Requiring Root Canal Treatment Research Articles

Incidence of post-operative pain after single visit and multiple visit root canal treatment: A randomized controlled trial

Aim:To compare the incidence and intensity of post-obturation pain after single or multi visit root canal treatment on single rooted teeth in a randomized controlled trial.Materials and Methods:Two hundred patients requiring root canal treatment on permanent single rooted teeth (both vital and non vital) were included. The patients were assigned randomly into two groups of 100 patients each. The teeth in Group1 (n = 100) were obturated at the first visit, whilst those in Group 2 (n = 100) were obturated in a second visit 7 days later. A modified Heft Parker visual analog scale was used to measure pre-operative pain and post-obturation pain at 6, 12, 24 and 48 hours after obturation. Independent-sample T-tests was used for statistical analysis.Results:Twelve patients were excluded from the study as they failed to follow the scheduled revisit. Data were obtained from the remaining 188 patients. There was no statistically significant difference in the incidence and intensity of post-obturation pain experienced by two groups.Conclusions:The incidence and intensity of post-obturation pain experience following one- or two-visit root canal treatment on teeth with a single canal were not significantly different.

Management of middle mesial canal in mandibular second molar

The primary objective of endodontic therapy is to achieve a three-dimensional obturation of the root canal space after adequate preparation of the canal space to remove the tissue debris, microorganisms, and their byproducts. Anatomical variations have frequently been encountered in endodontic practice and have to be adequately managed by the clinician. Missed roots and canals are a major reason for failure of therapy. Technological advances have given the clinician ample opportunity to identify and treat these aberrations successfully. The present report describes a left mandibular second permanent molar requiring root canal treatment, found to have three separate canals in the mesial root. This case demonstrates a rare anatomical configuration and emphasizes the need for the clinician to be aware of and look out for such variations and use adequate diagnostic methodologies prior to and during therapy to detect such variations. The possibility of additional canals, whenever in doubt, should be explored with the assistance of technologies such as those of magnification and illumination and various diagnostic aids. Operator experience has also shown to be a key factor in negotiation and management of these aberrant canal configurations.

Endodontic management of mandibular first molar with three distal root canals

A mandibular first molar tooth requiring root canal treatment was found to have one mesial and one distal root and a total of five canals. The mesial root had two separate canals; the distal root had three canals. This case demonstrates a rare anatomical configuration and supplements previous reports of the existence of such configurations in mandibular first molars.

Working length determination in general dental practice: a randomised controlled trial

To evaluate the ability of apex locators as a tool in determining working length in comparison to traditional working length radiographs in general dental practice. Randomised controlled clinical trial. General dental practices in the North West of England.Subjects Adults requiring root canal treatment of at least one tooth with minimal or moderate difficulty. Root canal treatment was carried out with the working length determined by apex locator in the treatment group (AL), and periapical radiograph in the control group (PA). The acceptability of the master cone gutta percha measured from a radiograph before obturation was used as the primary outcome. Twenty-one of 23 fillings in the AL group were judged as acceptable, compared to 17 of 23 fillings in the PA group. This difference was not statistically significant. In general dental practice, no significant difference was found in working length determined using apex locator combined with a master cone GP radiograph or using the conventional method. There is a need for larger trials to investigate these methods further.

Survey of General Dentists to Identify Characteristics Associated with Increased Referrals to Endodontists

Introduction Few studies have surveyed dentists in general practice (GPs) to assess their perceptions and understand the factors associated with referrals to endodontists. The purpose of the study was to understand the referral behavior of GPs by examining the effects of endodontist characteristics and professional behavior and the role of GP demographics and perceptions in determining referrals to endodontists. Methods Researchers conducted a cross-sectional study that included a quantitative online survey of 983 GPs in the United States from November 4–18, 2009. Results Ninety-four percent of the GPs had positive perceptions of endodontists, but they only referred 46% of patients who required root canal treatment to endodontists. The perception that endodontists are partners in patient care and endodontic services are worth the cost was strongly related to the likelihood of referring ( P < .05). GPs rated timely follow-up of reports and images (96%; n = 935), referring patients back for restorative treatment (94%; n = 916), and patient scheduling accommodation (92%; n = 900) as effective ways to build partnerships. Gender and years in practice moderated the relationships between several predictors (eg, communication, patient care, value of treatment, and expertise) and the likelihood of referring. Conclusions There are concrete actions endodontists can take and segments of the GP population that can be targeted to successfully address the issue of increasing referrals, but this is only the first step in addressing the complex relationships involved in referral behavior.

