Root Canal Treatment Protocol Research Articles

Root Canal Treatment and Demand for Continuing Education among Thai Dental Practitioners

Background In recent times, there have been significant advancements in the techniques and materials used for root canal treatment. Nevertheless, there is a lack of study on the current methods used for root canal treatment among dentists in Thailand. Therefore, the primary purpose of this study was to investigate the current root canal treatment procedures and the demand for continuing education among Thai dental practitioners. Methods The survey, consisting of two sections and a total of 25 questions, was randomly distributed to 412 dentists in Thailand, both online and offline. Data on demographics, information on current root canal treatment protocols, and demand for continuing education, were collected. The association between demographic data and current root canal treatment protocols was analyzed using the chi-square test. The data gathered were analyzed using the JASP statistical software version 0.18. Results Three hundred and ninety-four questionnaires were completed. Sixty percent of the respondents (236) regularly performed root canal treatment. Most respondents treated one to five anterior teeth weekly. Seventy-six percent of the respondents did not use magnification. Fifty-eight percent of the respondents used an electronic apex locator in conjunction with a radiograph to determine the working length. Forty-four percent of the respondents used hand files for mechanical instrumentation. Sodium hypochlorite was the most used irrigant, while cold lateral compaction was the preferred obturation technique. The participants revealed the most interest in enrolling in two to three-day short seminar courses. Conclusion More Thai dental practitioners strictly followed the standard protocol compared to the previous survey. The short seminar courses were the most preferred program for continuous education.

Postoperative pain of minimally invasive root canal treatment:a randomized clinical trial.

This randomized clinical trial compared postoperative pain between a minimally invasive (MP) and conventional root canal treatment protocol (CP). A total of 170 mature permanent teeth (either with vital or necrotic pulp), were randomly assigned into two groups. In the CP group, ProTaper Gold (Dentsply Sirona, Ballaigues, Switzerland) and a continuous wave of condensation technique were used, whereas, in the MP group, TruNatomy (Dentsply Sirona), ultrasonic-assisted irrigation (UI), calcium hydroxide, and a sealer-based obturation technique were used. Patients recorded preoperative and postoperative pain using a 0-10 numerical rating scale (NRS) at 4h, 1, 2, 3, 4, 5, 6, and 7days after instrumentation and 1day after canal obturation, respectively. There were no significant differences in pain intensity at any time points assessed between the two groups (p > 0.05). The occurrence of moderate/intense pain after instrumentation was significantly associated with preoperative periapical index (PAI) (p = 0.017) and NRS scores (p < 0.001). Preoperative pulp status (p = 0.009) and NRS score (p = 0.006) were identified as significant factors in the occurrence of moderate/intense pain after obturation. Instrumentation unequivocally reduced pain severity for both groups. The post-endodontic pain associated with the use of MP, combined with UI, Ca(OH)2, and calcium-silicate cement, did not differ from that of CP. Preoperative pain score, PAI, and preoperative pulp status were determined to be prognostic factors for postoperative pain.

Current trends in root canal treatment: An online survey of dentists working within the primary health-care corporation-Qatar

Introduction: Studies in many countries have reported that dentists do not always comply with treatment quality guidelines when undertaking root canal treatment (RCT). However, there is no information on the compliance of dentists in Qatar with quality guidelines. Using an online questionnaire, this study aimed to collect baseline information on how dentists working within the Primary HealthCare Corporation (PHCC), Qatar, carried out RCT. Materials and Methods: A questionnaire was E-mailed to general dental practitioners (GDPs) and specialists. The questionnaire collected demographic information, continuous professional development (CPD) hours, information on early stages of RCT, RCT protocols, use of technology and materials. Statistical analyses were undertaken using version 27 SPSS software. Results: The response rate was 55% of GDPs and 83% of specialists. Twenty-six percent of GDPs never used rubber dams whereas specialists always used rubber dam (P &lt; 0.001). The 57% of GDPs who undertook a complete RCT reported they treated mostly anterior and premolar teeth with few molars (12%), few attempted RCT retreatment (4%). All specialists treated molars (P &lt; 0.001) and 50% undertook retreatment (P &lt; 0.001). The majority of specialists reported using magnification (55%) with only 23% of GDPs using loupes (P &lt; 0.001). During the past 2 years, 42% of specialists earned &gt; 20 CPD hours which was significantly more than the 50% of the GDPs who undertook &lt; 5 h (P &lt; 0.001). Conclusions: Half of the GDPs working within the PHCC do not carry out RCT nor rubber dam isolation due to short duration of treatment session. Specialists generally follow the current guidelines when providing RCT, while the GDPs do so less often.

