Root Canal Treatment Of Teeth Research Articles

Survival rate of teeth adjacent and nonadjacent to dental implants: A retrospective cohort study.

The aim of this retrospective study was to investigate the risk of tooth loss for teeth adjacent and nonadjacent to dental implants. A total of 787 patients with an average follow-up of 57.1 months were examined to define the tooth loss, cumulative survival rate, and odds ratio (OR) for teeth adjacent versus nonadjacent to implants. A multivariate logistic regression was employed to assess the association between dental history and various recorded etiologies of tooth loss among teeth adjacent to implants. The incidence of tooth loss for teeth adjacent to implants was 8.1% at the tooth level and 15.1% at the patient level, while 0.7% and 9.5% at the tooth and patientlevel for teeth nonadjacent to implants. The 10-year cumulative survival rate for teeth adjacent to implants was 89.2%, and the primary etiology of tooth loss was root fracture (45.2%). The risk of tooth loss among teeth adjacent versus nonadjacent to implants was significantly higher (OR 13.15). Among teeth adjacent to implants, root canal-treated teeth had a significantly higher risk of tooth loss due to root fracture (OR 7.72), a history of existing restoration significantly increased the risk of tooth loss due to caries (OR 3.05), and a history of periodontitis significantly increased the risk of tooth loss due to periodontitis (OR 38.24). The present study demonstrated that after patients received dental implant treatment, teeth adjacent to implants showed a 13.2-fold higher risk of tooth loss compared to teeth nonadjacent to implants, with the primary etiology being root fracture.

The trend of radiographic healing after root canal treatment in teeth with apical periodontitis based on cone-beam computed tomography: A 4-year longitudinal study

ObjectivesThe aim of this study was to observe the radiographic healing of periapical lesions after root canal treatment via volumetric measurements based on cone-beam computed tomography (CBCT) over 4 years. MethodsIn total, 162 single-root teeth from patients with chronic periapical periodontitis who underwent primary root canal treatment were included in this retrospective study. Follow-up visits were scheduled at 1, 2, and 4 years after treatment. The volume of radiolucency at pretreatment and follow-up were measured, and the radiographic outcomes were classified into 4 categories: absence, reduction, uncertain or enlargement. Reduction or enlargement was considered when the volumetric change in radiolucency was 20 % or more. ResultsDuring the 4-year follow-up period, 128 teeth were reviewed at least once, including 3 extracted teeth. Of the remaining 125 teeth, the volume of radiolucency was reduced in 116 teeth (90.6 %), uncertain in 5, and enlarged in 4 teeth during 1 to 4 years after treatment. Among the 43 teeth with reduced radiolucency at 1 year after treatment, 42 (97.7 %) had continuing reduced lesions at 4 years. In the 2 teeth with enlarged radiolucency at 1 year, the volume of radiolucency doubled at 4 years. Cox regression analysis revealed that the preoperative radiolucency size was a risk factor for persistent periapical radiolucency. ConclusionsThe efficacy of root canal treatment for apical periodontitis was predictable. When the radiolucency changed by 20 % or more in volume on CBCT scans at 1 year after treatment, reversal of the radiographic healing tendency was rare. Clinical significanceThe volumetric changes in radiolucency on CBCT could reflect trends in the healing process and may foster early clinical decision-making.

To Compare and Evaluate the Fracture Resistance of Three Post Endodontic Restorations Including Silver Amalgam, Dual Cure Composite Resin and Fibre Reinforced Composite Resin

