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Smith R, Drummond K, Lovell A, Ng YL, Gulabivala K, Bryce G. A comparison of radiographically determined periapical healing and tooth survival outcomes of root canal (re)treatment performed in two care pathways within the United Kingdom Armed Forces. Int Endod J 2024; 57:667-681. [PMID: 38512015 DOI: 10.1111/iej.14060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Revised: 02/10/2024] [Accepted: 02/23/2024] [Indexed: 03/22/2024]
Abstract
AIMS To compare radiographic periapical healing and tooth survival outcomes of root canal (re)treatment performed within two care pathways (Routine Dental Care and Referred Treatment Pathway), in the United Kingdom Armed Forces (UKAF), and determine the effects of endodontic complexity on outcomes. METHODOLOGY This retrospective cohort study included 1466 teeth in 1252 personnel who received root canal (re)treatment between 2015 and 2020. General Dental Practitioners treated 661 teeth (573 patients) (Routine cohort), whilst Dentists with a Special Interest treated 805 teeth (678 patients) (Referred cohort). The latter group were graduates of an MSc programme in Endodontics with 4-8 years of postgraduation experience. Case complexity was retrospectively determined for each tooth using the endodontic component of Restorative Index of Treatment Need (RIOTN) guidelines. Periapical healing was determined using loose radiographic criteria. The data were analysed using chi-square tests, univariate logistic regression and Cox proportional hazards models. RESULTS A significantly (p < 0.0001) larger proportion of cases of low complexity had undergone root canal treatment within the Routine versus Referred cohort. The odds of periapical healing was significantly higher within the Referred versus Routine cohort, regardless of analyses using pooled (OR = 1.17; 95% CI: 1.11, 1.22) or moderate complexity (OR = 4.71; 95% CI: 2.73, 8.11) data. Within the Routine cohort, anterior teeth had higher odds of periapical healing than posterior teeth (OR = 1.13; 95% CI: 1.04, 1.22). The 60-month cumulative tooth survival was lower (p = 0.03) in the Routine (90.5%) than the Referred (96.0%) cohort. Within the Routine cohort, the hazard of tooth loss was higher amongst posterior teeth (HR = 4.03; 95% CI: 1.92, 8.45) but lower if posterior teeth had cast restorations (HR = 0.36; 95% CI: 0.19, 0.70). For the Referred cohort, posterior teeth restored with cast restoration (vs not) had significantly lower risk of tooth loss (HR = 0.21; 95% CI: 0.08, 0.55). CONCLUSIONS For UKAF patients, root canal (re)treatment provided within the Referred pathway was significantly more likely to achieve periapical healing and better tooth survival than those provided within the Routine pathway. Posterior teeth restored with an indirect restoration had a higher proportion of tooth survival. This study supported the utility of the endodontic component of RIOTN for assessing case complexity.
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Affiliation(s)
- Robert Smith
- Defence Centre for Rehabilitative Dentistry, Defence Primary Healthcare, Aldershot, UK
| | - Karl Drummond
- Defence Centre for Rehabilitative Dentistry, Defence Primary Healthcare, Aldershot, UK
| | - Alistair Lovell
- Defence Centre for Rehabilitative Dentistry, Defence Primary Healthcare, Aldershot, UK
| | - Yuan-Ling Ng
- UCL Eastman Dental Institute, University College London, London, UK
| | | | - Graeme Bryce
- Defence Centre for Rehabilitative Dentistry, Defence Primary Healthcare, Aldershot, UK
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Smith RB, Bryce GE, Ng Y, Gulabivala K, Dermont MA. Eight-year retrospective study investigating tooth survival after primary non-surgical root canal treatment in a UK military cohort. BMJ Mil Health 2024; 170:107-111. [PMID: 35788109 DOI: 10.1136/bmjmilitary-2021-002042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 05/19/2022] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Root canal treatment (RCT) plays an important role in preserving the dentition by deferring other invasive treatments. Data on tooth survival and predictive factors for tooth loss after RCT in the military cohort are lacking. This investigation aimed to determine the proportion of teeth surviving in an 8-year period after RCT and identify potential predictive factors for tooth loss in a UK military cohort. METHODOLOGY A retrospective review of an integrated electronic health record for military patients who had received RCT was performed in a random sample of 205 patients (n=219 root-filled teeth) who had received RCT between 1 January 2011 and 1 January 2012. Tooth survival was defined as tooth presence, regardless of signs or symptoms, and measured from the point of root filling until either the end of the designated study period or time of extraction. Survival was evaluated using Kaplan-Meier estimates and association with tooth loss using the χ2 test. Potentially significant predictive factors were investigated using univariate Cox regression. RESULTS Tooth survival following RCT was 98% after 24 months; 88% after 48 months; 83% after 72 months; and 78% after 96 months. Four predictive factors were found to affect tooth loss as follows: preoperative pain (HR=3.2; p<0.001), teeth with less than two proximal contacts (HR=3.0; p=0.01), teeth with cores involving more than two surfaces (HR=2.0; p=0.03) and postoperative unscheduled dental attendances (UDA) (HR=2.7; p=0.01). CONCLUSIONS Within the limitations of this study, the presence of preoperative pain; teeth with less than two proximal contacts or with cores involving more than two tooth surfaces; and occurrence of postoperative UDA were found to significantly increase the hazard of tooth loss.
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Affiliation(s)
| | - G E Bryce
- DCRD, Aldershot Garrison, Aldershot, UK
| | - Y Ng
- Endodontology, University College London, London, UK
- Restorative Dentistry and Endodontology, UCL Eastman Dental Institute, London, UK
| | - K Gulabivala
- Restorative Dentistry and Endodontology, UCL Eastman Dental Institute, London, UK
| | - M A Dermont
- Defence Public Health Unit, Defence Medical Services, Lichfield, UK
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Ng YL, Gulabivala K. Factors that influence the outcomes of surgical endodontic treatment. Int Endod J 2023; 56 Suppl 2:116-139. [PMID: 36710526 DOI: 10.1111/iej.13896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Revised: 01/23/2023] [Accepted: 01/25/2023] [Indexed: 01/31/2023]
Abstract
Surgical endodontic treatment encompasses a broad spectrum of procedures, amongst which root-end cavity preparation and filling, retrograde root canal treatment and through-and-through endodontic surgery, may be classified under the umbrella term 'Root-end surgery'. This narrative review considers the available data on periapical healing, soft tissue healing, tooth survival and oral health-related quality of life (OHRQoL), following root-end surgery and the factors that affect its outcomes. The pooled periapical healed rate for the studies published up to 2021 was 69% (95% CI: 65%, 73%) but increased to 76% (95% CI: 66%, 86%) when only data from the 2020's studies were analysed. The prognostic factors consistently reported for periapical healing have included: pre-operative periapical lesion with complete loss of buccal plate, quality of root-end preparation, remaining thickness of apical root dentine and restorative status. Soft tissue healing of the reflected flap was found to have a positive association with periapical healing. The survival rates following root-end surgery range from 48% to 93%, with failure of periapical healing associated with root and crown fracture, being the predominant reasons for tooth extraction. The factors influencing impact of root-end surgery on patients' quality of life could not be adequately evaluated due to design flaws in the available studies. In conclusion, if root canal treatment failure due to leakage through cracks, fractures or restoration margin are excluded, the remaining cases may represent localized residual infection and inflammation at the periapex that should be amenable to predictable management with the aid of modern root-end surgery.
