Root Canal Treatment Of Teeth Research Articles

Evaluation of Shears Strength of Dowel Amalgam and Post-amalgam in Root Canal-treated Teeth

Introduction: Amalgam, which can be applied with or without dowel, is one of the commonly used restorative materials for core restoration in pulpless teeth. The current study aimed to compare the shear strength of amalgam cores with and without dowel. Methods: A total number of 20 recently extracted mandibular premolars were assigned to two groups of 10 equal specimens, including group I: dowel amalgam restored with prefabricated dowel and amalgam core and group II: post-amalgam restored with amalgam as a post and core. All Specimens were stored at humidity and room temperature prior to testing. Each specimen was carefully placed in a special jig at a 90-degree angle to the axis of teeth and subjected to a load that was recorded in kgf on a Zwick/material testing machine at a crosshead speed of 0.5 mm/min until failure. Independent T-test was used to compare the results. Results: Based on the obtained results, the mean shear strengths were reported as 37.7±10.49 and 16.8±6.37 kgf for dowel amalgam and post-amalgam, respectively. There was a statistically significant difference between the two groups (P<0.0001). Conclusions: The obtained results demonstrated a significant difference between the two groups. Accordingly, the use of dowel with amalgam to restore pulpless teeth has higher compressive strength, as compared to the use of post-amalgam

Association of ankylosing spondylitis with radiographically and clinically diagnosed apical periodontitis: A cross-sectional study.

There are no studies evaluating the possible association between ankylosing spondylitis (AS) and apical periodontitis (AP). The aim of the present cross-sectional study was to investigate the possible association between AS and AP. Fifty patients diagnosed with AS, receiving treatment at the Rheumatology Clinic in Erzurum, Turkey, were included in the experimental group. Another 50 ageand gender-matched individuals without any history of systemic disease were included in the study as the control group. All patients were examined radiographically and clinically to diagnose the presence of AP. The following data was recorded for all patients: the smoking habit, the number of teeth present, the number of teeth with AP, the number of root canal-treated (RCT) teeth, and the number of RCT teeth with AP. There were 1,283 teeth in the AS group and 1,305 in the control group. There was a significant association between teeth with AP and AS, as the prevalence of teeth with AP was significantly lower in the control group (1.3%) than in the AS group (2.9%) (OR (odds ratio) = 2.250; p = 0.005). There was no statistically significant difference between the groups in terms of the number of RCT teeth and RCT teeth with AP (p > 0.05). Ankylosing spondylitis is significantly associated with an increased prevalence of AP. It can be concluded that patients with AS can be more prone to develop AP. However, AS does not reduce the success rate of endodontic treatment, because there was no significant difference between the AS and control groups in terms of RCT teeth with AP.

The incidence of nickel-titanium endodontic hand file fractures: A 7-year retrospective study in a tertiary care hospital.

Aim:The present retrospective cross-sectional study aims to evaluate the incidence and factors associated with nickel-titanium hand file fractures in root canal-treated teeth in a tertiary care hospital of western India.Methodology:The diagnostic records of intraoral periapical (IOPA) radiographs were analyzed to check for file fractures in the root canal-treated teeth. As a part of standardized departmental protocol, Hand ProTaper Universal file system (Dentsply, India) was used for chemomechanical preparation for root canal treatment. The file fractures were analyzed with reference to age group, type of teeth, curvature of the canal, site of file fracture in the canal, length of file fracture, level of file fracture, distance of the file fracture from the apex, and obturation status of the file-fractured tooth. Chi-square test was applied to assess the significance difference between the tested groups.Results:A total of 19,810 IOPA X-rays were screened and 2728 root canal-treated teeth were found and of these 2728 cases, 109 file-fractured teeth were observed.Conclusion:The total incidence of file fractures was 3.9/100 root canal-treated cases, and mandibular molars with severely curved canals (>25°) had shown the maximum incidence of file fractures.

Root and Canal Morphology of Maxillary Teeth in an Iranian Subpopulation Residing in Western Iran Using Cone-Beam Computed Tomography.

