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International Endodontic Journal Oct 2023Apical periodontitis (AP) is an inflammatory disease of the apical periodontium as sequelae of pulp death. It is managed by disinfection and filling of the root canal... (Review)
Review
BACKGROUND
Apical periodontitis (AP) is an inflammatory disease of the apical periodontium as sequelae of pulp death. It is managed by disinfection and filling of the root canal space.
OBJECTIVES
The aim of this systematic review was to investigate whether obturation techniques and materials used for root canal filling led to the management of AP.
METHODS
A systematic review protocol was written following the preferred reporting items for systematic reviews and meta-analyses (PRISMA) checklist and registered on the international prospective register of systematic reviews (PROSPERO; CRD42021260275) including two populations, interventions, comparisons, outcomes and time (PICOT) for the research questions querying the effectiveness of obturation techniques (PICOT 1) and materials (PICOT 2) for the management of AP. Electronic searches were conducted on PubMed, ScienceDirect, Scopus and Embase search engines. Searches on International Endodontic Journal, Journal of Endodontics, Clinical Oral Investigations, Journal of Dental Research and Journal of Dentistry websites were also conducted, until May 2021. Both primary (tooth survival) and secondary outcomes were evaluated. The risk of bias was assessed by Cochrane RoB2 for the randomized and ROBINS-I for the nonrandomized trials.
RESULTS
The search strategy identified 1652 studies, with 1600 excluded on the title and abstract screening, leaving 52 studies for full-text screening. In total, 10 studies met the inclusion criteria. The obturation technique and materials used did not affect the outcome of AP. Vertical compaction resulted in faster resolution of periapical lesions. The oral health-related quality of life of patients treated with lateral condensation exhibited poorer outcomes compared with single matched cone after 6 months of recall.
DISCUSSION
The inclusion and exclusion criteria used for this systematic review enabled the capture of all the literature available on the effect of obturation techniques and materials on the outcome of AP. The data were heterogenous, and a number of articles investigating obturation techniques had no information on the materials and techniques used as they looked at the quality of fill.
CONCLUSIONS
Included studies did not find any difference between different procedures (PICOT 1) and materials (PICOT 2). The risk of bias was high, thus the findings should be interpreted with caution.
REGISTRATION
PROSPERO registration number: CRD42021260275.
Topics: Humans; Root Canal Filling Materials; Gutta-Percha; Quality of Life; Systematic Reviews as Topic; Root Canal Obturation; Periapical Periodontitis; Root Canal Preparation; Dental Pulp Cavity
PubMed: 35735776
DOI: 10.1111/iej.13787 -
International Endodontic Journal Oct 2023In addition to non-surgical root canal treatment or retreatment, apical surgery may be carried out to manage teeth with apical periodontitis. However, it is unclear... (Review)
Review
BACKGROUND
In addition to non-surgical root canal treatment or retreatment, apical surgery may be carried out to manage teeth with apical periodontitis. However, it is unclear which treatment option is more effective.
OBJECTIVE
To systematically review the effectiveness of apical surgery compared with non-surgical treatment or retreatment in terms of clinical and patient-related outcomes in teeth with apical periodontitis.
METHODS
A literature search of electronic databases, the grey literature, the reference lists of included articles and previous reviews, and a hand search of leading endodontic journals, was conducted. Randomised and non-randomised control trials, and longitudinal observational studies on patients undergoing surgical (treatment group) and non-surgical root canal treatment or retreatment (control group) of teeth with apical periodontitis were included. The risk of bias was appraised using the Cochrane risk-of-bias tool; ROBINS-I and the Newcastle-Ottawa Scale.
RESULTS
Five studies, consisting of two randomised clinical trials, two non-randomised clinical trials, and a retrospective cohort study, were included. The interobserver agreement was high and kappa correlation coefficient was good. In total 529 teeth were available for follow-up that varied from 6 months to 8.7 years. The overall risk of bias was high for four studies and raised some concerns in one study. Apical surgery showed seemly better results regarding periapical healing and less need for more and further intervention, although tooth survival was higher in the control group. Given the heterogeneity of the studies, meta-analysis was not possible.
DISCUSSION
Previous systematic reviews have conducted an indirect comparison by separately pooling the outcomes of studies analysing either non-surgical, or surgical, treatment. In this systematic review, only studies that compared both treatments were included. Most results of this and previous reviews were similar.
CONCLUSION
No treatment option showed clear superiority. However, to arrive at statistically supported conclusions there is a need for additional high-quality comparative trials.
REGISTRATION
PROSPERO database (Registration number CRD42021260300).