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Affiliation(s)
- Yuan-Ling Ng
- Unit of Endodontology, Department of Restorative Dentistry, UCL Eastman Dental Institute, London, UK
| | - Kishor Gulabivala
- Unit of Endodontology, Department of Restorative Dentistry, UCL Eastman Dental Institute, London, UK
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Gulabivala K, Ng YL. Factors that affect the outcomes of root canal treatment and retreatment-A reframing of the principles. Int Endod J 2023; 56 Suppl 2:82-115. [PMID: 36710532 DOI: 10.1111/iej.13897] [Citation(s) in RCA: 17] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 01/24/2023] [Accepted: 01/25/2023] [Indexed: 01/31/2023]
Abstract
This paper undertakes a broad and comprehensive synthesis of relevant clinical, biological, biomechanical, technical and healthcare services data to understand the factors affecting outcomes of periapical healing after root canal (re)treatment. The medical and dental evidence-based era (1980-present) is contextualized with the earlier evidence drive in endodontics (1911-1940) triggered by the focal infection era. The current evidence-based approach has a sharper focus on evidence quality and derivation of practice guidelines. Contrary views question whether guideline-driven, or expertise-development-driven endeavours would best serve outcome improvement in society. The endodontic discipline functions in a broad healthcare framework and sustains industrial, economic and trend pressures that may be deemed to influence outcomes. The nature of root canal treatment and the challenges in determining the factors that affect its outcomes is discussed. The factors potentially affecting periapical healing after root canal treatment are classified into pre-operative, intra-operative and postoperative groups. These categories subsume multiple elements with interactive influences, creating a complex picture, further confounded by some apparently surprising, counter-intuitive and contradictory findings. The technical versus biological conundrum in root canal treatment continues to cause cognitive dissonance. However, due reflection and cross-discipline-synthesis resolve the apparent data conflicts into a very simple, consistent and plausible picture of how root canal treatment works and the key factors that affect periapical healing. Root canal retreatment is considered mainly in the context of its differences from primary treatment as the majority of factors influencing outcomes are common to both. The exceptional difference is that retreatments have a proportionately reduced probability of healing by virtue of compromised apical root canal ramification access or modified host/infection interactions. Root canal (re)treatment outcomes are dominantly influenced by the nature of prior dynamic host/infection interaction (pre-operative patient factors) and how the direction of this dynamic is influenced by two factors: (1) the active efficacy of the operators' root canal treatment protocol to sustain a microbial ecological shift (intra-operative treatment factors) and dampen periapical inflammation; and (2) the passive ability of the functional tooth (and its restoration margin) to maintain its integrity to resist infection reversal (postoperative restorative factors).
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Affiliation(s)
- Kishor Gulabivala
- Unit of Endodontology, Department of Restorative Dentistry, UCL Eastman Dental Institute, University College London, London, UK
| | - Yuan Ling Ng
- Unit of Endodontology, Department of Restorative Dentistry, UCL Eastman Dental Institute, University College London, London, UK
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Arora RK, Mordan NJ, Spratt DA, Ng YL, Gulabivala K. Bacteria in the cavity-restoration interface after varying periods of clinical service - SEM description of distribution and 16S rRNA gene sequence identification of isolates. Clin Oral Investig 2022; 26:5029-5044. [PMID: 35359188 PMCID: PMC9276561 DOI: 10.1007/s00784-022-04473-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 03/21/2022] [Indexed: 11/03/2022]
Abstract
OBJECTIVES To use extracted human teeth with amalgam (n = 26) or GIC (n = 3) restorations in service up to 20 years to evaluate microbiota at the cavity/restoration interface by SEM or culture. MATERIALS AND METHODS Extracted teeth with intracoronal restorations (n = 20) of known history (2-20 years) were fixed, split, and prepared for SEM to ascertain the pattern and structure of bacterial aggregates on cavity and restoration surfaces. Another 9 teeth were anaerobically decontaminated, split and sampled (cavity/restorations), and cultured (anaerobically, aerobically); recovered isolates were identified by 16S rRNA gene sequencing. RESULTS SEM showed rods, cocci, and filaments in 11/20 teeth (55%) on cavity and corresponding restoration surfaces; 4/20 (20%) on neither surface; 1/20 (5%) on just cavity; and 4/20 (20%) on just restoration. Microbial growth extended from marginal openings into the deeper interfacial microspace to varying extents but was not always evident. Restoration size or age did not predict bacterial presence. Bacteria-free surfaces (cavity/amalgam) showed possible calcification. Cultivation yielded 160 isolates, mainly Gram-positive (86%) and facultative (81%); and morphotypes of rods (43%), cocci (36%), and cocco-bacilli (18%) belonging to Actinobacteria (45%) and Firmicutes (50%). The most frequent genera were Staphylococcus, Streptococcus, Actinomyces, and Lactobacillus. Biofilms on cavity and restoration appeared independent of each other. CONCLUSIONS Cavity and amalgam surfaces were independently colonised and some not. The penetration of microbiota into marginal gaps varied; resembled root caries and was dominated by Gram-positive species. CLINICAL RELEVANCE Marginal gaps around restorations are unavoidable but are not always colonised by bacteria after long-term clinical service. Calcification of biofilms in the restorative interface may prevent further colonisation. The viable microbiota in the restorative interface resembled root caries and may be subject to ecological fluxes of activity and arrest and therefore preventative management.
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Affiliation(s)
- Roopinder Kaur Arora
- Unit of Endodontology, Departments of Restorative Dentistry, Microbial Diseases, UCL Eastman Dental Institute, University College London, Bloomsbury Campus, Rockefeller Building, 21 University Street, London, WC1E 6DE, UK
| | - Nicola J Mordan
- Biomaterials and Tissue Engineering, UCL Eastman Dental Institute, University College London, London, UK
| | - David A Spratt
- Unit of Endodontology, Departments of Restorative Dentistry, Microbial Diseases, UCL Eastman Dental Institute, University College London, Bloomsbury Campus, Rockefeller Building, 21 University Street, London, WC1E 6DE, UK
| | - Yuan Ling Ng
- Unit of Endodontology, Departments of Restorative Dentistry, Microbial Diseases, UCL Eastman Dental Institute, University College London, Bloomsbury Campus, Rockefeller Building, 21 University Street, London, WC1E 6DE, UK
| | - Kishor Gulabivala
- Unit of Endodontology, Departments of Restorative Dentistry, Microbial Diseases, UCL Eastman Dental Institute, University College London, Bloomsbury Campus, Rockefeller Building, 21 University Street, London, WC1E 6DE, UK.
