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Medicina (Kaunas, Lithuania) Jul 2022: In the presence of a persistent endodontic lesion or endodontic failure, the alternative for the recovery of the dental element is endodontic retreatment or endodontic... (Meta-Analysis)
Meta-Analysis Review
: In the presence of a persistent endodontic lesion or endodontic failure, the alternative for the recovery of the dental element is endodontic retreatment or endodontic surgery, which consists in the surgical removal of the root apices with retrograde closure of the endodontium. The objective of this systematic review and meta-analysis was to provide an updated value of the Risk Ratio between the two types of treatment in order to offer to clinicians who propose a non-surgical endodontic retreatment or an endodontic surgery a direct comparison. The revision was performed according to PRISMA indications: three databases (PubMed, Scopus and Cochrane register) were consulted through the use of keywords relevant to the revision topic: surgical endodontic retreatment, endodontic retreatment, apicoectomy. This search produced 7568 records which, after eliminating duplicates and applying the inclusion and exclusion criteria, resulted in a total of seven included articles. The meta-analyses were conducted by applying fixed-effects models, given the low percentage of heterogeneity. In addition, trial sequency analysis (TSA) was performed for the analysis of the statistical power of the results and GRADE for the quality of the evidence. The results of the meta-analyses' data report an aggregate risk ratio (RR) between non-surgical endodontic retreatment and surgical endodontic retreatment of: 1.05 [0.74, 1.47] at one year of follow-up; RR 2.22 [1.45, 3.41] at two years of follow-up; an RR 1.08 [0.73 1.62] for a follow-up period of 3-4 years; and an RR 0.92 [0.53, 1.61] for a follow-up period of 8-10 years. The results of the present meta-analysis show that in the long term, the risk of failure is identical for the two groups, and there is only a slightly higher risk of failure for non-surgical endodontic retreatments, when only two years of follow-up are considered.
Topics: Humans; Retreatment; Risk
PubMed: 35888613
DOI: 10.3390/medicina58070894 -
Journal of Clinical and Diagnostic... Feb 2015The aim was to evaluate treatment outcomes after apicoectomy and apexification in adjacent non-vital maxillary central incisors with large periapical radiolucencies, in...
The aim was to evaluate treatment outcomes after apicoectomy and apexification in adjacent non-vital maxillary central incisors with large periapical radiolucencies, in a 10-year-old boy. The patient had complained of tenderness in the upper central incisors on mastication and gave a history of trauma to those teeth three years ago. On examination, there were found to be non-vital. Apexification (using Metapex) and apicoectomy (obturation with gutta percha) were performed on 11 and 21, respectively. Radiographical observations were made six months, one year and two years, post-operatively. Apical repair was found to be more favorable after apicoectomy than apexification, for a non-vital maxillary central incisor with an open apex and large periapical radiolucency.
PubMed: 25859529
DOI: 10.7860/JCDR/2015/10078.5516 -
Dental and Medical Problems 2022The management of complex dental trauma can be modulated according to the emergencies that may arise over time. Clinical management of transverse root fractures may... (Review)
Review
The management of complex dental trauma can be modulated according to the emergencies that may arise over time. Clinical management of transverse root fractures may require different therapies based on situations, such as delay and error in the treatment of an avulsion trauma associated with apical third root fracture, patient's poor compliance, or external and internal root resorption. The primary aim of this article was to review studies regarding root fractures in the permanent dentition and root fracture management. The secondary aim was to present the inflammatory reaction and the complications (i.e., infections) that may occur if the International Association for Dental Traumatology (IADT) guidelines are not followed. In addition, a scenario is devised in which endodontic surgery, despite the baseline patient's conditions and negative prognosis, can help to inhibit the inflammatory root resorption and allow the preservation of soft and hard tissues within a long follow-up from the injury, for the purpose of demonstrating the next possible implant-prosthetic rehabilitation.
Topics: Humans; Tooth Fractures; Root Resorption; Tooth Avulsion; Fractures, Bone; Dentition, Permanent
PubMed: 36537854
DOI: 10.17219/dmp/145895 -
Brazilian Oral Research Oct 2018The purpose of this manuscript was to re-discuss apical periodontitis, apical biofilm, and its possible relationship with dendritic cells (DC). DCs are potent regulators... (Review)
Review
The purpose of this manuscript was to re-discuss apical periodontitis, apical biofilm, and its possible relationship with dendritic cells (DC). DCs are potent regulators of the immune system and their function is divided into three categories that involve the presentation of antigens: the presentation of antigens and activation of T cells; a not well established category suggested that DCs induce and maintain immunological tolerance; and the maintenance of the immune memory in conjunction with B cells. DCs in periapical inflammatory lesions are composed of at least two subpopulations that can be distinguished on the basis of ultrastructure and phenotype. These populations might differ in lineage, state of maturation, differentiation, activation, and/or function. The authors hereby analyzed the root apexes of teeth under SEM, after performing apicoectomy due to the failure of conventional endodontic treatment. Microbial biofilm with multispecies and areas of resorption with the presence of Howship lacunae, and images suggestive of denditric cells could be observed. The presence of DCs in periapical lesion could be an indication of the severity of the lesion, with a constant presence of antigen in the periradicular region.
