Successful Root Canal Treatment Research Articles

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.

Effectiveness of Chitosan Oligosaccharide as Chelating agent in Smear Layer Removal and The effect on Fracture Resistance of Endodontically Treated Teeth

One factor affecting root canal treatment's success is the cleanliness of root canal systems. Smear layer removal is needed to ensure the cleanliness of root canals. Fracture resistance is also essential things in endodontic-treated teeth. Chitosan is one of the irrigant alternatives in dentistry that is biocompatible. The study aimed to investigate the effect of chitosan oligosaccharide as a root canal chelating alternative in the cleaning smear layer and its impact on fracture resistance of endodontic treated teeth.Experimental research with 56 mandibular premolar teeth with a single canal was used. For the smear layer cleanliness test, 24 teeth were used and divided into four treatment groups. Statistical analysis used was the one‑way analysis of variance and LSD Post Hoc test. Thirty-two teeth were divided into two treatment groups for the fracture resistance test. The statistical analysis used was the Independent T-test. There was no significant difference between smear layer removal in chitosan oligosaccharide 2% and EDTA 17% groups. There was a considerable difference between fracture resistance of endodontic treated teeth in chitosan oligosaccharide 2% and EDTA 17% groups. Chitosan oligosaccharide 2% can be used as an alternative in the final irrigation of root canal treatment.

Investigating the technical quality of undergraduate endodontic treatment in a primary care-based dental school.

Introduction The success of root canal treatment (RCTx) relies on the technical quality of the root canal filling, often assessed through radiographic evaluation.Aims This audit aims to evaluate the technical proficiency of Peninsula Dental School (PDS) undergraduate dental students in RCTx, comparing it with established European standards.Design Conducted as a retrospective study, this evaluation focuses on assessing the technical quality of RCTx performed by undergraduate dental students at PDS across various academic years.Setting PDS, a primary care-based dental school in the UK, serves as the focal point for this evaluation.Materials and methods Reviewed 2021-2022 endodontic cases by supervised undergraduates. Analysed radiographs for obturation, voids and errors based on established benchmarks. Randomly selected unbiased cases, assessing voids, filling proximity, missed canals and canal anatomy preservation.Interventions Comparative analysis of RCTx quality between PDS students and counterparts from other dental schools, exemplified by Dublin Dental University Hospital (DDUH).Results Findings revealed that 62.07% of single-rooted and 60% of multi-rooted teeth treated by PDS students met European standards.Discussion The implications highlight the proficiency of PDS students in RCTx, comparing favourably to DDUH.Conclusion Recommendations emphasise conducting regular educational audits in dental schools to continually enhance RCTx techniques and ensure high-quality clinical teaching.

Root canal morphology of anterior permanent teeth in Jordanian population using two classification systems: a cone-beam computed tomography study

BackgroundAdequate knowledge of root canal morphology and its variation is essential for success of root canal treatment and to overcome treatemnt failure. The aim of this study was to investigate the root and canal morphology of mandibular anterior teeth using 2 classification systems.Methods3342 lower anteriors were evaluated from 557 CBCT scans. The images were examined in sagittal, axial and coronal views using a CS 3D imaging software (V3.10.4, Carestream Dental). Demographic data recorded, the number of roots and canal’s morphology were described according to Vertucci and Ahmed classifications.ResultsFrequency of Type I configuration was significantly the highest in incisors and canines (76%, N = 2539), followed by Type III (20.6%, N = 687). Type II (1.1%, N = 37), IV (1.1%, N = 37), and V (0.3%, N = 11) were rarely encountered. 0.9% (N = 31) of the teeth could not be classified with the Vertucci System. The frequency of 2 roots (2MA in Ahmed classification) which has no correspondence in the Vertucci classification, was 1.1% (N = 38), it was significantly higher in canines and in females (35 canines and 3 laterals). A moderate correlation in root canal morpology was found between the left and right sides (V > 0.30). 80% (N = 2538) of the teeth did not exhibit any divergence/merging. The bifurcation level occurred mostly in the middle third of the root.ConclusionsOne fourth of anterior teeth had variation from the simple type I canal configuration and therefore requires attention during treatment. The new classification system offers a more accurate and simplified presentation of canal morphology.Clinical relevanceThe prevalence and mid root bifurcation of second canal in lower anteriors requires attention to ensure adequate quality root canal treatment without compromising the integrity of teeth.