Clinical reproducibility of three electronic apex locators

To compare the reproducibility of three electronic apex locators (EALs), Dentaport ZX, RomiApex A-15 and Raypex 5, under clinical conditions. Forty-eight root canals of incisors, canines and premolars with or without radiographically confirmed periapical lesions required root canal treatment in 42 patients. In each root canal, all three EALs were used to determine the working length (WL) that was defined as the zero reading and indicated by 'Apex', '0.0' or 'red square' markings on the EAL display. A new K-file of the same size was used for each measurement. The file length was fixed with a rubber stop and measured to an accuracy of 0.01 mm. Measurements were undertaken by two calibrated operators. Differences in zero readings between the three EALs in the same root canal were statistically analysed using paired t-tests with the Bonferroni correction, Bland-Altman plot and Linn's concordance correlation coefficients at α = 0.05. Mean and standard deviation values measured by the three EALs showed no statistically significant differences. Identical readings by all three EALs were found in 10.4% of root canals. Forty-three per cent of readings differed by less than ± 0.5 mm and 31.3% exceeded a difference of ± 1 mm. The clinical reproducibility of Dentaport ZX, RomiApex A-15 and Raypex 5 was confirmed with the majority of readings within the ± 1.0 mm range. However, the small number of identical zero readings suggests that EALs are not reliable as the sole means of WL determination under clinical conditions.

Comparison of 2% chlorhexidine and 5.25% sodium hypochlorite irrigating solutions on postoperative pain: A randomized clinical trial

To compare the levels of postoperative pain after cleaning and shaping of root canals using two different root canal irrigants for debridement. Forty patients with irreversible pulpitis, pulp necrosis and non-vital teeth exhibiting acute apical periodontitis requiring root canal treatment were included. At random, canals were cleaned and shaped with the following protocols. 2% chlorhexidine solution in group I and 5.25% sodium hypochlorite solution in group II were used as an irrigants. Access cavities were closed with a sterile cotton pellet and cavit. The patients recorded degree of pain at various time intervals after cleaning and shaping on a visual analogue scale for 1 week. The mean pain score for group I was between 0.65 and 3.35 and for group II was between 0.95 and 4.50. There was significant difference in the pain level between the two groups only at 6 th hour postoperatively (P<0.05) and the pain was more in sodium hypochlorite group. More pain was present in teeth irrigated using 5.25% sodium hypochlorite when compared to that in teeth irrigated using 2% chlorhexidine solution. Significant difference in pain level was present only at 6th hour postoperatively, and at all other periods (24 th hour, 4 th and 7 th days) there was no significant difference in pain level between the two groups.

No high-level evidence to support use of ultrasonic instrumentation for root canal treatment

Searches were made for suitable reports using the Cochrane Oral Health Group Trials Register, Cochrane Central Register of Controlled Trials, Medline, Embase and LILACS (Latin American and Caribbean Health Sciences Literature), and within the reference lists of identified articles. There were no language restrictions. Randomised controlled trials (RCT) were selected if they had participants of over 18 years of age who had single and multiple permanent teeth with a completely formed apex and with no evidence of internal resorption, and which required root canal treatment. Individuals undergoing retreatment of a tooth were excluded. Screening of eligible studies was conducted in duplicate and independently. Results were to be expressed as fixed-effect or random-effects models using mean differences for continuous outcomes and risk ratios for dichotomous outcomes with 95% confidence intervals. Heterogeneity was to be investigated including both clinical and methodological factors. No eligible RCT were identified. This review illustrates the current lack of published or ongoing RCT, and the lack of availability of high-level evidence dealing with clinically relevant outcomes, for the effectiveness of ultrasonic instrumentation used alone or as an adjunct to hand instrumentation for orthograde root canal treatment. Future RCT might focus more closely on evaluating the effectiveness of combinations of these interventions with an emphasis not only on clinically relevant but also patient-centred outcomes.

