Teeth Undergoing Root Canal Treatment Research Articles

Prevalence of endodontic flare-up following intracanal medicament placement in permanent teeth undergoing endodontic treatment - A systematic review.

Background:Endodontic flare-up can occur in teeth undergoing root canal treatment. Intracanal medicaments are most commonly used in between appointments to eliminate microbial flora in the canal. However, extrusion of medicaments in the periapical region can cause an inflammatory reaction leading to postoperative pain.Aim:The aim of this study was to evaluate the prevalence of endodontic flare-up following intracanal medicament placement in permanent teeth undergoing endodontic treatment.Study Design:A comprehensive search was done in MEDLINE through PubMed, Cochrane, EBSCOhost, and Google Scholar from July 31, 1999 to July 31, 2019 to identify randomized trials involving the use of intracanal medicaments in teeth undergoing root canal treatment.Methods:The titles and abstracts of all retrieved articles were screened by two independent reviewers, and irrelevant studies were excluded. Full texts of the eligible studies were obtained and thoroughly assessed. Seventeen randomized control trials comprising 2665 subjects were included.Statistical Analysis:Narrative synthesis was provided for the findings obtained from the studies, mainly focusing on the intervention details. Heterogeneity of the previously mentioned characteristics was assessed using the Chi-square test and I2 statistics.Results:Placement of intracanal medicament was not associated with the occurrence of pain.Conclusion:The present review suggests that intracanal medicament do not cause endodontic flare-up rather reduces inter-appointment pain during endodontic treatment.

Diagnostic criteria and treatment modalities of taurodont teeth undergoing root canal treatment: A literature review of case reports and case series

Introduction: The objective of this article was to review the diagnostic tools and treatment modalities used in root canal treatment of taurodont teeth in published case reports and case series. Materials and Methods: An electronic search of the literature was performed in PubMed (Medline), EBSCOhost databases, and the reference lists of articles that had been published from 1990 to 2019. Data of the articles that had been included were extracted. Results: The initial search led to the retrieval of 558 articles. After removing duplicates, 121 articles were left, the titles of these articles along with abstracts were read which resulted in the selection of 48 articles for full-text reading. Thirty-six articles were later selected for data extraction and qualitative analysis. In all these articles, treatment was discussed for taurodontism. Conclusion: Treating a taurodont tooth can be quite a challenge and careful evaluation and treatment planning is important for a successful outcome.

Evaluation of various irrigation activation systems to eliminate bacteria from the root canal system: A randomized controlled single blinded trial

ObjectiveTo evaluate the effect of NaOCl irrigant activation using passive ultrasonic activation, F-files, XP-endo Finisher files and or needle irrigation alone on the reduction of intracanal bacteria from root canals in teeth undergoing root canal treatment. MethodsEighty patients with asymptomatic apical periodontitis were randomly divided into four groups. Access cavities were prepared and pre-treatment samples were taken (S1). Canals were then prepared and post-instrumentation samples (S2) taken. NaOCl was then activated with the various irrigant activation systems and post-irrigation samples (S3) taken. The samples were processed and colony forming units (CFUs) of bacteria were determined. The reduction in CFUs among the experimental groups were analysed using the Kruskal Wallis test and pairwise comparisons with the Mann-Whitney test. The Friedman test was used to compare the differences in the reduction of CFUs within the groups. ResultsOverall, for all groups there was a significant reduction in the CFUs from S1 to S2 (P < 0.05) and from S2 to S3 (P < 0.05). Both XP-endo Finisher and passive ultrasonic activation techniques were associated with the greatest reduction in CFUs with no significant difference between them (P = 0.24). However, both were associated with significantly lower CFUs when compared to F-file activation and needle irrigation (P < 0.05). F-file activation reduced the CFUs significantly more compared to needle irrigation (P = 0.04). ConclusionsXP-endo Finisher file activation and passive ultrasonic activation were equivalent in terms of reduction in CFUs. F-file activation did not reduce the CFUs to the same extent as the XP-endo Finisher file and ultrasonic activation but reduced the CFUs more than needle irrigation. Clinical SignificanceThe present study highlights the effect of new XP-endo Finisher file and passive ultrasonic activation in reducing the bacterial load from the root canal system which is important for the success of root canal treatment.

