Undergoing Root Canal Treatment Research Articles

Fracture Resistance of Endodontically Treated Premolars Reconstructed by Traditional Casting and CAD-CAM Milling Post and Cores.

Purpose Restoration of endodontically treated premolars has always been considered as a challenging procedure. This study compared the fracture strength and mode of failure of root canal treated premolars reconstructed with various post and core systems. Materials and Methods Twenty healthy extracted premolars were selected and underwent root canal treatment and then randomly assigned into 4 groups (n = 5). The teeth in group 1 restored with amalgam, whereas others reconstructed with post and cores made by cobalt-chromium (Co-Cr) casting (group 2), nonprecious gold (NPG) casting (group 3), or computer-aided design (CAD) and computer-aided manufacturing (CAM) milling (group 4). The force at fracture was measured in a universal testing machine, and the failure mode was recorded as repairable or nonrepairable. Results ANOVA revealed a significant difference in fracture resistance between groups (P=0.001). The control group displayed significantly lower strength than that of the CAD-CAM or CO-Cr groups (P < 0.05). The CAD-CAM posts were also more resistant to fracture than the NPG group (P < 0.05). The frequencies of repairable fracture in the control, Co-Cr, NPG, and CAD-CAM groups were 40%, 20%, 20%, and 60%, respectively. The chi-square test revealed no significant difference in the distribution of failure modes between groups (P=0.415). Conclusion The teeth reconstructed with post and cores were more resistant to fracture than those restored with amalgam alone. CAD-CAM milling could be considered as the best system for reconstruction of endodontically treated teeth, as it provided the highest fracture strength with less risk of nonrepairable tooth fracture.

Technical quality of endodontic obturation performed in a paediatric dental department.

Technical quality of endodontic obturation performed in a paediatric dental department.

Comparative evaluation of machine assisted irrigation activation technique and conventional syringe irrigation on postoperative pain in patients undergoing endodontic treatment: A Systematic review and meta-analysis

Objective: This systematic review and meta-analysis aimed to assess whether machine- assisted agitation resulted in less postoperative pain (PP) compared with syringe irrigation with needle alone in adult patients undergoing root canal treatment. Methodology: PICO strategy was used to electronically search key terms in the PubMed, Science Direct, Cochrane Library, Google Scholar and Wiley Online databases up to 2021 for randomized control trials (RCTs) with an observation period of at least 6 hours. The bias risk for RCTs was assessed using the Cochrane risk of bias tool. Meta-analysis was performed using RevMan 5.4 (RevMan 5.4, The Nordic Cochrane Centre, Copenhagen). Results: A total of 9 studies (for systematic review) including 1075 patients with a 565/530 male to female ratio and a mean age of 40.5 years met the inclusion criteria. Out of 9, 6 studies were selected for the meta-analysis. Meta-analysis of the 6 studies indicated that overall, the use of machine-assisted irrigation technique showed better postoperative pain reduction than conventional syringe irrigation. Conclusion: Overall, machine-assisted irrigation causes reduction in postoperative pain compared to conventional syringe irrigation.