Root canal treatment using thermoplasticized carrier condensation technique

Background: The management of pulpally and apically infected teeth has evolved into a modality of conservation with predictable degree of success. Root canal treatmentoften requiresprotracted chairside time. A new technique involving placement of thermoplasticized core carrier obturators was compared with conventional lateral condensation technique. Methods: A prospective, comparative, in-vivo cohort study was carried out on randomly selected 100 patients visiting a tertiary care centre from July 2005 to July 2007, for primary, non-surgical conservative management of teeth requiring root canal treatment. Two groups of fifty cases each were managed withlateral condensation and thermoplasticized core carrier obturation techniques. Outcome variables were rate of obturation and failure rates as assessed by clinical and radiological evaluation. Result: The time taken in case of lateral condensation of maxillary central incisor was 17.30 ± 3.373 minutes and 28.07 ± 2.586 minutes in case of mandibular molar. In the thermoplasticized carrier condensation technique, for the central incisors it took 13.00 ± 1.376 minutes and 21.07 ± 2.463 minutes for mandibular molars. The mean rank value for time taken for obturation as per Mann Whitney U test (p < 0.01) were 27.88 for maxillary incisor and 44.73 for mandibular molar in the lateral condensation technique and 13.13 and 16.27 respectively for thermoplasticized gutta percha carrier condensation. The values were statistically significant. With 16% and 14% cases having unsatisfactory filling as evaluatedby post filling radiograph, Chi square test two tailed p value was 0.6836 and there was no statistically significantdifference between the two groups. An absolute failure rate of 10% was seen in lateral condensation group and 6% in thermo-plasticized carrier condensation group. Fisher exact 2-tailed p value was 0.71 and the difference in failure rate was not statistically significant. Conclusion: Root canal obturation by thermoplasticized core carrier condensation technique is an effective alternative to conventional lateral condensation technique in terms of quick and successful outcome.

A 5‐year review of teeth filled with the noninstrumentation technology

The aim of this Case Series was to evaluate the radiographic quality of root fillings performed 5 years previously using the noninstrumentation technology (NIT)-obturation method and to assess radiographically the outcome of these root canal treatments. Seventeen patients requiring root canal treatment participated in this study and were re-evaluated after 5 years. After instrumentation with K-Flexofiles, Calcium-Hydroxide inter-appointment dressing, re-entry and copious irrigation with NaOCl, the teeth were root filled using the NIT. Immediately after obturation the root fillings were (-0.78 +/- 0.11 mm) short when taking the radiographic apex as a reference point. After 60 months these values were -0.85 +/- 0.11 mm. No statistical difference was found (P > 0.05). In the periapical region, PAI rating 1 and 2 increased from 20.1% to 75.6% after 60 months. * This prospective Case Series demonstrated the performance of the NIT-obturation method in vivo. * Root canals filled by the reduced-pressure method using sealer combined with gutta-percha cones showed good radiographic quality. * Periapical healing after 5 years was comparable with conventional filling techniques.

Endodontic management of badly broken down teeth using the canal projection system: two case reports

Teeth that have been weakened by caries and require root canal treatment to maintain their functional integrity may present with minimal coronal tooth structure and are a challenge for isolation and restoration. The aim of this clinical report is to demonstrate the management of badly broken down teeth using the Projector Endodontic Instrument Guidance System (PEIGS). The PEIGS is an adjunct to root canal treatment designed to enhance the ease of treatment delivery. Use of this system facilitates projection of canal orifices from the floor of the pulp chamber to the cavosurface, providing direct visualization of and physical access to the projected canals. This report demonstrates the use of this novel device for the management of two badly broken down teeth. Use of the endodontic projection system has the following advantages: * 'Projects' the canal orifice from the floor of the pulp chamber to the cavosurface, thereby enhancing visualization and access to the canals. * The bonded coronal build up reduces the risk of interappointment crack initiation and coronal-radicular fracture of weakened tooth structure. * Permits individualization of canals especially when they lie in close proximity to each other on the chamber floor. * Isolation may be facilitated by ease of clamp retention, rendering many structurally debilitated teeth endodontically treatable.

