Further Interventions after Root Canal Treatment Are Most Common in Molars and Teeth Restored with Direct Restorations: A 10-11-Year Follow-Up of the Adult Swedish Population

INTRODUCTION

The aims were to investigate 1) the frequency of nonsurgical retreatment, root-end surgery, extraction, and further restorative treatment during a follow-up of 10-11 years after root filling and compare the frequencies according to tooth group and type of coronal restoration and 2) the timing of nonsurgical retreatment, root-end surgery, and extraction.

METHODS

Data were collected from the Swedish Social Insurance Agency's register. A search for treatment codes identified teeth root filled in 2009 and the type of coronal restoration (direct, indirect, and unspecified) registered within 6 months of root filling. The root-filled teeth were followed 10-11 years, and further interventions were recorded. Descriptive statistics and chi-square tests were used for statistical analysis.

RESULTS

In 2009, root fillings were registered for 215,611 individuals/teeth. Nonsurgical retreatment, root-end surgery, and extraction were undertaken in 3.5%, 1.4%, and 20% teeth, respectively. The frequency of further interventions varied with respect to tooth group and type of coronal restoration, but only slightly for endodontic retreatments. Further interventions, except for root-end surgery, were registered more often for molars and directly restored teeth (P < .001). The majority of endodontic retreatments were undertaken within 4 years, while extractions were evenly distributed over 10-11 years.

CONCLUSIONS

The frequency numbers of nonsurgical retreatment and root-end surgery were low, despite 1 in 5 root-filled teeth registered as extracted. Further interventions were most common in molars and directly restored teeth. Endodontic retreatments were performed more often during the first 4 years.

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

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.

Survival of endodontically treated teeth in public dental service in Northern Finland: a practise-based register study

OBJECTIVE

The aim of this study was to explore the factors associated with the survival of root canal treated teeth in a practise-based study setting in a 5-year period.

MATERIAL AND METHODS

This retrospective study used data from the electronic patient registration system of the public dental services of the City of Oulu, Finland. The inclusion criteria for this study were patients aged ≥ 20 years who had root canal treatment (RCT) that was initiated in 2014. One RCT per patient was included in the study. A total of 713 patients met the inclusion criteria. The outcome variable for this study was the extraction of the RCT tooth during the 5-year period. Explanatory variables included age, diagnosis, tooth type (incisive, canine, premolar, molar), RCT technique (manual, motorized), time from RCT initiation to final restoration and type of final restoration (composite, glass ionomer, fixed dental prosthesis). To evaluate the association between the outcome variable and explanatory variables, Cox regression analyses were performed.

RESULTS

The overall survival rate was 91%. The middle-aged (40-59-years-old) and the oldest (60 and older) patients had a two-fold risk of extraction compared to younger (20-40-years-old) patients. Similarly, a short length of time from RCT initiation to final restoration (0-14 days) resulted in a nearly three times higher risk of extraction compared to a longer period (≥ 90 days).

CONCLUSIONS

The 5-year survival rate of RCTs seems high. Extractions were more common among patients over 40 years of age and if the RCT was completed shortly after its initiation.

Analysis of Prosthetic Joint Infections Following Invasive Dental Procedures in England

Importance

Dentists in the United States are under pressure from orthopedic surgeons and their patients with prosthetic joints to provide antibiotic prophylaxis before invasive dental procedures (IDP) to reduce the risk of late prosthetic joint infection (LPJI). This has been a common practice for decades, despite a lack of evidence for an association between IDP and LPJI, a lack of evidence of antibiotic prophylaxis efficacy, cost of providing antibiotic prophylaxis, and risk of both adverse drug reactions and the potential for promoting antibiotic resistance.

Objective

To quantify any temporal association between IDP and subsequent LPJI.

Design, Setting, and Participants

This cohort study used a case-crossover and time trend design to examine any potential association between IDP and LPJI. The population of England (55 million) was chosen because antibiotic prophylaxis has never been recommended to prevent LPJI in England, and any association between IDP and LPJI would therefore be fully exposed. All patients admitted to hospitals in England for LPJI from December 25, 2011, through March 31, 2017, and for whom dental records were available were included. Analyses were performed between May 2018 and June 2021.

