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Dawson VS, Fransson H, Isberg PE, Wigsten E. Further Interventions after Root Canal Treatment Are Most Common in Molars and Teeth Restored with Direct Restorations: A 10-11-Year Follow-Up of the Adult Swedish Population. J Endod 2024; 50:766-773. [PMID: 38492798 DOI: 10.1016/j.joen.2024.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 03/07/2024] [Accepted: 03/08/2024] [Indexed: 03/18/2024]
Abstract
INTRODUCTION The aims were to investigate 1) the frequency of nonsurgical retreatment, root-end surgery, extraction, and further restorative treatment during a follow-up of 10-11 years after root filling and compare the frequencies according to tooth group and type of coronal restoration and 2) the timing of nonsurgical retreatment, root-end surgery, and extraction. METHODS Data were collected from the Swedish Social Insurance Agency's register. A search for treatment codes identified teeth root filled in 2009 and the type of coronal restoration (direct, indirect, and unspecified) registered within 6 months of root filling. The root-filled teeth were followed 10-11 years, and further interventions were recorded. Descriptive statistics and chi-square tests were used for statistical analysis. RESULTS In 2009, root fillings were registered for 215,611 individuals/teeth. Nonsurgical retreatment, root-end surgery, and extraction were undertaken in 3.5%, 1.4%, and 20% teeth, respectively. The frequency of further interventions varied with respect to tooth group and type of coronal restoration, but only slightly for endodontic retreatments. Further interventions, except for root-end surgery, were registered more often for molars and directly restored teeth (P < .001). The majority of endodontic retreatments were undertaken within 4 years, while extractions were evenly distributed over 10-11 years. CONCLUSIONS The frequency numbers of nonsurgical retreatment and root-end surgery were low, despite 1 in 5 root-filled teeth registered as extracted. Further interventions were most common in molars and directly restored teeth. Endodontic retreatments were performed more often during the first 4 years.
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Affiliation(s)
- Victoria S Dawson
- Department of Endodontics, Faculty of Odontology, Malmö University, Malmö, Sweden.
| | - Helena Fransson
- Department of Endodontics, Faculty of Odontology, Malmö University, Malmö, Sweden
| | - Per-Erik Isberg
- Department of Statistics, Lund University School of Economics and Management, Lund University, Lund, Sweden
| | - Emma Wigsten
- Department of Endodontology, Institute of Odontology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Wei M, Tan S, Yu PTP, Kvist T, Yu VSH. A video-based decision aid improved knowledge and decreased decisional conflict for asymptomatic persistent endodontic lesions. Int Endod J 2024; 57:394-405. [PMID: 38251804 DOI: 10.1111/iej.14025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Revised: 11/27/2023] [Accepted: 01/08/2024] [Indexed: 01/23/2024]
Abstract
AIM This prospective cohort study aimed to (i) evaluate patients' treatment decisions, decisional conflict and knowledge levels before and after use of a video-based decision aid (DA) on asymptomatic persistent endodontic lesions (APEL) and to (ii) elicit important decision factors for patients in the decision-making process. METHODOLOGY A video DA modelled after the International Patient Decision Aids Standards (IPDAS) was designed. The video was pilot-tested, revised and used on 50 patients referred to the graduate endodontic clinic and presenting with an incidental finding of APEL detected on radiographs, with informed consent (DSRB 2020/00133). Recruitment was conducted from June 2020 to November 2021. Patients' treatment decisions and decision-making process were studied. Patients also completed a questionnaire on knowledge gain, decisional conflict and confidence levels. RESULTS Forty-three patients (48 teeth) out of 50 patients chose long-term monitoring of APEL while 7 patients (7 teeth) decided on endodontic intervention. Median knowledge scores increased from 58.3 (IQR: 41.7, 75.0) to 87.5 (IQR: 75.0, 100.0) (p < .001); median decisional conflict scale (DCS) scores decreased from 25.0 (IQR: 12.5, 34.4) to 3.1 (IQR: 0, 23.8) (p < .001), and 44 (88%) patients were confident or very confident with their treatment decisions. Statistical analyses showed that asymptomatic condition of tooth was the sole decision factor with statistical significance while socioeconomic factors (age, gender, race, education and income levels) showed no significant trend. CONCLUSIONS The majority of patients presenting with APEL in this study chose long-term monitoring over immediate intervention. Using the video-based DA in the decision-making process significantly improved patients' knowledge and decreased their decisional conflict levels.
