Radiographic and Clinical Findings of Single-Visit Root Canal Treatments with Apical Enlargement in Necrotic Teeth: A Retrospective Cohort Study

Effect of different obturation techniques on treatment results in single-visit non-surgical endodontic retreatment: randomized controlled clinical study

BACKGROUND

Evaluating the effect of different obturation techniques on postoperative pain level and radiographic healing on non-surgical endodontic retreatment (NSER) applied in a single visit in teeth with a single root canal and apical periodontitis (AP).

MATERIALS AND METHODS

Sixty-three teeth from 50 systemically healthy patients (mean age 34.19 ± 9.75 years; 27 women, 23 men) were included in the study. Residual root canal filling materials were removed. All teeth were randomly divided into three groups according to the obturation technique: cold lateral compaction (CLC), continuous wave compaction (CWC), and thermoplasticized gutta-core (TGC). Pain status was evaluated using the Numerical Pain Rating Scale (NRS) in all cases. Periapical index (PAI) scores were recorded in preoperative and postoperative 6-month on the periapical radiographs. Data were analyzed as statistically (IBM, Armonk, NY, USA). The significance level was determined as p < 0.05.

RESULTS

It was found that more postoperative pain occurred in the 3rd-hour interval after CLC and CWC compared to the 7th-day interval (p < 0.05). There was no difference in postoperative pain between obturation techniques in all evaluated time intervals (p > 0.05). There was no difference in the PAI scores recorded at six months between obturation techniques for all periods (p > 0.05). Similar radiographic improvement was observed in all obturation techniques at 6-months (p > 0.05).

CONCLUSION

CLC, CWC, and TGC root canal obturation techniques were found to have similar efficacy after NSER in a single visit in teeth with AP at six months.

TRIAL REGISTRATION

The research was retrospectively registered on the website www.

CLINICALTRIALS

gov with the registration number NCT06226740 on 26/01/2024.

Outcome of Nonsurgical Root Canal Retreatment of Teeth with Persistent Apical Periodontitis Treated with Foraminal Enlargement and 2% Chlorhexidine Gel: A Retrospective Cohort Study

INTRODUCTION

Nonsurgical root canal retreatment (NS-RCRT) becomes necessary when primary endodontic procedures fail. This study evaluates the efficacy of NS-RCRT using 2% chlorhexidine gel and foraminal enlargement techniques, aiming to assess whether these approaches enhance periapical healing outcomes and success rates compared to traditional NS-RCRT techniques reported in the literature.

METHODS

This retrospective cohort study analyzed 120 teeth diagnosed with persistent apical periodontitis, from 80 patients who underwent NS-RCRT between January 2014 and December 2018 at a specialist's private practice. Data were collected following the Preferred Reporting Items for Observational Studies in Endodontics 2023 guidelines. Periapical healing was evaluated using digital periapical radiographs by three calibrated examiners. The outcome of the treatment was analyzed through descriptive statistics and bivariate analyses, including the Chi-Square and Fisher's Exact tests. Treatment outcomes were deemed successful if they showed complete or incomplete repair and unsuccessful if no repair was observed.

RESULTS

The average follow-up period was 30 months. Under loose criteria, 92.50% (n = 111) of the teeth were categorized as successful, and 7.5% (n = 9) as unsuccessful. Bivariate analysis indicated that the radiographic restoration of apical transportation was the only factor that significantly influenced the outcome.

CONCLUSIONS

NS-RCRT performed in a single visit using the foraminal enlargement technique and 2% chlorhexidine gel demonstrated high success rates and may be an effective alternative to tooth extraction. This method promoted periapical healing and could significantly improve NS-RCRT protocols. Further prospective studies are recommended to corroborate these findings.

Postoperative pain after single-visit root canal treatments in necrotic teeth comparing instruments' kinematics and apical instrumentation limits - a prospective randomized multicenter clinical trial

OBJECTIVES

This prospective randomized multicenter clinical trial (PRMCT) investigated postoperative pain after single-visit root canal treatments in teeth affected by pulp necrosis (PN), and asymptomatic apical periodontitis (AAP) (with apical radiolucent areas) or normal periradicular tissues (without apical radiolucent areas) comparing different instruments' kinematics and apical instrumentation limits.

