The outcome of combined use of iRoot BP Plus and iRoot SP for root-end filling in endodontic microsurgery: a randomized controlled trial

OBJECTIVES

Root-end filling is important for the clinical outcome of endodontic microsurgery. Our previous study showed that combined application of iRoot BP Plus Root Repair Material (BP-RRM) and iRoot SP Injectable Root Canal Sealer (SP-RCS) in root-end filling exhibited better apical sealing as compared to the application of BP-RRM alone. The aim of this randomized controlled clinical trial was to evaluate the effect of the combined use of BP-RRM and SP-RCS on the prognosis of teeth with refractory periapical diseases after endodontic microsurgery.

MATERIALS AND METHODS

240 teeth with refractory periapical diseases scheduled for endodontic microsurgery were randomly divided into BP-RRM/SP-RCS group (n = 120) and BP-RRM group (n = 120). The patients were followed up at 3 months, 6 months, and 12 months after endodontic microsurgery. Pre- and post-operative clinical and radiographic examinations were performed to evaluate the treatment outcome. The 1-year success rate of endodontic microsurgery in BP-RRM/SP-RCS and BP-RRM groups was compared by Chi-square test. Factors that might impact the prognosis were further analyzed using Chi-square test or Fisher's exact test.

RESULTS

A total of 221 teeth completed the 12-month follow-up. The 1-year success rates of the BP-RRM/SP-RCS and BP-RRM groups were 94.5% (104/110) and 92.8% (103/111), respectively. The combined use of BP-RRM and SP-RCS achieved a clinical outcome comparable to BP-RRM alone (P = 0.784). Tooth type (P = 0.002), through-and-through/apico-marginal lesion (P = 0.049), periodontal status (P < 0.0001), and Kim's lesion classification (P < 0.0001) were critical factors associated with the 1-year success of endodontic microsurgery.

CONCLUSIONS

The combined use of BP-RRM and SP-RCS is a practicable method for root-end filling in endodontic microsurgery with a satisfactory 1-year clinical outcome.

CLINICAL RELEVANCE

The combined application of BP-RRM and SP-RCS in EMS is an effective root-end filling method with a satisfactory 1-year clinical outcome.

TRIAL REGISTRATION

This study was registered in the Chinese Clinical Trial Registry (ChiCTR2100052174).

A literature review of local and systemic considerations for endodontic treatments in older adults

OBJECTIVES

The aim of this literature review was to summarise the clinical important findings on the endodontic treatment outcome in older patients (≥60 years old) with pulpal/periapical disease considering local and systemic factors from a body of knowledge that is heterogeneous in methods or disciplines.

BACKGROUND

Due to the increasing number of older patients in the endodontic practice, and the current trend for tooth preservation, the need for clinicians to have a better understanding of age-related implications that may influence the required endodontic treatment in older adults to retain their natural dentition is indispensable.

METHODS

PubMed/Medline and Embase was searched by a medical librarian using specific terms based on inclusion/exclusion criteria. The reference list was hand-seached for additional relevant publications between 2005-2020. A combination of these terms was performed uing Boolean operators and MeSH terms.

RESULTS

Of the 1577 publications identified manually and electronically, 25 were included to be fully reviewed by the examiners. The data was derived from three systematic reviews, one systematic and meta-analysis, three case series, four prospective and 14 retrospective cohorts. Overall, there was heterogeneity in reporting as well as limitations in most studies.

CONCLUSIONS

The outcome of endodontic treatment (ET) either nonsurgical or surgical or combination of these is not affected by older age. ET can be the treatment of choice in older patients wiht pulpal/periapical disease. There is no evidence that older age per se affects the outcome of any type of endodontic treatment.

Periradicular tissue fluid-derived biomarkers for apical periodontitis: An in vitro methodological and in vivo cross-sectional study

BACKGROUND

Periradicular tissue fluid (PTF) offers a source of diagnostic, prognostic and predictive biomarkers for endodontic disease.

AIMS

(1) To optimize basic parameters for PTF paper point sampling in vitro for subsequent in vivo application. (2) To compare proteomes of PTF from teeth with normal apical tissues (NAT) and asymptomatic apical periodontitis (AAP) using high-throughput panels.