A 24-year-Old Boy with Previously Treated and Aberrant Root Canal Anatomy in Mandibular Left First Premolar Tooth

Perfect cleaning and shaping is the key to successful root canal treatment. Therefore, a careful understanding of the internal anatomy and structure of the root canal system is an important factor when performing cleaning and cosmetic procedures. Mandibular premolars are among the most complicated teeth to treat with root canals due to their abnormal root canal anatomy. Furthermore, it varies in different ethnic groups. Therefore, it is needed to evaluate and search for an abnormal root canal anatomy in a failed root canal. In light of these observations, this case report provides a case of previously root canal treated mandibular first premolar tooth which was failed due to different root canal patterns. The tooth was subjected to re-root canal treatment and after completion of the therapy, the tooth was symptomless and patient was referred to the Department of Prosthodontics for a full veneer crown.

Correlation between quality of obturation and outcome of pulpectomized primary molars following root canal instrumentation with pediatric rotary file systems

IntroductionThe success of root canal treatment is influenced by several factors including the type and technique of root canal preparation, the type of irrigants used, the quality of obturation, and post-endodontic restoration. Recent systematic reviews have concluded that there is no substantial evidence to establish the superiority of rotary file systems over hand files in terms of clinical and radiographic success in pulpectomized teeth. AimTo determine the correlation between quality of obturation and long-term outcome of pulpectomized primary molars following root canal instrumentation with pediatric rotary file systems and a hand file system. MethodsThe study involved 100 primary molars from children aged 4–7 years that required pulpectomy. The teeth were divided into four groups, each consisting of 25 teeth. In the first, second, third, and fourth groups, root canal instrumentation was carried out with Pedo-Flex pediatric rotary files (Group PF), Kedo-SG pediatric rotary files (Group KS), Pro-AF Baby Gold pediatric rotary files (Group BG), and hand nickel titanium K files (Group HF), respectively. Obturation was performed with zinc oxide eugenol cement using an engine-driven Lentulo-spiral. The quality of the root filling was assessed immediately after obturation through radiographic examination. The pulpectomized teeth were then evaluated both clinically and radiographically over a two-year period. ResultsThe quality of obturation was superior in the root canals instrumented with pediatric rotary file systems compared to hand files. At the end of follow-up period, the clinical success rate was 100% and the radiological success rates were 88%, 92%, 92%, and 80% in Groups PF, KS, BG, and HF, respectively. The optimally filled pulpectomized primary molars resulted in a superior success rate than compared to underfilled or overfilled teeth. ConclusionThe quality of obturation significantly influences the success rate of pulpectomized teeth. Therefore, the use of pediatric rotary files is recommended as rotary files contribute to a greater number of optimally filled canals.

THE KEYS TO A SUCCESSFUL ROOT CANAL TREATMENT

Failure of root canal treatment (RCT) occurs when endodontic treatment falls short of standard clinical guidelines. An improper mechanical debridement (shaping and cleaning), persistence of bacteria inside the canals and apex, poor obturation quality, coronal leakage, and experience of dentists all probably influence the RCT success or failure. Although there is substantial success of RCT, failures take place in many cases, which usually could be related to the previously mentioned factors. So, it’s considerably imperative to stop the foremost potential factors that cause RCT failure. This paper reviews how to increase the success rate of the RCT.

The Use of Mineral Trioxide Aggregate and Biodentine in Furcal Perforations Sealing – A Review Article

Abstract Pulp cavity perforation is defined as pathological connection between root canal system and external surface of the tooth. This iatrogenic pulp chamber injury may have serious implications on the success of root canal treatment. The sealing of perforation is crucial for good prognosis of the treated tooth. The ideal material for sealing perforations in the pulp cavity should be characterized by a good adhesion, lack of sensitivity to tissue fluids, volume stability, radiopacity on radiographs and excellent bioactivity and biocompatibility. To date the most well -known bioceramic material to is mineral trioxide aggregate. Due to over thirty years of its application in endodontics, it is called the „gold standard” for perforation repair. Recently, many new bioceramic materials have been developed and introduced to dentistry and endodontics, showing promising clinical results. One of the materials successfully used for pulp chamber floor perforation repair is Biodentine. According to the manufacturers, Biodentine has a much shorter setting time compared to other bioceramic cements, and also has better mechanical properties and is easier to use. The aim of the article is to analyse the available research and compare the properties of those bioceramic materials in a perforation sealing procedure. Based on the analysis of the current literature, it can be concluded that mineral trioxide aggregate is still the most proven and tested material among bioceramic materials, but Biodentine is a good alternative as it is relatively easy to manipulate but also has predictable clinical results.

