

Background: The technical quality of root canal treatment (RCT) may impact on the outcome. The quality of education received during undergraduate school may be linked to the quality of treatment provided in general dental practice.&#x0D; Objective: To compare the technical quality of RCT where rotary or manual step-back canal preparatory technique was employed in an undergraduate dental clinic in Turkey. Additionally, the present study aimed to compare radiographically commonly seen complications in both instrumentation systems.&#x0D; Materials and Methods: Dental records of 270 patients who received RCT undertaken by dental students were investigated by retrospective chart review. 565 root canals belonging to 270 patients were randomized into two groups [(rotary, n=280, and manual hand instruments, n=285)]. Root canal obturation was evaluated on the basis of the length of obturation being &gt;2mm from the radiographic apex, with uniform radiodensity and good adaptation to root canal walls. Inadequate root canal obturation included cases containing procedural errors such as perforation, ledge, transportation, instrument separation. Descriptive statistics were used to define categorical variables (n, %) and the level of significance was set at 0.05. &#x0D; Results: The technical quality of RCT performed by undergraduate dental students was classified as 'adequate' in 75% and 53.7% of the cases, respectively for rotary and manual groups, respectively (p &lt; 0.05). The highest procedural errors were seen in molars. Occurrence of procedural errors differed significantly between the groups, being 6.4% in rotary group and 12.3% in manual group (p = 0.017). However, occurrence of ledge formation was higher in manual group than that of rotary group (p = 0.007). &#x0D; Conclusion: In view of our findings, RCT performed by undergraduate dental students using rotary instrumentation systems is of higher technical quality and also has fewer procedural errors than manual instrumentation.

The impact of dental operating microscopes on the success rates of endodontic treatments

Recent advancements in dental technology, such as magnification devices like loupes and surgical microscopes, have greatly improved the accuracy and quality of root canal treatments. Dental operating microscopes (DOMs) have become widely accepted in endodontics, providing enhanced visualization and facilitating precise identification of anatomical landmarks, root canal orifices, and pulp remnants. The increased magnification and illumination offered by DOMs have improved treatment outcomes by enabling more efficient removal of bacteria, debris, and obturation materials from the root canal system. Studies have shown that the use of DOMs can significantly increase the success rates of endodontic treatments, allowing for the identification and treatment of even the smallest canals and anatomical variations. Additionally, DOMs enhance ergonomics, patient communication, and documentation in dental practice. However, challenges such as cost and limited office space hinder their widespread use. Increased education and awareness of the benefits of operating microscope utilization are essential for its broader adoption in endodontic procedures.

Përdorimi i diod lazerit në mjekimin endodontik te periodontitet apikale kronike

The complete elimination of microorganisms from the root canal is difficult due to the complex anatomy of the canal, the microbial invasion of the dentinal tubules, and the for- mation of the intracanal biofilm, which gives rise to contin- uous apical periodontitis. The use of lasers in the treatment of caries complications has led to the improvement of various endodontic diagnoses. The aim is to provide clin- ical-radiological data on increasing the effectiveness and quality of endodontic treatment, using a diode laser with a wavelength of 980 nm and a laser power of 0.8–1.0 W in the radicular canals, in the treatment of chronic apical periodontitis. Materials and methods: Eighty-four patients aged between 20 and 70 years were treated, with a total number of teeth of 91; of these, 64 were mono radicular and 27 multi radicular. We divided the patients into two groups; where the first group was the control one, with 40 patients in which 30 single-root teeth and 11 multi- root teeth were selected and treated with the traditional method by performing chemical-mechanical processes. The second group, which was the study one, treated 44 patients from which 36 single-root teeth with chronic peri- odontitis with periapical destruction and 14 multi-root teeth were selected; in this group, in addition to the chemical-mechanical processes, was also applied the diode laser with a wavelength of 980 nm. The cases were observed clinically and radiologically in dynamics for a period of time ranging from 6 to 12 months. Results: We highlighted that the number of complications in chronic apical periodontitis was reduced to a large per- centage in the diode laser group (study group), which achieved 96 % success after 12 months and 4 % failure. As for the control group, there were many complications in the first 6 months and after 12 months, where the final result was 78.1% success, while complications were 21.9%. Conclusions: The quality of root canal treatment with the traditional endodontic treatment protocol has not been sufficient to achieve a clinical effect for a long time. Modification of this protocol by diode laser processing showed high-quality sterilization of canals and rapid reduction of de- structive focus by stimulating osteogenesis.