Exposures

Exposure to IDP.

Main Outcomes and Measures

The main outcome was the incidence of IDP in the 3 months before LPJI hospital admission (case period) compared with the incidence in the 12 months before that (control period).

Results

A total of 9427 LPJI hospital admissions with dental records (mean [SD] patient age, 67.8 [13.1] years) were identified, including 4897 (52.0%) men and 4529 (48.0%) women. Of these, 2385 (25.3%) had hip prosthetic joints, 3168 (33.6%) had knee prosthetic joints, 259 (2.8%) had other prosthetic joints, and 3615 (38.4%) had unknown prosthetic joint types. There was no significant temporal association between IDP and subsequent LPJI. Indeed, there was a lower incidence of IDP in the 3 months prior to LPJI (incidence rate ratio, 0.89; 95% CI, 0.82-0.96; P = .002).

Conclusions and Relevance

These findings suggest that there is no rationale to administer antibiotic prophylaxis before IDP in patients with prosthetic joints.

Access to root canal treatment in a Nigerian sub-population: assessment of the effect of dental health insurance

Background

The final pathway of tooth mortality lies between tooth extraction, and the more expensive and less accessible root canal treatment (RCT).

Aim

To determine the extent to which individuals' financial resources as measured by socioeconomic status and dental insurance coverage affects their access to RCT.

Methods

A hospital-based study that used a 15-item questionnaire to collect data among patients scheduled for RCT. All scheduled subjects (N = 291) over a one-year period constituted the sample for the study. Using the SPSS software, associations between the subjects' variables, and the dental insurance status were carried out with Chi square and independent t test respectively at 95% confidence interval.

Results

Two hundred and ninety-one subjects were to have 353 RCTs within the study period. A high proportion (79.7%, p < 0.001) of the subjects had dental health insurance, majority (95.3%) of which was government funded. 20.9% of those with previous tooth loss was due to inability to afford cost of RCT. The lowest socioeconomic group had the highest proportion (90%, p = 0.421) of insured that visited for RCT.

Conclusion

Dental insurance increased access to RCT. Socioeconomic status did not affect dental insurance status and dental visit for RCT.

The "Plan" phase of a Deming cycle: Measurement of quality and outcome of root canal treatments in a university hospital

INTRODUCTION

In many countries, dental students are taught in private or university hospitals where they treat patients under the supervision of teachers. Assessing the quality of root canal treatments (RCT) would provide information about the quality of care patients receive when treated by students.

METHODS

This study describes the six-step "Plan" phase of a Plan-Do-Check-Act (PDCA) cycle that identifies and analyses clinical practices in endodontics in a university dental hospital service.

RESULTS

Step 3 reported that the proportion of RCTs of adequate quality reached 57.1% and this proportion was significantly decreased when specific indicators for treatment difficulties were present. The proportion of successful RCTs after 1 year was 65.6%, and its variation was influenced by the preoperative periapical status rather than the quality of RCTs. The consensual meeting in Step 6 proposed to introduce three new procedures for the further Do, Check and Act phases of the PDCA cycle.

CONCLUSION

This study encourages systematic evaluation of RCTs and provides the first step of the methodology that can be reproduced in private and hospital practices where students are asked to treat patients.

[Clinical evaluation of the prevalence of endodontic interappointment emergencies during intracanal medication before and after root canal preparation]

PURPOSE

To evaluate the incidence of pain during intracanal medication before and after root canal instrumentation for therapeutic reference.

METHODS

Three hundred and twenty four teeth were selected in this study, and the teeth received root canal therapy with crown-down technique using ProTaper rotary system, followed by calcium hydroxide intracanal medication. The degree of reported pain was recorded as 4 levels after treatment according to the Negm criteria. The incidence of endodontic interappointment emergencies (EIAE) at various recording times starting from root canal preparation was evaluated based on the results analyzed with MATLAB and SPSS19.0 software package.