Accurate information regarding the morphology of roots and canals is a prerequisite for successful endodontic treatment. This study aimed to assess the number of roots and canals and canal type of maxillary teeth according to the Vertucci's classification in an Iranian subpopulation residing in Western Iran using cone-beam computed tomography (CBCT). In this cross-sectional study, a total of 1750 teeth were evaluated on CBCT scans taken for purposes other than this study. For each tooth, 250 axial, sagittal and coronal sections with 1 mm slice thickness were evaluated using NNT Viewer software. The number of roots and canals and canal type according to the Vertucci's classification were determined and reported. Data were analyzed using descriptive and analytical statistics via Fisher's exact test and Chi square test. All data analyses were performed using SPSS version 18. All of the maxillary anterior teeth were single-rooted, and Vertucci's type I was the most common canal type. Maxillary premolars were mostly single-rooted and Vertucci's type I was the most common type except for the first maxillary premolars, in which type V had the highest frequency. Maxillary molars mostly had three roots and two canals in the mesiobuccal root and one canal in the distobuccal and palatal roots. Although the number of roots in this cross-sectional study was similar to the findings of previous studies, canal type was significantly different from the results of previous studies. The result of this study can help clinicians in efficient root canal treatment of teeth.

Association between Rheumatoid Arthritis and Apical Periodontitis: A Cross-sectional Study.

Objective:The present cross-sectional study aimed to investigate possible association between Rheumatoid Arthritis (RA) and Apical Periodontitis (AP).Methods:In table one it is mentioned 48 patients diagnosed with RA were included in the experimental group. Another 48 healthy age- and gender-matched participants who reported no history of any systemic disease were selected to form the control group. All the patients were examined radiographically and clinically to diagnose the presence of AP. The following data was recorded for all patients; the number of teeth present, the number of teeth with AP, the number of patients with AP, the number of patients with root canal treated teeth (RCT) and the number of patients with RCT+AP. The chi-square test and logistic regression analysis were used to determine the possible association between RA and AP.Results:A total of 1026 teeth were examined in the RA group and 45 of them was diagnosed as AP. In the control group, 1025 teeth were examined and 21 teeth were diagnosed as AP. It was found that the prevalence of teeth with AP (4.3%) was significantly higher in the RA group than the control (2%) (odds ratio [OR]=2.193, P=0.003). Logistic regression analysis showed that RA is significantly associated with AP.Conclusion:It can be concluded that patients with RA can be more prone to develop AP.

Prevalence of Apical Periodontitis in patients with Multiple Myeloma.

Background Aim Previous reports have been analyzed the prevalence/association of apical periodontitis (AP) with systemic diseases. The present study aims to analyze the prevalence of healthy/diseased periapex and endodontic treatments in patients with Multiple Myeloma (MM) and compare the results with those of control subjects. Material and Methods Methodology Panoramic radiographs of 50 individuals with MM were evaluated and compared with 50 controls that were sex and age matched exactly with the diseased group. Radiographic analysis was performed by 2 two experienced endodontists under standardized conditions. The periapical status (presence or not of AP) was assessed using the periapical index (PAI). Data included systemic health, technical quality of root fillings, total number of teeth, quality of restoration, and periapical status. Statistical evaluation of differences between groups included used chi-squared tests and Fisher’s exact tests. Results The prevalence of root canal-treated teeth was 10.11% in the MM group and 12.05% in the control group (p=0.90). The average root canal-treated teeth in the test group was 2,34 and 2.48 in the control group, where the difference was statistically significant (p=0.05). AP in 1 or more teeth was found in 86 % and in 78% of the patients in the MM and the control groups, respectively. When analyzed by subject, there was no statistically significant difference in the prevalence of AP (p>0.72). Similarly there was also no statistically significant difference in the prevalence of PA (p=0.85), when analyzed by tooth, AP was found in 63.2% and 62.9% in MM and control groups. Conclusions The presence of AP and endodontic treatment was not significantly different in individuals with MM compared with control subjects. Future studies are needed to elucidate and confirm the association between MM and AP. Key words:Apical periodontitis, multiple myeloma, endodontics, root canal treatment, systemic disease.

