Root Canal-filled Teeth Research Articles

Increasing the Apical Sizes of Root Enlarged for Root Canal Obturation Influences the Outcome of Single-Root-Canal Teeth Affected by Apical Periodontitis.

To investigate the effect of increasing the apical size of roots enlarged for root canal obturation on the outcome of non-surgical endodontic treatment for teeth with apical periodontitis. In this retrospective study, we included 210 cases of single-rooted canals treated at our dental units between October 2009 and January 2022. The clinical outcomes of teeth with enlarged root apical size from the International Organization for Standardization standard numbers 25 to 100 were investigated. The number of teeth with a root apical size of ≤50 and ≥ 55 were 158 and 52, respectively. In the former case, 144 (68.6%) teeth had good prognoses and 14 (6.7%) had poor prognoses. In the latter case, 28 (13.3%) teeth had good prognoses and 24 (11.4%) had poor prognoses. Unfavourable clinical outcomes were observed in root canal-filled teeth with an enlarged apical root size of ≥ 55. Thus, these sizes potentially indicate poor outcomes of nonsurgical endodontic treatments.

Prevalence of persistent apical periodontitis in patients with root canal-filled teeth: A cone-beam computed tomography study

Prevalence of persistent apical periodontitis in patients with root canal-filled teeth: A cone-beam computed tomography study

Treatment Outcome and Root Canal Preparation Techniques: 5-Year Follow-Up

This study aims at comparing treatment outcome and tooth survival of root canal-filled teeth following manual vs rotary instrumentation techniques over a 5-year period. This was a single-centre study conducted as a follow-up to a short-term parallel-arm randomised controlled noninferiority trial in which root canal treatment was performed on teeth using either rotary or manual instrumentation. Patients were monitored at post 6-month, 1-year, 4-year, and 5-year review periods by blinded evaluators. Treatment outcome was categorised as favourable, uncertain, and unfavourable (employing European Society of Endodontology categorisation based on strict clinical and radiographic criteria), and 5-year tooth survival was determined by assessing whether tooth was in situ in the oral cavity or extracted. The Kaplan-Meier method and log rank test evaluated tooth survival. P value <.05 was considered statistically significant. Ninety of 120 treated teeth were assessed in 37 men and 40 women with mean age of 30.6 ± 10.99 years. Treatment outcome was significantly more favourable in the rotary group compared to the manual group at post 6-month (P=.021) and 1-year (P=.043) review periods. The differences in favourable outcome (P=.498) and tooth survival (P=.296) between the 2 groups were, however, not significant at the 5-year review period. The rotary instrumentation technique was shown to be more effective in resolving clinical symptoms and promoting periapical healing after the post 6-month and 1-year review compared to the manual instrumentation technique; however, both groups had similar favourable outcomes and survival rates after an extended 5-year review period.

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.

Comparative Evaluation of Root Reinforcement Using MTA-based, Epoxy Resin-based, and Silicone-based Endodontic Sealers in Canals Instrumented with Single-file Rotary System: An In Vitro Study

To evaluate root reinforcement by four different sealers, namely, AH Plus, MTA Fillapex, Dia-ProSeal, and GuttaFlow 2, on endodontically treated teeth. Sixty human mandibular premolars were randomly divided into four groups of 15 teeth each, according to the type of sealer used: Group I AH Plus, Group II MTA Fillapex, Group III Dia-ProSeal, and Group IV GuttaFlow 2. All samples were decoronated to a length of 13 mm from the apex. Root canals were prepared by OneShape, 25/0.06 taper file and obturated with a matching single cone gutta percha (25/0.06) using the above-mentioned sealers. All samples were subjected to load by universal testing machine until a point at which root fractured, which was recorded. Teeth obturated with GuttaFlow 2 showed the maximum fracture resistance followed by AH Plus, Dia-ProSeal, and MTA Fillapex. There was no significant difference in fracture resistance between AH Plus and Dia-ProSeal. Teeth obturated with GuttaFlow 2 sealer, which has powdered gutta percha particles, showed the highest fracture resistance. According to the results obtained from this study, obturation of roots with GuttaFlow 2 increased the resistance of root canal-filled teeth to vertical root fracture.