Background: Endodontically treated teeth are thought to be more prone to fracture. The last stage in a successful root canal treatment is to restore root canal-treated teeth with a permanent, definitive postendodontic restoration. Dehydration, dentin loss during endodontic procedures, and the elimination of significant anatomic elements like cusps, ridges, and the pulp chamber's arched roof—all of which contribute significantly to the normal tooth's support—are the causes of the fracture of endodontically treated teeth. Consequently, intracoronal strengthening is necessary to prevent tooth fracture, especially in the posterior teeth where compressive stresses brought on by occlusal forces can cause tooth fractures.1 Since core materials typically replace a significant portion of the tooth structure and must withstand multidirectional masticatory forces,their compressive strength is crucial.2  Aim: The purpose of this study was to compare the compressive strengths of three direct post enododontic restorations.  Material and Methods: There are thirty extracted maxillary premolars chosen. After receiving root canal therapy, the teeth were divided randomly into three groups for immediate post-endodontic restorations: (i) silver amalgam (ii)Fiber-reinforced composite resin (iii) dual cure glass- reinforced composite resin . After that, a Universal Testing Machine was used to apply compressive stress on the teeth.  Statistical Analysis: Fracture loads will be compared statistically, and the data will be analysed using version 21.0 of SPSS software, analysis of variance and the Post-hoc test for multiple comparisons.  Result and Conclusion: Within the limits of the study, it showed that the post hoc tests reveal that the mean difference of compressive load strength is significant between all the groups, Amalgam has highest load strength followed by Fiber reinforced composite. Dual cure composite has lowest compressive load strength.

40-Year Outcome of Old-School, Non-Surgical Endodontic Treatment: Practice-Based Retrospective Evaluation.

(1) Background: Non-surgical endodontic treatment has been shown to be clinically successful; however, clinical long-term data are scarce. This practice-based retrospective clinical investigation evaluated endodontic outcomes over 40 years and identified relevant clinical co-factors. (2) Methods: Two experienced dental practitioners in two different private dental practices treated 174 patients with 245 teeth from 1969 to 1993. After root canal obturation, either a new direct restoration (amalgam, resin composite, or glass-ionomer cement) or the re-cementation of a pre-existing prosthetic restoration or renewal of prosthetic restoration followed. Metal posts (operator A) or metal screws (operator B) were inserted when coronal substance loss was significant. The primary outcome (i.e., tooth survival) was achieved when the endodontically treated tooth was, in situ, painless and had full function at the end of the observation period. A secondary outcome, the impact of different prognostic factors on survival rate, was evaluated. (3) Results: The overall mean survival was 56.1% of all treated teeth after 40 years of clinical service, resulting in an annual failure rate of 1.1%. Most investigated clinical co-factors (jaw, tooth position, intracanal dressings, post/screw placement, and gender) showed no significant influence on survival. (4) Conclusions: Even with materials and techniques from the 1970s and 1980s, successful root canal treatment was achievable. Except for post-endodontic restorations, most of the evaluated factors had no significant influence on the clinical long-term survival of root canal-treated teeth.

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.

DMAF-Net: Deformable multi-scale adaptive fusion network for dental structure detection with panoramic radiographs.

Panoramic radiography is one of the most commonly used diagnostic modalities in dentistry. Automatic recognition of panoramic radiography helps dentists in decision support. In order to improve the accuracy of the detection of dental structural problems in panoramic radiographs, we have improved the YOLO network and verified the feasibility of this new method in aiding the detection of dental problems. We propose a Deformable Multi-scale Adaptive Fusion Net (DMAF-Net) to detect five types of dental situations (impacted teeth, missing teeth, implants, crown restorations and root canal-treated teeth) in panoramic radiography by improving the You Only Look Once (YOLO) network. In DMAF-Net, we propose different modules to enhance the feature extraction capability of the network as well as to acquire high-level features at different scales, while using adaptive spatial feature fusion to solve the problem of scale mismatches of different feature layers, which effectively improves the detection performance. In order to evaluate the detection performance of the models, we compare the experimental results of different models in the test set, and select the optimal results of the models by calculating the average of different metrics in each category as the evaluation criteria. 1474 panoramic radiographs were divided into training, validation and test sets in the ratio of 7:2:1. In the test set, the average precision and recall of DMAF-Net are 92.7% and 87.6%, respectively; the mean Average Precision (mAP0.5 and mAP [0.5:0.95]) are 91.8% and 63.7%, respectively. The proposed DMAF-Net model improves existing deep learning models and achieves automatic detection of tooth structure problems in panoramic radiographs. This new method has great potential for new computer-aided diagnostic, teaching and clinical applications in the future.