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Affiliation(s)
- Mingrun Wei
- Khoo Teck Puat Hospital Dental Surgery, Singapore City, Singapore
| | - Shaoyong Tan
- Khoo Teck Puat Hospital Dental Surgery, Singapore City, Singapore
| | - Peter Tsao Pan Yu
- National University Hospital Singapore, Singapore City, Singapore
- National University Centre for Oral Health, Singapore City, Singapore
| | - Thomas Kvist
- Department of Endodontology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Victoria Soo Hoon Yu
- National University Hospital Singapore, Singapore City, Singapore
- Graduate Endodontics Residency Training Programme, Singapore City, Singapore
- Faculty of Dentistry, National University of Singapore, Singapore City, Singapore
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3
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Razdan A, Schropp L, Væth M, Kirkevang LL. Longitudinal study of endodontic and periapical status of an adult Danish population examined in 2009, 2014, and 2019: a repeated cohort study. Acta Odontol Scand 2024; 83:20-29. [PMID: 37874536 DOI: 10.1080/00016357.2023.2268699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 09/04/2023] [Accepted: 10/04/2023] [Indexed: 10/25/2023]
Abstract
OBJECTIVE To describe endodontic changes in an adult Danish population (C2;2009-2014-2019) and compare them with a similar cohort (C1;1997-2003-2008). MATERIAL AND METHODS A randomly selected cohort (C2) with three full-mouth radiographic examinations. The frequencies of teeth, apical periodontitis (AP), root filled teeth, and lost teeth in C2 were compared to a similar cohort (C1) using regression analyses; effect of age, cohort, and period was assessed. RESULTS C1 had 330 and C2, 170 participants (mean age, C1: 42.9; C2: 47.3 years, p < .001). The proportion of individuals with no AP was similar in C1 and C2 (p = .46). C2 had a higher proportion of individuals with no root filled teeth (p < .001) and no tooth loss (p = .02) than C1. The proportion of AP and root filled teeth increased with age in both cohorts. C2 had fewer root filled teeth and lost teeth, fewest lost teeth in the youngest age groups. CONCLUSIONS In C2, the prevalence of teeth with AP and root fillings increased with age, and few teeth were lost. Change in proportion of AP was similar in two cohorts; fewer root filled teeth and lost teeth in C2. The proportion of lost teeth in C2 showed cohort effect for older age groups.
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Affiliation(s)
- Ankur Razdan
- Section for Oral Radiology and Endodontics, Department of Dentistry and Oral Health, Aarhus University, Aarhus, Denmark.
| | - Lars Schropp
- Section for Oral Radiology and Endodontics, Department of Dentistry and Oral Health, Aarhus University, Aarhus, Denmark
| | - Michael Væth
- Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Lise-Lotte Kirkevang
- Section for Oral Radiology and Endodontics, Department of Dentistry and Oral Health, Aarhus University, Aarhus, Denmark
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Kirkevang LL. What does epidemiology tell us about treatment outcomes in endodontics. Int Endod J 2023; 56 Suppl 2:53-61. [PMID: 36254498 DOI: 10.1111/iej.13850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 10/13/2022] [Accepted: 10/14/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Available information on endodontic treatment outcome derives from clinical studies, of which the main part is observational with no randomization and little or no control of confounding factors. Several sources of bias may hamper the interpretation of results from observational studies if the problems are not addressed properly. OBJECTIVE The purpose of this narrative review is to describe and explain the potential benefits of employing epidemiological methodology when designing, conducting and reporting on observational, clinical outcome studies. DISCUSSION Epidemiology provides methodology that can be used to reduce the impact of several types of problems related to observational studies. These problems concern, external validity, which describes the generalisability of the study findings, and internal validity, which describe data quality parameters, such as selection bias, information bias and confounding. Furthermore reporting of a study should be systematized, and to that use, several checklists have been developed. CONCLUSION It can be concluded that epidemiological methods are important for conducting and interpretation of findings from clinical, observational studies in endodontology.