METHODS

Before chemomechanical preparation, 240 patients/teeth were randomly distributed into four groups (n = 60) according to the instruments' kinematics (rotary or reciprocating) and apical instrumentation limits (with or without intentional foraminal enlargement [IFE]). After that, specimens were submitted to the same irrigation and obturation techniques, and the patients were referred to undergo the definitive restorations. No medication was prescribed, but the patients were instructed to take either paracetamol (750 mg every 6 h for three days) or ibuprofen (600 mg every 6 h for three days) in pain cases. Postoperative pain incidence and levels were assessed at 24-, 48-, and 72 h following treatment completion according to a verbal rating scale (VRS) following a score. The Kolmogorov-Smirnov test was applied to assess the normality of the data. Mann-Whitney U, Chi-square, Friedman's ANOVA, and Friedman's multiple 2 to 2 comparison tests were employed to identify potential significant statistical differences among the variables in the study groups (P < .05).

RESULTS

Significant statistical differences were only observed among the groups considering tooth, periradicular status, and the occurrence of overfilling (sealer extrusion) (P < 0.00). Patients with teeth instrumented through rotary kinematics and without IFE experienced lower rates of postoperative pain; however, this difference was relevant only at 24 h (P < 0.05).

CONCLUSIONS

Postoperative pain was lower after using a rotary file system (Profile 04) inserted up to the apical constriction (AC). However, this finding was just statistically meaningful at 24 h.

TRIAL REGISTRATION

This PRMCT was approved by the Human Research Ethics Committee of the Paranaense University - UNIPAR, Francisco Beltrão, PR, Brazil (CAAE. 46,774,621.6.0000.0109) on 02/09/2021. It was registered at The Brazilian Registry of Clinical Trials - ReBEC (RBR-3r967t) on 01/06/2023, was performed according to the Principles of the Helsinki Declaration and is reported following the Consolidated Standards of Reporting Trials Statement.

Outcome of root canal treatment of teeth with chronic apical periodontitis treated with foraminal enlargement and 2% chlorhexidine gel: a retrospective cohort study

INTRODUCTION

This retrospective cohort study aimed to estimate the success rate (SR) of primary root canal treatment on teeth with a diagnosis of pulp necrosis (PN) and asymptomatic apical periodontitis (AAP) when using 2% chlorhexidine gel as an auxiliary chemical substance (ACS) and foraminal enlargement instrumentation technique.

METHODS

This study evaluated 178 patients with 206 teeth submitted to primary root canal treatment performed by graduate residents in endodontics. The inclusion criteria were patients who underwent treatment over a period of 1 to 7 years on teeth with a diagnosis of PN and AAP. The SR was evaluated clinically and radiographically and categorized considering strict' (complete resolution of periradicular lesion) or 'loose' (reduction in the size of existing periradicular lesion) criteria. Cases of clinical and/or radiographical absence of repair were classified as a failure. Two calibrated examiners independently assessed treatment outcomes using the ImageJ software.

RESULTS

The SR were 81.1% (95% CI: 75.7% - 86.4%) and 87.4% (95% CI: 82.8% - 91.9%) when considering the 'strict' or 'loose' criteria, respectively. Females had a higher SR when strict criteria were applied. Also, the SR was significantly reduced when there was an increase in the patient's age.

CONCLUSION

Within the limitations of this study, it was found that teeth with a diagnosis of PN and AAP and treated associating the use of 2% chlorhexidine gel and foraminal enlargement achieved substantial SR. Gender and age were prognostic factors that played a significant role in the SR. Future randomized controlled trials should further investigate the effects of foraminal enlargement and 2% chlorhexidine gel as an ACS.