Real-Time Three-dimensional Dynamic Navigation for Post Space Preparation in Root Canal-Treated Teeth: An In vitro Study

IntroductionThe aim of this study was to investigate the feasibility of a real-time three-dimensional dynamic navigation system (3D-DNS) for post space preparation (PSP) in root canal-treated teeth and to compare the accuracy and efficiency of 3D-DNS to freehand (FH) for PSP. MethodsFifty-four maxillary molars were divided into two groups: 3D-DNS (n = 27) and FH group (n = 27). Cone beam computed tomography (CBCT) scans were taken preoperatively and postoperatively. The drilling path for the PSP was virtually planned in the preoperative CBCT scan in the X-guide software (X-Nav Technologies, Lansdale, PA). For the 3D-DNS group, the PSP drilling was conducted under dynamic navigation. The 3D deviations and angular deflections were calculated. The residual dentin thickness (RDT) was determined after PSP. The operation time and the total number of mishaps were recorded. Shapiro-Wilk, t-test or Mann-Whitney rank sum, weighted Cohen's kappa, and Fisher exact tests were used (P < .05). ResultsThe PSP was completed in all samples (54/54). The 3D-DNS was more accurate than the FH, with significantly fewer 3D deviations and angular deflections (all, P < .05). The 3D-DNS required less operating time than the FH (P < .05). For the 3D-DNS, no teeth had RDT < 1 mm, whereas 6/27 in the FH showed RDT < 1 mm after the PSP. There was no difference in the total number of mishaps (P > .05). ConclusionWithin the limitations of this in vitro study, the 3D-DNS is feasible for PSP. The 3D-DNS improved the accuracy and efficiency of PSP. The dynamic navigation system can potentially become a safe and reliable technology for PSP.

Endodontic Procedural Errors and Associated Factors among Undergraduate Dental Students: A Cross-sectional Study.

To assess the procedural errors committed by undergraduate students at RAK College of Dental Sciences, during root canal treatments and the factors associated with these errors. In this cross-sectional study, 180 self-administered questionnaires were distributed, each comprising 26 questions, among 4th and 5th-year students. Participants were requested to report their endodontic mishaps based on feedback from their supervisors. The questionnaire assessed the frequency and types of procedural errors, considering patient, operator, and tooth-related factors. Data were collected tabulated and analyzed using the Chi-square test. A total of 124 root canal-treated teeth exhibiting iatrogenic errors done by students were assessed. Out of which, 53% were performed by 5th-year students, and 69% were conducted by female operators. About 62% of errors occurred in the upper teeth and 68% in the posterior teeth. The most prevalent errors during the rubber dam isolation step were soft tissue trauma (21%) and isolation leakage (20%), significantly associated with limited mouth opening, excessive salivation, and tooth malalignment (p < 0.05). Apical blockage (15%) emerged as the most frequent error during instrumentation phase, showing a significant association with canal dimension and curvature (p < 0.05). For access cavity and obturation phases, under-extended cavity (9%), and under-extended filling (11%) were the most reported errors, respectively. Tooth isolation emerges as a particularly challenging aspect for dental students, particularly when dealing with patients exhibiting limited mouth opening and excessive salivation. Clinical instructors should caution the undergraduates about the heightened risk of endodontic procedural errors when dealing with patients exhibiting limited mouth opening, excessive salivation, tooth misalignment, and narrow canals. Addressing these challenges is crucial for enhancing the proficiency of undergraduate students in performing successful root canal treatments. How to cite this article: Elsayed MA, Islam MS, Saleh DR, et al. Endodontic Procedural Errors and Associated Factors among Undergraduate Dental Students: A Cross-sectional Study. J Contemp Dent Pract 2023;24(12):998-1007.