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5
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Fransson H, Dawson V. Tooth survival after endodontic treatment. Int Endod J 2023; 56 Suppl 2:140-153. [PMID: 36149887 DOI: 10.1111/iej.13835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 09/16/2022] [Accepted: 09/18/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND There are several measures that are, or could be, in use in relation to estimating the outcome of endodontic treatments. It is important to reflect on when and why a certain outcome measure is used; when caring for an individual patient it is obvious that the goal always should be a tooth in a healthy state, that is striving to remove any infection and aim for the tooth to have healthy periapical tissues. For patients in general and for society, it is also interesting to know if endodontic treatments will lead to retention of teeth in a functioning state. From epidemiological studies, with high prevalence of root filled teeth with periapical radiolucencies, it is implied that dentists and/or patients accept the retention of a root filled tooth with persistent apical periodontitis. In conjunction with an endodontic treatment the prognosis is considered and since the prognostic factors seem to be somewhat different depending on whether one is considering for example the outcome 'healthy periapical tissues' or 'tooth survival' they are equally important to know. Factors affecting the outcome 'healthy periapical tissues' probably has to do with removal of infection and reconstituting the barrier to prevent leakage whilst 'tooth survival' is more likely associated with factors outside of the classical endodontic field such as restorability and avoidance of further destruction of tooth substance. Objective This narrative review will focus on tooth survival after endodontic treatment and root canal treatment will be the focus. Method The search was performed in PubMed. Results As a crude estimation, there is to be an annual loss of 2% of teeth which have received a root canal treatment. Conclusion Of the pre-, peri- and postoperative factors that have been studied in conjunction with root canal treatments the restoration of the tooth is the factor that has been most extensively studied. Many studies imply that root filled teeth restored with indirect restorations have a better survival than teeth restored with direct restorations, it is not possible to determine whether this indeed is a prognostic factor. Registration None.
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Affiliation(s)
- Helena Fransson
- Department of Endodontics, Faculty of Odontology, Malmö University, Malmö, Sweden
| | - Victoria Dawson
- Department of Endodontics, Faculty of Odontology, Malmö University, Malmö, Sweden
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Thyvalikakath T, LaPradd M, Siddiqui Z, Duncan W, Eckert G, Medam J, Rindal D, Jurkovich M, Gilbert G. Root Canal Treatment Survival Analysis in National Dental PBRN Practices. J Dent Res 2022; 101:1328-1334. [PMID: 35549468 PMCID: PMC9516632 DOI: 10.1177/00220345221093936] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
Few studies have examined the longevity of endodontically treated teeth in nonacademic clinical settings where most of the population receives its care. This study aimed to quantify the longevity of teeth treated endodontically in general dentistry practices and test the hypothesis that longevity significantly differed by the patient's age, gender, dental insurance, geographic region, and placement of a crown and/or other restoration soon after root canal treatment (RCT). This retrospective study used deidentified data of patients who underwent RCT of permanent teeth through October 2015 in 99 general dentistry practices in the National Dental Practice-Based Research Network (Network). The data set included 46,702 patients and 71,283 RCT permanent teeth. The Kaplan-Meier (product limit) estimator was performed to estimate survival rate after the first RCT performed on a specific tooth. The Cox proportional hazards model was done to account for patient- and tooth-specific covariates. The overall median survival time was 11.1 y; 26% of RCT teeth survived beyond 20 y. Tooth type, presence of dental insurance any time during dental care, placement of crown and/or receiving a filling soon after RCT, and Network region were significant predictors of survival time (P < 0.0001). Gender and age were not statistically significant predictors in univariable analysis, but in multivariable analyses, gender was significant after accounting for other variables. This study of Network practices geographically distributed across the United States observed shorter longevity of endodontically treated permanent teeth than in previous community-based studies. Also, having a crown placed following an RCT was associated with 5.3 y longer median survival time. Teeth that received a filling soon after the RCT before the crown was placed had a median survival time of 20.1 y compared to RCT teeth with only a crown (11.4 y), only a filling (11.2 y), or no filling and no crown (6.5 y).