The expression of nuclear factor of activated T cell c1 and receptor activator of nuclear factor kappa β induced by Enterococcus faecalis in osteoclastogenesis (laboratory experiment on Wistar rats)

Background: Enterococcus faecalis (E. faecalis) is the most common bacteria species in persistent endodontic infection of teeth undergoing root canal treatment at a prevalence of 38%. The virulence factor of this bacterium is Lipoteichoic acid (LTA) which can be recognized by Toll-like receptors-4 (TLR-4) that produce a stimulus and provoke an immune response. Inflammation results in bone defects that feature multiple cytokines and interactions between different cell types. Bone loss within a periapical tooth is characterized by osteoclast formation (osteoclastogenesis) in the bone. Purpose: This study aimed to determine the expression of nuclear factor of activated T cell c1 (NFATc1) and receptor activator of nuclear factor kappa β (RANK) which played a role in osteoclastogenesis at different time intervals. Methods: 36 upper molar teeth of the research subjects were induced with 106 CFU Enterococcus faecalis and subsequently observed for 7 and 21 days with the NFATc1 and RANK being counted microscopically at 1000X magnification across 20 viewing fields. Thereafter, the data was examined and analyzed by means of an independent T test using SPSS. Results: NFATc1 and RANK expression were higher in the group including E. faecalis on days 7 and 21 than in the control group. There were significant differences between the treatment group and control group with regard to NFATc1 and RANK expression (p&lt;0.05). Conclusion: The study showed that the expression of NFATc1 and RANK, which plays a role in osteoclastogenesis, was higher in periapical bone defects in Wistar rats induced by E. faecalis than those which were not induced.

Effect of magnesium sulphate added to lidocaine on inferior alveolar nerve block success in patients with symptoms of irreversible pulpitis: a prospective, randomized clinical trial.

To investigate the effect of magnesium sulphate used as an adjuvant to lidocaine with epinephrine local anaesthetic on the success of inferior alveolar nerve blocks (IANB) in patients with symptoms of irreversible pulpitis undergoing root canal treatment. In a double-blind clinical trial, following power calculation, 124 patients with symptoms of irreversible pulpitis in mandibular molar teeth were selected, and initial pain data were collected using a Heft-Parker (Pain, 19, 1984 and 153) visual analogue scale. The first group (control) received IANB with 1.8 mL of a local anaesthetic solution containing 1.8% lidocaine with 1:88000 epinephrine while the second group (test) received IANB with 1.8 mL of an anaesthetic solution containing 1% magnesium sulphate, and 1.8% lidocaine with 1:88000 epinephrine. Pain data were collected after access cavity and penetration of files in the canals using a Heft-Parker visual analogue scale. Two patients were not included in the study as they did not consent, and a further 54 patients were excluded as they did not report lip numbness within 15min after IANB administration; thus, the data presented in this study are related to 68 patients. The data were analysed using chi-square and t-test (α=0.05). The success of pulpal anaesthesia with IANB was 82% for the magnesium sulphate group and 53% for the control group. There was a significant difference in the effectiveness of the IANB between the two groups (P<0.001). There was no significant difference between the magnesium sulphate and control groups regarding gender (P=0.598) or age (P=0.208) or initial pain scores (P=0.431). The addition of 1% magnesium sulphate to 1.8% lidocaine with 1:88000 epinephrine resulted in a positive impact for the success of IANB in patients with a diagnosis of irreversible pulpitis related to mandibular molar teeth undergoing root canal treatment. Thus magnesium sulphate may be used as adjuvant for achieving profound pulpal anaesthesia in challenging cases. However, more studies with larger sample size and different concentration doses must be carried out to establish an appropriate conclusion before its routine clinical use.