METHODOLOGY

(1) To assess volume absorbance, paper points (n = 20) of multiple brands, sizes and sampling durations were inserted into PBS/1%BSA at several depths. Wetted lengths (mm) were measured against standard curves to determine volume absorbance (μL). To assess analyte recovery, paper points (n = 6) loaded with 2 μL recombinant IL-1β (15.6 ng/mL) were eluted into 250 μL: (i) PBS; (ii) PBS/1% BSA; (iii) PBS/0.1% Tween20; (iv) PBS/0.25 M NaCl. These then underwent: (i) vortexing; (ii) vortexing/centrifugation; (iii) centrifugation; (iv) incubation/vortexing/centrifugation. Sandwich-ELISAs determined analyte recovery (%) against positive controls. (2) Using optimized protocols, PTF was retrieved from permanent teeth with NAT or AAP after accessing root canals. Samples, normalized to total fluid volume (TFV), were analysed to determine proteomic profiles (pg/TFV) of NAT and AAP via O-link Target-48 panel. Correlations between AAP and diagnostic accuracy were explored using principal-component analysis (PCA) and area under receive-operating-characteristic curves (AUC [95% CI]), respectively. Statistical comparisons were made using Mann-Whitney U, anova and post hoc Bonferonni tests (α < .01).

RESULTS

(1) UnoDent's 'Classic' points facilitated maximum volume absorbance (p < .05), with no significant differences after 60 s (1.6 μL [1.30-1.73]), 1 mm depth and up to 40/0.02 (2.2 μL [1.98-2.20]). For elution, vortexing (89.3%) and PBS/1% BSA (86.9%) yielded the largest IL-1β recovery (p < .05). (2) 41 (NAT: 13; AAP: 31) PTF samples proceeded to analysis. The panel detected 18 analytes (CCL-2, -3, -4; CSF-1; CXCL-8, -9; HGF; IL-1β, -6, -17A, -18; MMP-1, -12; OLR-1; OSM; TNFSF-10, -12; VEGF-A) in ≥75% of AAP samples at statistically higher concentrations (p < .01). CXCL-8, IL-1β, OLR-1, OSM and TNFSF-12 were strongly correlated to AAP. 'Excellent' diagnostic performance was observed for TNFSF-12 (AUC: 0.94 [95% CI: 0.86-1.00]) and the PCA-derived cluster (AUC: 0.96 [95% CI: 0.89-1.00]).

CONCLUSIONS

Optimized PTF sampling parameters were identified in this study. When applied clinically, high-throughput proteomic analyses revealed complex interconnected networks of potential biomarkers. TNFSF-12 discriminated periradicular disease from health the greatest; however, clustering analytes further improved diagnostic accuracy. Additional independent investigations are required to validate these findings.

Analysis of obtaining apical patency indexes during endodontic treatments considering gender, age, pulpoperiradicular diagnosis and canal/tooth-A clinical study

This study aimed to perform an analysis of obtaining apical patency indexes during endodontic treatments considering gender, age, pulpoperiradicular diagnosis and canal/tooth (n. 639/383). Following previous clinical procedures, a thin K-File (No. 20, 15, 10 or 08) was used to achieve apical patency. These specific data and some demographic and clinical information were submitted to the statistical analysis (p < 0.05). Significant statistical differences were not identified considering gender (p = 0.156) and age (p = 0.793). However, in 14.6% of the canals of vital teeth and 14.1% of the canals of necrotic teeth without periapical lesions, apical patency could not be achieved, which occurred in only 7% of the canals of necrotic teeth with periradicular disease (p = 0.009). Considering canal/tooth, apical patency was more challenging to obtain in canals of posterior teeth (p = 0.000). The pulpoperiapical diagnosis and canal/tooth significantly influenced the obtaining of apical patency.

[Clinical guidelines for pulp therapies of primary teeth]

Pulpal and periapical diseases are the most prevalent dental conditions damaging the oral health of children in China. In view of China's national condition, the level of diagnosis and treatment for pulpal and periapical diseases of deciduous teeth is uneven and clinically there are inconsistent standards on the selection of operation methods for the endodontic treatment in deciduous teeth. Targeting these problems, the Society of Pediatric Dentistry, Chinese Stomatological Association organized experts from several famous universities and hospitals in China to carry out a panel discussion. The results of domestic and overseas researches and diagnosis and treatment experiences on dental pulp disease and periapical disease of deciduous teeth were also referred to. The present guideline was finally developed for the reference of dental clinicians.

Association between type 2 diabetes mellitus and the evolution of endodontic pathology

OBJECTIVE

The purpose of the present study was to assess the influence of type 2 diabetes mellitus (DM) on the evolution of pulpal and periapical pathology.

METHOD AND MATERIALS

Two reviewers independently conducted a systematic search for articles published between 1 January 2001 and 31 December 2018 on MEDLINE/PubMed, ISI Web of Science, and Scopus databases. An additional manual search was also carried out.

RESULTS

Ten studies fulfilling the inclusion criteria were included in the review (two longitudinal studies with 1-year follow-up comparing the success of primary root canal treatment between type 2 diabetic patients and non-diabetic patients, and eight cross-sectional studies). Analysis of the ten studies showed that inadequate control of type 2 DM may predispose and influence the inflammatory pulpal and periapical disease evolution.