Influence of Root Canal Fillings on Alveolar Bone Crest Level—An Observational Cross Sectional CBCT Analysis

The aim of this study was to compare the alveolar bone crest (ABC) level of root canal filled (RCF) teeth without apical periodontitis with corresponding non-filled teeth in the same individual using three-dimensionally cone-beam computed tomography (CBCT) data. Two hundred and thirty-five matching pairs of RCF teeth and corresponding teeth without RCF were selected from a pool of 580 random CBCT-images (voxel size 160–200 µm). Teeth with apical periodontitis, perio-endodontic lesions or surgical endodontic treatment were excluded. The distance between the cemento–enamel-junction (CEJ) and the ABC was assessed centrally mesial, distal, palatal/lingual and buccal at each tooth (∑1880 measuring points) in a standardized manner. Topographic, gender, and age-related relationships were also noted. Data were analyzed using the Kruskal–Wallis-test. The ABC-level between RCF teeth (2.64 ± 1.25 mm) and teeth without RCF (2.61 ± 1.16 mm) did not differ significantly (p &gt; 0.05). No differences concerning localization (maxilla/mandible, tooth type) and gender (p &gt; 0.05) occurred. Overall, ABC-level in the maxilla (2.74 ± 1.48 mm) was significantly lower (p &lt; 0.001) compared to mandibular teeth (2.50 ± 1.41 mm). Patients &gt; 41 years had significantly lower ABC-levels than younger patients (p &lt; 0.05). Men showed a reduced bone level compared to women (p &lt; 0.05). In conclusion, RCF teeth are identical to their non-RCF counterparts, at least in terms of crestal bone level, regardless of the location or type of tooth and the gender of the patient. Thus, root canal treatment is an essential pillar for long-term tooth preservation.

New Bacterial Combinations in Secondary Endodontic Infections of Patients with a Recent Systematic Antibiotic Therapy.

To date, the microbiota associated with persistent endodontic infections has only been analyzed in patients who did not receive any antibiotic therapy for at least 3 months before endodontic treatment. In this clinical study, secondary endodontic infections of patients who recently received systematic antibiotic therapy before endodontic treatment were analyzed and compared with the actual data available in the literature. Root canal-filled teeth with periradicular lesions of 20 patients who were under systematic antibiotic therapy which ended 1-21 days before the endodontic treatment were studied. A wide range of antibiotics was administered, including amoxicillin, amoclav, amoxicillin/metronidazole, ampiclox (ampicillin and cloxacillin), doxycycline, tetracycline, ciprofloxacin, and azithromycin. Microorganisms were isolated according to standard protocols and identified using MALDI-TOF-MS. A narrative review of the literature was conducted to compare the results of this study with the data reported so far. The presence and concentrations of bacteria isolated from the infected root canals were comparable with those depicted in the literature, although the total colony-forming units number in saliva was rather low. The number of different bacterial species isolated and identified in each patient as well as the diversity over all patients did not show signs of any influence of the administered antibiotics. Weissella hellenica and Cellulomonas spp. were detected in root canals for the first time. Granulicatella adiacens and Dietzia spp., previously isolated from primary endodontic infections, were detected for the first time in persistent root canal infections in this patient group. The bacterial diversity reported to date in secondary endodontic infections should be extended with the new microbial composition revealed in endodontic patients who had recently received systematic antibiotic therapy.

Sealing Ability of AH Plus and GuttaFlow Bioseal.