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Affiliation(s)
- T. Thyvalikakath
- Dental Informatics, Department of Cariology, Operative Dentistry & Dental Public Health, Indiana University School of Dentistry, Indianapolis, IN, USA
- Center for Biomedical Informatics, Regenstrief Institute, Inc., Indianapolis, IN, USA
| | - M. LaPradd
- Current affiliation: Syneos Health, Morrisville, NC, USA
- Department of Biostatistics and Health Data Science, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Z. Siddiqui
- Current affiliation: West Virginia University School of Pharmacy, Morgantown, WV, USA
- Dental Informatics, Department of Cariology, Operative Dentistry & Dental Public Health, Indiana University School of Dentistry, IUPUI, Indianapolis, IN, USA
| | - W.D. Duncan
- Current affiliation: University of Florida College of Dentistry, Gainesville, FL, USA
- Affiliation during study: Biomedical Data Science and Shared Resource, Roswell Park Cancer Center, Buffalo, NY, USA
| | - G. Eckert
- Department of Biostatistics and Health Data Science, Indiana University School of Medicine, Indianapolis, IN, USA
| | - J.K. Medam
- Dental Informatics, Department of Cariology, Operative Dentistry & Dental Public Health, Indiana University School of Dentistry, IUPUI, Indianapolis, IN, USA
- Current affiliation: ELLKAY, Elmwood Park, NJ, USA
| | - D.B. Rindal
- HealthPartners Institute, Minneapolis, Bloomington, MN, USA
| | - M. Jurkovich
- HealthPartners Institute, Minneapolis, Bloomington, MN, USA
| | - G.H. Gilbert
- National Dental Practice-Based Research Network, Department of Clinical and Community Sciences, School of Dentistry, University of Alabama at Birmingham, Birmingham, AL, USA
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Saydzai S, Buontempo Z, Patel P, Hasan F, Sun C, Akcalı A, Lin GH, Donos N, Nibali L. Comparison of the efficacy of periodontal prognostic systems in predicting tooth loss. J Clin Periodontol 2022; 49:740-748. [PMID: 35702014 PMCID: PMC9543611 DOI: 10.1111/jcpe.13672] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 05/11/2022] [Accepted: 05/18/2022] [Indexed: 12/14/2022]
Abstract
Aim The aim of this analysis was to assess how different tooth‐prognosis systems could predict tooth loss in a cohort of periodontitis patients followed up prospectively during supportive periodontal care (SPC). Materials and Methods Clinical and radiographic data of 97 patients undergoing regular SPC for 5 years were used to assign tooth prognosis using four different systems (McGuire & Nunn, 1996; Kwok & Caton, 2007; Graetz et al., 2011; Nibali et al., 2017). Three independent examiners assigned tooth prognosis using all four systems, following a calibration exercise. The association between prognostic categories and tooth loss was tested for each prognostic system separately and across prognostic systems. Results All four systems showed good reproducibility and could identify teeth at higher risk of being lost during 5 years of SPC; the risk of tooth loss increased with the worsening of tooth‐prognosis category (p < .0001). Although specificity and negative predictive values were good, low sensitivity and positive predictive values were detected for all systems. Conclusions Previously published periodontal prognostic systems exhibited good reproducibility and predictive ability for tooth retention. However, low sensitivity was detected, with several teeth in the worst prognosis category being retained at 5 years. Some modifications in the number of categories and their definitions are suggested.
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Affiliation(s)
- Selai Saydzai
- Periodontology Unit, Centre for Host-Microbiome Interactions, Dental Institute, King's College London, London, UK
| | - Zoe Buontempo
- Periodontology Unit, Centre for Host-Microbiome Interactions, Dental Institute, King's College London, London, UK
| | - Pankti Patel
- Periodontology Unit, Centre for Host-Microbiome Interactions, Dental Institute, King's College London, London, UK
| | - Fatemah Hasan
- Periodontology Unit, Centre for Host-Microbiome Interactions, Dental Institute, King's College London, London, UK
| | - Chuanming Sun
- Department of Periodontology, Faculty of Dentistry, Suzhou Health College, Suzhou, China
| | - Aliye Akcalı
- Department of Periodontology, Faculty of Dentistry, Dokuz Eylul University, Izmir, Turkey.,Centre for Oral Clinical Research, Barts and The London School of Medicine & Dentistry, Institute of Dentistry, Queen Mary University of London (QMUL), London, UK
| | - Guo-Hao Lin
- Department of Orofacial Sciences, School of Dentistry, University of California San Francisco, San Francisco, California, USA
| | - Nikos Donos
- Centre for Oral Clinical Research, Barts and The London School of Medicine & Dentistry, Institute of Dentistry, Queen Mary University of London (QMUL), London, UK
| | - Luigi Nibali
- Periodontology Unit, Centre for Host-Microbiome Interactions, Dental Institute, King's College London, London, UK
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8
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Pigg M, Brodén J, Fransson H, Vareman N. How do we and how should we deal with uncertainty in Endodontics? Int Endod J 2021; 55:282-289. [PMID: 34967026 PMCID: PMC9305865 DOI: 10.1111/iej.13679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 12/28/2021] [Indexed: 11/30/2022]
Abstract
In many clinical cases a dentist may feel certain when for example diagnosing, deciding on treatment, or assessing the prognosis—in other cases many dentists may feel a degree of doubt or uncertainty. This paper aims to explore the philosophical concept of uncertainty and its different dimensions, using the condition “persistent apical periodontitis associated with a previously root filled tooth” as an example. Acknowledging that uncertainty exists in any clinical situation can be perceived as uncomfortable, as some might regard it as a weakness. Whilst some types of uncertainty met in dental practice can be addressed and reduced, there are other types which are inevitable and must be accepted. To make sound decisions, it is pertinent that the dentist reflects on and values the consequences of uncertainty. In this paper, a conceptual model is presented by which the dentist can identify the type of uncertainty in a clinical case, making it possible to decide on a strategy on how to manage the uncertainty and its possible consequences, with the aim to support the dentist's care for their patients. The understanding that uncertainty exists and the ability to acknowledge and be comfortable with it when making decisions should be addressed throughout our professional career, and thus ought to be developed during undergraduate education. Some suggestions on how teachers could target this are given in the paper.