Assessment of apical periodontitis in relation to quality of root canal fillings and coronal restorations in a Turkish subpopulation: A retrospective cone-beam computed tomography study

Introduction: This study aims to investigate the prevalence of apical periodontitis (AP) and relate the quality of root canal fillings (RCFs) and coronal restorations (CRs) with using cone-beam computed tomography (CBCT) in a Turkish subpopulation. Materials and Methods: A total of 824 CBCT scans were performed at the Dicle University Faculty of Dentistry between January 2015 and December 2017. The age, sex, root canal-treated teeth of each patient, quality of RCF and CR, and CBCT periapical index (CBCTPAI) scores of teeth were calculated and recorded. Data were statistically analyzed. Results: Among 333 patients, 152 (45.6%) patients were male and 181 (54.3%) were female. The mean age was 30.1 ± 5.3 years. The total number of endodontically treated teeth was 550, and 76.2% had AP. In 238 (43.3%) teeth with inadequate RCF, AP rate was 89.4%. There was a significant correlation between the density of the RCF and AP (P Conclusions: The RCF quality, adequate CR, and the type of CR are related to AP.

Intraligamentary anaesthesia as a possible anaesthetic option in oral implantology: a retrospective analysis

This investigation was conducted to analyse the usefulness of intraligamentary anaesthesia (ILA) as an alternative anaesthetic procedure in oral implantology. Forty consecutive patients with single-tooth gaps in the posterior mandible were included in the analysis. Implant insertion was performed after ILA of the gap-delimiting teeth (two injections distal to the mesial tooth, two injections mesial to the distal tooth). Implant surgery was performed successfully under ILA of the gap-delimiting teeth in 39 cases. Injection pain correlated significantly with lower periodontal probing depths (<3mm) of the delimiting teeth (P=0.003). The total amount of anaesthetic solution and the pain during surgery were significantly higher if a root canal-treated tooth was present in the area of surgery (P=0.010 and P=0.020, respectively). Overall, the mean pain score during treatment was low at 0.76±0.51 on a numerical rating scale from 0 to 10. At the control visit, no major complication was encountered. All implants were successfully restored with single crowns after a healing period of 2 months. Taking into consideration the limitations of the study, ILA seems to fulfil all conditions to be defined as an alternative, minimally invasive anaesthetic technique for the insertion of single-gap implants.

Is articaine more effective than lidocaine in patients with irreversible pulpitis? An umbrella review.

Pain management can be challenging during root canal treatment of teeth with irreversible pulpitis. To identify whether articaine or lidocaine is the most appropriate local anaesthetic solution for teeth with irreversible pulpitis undergoing root canal treatment. The protocol of this umbrella review is registered in the PROSPERO database (CRD42019137624). PubMed, EBSCHO host and Scopus databases were searched until June 2019. Systematic reviews published in English comparing the effectiveness of local anaesthesia following administration of articaine or lidocaine in patients undergoing root canal treatment of teeth diagnosed with irreversible pulpitis were included. Two independent reviewers selected the studies and carried out the data extraction and the appraisal of the included reviews. Disagreements were resolved in consultation with a third reviewer. The quality of the included reviews was appraised by two independent reviewers using the AMSTAR tool (a measurement tool to assess systematic reviews). Each of the 11 AMSTAR items was given a score of 1 if the specific criterion was met, or 0 if the criterion was not met or the information was unclear. Five systematic reviews with meta-analyses were included. The AMSTAR score for the reviews ranged from 8 to 11, out of a maximum score of 11, and all reviews were categorized as 'high' quality. Two reviews scored 0 for item 8 in AMSTAR because the scientific quality of the clinical trials included in these reviews was not used in the formulation of the conclusions. Systematic reviews published only in the English language were included. Only a small number of studies were available to assess pain intensity during the injection phase, the time until the onset of anaesthesia and the occurrence of adverse events. Articaine is more effective than lidocaine for local anaesthesia of teeth with irreversible pulpitis undergoing root canal treatment. There is limited evidence that injection of articaine is less painful, has more rapid onset and has fewer adverse events compared with lidocaine.