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

This cross-sectional study evaluated the prevalence of apical periodontitis (AP) and the technical quality of root canal fillings in an adult Kuwaiti subpopulation using cone-beam computed tomography (CBCT) images. Two experienced examiners analyzed 250 CBCT images obtained from Kuwaiti patients aged 15-65 years who attended government dental specialist clinics between January 2019 and September 2020. The assessment followed the radiographic scoring criteria proposed by De Moor for periapical status and the technical quality of root canal filling. Chi-square and Fisher's exact tests were used for statistical analysis, with significance level set at p < 0.05. Among the 2,762 examined teeth, 191 (6.91%) exhibited radiographic signs of AP, and 176 (6.37%) had undergone root canal filling. AP prevalence in root canal-treated teeth was 32.38%, with a significant difference between males and females. Most of the endodontically treated teeth exhibited adequate root canal filling (71.5%). The study demonstrated a comparable prevalence of AP and satisfactory execution of root canal treatment compared to similar studies in different countries.

A randomized clinical study evaluating the 30-month clinical performance of class II indirect restorations in endodontically treated teeth using ceramic, hybrid, and composite computer-aided design/computer-aided production blocks.

In the literature, the information about which indirect material is the most appropriate for the restoration of endodontically treated teeth is insufficient. Therefore, studies evaluating the clinical performance of root canal-treated teeth will shed light on this issue for clinicians. This clinical study aimed to evaluate the clinical performances of class II indirect restorations using ceramic, hybrid, and composite blocks to endodontically treated teeth. A total of 60 indirect class II restorations were performed in 51 patients using Cerasmart (GC Dental Products Europe, Leuven, Belgium) composite, IPS e.max computer-aided design CAD (Ivoclar Vivadent, Schaan, Liechtenstein) ceramic, and Vita Enamic (Vita Zahnfabrik, Bad Sackingen, Germany) hybrid blocks. All the restored teeth had root canal treatment. The restorations were evaluated using modified FDI criteria for 30 months. The data were analyzed using Kruskal-Wallis analysis and Friedman two-way analysis of variance. A total of 53 restorations of the 60 restorations could be followed up at the end of 30 months. No statistically significant difference was observed between the groups after 30 months in terms of all criteria evaluated (P > 0.05). Composite, ceramic, and hybrid blocks showed successful clinical performance in endodontically treated posterior teeth with large material loss.

Assessment of Periapical Status in Posterior Root Canal-Treated Teeth Using Cone Beam Computed Tomography in the Iranian Population

Background: Periapical radiolucency occurs due to root canal infections. In this respect, effective root canal treatment and appropriate coronal restoration can aid in preventing these lesions. Thus, the present study aimed to assess the periapical status in posterior root canal-treated teeth by cone-beam computed tomography (CBCT) in the Iranian population. Methods: The CBCT images of 210 patients (475 endodontically treated molars and premolars) referred to the Hamadan Dental School (from 2020 to 2022) were evaluated in this observational study. The images were obtained by a NewTom 3G CBCT device (NewTom, Verona, Italy) with an FOV of 6×6 inches at 110 kVp and varying milliampers and exposure times according to the patient’s age and body size. They were observed by two maxillofacial radiologists who recorded the periapical status, coronal seal, and endodontic treatment quality of root canal-treated teeth. The Chi-square test was used for data analysis (P≤0.05). Finally, the periapical lesion was determined, along with its association with gender, type of tooth, endodontic treatment quality, and appropriate restoration. Results: The results revealed no significant association between periapical radiolucency and gender. The prevalence of periapical lesions was higher in males aged 25–50 years, but no significant correlation was found in this regard. There was no significant relationship between tooth type and the presence of periapical lesions, while it had the highest prevalence in maxillary molars. Endodontic treatment quality and coronal restoration showed significant correlations with the presence of periapical radiolucency. Conclusion: There was no significant association between the presence of periapical radiolucency and gender and age. The prevalence of periapical lesions was higher in males. Cases with poor endodontic treatment and poor restoration demonstrated the highest prevalence of periapical lesions.