Hand and ultrasonic instrumentation for orthograde root canal treatment of permanent teeth

Endodontic treatment of root canals or root canal treatment is a frequently performed dental procedure and is carried out on teeth in which irreversible pulpitis has led to necrosis (death) of the dental pulp (nerve). Removal of the necrotic tissue remnants and cleaning and shaping of the root canal are important phases of root canal treatment. Treatment options include the use of hand and rotary instruments and methods using ultrasonic or sonic equipment. The objectives of this review were to determine the relative clinical effectiveness of hand instrumentation versus ultrasonic instrumentation alone or in conjunction with hand instrumentation for orthograde root canal treatment of permanent teeth. We searched the Cochrane Oral Health Group Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE and LILACS. We searched the reference lists of relevant articles in an attempt to locate additional published and unpublished trials. No language restriction was applied. The last electronic search was conducted in December 2007. Randomised controlled trials involving people over 18 years of age with single and multiple permanent teeth with a completely formed apex and with no evidence of internal resorption requiring root canal treatment were included. Patients undertaking re-treatment of a tooth were excluded. Screening of eligible studies was conducted in duplicate and independently. Results were to be expressed as fixed-effect or random-effects models using mean differences for continuous outcomes and risk ratios for dichotomous outcomes with 95% confidence intervals. Heterogeneity was to be investigated including both clinical and methodological factors. No eligible randomised controlled trials were identified. This review illustrates the current lack of published or ongoing randomised controlled trials and the unavailability of high level evidence, based on clinically relevant outcomes, for the effectiveness of ultrasonic instrumentation used alone or as an adjunct to hand instrumentation for orthograde root canal treatment.Future randomised controlled trials might focus more closely on evaluating the effectiveness of combinations of these interventions with an emphasis on not only clinically relevant but also patient-centred outcomes.

Insufficient evidence for the effectiveness of ultrasonic instrumentation for root canal treatment

Relevant studies were sourced using the Cochrane Oral Health Group Trials Register, Cochrane Central Register of Controlled Trials (CENTRAL), Medline and Embase. The reference lists of relevant articles were searched and personal databases of trial reports used, in an attempt to locate additional published and unpublished trials. No language restriction was applied. Randomised controlled trials (RCT) were selected that involved people of age >/=18 years with single and multiple permanent teeth with a completely formed apex and no evidence of internal resorption, who required root canal treatment. Patients undertaking retreatment of a tooth were excluded. Screening of eligible studies was conducted in duplicate and independently by two review authors. Results were to be expressed as fixed- or random-effects models using mean differences for continuous outcomes and risk ratios for dichotomous outcomes with 95% confidence intervals. Heterogeneity was to be investigated including both clinical and methodological factors. No eligible RCT could be found. This review illustrates how there are no published or ongoing RCT relevant to this review question and that there is currently insufficient evidence regarding the effectiveness of ultrasonic instrumentation used alone for orthograde root canal treatment. Future RCT might focus more closely on evaluating the effectiveness of hand instrumentation compared with hand instrumentation and adjunctive ultrasonic instrumentation.

A Six Year Evaluation of Cracked Teeth Diagnosed with Reversible Pulpitis: Treatment and Prognosis

The purpose of this investigation was to report on the clinical outcomes of cracked teeth diagnosed with reversible pulpitis (RP). Eight thousand one hundred seventy-five patients referred for evaluation and treatment during a 6-year period had medical and dental histories, radiographs, pulpal and periapical diagnosis, periodontal probings, direct identification of crack(s) with transillumination, and biting responses on various cusps recorded. All data were stored daily in a database. All cases were treatment planned according to the pulpal and periapical diagnosis. Cases with RP were treatment planned for crowns only, regardless of periapical diagnosis. All patients were recalled at 1 year unless root canal treatment was needed before the anniversary. Results indicated that cracks were identified in 9.7% (796 of 8175) of all teeth evaluated during this time period. Of 127 patients specifically diagnosed with RP, 27 converted to irreversible pulpitis (N = 21) in 58 days or to necrotic pulp (N = 6) in 149 days. To date, none of the original remaining 100 cases of RP have required root canal treatment. The outcomes of this study suggest that if a marginal ridge crack is identified early enough in teeth with a diagnosis of RP and a crown is placed, root canal treatment will be necessary in about 20% of these cases within a 6-month period.