LANGERHANS CELL HISTIOCYTOSIS: REPORT OF AN EXTENSIVE CASE IN A TEENAGER

Langerhans cell histiocytosis is a myeloid dendritic cell neoplasm with Langerhans cell phenotype (CLang). A 15-year-old male patient presented with pain when chewing, and facial asymmetry was observed on the right side. It lasted for 1 year. He also reported having undergone root canal treatment on a tooth in the corresponding region, which was extracted, but the pain persisted. Periapical images brought by the patient showed tooth 46 was treated about 8 months ago. On intraoral examination, there was a swelling in the right retromolar area, and panoramic radiograph showed extensive radiolucency extending from tooth 44 to 47, with floating teeth and resorption of the mandibular base. After incisional biopsy, the anatomopathologic examination revealed a histiocytosis of CLang, characterized by infiltration of histiocytoid and eosinophil cells with areas of fibrosis, positive for S-100 and CD1a. The patient was referred to the hospital but did not return for another appointment. Langerhans cell histiocytosis is a myeloid dendritic cell neoplasm with Langerhans cell phenotype (CLang). A 15-year-old male patient presented with pain when chewing, and facial asymmetry was observed on the right side. It lasted for 1 year. He also reported having undergone root canal treatment on a tooth in the corresponding region, which was extracted, but the pain persisted. Periapical images brought by the patient showed tooth 46 was treated about 8 months ago. On intraoral examination, there was a swelling in the right retromolar area, and panoramic radiograph showed extensive radiolucency extending from tooth 44 to 47, with floating teeth and resorption of the mandibular base. After incisional biopsy, the anatomopathologic examination revealed a histiocytosis of CLang, characterized by infiltration of histiocytoid and eosinophil cells with areas of fibrosis, positive for S-100 and CD1a. The patient was referred to the hospital but did not return for another appointment.

Radiological assessment of prevalence and quality of endodontic treatments in a Turkish subpopulation

<h3>Objective</h3> The aim of this study was to determine the current prevalence and quality of endodontic treatments and investigate the relationship of various factors with periapical status in a Turkish subpopulation. <h3>Study Design</h3> The CBCT images of 1069 patients (50.9% males, 49.1% females; mean age 45.32 ± 13.50 years) who applied to Kocaeli University Faculty of Dentistry between 2015 and 2020 were retrospectively analyzed. In total, 20,646 teeth were examined; 1,604 teeth that had undergone root canal treatment met the criteria and were included in the study. The relationship between periapical status of the endodontically treated teeth and the quality of the root canal treatment was recorded. Periapical status was assessed using a modified CBCT periapical index (PAI) by two independent observers. The relation between periapical status and quality of root canal fillings (RCFs) was analyzed statistically using the chi-square test. <h3>Results</h3> The prevalence of apical periodontitis (AP) for teeth with RCF was 56.8%, while 7.8% of all teeth had had endodontic treatment. The prevalence of AP was 44.3% in teeth with short RCF, 10.8% with overextended RCF, 35.7% with inadequate RCF, and 15.5% with untreated root canals. 76.2% of root canal obturated teeth with procedural errors were associated with AP. No statistically significant differences were found between genders in terms of AP (p>0,05). AP developed more frequently in teeth treated with procedural errors. <h3>Conclusion</h3> The quality of root canal treatment was poor in this subpopulation. There is a substantial need to improve the technical quality of endodontic treatment. <b>Statement of Ethical Review</b> Human/Animal subjects were used and this study was approved by an institutional ethics panel

Long term outcomes of en-block autotransplantation of a tooth.

Repositioning of impacted teeth in the dental arch through en-bloc autotransplantation showed short-term efficacy of 89%. The objective of this study was to evaluate the technique for long-term efficacy. The analysis involved 23 teeth transplanted to the alveolar ridge through harvesting the tooth with the adjacent bone tissue. Development of the root was completed and the apical foramen was closed in all the teeth. The teeth were examined clinically and radiologically (CBCT) and compared to contralateral ones. The obtained data were analysed statistically. The efficacy of the procedure amounted to 81% including two teeth lost at an early stage and another two lost during follow-up. The mean age of patients upon performing the procedure was 29.8. The long-term follow-up amounted to the mean of 34.3months. In the study group recession of 1-2mm as well as 3-5mm was found, which was not noted on the control group. In 11.1% of the study group teeth the external root resorption was observed. No transplanted tooth underwent root canal treatment, no periapical changes were observed at CBCT and 77.8% of those showed positive reaction to ethyl chloride. One case of ankylosis was observed in tooth 11 and in two cases increased mobility of the transplanted tooth was found. Regeneration of nerves as well as revascularization in the en-bloc autotransplantation proceeded with high predictability and the risk of ankylosis of the treated tooth seemed to be negligible. Gingival recession was observed more often in case of en-bloc transplantation compared to the control group. The long-term follow-up suggested that this the technique does not prevent external resorption in 100%.