RESULTS

All patients reported of pain immediately after root canal therapy and calcium hydroxide intracanal medication, of which 1.54% were diagnosed as EIAE, the prevalence and degree of pain were increased. The prevalence of EIAE reached 25.62% one day after treatment, and decreased to 3.70% 3 days later. Most of the pain released without treatment; however, few patients experienced severe pain. The relationship between the EIAE percentage and time duration after treatment was fitted by using MATLAB as P(t)=100%×0.066t exp[-0.076t] (t: hour; RMSE=3.91). The patient started to report free of pain 6 hours after the treatment, 33.64% of the patients were painless 1 week after treatment, and 82.71% were painless 2 weeks later. There was significant difference between the pain level before and 2 weeks after treatment (P<0.01).

CONCLUSIONS

During root canal preparation and intracanal medication, the prevalence and degree of pain were increased immediately after treatment, decreased 3 days later, and most of the pain was released 2 weeks after treatment.

Reasons for Apical Surgery Treatment in an Underserved New York City Population

Endodontic retreatment often involves remaking restorations. The total cost may steer the treatment towards surgery. The aim of this study was to retrospectively record the reasons for performing apical surgery in an economically deprived patient population. The clinical reasons (59%) for apical surgery were most common, but the nonclinical (financial) reasons (41%) emerged as a major cause. The finding that 41% of the apicoectomies were performed because of nonclinical constraints is a high figure and may not reflect the situation generally. Still, economic factors potentially play a major role in the selection of surgical versus nonsurgical endodontic retreatment.

Frequency and distribution of teeth treated by single- and multiple- visit root canal treatment in a Nigerian population by differently skilled operators

BACKGROUND

Single visit root canal treatment (RCT) is being advocated around the world. This study profiles RCT in a Nigerian population and compares pattern of single versus multiple visit RCT to tooth type and skill level of the doctors.

METHOD

A retrospective study was carried out on RCT performed in one year by fresh graduates and postgraduate dentists. Records retrieved included patients' sex and age, tooth type, location in the jaw and whether single- or multiple-visit RCT was done.

RESULTS

Records of 705 teeth were reviewed, 54.6% belonged to females. Age range was 18-87 years, mean of 31.76 (± 12.31) years. Majority (70.1%) belonged to 20-39 years' age group. Most teeth were located in the maxilla (60.8%) and in posterior regions (73.6%). The most frequently root filled tooth was the mandibular first molar (20.7%) followed by maxillary central incisor (18.4%) then maxillary premolar (12.8%). However, all molars accounted for 47.3%, premolars 26.3% and incisors 25.0%. Canines (1.45%) were least frequently root-filled. Incisors (54.8%) were the teeth most frequently treated in single-visit followed by premolars (28.8%). Most frequently treated by multiple-visit were molars (51.0%). All doctors performed multiple-visit RCT in an approximately equal proportion but a significant percentage of single-visit RCT was carried out by senior doctors (71.2%).

CONCLUSION

The most frequently root filled teeth were mandibular first molars. Teeth most likely to be treated by single-visit RCT were incisors. Appropriate operator skill and experience is important in the decision to perform single-visit RCT. Single-visit RCT is advocated in the developing environment.

SUCCESS RATE OF OVERFILLED ROOT CANAL TREATMENT

BACKGROUND

Traditionally, poor obturation has been considered the primary cause of root canal treatment failures. The purpose of this study was to assess the success rate of overfilled root canal treatment cases in order to decide whether a definitive restoration can be placed immediately following treatment in an overfilled case or whether the patient needs to be kept on a follow up prior to the placement of a definitive restoration.

METHODS

A total of 1242 patient's periapical radiographs (1748 teeth) were assessed, out of which 397 teeth (in 285 patients) were found to be overfilled. Out of these 285 patients, 111 (128 cases) agreed to participate in this cross sectional study and were recalled for clinical and radiographic examination. Success was evaluated clinically by absence of symptoms (pain, swelling, tenderness to percussion and sinus tract) and radiograhically by the decrease in size of periapical lesion or no change in size. Increase in size of periapical lesion was deemed to be a failure.