Topics: Antigens; Biofilms; Dendritic Cells; Humans; Microscopy, Electron, Scanning; Periapical Periodontitis; T-Lymphocytes
PubMed: 30365612
DOI: 10.1590/1807-3107BOR-2018.vol32.0071 -
Journal of Dental Sciences Apr 2022Sphingosine-1-phosphate (S1P) is a lipid mediator that exerts its physiological functions in vivo through receptors. In the bone, S1P induces osteoblast...
BACKGROUND/PURPOSE
Sphingosine-1-phosphate (S1P) is a lipid mediator that exerts its physiological functions in vivo through receptors. In the bone, S1P induces osteoblast differentiation. Here, we investigated the effects of S1P receptor agonists on the expression of osteoblast differentiation markers locally in the bone. Then, a rat apicoectomy and alveolar bone defect model was established to extend S1P applications to endodontics, and the effect of local administration of S1P receptor agonist on postoperative bone formation was examined.
MATERIALS AND METHODS
Sphingosine-1-phosphate receptor (S1PR) 1/S1PR3 agonists, S1PR2 agonists, and their signal-related agents were intraperitoneally administered to mice. Using the mRNA collected from the tibial bone, the expression of osteoblast differentiation markers was evaluated by real-time reverse-transcriptase quantitative polymerase chain reaction. An apicoectomy and alveolar bone defect model was established on the mesial root of the rat mandibular first molar. Bone formation parameters were measured by micro-computed tomography analysis 3 weeks after the procedure.
RESULTS
Intraperitoneal administration of S1PR2 agonist significantly increased the mRNA expression of osteoblast differentiation markers, including alkaline phosphatase (, osteopontin (, bone sialoprotein (), and osteocalcin, in the local tibial bone of mice. The S1PR2/Rho-associated coiled-coil forming kinase (ROCK) signaling was thought to be involved in the upregulated mRNA expression of , , and . In the rat apical defects, bone formation parameters significantly increased following local administration of S1PR2 agonist.
CONCLUSION
In the rat apicoectomy and alveolar bone defect model, therapeutic agents targeting S1PR2 agonist are effective against osteogenesis.
PubMed: 35756763
DOI: 10.1016/j.jds.2021.10.004 -
Journal of Clinical Medicine Jun 2022This scoping review aimed at reporting the outcomes of the bone lid technique in oral surgery in terms of bone healing, ridge preservation, and incidence of... (Review)
Review
This scoping review aimed at reporting the outcomes of the bone lid technique in oral surgery in terms of bone healing, ridge preservation, and incidence of complications. Bone-cutting instruments and stabilization methods were also considered. PubMed, Scopus, and the Cochrane Register of Controlled Trials were searched using a combination of terms, including bone lid, bony window, piezosurgery, microsaw, cysts, endodontic surgery, impacted teeth, and maxillary sinus. A hand search was also performed. The last search was conducted on 30 November 2021. No date limitation was set. Searches were restricted to human clinical studies published in English. All types of study design were considered except reviews and case reports. After a two-step evaluation, 20 (2 randomized studies, 2 case-control studies, 3 cohort studies, 13 case series) out of 647 screened studies were included, reporting on 752 bone lid procedures. The bone lid technique was associated with favorable bone healing when compared to other methods, and with a very low incidence of major complications. Clinical indications, surgical procedures, study design, follow-up duration, and outcomes varied among the studies. Overall, favorable outcomes were reported using the bone lid approach, though evidence-based studies were scarce.
PubMed: 35806950
DOI: 10.3390/jcm11133667 -
Journal of Endodontics Jun 1993Apical surgery is known to be an effective and practical way of treating endodontic failures. However, in spite of seemingly proper root end management, surgical...
Apical surgery is known to be an effective and practical way of treating endodontic failures. However, in spite of seemingly proper root end management, surgical failures may occur as a result of lateral canal, dentinal tubule, end retrograde leakage. Since surgical retreatment of such failures would likely result in failure, the alternative of a nonsurgical retreatment should be carefully considered. An understanding of the relationship which exists between the quality of the orthograde treatment and the surgical prognosis is necessary to properly direct the course of treatment.