Crown Lengthening for Obtaining Biological Width in Dental Restoration: A Case Report

Background: Biological width is a natural defensive space for periodontal tissue which is important for maintaining healthy periodontal tissue so that it can support the success of dental restoration treatment. The localized alveolar bone loss, gingival recession, localized gingival hyperplasia or a combination of all three can be caused by poor biological width restoration. Biological width is obtained through crown lengthening when restoration of teeth have caries or subgingival fractures under the gingival attachment. The crown-lengthening procedure is performed to increase the height of the clinical crown for restoring and improving the esthetics of the teeth.&#x0D; Objective: This case report presents two cases of crown lengthening with osteotomy before the dental restoration procedure.&#x0D; Case Report: The first case was of a 43-year-old woman who was referred from the prosthodontics clinic RSKGM FKG UI before making permanent restorations on tooth 13. Clinical examination showed red gums, swelling and caries that extended to subgingival especially in the distal part. A crown-lengthening procedure with an osteotomy was performed distally to increase the height of the clinical crown so that it had a good ferrule effect for the restoration of the tooth. The second case was of a 25-year-old female patient who had undergone root canal treatment by a general dentist. The clinical appearance of the tooth showed an imbalance in the height of the gingival zenith with the tooth next to it, and the clinical crown looked short. Crown lengthening with osteotomy was done to get a balanced zenith height.&#x0D; Conclusion: Crown lengthening is a periodontal surgical treatment performed to obtain optimum biological width to support tooth restoration.&#x0D; Keywords: crown lengthening, osteotomy, biological width

Patient perception who had undergone root canal treatment

Introduction: Root canal treatment (RCT) is generally known as a painful procedure. One of the most significant disadvantages of root canal therapy is that most patients are unaware of it. To effectively address the problem, it is important to understand and recognise the factors that prevent or deter patients from undergoing RCT. According to a review of the literature, there is a scarcity of data on RCT knowledge and acceptance among patients in the Indian population. Aim: The aim of this present study is to assess the patients perception who had undergone root canal treatment. Materials and Methods: 100 participants were involved in the study. A well structured questionnaire containing 15 questions was administered to the participants through an online survey link. The responses were analysed through descriptive statistics using SPSS software. The results are represented through pie charts and association graphs. Results and Discussion: The patients association is not significant. This shows that if patients are not properly educated regarding RCT, they get motivated to undertake the treatment. Patients' confidence can be increased by informing them about potential post endodontic pain and administering drugs to handle it.

Dental Pulp Regeneration Induced by Allogenic Mesenchymal Stromal Cell Transplantation in a Mature Tooth: A Case Report

IntroductionCellular therapy constitutes a new therapeutic alternative in regenerative endodontics. In this case report, we evaluated the capacity of allogeneic mesenchymal stromal cells (MSCs) to induce dental pulp and apical bone regeneration in a tooth previously endodontically treated. MethodsA healthy 55-year-old female patient consulting for swelling and a sinus tract associated with tooth #8 was referred for an endodontic evaluation. Previously, tooth #8 had undergone root canal treatment and apical resection and had no response to thermal or electric pulp testing. Radiographically, tooth #8 showed root canal treatment, a cut apex angle, and periapical radiolucency. The root canal was recleaned and shaped, and calcium hydroxide was used as an interappointment medication. Cryopreserved allogeneic bone marrow MSCs were thawed, expanded, incorporated into preclotted platelet-rich plasma, and implanted into the pulp cavity of tooth #8. The cervical part of the canal was sealed with bioceramic cement and a composite. ResultsAfter 14 months of MSC transplantation, tooth #8 showed sensitivity to cold and electric pulp tests. Radiographic and cone-beam computed tomographic imaging showed signs of increased periapical bone density, healing of the periapical lesion, and almost complete apical remodeling. ConclusionsThis case report shows periodontal bone formation, apex remodeling, and dental pulp regeneration induced by allogeneic MSC transplantation in a mature nonvital tooth. Allogeneic MSCs may constitute a first-line therapy in regenerative endodontics.