Topics: Humans; Clinical Trials as Topic; Dental Pulp Cavity; Periapical Periodontitis; Retreatment; Retrospective Studies; Root Canal Therapy
PubMed: 35762859
DOI: 10.1111/iej.13793 -
Journal of Clinical Medicine May 2024The gradual formation of hard tissue along the root canal walls is a natural process associated with aging, typically progressing slowly over time. In reaction to tooth... (Review)
Review
The gradual formation of hard tissue along the root canal walls is a natural process associated with aging, typically progressing slowly over time. In reaction to tooth wear, operative procedures, vital pulp treatments, or regenerative endodontic procedures, hard tissue may also accumulate within the pulp canal space at a slow rate. In certain cases, such as dental trauma, autotransplantation, or orthodontic treatment, this deposition of hard tissue can accelerate unexpectedly, resulting in rapid narrowing or complete closure of the root canal space. This situation is called calcific metamorphosis (CM), root canal calcification, or pulp canal obliteration (PCO). Performing conventional endodontic therapy on severely calcified canals presents significant challenges and increases the risk of procedural accidents. Calcified canals introduce such complexity that dedicated negotiation concepts and specially designed instruments have been developed to deal with the challenge. This article seeks to review the existing methods for effectively navigating calcified canals and to introduce the buckling resistance activation test (BRAT) technique.
PubMed: 38731233
DOI: 10.3390/jcm13092703 -
International Journal For Numerical... Aug 2023Root canal irrigation is an important step in root canal preparation procedures and has a great impact on the success rate of root canal treatment. Computational fluid... (Review)
Review
Root canal irrigation is an important step in root canal preparation procedures and has a great impact on the success rate of root canal treatment. Computational fluid dynamics (CFD) is a new method to study root canal irrigation. It can be used to simulate and visualize the process of root canal irrigation, and quantitatively evaluate the effect of root canal irrigation through parameters such as flow velocity and wall shear stress. In recent years, researchers have conducted extensive studies on the factors that influence root canal irrigation efficiency, such as the position of the irrigation needle, the size of root canal preparation, the types of irrigation needles, and so on. This article reviewed the development of root canal irrigation research methods, the steps of CFD simulation in root canal irrigation, and the application of CFD in root canal irrigation in recent years. It aimed to provide new research ideas for the application of CFD to root canal irrigation and to provide a reference for the clinical application of CFD simulation results.
Topics: Hydrodynamics; Dental Pulp Cavity; Rheology; Root Canal Irrigants; Therapeutic Irrigation
PubMed: 37310003
DOI: 10.1002/cnm.3738 -
Clinical Oral Investigations Nov 2023This review aims to discuss the implications of anatomy of the root, pulp chamber, and canals on pulpotomy and revitalization procedures (RPs) as treatment alternatives... (Review)
Review
OBJECTIVES
This review aims to discuss the implications of anatomy of the root, pulp chamber, and canals on pulpotomy and revitalization procedures (RPs) as treatment alternatives to root canal treatment procedures.
METHODS
This narrative review was undertaken to address two main questions - why remove vital pulp tissue in teeth with complex canal anatomy when it can be preserved? And why replace the necrotic pulp in teeth with mature roots with a synthetic material when we can revitalize? This review also aims to discuss anatomical challenges with pulpotomy and revitalization procedures.
RESULTS
Maintaining the vitality of the pulp via partial or full pulpotomy procedures avoids the multiple potential challenges faced by clinicians during root canal treatment. However, carrying out pulpotomy procedures requires a meticulous understanding of the pulp chamber anatomy, which varies from tooth to tooth. Literature shows an increased interest in the application of RPs in teeth with mature roots; however, to date, the relation between the complexity of the root canal system and outcomes of RPs in necrotic multi-rooted teeth with mature roots is unclear and requires further robust comparative research and long-term follow-up.
CONCLUSIONS
Whenever indicated, pulpotomy procedures are viable treatment options for vital teeth with mature roots; however, comparative, adequately powered studies with long-term follow-up are needed as a priority in this area. RPs show promising outcomes for necrotic teeth with mature roots that warrant more evidence in different tooth types with long-term follow-ups. CLINICAL RELEVANCE: Clinicians should be aware of the pulp chamber anatomy, which is subject to morphological changes by age or as a defensive mechanism against microbial irritation, before practicing partial and full pulpotomy procedures. RP is a promising treatment option for teeth with immature roots, but more evidence is needed for its applications in teeth with mature roots. A universal consensus and considerably more robust evidence are needed for the standardization of RPs in teeth with mature roots.
Topics: Humans; Pulpotomy; Dental Pulp Cavity; Root Canal Therapy; Dental Pulp; Dental Pulp Necrosis
PubMed: 37870593
DOI: 10.1007/s00784-023-05284-9 -
Journal of the College of Physicians... Dec 2023To determine the dental morphology and root canal anatomy of maxillary and mandibular second molars in Pakistani population living in Hyderabad.
