Endodontic microsurgery outcomes over 10 years and associated prognostic factors: a retrospective cohort study

INTRODUCTION

This retrospective cohort study aimed to evaluate long-term healing outcomes (10-17.5 years) following contemporary endodontic microsurgery (EMS) and identify associated prognostic factors.

METHODS

Clinical and radiographic data of an EMS cohort (2006-2013) from the electronic data base of Dental Hospital were reviewed retrospectively by two independent examiners to determine their survival and healing outcomes, and potential prognostic factors analyzed by Cox proportional hazards regression and logistic regression (α = 0.05).

RESULTS

Through strict inclusion and exclusion criteria, and 721 EMS-treated teeth in the cohort, 309 (42.9%) were included (male, 35.0%; female, 65.0%; age, 45.83 ± 15.53 years) with mean final follow-up of 152.26 ± 26.37 months (range, 120-211; median, 148). Clinical and radiographic assessments found 80.5% of 10 years survival rate with 63.4% of success. Collectively, tooth type, tooth mobility, preoperative lesion size, clinical crown-root ratio, and crown restorations at follow-up were significantly associated with long-term success and survival over 10 years.

CONCLUSIONS

The preoperative status and condition of the tooth including its alveolar bone support, and adequate full crown restorations may be relevant prognostic determinants of success and survival following EMS over time.

The effect of ultrasonic and multisonic irrigation on root canal microbial communities: An ex vivo study

AIM

To analyse the effect of ultrasonic irrigant activation (UIA) and the GentleWave (GW) multisonic irrigation (GW) with minimal instrumentation on the root canal microbial diversity in an ex vivo model that used extracted molars with a history of pulp necrosis.

METHODOLOGY

Twenty-three mandibular molars were prepared ex vivo for collection of superficial (surface control), pre-treatment and post-treatment samples 24 h after extraction. Samples were divided into two groups: UIA using 6% NaOCl (n = 11) and GW group (n = 12). All samples were processed using quantitative real-time polymerase chain reaction (qPCR) and 16S rRNA next-generation sequencing to measure microbial diversity before and after the antimicrobial treatment. For qPCR, a t-test (α = .05) was used to compare the log10 reduction. The Chao1 and Shannon indices evaluated alpha diversity. Differences in community composition (beta diversity) were evaluated by analysis of similarity (ANOSIM). Kruskal-Wallis test with Bonferroni corrections was performed to evaluate the differences in abundances genera in the samples.

RESULTS

Quantitative real-time polymerase chain reaction revealed an estimated 1.6 and 2.6 log10 reduction for UIA and GW groups respectively (p = .048). An average of 5 ± 4 and 3 ± 5 operational taxonomic units (OTUs) were found in surface's samples in the UIA and GW group respectively. These values were significantly lower (p < .001) compared to the number of preoperative OTUs in those groups (155 ± 79 and 187 ± 121). In assessing beta diversity, there were no significant differences found in pre-treatment samples (R = .090, p = .070 ANOSIM with Bonferroni corrections). Also, no significant differences in community composition were observed in post-treatment samples (R = -.05, p = .829). After treatment, there was a significant reduction of Eubacterium using conventional treatment with UIA and a significant reduction of Prevotella using minimal instrumentation with GW irrigation (p = .007 and p = .002 respectively).

CONCLUSION

Quantitative PCR analysis revealed a significant reduction in microbial load for GW group. Overall, diversity changes were similar between UIA and GW irrigation in this ex vivo model that used extracted teeth with a history of pulp necrosis. OTUs obtained from the surface sample were negligible and did not affect the statistical outcome of the study.

Retreatment versus initial root canal treatment: factors affecting posttreatment pain

OBJECTIVE

The purpose of this study was to determine the factors associated with posttreatment pain in patients receiving root canal retreatment (RCR) and in those receiving initial root canal treatment (IRCT).

STUDY DESIGN

Eighty four patients scheduled for RCR or IRCT completed questionnaires on pretreatment pain levels (Visual Analogue Scale, 0-100) and demographic data. Diagnosis and original obturating material, if applicable, were also recorded, and treatment was initiated. At 4, 8, 12, 24, 48, 72, 96, and 120 hours, patients recorded posttreatment pain levels. Seventy one patients returned completed questionnaires.

RESULTS

There was no significant difference in posttreatment pain with respect to patients undergoing RCR and patients undergoing IRCT, type of original obturating material, or pretreatment diagnosis. Posttreatment pain levels were significantly increased at 4, 8, and 12 hours after treatment. Patients reporting higher levels of pretreatment pain (Visual Analogue Scale > 20) had significantly increased posttreatment pain (P <.05) up to 24 hours after the procedure.

CONCLUSIONS

Pretreatment pain level influenced posttreatment pain more than RCR or IRCT, the type of original obturating material, or the pretreatment diagnosis.

Detection of pulpal circulation in vitro by pulse oximetry

Evaluation of pulse oximetry as a potential method of determining pulp vitality was the subject of this research. An in vitro model of pulpal circulation was fabricated to test the design for a dental pulse oximetry sensor. Blood samples equilibrated with hypoxic gas mixtures were circulated through the model by a peristaltic pump. A pulse was simulated by introduction of gas bubbles into the blood circulation. Pulse oximeter readings for saturation were recorded and compared with blood gas analysis results. Statistical analysis revealed no difference between pulse oximetry and blood gas analysis with a highly significant correlation coefficient. Clinical evaluation of this application is currently in progress.

Geriatric dentistry

The over-55 age group--the most rapidly expanding portion of the population--until recently has been the least understood patient group treated in the dental office. During the last decade, the special dental care needs of geriatric patients have been the subject of many research efforts. Understanding the interactions between the systemic health problems and disease trends of the elderly and their oral health has helped the dental profession gain greater insight into treatment strategies tailored to their needs. Evaluation of the patient's systemic health is critical to identifying complicating factors that can interfere with or be exacerbated by dental treatment. Understanding these disease trends can also sensitize the dentist to the presence of previously undiagnosed oral signs of systemic disease. In addition to the patient's systemic health, oral and dental status and individual expectations and desires must be considered when developing a treatment plan. In considering all of these variables, optimal treatment can be rendered to restore function and aesthetics in a manner that will help maintain and improve the patient's health and psychologic well-being.