MINIMAL INVASIVE FOR MAXIMAL RECOVERY IN DENTAL TRAUMA : A CASE REPORT

Introduction: Dentoalveolar fractures can be treated in a simple non-surgical procedure by repositioning the fractured fragments and immobilizing them. One of the factors affecting the success of dentoalveolar fracture treatment is the choice of material and immobilization technique. Case: A 16-year-old girl came to the Emergency Department with complaints of bleeding from the mouth due to a traffic accident 5 hours ago. Her lip hit the handlebar of a motorcycle. There was no history of fainting, vomiting, and bleeding from the ears and nose. Extraoral examination revealed an asymmetrical face. Edema and laceration on the upper lip. Intraoral examination revealed gingival laceration of teeth 12-22 and avulsion of teeth 12,22. Panoramic x-ray revealed supra position of teeth 11, 21 and avulsion of teeth 12, 22. Case Management: Wound debridement, indirect root canal treatment of teeth 12, 22, repositioning of teeth 12-22, fixation with wire and composite splinting, selective grinding, antibiotics, and analgesics were performed. Post-operative instructions included maintaining oral hygiene, a soft diet, and a return for splinting control. Discussion: The goal of dentoalveolar trauma treatment is to restore the normal function and shape of the masticatory organs. The treatment in this case uses flexible splinting because it has ability to resemble the physiological mobility condition of the teeth which can help the healing of the periodontal ligament. The treatment results showed soft and hard tissue healing after one month of treatment. Conclusion: Successful treatment of dentoalveolar fractures will be achieved if performed promptly and if accurate immobilization and accurate tools are used. Simple tools and techniques make flexible splinting a good treatment for simple dentoalveolar fractures.

Effectiveness of full Pulpotomy compared with Root canal treatment in managing teeth with signs and symptOms indicative of irreversible pulpitis: a protocol for prospectiVE meta-analysis of individual participant data of linked randomised clinical trials (PROVE)

BackgroundFull pulpotomy has been proposed as an alternative to root canal treatment in teeth with signs and symptoms indicative of irreversible pulpitis (IRP), but the evidence is limited, relying on underpowered studies with a high risk of bias. The aim of this study is to conduct a prospective meta-analysis (PMA) of individual participant data of a series of individual randomised trials to provide robust evidence on the clinical and cost-effectiveness of pulpotomy compared with root canal treatment.MethodsIndividual participant data will be obtained from a series of randomised trials designed and conducted by a consortium of multi-national investigators with an interest in vital pulp treatment. These individualised trials will be conducted using a specified protocol, defined outcomes, and outcome measures. Ten parallel-group randomised trials currently being conducted in 10 countries will provide data from more than 500 participants. The primary outcome is a composite measure defined as (1) the absence of pain indicative of IRP, (2) the absence of signs and symptoms indicative of acute or chronic apical periodontitis, and (3) the absence of radiographic evidence of failure including radiolucency or resorption. Individual participant data will be obtained, assessed, and checked for quality by two independent reviewers prior to the PMA. Pooled estimates on treatment effects will be generated using a 2-stage meta-analysis approach. The first stage involves a standard regression analysis in each trial to produce aggregate data on treatment effect estimates followed by an inverse variance weighted meta-analysis to combine these aggregate data and produce summary statistics and forest plots. Cost-effectiveness analysis based on the composite outcome will be undertaken as a process evaluation to evaluate treatment fidelity and acceptability by patients and dentists.ResultsThe research question and trial protocol were developed and approved by investigators in all 10 sites. All sites use shared resources including study protocols, data collection forms, participant information leaflets, and consent forms in order to improve flow, consistency, and reproducibility. Each site obtained its own Institutional Review Board approval, and trials were registered in appropriate open access platforms. Patient recruitment has started in most sites, as of July 2023.DiscussionPMA offers a rigorous, flexible, and efficient methodology to answer this important research question and provide results with improved generalisability and external validity compared with traditional trials and retrospective meta-analyses. The results of this study will have implications for both the delivery of clinical practice and structured clinical guidelines’ development.Trial registrationPROSPERO CRD42023446809. Registered on 08 February 2023.