OBJECTIVE
To determine the dental morphology and root canal anatomy of maxillary and mandibular second molars in Pakistani population living in Hyderabad.
STUDY DESIGN
Retrospective, cross-sectional study. Place and Duration of the Study: Department of Operative Dentistry and Endodontics, Liaquat University of Medical and Health Sciences (LUMHS), Jamshoro, from April to May 2023.
METHODOLOGY
This study analysed the number of roots, root canal configurations, and frequency of C-shaped root canals and their configuration assessment. The data was obtained from Cone Beam Computerised Tomography (CBCT) records sourced from the Department of Radiology at Advanced Dental Care Centre of LUMHS.
RESULTS
Two-rooted maxillary second molar was present in 10.6% of teeth, while 5.3% were single-rooted. Among mandibular second molars, 6.8% had one root, while 2.3% had three. The maxillary second molar mesiobuccal roots were Type I in 47.7% cases. The maxillary second molars had C1-shaped canals in 3.8% of cases. The study revealed that 10.6% of mandibular second molars had C-shaped canals, 3.0% were C1, 6.8% C3a, and 0.8% C4. A minority of patients had palatal morphology with two roots (MP and DP) and Type 1 canal structure, while a subset had both MP and DP canals.
CONCLUSION
The prevalence of radix in mandibular second molars was found to be relatively infrequent. The prevalent root canal configurations were Type I in the mesiobuccal and palatal roots and Type IV in the mesial root of mandibular second molars. A noteworthy correlation was detected between the molar type characterised by a single root and the existence of a C-shaped canal in the female population.
KEY WORDS
CBCT, Dental anatomy, Gender, Root canal, Morphology, Pakistani population.
Topics: Humans; Female; Dental Pulp Cavity; Retrospective Studies; Cross-Sectional Studies; Pakistan; Molar
PubMed: 38062591
DOI: 10.29271/jcpsp.2023.12.1372 -
International Journal of Oral Science Mar 2024Endodontic diseases are a kind of chronic infectious oral disease. Common endodontic treatment concepts are based on the removal of inflamed or necrotic pulp tissue and... (Review)
Review
Endodontic diseases are a kind of chronic infectious oral disease. Common endodontic treatment concepts are based on the removal of inflamed or necrotic pulp tissue and the replacement by gutta-percha. However, it is very essential for endodontic treatment to debride the root canal system and prevent the root canal system from bacterial reinfection after root canal therapy (RCT). Recent research, encompassing bacterial etiology and advanced imaging techniques, contributes to our understanding of the root canal system's anatomy intricacies and the technique sensitivity of RCT. Success in RCT hinges on factors like patients, infection severity, root canal anatomy, and treatment techniques. Therefore, improving disease management is a key issue to combat endodontic diseases and cure periapical lesions. The clinical difficulty assessment system of RCT is established based on patient conditions, tooth conditions, root canal configuration, and root canal needing retreatment, and emphasizes pre-treatment risk assessment for optimal outcomes. The findings suggest that the presence of risk factors may correlate with the challenge of achieving the high standard required for RCT. These insights contribute not only to improve education but also aid practitioners in treatment planning and referral decision-making within the field of endodontics.
Topics: Humans; Consensus; Root Canal Therapy; Gutta-Percha; Dental Pulp Necrosis; Retreatment; Dental Pulp Cavity; Root Canal Filling Materials; Root Canal Preparation
PubMed: 38429281
DOI: 10.1038/s41368-024-00285-0 -
International Endodontic Journal Jul 2024Microorganisms are the primary aetiological factor of apical periodontitis. The goal of endodontic treatment is to prevent and eliminate the infection by removing the... (Review)
Review
Microorganisms are the primary aetiological factor of apical periodontitis. The goal of endodontic treatment is to prevent and eliminate the infection by removing the microorganisms. However, microbial biofilms and the complex root canal anatomy impair the disinfection process. Effective and precise endodontic therapy could potentially be achieved using advanced multifunctional technologies that have the ability to access hard-to-reach surfaces and perform simultaneous biofilm killing, removal, and detection of microorganisms. Advances in microrobotics are providing novel therapeutic and diagnostic opportunities with high precision and efficacy to address current biofilm-related challenges in biomedicine. Concurrently, multifunctional magnetic microrobots have been developed to overcome the disinfection challenges of current approaches to disrupt, kill, and retrieve biofilms with the goal of enhancing the efficacy and precision of endodontic therapy. This article reviews the recent advances of microrobotics in healthcare and particularly advances to overcome disinfection challenges in endodontics, and provides perspectives for future research in the field.