Assessment of Modality and Accuracy of Single Root Canal Treatment Performed by Undergraduate Students in Saudi Arabia: A Retrospective Study.

Aim To assess the radiographic quality of root canal treatment (RCT) performed on single-rooted anterior teeth by undergraduate dental students of Imam Abdulrahman Bin Faisal University (IAU). Moreover, the study also aimed to assess the types of procedural errors encountered during root canal treatment and to compare the results between male and female students. Methodology The record of patients who visited the endodontic clinics at IAU between the years 2018 and 2021 was obtained from the medical records department. The inclusion criteria for the study involved: i) RCT performed on anterior teeth with a single root; ii) RCT performed by fourth, fifth, and sixth-year undergraduate dental students; and iii) availability of pre-operative and post-operative peri-apical radiographs. After the inclusion criteria, a total of 278 records were selected. The radiographs were accessed by two calibrated examiners for the length of the obturation, homogeneity, and taper. In addition, procedural errors such as the presence of a ledge, perforation, or fractured instruments were also observed. Analysis was done using the Chi-square test. Results A total of 139 teeth (50%) were found to have an adequate quality root canal treatment. Regarding the length of the obturation, 85.6% were considered acceptable, while 65.1% of the obturations had acceptable radiographic homogeneity. The acceptable taper was found in 71.9% of the obturations. Dental students who participated in this study demonstrated a low rate of procedural errors, with 4.7% ledge formation and 1% perforation. A statistically significant difference was found in the quality of root canal obturation (P=<0.001) performed by fourth, fifth, and sixth-year students. Moreover, a significant difference was also observed between maxillary and mandibular teeth (P= 0.032). Conclusion The quality of RCT performed by undergraduate dental students demonstrated that improvements are required. The teaching methods used in the endodontic courses need to be developed and improved to ensure the best possible learning and treatment outcomes.

Diş Hekimliği Öğrencileri Tarafından Yapılan Kök Kanal Tedavilerinin Teknik Kalitesinin Değerlendirilmesi: Kesitsel Çalışma

Amaç: Bu çalışmanın amacı, Selçuk Üniversitesi Diş Hekimliği Fakültesi Endodonti Kliniğinde, 2018-2019 yılları arasında 5. sınıf stajyer diş hekimleri tarafından yapılmış kök kanal tedavilerinin periapikal radyograf üzerinde teknik kalitesini incelemektir. Bu sayede stajyer diş hekimleri tarafından yapılan kök kanal tedavilerinde; iyatrojenik hataları tespit etmek ve bu hataların olası sebeplerini incelemek ve tedavi kalitesinin arttırılmasına katkıda bulunmaktır. Gereç ve Yöntemler: Kök kanal tedavileri; kök kanal dolum uzunluğu ve radyolojik apeks arasındaki mesafe 0-2 mm, kök kanal dolumu homojen, yeterli taper açısına sahipse ve diş iyatrojenik hata içermiyorsa; teknik olarak yeterli-başarılı kabul edilmiştir. Kök kanal dolgu kalitesi ile diş grupları arasındaki ilişkinin istatistiksel değerlendirmesi ki-kare testi kullanılarak yapılmıştır (p=0,050). Kök kanalının eğimli veya düz olması da ayrıca dikkate alınmıştır. Bulgular: Kabul edilir kök kanal dolumu 1.235 dişten 780 (%63,2) dişte görülmüştür. Maksilladaki dişler (%67,8), mandibuladaki dişlerden (%58) daha başarılı bulunmuş ve her iki çenede molar dişlerin başarısı (%47), anterior (%84,9) ve premolar (%80,8) bölgedeki dişlerin başarısından düşük bulunmuştur. Toplam dişlerin %13,5'inde iyatrojenik hata görülmüştür. Eğimli kök kanallarında iyatrojenik hata oranının arttığı ve yeterli kök kanal dolum oranının azaldığı görülmüştür. Sonuç: Çalışmamıza göre kök kanal tedavilerinde radyografik teknik kaliteyi etkileyen en önemli faktörler; dişin ağız içerisindeki lokalizasyonu ve kök kanallarının eğimli olması bulunmuştur.