The Effect of Different Cavity Designs and Temporary Filling Materials on the Fracture Resistance of Upper Premolars

IntroductionThe aim of this study was to compare the fracture resistance of upper premolars undergoing root canal treatment that had been temporarily restored with 4 different temporary filling materials. MethodsThis study was based on 120 extracted upper premolars. Eight teeth were left intact and served as the negative control group. Mesio-occluso-distal cavities with 2 different designs were prepared for the rest of the teeth (for group 1 a width of one third of the intercuspal distance and for group 2 a width of two thirds of the intercuspal distance). Then, the endodontic access cavities were prepared, and the root canals instrumented with Revo-S rotary files (MicroMega, Besancon, France). Thereafter, a total of 16 teeth consisting of 8 each from group 1 and group 2 served as the positive control group and did not have any temporary filling material. The teeth were randomly divided into 4 subgroups (n = 12) according to the temporary filling material: Cavit G (3M ESPE, St Paul, MN), Coltosol F (Coltène/Whaledent AG, Altstätten, Switzerland), Intermediate Restorative Material (Dentsply Sirona, Konstanz, Germany), or DiaTemp (DiaDent Europe BV, Almere, Netherlands). Each specimen was then subjected to a fracture resistance test using a universal testing machine until the fracture occurred. The force required to fracture each specimen was recorded, and the data were statistically analyzed. ResultsThe negative control group showed the highest fracture resistance values compared with the other groups, whereas the positive control groups showed the lowest fracture resistance values. There were no statistically significant differences in the fracture resistance of upper premolar teeth undergoing root canal treatment among Cavit G, Intermediate Restorative Material, Coltosol F, and DiaTemp, regardless of the cavity width (P > .05). ConclusionsThe cavity design was found to be an effective factor on the fracture resistance of upper premolar teeth undergoing root canal treatment. The temporary filling materials tested did not affect the fracture resistance.

Root canal reconstruction using biological dentin posts: A 3D finite element analysis.

Background. Several types of post have been developed for clinical use. A biological dentin post obtained from an extracted tooth eliminates the problems arising from material differences and reduces the fracture rate in teeth undergoing root canal treatment. This study used finite element analysis to compare a biological dentin post with posts made of two different materials. Methods. Three 3D models of the upper central incisor were created, and stainless-steel, glass fiber and biological dentin posts were applied to these models. The restoration of the models was completed by applying a composite as the core structure and a ceramic crown as the superstructure. Using finite element stress analysis in the restoration models, a 100-N force was applied in the vertical and horizontal directions and at a 45º angle, and the suitability of the biological dentin post was evaluated by comparing the data. Results. Under the applied forces, the greatest stress accumulation was seen in the models with the stainless steel post. Because the stainless steel post was more rigid, stress forces accumulated on the surface instead of being transmitted to the tooth tissue. In the models with the glass fiber and biological dentin posts, the post material responded to the stratification in tandem with the dental tissue and did not cause excessive stress accumulation on the tooth or post surfaces. Conclusion. The results showed that biological dentin posts prevent the accumulation of stresses that might cause fractures in teeth undergoing root canal treatment. In addition, the physical compatibility and biocompatibility of a biological dentin post with the tooth imply that it is a good alternative to the types of post currently used.

2016 ASE undergraduate essay competition candidate information.

The aim of this review is to discuss the role of medicaments and materials used in teeth undergoing root canal treatment and how they affect the overall prognosis of root canal treated teeth. Irrigants, medicaments and materials play a vital role in RCT. They reduce the overall microbial load within the root canal system, help reduce inter-appointment pain, and induce apexification during RCT of permanent teeth with immature apices. In addition, they also help create a hermetic coronal and periradicular seal to entomb any residual microorganisms within the canals and prevent future ingress of contaminants into the root canal system and subsequent reinfection. Whilst the role of various materials in RCT has been thoroughly investigated, the available literature and longitudinal clinical studies evaluating the affect of such materials on the prognosis of RCT is scarce, and requires further investigation.