Topics: Humans; Biofilms; Disinfection; Robotics; Endodontics; Periapical Periodontitis; Root Canal Therapy; Dental Pulp Cavity
PubMed: 38761098
DOI: 10.1111/iej.14082 -
The Libyan Journal of Medicine Dec 2024The study aimed to radiographically assess the characteristics of pulp stones (PS) and pulp canal obliteration (PCO) in teeth and examined their associations with... (Observational Study)
Observational Study
The study aimed to radiographically assess the characteristics of pulp stones (PS) and pulp canal obliteration (PCO) in teeth and examined their associations with various dental parameters such as caries, restorations, periodontal status, and age. This cross-sectional observational study was conducted at the Faculty of Dentistry, King Abdulaziz University between September 2022, and May 2023, involved 101 patients exhibiting 402 teeth with PS or PCO. Data were collected from periapical and bitewing radiographs, and analyzed by two calibrated dentists. Multiple dental parameters were assessed, including caries level, presence and level of restorations, periodontal condition, and age of the patient. The study population consisted of 62 females and 39 males, with an age range of 18-65 years. Inter- and intra-examiner reliability were high (Kappa = 0.88 and 0.98 respectively). PS were more commonly found in molars (81.2%), while PCO were presented in only 115 teeth (23%). Age significantly affected the type of calcification ( < 0.001), with PS more common in the 20-30 age group and PCO more common in individuals over 40. Presence of caries was significantly associated with the type of calcification ( = 0.013), but restoration was not. The majority of teeth with PS (76%) or PCO (93%) had healthy periodontium. Around 40% of teeth with PCO showed signs of periapical changes, a finding significantly different from those with PS ( < 0.001). Pulp calcifications were significantly associated with various dental parameters, including caries presence, age, and periodontal status. The findings provide crucial insights into the epidemiology and aetiology of pulp calcifications.
Topics: Female; Male; Humans; Adolescent; Young Adult; Adult; Middle Aged; Aged; Cross-Sectional Studies; Dental Pulp Calcification; Dental Pulp Cavity; Reproducibility of Results
PubMed: 38258544
DOI: 10.1080/19932820.2024.2306768 -
Clinical Oral Investigations Dec 2023This study aimed to determine the degree of similarity and symmetry in the anatomy of contralateral mandibular incisors. Three-dimensional (3D) models of extracted teeth...
OBJECTIVES
This study aimed to determine the degree of similarity and symmetry in the anatomy of contralateral mandibular incisors. Three-dimensional (3D) models of extracted teeth were obtained from microtomography (micro-CT) scans. Qualitative and quantitative assessments of the morphology and comparison of contralateral pairs were made. The null hypothesis was that contralateral mandibular incisors could not be considered identical in simple morphometric measurements.
METHODS
Sixty pairs of mandibular incisors were extracted from 30 patients and scanned with micro-CT. Virtual models of the cemento-enamel junction to the root apex were rendered. Parameters such as length, canal width, dentinal thicknesses, tortuosity, centerline length, accessory canals, root canal configurations, and root canal orifice cross-sections were used to compare the teeth. Width and thickness comparisons between paired teeth in the same individual were made by paired t-test (Wilcoxon signed-rank test for variables not normally distributed). An online randomization tool generated randomized pairs (independent of the individual/patient). Subsequently, an unpaired t-test (or Mann-Whitney U test for non-normally distributed parameters) and a correlation analysis were conducted. Canal configurations were classified according to preexisting classification schemes. The number and location of accessory canals and apical foramina were registered and compared.
RESULTS
Utilizing advanced imaging techniques and quantitative analyses, our study establishes that contralateral mandibular incisors exhibit a remarkable degree of symmetry in multiple morphological parameters, including length, canal width, and dentinal thicknesses. The apical third showed a high degree of inter-variability for the contralateral pairs. The rigorous statistical analysis of the normalized parameters by Z-score showed no statistically significant differences between the contralateral mandibular incisors. Comparisons between central and lateral teeth revealed differences in root length but no significant disparity in the distribution of accessory canals. Central teeth, on average, were longer, while accessory canals were distributed relatively evenly between central and lateral teeth.
CONCLUSIONS
The findings of this study further establish the significant similarities between contralateral mandibular incisors, reinforcing their suitability as a reliable substrate for root canal comparison studies.
CLINICAL RELEVANCE
The absence of statistically significant differences between contralateral pairs in normalized parameters underscores their potential as a reliable reference point for root canal comparison studies in clinical dentistry. Furthermore, our findings emphasize the importance of individualized treatment planning, considering the natural symmetry in mandibular incisors to enhance clinical decision-making. This research contributes valuable insights to the field of endodontics, offering a standardized approach to sample selection and enriching the understanding of dental anatomy.
Topics: Humans; Incisor; X-Ray Microtomography; Dental Pulp Cavity; Root Canal Therapy; Endodontics
PubMed: 38147175
DOI: 10.1007/s00784-023-05419-y