Patient record assessment of results and related resources spent during 1year after initiation of root canal treatment in a Swedish public dental organization.

AimTo document treatment outcomes and related resources, in patients undergoing root canal treatment (RCT) in county public dental clinics, by monitoring patient records for 12 months from treatment start.MethodologyThe subjects comprised 243 patients starting RCT at 20 public dental clinics in Västra Götaland county, Sweden. Their computerized dental records were monitored prospectively for a year after starting their endodontic treatment. Treatment was completed with either a root filling or extraction. The following treatment‐specific variables were registered: number of appointments and days until treatment was completed, possible complications and prescriptions for antibiotics, and for the root filled teeth: type of coronal restoration and further procedures undertaken within the year. The treatment outcomes were compared with the preoperative variables and in a logistic regression analysis.ResultsComplete data were available for 240 patients (98.8%): 128 women and 112 men, with a mean age of 48.5 years (SD = 16.3). Molar teeth predominated (n = 113, 47.1%). Most cases were completed with a root filling (n = 169, 70.4%). The remainder were extracted (n = 32, 13.3%) or were still uncompleted (n = 39, 16.3%). On average, a root filling was completed in 2.4 (SD = 0.9) appointments, or extraction at the third appointment (SD = 1.6). The molars were less often completed and often predominant among the extracted teeth. The indication for extraction was often for endodontic or RCT‐related reasons. Most complications were registered in the molars and antibiotics were prescribed in 20 cases. Most root filled teeth were restored with a direct restoration. Four root filled teeth (2.4%) were extracted within the time period.ConclusionsPatient records, followed from the start of treatment, show that 12 months on, the root filling had not been completed in just under 30% of the teeth. Of these, about half were extracted. Of particular concern is the outcome for endodontic treatment of molar teeth. In the general practice setting, molar endodontics are not only technically challenging but also very demanding in terms of chairside resources. In the present study, a successful outcome was achieved in just over half the cases.

Comparative evaluation of decalcifying agents for dissolution of pulp stones: An in vitro study.

Background:Despite constant advances in science, obscurity remains in the efficient removal of pulp stones to aid in successful root canal treatment. In this context, chemical means of dissolving pulp stones were explored.Aim:The aim of this study is to evaluate and to compare the efficacy of decalcifying agents on the dissolution of pulp stones.Materials and Methods:The study was divided into two groups for pulp stone analysis (21 samples) and dentin analysis (54 samples). Twenty-one pulp stones from patients aged 18–70 who underwent root canal treatment were collected and divided into three subgroups (n = 7) randomly. They were subjected to chemical treatment in a labeled glass container with 5 ml of the respective chemical agents, such as 17% ethylenediaminetetraacetic acid solution (positive control), no treatment (negative control), and newly developed Physiological Simulated Decalcifying Agent (PSDA). At the end of the study period (24 h), the samples were removed, rinsed with deionized water, and subjected to physical analysis, scanning electron microscopy (SEM), and Energy –dispersive X-ray spectroscopy (EDS) analysis. Under dentin analysis, 54 maxillary premolars scheduled for orthodontic extraction without caries or extensive restorations were selected, following which 2-mm thick transverse dentinal sections at the cementoenamel junction level were obtained and randomly divided into two groups for SEM (n = 21) and microhardness analysis (n = 33). The samples were subjected to respective chemical treatment groups similar to pulp stones for 24 h and analyzed using SEM, EDS, and microhardness analysis.Results:Postchemical treatment with the newly developed decalcifying solution, the pulp stones showed the absence of nodular crystallites and surface softening under SEM and a decrease in the calcium level under EDS analysis. Concerning the microhardness of dentin, no significant changes could be observed.Conclusion:The newly explored PSDA was found to be efficacious in the decalcification of pulp stones at a clinically relevant time of 24 h, without significantly affecting the structural integrity and the hardness values of dentin.