CONCLUSIONS

The present systematic review suggests that there are biologic bases to suggest that type 2 DM may act as a risk factor for developing an endodontic pathology, affecting the course of the disease in terms of susceptibility, prevalence, progression, and tissue healing capacity as a consequence of a disrupted immune response. However, more well-designed clinical investigations carrying out suitable research methodologies are needed to elucidate the influence of type 2 DM on the pulpal and periapical disease evolution.

The dimensions of the facial alveolar bone at tooth sites with local pathologies: a retrospective cone-beam CT analysis

OBJECTIVE

To assess the impact of various local pathologies on facial alveolar bone dimensions at tooth sites.

MATERIALS AND METHODS

Cone-beam computed tomography images of 60 patients were analyzed. Healthy teeth and teeth with local pathologies (i.e., endodontically treated, periodontally diseased teeth, and teeth with periapical lesions) were included. The thickness of the facial alveolar bone was measured at five locations: (1) the bone crest (W0), (2) 25% (W25), (3) 50% (W50), (4) 75% (W75) of the distance from the bone crest to the root apex (A), and (5) in the A region (W100). The results were considered statistically significant at p < 0.0008 (adjustment according to the statistical correction for multiple testing).

RESULTS

A total of 1174 teeth (707 healthy and 467 with the local pathologies) were assessed. Periodontally diseased maxillary premolars and anterior teeth in the mandible in the W0 position, as well as maxillary molars in the W25 position, tended to have a lower facial bone thickness when compared to the healthy teeth (0.68 mm vs. 0.84 mm, p = 0.008; 0.47 mm vs. 0.55 mm, p = 0.004; and 1.27 mm vs. 1.72 mm; p = 0.009, respectively). In contrast, the observed tendency pointed towards thicker facial bone wall for the periodontally diseased mandibular anterior teeth in the W50 position (0.74 vs. 0.52, p = 0.001). Healthy maxillary molars tended to display a thicker facial alveolar bone compared to the teeth with local pathologies in the W25, W50, and W75 positions (p = 0.001, p = 0.005, and p = 0.004, respectively).

CONCLUSIONS

The present analysis has indicated that local pathologies are commonly associated with a compromised socket morphology.

CLINICAL RELEVANCE

The facial bone thickness was particularly reduced at periodontally diseased teeth, which may challenge implant therapy.

Development of Medication-Related Osteonecrosis of the Jaw After Extraction of Teeth With Experimental Periapical Disease

PURPOSE

Medication-related osteonecrosis of the jaw (MRONJ) is a rare but severe side effect of antiresorptive medications. Most animal models use tooth extraction as an instigating local factor to induce MRONJ, with varied results. However, these teeth are healthy and absent of dental disease, a rare finding that does not reflect clinical practices. The authors hypothesized that extraction of teeth with periapical inflammation would lead to MRONJ in rats treated with high-dose bisphosphonates.

MATERIALS AND METHODS

Rats were pretreated with zoledronic acid (ZA) for 1 week. Pulp exposure (PE) was established by exposing the pulpal chamber of the first and second molars. Experimental periapical disease (EPD) was induced by PE and bacterial inoculation into pulp chambers of the first and second mandibular molars. The mandibular molars were extracted 4 weeks after PE or EPD, and animals were euthanized 4 weeks after tooth extraction. Extraction sockets were assessed clinically, radiographically, and histologically.

RESULTS

Clinically, radiographically, and histologically, socket healing was observed in all vehicle-treated animals and in ZA-treated animals after extraction of healthy teeth or teeth with PE. In contrast, bone exposure, lack of socket healing, and osteonecrosis were present in most ZA-treated animals after extraction of teeth with EPD. Bacterial presence was noted in areas of osteonecrotic alveolar bone.

CONCLUSION

These data support a synergistic contribution of severe dental disease and tooth extraction to MRONJ pathogenesis. Importantly, this model is amenable to manipulation of methodologic conditions for the dissection of parameters involved in MRONJ pathogenesis.

[Cause and regulation of pain during root canal therapy]

In stomatology, root canal therapy is a commonly used and effective treatment for dental pulp diseases and periapical diseases. However, pain may occur during or after treatment and may severely affect patients. This article aimed to analyze the mechanism and cause of pain during root canal therapy, which may reduce or relieve pain.

Guidelines for Root Canal Therapy

Root canal therapy is currently the main method to treat pulpal and periapical diseases. Root canal therapy consists of a series of complex procedures, requires specific equipments, instruments and materials, and should be performed by qualified stomatologists (clinicians). Complicated cases should be referred to endodontic specialists or the clinicians trained by intense endodontic courses. In 2004, the Society of Cariology and Endodontology of Chinese Stomatological Association (CSA) published the 'Practices and evaluation criteria of root canal therapy (Discussion Version)'. Since then, opinions and comments regarding the 'Discussion Version' have been widely circulated within the society. The final version of the guideline was based on systematic reviews of scientific literature and requirements for the edit of technical guidelines, through several rounds of discussions, revisions and supplements. The society recommends this guideline for stomatologists (clinicians) to use during endodontic treatment.