Topics: Adult; Apicoectomy; Dental Fistula; Dental Pulp Cavity; Female; Humans; Middle Aged; Patient Care Planning; Prognosis; Reoperation; Retrograde Obturation; Root Canal Therapy; Treatment Failure
PubMed: 8228752
DOI: 10.1016/s0099-2399(06)80462-0 -
Clinical Case Reports Jan 2022At times, an infected tooth that may be deemed unrestorable may be salvaged by atraumatic removal, an in-hand apicoectomy and retrograde seal, then replantation. This...
At times, an infected tooth that may be deemed unrestorable may be salvaged by atraumatic removal, an in-hand apicoectomy and retrograde seal, then replantation. This patient was referred to this author for an extraction and implant treatment of the maxillary left second premolar. After a discussion, the patient preferred to salvage the tooth if possible. The tooth was successfully atraumatically removed, and an in-hand apicoectomy and retrograde amalgam seal was placed. The tooth was immediately replaced into its socket and was stable. The occlusal surface was flattened to prevent and off axial loading. A bis-acryl brace was applied to the facial and lingual aspect to prevent an overload while the tooth was healing. The patient was admonished to maintain a soft diet. After 3 weeks, the braces were removed, and the tooth was found to be stable. After 8 weeks, the tooth was asymptomatic, and the patient was able to revert to her normal diet without pain. While extraction, placing an apical seal and replantation of teeth is not a new modality; nonetheless, clinicians may need to be reminded of this procedure to increase the number of options presented to patients.
PubMed: 35106162
DOI: 10.1002/ccr3.5278 -
Medicina Oral, Patologia Oral Y Cirugia... Jul 2022A study is made of the findings of high-magnification rigid endoscopy at the root end surface following apicoectomy of teeth subjected to periapical surgery.
BACKGROUND
A study is made of the findings of high-magnification rigid endoscopy at the root end surface following apicoectomy of teeth subjected to periapical surgery.
MATERIAL AND METHODS
A cross-sectional study was made of patients subjected to periapical surgery at the Unit of Oral Surgery and Implantology (University of Valencia, Valencia, Spain) between 2011 and 2019. Following apicoectomy, the root end surfaces were inspected, with the evaluation of untreated canals, isthmuses, craze lines, crack lines, opaque dentin and gaps. Likewise, an analysis was made of the association between patient age and the tooth type and restoration and the presence of craze lines, cracks, opaque dentin and gaps.
RESULTS
The final sample consisted of 168 patients subjected to periapical surgery, with 177 operated teeth and 206 roots. Untreated canals were observed in 14 roots (6.8%). Isthmuses were identified in 74 roots (35.9%), particularly in the mesial root of the lower first molar (94.1%). In turn, craze lines were identified in 8.3% of the roots, cracks in 3.9%, and gaps in 53.4%. The prevalence of opaque dentin was 78.3%, with a greater presence in posterior teeth (90.3% in premolars and 86.2% in molars) than in anterior teeth (50.6%) (p<0.001). Patient age and tooth restoration showed no correlation to the studied parameters.
CONCLUSIONS
Craze lines and crack lines were observed in less than 10% of the roots, though opaque dentin was identified in 73% of the roots, particularly in posterior teeth, and gaps were found in over half of the canals.
Topics: Apicoectomy; Cross-Sectional Studies; Dental Pulp Cavity; Humans; Molar; Tooth Root
PubMed: 35660728
DOI: 10.4317/medoral.25311 -
Revista Cientifica Odontologica... 2021Interpretation of the state of healing of chronic apical periodontitis or apical curettage with apicoectomy in radiological images is based on the analysis of changes in... (Review)
Review
Interpretation of the state of healing of chronic apical periodontitis or apical curettage with apicoectomy in radiological images is based on the analysis of changes in the appearance of the periapical area and in the bone structure adjacent to the site of inflammation or surgical intervention, which are projected onto normal bone structures. However, distortion of structures or the superposition of anatomical images should be considered when interpreting radiographs. We compared conventional studies of evaluation of the periapical area following treatment, together with 2D images, with the periapical index and the criteria of evaluation in both successful and unsuccessful cases of endodontic surgical treatment. Some studies have reported that the radiographic appearance of the tooth crown and root may facilitate interpretation of the periapical area. In addition, cone-beam computed tomography can show the relationship between injured and repairing tissue using buccal and lingual tables to measure the periphery in transverse reconstruction. Indeed, complex biological events and mechanisms can occur during the healing process of periapical and root tissues. Knowledge of the diversity of tissues is essential to identify the dynamics of the signs of regeneration or the presence of healing due to repair. Hence, the aim of this article was to identify the criteria used to interpret periapical healing in two-dimensional or three-dimensional images and their relationship with diagnosis and treatment according to the literature currently available.
PubMed: 38463730
DOI: 10.21142/2523-2754-0904-2021-087