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Affiliation(s)
- Maria Pigg
- Department of Endodontics, Faculty of Odontology, Malmö University, Malmö, Sweden
| | - Joséphine Brodén
- Department of Oral Biology, Faculty of Odontology, Malmö University, Malmö, Sweden
| | - Helena Fransson
- Department of Endodontics, Faculty of Odontology, Malmö University, Malmö, Sweden
| | | | | | - Niklas Vareman
- Department of Medical Ethics, Lund University, Lund, Sweden
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9
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Göransson H, Lougui T, Castman L, Jansson L. Survival of root filled teeth in general dentistry in a Swedish county: a 6-year follow-up study. Acta Odontol Scand 2021; 79:396-401. [PMID: 33612053 DOI: 10.1080/00016357.2021.1887513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVE The purpose of the present study was to investigate the survival rate of root filled teeth in general dentistry in a Swedish county and to identify risk predictors with a significant influence on the survival rate. MATERIALS AND METHODS This is a retrospective 6-year follow-up study on 1642 recall patients with 1720 teeth root filled in general dentistry in the Public Dental Service in the county of Stockholm, Sweden. Background variables were collected from the database at baseline as potential predictors of tooth loss. The outcome variables were extraction during the 6-year follow-up period and the reason for the extraction. Stepwise Cox regression analysis was adopted in order to investigate the influence of the potential risk predictors on the risk for tooth extraction. RESULTS Nine percent of the root filled teeth were lost after 6 years. The most frequent reason for tooth loss was fracture and/or cracks (58%). The survival rate of the root filled teeth increased significantly for younger patients, root filled teeth with metal crowns (96%) and high quality of the root filling (93%). The survival rate differed significantly between tooth groups with the lowest survival for molars (83%). Composite fillings were significantly associated with lower quality of the root fillings. CONCLUSIONS Ninety-one percent of the root filled teeth survived after 6 years. The survival rate was significantly higher for teeth with root-fillings of high quality and metal crowns as well as for root filled teeth in younger patients. The lowest survival rate was found for molars.
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Affiliation(s)
- Helena Göransson
- Department of Endodontics, Public Dental Service at Eastmaninstitutet, Stockholm County Council, Stockholm, Sweden
| | - Tarek Lougui
- Department of Endodontics, Public Dental Service at Eastmaninstitutet, Stockholm County Council, Stockholm, Sweden
| | - Lennart Castman
- Public Dental Service, Stockholm County Council, Stockholm, Sweden
| | - Leif Jansson
- Department of Endodontics, Public Dental Service at Eastmaninstitutet, Stockholm County Council, Stockholm, Sweden
- Department of Dental Medicine, Division of Periodontology, Karolinska Institutet, Huddinge, Sweden
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10
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Fransson H, Bjørndal L, Frisk F, Dawson VS, Landt K, Isberg PE, EndoReCo, Kvist T. Factors Associated with Extraction following Root Canal Filling in Adults. J Dent Res 2021; 100:608-614. [PMID: 33402028 PMCID: PMC8138334 DOI: 10.1177/0022034520982962] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Essentially, root fillings are performed to preserve natural teeth. Over time, however, some root-filled teeth will inevitably be extracted. The aim of this historical prospective cohort study in the adult Swedish population was to identify factors associated with extractions within 5 y of registration of a root filling. The cohort consisted of all those whose root fillings had been reported to the tax-funded Swedish Social Insurance Agency (SSIA) in 2009. Demographic data on the individuals registered with a root filling (sex, age, country of birth, disposable income, educational level, and marital status) were received from Statistics Sweden or the SSIA. Dental care setting, tooth type, and any registration of subsequent restorations within 6 mo were received from the SSIA. Multivariable regression analysis was used, and P < 0.05 was considered statistically significant. In total, 216,764 individuals had been registered with at least 1 root filling. Individuals (n = 824) without complete data were excluded from the analyses. After 5 y, 9.3% of the root-filled teeth had been registered as extracted. Logistic regression analysis found significant associations for all variables except country of birth, disposable income, and educational level. The highest odds ratios for extractions were associated with the type of restoration: teeth with no registration of any restoration and teeth with a direct restoration combined with a post were 3 times more likely to undergo extraction than teeth restored with an indirect restoration combined with a post and core. Overall, high odds ratios for extractions were associated with any type of composite restoration, including composite fillings and crowns combined with or without any post. In summary, after root filling in the Swedish adult population, several individual- and tooth-specific variables were associated with extraction. The reasons for the extractions remain to be studied further.