Acute Pain Rate of Single Versus Two-visit Root Canal Treatment of Teeth With Necrotic Pulps

Acute Pain Rate of Single Versus Two-visit Root Canal Treatment of Teeth With Necrotic Pulps

Clinical pathology conference case 5: bilateral maxillary sinus resorptive disease with palatal ulceration in a 42-year-old patient

A 42-year-old female presented with bilateral periodontal swellings of 6 months’ duration in the maxillary area palatal to the maxillary molar and premolar teeth. The lesions had been treated by a general dentist as localized periodontal disease, and because of local pain, root canal treatment of tooth #2 was administered. As a result of medial expansion of the lesions toward the hard palate (Figure 1) over the next few months and the occurrence of pus-like discharge, orthopantomography (Figure 2) and computed tomography (CT) (Figure 3) were performed, and the examinations showed bilateral lytic lesions of the hard palate involving the roots of teeth # 4 to #14, respectively.

Local infiltration of corticosteroids may decrease pain 48 hours after 1-visit endodontic treatment in patients with irreversible pulpitis

Yavari HR, Jafari F, Jamloo H, Hallaj-Nezhadi S, Jafari S. The effect of submucosal injection of corticosteroids on pain perception and quality of life after root canal treatment of teeth with irreversible pulpitis: a randomized clinical trial [published online ahead of print]. J Endod. https://doi.org/10.1016/j.joen.2019.01.005.

Influence of anti-inflammatory irrigant on substance P expression for single-visit root canal treatment of teeth with irreversible pulpitis.

One of the main objectives of root canal treatment is to alleviate the pain associated with irreversibly inflamed pulps. However, some patients may have moderate to severe pain following treatment. The aim of this study was to compare and assess the effect of ketorolac tromethamine on substance P expression in the pulp and periapical tissues when used as a root canal irrigant for single-visit root canal treatment in teeth with irreversible pulpitis. Thirty-six patients were randomly allotted to three irrigant groups - saline (n=14), 3% sodium hypochlorite (n=11) and ketorolac tromethamine (n=11). Pulp blood samples (S1) were collected on gaining access to the pulp, and periapical blood samples (S2) were collected after root canal preparation. Quantification of substance P was done by ELISA test. The ketorolac tromethamine group had greater reduction in substance P expression (S2). Post-operative pain levels were not significantly influenced by the different root canal irrigants.

Prognosis of root canal treatment in teeth with preoperative apical periodontitis: a study with cone-beam computed tomography and digital periapical radiography.

This observational cohort study aimed: (i) to determine retrospectively after a 1- to 12-year follow-up period, the strength and independence of the association of various patient-, tooth- and treatment-related prognostic variables with the outcome of root canal treatment in patients with pre-therapeutic apical periodontitis; and (ii) to establish the concordance between those predictors evaluated by both cone-beam computed tomography (CBCT) and digital periapical radiography (DPR). The study cohort included 125 teeth in 84 individuals. The postoperative clinical signs/symptoms, plus DPR/CBCT-PAI estimations, were used to determine the healing outcome. For statistical analysis, results were dichotomized into completely healed periapical structures versus persistent disease cases. The association between candidate predictor variables with persistent disease was analysed individually and adjusted for confounders using a multivariate binary logistic regression model. The success rate was 53.6%. After logistic regression analysis, mandibular tooth location, periapical lesion size >10mm, poor quality of the coronal restoration, lack of magnification/illumination, lack of disinfection of gutta-percha, time elapsed to definitive coronal restoration >1week and poor density of root canal filling remained as robust predictors of failures. Concordance between DPR and CBCT scores varied from moderate to almost perfect agreement. The findings of this study suggest that several tooth- and treatment-related predictor variables, including tooth location, periapical radiolucency size, quality of the coronal restoration, magnification/illumination, disinfection of gutta-percha, time elapsed to definitive coronal restoration, as well as, the density of root canal filling may act strongly and independently for determining the root canal treatment outcome in teeth with pre-therapeutic apical periodontitis.