Clinical and radiographic assessment of root canal treatments performed by dental students

Retrospective assessment of procedures performed in dental school clinics is a valuable tool to critically assess the teaching/learning process. Objective: This retrospective study assessed the success rate of root canal treatments executed by dental students during a two-year time span. Material and methods: Patients who had undergone root canal treatments at the clinics of the School of Dentistry of Unochapeco during 2011-2013 were recalled for assessment of the quality of the procedure and the associated coronal restoration. The quality of the root canal treatments was assessed clinically and radiographically, while the coronal restorations were assessed clinically by a trained dental student. Data were analyzed by descriptive statistics and chi-square test ( α=0.05). Results: Thirty-two patients returned for evaluation of 38 root canal treatments and coronal restorations. The success of root canal treatments was 89.5%, while 78.5% of the coronal restorations were considered successful. A significant association was observed between the success of the root canal treatments and the quality of the coronal restoration (p<0.005) and the apical length of the root canal filling (p<0.011). The presence of flaws within the filling material was not significantly associated to the success/failure of the root canal treatment (p=0.459). Conclusion: A high success rate of root canal treatment performed by dental students at an average 13-month evaluation period was observed. An adequate coronal restoration and a good apical sealing is required for a good prognosis of teeth undergoing root canal treatment.

Clinical and radiographic assessment of root canal treatments performed by dental students

Retrospective assessment of procedures performed in dental school clinics is a valuable tool to critically assess the teaching/ learning process. Objective: This retrospective study assessed the success rate of root canal treatments executed by dental students during a two-year time span. Material and methods: Patients who had undergone root canal treatments at the clinics of the School of Dentistry of Unochapecó during 2011-2013 were recalled for assessment of the quality of the procedure and the associated coronal restoration. The quality of the root canal treatments was assessed clinically and radiographically, while the coronal restorations were assessed clinically by a trained dental student. Data were analyzed by descriptive statistics and chi-square test (α=0.05). Results: Thirtytwo patients returned for evaluation of 38 root canal treatments and coronal restorations. The success of root canal treatments was 89.5%, while 78.5% of the coronal restorations were considered successful. A significant association was observed between the success of the root canal treatments and the quality of the coronal restoration (p&lt;0.005) and the apical length of the root canal filling (p&gt;&lt;0.011). The presence of flaws within the filling material was not significantly associated to the success/failure of the root canal treatment (p=0.459). Conclusion: A high success rate of root canal treatment performed by dental students at an average 13-month evaluation period was observed. An adequate coronal restoration and a good apical sealing is required for a good prognosis of teeth undergoing root canal treatment. &gt;&lt;0.005) and the apical length of the root canal filling (p&lt;0.011). The presence of flaws within the filling material was not significantly associated to the success/failure of the root canal treatment (p=0.459). Conclusion: A high success rate of root canal treatment performed by dental students at an average 13-month evaluation period was observed. An adequate coronal restoration and a good apical sealing is required for a good prognosis of teeth undergoing root canal treatment.

A temporary filling material during endodontic treatment may cause tooth fractures in two-surface class II cavities in vitro.

To investigate the effect of a zinc oxide/zinc sulphate-based cement as a temporary filling material during root canal treatment on the occurrence of cracks within the filling material or the tooth. Root canals of 122 extracted human molars were prepared using ProTaper instruments. Standardized occlusal-distal cavities were prepared. After placing calcium hydroxide into the root canals, the teeth were divided randomly into four groups containing 33 specimens each. In the Coltosol group, the cavity was completely filled with Coltosol® F. In the Coltosol-Clearfil group, a 2-mm layer of Coltosol® F was placed into the apical part of the pulp chamber, and in the Clearfil group, a foam pellet was placed into the coronal pulp chamber. The remaining cavities were filled with Clearfil™. In the control group, the cavities were not restored. The teeth were stored at 37 °C for 14 days and examined every 24 h under a stereomicroscope. Fractures of the filling and/or the tooth were only observed in the Coltosol group. All Coltosol® F restorations had cracks after 24 h. Tooth fractures were found in 25 (76 %) teeth. Among these teeth, 21 (84 %) had crown fractures, four (16 %) had root-crown fractures. All root-crown fractures were vertical. Coltosol® F when used alone led to tooth fractures in two-surface class II cavities in teeth undergoing root canal treatment. Coltosol® F solely used as restorative material may lead to tooth fractures in two-surface class II cavities.

Use of electronic apex locators may improve determination of working length.