RESULTS

Our findings revealed that despite overfill, the treatment was successful in 115 cases and failure was noted in 13 cases showing an overall success rate of 89.8% and failure rate of 10.2%. Out of 13 cases of failure, all 13 showed an increase in periapical lesion size, out of which 10 were accompanied with pain.

CONCLUSION

We have determined that there is no need to delay placement of a permanent restoration on overfilled teeth (ruling out the presence of other procedural errors) nor is there any need to pursue any further surgical or non-surgical endodontic treatment. However we would suggest that patients should be kept on follow-up after placement of permanent restoration.

The Landscape of Predoctoral Endodontic Education in the United States and Canada: Results of a Survey

Few recent surveys have examined the contemporary landscape of predoctoral endodontic education in the United States and Canada, but anecdotal reports suggest that current dental students have difficulty obtaining adequate clinical endodontic experiences. The aims of this study were to quantify the clinical endodontic experiences of current U.S. and Canadian dental students, to explore the issues surrounding their clinical endodontic competence, and to ask more broadly if current graduating dentists are competent to perform endodontic procedures. In August 2014, a hyperlink to a web-based survey with 27 questions was emailed to the 67 predoctoral endodontic directors of U.S. and Canadian dental schools using a list provided by the American Association of Endodontists. Out of these 67 possible participants, 40 responded, for a response rate of 60%. The findings were varied. The average 2014 graduate completed 5.9 (± 2.4) root canal treatments on live patients, and 69% of the respondents voiced concern regarding a shortage of patient experiences. A majority (59%) of the respondents reported thinking that the supply of endodontic patients has decreased and that students have an inadequate supply of endodontic patients. This study found that a clear majority of predoctoral endodontics directors perceived a shortage of patient experiences for their students although, in reality, the number of completed clinical cases appeared to be unchanged since 1975. In addition, 36% of the respondents reported feeling that their 2014 graduates were not competent to perform molar endodontic treatment in their practices.

General Dentists' Use of Isolation Techniques during Root Canal Treatment: From the National Dental Practice-based Research Network

INTRODUCTION

A preliminary study done by a National Dental Practice-Based Research Network precursor observed that 44% of general dentists (GDs) reported always using a rubber dam (RD) during root canal treatment (RCT). This full-scale study quantified the use of all isolation techniques, including RD use.

METHODS

Network practitioners completed a questionnaire about isolation techniques used during RCT. Network enrollment questionnaire data provided practitioner characteristics.

RESULTS

One thousand four hundred ninety of 1716 eligible GDs participated (87%); 697 (47%) reported always using an RD. This percentage varied by tooth type. These GDs were more likely to always use an RD, do not own a private practice, perform less than 10 RCTs/month, and have postgraduate training.

CONCLUSIONS

Most GDs do not use an RD all the time. Ironically, RDs are used more frequently by GDs who do not perform molar RCT. RD use varies with tooth type and certain dentist, practice, and patient characteristics.

Root canal treatment and prevalence of apical periodontitis in a nigerian adult subpopulation: a radiographic study

PURPOSE

To evaluate the frequency, distribution and quality of root canal treatment in an adult Nigerian subpopulation and to determine the prevalence of apical periodontitis.

MATERIALS AND METHODS

The periapical status and length of root fillings of 756 patients attending Obafemi Awolowo University Teaching Hospital, Ile-Ife, Nigeria for the first time were evaluated using full mouth periapical radiographs. The length of the root canal filling was considered 'adequate' if it was ≤ 2 mm from the radiographic apex, 'under-filled' if it was > 2 mm short of the apex, and 'overfilled' if filling material extended beyond the radiographic apex. Periapical status was assessed using the periapical index (PAI) with teeth classified as having apical periodontitis if the score was over 2.

RESULTS

Overall, 61.2% of the patients had root-filled teeth and 67.2% featured apical periodontitis. Of the 21,468 teeth examined, 12.2% had been root filled, and of these 41% exhibited apical periodontitis. The prevalence of root-filled teeth was higher in the younger patients, while the prevalence of apical periodontitis in root-filled teeth was similar between age groups. Root-treated teeth that were overfilled or were mandibular incisors had the highest prevalence of apical disease. Overfilled teeth were more prone to developing an apical radiolucency than were under-filled teeth (P < 0.001 and P < 0.05, respectively).