Healing of Periapical Lesion in Teeth Obturated with Different Techniques and Lengths (Radiographic Assessment)

Aim: The purpose of this study was to assess healing of periapical lesion in either symptomatic or asymptomatic cases after obturation with different obturation techniques: cold lateral compaction and single cone obturation techniques at different apical extensions; 1 mm &2mm. Materials and Methods: A total of eighty patients were divided into two main groups; symptomatic or asymptomatic (n=40) then each group was subdivided into two subgroups (n=20) according to the obturation technique; subgroup a: Cold lateral compaction technique and subgroup b: single cone obturation technique. Further, each subgroup was divided into two divisions (n=10) depending on whether the apical extent; 1 or 2 mm from radiographic apex. All cases were prepared and obturated. CBCT scans were taken preoperatively, at 3, 6, and nine months and volume of the lesion was calculated to determine the treatment outcome. Data were then gathered, tabulated and statistically analyzed. Results: At 1mm, no significant difference between mean % changes in lesion volume after using lateral compaction or single cone techniques either asymptomatic or symptomatic along the evaluation periods while at 2mm lateral compaction technique showed higher mean % decrease in lesion volume than single cone technique after 3, 6 as well as 9 months. In both groups, using lateral compaction technique, no significant difference was recorded at 1 or 2 mm apical extension of filling while in single cone, at 1mm apical extension revealed higher decrease in lesion volume than 2mm Conclusions: Radiographic success rate of the single cone obturation technique was comparable with those of the lateral compaction obturation technique in root canal treatment of teeth with periapical lesions in short term evaluations at 1mm apical extension.

The Effect of Submucosal Injection of Corticosteroids on Pain Perception and Quality of Life after Root Canal Treatment of Teeth with Irreversible Pulpitis: A Randomized Clinical Trial

IntroductionThe aim of the present investigation was to study the effect of local infiltration of corticosteroids on postoperative pain and quality of life (QOL) in teeth with irreversible pulpitis after 1-visit endodontic treatment. MethodsIn this double-blind randomized clinical trial, 242 healthy patients with irreversible pulpitis undergoing 1-visit endodontic treatment were included. Forty-five patients were lost during the follow-up, and the remaining 197 patients were followed for 7 days (67 patients in the placebo group, 66 in the long-acting betamethasone group, and 64 in the dexamethasone group). The patients marked their level of pain and QOL before treatment and at 6-, 12-, 24-, 48-, and 72-hour and 7-day postoperative intervals using a questionnaire. Freidman and Kruskal-Wallis tests were used for statistical analysis. P ≤ .05 was considered significant. ResultsThe pain was more severe in the placebo group compared with the other groups at all time intervals. A significant increase was observed in pain severity after 12 hours in all 3 groups. In general, the pain was less severe in the dexamethasone group compared with the betamethasone group at 6-, 12-, and 24-hour intervals. The pain severity was similar in both groups at 48 hours, and it was less severe in the long-acting betamethasone group compared with the dexamethasone group after 72 hours and 7 days. There were no significant differences in the betamethasone and dexamethasone groups in pain intensity between males and females. Moreover, overall pain perception was higher in the mandible than in the maxilla. There was an inverse and significant relationship between pain severity and QOL. ConclusionsInfiltration of long-acting betamethasone and dexamethasone resulted in decreased postoperative pain experience. Dexamethasone was more effective in alleviating pain within the first 24-hour period after treatment. Infiltration of long-acting betamethasone and dexamethasone exhibited the same efficacy in 48 hours. The efficacy of long-acting betamethasone in pain relief lasted for 7 days. The QOL in the 2 groups receiving corticosteroids was higher than that in the placebo group.