Factors that affect the outcomes of root canal treatment and retreatment-A reframing of the principles.

This paper undertakes a broad and comprehensive synthesis of relevant clinical, biological, biomechanical, technical and healthcare services data to understand the factors affecting outcomes of periapical healing after root canal (re)treatment. The medical and dental evidence-based era (1980-present) is contextualized with the earlier evidence drive in endodontics (1911-1940) triggered by the focal infection era. The current evidence-based approach has a sharper focus on evidence quality and derivation of practice guidelines. Contrary views question whether guideline-driven, or expertise-development-driven endeavours would best serve outcome improvement in society. The endodontic discipline functions in a broad healthcare framework and sustains industrial, economic and trend pressures that may be deemed to influence outcomes. The nature of root canal treatment and the challenges in determining the factors that affect its outcomes is discussed. The factors potentially affecting periapical healing after root canal treatment are classified into pre-operative, intra-operative and postoperative groups. These categories subsume multiple elements with interactive influences, creating a complex picture, further confounded by some apparently surprising, counter-intuitive and contradictory findings. The technical versus biological conundrum in root canal treatment continues to cause cognitive dissonance. However, due reflection and cross-discipline-synthesis resolve the apparent data conflicts into a very simple, consistent and plausible picture of how root canal treatment works and the key factors that affect periapical healing. Root canal retreatment is considered mainly in the context of its differences from primary treatment as the majority of factors influencing outcomes are common to both. The exceptional difference is that retreatments have a proportionately reduced probability of healing by virtue of compromised apical root canal ramification access or modified host/infection interactions. Root canal (re)treatment outcomes are dominantly influenced by the nature of prior dynamic host/infection interaction (pre-operative patient factors) and how the direction of this dynamic is influenced by two factors: (1) the active efficacy of the operators' root canal treatment protocol to sustain a microbial ecological shift (intra-operative treatment factors) anddampenperiapicalinflammation; and (2) the passive ability of the functional tooth (and its restoration margin) to maintain its integrity to resist infection reversal (postoperative restorative factors).

Presentation and non‐surgical endodontic treatment of two patients with X‐linked hypophosphatemia: a case report

To describe two patients with X-linked hypophosphatemia presenting with spontaneous signs of pulpal necrosis in multiple intact teeth. The presentation and management are discussed, along with the diagnostic and endodontic treatment challenges. Two young male patients with X-linked hypophosphatemia were referred to the Department of Restorative Dentistry at the Edinburgh Dental Institute for management of dental infection. Both patients were referred due to their unusual clinical presentation and abnormal root canal morphology. They subsequently presented on multiple occasions with pain or sinus tracts over a 3- and 5-year period whilst under care. Clinical examination revealed intact teeth with buccal swellings, draining buccal sinuses and negative responses to sensibility testing. Radiographic examination, generally consisting of periapical radiographs, revealed intact teeth with a range of unusual morphological features including large pulp chambers, wide canals, short roots and open apices, all with associated periapical radiolucencies. Due to the unusual morphology, some teeth required apexification with a mineral trioxide aggregate plug. Patient 1 underwent root canal treatment on teeth 21 and 43 over a 3-year period. Patient 2 underwent root canal treatment on 10 permanent teeth over a 5-year period. At follow-up, both patients were asymptomatic and clinically the teeth had no signs of infection or periapical inflammation. Radiographic examination confirmed complete resolution of the apical radiolucencies on 11 out of 12 teeth. Favourable outcomes have been demonstrated up to a follow-up of 4.5-years. Patients with X-linked hypophosphatemia may present with 'spontaneous' signs of pulp necrosis in multiple teeth in the absence of caries and trauma posing a diagnostic challenge. Abnormal morphological features, including wide canals and open apices, may present challenges during endodontic treatment. Outcomes demonstrate that an appropriate root canal treatment protocol, including the application of apexification procedures, may be implemented to successfully manage such cases.