Effect of sonic and ultrasonic irrigation on improving root canal cleanliness after post space preparation: A confocal laser scanning microscopic study

Introduction: Removing the secondary smear layer has been presumed to increase the micromechanical retention of fiber posts. The additional use of irrigation techniques is intended to improve the cleanliness of the root canal walls. The present study aimed to determine the effectiveness of sonic and ultrasonic irrigation techniques on root canal cleanliness after the post space preparation.Materials and Methods: A total of 27 extracted single-rooted premolar samples underwent root canal treatment using gutta-percha and AH Plus that was labeled with rhodamine B. Gutta-percha was removed during the post preparation. The sample was then divided into three groups (n = 9): irrigation with sonic activation, ultrasonic activation, or without activation, respectively. The teeth were subsequently cut in the middle third area of the root, and the remnant of smear layers was observed using a confocal laser scanning microscope. Cleanliness was expressed as a percentage of the angle that contained part of the red area representing the smear layer. The results were statistically analyzed with a one-way ANOVA test and post hoc Bonferroni test set at 5% significance level.Results: The sonic group had the greatest percentage of root canal wall cleanliness (89.00 ± 2.77), followed by the ultrasonic (78.33 ± 3.09) and nonactivated groups (67.77 ± 3.37). Conversely, there was no significant difference in root canal wall cleanliness between the sonic and ultrasonic groups (P = 0.067) or the ultrasonic and nonactivation groups (P = 0.071).Conclusions: Irrigation with sonic activation improved cleanliness of the root canal dentinal wall after post space preparation.

Preserving the tissue profile with immediate implant placement and immediate provisionalization technique

Background: Single-tooth replacement in the esthetic zone with a dental implant remains a challenge for clinicians. One challenge is the difficulty of creating a natural tissue profile in the cervical of the implant restoration. In a healed edentulous ridge, multiple surgeries along with hard- and soft-tissue augmentation will be required to gain sufficient tissue volume, thus significantly increasing the patient morbidity. Immediate implant placement, combined with a customized healing abutment, can potentially overcome these difficulties. Case Report: This case report describes the treatment of a patient with a subgingival fracture of the upper central incisor with an implant placement immediately after tooth extraction, xenograft gap filling, and nonfunctional provisional restoration to seal the extraction socket. The incisor had previously undergone root canal treatment and had been restored using a fiber post and ceramic crown. Conclusions: The use of the immediate implant placement with a nonfunctional provisional restoration (immediate implant placement and immediate provisionalization) technique preserves the tissue profile and volume during the implant healing period. This provides the clinician with a natural soft-tissue profile for implant restoration, without the need for an additional surgery.

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.

Effect of Phytic acid on the tissue dissolving ability of Sodium hypochlorite: An ex-vivo study

Aim: To evaluate the effect of Phytic acid on the pulp dissolving ability of sodium hypochlorite (Naocl).&#x0D; Methodology: Pulp tissue was collected from patients undergoing root canal treatment using barbed broach and stored in 10% formalin. The tissue was then divided into fragments of equal weight and immersed in solutions consisting of 5.25 % Naocl and mixture of 1:1(w/w) Phytic acid and 5.25% Naocl for a period of 30 minutes. Tissue fragments were removed and weighed again. The difference between the initial and final weight was used to calculate weight loss there by representing tissue dissolving ability of each solution used.&#x0D; Results: No significant difference was found in the tissue dissolving ability for both the tested groups. (P˂0.05).&#x0D; Conclusion: Addition of Phytic acid did not alter the pulp dissolving ability of Naocl.&#x0D;

Impact of Educational Videos on Dental Anxiety and Fear in Patients Undergoing Root Canal Treatment in Shiraz, Iran

Impact of Educational Videos on Dental Anxiety and Fear in Patients Undergoing Root Canal Treatment in Shiraz, Iran

Major approaches on the use of ozone therapy in endodontics: a concise systematic review