Application of fluorescence microscopy on hematoxylin and eosin-stained sections of healthy and diseased teeth and supporting structures

Destruction of dental tissue and supporting structures is usually microscopically assessed by routine hematoxylin and eosin (HE)-stained sections. This short communication is concerned with the potential role of fluorescence microscopy of HE-stained sections to study morphological aspects of intact and pathological teeth in dental research. This methodology improves the visualization of the anatomical structures of the intact teeth, especially anatomical features and periodontal ligament spatial distribution. This technique also improves the visualization of the root and bone resorption and the delineation of the periapical lesion extension. The fluorescence microscopy technique of HE-stained sections is an easy, reliable and inexpensive method that seems to be a useful tool for evaluating morphological aspects of intact and pathological teeth in dental research.

[Animal experimental study of the treatment of periapical disease with recombinant human bone morphogenetic protein-2 composite]

OBJECTIVE

To investigate the effect of the treatment of periapical diseases with recombinant human netic protein (rhBMP-2) composite in dog models so as to provide basis for its clinical application.

METHODS

The endotoxin-bacteria mixed fluid was injected into each root canal of the experimental teeth of dogs and the animal periapical were built. The rhBMP-2 composite was mixed by rhBMP-2, TCP, collagen and metronidazole and used in the treatment cal diseases in dog models as root apex screen. The imageology and pathology research were went on.

RESULTS

The effective rate of the experimental group was remarkably higher than that of the carrier group and the control group with remarkable ference (P < 0.05). The quality of the repair of tissue was obviously better than the two other groups.

CONCLUSION

The rhBMP-2 composite is a promising biological root-canal filling material.

Long-term survival of root-canal-treated teeth: a retrospective study over 10 years

In this retrospective study the survival rate of 190 root-canal-treated teeth of 144 patients after 10-yr minimum was evaluated. Students during their training in 1987 and 1988 had performed the treatments. Age, gender, jaw, or quantity of root canals had no influence to the success of a root-canal treatment. Teeth with an apical lesion before the endodontic treatment showed a significantly shorter likelihood of survival. The best results could be found in root-canal fillings ending 0 to 1 mm and 1 to 2 mm before the apex. Comparing types of restoration, prosthetic-treated teeth with retention post and crown seem to be favorable. The study showed that root-canal treatment even conducted by students has a survival rate of 85.1% (Kaplan-Meier) after 10 yr and is a long-lasting, conservative therapy.

Recent development in endodontic research

In essence, endodontics as a clinical discipline is concerned with the prevention and treatment of pulpal and periapical infection. In recent research the infective process has been investigated as well as the mechanisms by which the pulp and periodontium deal with microbial insults. With regard to the pulp, findings on the hemodynamics of pulpitis suggest that the inflammatory response in this tissue is much less influenced by the special anatomic environment of the tooth than was previously believed. Pulpal diseases are being underdiagnosed, mostly because of inadequate examination methods. Laser Doppler flowmetry which gives a vascular rather than a nervous response may gain importance in pulpal diagnostics in the future. It is established that apical periodontitis with bone resorption cannot develop in the absence of bacteria in the root canal system. Root canal infection is characterized by a wide variety of combinations of relatively few anaerobic bacteria, and bacterial synergism plays an important role in maintaining the infection. Microbial invasion of an apical granuloma may take place. Non-oral and environmental organisms like Pseudomonas aeruginosa are frequently isolated from treatment-resistant cases. Success of endodontic treatment depends on the reduction or elimination of the infecting bacteria. This may predictably be obtained after a thorough chemo-mechanical instrumentation and disinfection of the root canal with calcium hydroxide. The standardized technique which entails the preparation of a cylindrical apical box with removal of significant amounts of dentin near the root apex predictably gives a clean canal. This technique has provided excellent clinical and radiographic results in well documented follow-up studies.

Apexification: follow-up after 6-12 years

Thirty 'apexified' immature permanent anterior teeth treated utilising Ca(OH)2 as root canal dressing assessed clinically and radiographically after greater than 6 less than or equal to 12 years revealed that in 15 teeth bridge remained the same; in 10 consolidated, while in 3 it decreased. Periapical radiolucency reappeared in one case, while in two it was questionable but clinically the teeth were comfortable; these cases were ones showing decrease in bridge consolidation: two teeth had been extracted during this observation period by some dentists because of complaint of discolouration.