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Affiliation(s)
- H Fransson
- Department of Endodontics, Malmö University, Malmö, Sweden.,Department of Endodontology, University of Gothenburg, Gothenburg, Sweden
| | - L Bjørndal
- Section of Clinical Oral Microbiology, Cariology and Endodontics, University of Copenhagen, Copenhagen, Denmark
| | - F Frisk
- Department of Endodontology, University of Gothenburg, Gothenburg, Sweden.,Institute for Postgraduate Dental Education, Jönköping, Sweden
| | - V S Dawson
- Department of Endodontics, Malmö University, Malmö, Sweden
| | - K Landt
- Department of Endodontics, Malmö University, Malmö, Sweden
| | - P-E Isberg
- Department of Statistics, Lund University School of Economics and Management, Lund University, Lund, Sweden
| | - EndoReCo
- Endodontic Research Collaboration in Scandinavia
| | - T Kvist
- Department of Endodontology, University of Gothenburg, Gothenburg, Sweden
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11
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Sadaf D. Survival Rates of Endodontically Treated Teeth After Placement of Definitive Coronal Restoration: 8-Year Retrospective Study. Ther Clin Risk Manag 2020; 16:125-131. [PMID: 32110030 PMCID: PMC7041432 DOI: 10.2147/tcrm.s223233] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Accepted: 01/27/2020] [Indexed: 11/23/2022] Open
Abstract
Introduction Preservation of endodontically treated teeth (ETT) depends upon several patient-related and operator-related factors. The objectives of this study were to assess the effects of different types of coronal restoration and delayed placement on ETT survival. Methods Data on dates of root canal treatment (RCT), restoration type, and extraction time of tooth, when applicable, were analyzed for all patients who underwent RCT from 2010 to 2018 at our institution. Inclusion Criteria Root canal-treated teeth with complete preoperative and postoperative radiographs; ETT that were restorable and received final permanent coronal restorations; no periodontal disease or crack detected during RCT; and ETT with acceptable RCT quality. Exclusion Criteria Patients who did not attend for follow-up, those had incomplete information available about the coronal restoration, and those with periodontally compromised teeth were excluded. ETT that involved any procedural error were also excluded. The teeth were categorized according to whether they underwent definitive coronal restoration 0–14 days, 15–59 days, or 60+ days after RCT. The statistical analysis was performed using SPSS version 25 (IBM Corp., Armonk, NY). The rate of survival of ETT of 8 years was estimated, and the differences between groups were determined after applying Kaplan–Meier statistics and log-rank tests. A multivariate Cox regression test and Wilcoxon (Gehan) statistics were computed to analyze the influence of different variables. A P-value <0.05 was considered as statistically significant. Results The type of restoration, opposing dentition, presence of a post, and dentistry training (year 4 or 5 students) showed significant effects on the survival of ETT (P ≤ 0.000). ETT which received crowns was 2.05 times more likely to need extraction than those in which a composite buildup was performed (hazard ratio [HR] 2.05; confidence interval [CI] 1.84–2.29; P ≤ 0.000). All composite buildups were performed within 14 days of completion of RCT. There was a significant correlation between the time of placement of the final coronal restoration and ETT survival (P ≤ 0.000). Extraction of ETT was 25% more likely (HR 0.25; CI 0.231–0.277) when the final coronal restoration was placed 15–59 days after completion of RCT and 73% more likely (HR 0.73; CI 0.655–0.814) when placed after 60 days than when placed at 0–14 days. Conclusion Timely placement of the final coronal restoration is found to be the most critical factor affecting the long-term survival of teeth after RCT.