The objective of root canal obturation is to achieve a fluid-tight seal. Recently, GuttaFlow bioseal (GB), a root canal sealer composed of polydimethylsiloxane, gutta-percha particles, and bioactive glass ceramics, has been developed, to enhance the sealing ability of root canal filling material. The objective of this study was to assess the sealing ability of GB using a subnanoliter-scaled fluid-flow measuring device and to compare with that of AH Plus (AH). The fluid flow in root canal-filled teeth using either gutta-percha cone (GP) with AH (GAR; n = 10) or GP with GB (GBR; n = 10) and in GP inserted in AH blocks (GA; n = 10) or GP inserted in GB blocks (GB; n = 10) was measured. In addition, fluid flow in sealer blocks of AH (A; n = 10) and GB (B; n = 10), which served as negative controls, was measured. Root canal-filled teeth using GP without any sealer (GR) acted as positive controls (n = 10). The leakage was obtained by calculating the volume of moved water by time (s), after stabilization of the fluid flow was achieved. Statistical analysis was performed using the Kruskal–Wallis test and Mann–Whitney U-test with Bonferroni correction. A p value less than 0.00238 (0.05/21) was considered significantly different. The mean leakages (nL/s) in the groups are as follows: GAR, 0.0958 ± 0.0543; GBR, 0.0223 ± 0.0246; GA, 0.0644 ± 0.0803; GB, 0.0267 ± 0.0182; A, 0.0055 ± 0.0057; B, 0.0052 ± 0.005; and GR, 0.2892 ± 0.3018. The mean leakage in the GBR group was lower than that in the GAR group (p = 0.001), while the mean leakages in the GA and GB groups were not significantly different. GuttaFlow bioseal can be useful in single-cone obturation technique.

Quality of root canal fillings and prevalence of apical radiolucencies in a German population: a CBCT analysis.

The aim of this study was to determine the frequency and quality of root canal fillings (RCF) and the prevalence of apical radiolucency (AR) in a German population. Five hundred randomly selected full-size CBCT images (Planmeca ProMax 3D, FOV = 8 × 8cm, voxel size 160μm or 200μm) were obtained from German patients (40.6% = ♂; 59.4% = ♀; mean age = 50.21 ± 12.45years). A total of 8254 teeth were examined for pathology (AR, widened periodontal ligament). The relationship between AR and existing RCF and the quality of RCF were documented. Frequency and correlations between the left and right sides and gender distribution were analyzed statistically using the chi-square test. The overall prevalence of AR was 3.8%, whereas for teeth with RCF, it was 42.5%. Patients had approximately 1.4 root canal-filled teeth (8.2% of all teeth). RCF terminated more than 2mm short of the radiological apex in 31.2%, 5.1% reached beyond the apex, 8.1% were associated with extruded sealer, and 5.3% presented untreated root canals. Odds ratio of having an AR was highest in teeth with RCF beyond the apex (OR = 27.0) followed by RCF <2mm short of the apex (OR = 4.4), untreated root canals (OR = 2.9), and inhomogeneity of RCF (OR = 1.2). Extrusion of sealer was least associated with AR. Molars were most frequently associated with AR (P < 0.05). Root canal-filled teeth showed significantly more AR in men compared with women (P < 0.05). About 42.5% of root canal-filled teeth were associated with AR, and in about one-third of these teeth, the RCF terminated more than 2mm short of the apex. Each step in root canal therapy influences treatment outcome and prevalence of periapical radiolucencies. Determination of the working length is still one of the key points to achieve predictable periapical healing, and homogenous root canal filling reaching the foramen major seems to be essential.

Radiographic Diagnosis of Periapical Status and Quality of Root Canal Fillings in a Saudi Arabian Subpopulation.