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Eames I, D'Aiuto F, Shahreza S, Javanmardi Y, Balachandran R, Hyde M, Ng YL, Gulabivala K, Watson S, Davies H, Szita N, Khajeh J, Suvan J, Moeendarbary E. Removal and dispersal of biofluid films by powered medical devices: Modeling infectious agent spreading in dentistry. iScience 2021; 24:103344. [PMID: 34825134 PMCID: PMC8603215 DOI: 10.1016/j.isci.2021.103344] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 08/27/2021] [Accepted: 10/22/2021] [Indexed: 01/10/2023] Open
Abstract
Medical procedures can disperse infectious agents and spread disease. Particularly, dental procedures may pose a high risk of disease transmission as they use high-powered instruments operating within the oral cavity that may contain infectious microbiota or viruses. Here we assess the ability of powered dental devices in removing the biofluid films and identified mechanical, hydrodynamic, and aerodynamic forces as the main underlying mechanisms of removal and dispersal processes. Our results indicate that potentially infectious agents can be removed and dispersed immediately after dental instrument engagement with the adherent biofluid film, while the degree of their dispersal is rapidly depleted owing to the removal of the source and dilution by the coolant water. We found that droplets created by high-speed drill interactions typically travel ballistically, while aerosol-laden air tends to flow as a current over surfaces. Our mechanistic investigation offers plausible routes for reducing the spread of infection during invasive medical procedures. Mechanical, hydrodynamic, and aerodynamic forces drive removal/dispersal processes The air-rotor has the highest ability to remove and disperse infectious agents The aerosol cloud flows as a current and continuously settles Manipulating rheological properties of the fluids can suppress aerosol generation
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Affiliation(s)
- Ian Eames
- Department of Mechanical Engineering, University College London, Torrington Place, London WC1E 7JE, UK
| | - Francesco D'Aiuto
- Unit of Periodontology, UCL Eastman Dental Institute, University College London, London, WC1X 8LT, UK
| | - Somayeh Shahreza
- Department of Mechanical Engineering, University College London, Torrington Place, London WC1E 7JE, UK
| | - Yousef Javanmardi
- Department of Mechanical Engineering, University College London, Torrington Place, London WC1E 7JE, UK
| | | | - Martin Hyde
- TSI, 30 Millbank, Westminster, London, SW1P 4WP, UK
| | - Yuan-Ling Ng
- Unit of Endodontology, UCL Eastman Dental Institute, University College London, London, WC1X 8LT, UK
| | - Kishor Gulabivala
- Unit of Endodontology, UCL Eastman Dental Institute, University College London, London, WC1X 8LT, UK
| | - Sara Watson
- Department of Mechanical Engineering, University College London, Torrington Place, London WC1E 7JE, UK
| | - Hywel Davies
- Department of Mechanical Engineering, University College London, Torrington Place, London WC1E 7JE, UK
| | - Nicolas Szita
- Department of Biochemical Engineering, University College London, Bernard Katz Building, Gower Street, London WC1E 6BT, UK
| | - Janette Khajeh
- Department of Mechanical Engineering, University College London, Torrington Place, London WC1E 7JE, UK
| | - Jeanie Suvan
- Unit of Periodontology, UCL Eastman Dental Institute, University College London, London, WC1X 8LT, UK
| | - Emad Moeendarbary
- Department of Mechanical Engineering, University College London, Torrington Place, London WC1E 7JE, UK.,Department of Biological Engineering, Massachusetts Institute of Technology, Cambridge 02139, MA, USA
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Gulabivala K, Azam I, Mahdavi-Izadi S, Palmer G, Georgiou G, Knowles JC, Y-L N. Effect of root canal irrigant (sodium hypochlorite & saline) delivery at different temperatures and durations on pre-load and cyclic-loading surface-strain of anatomically different premolars. J Mech Behav Biomed Mater 2021; 121:104640. [PMID: 34126506 DOI: 10.1016/j.jmbbm.2021.104640] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 06/02/2021] [Accepted: 06/05/2021] [Indexed: 11/25/2022]
Abstract
AIM To evaluate the effect of NaOCl (5%) and saline (control) irrigant delivery at different temperatures and durations on pre-load and cyclic-loading tooth-surface-strain (TSS) on anatomically different premolars. METHODOLOGY Single-rooted premolars (n = 36), root-canal-prepared in standard manner, were randomly allocated to six irrigation groups: (A1) NaOCl-21 °C; (A2) NaOCl-60 °C; (A3) saline-21 °C then NaOCl-21 °C; (A4) saline-60 °C then NaOCl-21 °C; (A5) saline-21 °C then NaOCl-60 °C; (A6) saline-60 °C then NaOCl-60 °C. A1-2 received nine 10-min irrigation periods (IP) with NaOCl; A3-6 received nine 10-min IP with saline, followed by 9 IP with NaOCl at different temperature combinations. Premolars (n = 56) with single, fused or double roots prepared by standard protocol, were stratified and randomly allocated to: (B1) saline-21 °C; (B2) saline-80 °C; (B3) NaOCl-21 °C; (B4) NaOCl-80 °C. TSS (μє) was recorded pre-irrigation, post-irrigation and pre-load for each IP and during cyclic loading 2 min after each IP, over 30-274 min, using strain-gauges. Generalised linear mixed models were used for analysis. RESULTS Baseline TSS in double-rooted premolars was significantly (p=0.001) lower than in single/fused-rooted-premolars; and affected by mesial-wall-thickness (p=0.005). There was significant increase in loading-TSS (μє) after NaOCl-21 °C irrigation (p=0.01) but decrease after NaOCl-60 °C irrigation (p=0.001). TSS also increased significantly (p = 0.005) after Saline-80 °C irrigation. Pre-load "strain-shift" was noted only upon first saline delivery but every-time with NaOCl. Strain-shift negatively influenced loading-TSS after saline or NaOCl irrigation (A3-6) but was only significant for saline-21 °C. CONCLUSIONS Tooth anatomy significantly affected its strain characteristics, exhibiting limits within which strain changes occurred. Intra-canal introduction of saline or NaOCl caused non-random strain shifts without loading. Irrigation with NaOCl-21 °C increased loading tooth strain, as did saline-80 °C or NaOCl-80 °C but NaOCl-60 °C decreased it. A "chain-link" model was proposed to explain the findings and tooth biomechanics.
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Affiliation(s)
- K Gulabivala
- Unit of Endodontology, Division of Restorative Dental Science, UK.