The use of guided tissue regeneration in endodontic Microsurgery: Setting a threshold

AimWe aimed to compare the radiographic outcomes of conventional and regenerative approaches in endodontic microsurgery (EMS) and set a critical defect size for healing in conventional and regenerative therapies. MethodologyThe study evaluated 53 root canal-treated teeth (33 patients) with periapical lesions. Among them, 19 teeth (35.8 %) were treated with regenerative treatment, whereas 34 teeth (64.1 %) were managed with the conventional approach. Conventional and regenerative approaches were performed by endodontic and periodontic residents under consultants’ supervision. Healing was evaluated after a minimum period of 6 months by comparing pre- and post-operative cone-beam computed tomography (CBCT) findings. The radiographic interpretation was conducted by a single examiner who was not participating in the surgeries and was blind on the type of treatment prior to CBCT evaluation. New healing criteria were proposed owing to the limitations on the present criteria in evaluating endodontic surgery after regenerative treatment. Critical measurements were calculated for each approach based on periapical lesion dimensions. ResultsThe regenerative approach presented significantly better healing than conventional treatment (mean, 1.21 and 1.59, respectively; p = 0.047). Based on the critical-point calculations, the conventional approach was effective in lesions of up to 3 mm depth and height, whereas the regenerative approach resulted in better healing rates in lesions with 3–9 mm depth and 3–6 mm height. ConclusionsPerforming the regenerative approach in EMS resulted in better healing rates than those of the conventional approach. The conventional approach is recommended for small periapical lesions, whereas the first had better results in larger lesions.

Evaluation of Canal-centering Ability and Apical Transportation of Hyflex-EDM, OneShape, WaveOne Gold, and Reciproc Files: An Ex Vivo Study.

To evaluate and compare canal-centering ability (CCA), canal transportation (CT), and dentinal crack formation by using Hyflex-electrical discharge machining (EDM), OneShape, WaveOne Gold, and Reciproc single file system in the mesiobuccal root of maxillary first molar at coronal, middle, and apical third using cone-beam computed tomography (CBCT) and scanning electron microscopy (SEM). Mesiobuccal roots of 120 freshly extracted maxillary molar teeth were divided into four experimental groups; Hyflex-EDM, OneShape, WaveOne Gold, and Reciproc (n = 30/group). Preinstrumentation scanning was done using CBCT for all samples at coronal one-third (4 mm), middle one-third (8 mm), and apical one-third (12 mm). After cleaning and shaping with standard irrigation protocol, the specimens were again scanned. Canal-centering ability and CT were calculated using pre- and postinstrumentation CBCT values. A scanning electron microscope was used to identify dentinal crack formation. No significant difference was found for CCA by any of the systems at coronal, middle, and apical third, respectively. However, OneShape was found to have better CCA at the coronal third and WaveOne Gold at the middle and apical third. There was a significant difference in canal transportation at the apical third (p = 0.004) with WaveOne Gold having the least CT followed by Reciproc at the apical third. OneShape resulted in more dentinal cracks in the coronal and middle thirds. Also, Hyflex-EDM was better in the apical third. No difference in CCA was observed between the groups. The lowest values for CT were obtained for WaveOne Gold (similar to Reciproc) whereas both rotary files showed higher values for CT. Also, OneShape showed the most dentinal at all levels. Furthermore, Hyflex-EDM and WaveOne Gold produced the least dentinal cracks at all levels. Given that the Reciprocating file system had the least CT and least dentinal cracks, the clinical success rate of root canal treatment (RCT) with the Reciprocating file system can be a better choice to improve the longevity of root canal-treated teeth.

Changes in periapical status of root canal-treated teeth after head and neck IMRT: a retrospective study.