The effect of AH26, Endoseal and ZOE sealers on Candida albicans and Enterococcus faecalis.

In the oral cavity, root canal treatment failure (endodontics) is often due to the persistence of microorganisms in the root canal system after treatment, or re-infection of the root due to insufficient flooding. In addition, microorganisms are essential for the development of peri radicular diseases and are one of the main factors related to root canal treatment failure. Microorganisms that are commonly isolated from teeth that have failed endodontic treatment include Enterococcus (E.) faecalis and Candida (C.) albicans. Bacterial infection is closely related to the failure of root canal treatment, and the use of root sealer with antimicrobial activity and biological compatibility is necessary for the success of root canal treatment. One of the main goals of endodontic treatment is to eliminate intracanal infection and root canal flooding in order to prevent re-infection. Therefore, the aim of the current study is to evaluate the antibacterial and antifungal activity of ZOE, AH26 and Endoseal sealers in vitro. To study the effect of each sealer; AH26, ZOE and Endoseal on E. faecalis and C. albicans, 10 samples were considered. Firstly, the freshly prepared sealers were poured inside the microtube with nutrient broth and then 10 µl of E. faecalis and C. albicans suspensions were separately added into a microtube and were kept 24 hours in the incubator to grow. The data were analyzed with Kolmogrov-Smirnov test and SPSS Version 19. Our results demonstrated that the resistance rate of C. albicans to ZOE, Endoseal and AH26 sealers was 0%, 100% and 70%, respectively. These values for the E. faecalis was 80%, 100% and 40% respectively. The resistance was defined when the microorganism was growth in subculture in LB agar. ZOE sealer has highest antimicrobial effect after that AH26 sealer and the least antimicrobial effect is related to Endoseal sealer.

Antimicrobial Efficacy of Simvastatin and Double Antibiotic Paste as Intracanal Medicaments: A Randomised Clinical Study

Abstract Introduction: Root canal debridement, irrigation and a microorganism-free environment are key factors in the success of root canal treatment. Intracanal medicaments are used to enhance root canal disinfection. Simvastatin is derived from lovastatin and is a semisynthetic medication. This study compares and evaluates the effect of simvastatin and double antibiotic paste (DAP) as an intracanal medicament in single-rooted teeth with apical periodontitis using colony-forming units (CFUs)/ml. Materials and Methods: Twenty-eight patients with single-rooted teeth diagnosed with apical periodontitis were selected. Under aseptic conditions, patency was gained, sterile saline solution was deposited in the canal and the first sample (S1) was collected. Cleaning and shaping were then carried out following an appropriate technique depending on the configuration of the canal. After irrigation and biomechanical preparation, teeth were randomly assigned to two different groups, and the test intracanal medicament was applied to the root canals. Coronal openings were sealed with temporary restorative cement. The second sample (S2) was collected after 7 days. The samples obtained were checked for a reduction in the bacterial load. They were incubated aerobically for 48 h, and the CFUs were calculated. The Mann–Whitney U and Wilcoxon’s signed-rank tests were used to analyse the results statistically. Results: A significant reduction in bacterial count was present after administration of the intracanal medicament. On intergroup comparison, there was no statistically significant difference in bacterial decrease between the two groups. Comparatively, the mean reduction in the bacterial count was higher in the DAP group. Conclusion: It can be concluded that DAP and simvastatin were effective in the reduction of the bacterial count in single-rooted teeth diagnosed with apical periodontitis. However, DAP demonstrated a better performance in the reduction of bacterial counts.

Evaluation of Dentin Cracks by Stereomicroscope after Preparation of Mesiobuccal Canal of Maxillary First Molars Using Edge Taper Platinum and ProTaper Gold Rotary Files: A Laboratory Study