| | - I Azam
- Unit of Endodontology, Division of Restorative Dental Science, UK
| | - S Mahdavi-Izadi
- Unit of Endodontology, Division of Restorative Dental Science, UK
| | - G Palmer
- Division of Biomaterials & Tissue Engineering; UCL Eastman Dental Institute, UK
| | - G Georgiou
- Division of Biomaterials & Tissue Engineering; UCL Eastman Dental Institute, UK
| | - J C Knowles
- Division of Biomaterials & Tissue Engineering; UCL Eastman Dental Institute, UK; The Discoveries Centre for Regenerative and Precision Medicine, UCL Campus, London, UK; Department of Nanobiomedical Science and BK21 Plus NBM, Global Research Center for Regenerative Medicine, Dankook University, 518-10, Anseo-dong, Dongnam-gu, Cheonan, Chungcheongnam-do, Republic of Korea
| | - Ng Y-L
- Unit of Endodontology, Division of Restorative Dental Science, UK
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Ng Y, Reddington LP, Berman A, Knowles JC, Nazhat SN, Gulabivala K. Viscoelastic and chemical properties of dentine after different exposure times to sodium hypochlorite, ethylenediaminetetraacetic acid and calcium hydroxide. AUST ENDOD J 2020; 46:234-243. [DOI: 10.1111/aej.12397] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/26/2020] [Indexed: 11/28/2022]
Affiliation(s)
- Yuan‐Ling Ng
- Unit of Endodontology Division of Restorative Dental Science UCL Eastman Dental Institute University College London London UK
| | - Liam P. Reddington
- Unit of Endodontology Division of Restorative Dental Science UCL Eastman Dental Institute University College London London UK
| | - Antony Berman
- Unit of Endodontology Division of Restorative Dental Science UCL Eastman Dental Institute University College London London UK
| | - Jonathan C. Knowles
- Division of Biomaterials & Tissue Engineering UCL Eastman Dental Institute University College London London UK
- Department of Nanobiomedical Science & Institute for Tissue Regeneration Engineering Dankook University Cheonan Korea
- Discoveries Centre for Regenerative and Precision Medicine UCL Campus London UK
| | - Showan N. Nazhat
- Department of Mining and Materials Engineering McGill University Montreal Quebec Canada
| | - Kishor Gulabivala
- Unit of Endodontology Division of Restorative Dental Science UCL Eastman Dental Institute University College London London UK
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Bryce G, Pratten J, Ready D, Ng YL, Gulabivala K. Disruption and bactericidal indices depicted in polygonal graphs to show multiple outcome effects of root canal irrigant supplements on single- and dual-species biofilms. Clin Oral Investig 2020; 24:3255-3264. [PMID: 31953683 DOI: 10.1007/s00784-020-03202-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Accepted: 01/07/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVES The aims of this study were to (1) investigate the relative time-dependent disruption and bactericidal effects of detergent-type surfactants on single- or dual-species biofilms of root canal isolates and (2) to examine the utility of polygonal graphs for depiction of biofilm disruption and cell killing. MATERIALS AND METHODS Single-species biofilms of Streptococcus sanguinis, Enterococcus faecalis, Fusobacterium nucleatum and Porphyromonas gingivalis were grown on nitro-cellulose membranes for 72 h and immersed in Tween®80, cetyltrimethylammoniumbromide (CTAB), and sodium dodecyl sulphate (SDS) for 1-, 5- or 10-min (n = 3 per test). The number of viable and non-viable bacteria "disrupted" from the biofilm and those "remaining-attached" was determined using a viability stain in conjunction with fluorescence microscopy. The data were analysed using non-parametric Kruskal-Wallis test with 5% significance level. RESULTS Gram-negative obligate anaerobes were more susceptible to cell removal than gram-positive facultative anaerobes. The majority of cells were disrupted after 1-min of exposure; however, the extent varied according to the agent and species. CTAB and SDS were more effective than Tween 80™ at disrupting biofilms and killing cells but all agents failed to achieve 100% disruption/kill. CONCLUSIONS Biofilm disruption and cell viability were influenced by the species, the test agent and the duration of exposure. CTAB and SDS were more effective in biofilm disruption than Tween 80™. Graphical depiction of biofilm disruption- and viability-outcomes provides an alternative means of simultaneously visualising and analysing relative efficacy in different domains. CLINICAL RELEVANCE Surfactants were not as effective at biofilm disruption as NaOCl but may be added to other non-disruptive antibacterial agents to enhance this property.
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Affiliation(s)
- G Bryce
- Defence Primary Health Care, Defence Centre for Rehabilitative Dentistry, Evelyn Woods Road, Aldershot, GU11 2LS, UK
| | - J Pratten
- Public Health England, Respiratory and Systemic Bacteria Section, PHE - National Infection Service, London, UK
| | - D Ready
- Clinical Microbiology and Public Health Laboratory, Public Health England, England, UK
| | - Y-L Ng
- Unit of Endodontology, Department of Restorative Dentistry, UCL Eastman Dental Institute, University College London, 256 Grays Inn Road, London, WC1X 8LD, UK.
| | - K Gulabivala
- Unit of Endodontology, Department of Restorative Dentistry, UCL Eastman Dental Institute, University College London, 256 Grays Inn Road, London, WC1X 8LD, UK
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Kafantari N, Gulabivala K, Georgiou G, Knowles J, Ng YL. Effect of Heated Sodium Hypochlorite on the Viscoelastic Properties of Dentin Evaluated Using Dynamic Mechanical Analysis. J Endod 2019; 45:1155-1160. [DOI: 10.1016/j.joen.2019.05.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Revised: 05/23/2019] [Accepted: 05/26/2019] [Indexed: 11/30/2022]
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Browne JT, Ng Y, Odlyha M, Gulabivala K, Bozec L. Influence of root maturity or periodontal involvement on dentinal collagen changes following Na
OC
l irrigation: an
ex vivo
study. Int Endod J 2019; 53:97-110. [DOI: 10.1111/iej.13200] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Accepted: 08/05/2019] [Indexed: 11/29/2022]
Affiliation(s)
- J. T. Browne
- Unit of Endodontology Divisions of Restorative Dental Science UCL Eastman Dental Institute University College London LondonUK
| | - Y.‐L. Ng
- Unit of Endodontology Divisions of Restorative Dental Science UCL Eastman Dental Institute University College London LondonUK
| | - M. Odlyha
- Department of Biological Sciences Birkbeck University of LondonLondon UK
| | - K. Gulabivala
- Unit of Endodontology Divisions of Restorative Dental Science UCL Eastman Dental Institute University College London LondonUK
| | - L. Bozec
- Biomaterials & Tissue Engineering UCL Eastman Dental Institute University College London London UK
- Faculty of Dentistry University of Toronto Toronto Canada
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Karunanayake G, Ng YL, Knowles JC, Delgado AHS, Young AM, Gulabivala K, Nazhat SN. The effect of NaOCl and heat treatment on static and dynamic mechanical properties and chemical changes of dentine. J Mech Behav Biomed Mater 2019; 97:330-338. [PMID: 31153114 DOI: 10.1016/j.jmbbm.2019.05.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Revised: 05/23/2019] [Accepted: 05/27/2019] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To determine the effect of heat on flexural strength (FS), maximum strain (MS), storage modulus (SM), tan delta (TD) and chemical changes through micro-Raman spectroscopy of dentine exposed to 2.5% NaOCl or saline. METHOD ology: Dentine bars were randomly allocated to 8 test groups. Half (groups 2,4,6,8) were treated with NaOCl for 20 min; the rest (groups 1,3,5,7) remained in saline. FS/MS were measured in groups 1-4 (n = 15) (3/4 were also heated to 200 °C & re-hydrated in saline). Micro-Raman spectroscopy was performed on bars from groups 1-4. SM/TD were measured in 5-8: in 5/6 (n = 10), repeated after heating (200 °C), then following re-hydration; in 7/8 (n = 3) after heating to 25-185 °C. RESULTS Increase in MS on heat and FS/MS on heat + NaOCl was not significant (P > 0.05). SM increased (P = 0.06) after heat treatment but reduced to initial state after rehydration (P = 0.03). TD did not change (P = 0.4) after heat (200 °C) treatment but rehydration increased it compared with pre-treatment state (P = 0.001). For dentine bars pre-treated with NaOCl, SM did not change (P = 0.6) after heat (200 °C) treatment or rehydration but TD significantly increased (P = 0.02) upon re-hydration compared with pre- (P=0.007), or post- (P = 0.03) heat-treatment states. SM and TD varied between 25-185 °C with no consistent trend amongst the NaOCl pre-treated bars. Micro-Raman only detected chemical changes following NaOCl treatment in the mineral phase. CONCLUSIONS Exposure of dentine bars to heat and NaOCl produced only moderate changes to quasi-static but marked changes to viscoelastic properties, which may be explained by chemical alterations.