A cross-sectional study of the periapical status of teeth and quality of root canal treatment in a selected population of young Turkish and foreigners living in Türkiye

A cross-sectional study of the periapical status of teeth and quality of root canal treatment in a selected population of young Turkish and foreigners living in Türkiye

Radiographic Evaluation of Errors during the Root Canal Treatment by 5th and 6th Year Undergraduate Students of Islamic Azad University of Isfahan (Khorasgan) from 2015 to 2018

Introduction: Quality of root canal treatment is considered as an important prognostic factor for endodontic therapy success. The aim of this study is to evaluate radiographic errors during the root canal treatment by 5th and 6th year undergraduate students of Islamic Azad university of Isfahan (Khorasgan) from 2015 to 2018.&#x0D; Materials &amp; Methods: In this study records of 860 cases of endodontic treatment of patients referred to the General Endodontics Department and the Comprehensive Treatment Department of Isfahan Azad University (Khorasgan) during 2015-2018 including 1903 root canals that had received root canal treatment were examined. Periapical radiography was used to evaluate errors during access cavity preparation, canal preparation, and canal filling by two endodontic specialists and it was recorded in pre-prepared forms. In the access cavity preparation: furcation perforation, low access cavity expansion, high access cavity expansion were evaluated. During the canal preparation phase, errors such as missing of canal, ledge, transport, perforation types and broken instruments were investigated. Length and density of root filing were the criteria evaluated at the canal filling stage. The analysis was performed at both descriptive and inferential levels. Statistical analysis was performed by Chi-Square test and exact Fisher's test.&#x0D; Results: Frequency of acceptable root canal treatment (without errors) was 37.5%. Lower first molars showed the highest error rate (40.7%). Furcation perforation was reported with 9.4% highest error of access cavity preparation. The highest error rate was reported transport (7.8%) in the preparation phase. Inadequate density (gap) of 36.9% and under filling of 31.1% had the highest error in filling stage.&#x0D; Conclusion: According to the results of this study, it can be stated that general endodontics department needs careful planning to increase the quality of root canal treatments performed by students.

Effectiveness of pulpotomy compared with root canal treatment in managing non-traumatic pulpitis associated with spontaneous pain: A systematic review and meta-analysis.

Pulpitis characterized by spontaneous pain can result in debilitating pain. Dogma has existed to offer only have two treatment options, namely root canal treatment (RCT) or extraction, although pulpotomy has always remained a potential treatment modality. This review aimed to answer the following research question: 'Does pulpotomy (partial or full) (I) result in better patient and clinical reported outcomes (O), compared with RCT (C) in permanent teeth with pulpitis characterized by spontaneous pain (P) evaluated at various time intervals?' (T). Two authors independently performed study selection, data extraction and risk of bias assessment. The literature search was conducted in the following electronic databases: Clarivate Analytics' Web of Science, Scopus, PubMed and Cochrane Central Register of Controlled Trials. English language clinical trials comparing the patient and clinical reported outcomes between RCT and pulpotomy were included. The meta-analysis was performed on a fixed-effect model and the quality of evidence assessed by the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) approach. Two randomized clinical trials were included. Amongst two trials, one has published four reports at different time points involving the same cohorts. The meta-analysis revealed no difference in postoperative pain (Day 7) between RCT and pulpotomy (OR=0.99, 95% CI 0.63-1.55, I2 = 0%) and quality of evidence was graded as 'High'. Clinical success was high at year 1, 98% for both interventions, however, decreased over time to 78.1% (pulpotomy) and 75.3% (RCT) at 5 years. Pulpotomy is a definitive treatment modality that is as effective as RCT. This could have a significant impact on treatment of such patients affording the advantages of retaining a vital pulp and preventing the need for RCT. This review could only include two trials, hence there is insufficient evidence to draw robust conclusions. The clinical data accumulated so far suggests no difference in pain between RCT and pulpotomy at Day 7 postoperatively and a single randomized control trial suggests that the clinical success rate for both treatment modalities is similar long term. There is a need for more well-designed trials by different research groups to develop a stronger evidence base in this area. PROSPERO database (CRD42021259744).