Background: Successful root canal treatment depends on correct cleaning, widening, and shaping of the root canal system. Root canal preparation using rotary files can cause dentin cracks. This study aimed to evaluate the number of dentin cracks created after the preparation of the mesiobuccal root canal of the first maxillary molars by ProTaper Gold and Edge taper platinum rotary files using a stereomicroscope. Methods: In this laboratory study, 72 maxillary first molars were collected and randomly divided into three groups (n=24): control group, ProTaper Gold group, and Edge taper platinum group. Mesiobuccal canal preparation was performed in Edge taper platinum and ProTaper Gold groups up to file size F2. All roots were cut horizontally at distances of 3, 6, and 9 mm from the apex with a disc. The sections were examined under a stereomicroscope at 40x magnification. Fisher’s exact test and Chi-square test were used in SPSS version 22.0 for analyzing data. A significant level of 5% was considered. Results: In the control group, no cracks were observed in any of the sections. At 3 and 9 mm from the apex, the ProTaper Gold group had the highest frequency of cracks and at 6 mm from the apex, the Edge taper platinum group had the highest frequency of cracks. There was no significant difference in the frequency of dentin cracks between ProTaper Gold and Edge taper platinum groups in any of the sections. Conclusion: Both ProTaper Gold and Edge taper platinum systems caused the formation of dentin cracks. Preparation of root canals by Edge taper platinum and ProTaper Gold rotary files causes the formation of dentin cracks to the same extent.

Perawatan saluran akar periodontitis apikalis kronis pada gigi insisivus lateral maksilaris kiri

Background: Root canal treatment is one of the modalities to treat periapical lesions. The success of root canal treatment in periapical lesions can be seen with the patient's chief complaint and the healing of periapical lesions as seen by the radiograph. Objective: This case report aims to demonstrate root canal treatment on a maxillary anterior tooth with periapical lesion. Case report: A 22-year-old female patient came with complaints of a maxillary anterior tooth that had throbbing pain several months ago, after having it filled by a previous dentist, and since then, it has never hurt again. Intra-oral examination of tooth 12 showed composite resin on the mesiopalatal surface. Radiographic findings showed that there was a round radiolucency in the periapical area with a diameter of 4 mm. Root canal treatment was performed based on the diagnosis of chronic apical periodontitis et causa necrotic pulp. Root canal treatment begins with the application of a rubber dam, opens the cavity, explores the root canal, and shapes the root canal. Biomechanical preparation was carried out using Protaper Hand Use with crown down technique, combined with 2.5% NaOCl irrigation. The first visit ends with the disinfection of the root canal using calcium hydroxide. Subsequent treatment was carried out with subjective and objective examination, removal of temporary filling, cleaning of calcium hydroxide, and final irrigation with 2.5% NaOCl, 17% EDTA, and 2% CHX. Obturation was achieved using the vertical condensation technique. The restoration was accomplished at the next visit using composite resin. Conclusion: Root canal treatment on teeth with chronic apical periodontitis was successfully carried out.

Antibacterial Potency of Various Concentrations of Pineapple Peel Extract (Ananas comosus) against Enterococcus faecalis

Introduction: Enterococcus faecalis is a Gram-positive bacterium commonly found in cases of failed root canal treatment. Irrigation material with antibacterial effects are important in supporting the success of root canal treatment. Pineapple peel as a natural ingredient is reported to contain compounds such as flavonoids, saponins, tannins, and bromelain enzymes that have been proven antibacterial effects. Purpose: To determine antibacterial potency of pineapple peel extract (Ananas comosus) with concentrations of 1.56%, 3.125%, 6.25% and 12.5% against E. faecalis. Methods: In vitro quasi-laboratory experimental study with a post-test only control group design consisting of pineapple peel extract with concentrations of 1.56%, 3.125%, 6.25%, 12.5%, and aquadest as negative control with repetition 6 times. The inhibition test was determined using the disc diffusion method on Mueller-Hinton Agar media. The MIC value can be determined using the broth dilution method and the MBC value can be determined using the solid dilution method. The inhibition zone diameter data were analyzed using One Way ANOVA test and Post Hoc Tukey test. Results: Pineapple peel extract with concentrations 12,5% had the largest mean inhibition zone, which is was 3.13 mm. The MIC and MBC values of pineapple peel extract were determined at a concentration of 6.25%. Conclusion: Pineapple peel extract (Ananas comosus) has antibacterial potency against Enterococcus faecalis.

The Complexity of the Root Canal Anatomy and Its Influence on Root Canal Debridement in the Apical Region: A Review.