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Affiliation(s)
- G Karunanayake
- Unit of Endodontology, Division of Restorative Dental Science, UCL Eastman Dental Institute, University College London, London, UK
| | - Y-L Ng
- Unit of Endodontology, Division of Restorative Dental Science, UCL Eastman Dental Institute, University College London, London, UK.
| | - J C Knowles
- Biomaterials & Tissue Engineering, UCL Eastman Dental Institute, University College London, London, UK; Institute of Tissue Regeneration Engineering (ITREN) and Department of NanobiomedicalScience and BK21 Plus NBM, Global Research Center for Regenerative Medicine, DankookUniversity, 518-10, Anseo-dong, Dongnam-gu, Cheonan, Chungcheongnam-do, South Korea; The Discoveries Centre for Regenerative and Precision Medicine, UCL Campus, GowerStreet, London, WC1E 6BT, UK
| | - A H S Delgado
- Biomaterials & Tissue Engineering, UCL Eastman Dental Institute, University College London, London, UK
| | - A M Young
- Biomaterials & Tissue Engineering, UCL Eastman Dental Institute, University College London, London, UK
| | - K Gulabivala
- Unit of Endodontology, Division of Restorative Dental Science, UCL Eastman Dental Institute, University College London, London, UK
| | - S N Nazhat
- Department of Mining and Materials Engineering, McGill University, Montreal, Qc, H3A 0C5, Canada
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Philpott R, Gulabivala K, Leeson R, Ng YL. Prevalence, predictive factors and clinical course of persistent pain associated with teeth displaying periapical healing following nonsurgical root canal treatment: a prospective study. Int Endod J 2018; 52:407-415. [PMID: 30332512 DOI: 10.1111/iej.13029] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Accepted: 10/13/2018] [Indexed: 11/26/2022]
Abstract
AIMS To investigate the prevalence, pain catastrophizing and other predictive factors and clinical course of persistent pain/discomfort associated with teeth displaying periapical healing following nonsurgical root canal treatment (NSRCT). METHODOLOGY One hundred and ninety-eight patients (264 teeth) who had NSRCT were reviewed at 5-14 months, postoperatively. Teeth with persistent post-treatment pain or discomfort, plus evidence of periapical healing were further monitored 0.5, 4 and 10 years later. Pain Catastrophizing Scale (PCS) and Short Form of the McGill Pain Questionnaire (SF-MPQ) were completed. Predictive factors were investigated using logistic regression models. RESULTS Twenty-four per cent (60/249) of teeth displaying periapical healing at first review were associated with persistent pain or discomfort. Fifty-five teeth monitored 6-7 months later were associated with reduction in pain (17/30) or discomfort (7/25). Cone beam computed tomography (CBCT) of eight teeth with persistent symptoms and complete periapical healing (by conventional radiographs) revealed distinct, small apical radiolucencies (n = 3) or root apex fenestration through the buccal plate (n = 2). History of chronic pain (headache, temporo-mandibular joint, masticatory muscle, neck, shoulder or back pain; P = 0.005), preoperative pain (P = 0.04), responsive pulp (P = 0.009), tooth crack (P = 0.05) and small periapical radiolucency (P = 0.005) were significant predictive factors. The PCS revealed 16 patients (22 teeth) were catastrophizers (PCS ≥ 30), but this had no influence on post-treatment symptoms (P = 0.5). CONCLUSIONS Persistent pain or discomfort associated with teeth showing periapical healing at the first review after NSRCT, decreased in intensity in most cases over the following 6 months. Longer-term follow-up revealed spontaneous improvement or symptom resolution in the majority of those with confirmed radiographic the absence of periapical disease. Five predictive factors (history of chronic pain, teeth with responsive pulps, association with pain, diagnosis of tooth crack before treatment and diameter of preoperative radiolucency) were identified.
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Affiliation(s)
- R Philpott
- Department of Restorative Dentistry, Edinburgh Dental Institute, University of Edinburgh, Edinburgh, UK
| | - K Gulabivala
- Unit of Endodontology, UCL Eastman Dental Institute, University College London, London, UK
| | - R Leeson
- Unit of Maxillo-Facial Surgery, UCL Eastman Dental Institute, University College London, London, UK
| | - Y-L Ng
- Unit of Endodontology, UCL Eastman Dental Institute, University College London, London, UK
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Morgan AD, Ng YL, Odlyha M, Gulabivala K, Bozec L. Proof-of-concept study to establish an in situ method to determine the nature and depth of collagen changes in dentine using Fourier Transform Infra-Red spectroscopy after sodium hypochlorite irrigation. Int Endod J 2018; 52:359-370. [PMID: 30144371 DOI: 10.1111/iej.13004] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Accepted: 08/22/2018] [Indexed: 11/28/2022]
Abstract
AIM To establish a method using Fourier Transform Infra-Red spectroscopy (FTIR) to characterize the nature and depth of changes in dentinal collagen following exposure to sodium hypochlorite (NaOCl) during root canal irrigation in an ex vivo model. METHODOLOGY Fourier Transform Infra-Red spectroscopy was used to assess the changes in dentinal collagen when the root canal was exposed to NaOCl. The changes in dentinal collagen caused by NaOCl irrigation of root canals in transverse sections of roots, at 0.5 mm from the canal wall and 0.5 mm from the external root surface, were assessed by FTIR. The data were analysed using paired t-test with 5% significance level. RESULTS Fourier Transform Infra-Red spectroscopy confirmed that NaOCl exposure caused alterations in the chemistry and structure of collagen in dentine. FTIR spectra obtained from dentine surfaces and dentine adjacent to root canals exposed to NaOCl, all consistently showed degradation and conformational change of the collagen structure. FTIR data from the ex vivo model showed that the depth of effect of NaOCl extended to at least 0.5 mm from the canal wall. CONCLUSION In extracted human teeth, NaOCl caused changes in dentinal collagen that were measurable by FTIR. In an ex vivo model, the depth of effect into dentine extended at least 0.5 mm from the canal wall.