The effect of periapical lesion size on the success rate of different endodontic treatments: a systematic review and meta-analysis

INTRODUCTION

This systematic review evaluated the effect of periapical lesion (PL) size on the success rate of different endodontic treatments, including root canal treatment (RCT), non-surgical retreatment (NSR), and apical surgery (AS).

METHODS

Cohorts and randomized controlled trials investigating the outcomes of endodontic treatment of permanent teeth with PL and its size were identified electronically through Web of Science, MEDLINE, Scopus, and Embase databases. Two reviewers independently conducted the study selection, data extraction, and critical appraisal process. The quality of the included studies was evaluated using the Newcastle-Ottawa Scale and the 11-item Critical Appraisal Skills Program checklist for randomized controlled trials. The success rates of the endodontic treatments (small lesions and large lesions) were estimated using the rate ratios (RRs) with an associated 95% confidence interval (CI).

RESULTS

Out of 44 included studies, 42 were cohort, and 2 were randomized controlled trials. Thirty-two studies had poor quality. For the meta-analysis, five studies in RCT, 4 in NSR, and 3 in AS were considered. The RR of the endodontic treatment success in PLs was 1.04 in RCT (95% CI, 0.99-1.07), 1.11 in NSR (95% CI, 0.99-1.24), and 1.06 in AS (95% CI, 0.97-1.16). Only sub-group analysis of long-term follow-up of RCT showed a significantly higher success rate in small lesions than in large lesions.

CONCLUSIONS

Considering the quality of studies and variation in outcomes and size classification, our meta-analysis demonstrated that the PL size had no significant effect on the success rate of different endodontic treatments.

The Effect of Speed and Rotation for Protaper File Systems on Postobturation Pain in a Single Visit and Multiple (Two) Visits in Root Canal Therapy: An In Vivo Study

INTRODUCTION

The basic idea of a root canal treatment is to alleviate the pain and heal the infection within the infected tooth, which can be resolved in a single visit or multiple visits in root canal therapy. Therefore, in this article, an in vivo comparison of single visits and multiple visits using different rotation and speed for two Protaper universal design file systems is done on the basis of time taken and incidence of pain.

MATERIALS AND METHODS

One hundred single-rooted premolars with irreversible symptomatic pulpitis were assigned to two groups of 50 patients each using the odd-even method, GA to be treated endodontically in a single visit and GB to be treated endodontically in multiple visits. Each group was further divided into two subgroups of 25 patients each on the basis of two different variations of speed and rotation for two Protaper file systems of the same design, GA1 (Hand Protapers) and GA2 (Rotary Protapers), GB1 (Hand Protapers) and GB2 (Rotary Protapers), respectively. After proper biomechanical shaping and cleaning, obturation was done with Gutta-percha cones and Ah plus sealer using Fast Pack obturation pen for warm vertical compaction. The pain was measured by a 100 mm modified visual analogue scale, and time was measured using a stopwatch.

RESULTS

At 6-h intervals, post-obturation pain was more in single-visit root canal therapy than multiple-visit root canal therapy (P < 0.01). Single-visit rotary Protaper (GA2) had less incidence of post-obturation pain as compared with single-visit hand protapers (GA1) (P < 0.05). There was no significant difference in post-obturation pain in the multiple-visit hand protaper subgroup (GB1) and multiple-visit rotary protaper subgroup (GB2) (P > 0.05). Preoperative pain significantly influences the post-obturation pain. The statistical analysis was done using SPSS (Statistical Package for Social Sciences) version 17.0 statistical Analysis Software.

CONCLUSIONS

The presence of preoperative pain can significantly influence the presence of postoperative pain. Most of the pain in both single-visit and multiple-visits root canal therapy occurred in the first 48 h after obturation, which decreases thereafter. Single-visit rotary protaper (GA2) had less incidence of post-obturation pain as compared with single-visit hand protapers (GA1). There was no significant difference in post-obturation pain in the multiple-visit hand protaper subgroup (GB1) and multiple-visit rotary protaper subgroup (GB2). Presence of sealer puff influences the duration of pain.