Prevalence of Periradicular Radiolucencies and its Association with the Quality of Root Canal Treatment and Coronal Restorations in an Adult Nepali Population

Although root canal treatment is carried out to eliminate the existing microorganism and create favorable environment for healing and prevent reinfection, the occurrence of post treatment disease poses a significant challenge in general population. Cross sectional studies from different countries shows that there is varying degree of prevalence of periradicular radiolucencies (PR) in root filled teeth. Since no such prevalence studies have been done in Nepal, we are unaware of the existing problem in our population. Thus, aim of this study was to investigate the prevalence of periradicular radiolucencies and its association with the quality of root canal treatment and coronal restorations in an adult Nepali population. Among 350 patients, 40.8% (389) presented with PR. Significantly better outcome was seen in teeth with adequate qualities of root filled teeth and coronal restoration. The prevalence of PR in Nepali population was seen relatively high and the considerable efforts to improve the length control during the procedure followed by proper restoration, to lessen the development of PR cannot be over emphasized.

Comparative Evaluation of Adequacy of Root Canal Treatment Performed by Interns and Undergraduate Dental Students—A Cross-Sectional, Retrospective Study

This study aimed to assess the errors that happened during root canal treatment (RCT) and compare the quality of root canal fillings (RCFs) performed by different academic grades of dental students at Jouf University. Materials and Methods: a retrospective audit study was conducted to check the errors that occurred during RCT performed by seniors and undergraduates. The quality of the RCFs were evaluated, using digital periapical radiographs depending on previously validated criteria. Data analyses were performed using Statistical Package for the Social Sciences. Descriptive statistics were used for expressing the frequencies of variables and the Chi-square test was used for comparing different variables with a 0.05 level of significance. Results: overall, 332 endodontically treated teeth (566 root canals) were finally chosen for the study. Out of these treated cases, 156 teeth (47%) had a total of 287 recorded errors, mainly in posterior teeth. From the total number of errors, short obturation was the highest error occurred (29%), followed by lack of apical seal (25.1%). Root perforation was the least reported error (2.8%), proceeded by broken instruments (5.6%). A total of 13.2% of the errors were teeth left with unfilled canals, while 7.7% were for an overextended filling. There were no significant differences between the quality of RCF performed by different academic grades. Conclusion: depending on the current study, the quality of RCTs performed by seniors and undergraduate students was 53% acceptable. A clear plan should be applied to improve the quality of treatment outcomes of undergraduate students by implementing more effective preclinical training courses, increasing the ration of supervisor-to-students, and using more advanced modalities during treatment.

Radiological assessment of prevalence and quality of endodontic treatments in a Turkish subpopulation

<h3>Objective</h3> The aim of this study was to determine the current prevalence and quality of endodontic treatments and investigate the relationship of various factors with periapical status in a Turkish subpopulation. <h3>Study Design</h3> The CBCT images of 1069 patients (50.9% males, 49.1% females; mean age 45.32 ± 13.50 years) who applied to Kocaeli University Faculty of Dentistry between 2015 and 2020 were retrospectively analyzed. In total, 20,646 teeth were examined; 1,604 teeth that had undergone root canal treatment met the criteria and were included in the study. The relationship between periapical status of the endodontically treated teeth and the quality of the root canal treatment was recorded. Periapical status was assessed using a modified CBCT periapical index (PAI) by two independent observers. The relation between periapical status and quality of root canal fillings (RCFs) was analyzed statistically using the chi-square test. <h3>Results</h3> The prevalence of apical periodontitis (AP) for teeth with RCF was 56.8%, while 7.8% of all teeth had had endodontic treatment. The prevalence of AP was 44.3% in teeth with short RCF, 10.8% with overextended RCF, 35.7% with inadequate RCF, and 15.5% with untreated root canals. 76.2% of root canal obturated teeth with procedural errors were associated with AP. No statistically significant differences were found between genders in terms of AP (p>0,05). AP developed more frequently in teeth treated with procedural errors. <h3>Conclusion</h3> The quality of root canal treatment was poor in this subpopulation. There is a substantial need to improve the technical quality of endodontic treatment. <b>Statement of Ethical Review</b> Human/Animal subjects were used and this study was approved by an institutional ethics panel

Genetic, Cellular and Molecular Aspects involved in Apical Periodontitis.