Introduction: Issues related to endodontic treatment are intrinsically linked to the prevention and total control of pulp and periapical infections. The presence of microorganisms is not limited to the endodontic but is also present in the periradicular regions, characterized by an apical biofilm that is strongly adhered to the surface. In this context of decontamination of root and periapical canals, ozone has been highlighted as an important sanitizer. Objective: To demonstrate the main experimental and clinical findings of the use of ozone therapy alone and in association with conventional treatments as an antiseptic in the treatment of root canals. Methods: The research was carried out from May 2021 to June 2021 and developed based on Scopus, PubMed, Science Direct, Scielo, and Google Scholar, following the Systematic Review-PRISMA rules. The quality of the studies was based on the GRADE instrument and the risk of bias was analyzed according to the Cochrane instrument. Results: There is moderate evidence to provide important preliminary information about ozone therapy. As for reducing the microbial load for patients undergoing root canal treatment, ozone therapy has inferior results when compared to conventional chemomechanical techniques using NaOCl. The joint action of these treatments proved to be quite effective. Conclusion: Ozone therapy is proving to be a useful new treatment modality that offers great benefits to patients. The strong antimicrobial power of ozone, together with its ability to stimulate the circulatory system and modulate the immune response, makes it a corrective agent of choice in the treatment of various oral infectious diseases. More research is needed to help with its reproducibility, its use should be indicated by the dentist in clinical practice.

Extra canal in permanent maxillary first molar in patients undergoing root canal treatment at a tertiary care dental hospital, Nepal

Background: Permanent maxillary first molar normally has three root canals but it can have extra root canals for which several studies were done in many parts of the globe. However, this type of study to explore extra canal is lagging in the context of Nepal. Objectives: The objective was to determine the percentage of extra canal in permanent maxillary first molar in patients undergoing root canal treatment and to compare the same between male and female. Methods: The descriptive cross-sectional study was conducted in the department of conservative dentistry and endodontics of People’s Dental College and Hospital from 20th December 2019 to 20th December 2020 after receiving ethical approval from Nepal Health Research Council on 18th December 2019 (ERB protocol No 888/2019) . One hundred and eighty permanent maxillary first molar teeth without root canal calcification were enrolled. Convenient sampling was done. Access opening was done and all canal orifices were located and recorded. Data were analyzed using Statistical Package for the Social Sciences (SPSS) version 22.0 with frequency table. Chi-square test was used for inferential statistics. Results: Out of 180 teeth, extra canals were present in 44(24.4%) having more numbers in male than in females. Extra canal was present in the mesiobuccal root. Conclusion: Extra canal in the permanent maxillary first molar is present in Nepalese population with greater number in male than in female. Thus, exploration of the pulp chamber in search of an extra canal is necessary to prevent failure of root canal treatment.

Number of Calcified Maxillary Anteriors Undergoing Root Canal Treatment Under 50 Years of Age - an Institutional Study

Number of Calcified Maxillary Anteriors Undergoing Root Canal Treatment Under 50 Years of Age - an Institutional Study

Do Third Molars Play a Role in Second Molars Undergoing Endodontic Treatment?

Background and aim: This study evaluated the rates of second molars undergoing endodontic treatment due to partially or fully erupted lower and upper third molars. Materials and Methods: Radiographic data from 579 patients were analyzed to calculate the rates of second molars undergoing endodontic treatment due to third molars and other reasons. Descriptive statistics were expressed as numbers and percentages for categorical variables. The chi-square test was used to determine the relationships between categorical variables. Results: The rate of second molars undergoing root canal treatment for reasons unrelated to third molars was statistically higher than that of second molars undergoing treatment because of third molars (p &lt; 0.001). The rate of lower second molars with endodontic treatment was significantly higher than that of upper second molars (p &lt; 0.001). There was no statistically significant difference between partially and fully erupted third molars causing root canal treatment of second molars (p = 0.344). Conclusion: Root canal treatment of second molars can be related to fully or partially erupted third molars. All preventive measures should be taken to avoid the need for root canal treatment.