Impact of root canal preparation performed by ProTaper Next or Reciproc on the quality of life of patients: a randomized clinical trial

Influence of Root Canal Treatment on Oral-Health-Related Quality of Life (OHRQoL) in Saudi Patients: A Cross-Sectional Study

Objective This cross-sectional study aimed to assess the influence of root canal treatment on the oral-health-related quality of life (OHRQoL) of patients in the Kingdom of Saudi Arabia (KSA). The data on KSA's population are significantly limited, highlighting the significance of additional research to be carried out in this particular field. Methods The study was conducted at the dental clinics of the College of Dentistry, Qassim University, from January to June 2022. A total of 112 patients who had undergone endodontic therapy (ET) for teeth with irreversible pulpitis were included. Demographic data and treatment procedures were recorded. The patients' responses to the OHIP-14 questionnaire were analyzed to assess their OHRQoL. The scores were converted into qualitative categories (good, moderate, poor) for classification. Results The majority of patients (59.8%) reported a good OHRQoL after ET. Physical pain was the only variable where more than 50% of patients reported experiencing pain. Older age and smoking status were significantly associated with a poorer OHRQoL. However, no significant gender differences in OHRQoL were observed. Conclusion ET had a positive impact on the OHRQoL of patients in Saudi Arabia. The study highlights the importance of considering patient-centered outcomes, such as OHRQoL, in assessing the success of root canal treatment. Further research with longitudinal designs and randomized controlled trials is needed to better understand the long-term effects of root canal treatment on patients' OHRQoL and to compare them with other dental treatments.

Patient-related outcomes and Oral Health-Related Quality of Life in endodontics

There is increased interest in outcome measures that complement the classic goal of endodontics, being the prevention and healing of apical periodontitis. Possible outcome measures can be subdivided into patient-centred outcomes (PCOs), encompassing data collected by nonpatients aiming to assess the effectiveness of an intervention and patient-reported outcomes (PROs), which are reported directly by the patient. PROs can be subsequently classed into PRO measures that ascertain patients' view of their symptoms, their functional status, and their health-related quality of life, and patient-reported experience measures that focus on aspects including the humanity of care, patient satisfaction, patient preference and adherence, personal costs, expectation fulfilment, and decision regrets. The present review aims to define various patient-related outcomes and discuss the literature available regarding PCOs and PROs in endodontics. This includes those proposed to assess the effectiveness of endodontic treatment for pulpitis and apical periodontitis for use in the development of European Society of Endodontology S3-level clinical practice guidelines that have been included by all working groups, except for the radiographic assessment of apical periodontitis. Based on limited evidence in the field, it can be summarized that after recall periods of various lengths, endodontic treatment is associated with a high likelihood of tooth survival and limited need for further intervention, including extraction and further restorative procedures. Oral Health-Related Quality of Life (OHRQoL) is likely to improve following the completion of treatment. Nonetheless, the literature assessing the association between OHRQoL and endodontics is hampered by the use of instruments that have not been previously validated. Amongst the remaining outcome measures discussed in the present review, it is worth highlighting that there is only one study assessing exacerbations in teeth with the presence of endodontic pathosis, which suggests a very low incidence of this adverse effect following endodontic treatment. Patients' expectation fulfilment, adherence, and satisfaction are closely inter-related and depend also on various nonclinical factors. Further studies assessing PCOs and PROs, in association with healing and prevention of apical periodontitis, are required to better understand endodontic treatment from the perspective of patients.