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Affiliation(s)
- A D Morgan
- Unit of Endodontology, Division of Restorative Dental Science, UCL Eastman Dental Institute, London, UK
| | - Y-L Ng
- Unit of Endodontology, Division of Restorative Dental Science, UCL Eastman Dental Institute, London, UK
| | - M Odlyha
- Department of Biological Sciences, Birkbeck, University of London, London, UK
| | - K Gulabivala
- Unit of Endodontology, Division of Restorative Dental Science, UCL Eastman Dental Institute, London, UK
| | - L Bozec
- Division of Biomaterials & Tissue Engineering, UCL Eastman Dental Institute, London, UK
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Bryce G, MacBeth N, Gulabivala K, Ng YL. The efficacy of supplementary sonic irrigation using the EndoActivator®system determined by removal of a collagen film from anex vivomodel. Int Endod J 2017; 51:489-497. [DOI: 10.1111/iej.12870] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2017] [Accepted: 10/30/2017] [Indexed: 12/17/2022]
Affiliation(s)
- G. Bryce
- Defence Primary Healthcare; Centre for Restorative Dentistry; Aldershot UK
| | - N. MacBeth
- Defence Primary Healthcare; Centre for Restorative Dentistry; Aldershot UK
| | - K. Gulabivala
- Unit of Endodontology; Department of Restorative Dentistry; UCL Eastman Dental Institute; University College London; London UK
| | - Y-L. Ng
- Unit of Endodontology; Department of Restorative Dentistry; UCL Eastman Dental Institute; University College London; London UK
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Ramírez-Bommer C, Gulabivala K, Ng YL, Young A. Estimated depth of apatite and collagen degradation in human dentine by sequential exposure to sodium hypochlorite and EDTA: a quantitative FTIR study. Int Endod J 2017; 51:469-478. [DOI: 10.1111/iej.12864] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2017] [Accepted: 10/05/2017] [Indexed: 11/30/2022]
Affiliation(s)
- C. Ramírez-Bommer
- Unit of Endodontology; Department of Restorative Dentistry; UCL Eastman Dental Institute; University College London; London UK
| | - K. Gulabivala
- Unit of Endodontology; Department of Restorative Dentistry; UCL Eastman Dental Institute; University College London; London UK
| | - Y.-L. Ng
- Unit of Endodontology; Department of Restorative Dentistry; UCL Eastman Dental Institute; University College London; London UK
| | - A. Young
- Division of Biomaterials and Tissue Engineering; UCL Eastman Dental Institute; University College London; London UK
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van der Meer WJ, Vissink A, Ng YL, Gulabivala K. 3D Computer aided treatment planning in endodontics. J Dent 2015; 45:67-72. [PMID: 26627596 DOI: 10.1016/j.jdent.2015.11.007] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2015] [Revised: 10/28/2015] [Accepted: 11/21/2015] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVES Obliteration of the root canal system due to accelerated dentinogenesis and dystrophic calcification can challenge the achievement of root canal treatment goals. This paper describes the application of 3D digital mapping technology for predictable navigation of obliterated canal systems during root canal treatment to avoid iatrogenic damage of the root. METHODS Digital endodontic treatment planning for anterior teeth with severely obliterated root canal systems was accomplished with the aid of computer software, based on cone beam computer tomography (CBCT) scans and intra-oral scans of the dentition. On the basis of these scans, endodontic guides were created for the planned treatment through digital designing and rapid prototyping fabrication. RESULTS The custom-made guides allowed for an uncomplicated and predictable canal location and management. CONCLUSION The method of digital designing and rapid prototyping of endodontic guides allows for reliable and predictable location of root canals of teeth with calcifically metamorphosed root canal systems. CLINICAL SIGNIFICANCE The endodontic directional guide facilitates difficult endodontic treatments at little additional cost.
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Affiliation(s)
- Wicher J van der Meer
- Unit of Endodontology, UCL Eastman Dental Institute, University College London, London, UK; Department of Orthodontics, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Arjan Vissink
- Department of Oral and Maxillofacial Surgery, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | - Yuan Ling Ng
- Unit of Endodontology, UCL Eastman Dental Institute, University College London, London, UK
| | - Kishor Gulabivala
- Unit of Endodontology, UCL Eastman Dental Institute, University College London, London, UK.
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Abstract
AIM To investigate the probability of and factors influencing periapical status of teeth following primary (1°RCTx) or secondary (2°RCTx) root canal treatment. METHODOLOGY This prospective study involved annual clinical and radiographic follow-up of 1°RCTx (1170 roots, 702 teeth and 534 patients) or 2°RCTx (1314 roots, 750 teeth and 559 patients) carried out by Endodontic postgraduate students for 2-4 (50%) years. Pre-, intra- and postoperative data were collected prospectively on customized forms. The proportion of roots with complete periapical healing was estimated, and prognostic factors were investigated using multiple logistic regression models. Clustering effects within patients were adjusted in all models using robust standard error. RESULTS proportion of roots with complete periapical healing after 1°RCTx (83%; 95% CI: 81%, 85%) or 2°RCTx (80%; 95% CI: 78%, 82%) were similar. Eleven prognostic factors were identified. The conditions that were found to improve periapical healing significantly were: the preoperative absence of a periapical lesion (P = 0.003); in presence of a periapical lesion, the smaller its size (P ≤ 0.001), the better the treatment prognosis; the absence of a preoperative sinus tract (P = 0.001); achievement of patency at the canal terminus (P = 0.001); extension of canal cleaning as close as possible to its apical terminus (P = 0.001); the use of ethylene-diamine-tetra-acetic acid (EDTA) solution as a penultimate wash followed by final rinse with NaOCl solution in 2°RCTx cases (P = 0.002); abstaining from using 2% chlorexidine as an adjunct irrigant to NaOCl solution (P = 0.01); absence of tooth/root perforation (P = 0.06); absence of interappointment flare-up (pain or swelling) (P =0.002); absence of root-filling extrusion (P ≤ 0.001); and presence of a satisfactory coronal restoration (P ≤ 0.001). CONCLUSIONS Success based on periapical health associated with roots following 1°RCTx (83%) or 2°RCTx (80%) was similar, with 10 factors having a common effect on both, whilst the 11th factor 'EDTA as an additional irrigant' had different effects on the two treatments.
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Affiliation(s)
- Y-L Ng
- Unit of Endodontology, UCL Eastman Dental Institute, University College London, London, UK.
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Affiliation(s)
- Y-L Ng
- Unit of Endodontology, UCL Eastman Dental Institute, University College London, London, UK.
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Abstract
AIM To investigate a possible relationship between apical root impedance and canal anatomy. METHODOLOGY Twenty-three roots from human extracted teeth with different apical anatomy (classified by number of apical canal exits) were selected. After impedance measurements, the root canals were stained and the teeth cleared to confirm their division into simple (S - Vertucci type 1; n=12) and complex (C - various Vertucci canal types with multiple exits; n=11) root types. Impedance measurements were taken using a frequency response analyser at seven apico-coronal levels in each root (0.0, 0.5, 1.0, 2.0, 3.0, 4.0, 5.0 mm short of the apical terminus) at 14 frequencies ranging from 1120 to 100,000 Hz. Potential confounding factors were controlled. The impedance characteristics of individual roots were compared with 37 equivalent circuits to select best fit. The association between impedance characteristic (described by the selected equivalent circuit) and canal anatomy (S/C) was investigated using logistic regression with robust standard error to account for multiple data-sets from the same root. RESULTS Canal anatomy had a significant (P= 0.046) effect on the equivalent circuit model. One circuit (model 10) occurred significantly more commonly in the simple canals. The odds of selecting circuit-model-10 were 2.2 times (odds ratio 2.17, 95% confidence interval 1.01-4.63) higher in canals with simple anatomy compared to those with complex anatomy. CONCLUSION Canal anatomy had a significant effect on the equivalent circuit describing its impedance characteristics. It is theoretically possible to use impedance spectroscopy to clinically predict and image apical canal complexities.