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Affiliation(s)
- Durre Sadaf
- Conservative Dentistry Department, College of Dentistry, Qassim University, Qassim, Saudi Arabia.,Graduate Reading, Centre of Evidence-Based Medicine, University of Oxford, Oxford, UK
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12
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Danesh N, Ljunggren AC, Wolf E, Fransson H. Development of criteria for investigation of periapical tissue from root-filled teeth. Acta Odontol Scand 2019; 77:269-274. [PMID: 30623701 DOI: 10.1080/00016357.2018.1538534] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
OBJECTIVE To develop and assess a set of criteria to grade inflammation including relative area of inflammation in periapical lesions in endodontically treated teeth. MATERIAL AND METHODS A set of criteria was developed, encompassing data on: Lymphocytes, denoting chronic inflammation, were graded 0 (occasional) to 4 (heavy/dense inflammation). Polymorphonuclear cells, denoting acute inflammation, were graded 0 (none) to 2 (many). The third parameter, area of inflammation, that is, the relative area of the specimen that was inflamed, was graded 0 (none) to 4 (76-100%). The criteria were tested on 199 consecutive biopsies from 180 patients (aged 31-75 years). Information about symptoms was retrieved from the referrals. Mann-Whitney's U-test was used to calculate possible differences in average values for the histopathological variables in the two groups of patients: symptomatic or asymptomatic. RESULTS Using the criteria, varying grades of inflammation were seen in the biopsies. The majority showed few or no PMN cells. There was a correlation between symptoms and the extent of infiltration of lymphocytes and plasma cells (p = .001), PMN cells (p < .001) and the area of inflammation (p = .002): biopsies from the asymptomatic patients exhibited less pronounced and relatively smaller areas of inflammation. CONCLUSIONS Using the criteria on a specific selection of root-filled teeth with persisting apical periodontitis, periapical inflammation was common, but varied in extent and severity. The inflammation was less pronounced and affected a relatively smaller area in asymptomatic teeth, although outliers in both directions were identified.
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Affiliation(s)
- Noushin Danesh
- Department of Endodontics, Faculty of Odontology, Malmö University, Malmö, Sweden
| | | | - Eva Wolf
- Department of Endodontics, Faculty of Odontology, Malmö University, Malmö, Sweden
| | - Helena Fransson
- Department of Endodontics, Faculty of Odontology, Malmö University, Malmö, Sweden
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Jungnickel L, Kruse C, Vaeth M, Kirkevang LL. Quality aspects of ex vivo root canal treatments done by undergraduate dental students using four different endodontic treatment systems. Acta Odontol Scand 2018; 76:169-174. [PMID: 29082806 DOI: 10.1080/00016357.2017.1396494] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To evaluate factors associated with treatment quality of ex vivo root canal treatments performed by undergraduate dental students using different endodontic treatment systems. MATERIAL AND METHODS Four students performed root canal treatment on 80 extracted human teeth using four endodontic treatment systems in designated treatment order following a Latin square design. Lateral seal and length of root canal fillings was radiographically assessed; for lateral seal, a graded visual scale was used. Treatment time was measured separately for access preparation, biomechanical root canal preparation, obturation and for the total procedure. Mishaps were registered. An ANOVA mirroring the Latin square design was performed. RESULTS Use of machine-driven nickel-titanium systems resulted in overall better quality scores for lateral seal than use of the manual stainless-steel system. Among systems with machine-driven files, scores did not significantly differ. Use of machine-driven instruments resulted in shorter treatment time than manual instrumentation. Machine-driven systems with few files achieved shorter treatment times. With increasing number of treatments, root canal-filling quality increased, treatment time decreased; a learning curve was plotted. No root canal shaping file separated. CONCLUSIONS The use of endodontic treatment systems with machine-driven files led to higher quality lateral seal compared to the manual system. The three contemporary machine-driven systems delivered comparable results regarding quality of root canal fillings; they were safe to use and provided a more efficient workflow than the manual technique. Increasing experience had a positive impact on the quality of root canal fillings while treatment time decreased.