DENTAL PATIENT-REPORTED OUTCOMES IN ENDODONTICS - A NARRATIVE REVIEW

Recently in oral health care settings, the focus of assessing treatment outcomes has shifted from the perspective of the clinician towards that of the patient. Endodontology is a specialty of dentistry concerned with the prevention and treatment of pulp and periapical diseases. Research in endodontology and its associated treatment outcomes have focused mainly on clinician-reported outcomes (CROs) and not dental patient-reported outcomes (dPROs). As a result, there is a need to emphasize the importance and relevance of dPROs to researchers and clinicians. The aim of this review is to present an overview of dPROs and dPROMs within endodontics in an attempt to create a better understanding of the patient experience, highlight the need to place the patient at the center of treatment, enhance patient care and encourage more research into dPROs. The key dPROs following endodontic treatment include pain, tenderness, tooth function, need for further intervention, adverse effects (exacerbation of symptoms, tooth discoloration) and Oral Health-Related Quality of Life. dPROs are important following endodontic treatment because they assist clinicians and patients when they discuss and select the most appropriate management options, help clinicians make decisions on pre-operative assessment, prevention and treatment, and improve the methodology and design of future clinical studies. Clinicians and researchers in endodontology should prioritize patient welfare and undertake routine analyses of dPROs using appropriate and robust measures. Due to the lack of agreement over the reporting and definition of endodontic treatment outcomes, a comprehensive project to define a ``Core Outcome Set for Endodontic Treatment Methods (COSET)'' is currently ongoing. In the future, a new and exclusive assessment tool should be developed to reflect the viewpoints of patients receiving endodontic treatment more accurately.

Patient discomfort levels during instrumentation procedure using nickel-titanium files with different kinetic movements

This study evaluated the perceived vibration, noise and discomfort levels associated with two nickel-titanium file systems with different kinetics; reciprocating motion (REC) using WaveOne Gold and continuous rotation motion (CON) using ProTaper NEXT. Forty roots with two canals from maxillary premolar and molar of 40 patients were included. Root canals were instrumented using each system for each canal. Patients were surveyed about the vibration, noise and discomfort experienced using visual analogue scale, and their preference. The responses were statistically analysed using Wilcoxon Signed-Rank test, Mann-Whitney U test and Spearman's rank correlation test at the 95% of significance level. The vibration, noise and discomfort experienced were significantly greater in REC than CON (P < 0.05). In REC, male subjects reported significantly higher vibration than female (P < 0.05). Majority respondents (72.5%) preferred the CON method. The perceived vibration, noise and discomfort were less apparent from the CON than the REC.

The effect of clinical interventions on the oral health-related quality of life in older adults

This paper reviews the literature to assess the effectiveness of oral health interventions in influencing oral health-related quality of life (OHRQoL) in older adults. Clinical studies published in 2010 onwards reporting oral health interventions in older adults and subsequent changes in OHRQoL were systematically searched in Medline, Web of Science and EMBASE databases. Reporting followed Preferred Reporting Items for Systematic Review and Meta-Analysis criteria. Eligibility evaluation and data abstraction from eligible studies were guided by predefined PICO questions and bias assessment by the Quality in Prognosis Studies tool. The search retrieved 144 articles. Of the 20 articles that met the eligibility criteria, 45% (9) reported a statistically significant improvement in OHRQoL. The majority of studies were conducted in adults with complete edentulism (70%) and mainly focused on implant provision to support a removable prosthesis (30%). The search indicates the limited scope of current literature on geriatric dental interventions, focusing mainly on denture realignments, denture fabrication and implant placement. Although the majority of the oral health interventions focused on edentulism and removable prostheses, there are many areas of oral health interventions and their potential impact on OHRQoL in this demographic group that have yet to be explored.

PROMs Following Root Canal Treatment and Surgical Endodontic Treatment

The FDI is currently working on developing a tool to encompass patient-reported outcome measures (PROMs) within the overall assessment of outcomes of endodontic treatment. The outcome of endodontic treatment has traditionally been determined by various clinical and radiographic criteria. However, these parameters do not address the impact of treatment on a patient's oral health-related quality of life (OHRQoL). OHRQoL, a crucial PROM, can be used to understand treatment outcome from a patient-centred perspective, thus improving clinician-patient communication whilst guiding decision-making. This focussed review aims to recount the OHRQoL of patients following nonsurgical root canal treatment and surgical endodontic treatment, with a specific focus on the minimal important difference (MID; the minimum score changes of an outcome instrument for a patient to register a clinically significant change in their OHRQoL and/or oral condition) and the methods used to determine it. The current evidence indicates that the OHRQoL of patients requiring root canal treatment is poorer than those without such need. Accordingly, the literature suggests that OHRQoL improves following nonsurgical or surgical endodontic treatment. However, study methodologies vary widely, and conclusions cannot be drawn with high confidence, nor can MID recommendations be provided. Well-designed clinical studies with baseline measurements and appropriate follow-up time frames are therefore needed. Despite that the literature is rife with outcome studies, research on PROMs is an area that deserves greater attention, particularly in relation to the MID. Determining the MID will facilitate the understanding of changes in outcome scores from the patients' perspective, thus allowing for more informed decision-making in clinical practice.