The main goal of root canal treatment is to eliminate the infection in the complex root canal system for the long-term preservation of a functional tooth. Proper debridement of the root canal system, especially in the apical portion, is essential for successful root canal treatment. The complexity of the canal anatomy in the apical region plays a crucial role in reducing the microbial load. Therefore, clinicians must have a thorough knowledge of the anatomy of the root canal system and its variations, especially in the apical portion. Root canal configurations in cross-section have been classified as round, oval, long oval, flattened, or irregularly shaped. Treating oval, long oval, flattened, or irregularly shaped canals is challenging and should be approached differently than a circular canal. Recognizing the root canal shape and apical anatomy determines the different strategies to be used in cleaning, shaping, and obturation to achieve the best result of root canal treatment. The recent development of the instrumentation system improves the treatment outcome for clinicians and patients. This review aimed to discuss the definition, prevalence, and instrumentation for cleaning and shaping in the apical area with the complexity of root canal systems. Therefore, with the aid of this review, we can better understand the variations in the anatomy of the root canal, especially at the apical portion.

Ingredients in Root Canal Treatment Success and Tooth Preservation

Ingredients in Root Canal Treatment Success and Tooth Preservation

The Effect of Coronal Pre-flaring and Type of Root Canal Irrigation on Working Length Accuracy Using Electronic Apex Locators.

Background: Successful root canal treatment is influenced by the apical extent of root canal preparation and the eventual root canal filling. Achieving the full working length until the apical constriction, which is usually 0.5 - 1 mm shorter than the anatomical apex, is crucial. Electronic apex locators were used to detect the working length more accurately. There are six generations of electronic apex locators in the market. The selection of the appropriate irrigation with each apex locator for accurate working length determination is not fully investigated. Methods: The actual working lengths of 120 freshly extracted human single-rooted teeth were measured and compared with their working lengths using 3 rd generation (Root ZX) followed by 6 th generation (Raypex 6) apex locators in dry medium, presence of 5.25% sodium hypochlorite, and 2% chlorhexidine, without coronal pre-flaring and after coronal pre-flaring using the same irrigating media. Data were collected, tabulated, and afterward analyzed using one-way ANOVA with post-hoc to evaluate the significant difference in average working length between actual working length, Root ZX, and Raypex 6 apex locator working lengths accuracy. Results: The significant results were shown in roots that were coronally pre-flared and their working lengths were measured in a dry medium using Raypex 6 apex locator. While using the Root ZX apex locator, the most accurate results were shown in roots that were coronally pre-flared and their working lengths were measured while using a chlorhexidine irrigating solution. Conclusions: It is concluded that it is very important to know the specific irrigating medium to be used with each specific electronic apex locator to achieve the most accurate working length results.

A comprehensive case study: successful root canal treatment of a three-rooted maxillary second premolar

A comprehensive case study: successful root canal treatment of a three-rooted maxillary second premolar

Successful root canal treatment of a three-rooted maxillary second premolar

Successful root canal treatment of a three-rooted maxillary second premolar

Successful Root Canal Treatment of a Three-Rooted Maxillary Second Premolar

Successful Root Canal Treatment of a Three-Rooted Maxillary Second Premolar

Smear Layer Removal Efficacy of EDTA and Citric Acid in Endodontics

Introduction: Smear layer is formed by organic and inorganic components generated during endodontic instrumentation. Smear layer has many deleterious effects on the success of root canal treatment. So removal of smear layer is advocated. Sodium Hypochlorite (NaOCl) and a chelating agent like Ethylene Diamine Tetra Acetic Acid (EDTA) or Citric Acid is commonly used alternatively to remove smear layer. But the alternate use increase dentine erosion in root canal surface. This in vitro study attempts to compare the smear layer removal efficacy of 15% EDTA & 10% Citric Acid as a final rinsing solution. Materials and Methods: Forty extracted, single rooted and single canal human anterior tooth were used. Endodontic preparation of the root canal was done after grouping and access cavity preparation. Final irrigation was given with 15% EDTA & 10% Citric Acid to the test groups and distilled water control groups and kept for one minute. Photomicrograph of the root canal surface at 3000X magnification at coronal, middle and apical regions were taken with the help of SEM and scoring for smear layer removal was done. Data was analyzed using SPSS version 16 and were compared with the control samples and subjected to statistical analysis by one way ANOVA and Bonferroni multiple comparison tests at 5% level of significance. Result: The test solutions removed smear layer but none could be removed completely from all of the three root canal regions. 10% Citric Acid removed smear layer better from the coronal and middle region but in apical region 15% EDTA produced a better result. The difference of smear layer removal efficacy of 15% EDTA & 10% Citric Acid with the Control solution was found statistically significant (p<0.001) but in between 15% EDTA & 10% Citric Acid it was not significant in all three root canal regions. Conclusion: Regarding the smear layer removal efficacy of 10% Citric Acid was found better as a final rinse solution. Update Dent. Coll. j: 2023; 13(2):9-14