Survival rates of teeth treated with bacterial photo-dynamic therapy during disinfection of the root canal system.

Objective To ascertain the survival of teeth having undergone root canal therapy, when bacterial photo-dynamic therapy (bacterial PDT) was used as an adjunct during root canal system disinfection. Design Retrospective survival analysis (Kaplan-Meier method) of endodontically-treated teeth, when bacterial PDT was used as an adjunct during root canal system disinfection by a single operator in a private general dental practice. Materials and methods The records relating to endodontically treated teeth, performed between 27 May 2001 and 23 June 2016, were sourced. The details of these were placed into a database that permitted flexible interrogation. Survival data on de novo root canal treated teeth (RCT), and those requiring revision of the endodontic treatment (reRCT), were exported into a statistical package to permit survival analysis by the method of Kaplan-Meier. Results The number of teeth available for analysis were RCT = 620 and reRCT = 167. Percentage survival at two, four, six, eight, and ten years for RCT was 98.31, 97.38, 95.76, 91.81 and 91.80 respectively. When non-endodontic failures were excluded percentage survival was 99.27, 98.91, 98.28, 97.33 and 97.33 respectively. Percentage survival of teeth having undergone reRCT at the same time periods was 94.14, 92.77, 86.52, 84.09 and 84.09 respectively and respectively. When non-endodontic failures were excluded percentage survival was 96.01,96.01,93.67,63.67 and 93.67 respectively. Conclusions Within the limitations of the study, the survival rates of teeth treated with bacterial PDT, as an adjunct during root canal system disinfection, compare very favourably with previously published work where bacterial PDT was not used. The effectiveness of conventional chemo-mechanical disinfection of the root canal system may be enhanced by the adjunctive use of bacterial PDT, particularly in reRCT cases.

Characterization of successful root canal treatment of teeth with periapical lesion by PCR-RT

Characterization of successful root canal treatment of teeth with periapical lesion by PCR-RT

Adenoid cystic carcinoma: immunohistochemistry and differential diagnosis, a case report

ABSTRACT A 52-year-old male patient complained of loss of sensitivity and pain in the maxilla. After examination, root canal treatment of tooth 12 was requested. Subsequently, there was a purplish increased volume of softened consistency in the area of vestibular attached gingiva of tooth 12. The anterior upper dental segment presented mobility. Incisional biopsy revealed malignant neoplasm of glandular epithelial origin, suggestive of solid adenoid cystic carcinoma (ACC). An immunohistochemical panel was performed, which confirmed the histopathological suspicion. Solid ACC may lead to diagnostic difficulties, since this lesion exhibits morphological features similar to other malignancies.

Apical microleakage in root canal-treated teeth containing broken hand files obturated with two different obturating materials: An in vitro study

Introduction: Separated instruments in root canals complicate routine endodontic treatment. This study aimed to compare apical microleakage in root canals containing separated hand stainless steel K-files obturated with gutta-percha and Portland cement. Materials and Methods: In this in vitro, experimental study, forty single-rooted freshly extracted teeth were decoronated and then the roots were randomly divided into four groups (n = 40). The biomechanical preparation was done according to the step-back technique. The K-file of 25 size was intentionally broken in apical third and obturation was done with gutta-percha and AH Plus sealer using lateral compaction technique and with Portland cement. Apical microleakage was measured using dye penetration method; teeth were immersed in Indian ink for 48 h. The roots were rinsed and sectioned by a cutting saw. The sections were evaluated under a stereomicroscope under ×50 magnification by two observers. Data were analyzed using ANOVA test. Results: Root canals filled with Portland cement have shown lowest microleakage when compared to laterally compacted gutta-percha according to dye penetration depth. Statistical results with ANOVA have showed a significant difference in microleakage among the four groups (P Conclusion: The results of this study have shown that apical microleakage is less in instrument-separated teeth obturated with Portland cement than in instrument-separated teeth obturated with gutta-percha.