To assess the prevalence of apical periodontitis (AP), as determined by orthopantomograms (OPGs), and its correlation with the quality of root fillings and coronal restorations. This cross-sectional study evaluated a random sample of 193 patients--112 (58%) females and 81 (42%) males--who presented as new patients at the Division of Endodontics. Digital OPGs were independently examined by two reliability-calibrated endodontists. The total number of teeth present, the location of the root canalfilled teeth, and the presence or absence of AP were recorded for each radiograph. The results were statistically analysed using the chi-square test followed by model building using multiple logistic regression. A total of 324 endodontically treated teeth from the 193 selected radiographs were analysed. The mean number of teeth per patient was 25.5 ± 4.6, with an average of 1.64 root canal treatments per subject. Radiographically detected AP was associated with 190 (58.6%) root canal-treated teeth. The logistic model shows that the quality of endodontic treatment (adjusted odds ratio [ORa] = 1.82; 95% confidence interval [CI]: 1.40-3.17), status of coronal restoration (ORa = 1.77; 95% CI: 1.20-2.61) and the type of material used for coronal restorations (ORa = 1.39; 95% CI: 1.03-1.87) were significantly related to the periapical health of the teeth. The quality of endodontic treatment, status of coronal restoration and the type of coronal restorative material were found to be the most important factors influencing the health of periradicular tissue.

Prevalence of periradicular radiolucencies and its association with the quality of root canal procedures and coronal restorations in an adult urban Indian population.

Aims:The aim of this cross-sectional study was to determine the prevalence of periradicular radiolucencies (PR) from an urban adult Indian population and to investigate the quality of root canal procedures and coronal restorations and their association with prevalence of PR in root-filled teeth.Settings and Design:Cross-sectional study.Material and Methods:A total of 1,340 subjects (18+ years of age) who reported for non-emergency dental care to 5 different dental care centers had their panoramic radiographs taken during the period from January to December 2013. The periradicular status of 30,098 teeth in these radiographs was evaluated using the Periapical Index Score (PAI). The assessment of the technical quality of the procedure was evaluated based on the criteria of root canal filling length and quality of coronal restoration.Statistical Analysis Used:The data was analyzed statistically by chi-squared test and odds ratio.Results:PR was found in 65% of subjects (n = 865) and 5.8% (n = 1,759) of the 30,098 teeth evaluated (4.30% untreated teeth and 1.53% were root-filled teeth). In all, 4.1% of the teeth (n = 1,234) had some filling material in the root canal(s) and the prevalence of PR in these root-filled teeth was 37.4%, while the remaining 62.6% of root canal-filled teeth showed no evidence of PR. PR occurred significantly more often in teeth where root canal filling was filled more than 2 mm short of radiographic apex or when root filling extruded through the apex.Conclusions:The prevalence of PR in teeth with untreated root canals in India is 4.30%, which is more than twice the weighted world average, while the prevalence of root-filled teeth (4.1%) is lower than the world average (9.6%). The prevalence of PR in root-filled teeth in India is comparable to that in other populations. Inadequate root canal treatment and poor quality of coronal restoration were associated with increased prevalence of PR.

Comparative assessment of the incidence of vertical root fractures between conventional versus surgical endodontic retreatment

Vertical root fractures (VRFs) are a common cause of tooth loss. Little evidence exists though, relating the incidence of VRFs to the type of endodontic retreatment. This retrospective study aimed at evaluating the impact of conventional versus surgical endodontics on root canal-filled teeth with VRFs. Over a period of 13 years, 200 endodontically retreated teeth from 192 patients with VRFs were extracted and further examined. VRFs were assessed in relation to age, gender, tooth group, clinical signs, extension on the root surface, patency, as well as type of endodontic retreatment and restoration. Statistical analysis was conducted using a Cox PH Model, Chi-squared, Wilcoxon rank-sum, and Log rank tests at a significance level of 5 %. The majority of teeth with VRFs (62.31 %) had undergone the combination of conventional root canal retreatment and apical surgery. Women (64.06 %) presented VRFs more frequently than men (35.94 %) at the mean age of 51.1 and 55.1 years, respectively. Maxillary first (17.5 %) and second (16.5 %) premolars, restored by a resin-based material without a post (56.28 %) were more susceptible to VRFs. Apically initiated (84.1 %) VRFs could be diagnosed more easily on radiographs. The type of endodontic treatment strongly correlated with VRFs. The prevalence of VRFs in teeth having undergone both conventional and surgical endodontic retreatment could be attributed, among others, to additive dentin damage related to the aforementioned endodontic procedures. The possible involvement of endodontic retreatment in the multifactorial etiology of VRFs needs to be taken into consideration in clinical practice.