Osteoclast formation, inflammation, and matrix metalloproteinase-9 are downregulated in bone repair following root canal treatment in dogs teeth.

The aim of this study was to investigate the inflammatory infiltrate, osteoclast formation, and expression of MMP-9 during the healing phase following root canal treatment in teeth with apical periodontitis. Apical periodontitis was induced in dogs teeth, and root canal treatment was performed in a single visit or using calcium hydroxide as intracanal medication. One hundred and eighty days following treatment the presence of inflammation was examined, and the tissues were stained to detect osteoclasts by means of a tartrate resistant alkaline phosphatase (TRAP) assay. Synthesis of MMP-9 was detected using Western blotting and immunohistochemistry. Teeth with apical periodontitis that had root canal therapy performed in a single visit presented a higher synthesis of MMP-9 compared with root canal treatment using calcium hydroxide. Treatment with calcium hydroxide resulted in a reduced amount of inflammatory cells and MMP-9 positive cells. Osteoclast formation, the number of MMP-9 positive osteoclasts and cementocytes, was reduced following root canal treatment, regardless of the root canal treatment protocol used. Root canal treatment reduced the amount of inflammatory cells and osteoclasts in periapical area. The use of calcium hydroxide as intracanal medication resulted in a lower synthesis of MMP-9, though the number of osteoclasts and MMP-9 positive osteoclasts were similar between the groups. Periapical bone repair following root canal treatment is impacted by therapy performed either in single visit or using calcium hydroxide dressing measured by inflammatory cell recruitment, osteoclast formation, and MMP-9 synthesis.

The impact of two root canal treatment protocols on the oral health-related quality of life: a randomized controlled pragmatic clinical trial.

To assess the impact of two root canal treatment protocols on the oral health-related quality of life (OHRQoL) of patients in need of root canal treatment on their anterior teeth. The sample consisted of 120 participants (mean age: 34years) enrolled in a pragmatic randomized clinical trial evaluating two root canal treatment protocols. Anterior teeth with nonvital pulps were allocated for root canal preparation with either hand files and filled with lateral compaction of gutta-percha (manual protocol) or canal preparation with a single file in a reciprocating movement and filled with a single cone technique (Reciproc protocol). OHRQoL data were assessed using the Oral Health Impact Profile instrument (OHIP-14), which was administered before the root canal intervention (baseline), and 6 and 12months after treatment. Demographic and clinical characteristics of participants were collected at baseline. Data were analysed using bivariate analyses, Poisson univariate and multiple regression (α=0.05). The drop-out rate from baseline was 27% and 28% at 6 and 12months after treatment, respectively. Both root canal protocols significantly enhanced patients' OHRQoL, regardless of the follow-up time (P<0.001). After 6months, patients treated with the Reciproc protocol had significantly lower OHIP-14 overall scores (P=0.030), as well as significantly lower scores for psychological discomfort (P=0.031) and social disability (P=0.013). After 12months, no significant difference was observed between the two root canal protocols for OHIP-14 overall scores (P=0.174). Either large or moderate effect sizes were observed for all domains and overall scores at both evaluation times, irrespective of the protocol. Low-income persons (RR=2.03) and the Reciproc protocol (RR=1.52) had a higher likelihood of a positive impact on OHRQoL 12months after root canal treatment. The two root canal protocols improved the OHRQoL and differences in scores were observed only after 6months with poorer OHRQoL for the manual protocol. After 12months, patients with low-income status and treated with Reciproc were associated with a greater improvement in OHRQoL scores.

Root Canal Perforation: A Quick Review

Root canal perforation is a communication between the root canal system and supporting tissues of the teeth (periodontium). Causes of root canal perforation can be duo to multiple factor i.e., Caries, Resorption, Iatrogenic, Perforation prognosis depend on multiple factor these are; time size and location, based on the prognostic factors perforation can be classified into, Fresh Perforation, Old Perforation, Small Perforation, Large Perforation, Coronal Perforation, Crestal Perforation, Apical Perforation. A wide variety of materials to seal the perforations have been suggested in literature. Root perforation complicates the treatment and deprives the prognosis if not properly managed. Root canal perforation can be avoided in most of the cases if the clinician follows the basic principle of the root canal treatment protocol.

Predicting pre- and postoperative pain of endodontic origin in a southern Brazilian subpopulation: an electronic database study.