Present Status and Future Directions - Canal Shaping

This narrative review will focus on the evolution, present and future of engine‐driven root canal preparation. Root canal preparation changed drastically when Walia in 1988 introduced the use of nickel‐titanium (NiTi) alloys in Endodontics. In 2013, five generations of NiTi endodontic instruments had been established based on their metallurgical, mechanical properties and design features. Since then, manufacturers have been introducing further major changes in instrument design and characteristics that have not been translated in new recognized generations of instruments. In general, those changes have demonstrated enhanced instrument properties, but it is not clear yet if all those improvements are directly translated to an improvement in clinical success. This narrative review attempts to address the present status of engine‐driven instruments in terms of both evidence from laboratory‐based studies and clinical data, to identify potential further generations of instruments, and last to anticipate future directions for research and development.

Oral health-related quality of life (OHRQOL) of preschool children's anterior teeth restored with zirconia crowns versus resin-bonded composite strip crowns: a 12-month prospective clinical trial

OBJECTIVES

To compare oral health-related quality of Life (OHRQOL) of preschool children's anterior teeth restored with prefabricated zirconia crowns (ZC) versus resin-bonded composite strip crown (RCSC).

MATERIALS AND METHODS

A prospective clinical trial included 136 children with early childhood caries aged 36-71 months who were assigned into prefabricated ZC and RCSC groups. A total of 344 teeth were restored either with 170 ZCs (49.4%) and 174 RCSCs (50.6%). Wilson and Cleary's conceptual model was to associate the study predictors to the OHRQOL. Early Childhood Oral Health Impact Scale (ECOHIS) was used to assess the OHRQOL at 6 and 12 months. Mann-Whitney U test was used in comparing OHRQOL mean scores in the two groups and Wilcoxon signed-rank test with the effect size (r) to measure the intragroup OHRQOL change. A Poisson regression model was used to study potential risk factors associated with the overall OHRQOL.

RESULTS

After 12 months, the USPHS parameters of the ZC were significantly superior compared to the RCSC. Overall ECOHIS mean scores in the ZC group were significantly lower than that of the RCSC group at T₁ and T₂ (p < 0.001). Remarkable enhancement of the OHRQOL at the follow-ups with a large effect size (r < 0.8) was observed. Restoration type, retention, baseline OHRQOL, and color had a significant impact on the overall OHRQOL at 12 months.

CONCLUSIONS

Preschool children OHRQOL treated with ZC were significantly better than those who received RCSC.

CLINICAL RELEVANCE

One of the optimum treatment standards in pediatric dentistry is the esthetic demand which has significance on the child's OHRQOL and subsequently child's general health quality of life. It is beneficial to the dentist to identify the influence of esthetic restorations on the OHRQOL of preschool children which aids in future decision-making. The longitudinal nature of the study enables the dentist to identify the changes of children's OHRQOL.

Assessment of postoperative pain after single-visit root canal treatment using rotary and reciprocating file systems: an in vivo study

Background

Various instrument kinematics used in single-visit endodontics influence the occurrence of pain after endodontic therapy. This study aimed to evaluate the occurrence of pain after mechanical instrumentation with Hyflex EDM (HEDM) and WaveOne Gold (WOG) during single-visit endodontic therapy.

Methods

Sixty patients diagnosed with asymptomatic irreversible pulpitis and normal apical tissues in mandibular premolar teeth were included in the study for single-visit root canal therapy. The patients were divided into two groups (n = 30) according to the rotary instrument used during root canal preparation (group A [HEDM] and group B [WOG]). Pain was evaluated after endodontic therapy at 8, 24, and 48 h intervals using the visual analog scale (VAS). Data obtained were analyzed using the chi-square test, independent t-test, MannWhitney U test, and Wilcoxon matched-pairs test.

Results

Statistically significant differences were observed between the two groups (P < 0.001) at 8, 24, and 48 h, with WOG exhibiting less pain than HEDM files.

Conclusion

Postoperative pain was lower in the WOG file system than in the HEDM file system after single-visit root canal therapy at 8, 24, and 48 h.