Nonsurgical endodontic management of a double tooth: a case report

To present a case with various morphological irregularities requiring root canal treatment and to discuss the problems and options for orthograde root canal treatment. Root canal treatment of a double tooth presenting with an acute alveolar abscess is described. The anatomical variations of this tooth included double tooth, dental invagination, incomplete apical closure, three root canal systems and an internal lacuna. The tooth was treated nonsurgically with orthograde root canal treatment resulting in nearly complete radiographic apical repair after 4 years. *Double teeth occur infrequently and may be distinguished from fusion, gemination, concrescence and dental twinning. *Several malformations may be present in a single tooth. *Orthograde root canal treatment may be an adequate treatment option even in teeth with a complex internal anatomy.

Effect of MTAD on Postoperative Discomfort: A Randomized Clinical Trial

The purpose of this study was to compare levels of postoperative discomfort after cleaning and shaping of root canals using two protocols for removal of smear layer. Seventy-three consecutive patients requiring root canal treatment were included. At random, canals were cleaned and shaped with one of the following protocols. In group 1, 5.25% sodium hypochlorite was used as the root canal irrigant. The smear layer was removed by placing 17% EDTA in the canal(s) for 1 min followed by a 5-ml rinse with 5.25% NaOCl. In group 2, canals were irrigated with 1.3% NaOCl; the smear layer was removed by placing MTAD in the canal(s) for 5 min. Access cavities were closed with a sterile cotton pellet and Cavit. The patients recorded degree of discomfort at various time intervals after cleaning and shaping on a visual analogue scale for 1 wk. No significant statistical difference was found in the degree of discomfort between the two groups (p = 0.58).

Clinical Management of a Mandibular First Molar with Multiple Mesial Canals: A Case Report

A right mandibular first molar requiring root canal treatment was found to have three separate mesial canals. This case demonstrates an extraordinary anatomical configuration and supplements previous reports of the existence of such configurations in mandibular first molars.

Management of a totally fused central and lateral incisor with internal resorption perforating the lateral aspect of the root

Form and structure of developing teeth may be affected by either systemic or local conditions. Sometimes, the structure of the tooth may be changed and the gross appearance remains normal. At other times, the gross appearance is changed and the structure remains normal. Less frequently are both appearance and structure altered simultaneously. Included in the category of abnormalities of anatomical form and histologic structure are the various forms of multiple teeth: gemination, fusion, concrescence, and dens invaginatus. Geminated teeth arise from a single tooth germ that at tempts to divide by an invagination. The result is usually two completely or incompletely separate crowns with a single root and a common root canal system. The two crowns may be approximately equal in size or one may be rudimentary in size and form. It is not always possible to distinguish between trae geminat ion and fusion of a normal tooth and a supernumerary tooth. Fused teeth are produced by the union of two normal, adjacent tooth germs. The fusion may be total and involve both the crowns and the roots, or it may be partial and involve either the crowns or the roots. Fusion may also occur between a normal tooth and a supernumerary tooth; however, true fusion must show confluent dentin. Concrescence, on the other hand, is the connection of two teeth by cementum only. The condit ion occurs after root formation has taken place and is thought to be due to t rauma or crowding of teeth where the interdental bone has been lost and the two roots have come into contact. Cemen tum is then laid down between the two roots and joins them together. Dens invaginatus is caused by an invagination in the crown of a tooth before calcification has occurred. The condition appears radiographically as a tooth within a tooth. The inside tooth is inverted, and contains dentin on the outside and enamel on the inside. The condition is usually seen in the maxillary lateral incisor. Because of a communica t ion between the oral cavity and the inside of the tooth through the deep lingual pit, debris and bacteria can enter the inside of the tooth, which causes pulpitis and eventual pulpal degeneration. Thus, most of these teeth eventually require root canal treatment. C A S E R E P O R T