The development, establishment and repair of apical periodontitis (AP) is dependent of several factors, which include host susceptibility, microbial infection, immune response, quality of root canal treatment and organism's ability to repair. The understanding of genetic contributions to the risk of developing AP and presenting persistent AP has been extensively explored in modern Endodontics. Thus, this article aims to provide a review of the literature regarding the biochemical mediators involved in immune response signaling, osteoclastogenesis and bone neoformation, as the genetic components involved in the development and repair of AP. A narrative review of the literature was performed through a PUBMED/MEDLINE search and a hand search of the major AP textbooks. The knowledge regarding the cells, receptors and molecules involved in the host's immune-inflammatory response during the progression of AP added to the knowledge of bone biology allows the identification of factors inherent to the host that can interfere both in the progression and in the repair of these lesions. The main outcomes of studies evaluated in the review that investigated the correlation between genetic polymorphisms and AP in the last five years, demonstrate that genetic factors of the individual are involved in the success of root canal treatment. The discussion of this review gives subsides that may help to glimpse the development of new therapies based on the identification of therapeutic targets and the development of materials and techniques aimed at acting at the molecular level for clinical, radiographic and histological success of root canal treatment.

Quality of root canal treatment performed by undergraduate students using nickel-titanium reciprocating versus hand instruments.

To compare the technical quality of root canal treatment (RCT) depending on the incidence of procedural errors performed by undergraduate students using nickel-titanium reciprocating and conventional hand instrumentation techniques, and to assess the impact of case difficulty and localization of the teeth (maxillary or mandibular molars). Dental records and periapical radiographs of molars that were treated with either hand or reciprocating WaveOne (WO) instruments were evaluated retrospectively. The technical quality of RCTs, the incidence of ledge formation, perforation, instrument fracture, overinstrumentation, underfilling, overfilling, inadequate root canal filling, and the effects of case difficulty and tooth localization were compared using the chi-square test with a significance of 5% (α=0.05). While overinstrumentation was more frequent in the WO group (247 teeth), the incidence of inadequate root canal fillings was higher in the hand instrumentation group (245 teeth) (p<0.01). No significant difference was observed in the incidence of other procedural errors (p>0.05). The number of teeth with acceptable technical quality in preparation and obturation was 172 (69.6%) in the WO group, whereas it was 142 (58%) in the hand instrumentation group, presenting a significant difference between the instrumentation techniques (p<0.01). Higher technical quality rates were observed with WO instrumentation in the high difficulty category and in maxillary teeth (p<0.01). Higher technical quality in preparation and obturation can be achieved with WO reciprocating instruments and file-matched greater tapered gutta-percha cones. No significant difference was observed between the groups in the incidence of procedural errors except for overinstrumentation and insufficient root canal filling. WO instrumentation and obturation with file-matched greater tapered gutta-percha cones provided better technical quality in the high difficulty category and in maxillary teeth.

Apical status and prevalence of endodontic treated teeth among Saudi adults in Eastern province: A prospective radiographic evaluation

IntroductionThe main cause for developing periapical lesions (PA) is the root canal infection. The mentioned causes may play a role in not controlling it but are not a “true” cause. ObjectiveTo determine apical status and prevalence of endodontic treated tooth using radiograph assessment in relation to quality of root canal treatment and clinical factors among Saudi adults in the Eastern province. Patients and methodsThis prospective case series study included 2161 patients who received root canal treatment (RCT) at Dammam Specialized Dental Center, Dammam Medical Complex, Ministry of Health, Saudi Arabia, between October 21, 2019 and April 22, 2020, after getting ethical approval from the Institutional Research Board (IRB). Saudi natives of either gender, age ≥ 18, with at least one fixed bridge or single dental crown evaluated on a clear, high-quality radiography image were recruited for the study. To determine the periapical state of root canal-filled teeth, the 'periapical index' (PAI) was used. All pertinent patient information was analyzed in SPSS verion-20 (IBM product, Chicago). ResultsOut of 2161 cases, a PA lesion was present in 756 (35.0%). The prevalence of periapical lesions in endodontically treated teeth was 31.2%. PA lesion was associated with molar involvement (50.8% vs. 36.6%, p = 0.001), poor RCT quality (85.2% vs. 51.0%, p = 0.001), and smoking (13.6% vs. 10.5%, p = 0.028). According to logistic regression model, female gender, molar tooth, and poor RCT quality were more likely to expose PA lesion 1.5 times, 1.8 times, and 5 times, respectively. ConclusionIt is concluded that approximately 1/3rd of endodontically treated teeth are susceptible to the occurrence of periapical lesions in radiographic assessment, which are significantly associated with females, molars, and poor RCT quality, indicating a challenge for endodontists to improve their root canal assessment accuracy.