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Affiliation(s)
- Luise Jungnickel
- Section of Oral Radiology, Department of Dentistry and Oral Health, Aarhus University, Aarhus, Denmark
| | - Casper Kruse
- Section of Oral Radiology, Department of Dentistry and Oral Health, Aarhus University, Aarhus, Denmark
| | - Michael Vaeth
- Section for Biostatistics, Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Lise-Lotte Kirkevang
- Section of Oral Radiology, Department of Dentistry and Oral Health, Aarhus University, Aarhus, Denmark
- Department of Endodontics, Institute of Clinical Dentistry, Faculty of Dentistry, University Oslo, Oslo, Norway
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Prati C, Pirani C, Zamparini F, Gatto MR, Gandolfi MG. A 20-year historical prospective cohort study of root canal treatments. A Multilevel analysis. Int Endod J 2018; 51:955-968. [DOI: 10.1111/iej.12908] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Accepted: 02/06/2018] [Indexed: 01/26/2023]
Affiliation(s)
- C. Prati
- Endodontic Clinical Section; University of Bologna; Bologna Italy
| | - C. Pirani
- Endodontic Clinical Section; University of Bologna; Bologna Italy
| | - F. Zamparini
- Endodontic Clinical Section; University of Bologna; Bologna Italy
| | - M. R. Gatto
- Laboratory of Biomaterials and Oral Pathology; Dental School; Department of Biomedical and Neuromotor Sciences; University of Bologna; Bologna Italy
| | - M. G. Gandolfi
- Laboratory of Biomaterials and Oral Pathology; Dental School; Department of Biomedical and Neuromotor Sciences; University of Bologna; Bologna Italy
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Nibali L, Sun C, Akcalı A, Meng X, Tu YK, Donos N. A retrospective study on periodontal disease progression in private practice. J Clin Periodontol 2016; 44:290-297. [DOI: 10.1111/jcpe.12653] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/21/2016] [Indexed: 11/26/2022]
Affiliation(s)
- Luigi Nibali
- Centre for Oral Clinical Research; Institute of Dentistry; Barts and The London School of Medicine and Dentistry; Queen Mary University London (QMUL); London UK
| | - Chuanming Sun
- Department of Periodontology; Faculty of Dentistry; Suzhou Health College; Suzhou China
| | - Aliye Akcalı
- Centre for Oral Clinical Research; Institute of Dentistry; Barts and The London School of Medicine and Dentistry; Queen Mary University London (QMUL); London UK
| | - Xsuan Meng
- Institute of Epidemiology and Preventive Medicine; College of Public Health; National Taiwan University; Taipei Taiwan
| | - Yu-Kang Tu
- Institute of Epidemiology and Preventive Medicine; College of Public Health; National Taiwan University; Taipei Taiwan
| | - Nikos Donos
- Centre for Oral Clinical Research; Institute of Dentistry; Barts and The London School of Medicine and Dentistry; Queen Mary University London (QMUL); London UK
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Dawson VS, Petersson K, Wolf E, Åkerman S. Periapical Status of Root-filled Teeth Restored with Composite, Amalgam, or Full Crown Restorations: A Cross-sectional Study of a Swedish Adult Population. J Endod 2016; 42:1326-33. [PMID: 27452294 DOI: 10.1016/j.joen.2016.06.008] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Revised: 06/08/2016] [Accepted: 06/12/2016] [Indexed: 10/21/2022]
Abstract
INTRODUCTION The aim was to compare the periapical status of root-filled teeth restored with resin composite, laboratory-fabricated crowns, or amalgam in a Swedish adult population. METHODS The subjects consisted of 440 individuals from a randomly selected sample of 1000 adult residents of a Swedish county. The type, material, and quality of the restorations were recorded for all root-filled teeth by using clinical examination and intraoral clinical photographs. Periapical status, root-filling quality, and marginal bone loss were evaluated on panoramic radiographs. The association between periapical status and type, material, and quality of the restorations was analyzed by using the χ(2) test and logistic regression. RESULTS No difference in the frequency of apical periodontitis (AP) between teeth restored with resin composite, laboratory-fabricated crowns, or amalgam (29.7%, 26.2%, and 43.1%, respectively) of adequate quality was found. No association between AP and resin composite restorations was disclosed; however, there was an association between AP and inadequate root-filling quality and marginal bone loss >1/3 of the root length. CONCLUSIONS The results did not indicate any association between AP and resin composite restorations. Neither the type nor the material of the restoration was of significance for periapical status as long as the quality was adequate.
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Affiliation(s)
- Victoria S Dawson
- Department of Endodontics, Faculty of Odontology, Malmö University, Malmö, Sweden.
| | - Kerstin Petersson
- Department of Endodontics, Faculty of Odontology, Malmö University, Malmö, Sweden
| | - Eva Wolf
- Department of Endodontics, Faculty of Odontology, Malmö University, Malmö, Sweden
| | - Sigvard Åkerman
- Department of Orofacial Pain and Jaw Function, Faculty of Odontology, Malmö University, Malmö, Sweden
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