A critical appraisal of research methods and experimental models for studies on root canal preparation

It is the aim of this review to present a critical overview and summary on the contemporary possibilities, limitations and challenges of research related to root canal preparation. Frequently used research tools and contemporary research designs will be presented and discussed critically focussing on shortcomings and benefits with special regard to clinical relevance and scientific evidence. A plethora of experimental set-ups for assessing the shaping of root canals have been described in the endodontic literature using a considerable number of techniques and instruments. Nevertheless, it can be stated that scientific evidence demonstrating the clinical impact of many investigated topics is questionable or even missing. Instead of technical, radiographic and geometrical parameters, further research should focus on biological aspects and clinical evidence of the impact of root canal preparation on the outcome of root canal treatment.

Retreatment of Experimental Carrier-Based Obturators with the Remover NiTi Instrument: Evaluation of Apical Extrusion and Effects of New Kinematics

The objective of this study is to evaluate the retreatment time and weight of apically extruded debris yielded by two different kinematics during the removal of different root canal filling materials. Forty straight single-rooted extracted teeth were instrumented with HyFlex CM files and obturated with two different techniques: 25.04 HyFlex experimental carrier-based obturators (Coltène/Whaledent, Altstätten, Switzerland) (group 1) or 25.04 single gutta-percha cones (Roeko Coltène/Whaledent, Altstätten, Switzerland) (group 2) and Guttaflow Bioseal as the sealer. Samples were divided into four subgroups (n = 10) according to the used kinematics for the removal of root canal filling materials: continuous rotation (A) or retreatment motion (B) with a Remover and HyFlex EDM Nickel-Titanium instruments activated with a CanalPro Jeni micromotor (Coltène/Whaledent, Altstätten, Switzerland). Time for retreatment was digitally recorded, and debris extruded from the apex was collected in Eppendorf tubes and weighted with an analytical balance. Data on retreatment time and apical extrusion were statistically analyzed with the Kruskal–Wallis test (p < 0.05). Working length was achieved in all the retreated samples. The removal of root filling material resulted significantly faster with the Jeni mode (p < 0.001), and the difference was significant for the removal of both filling materials (p < 0.05). No significant differences on debris extrusion between single cone and experimental obturators groups were noted (p > 0.05), and no significant differences between kinematics (continuous rotation vs. Jeni motion) were observed (p > 0.05). All the tested retreatment strategies lead to an extrusion of material from the apex, and the weight of apically extruded debris was similar. The use of the innovative CanalPro Jeni kinematics accelerates the time for the removal of root filling materials.

Shaping Ability and Debris Extrusion of New Rotary Nickel-Titanium Root Canal Instruments

The aim was to evaluate the canal straightening and the amount of apically extruded debris associated with five rotary nickel-titanium when preparing curved root canals. A total of 100 root canals in extracted human teeth (angles of curvatures 20°–30°; radii 5.9–13.5 mm) were divided into five groups (n = 20/group). The groups were balanced with respect to the angle and the radius of canal curvature. The root canals were prepared using conventional austenite 55-NiTi alloy instruments F360, F6 SkyTaper (both Komet, Lemgo, Germany), and the heat-treated NiTi Jizai, Silk-Complex and Silk-Standard instruments (all Mani, Tochigi, Japan) to an apical size 25. The amount of extruded debris was assessed with a micro balance. Statistical analysis was performed using Kruskal–Wallis test with Bonferroni correction at a significance level of p < 0.05. During canal preparation, neither instrument fractures nor procedural preparation errors were noticed. Regarding canal straightening, the use of Jizai instruments resulted in the significantly lowest straightening (p < 0.05), while no significant differences were obtained between all other groups (p > 0.05). Regarding the amount of apically extruded debris, no significant differences between all groups were obtained (p > 0.05). Within the limitations of this study, all instruments performed well, and especially the Jizai instruments showed an excellent shaping ability.

Effect of Rotary and Reciprocating Instrumentation Motions on Postoperative Pain Incidence in Non-Surgical Endodontic Treatments: A Systematic Review and Meta-Analysis

OBJECTIVE

A systematic review and meta-analysis were conducted to determine whether there are postoperative pain differences resulting from rotary and reciprocation engine-driven instrumentation motions in non-surgical endodontic treatment or retreatment at 12, 24, and 48 hours.