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Affiliation(s)
- S M Ardeshna
- Unit of Endodontology, Department of Restorative Dentistry, UCL Eastman Dental Institute, University College London, London, UK
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Kapalas A, Spratt DA, Ng YL, Gulabivala K. An investigation of a potential confounder in ex vivo microbiological studies--the bulk flow of fluid through apical foramina during tooth extraction. Int Endod J 2011; 44:534-42. [PMID: 21272043 DOI: 10.1111/j.1365-2591.2011.01858.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
AIMS To investigate the factors affecting bulk flow of dye and bacterial suspensions into and out of apical foramina during simulated tooth extraction, using an ex vivo model. METHODOLOGY Sixty extracted, single-rooted, human teeth were accessed, root canals located and in 50 the pulps dissolved; 10 teeth with attached periapical lesions were preserved. The size of apical foramina was determined digitally. The teeth were mounted in vials with polyvinylsiloxane impression material. Part 1: different dyes were inoculated in the coronal half of root canals or cervical 'gingival' margin, respectively, in separate experiments using the same teeth. Tooth extraction movements were simulated and apical penetration of the dye solutions with and without coronal restorations were examined in each case (20 teeth re-used 4 × ). Part 2: the same procedures were repeated on 30 more teeth but using a standard inoculum of Acidovorax sp. Part 3: 10 teeth with attached periapical lesions were inoculated with Acidovorax sp. in the absence of coronal restorations. Bacterial leakage into the periapical lesions was assessed. RESULTS Coronal restorations significantly reduced the flow of dyes (P=0.002) or bacterial suspension (P=0.001) out of the canals and bacterial suspension into (P=0.02) the canals during simulated tooth extraction. The 'size of apical foramina' were positively correlated with passage of bacterial suspension out of the canal (P=0.04) and from the gingival trough into the canal (P=0.008), in the presence of a coronal restoration. CONCLUSIONS The presence of coronal restorations, the size of apical foramina and presence of native canal contents with attached periapical lesions, all influenced fluid flow into and out of canals during simulated tooth extraction movements.
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Affiliation(s)
- A Kapalas
- Department of Restorative Dentistry, UCL Eastman Dental Institute, University College London, London, UK
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Wei LL, Gellynck K, Ng YL, Gulabivala K, Buxton P. The influence of a bisphosphonate on bone generation determined using a chick-femur model. Int Endod J 2011; 44:550-9. [DOI: 10.1111/j.1365-2591.2011.01861.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Abstract
AIMS To investigate (i) the effect of study characteristics on reported tooth survival after root canal treatment (RCTx) and (ii) the effect of clinical factors on the proportion of root filled teeth surviving after RCTx. METHODOLOGY Longitudinal human clinical studies investigating tooth survival after RCTx which were published up to the end of 2007 were identified electronically (MEDLINE and Cochrane database 1966-2007 December, week 4). In addition, four journals (Dental Traumatology, International Endodontic Journal, Journal of Endodontics, Oral Surgery Oral Medicine Oral Pathology Oral Radiology & Endodontics), bibliographies of all relevant articles and review articles were hand searched. Two reviewers (Y-LN, KG) assessed and selected the studies based on specified inclusion criteria and extracted the data onto a pre-designed proforma, independently. The criteria were as follows: (i) clinical study on RCTx; (ii) stratified analysis of primary and secondary RCTx available; (iii) sample size given and larger than 10; (iv) at least 6-month postoperative review; (v) success based on survival of tooth; and (vi) proportion of teeth surviving after treatment given or could be calculated from the raw data. Three strands of evidence or analyses were used to triangulate a consensus view. The reported findings from individual studies, including those excluded for quantitative analysis, were utilized for the intuitive synthesis, which constituted the first strand of evidence. Secondly, the pooled weighted proportion of teeth surviving and thirdly the combined effects of potential prognostic factors were estimated using the fixed and random effects meta-analyses on studies fulfilling all the inclusion criteria. RESULTS Of the 31 articles identified, 14 studies published between 1993 and 2007 were included. The majority of studies were retrospective (n = 10) and only four prospective. The pooled percentages of reported tooth survival over 2-3, 4-5 and 8-10 years following RCTx were 86% (95% CI: 75%, 98%), 93% (95% CI: 92%, 94%) and 87% (95% CI: 82%, 92%), respectively. Substantial differences in study characteristics were found to hinder effective direct comparison of findings. Evidence for the effect of prognostic factors on tooth survival was weak. Based on the data available for meta-analyses, four conditions were found to significantly improve tooth survival. In descending order of influence, the conditions increasing observed proportion of survival were as follows: (i) a crown restoration after RCTx; (ii) tooth having both mesial and distal proximal contacts; (iii) tooth not functioning as an abutment for removable or fixed prosthesis; and (iv) tooth type or specifically non-molar teeth. Statistical heterogeneity was substantial in some cases but its source could not be investigated because of insufficient available information. CONCLUSIONS The pooled proportion of teeth surviving over 2-10 years following RCTx ranged between 86% and 93%. Four factors (listed above) were identified as significant prognostic factors with concurrence between all three strands of evidence.
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Affiliation(s)
- Y-L Ng
- Unit of Endodontology, UCL Eastman Dental Institute, University College London, London.
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Ng YL, Mann V, Gulabivala K. The probability of and factors influencing tooth survival following non-surgical root canal treatment - a prospective study. Int Endod J 2010. [DOI: 10.1111/j.1365-2591.2010.01682_4.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Philpott R, Gulabivala K, Ng YL. The influence of pain catastrophising on the experience of persistent pain/discomfort following non-surgical root canal treatment. Int Endod J 2010. [DOI: 10.1111/j.1365-2591.2010.01682_3.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Sairafi R, Ready D, Gulabivala K, Nair S. Investigation of the interactions between neutrophils and endodontic isolates of Enterococcus faecalis. Int Endod J 2010. [DOI: 10.1111/j.1365-2591.2010.01682_1.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Sobhani OE, Gulabivala K, Knowles JC, Ng YL. The effect of irrigation time, root morphology and dentine thickness on tooth surface strain when using 5% sodium hypochlorite and 17% EDTA. Int Endod J 2010; 43:190-9. [DOI: 10.1111/j.1365-2591.2009.01655.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Rajasingham R, Ng YL, Knowles JC, Gulabivala K. The effect of sodium hypochlorite and ethylenediaminetetraacetic acid irrigation, individually and in alternation, on tooth surface strain. Int Endod J 2010; 43:31-40. [DOI: 10.1111/j.1365-2591.2009.01625.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Richardson N, Mordan NJ, Figueiredo JAP, Ng YL, Gulabivala K. Microflora in teeth associated with apical periodontitis: a methodological observational study comparing two protocols and three microscopy techniques. Int Endod J 2009; 42:908-21. [DOI: 10.1111/j.1365-2591.2009.01594.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Bryce G, O'Donnell D, Ready D, Ng YL, Pratten J, Gulabivala K. Contemporary Root Canal Irrigants Are Able to Disrupt and Eradicate Single- and Dual-Species Biofilms. J Endod 2009; 35:1243-8. [DOI: 10.1016/j.joen.2009.05.034] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2008] [Revised: 05/28/2009] [Accepted: 05/28/2009] [Indexed: 10/20/2022]
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Alani A, Knowles JC, Chrzanowski W, Ng YL, Gulabivala K. Ion release characteristics, precipitate formation and sealing ability of a phosphate glass–polycaprolactone-based composite for use as a root canal obturation material. Dent Mater 2009; 25:400-10. [DOI: 10.1016/j.dental.2008.10.010] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2008] [Accepted: 10/22/2008] [Indexed: 11/26/2022]
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Affiliation(s)
- Y-L Ng
- Unit of Endodontology, UCL Eastman Dental Institute, University College London, London, UK.