3D analyses of interface voids in root canals filled with different sealer materials in combination with warm gutta-percha technique

The aim of the present study was to analyze the formation of voids and gaps in root canals obturated with different sealer materials in combination with warm gutta-percha vertical compaction technique by using BeeFill® 2in1. Twenty-four single-rooted teeth were collected, and root canals were prepared by using rotary files. All teeth were randomly allocated into three groups. Each group was obturated by using the BeeFill® 2in1 system in combination with Sealapex (non-eugenol, calcium hydroxide polymeric root canal sealer; Kerr Sybron, USA), RoekoSeal (polydimethylsiloxane-based sealer; Roeko, Germany), or 2Seal (epoxy-amine resin-based sealer; VDW, Germany). Following preparation, all teeth were scanned with a micro-computed tomography (CT) scanner, and a three-dimensional reconstruction of the obturated root canals was performed to analyze the volume of interface voids and gaps in the obturated teeth. Statistical analysis demonstrated that the silicon-based sealer RoekoSeal induced significantly less voids and gaps than other tested materials. The amount of voids and gaps significantly was higher in the apical region. These data indicate that none of the root canal-filled teeth were free of gaps. Teeth obturated with RoekoSeal demonstrated to have the highest quality in terms of voids and gaps formation in combination with the BeeFill® 2in1 obturation system. These findings point to the potential benefit of micro-CT analyses for in vitro evaluation of root canal obturation systems and provide further information about sealer materials used in combination with a warm gutta-percha vertical compaction technique.

To Evaluate the Effect of Presence and Absence of Smear Layer with Different Instruments and Obturation Methods on Microleakage of Root Canal-Filled Teeth: An in vitro Study

ABSTRACT Aim To evaluate the effects of presence and absence of smear layer with different instruments and obturation methods on microleakage of root canal-filled teeth. Materials and methods A total of 100 extracted human maxillary central incisors with closed apices and single roots were taken for the study. The teeth were divided into six groups A to F consisting of 15 teeth each. Control group consisted of 10 teeth with five positive and five negative teeth each. Groups A, B, C and D were instrumented with rotary files and groups E and F were instumented with conventional stainless steel files. Groups A, B, C and D were flushed with 3 ml of EDTA to remove the smear layer prior to obturation. All teeth were flushed with 5% NaOCl, then obturated with AH-26 sealer with lateral condensation technique on groups C, D, E, F and injectable thermoplasticized gutta-percha obturation technique on groups A and B. Using electrochemical technique the current flow in the circuit was observed for 45 days. The magnitude of the current for each tooth was directly proportional to the extent of leakage. At the intervals of 10, 20, 30 and 45 days the groups A-F were compared to identify statistically significant differences using students t-test. Results Significantly less microleakage occurred when the smear layer was removed and when the canals were obturated with thermoplasticized gutta-percha. Canals instrumented with engine driven NiTi files exhibited less leakage than hand instrumented canals. Conclusion Rotary instrumentation of the root canals provides a superior preparation in comparison to hand instrumentation. Removal of smear layer increases the resistance of microleakage. Thermoplasticized gutta-percha obturation appears to provide a superior seal as compared to lateral condensation. How to cite this article Shetty P, Uppin V, Shetty D. To Evaluate the Effect of Presence and Absence of Smear Layer with Different Instruments and Obturation Methods on Microleakage of Root Canal-Filled Teeth: An in vitro Study. World J Dent 2013;4(2):103-107.