METHODS

Four electronic databases (PubMed, Embase, Cochrane Library, and Scopus) were searched to identify randomised controlled trials that compared the effects of rotary and reciprocating instrumentation motions on postoperative pain. Two authors independently screened the search results, extracted the data, and assessed the quality using the Cochrane risk of bias tool. Due to numerous variables across studies, the random effect inverse variance method for meta-analysis was applied. When significant heterogeneity among studies was present, the random effects multi-variable meta-regression analysis was performed to determine the source of heterogeneity.

RESULTS

At all time intervals, the incidence of postoperative pain was higher in the reciprocating instrumentation group, but was not statistically significant. There was no significant difference in the analgesic intake between groups. Meta-regression analysis determined study population sizes as a significant heterogeneous factor, while significance was not observed for preoperative pain or the pulpal diagnosis.

CONCLUSION

There was no difference in postoperative pain at 12, 24, and 48 hours after non-surgical root canal treatment and retreatment, using reciprocating or rotary instrumentation motions.

Impact on Quality of Life of Patients Treated by Different File Systems for Root Canal Treatment

Introduction The outcomes of oral health conditions and therapy for those conditions are described by the term “oral health-related quality of life.” Oral health-related quality of life is recognized by the World Health Organization as an important part of the Global Oral Health Program. The study aims to compare the impact of three root canal preparation systems on patients’ quality of life and correlate postoperative pain with the impact on the quality of life.

Materials and Methods A survey was performed in which 90 patients were randomly assigned to three groups based on the root canal preparation system: (1) ProTaper Gold (Dentsply, Tulsa Dental Specialties, Tulsa, Oklahoma, United States), (2) Neoendo flex (Neoendo, India), and (3) Hyflex EDM/CM (Coltene Whaledent) that included 30 participants in each group. Data collection included the implementation of a demographic data questionnaire, Oral Health Impact Profile 14 (quality of life), and visual analogue scale(pain). The questionnaire was given after root canal treatment in the first 24 hours. The data obtained were statistically analyzed.

Results No significant differences were found in the quality of life among study groups. Group 1 demonstrated a highly significant difference in the postoperative pain with p value of 2.67.

Conclusion Within the limitations of the present study, Protaper Gold showed a highly significant difference in postoperative pain when compared with other file systems. No significant differences were found in the quality of life among the study groups.

The impact of two root canal treatment protocols on the oral health-related quality of life: a randomized controlled pragmatic clinical trial

AIM

To assess the impact of two root canal treatment protocols on the oral health-related quality of life (OHRQoL) of patients in need of root canal treatment on their anterior teeth.

METHODOLOGY

The sample consisted of 120 participants (mean age: 34 years) enrolled in a pragmatic randomized clinical trial evaluating two root canal treatment protocols. Anterior teeth with nonvital pulps were allocated for root canal preparation with either hand files and filled with lateral compaction of gutta-percha (manual protocol) or canal preparation with a single file in a reciprocating movement and filled with a single cone technique (Reciproc protocol). OHRQoL data were assessed using the Oral Health Impact Profile instrument (OHIP-14), which was administered before the root canal intervention (baseline), and 6 and 12 months after treatment. Demographic and clinical characteristics of participants were collected at baseline. Data were analysed using bivariate analyses, Poisson univariate and multiple regression (α = 0.05).

RESULTS

The drop-out rate from baseline was 27% and 28% at 6 and 12 months after treatment, respectively. Both root canal protocols significantly enhanced patients' OHRQoL, regardless of the follow-up time (P < 0.001). After 6 months, patients treated with the Reciproc protocol had significantly lower OHIP-14 overall scores (P = 0.030), as well as significantly lower scores for psychological discomfort (P = 0.031) and social disability (P = 0.013). After 12 months, no significant difference was observed between the two root canal protocols for OHIP-14 overall scores (P = 0.174). Either large or moderate effect sizes were observed for all domains and overall scores at both evaluation times, irrespective of the protocol. Low-income persons (RR = 2.03) and the Reciproc protocol (RR = 1.52) had a higher likelihood of a positive impact on OHRQoL 12 months after root canal treatment.

CONCLUSIONS

The two root canal protocols improved the OHRQoL and differences in scores were observed only after 6 months with poorer OHRQoL for the manual protocol. After 12 months, patients with low-income status and treated with Reciproc were associated with a greater improvement in OHRQoL scores.