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Borbely P, Gulabivala K, Knowles JC. Degradation properties and ion release characteristics of Resilon®and phosphate glass/polycaprolactone composites. Int Endod J 2008; 41:1093-100. [DOI: 10.1111/j.1365-2591.2008.01478.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Al-bulushi A, Levinkind M, Flanagan M, Ng YL, Gulabivala K. Effect of canal preparation and residual root filling material on root impedance. Int Endod J 2008; 41:892-904. [DOI: 10.1111/j.1365-2591.2008.01450.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Wei WLL, Gellynck K, Ng YL, Gulabivala K, Buxton P. The influence of bisphosphonates on bone generation using a chick femur model. Int Endod J 2008. [DOI: 10.1111/j.1365-2591.2008.01447_9.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Alani A, Knowles J, Ng YL, Gulabivala K. Ion release characteristics, precipitate formation and sealing ability of a potential new root canal filling material. Int Endod J 2008. [DOI: 10.1111/j.1365-2591.2008.01447_11.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Ardeshna SM, Flanagan M, Ng YL, Gulabivala K. An investigation into the relationship between apical root Impedance and canal anatomy. Int Endod J 2008. [DOI: 10.1111/j.1365-2591.2008.01447_1.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Ypsilanti K, Gulabivala K, Buxton P. The effect of purmorphamine on murine osteoclast activity. Int Endod J 2008. [DOI: 10.1111/j.1365-2591.2008.01447_2.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Flynn D, Ready DR, Mordan N, Pratten J, Gulabivala K. The effect of conditioning films on colonization of root canal dentine by endodontic bacterial isolates. Int Endod J 2008. [DOI: 10.1111/j.1365-2591.2008.01447_4.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Iacovidou A, Mordan N, Figueiredo JAP, Gulabivala K. Utility of the FISH technique in conjunction with confocal microscopy to study the intraradicular microflora of teeth associated with apical periodontitis. Int Endod J 2008. [DOI: 10.1111/j.1365-2591.2008.01447_12.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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McGill S, Gulabivala K, Mordan N, Ng YL. The efficacy of dynamic irrigation using a commercially available system (RinsEndo®) determined by removal of a collagen ‘bio-molecular film’ from an ex vivo model. Int Endod J 2008; 41:602-8. [DOI: 10.1111/j.1365-2591.2008.01408.x] [Citation(s) in RCA: 87] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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Ng YL, Mann V, Rahbaran S, Lewsey J, Gulabivala K. Outcome of primary root canal treatment: systematic review of the literature – Part 2. Influence of clinical factors. Int Endod J 2007; 41:6-31. [PMID: 17931388 DOI: 10.1111/j.1365-2591.2007.01323.x] [Citation(s) in RCA: 193] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Y-L Ng
- Unit of Endodontology, UCL Eastman Dental Institute, University College London, London, UK.
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Ng YL, Mann V, Rahbaran S, Lewsey J, Gulabivala K. Outcome of primary root canal treatment: systematic review of the literature - part 1. Effects of study characteristics on probability of success. Int Endod J 2007; 40:921-39. [PMID: 17931389 DOI: 10.1111/j.1365-2591.2007.01322.x] [Citation(s) in RCA: 307] [Impact Index Per Article: 18.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
AIMS The aims of this study were (i) to conduct a comprehensive systematic review of the literature on the outcome of primary (initial or first time) root canal treatment; (ii) to investigate the influence of some study characteristics on the estimated pooled success rates. METHODOLOGY Longitudinal clinical studies investigating outcome of primary root canal treatment, published up to the end of 2002, were identified electronically (MEDLINE and Cochrane database 1966-2002 December, week 4). Four journals (International Endodontic Journal, Journal of Endodontics, Oral Surgery Oral Medicine Oral Pathology Endodontics Radiology and Dental Traumatology & Endodontics), bibliographies of all relevant papers and review articles were hand-searched. Three reviewers (Y-LN, SR and KG) independently assessed, selected the studies based on specified inclusion criteria, and extracted the data onto a pre-designed proforma. The study inclusion criteria were: longitudinal clinical studies investigating root canal treatment outcome; only primary root canal treatment carried out on the teeth studied; sample size given; at least 6-month postoperative review; success based on clinical and/or radiographic criteria (strict, absence of apical radiolucency; loose, reduction in size of radiolucency); overall success rate given or could be calculated from the raw data. The findings by individual study were summarized and the pooled success rates by each potential influencing factor were calculated for this part of the study. RESULTS Of the 119 articles identified, 63 studies published from 1922 to 2002, fulfilling the inclusion criteria were selected for the review: six were randomized trials, seven were cohort studies and 48 were retrospective studies. The reported mean success rates ranged from 31% to 96% based on strict criteria or from 60% to 100% based on loose criteria, with substantial heterogeneity in the estimates of pooled success rates. Apart from the radiographic criteria of success, none of the other study characteristics could explain this heterogeneity. Twenty-four factors (patient and operative) had been investigated in various combinations in the studies reviewed. The influence of preoperative pulpal and periapical status of the teeth on treatment outcome were most frequently explored, but the influence of treatment technique was poorly investigated. CONCLUSIONS The estimated weighted pooled success rates of treatments completed at least 1 year prior to review, ranged between 68% and 85% when strict criteria were used. The reported success rates had not improved over the last four (or five) decades. The quality of evidence for treatment factors affecting primary root canal treatment outcome is sub-optimal; there was substantial variation in the study-designs. It would be desirable to standardize aspects of study-design, data recording and presentation format of outcome data in the much needed future outcome studies.
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Affiliation(s)
- Y-L Ng
- Unit of Endodontology, UCL Eastman Dental Institute, University College London, London, UK.
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Huang TY, Gulabivala K, Ng YL. A bio-molecular film ex-vivo model to evaluate the influence of canal dimensions and irrigation variables on the efficacy of irrigation. Int Endod J 2007; 41:60-71. [PMID: 17916068 DOI: 10.1111/j.1365-2591.2007.01317.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
AIMS To devise an ex vivo model to test the efficacy of irrigation (static/dynamic) in removing a bio-molecular film from root canal walls. METHODOLOGY Forty human teeth with single straight canals were randomly allocated to two groups for static (n = 20) or dynamic (n = 20) irrigation. The root canals were prepared to different apical sizes (20, 40) and tapers (0.04, 0.08). The teeth were split longitudinally into two, stained collagen was applied to the canal surfaces and the tooth reassembled in a silicone matrix for dynamic or static irrigation. Digital images of the canal surface were taken before and after irrigation with 9, 18, 27 and 36 mL solution. The percentage of canal surface covered with stained collagen was quantified (ipWin4). The data were analysed using paired t-tests and linear regression models. RESULTS All the five explanatory variables: 'volume of irrigant used', 'mode of irrigation', 'orientation of open port of needle', 'corono-apical level of canal' and 'root canal dimension' had a significant (P < 0.001) influence on outcome of irrigation. The corono-apical level of canal was the most dominating factor. After irrigation, the apical third had 19.9% and 33.8% less area covered with the bio-molecular film than the middle and coronal thirds respectively. CONCLUSIONS The stained collagen bio-molecular film could not be removed completely by either static or dynamic irrigation. Factors influencing removal, in rank order of decreasing priority, were: corono-apical level, apical size and taper of canal preparation, and dynamic/static irrigation.
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Affiliation(s)
- T-Y Huang
- Unit of Endodontology, UCL Eastman Dental Institute, London, UK
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Ng YL, Mann V, Gulabivala K. Outcome of secondary root canal treatment ? Systematic review of the literature. Int Endod J 2007. [DOI: 10.1111/j.1365-2591.2007.01277_3.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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McGill S, Gulabivala K, Ng YL. A collagen ?bio-molecular film?ex vivo model to evaluate the efficacy of dynamic irrigation using the RinsEndo �system. Int Endod J 2007. [DOI: 10.1111/j.1365-2591.2007.01277_2.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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