To determine the prevalence of preoperative endodontic pain (PREP) and the incidence of postoperative endodontic pain (POEP), identifying the predictors of PREP and POEP in a southern Brazilian subpopulation, using clinical data from an electronic chart database (ECD). This retrospective observational study included 563 consecutive individuals presenting for root canal treatment (RCT). Patients were treated by undergraduate and graduate students, following standard RCT protocols. Demographic, medical and dental variables were extracted from a pre-structured and standardized ECD. The main outcomes PREP and incident POEP were collected through a 0-10 numeric rating scale, dichotomized as none/mild (<4) or moderate/severe (≥4) pain. Predictive models calculating the prevalence ratios (PR) of PREP and the relative risks (RR) of incident POEP were carried out with Poisson regression analysis, estimating the relationship between clinical factors, PREP and incident POEP. Mean age at baseline was 49.2±17.1years, with 68.4% women. The prevalence and incidence of moderate/severe PREP and POEP were 44.4% and 3.8%, respectively. RCT intervention significantly reduced PREP (P<0.001). Multivariate analysis revealed that group of teeth, location (mandibular teeth), pulpitis, necrotic pulp, preoperative swelling and periapical radiolucency were independently associated with moderate/severe PREP, whilst age ≥60years and root canal retreatments were independent protective factors to PREP (P<0.05). No demographic, medical or dental variables were associated with POEP, although molar teeth (RR=4.23, 95%CI=0.93-19.2, P=0.056) had a borderline nonsignificant association. Moderate/severe PREP was independently associated with age, group of teeth, location, preoperative swelling, retreatments and pulp and periapical status. No demographic, medical or dental variable predicted moderate/severe POEP following RCT amongst this subpopulation.

Overview on the current antibiotic containing agents used in endodontics.

Antibiotics are systemically and locally used extensively in endodontics. However, local antibiotic application mode is considered more effective than systemic administration. The local mode enables the dentist to target bacteria in every nook and corner of root canal system, which is otherwise beyond reach if targeted by instrumentation or conventional root canal treatment protocols. Therefore, they are an important adjunct to conventional treatment of root canal. The present study reviews the various antibiotic containing dental agents used in endodontics. A web-based research on MedLine was performed with terms Review Articles published in the last 10 year's dental journals in English for literature researching, extracting, and synthesizing data. Relevant articles were shortlisted. Important cross-reference articles were also reviewed.

One-Visit Versus Two-Visit Root Canal Treatment: Effectiveness in the Removal of Endotoxins and Cultivable Bacteria

IntroductionThis clinical study was conducted to compare the effectiveness of 1-visit versus 2-visit root canal treatment in removing endotoxins and cultivable bacteria from primarily infected root canals. MethodsForty-eight primarily infected root canals were selected and randomly divided into 4 groups: G1, 1% NaOCl; G2, 2% chlorhexidine (CHX) gel; G3, 1% NaOCl + Ca(OH)2; and G4, 2% CHX gel + Ca(OH)2 (all, n = 12). G1 and G2 involved 1-visit treatment, whereas G3 and G4 involved 2-visit treatment with the placement of Ca(OH)2 medication for 14 days. Samples were collected before and after root canal procedures. A chromogenic LAL assay test was used to quantify endotoxins. Culture techniques were used to determine bacterial counts. ResultsEndotoxins and cultivable bacteria were detected in 100% of the initial samples. All treatment protocols were effective in reducing bacterial load from infected root canals: G1 (1% NaOCl, 99.97%), G2 (2% CHX gel, 99.75%), G3 (1% NaOCl + Ca(OH)2, 99.90%), and G4 (2% CHX gel + Ca(OH)2, 96.81%), respectively (P < .05). No differences were found in bacterial load reduction when comparing 1-visit and 2-visit treatment groups, irrespective of the irrigant tested (P > .05). Higher median percentage values of endotoxin reduction were achieved in the 2-visit treatment groups (G3, 98.01% and G4, 96.81%) compared with 1-visit treatment groups (G1, 86.33% and G2, 84.77%) (all P < .05). ConclusionsBoth 1-visit and 2-visit root canal treatment protocols were effective in reducing bacteria and endotoxins, but they were not able to eliminate them in all root canals analyzed. Furthermore, 2-visit root canal treatment protocols were more effective in reducing endotoxins than 1-visit root canal treatment protocols.