The objective of this retrospective study was to analyze the effect of the intensity modulated radiotherapy (IMRT) of the head and neck region on root canal-treated teeth and their periapical changes due to radiation. Patients undergoing IMRT of the head and neck region were evaluated. Different types of teeth (molars, premolars, incisors and canines) were compared. Panoramic and dental radiographs were used to assess the periapical region of root canal-treated teeth using the periapical index (PAI) before and after radiotherapy (RT) and put in relation to the radiation dose per tooth. Further parameters (patient-, therapy- and tooth-related factors) were included in this study. One hundred and twenty-four root canal-treated teeth (maxilla and mandible) of 51 patients were observed. A radiolucency in the periapical region was seen in 34.7% of the samples before IMRT and an increasing number of 46% after IMRT (p-value 0.092). Clinical or radiological signs of osteoradionecrosis could not be determined. The only statistically significant difference was detected in regions irradiated with less than 40 Gy (p-value 0.045). In regions irradiated with higher doses (>40 Gy), comparable pathologies increased in non-significant numbers. A statistically significant increase of periapical pathologies was detected in premolars of the maxilla. The observations reported here suggest that a high radiation dose during IMRT has no significant consequences on root canal-treated teeth. To compare the success of endodontic treatment before versus after IMRT, further research needs to be done.

Evaluation of the effect of class II fixed orthodontic treatment on the periradicular bone structure of endodontically treated mandibular molar teeth using fractal dimension analysis

Aim: The aim of this study was to investigate whether changes in periradicular tissues with orthodontic movement of root canal-treated teeth differ from those without root canal treatment using fractal dimension analysis (FA). Methodology: A retrospective archive study was performed using panoramic radiographs taken before (T1) and after (T2) fixed orthodontic treatment. Panoramic radiographs of a total of 32 mandibular 1st and 2nd molar teeth were divided into groups: Group 1 (n:17), the control group, comprised radiographs of mandibular 1st or 2nd teeth without root canal treatment, and Group 2 (n:15) comprised radiographs of 1st or 2nd mandibular molars with root canal treatment. Fractal analyses were performed in four different regions—the periapical, bifurcation, mesial periapical, and distal periapical regions—of the mandibular molar teeth included in the study for a total of 128 analyses. Results: In the control group, orthodontic treatment did not make a statistically significant difference to the fractal dimension values in the four regions of the tooth (p &gt; 0.05). In the endodontically treated group, the fractal dimension values of the mesial periapical regions increased statistically significantly after orthodontic treatment (p &lt; 0.05). Conclusion: The FA values of this study showed that more biological interaction occurred in the root canal treatment group and in the mesial periapical region. Thus, it is important to keep orthodontic force within the tooth’s physiological limits to avoid damaging the tooth in the periapical areas where stress accumulates during orthodontic treatment. How to cite this article: Küçükkaraca E, Sarıçam E. Evaluation of the effect of class II fixed orthodontic treatment on the periradicular bone structure of endodontically treated mandibular molar teeth using fractal dimension analysis. Int Dent Res 2023;13(S1):38-43. https://doi.org/10.5577/idr.2023.vol13.s1.6 Linguistic Revision: The English in this manuscript has been checked by at least two professional editors, both native speakers of English.

Survival of root canal-treated teeth adjacent to an implant: A retrospective case-control study