PubMed, LILACS, Science Direct, Cochrane Collaboration, NHS Evidence databases and in Evidence Based Dentistry and Journal of Evidence-Based Dental Practice. Randomised controlled trials (RCTs), clinical trials (CTs), diagnostic comparative studies and evaluation studies undertaken in adults where working length determination by both electronic and radiographic methods were used were considered. Two reviewers independently assessed study quality. Twenty-one studies were included, five RCTs and 16 in vivo diagnostic test studies. There was considerable heterogeneity between the EALs used and the study designs and a narrative summary of the findings were presented. Working length measurement was compared using three different methods: distance to the radiographic apex in teeth undergoing root canal treatment, (11 studies); concordance between the comparative measurements with EAL and radiography, (two studies); distance to specific anatomic apical reference points evaluated after tooth extraction (four studies)ded. The body of evidence was once again assessed as of low quality. Within the limitations of this review, it is suggested that working length determination by using EAL may perform better than radiography alone.

A temporary filling material used for coronal sealing during endodontic treatment may cause tooth fractures in large Class II cavities in vitro

To investigate the use of a zinc oxide/zinc sulphate-based cement (Coltosol(®) F, Coltène Whaledent, Cuyahoga Falls, OH, USA) as a temporary filling material during multiple-visit root canal treatments and the occurrence of cracks within the filling material or the tooth. Root canals of one hundred and twenty-two extracted human molars were prepared using ProTaper instruments up to size F2. After root canal preparation, standardized mesial-occlusal-distal cavities were prepared. The buccal-lingual/palatal width of the cavities was 4.5 mm), so that the remaining cavity walls had a mean thickness of 3.5 mm. Teeth were checked for cracks and fracture lines using a stereomicroscope with 10× magnification. A calcium hydroxide slurry was used as an intracanal dressing. The teeth were divided into three groups. In the Coltosol group, the cavity was filled with Coltosol(®) F. In the Coltosol-Clearfil group, a 2-mm layer of Coltosol(®) F was placed into the coronal pulp chamber, the remaining cavity was filled with Clearfil(™) . In the Clearfil group, a foam pellet was placed onto the orifices of the root canals, the remaining cavity was filled with Clearfil(™) . In the control group, the cavities were left without any filling material. The teeth were stored in water at 37 °C for 14 days and examined every 24 h under a stereomicroscope for fracture lines occurring on the tooth surface or in the filling material. In the Coltosol group, fractures within the filling material were observed in 28 (85%) of 33 teeth. 13 (39%) teeth had tooth fractures. Amongst these teeth, 8 (61%) had root fractures, 1 (8%) had a crown fracture and 4 (31%) had a root-crown fracture. Coltosol(®) F, when used alone as a restorative material, led to tooth fractures in Class II cavities in teeth undergoing root canal treatment. Tooth fractures may occur 4 days after placement of the filling.

Gram-positive rods prevailing in teeth with apical periodontitis undergoing root canal treatment.

To identify Gram-positive rods from root canals of teeth with apical periodontitis and to examine their associations with other species. Consecutive root canal samples (RCSs) from 139 teeth undergoing root canal treatment were analyzed prospectively for cultivable microbes. Gram-positive rods in the first RCS submitted after chemo-mechanical preparation were categorised to genus level by selective media and gas-liquid chromatography (GLC), and identified to species level by sodium dodecyl sulphate-polyacrylamide gel electrophoresis (SDS-PAGE). Associations between organisms were measured by odds ratios (OR). In the first samples submitted a total of 158 Gram-positive rods, 115 Gram-positive cocci, 26 Gram-negative rods and 9 Gram-negative cocci, were identified. At genus levels Gram-positive rods were classified into: Lactobacillus spp. (38%), Olsenella spp. (18%), Propionibacterium spp. (13%), Actinomyces spp. (12%), Bifidobacterium spp. (13%) and Eubacterium spp. (6%). The most frequent species were Olsenella uli, Lactobacillus paracasei and Propionibacterium propionicum. In subsequent samples taken during treatment, Gram-positive rods were also identified, although the number of strains was considerably reduced. Positive associations were observed between members of the genus lactobacilli and Gram-positive cocci (OR>2). Olsenella uli and Lactobacillus spp. predominated over other Gram-positive rods. A possible association exists between Lactobacillus spp. and Gram-positive cocci in root canals of teeth with apical periodontitis receiving treatment.