Efficacy of Mineral Trioxide Aggregate as an Apical Plug in Non-Vital Young Permanent Teeth: Preliminary Results

The purpose of this study was to evaluate the efficacy of Mineral trioxide aggregate (MTA) clinically and radiographically as material used to induce root end closure in nonvital permanent teeth with immature apices (apexification) in children. The study included 30 non vital young permanent, single rooted teeth of 22 children between 8 and 13 years of age. Treatment followed a standard non-surgical root canal treatment protocol and the root canal was filled with a apical plug of 4-5 mm of MTA (white MTA--Angelus, Brazil), followed by gutta-percha obturation. The children were reviewed for 1 year at 3 month interval and the teeth were assessed clinically and radiographically. MTA showed success rate of 100% both clinically and radiographically at the 12th months follow up and root end closure was seen in 86.6% of cases and root growth in 30% of cases. MTA showed clinical and radiographic success as an apexification material by inducing root end closure and root growth in non-vital young permanent teeth.

Enhancement of Healing Kinetics of Periapical Lesions in Dogs by the Apexum Procedure

In nonsurgical endodontic procedures, the healing of apical periodontitis is achieved by treatment provided within the root canal system. The new Apexum procedure is based on advancing the debridement one step further by minimally invasive removal of the inflamed periapical tissues through root canal access, thereby enhancing the healing kinetics of periapical lesions. The Apexum procedure uses 2 sequential rotary devices designed to extend beyond the apex and to mince periapical tissues on rotation in a low-speed handpiece, followed by washing out the minced tissue. This initial animal study was conducted to evaluate the efficacy and potential adverse effects of this procedure. Periapical lesions were induced in the lower premolars in dogs by placement of autologous dental plaque and subsequent radiographic verification. Fifty roots with periapical lesions were then subjected to cleaning, shaping and disinfection of their root canals, using a conventional root canal treatment protocol. Teeth in group 1 were subjected to the new Apexum procedure just before obturation, whereas roots in group 2 were subjected to no additional intervention before obturation. Clinical and radiographic follow-ups were carried out for 6 months. Radiographic healing of the periapical lesions in dogs at 3 and 6 months showed significantly enhanced kinetics in the Apexum-treated group compared with the conventional treatment group, at both time points (p <0.01). No noticeable adverse events occurred in either of the groups. This new procedure might significantly enhance healing kinetics of apical periodontitis compared with conventional nonsurgical endodontic treatment.

Reconsideration of treatment protocol on the reduction ofEnterococcus faecalisassociated with failed root canal treatment

Microorganism survived in the root canal after root canal cleaning and shaping procedure is a main cause of root canal treatment failure. There are several mechanisms for the bacteria to survive in the root canal after chemomechanical preparation and root canal irrigation. Bacteria organized as biofilm has been suggested as an etiology of persistent periapical lesion. Recent studies were focus on removal of Enterococcus faecalis biofilm due to the report that the persistence of this bacteria after root canal treatment may be associated with its ability to form biofilm. Several investigations demonstrated that current root canal treatment protocol including use of NaOCl, EDTA and Chlorhexidine as irrigants is quite effective in eliminating E. faecalis biofilm. However, this microorganism still can survive in inaccessible areas of root canal system and evade host immune response, suppress immune activity and produce biofilm. Up to date, there is no possible clinical method to completely get rid of bacteria from the root canal. Once the root canal treatment failure occurred, and conventional treatment incorporating current therapeutic protocol has failed, periapical surgery or extraction should be considered rather than prolong the ineffected retreatment procedure. [J Kor Acad Cons Dent 33(6):560-569, 2008]

Revascularization of an immature permanent tooth with apical periodontitis and sinus tract

A necrotic immature mandibular second premolar with periapical involvement in a 13-year-old patient was treated. Instead of the standard root canal treatment protocol and apexification, antimicrobial agents were used in the canal, after which the canal was left empty. Radiographic examination showed the start of apical closure 5 months after the completion of the antimicrobial protocol. Thickening of the canal wall and complete apical closure was confirmed 30 months after the treatment, indicating the revascularization potential of a young permanent tooth pulp into a bacteria-free root canal space.