Comparative micro-computed tomographic evaluation of two carrier-based obturation systems

The aim of the study was to measure the percentage of volume of voids and gaps in the apical third of root canals obturated with two techniques using micro-computed tomography. Fifty-four single-rooted teeth were collected and root canal-prepared. The roots were randomly allocated into two groups; each group was obturated by using thermoplasticized technique with a different material (gutta-percha and Topseal for Thermafil, Resilon and RealSeal for RealSeal 1). Roots were then scanned, and volume measurements for voids and gaps in the obturated roots were carried out using specialized CT software. Percentage of gaps and voids was calculated. The present study showed that none of the root canal-filled teeth was gap free. Student t test was conducted. No significant difference was found between Thermafil and RealSeal 1 concerning percentage of voids in the apical third (P > 0.05). Both materials showed statistically significant difference between the levels where 1 mm showed the highest volume of voids (P < 0.05). Both carrier-based techniques allowed a good sealing ability in root canals but none of the materials was gap free. Statistically significant difference between the levels was found and 1 mm showed the highest volume of voids. This study shows the efficiency of carrier-based obturation systems in filling root canals hermetically. It compares new adhesive endodontic materials with the traditional gold standard gutta-percha. Results show the good sealing ability of both techniques making them appropriate to use in daily endodontic obturations.

Root Canal Filled Versus Non-Root Canal Filled Teeth: A Retrospective Comparison of Survival Times

This matched cohort study used data from a large dental HMO in the Pacific Northwest to evaluate the degree to which pulpal involvement and subsequent endodontic therapy affects tooth survival. Root canal filled (RCF) teeth were used as an indicator of pulpal involvement. Our hypothesis was that RCF teeth would be extracted sooner than non-RCF teeth matched within subjects, controlling for tooth-level variables of interest. The HMO's treatment databases and a subsequent chart audit were used to identify 202 eligible subjects, each of whom had one tooth endodontically treated in 1987-88 and a similar contralateral tooth that was non-RCF at that time. Both teeth were followed from the endodontic access date through the extraction date, the endodontic access date (for initially non-RCF teeth), or 12/31/94, whichever was earliest. Time-to-event analyses were carried out, with Kaplan-Meier curves generated and multivariable marginal proportional hazards regression models fitted to describe the effect of RCF status on tooth survival. All statistical analyses accounted for the complex sampling strategy used in generating the dataset. Teeth were followed for up to eight (median = 6.7) years. RCF teeth had substantially worse survival than their non-RCF counterparts (p < 0.001), with a greater effect of RCF status evident among molars than non-molars. Adjusted hazard ratios (95% confidence intervals) for loss of RCF versus non-RCF molars and non-molars were 7.4 (3.2-15.1) and 1.8 (0.7-4.6), respectively. Though endodontic therapy can prolong tooth survival, pulpal involvement still may hasten tooth loss, underscoring the importance of caries prevention and prompt restorative care.

Factors related to loss of root canal filled teeth.

This case-control study characterized factors related to loss of root canal filled (RCF) teeth among members of the Kaiser Permanente Dental Care Program, a dental health maintenance organization based in Portland, Oregon. Individuals were identified who were enrolled continuously from January 1, 1987, through December 31, 1994, underwent initial root canal therapy on a permanent tooth (excluding third molars) in 1987 or 1988, had a clinical examination within two years after endodontic access, and were at least 21 years old at access. Patients who lost the RCF tooth by December 31, 1994, were defined as cases (n = 96); those who did not were defined as controls (n = 120). Computerized data, dental radiographs, and chart entries were reviewed to ascertain variables of interest, and multivariable logistic regression was used to describe differences between the groups. RCF teeth of cases had fewer proximal contacts at access than RCF teeth of controls (odds ratio = 2.7; 95% Cl = 1.4, 5.1). Cases were older (odds ratio = 1.4; 95% Cl = 1.1, 1.9 per 10-year increase) and more likely to have had a facial injury than controls (odds ratio = 3.6; 95% Cl = 1.2, 10.5). Cases also had more missing teeth (odds ratio = 1.5; 95% Cl = 1.0, 2.1) and more plaque (odds ratio = 1.7; 95% Cl = 1.0, 2.6). Conditions evident during treatment planning may help dentists assess patients' chances of losing an RCF tooth.