ObjectivesTo evaluate the survival of root canal treated (RCT) teeth adjacent to an implant compared with that of RCT teeth of the same patient non-adjacent to an implant. Materials and methodsRCT tooth of each patient adjacent to an implant were included in the test group. The control group consisted of another RCT tooth of the same patient; the control RCT tooth was not adjacent to an implant and selected to be of the same type of the RCT tooth in the test group. 72 teeth of 36 patients with at least 4-year follow-up were included. In addition to survival, other clinical and demographic parameters investigated were age, sex, tooth type and position, presence of a crown, presence of retreatment, presence of a post-core, presence of adjacent edentulous area, presence of implant-supported fixed prosthetic restoration on the antagonist tooth and periapical health status. Pearson Chi-Square and Fisher Exact tests were used to compare the test and the control groups with categorical variables (α=0.05). Survival curves were obtained by the Kaplan-Meier method, and the Log-rank test was performed to compare the survival probabilities (α=0.05). ResultsNo significant difference in survival rates was observed between the test and the control groups (p = 0.72). Similarly, no significant relationship was found between the investigated clinical variables and the survival rates of RCT teeth (p>0.05). Survival times differed depending on the presence of an adjacent edentulous area (p<0.001) and the periapical health status (p = 0.026). ConclusionsRCT teeth with unhealed periapical tissues had a shorter cumulative survival time. Similarly, those adjacent to an edentulous area had shorter cumulative and complication-free survival times. Clinical SignificanceThis is the first study to determine the survival outcome of a RCT tooth adjacent to an implant compared to a non-adjacent one in the same patient. Being adjacent to an implant did not have a detrimental effect on the survival time and rate of RCT teeth.

Single nucleotide polymorphisms in inducible nitric oxide synthase gene are not associated with persistent apical periodontitis.

The aim of this study was to investigate whether there is an association between inducible in single nucleotide polymorphisms in nitric oxide synthase (rs2297518 and rs2779249) and persistent apical periodontitis. A total of 291 Brazilian subjects were included: 125 with signs/symptoms of persistent apical periodontitis and 166 with root canal-treated teeth exhibiting healthy perirradicular tissues. Endodontically treated patients were followed up after 1 year. The two single nucleotide polymorphisms in nitric oxide synthase were analysed using real-time polymerase chain reaction. Chi-square test and odds ratio with 95% confidence intervals were performed to compare genotype distributions between 'healed' and 'persistent apical periodontitis' groups (p < 0.05). Logistic regression analysis was used to evaluate SNP-SNP interactions. The allele and genotype distributions for the polymorphisms between the persistent apical periodontitis and healed groups were not statistically significant (p > 0.05). In the logistic regression analysis, the polymorphisms were not associated with persistent apical periodontitis and SNP-SNP interactions.

Effect of Delayed Endodontic Sealing with Dentin Biomodification on Fracture Resistance of Endodontically Treated Teeth

Aim: Endodontically treated teeth display altered tooth structure pertaining to various chemical irrigants and intracanal medicaments. To prevent the compromised adhesive bond, dentin biomodification is indicated. This study was designed to evaluate the influence of dentin biomodification on the fracture resistance of root canal-treated teeth following Delayed Endodontic Sealing (DES). Materials and Methods: In 50 maxillary central incisors, Class III cavities along with access cavities were prepared. The samples were randomly divided into five groups. Group 1: Intact teeth ( N = 10), Group 2: Immediate Endodontic Sealing (IES) ( N = 10); Group 3: DES after irrigation with 3% NaOCl ( N = 10); Group 4: DES with 2% chlorhexidine (CHX) as a biomodifier ( N = 10) and Group 5: DES with 5% grape seed extract (GSE) as a biomodifier ( N = 10). In Group 2 samples, composite restorations were done prior to irrigation with 3% sodium hypochlorite (NaOCl). Group 3 samples received root canal irrigation with 3% NaOCl for 1 min, etch and rinse procedure and composite restorations. In Groups 4 and 5, dentin biomodification was done prior to composite restorations. Teeth were subjected to fracture resistance tests. Statistical analysis was carried out employing analysis of variance (ANOVA) and Tukey’s post hoc tests ( p &lt; .05). Results: IES group demonstrated the highest fracture resistance, with a significant difference statistically ( p &lt; .05) when compared with the DES groups. DES modified with GSE resulted in significantly superior fracture resistance compared to DES only, but no statistical difference was present between the CHX and grape seed-treated DES groups. Conclusion: DES with the use of dentin biomodifiers such as 5% GSE and 2% CHX increased the fracture resistance of root canal-treated teeth compared to DES only.