CONCLUSIONS

The prevalences of endodontically treated teeth and apical periodontitis were within the range reported for other countries; however, a very large number of patients required treatment or retreatment.

A register-based study of variations in services received among dental care attenders

OBJECTIVES

To investigate whether receipt of dental services, among attenders, reflects variations in dental health or whether and to what degree it is associated with socioeconomic status, with irregular or regular dental attendance and with the availability of dentists in residential areas.

MATERIALS AND METHODS

This retrospective register-based study followed two Danish cohorts, aged 25 and 40, with a dental examination in 2009 (n = 32,351). The dental service data were registered during 2005-2009. The number of dental examinations, individual preventive services (IPS), tooth extractions, root fillings and composite fillings were analyzed in relation to socioeconomic status, irregular/regular dental attendance, inhabitant/dentist ratio and to DMFT at age 15 (DMFT15) and change in DMFT (ΔDMFT) from age 15 to age 25 and age 40, respectively. Poisson regression and negative binomial regression analyses were used.

RESULTS

The variations in number of services received in the study population were small (SD = 0.2-2.7). However, with a few exceptions, high levels of DMFT15 and ΔDMFT were associated with receipt of more dental services. Socioeconomically-privileged individuals received more dental examinations but fewer tooth extractions, root fillings and composite fillings compared to disadvantaged persons, when controlled for dental health levels. Irregular attenders received fewer IPS and composite fillings but had more extractions compared to regular attenders.

CONCLUSIONS

Variations in dental care services were found to reflect variations in dental health, but the variations were also related to individual socioeconomic status, residential area and dental attendance patterns.

Periradicular lesions in HIV-infected patients attending the faculty of dentistry: clinical findings, socio-demographics status, habits and laboratory data - seeking an association

OBJECTIVE

The purpose of this study was to estimate the prevalence of periradicular lesions in HIV-infected Brazilian patients and to assess the correlation of several factors with the periradicular status.

METHOD

One hundred full-mouth periapical radiographs were evaluated. A total of 2,214 teeth were evaluated for the presence of periradicular lesions, caries lesions, coronal restorations, pulp cavity exposure and endodontic treatment.

RESULTS

The prevalence of periradicular lesions was 46%. There were no significant differences between individuals with or without periradicular lesions with respect to their socio-demographic status, habits, laboratory data and route of HIV infection. However, the presence of a periradicular lesion was statistically correlated with the number of teeth with endodontic treatment (p = 0.018), inadequate endodontic treatment (p = 0.025), images suggesting pulp cavity exposure (p = 0.002) and caries lesions (p = 0.001).

CONCLUSIONS

The prevalence of periradicular lesions in HIV-infected individuals was 46% and was not related to HIV infection.

Assessment of root canal treatment outcomes performed by Turkish dental students: results after two years

The aim of this study was to evaluate radiographically the periapical status and technical standard of root canal therapies performed by a group of undergraduate dental students in Turkey two years following completion of the treatments. A random sample of 264 patients who received root canal treatment from undergraduate students at the Yeditepe University Faculty of Dentistry in 2009 were recalled after two years. The study sample consisted of 319 root-filled teeth in 158 dental patients (females=97, males=61) who presented to the student clinics during that time frame. For each root-filled tooth, two periapical radiographs were examined to identify the periapical status, one showing pre-treatment and the other showing post-treatment status. The quality of endodontic treatment was examined according to the distance between the end of root filling and radiographic apex and the density of the obturation according to presence of voids within the root filling material. This examination found that 54.2 percent of roots had fillings of acceptable length, while 37.3 percent were short, 7.8 percent were overfilled, and 0.6 percent was unfilled; 2.5 percent of the teeth were observed with broken root canal instruments. After two years, PAI scores of teeth with acceptable length of root canal filling (0-2 mm from the radiographic apex) were found to be lower than those of the overfilling and short filling cases (>2mm) (p<0.01). Moreover, voids were detected in the root canal fillings of 52.7 percent of endodontically treated teeth. The PAI scores of root fillings with inadequate density were significantly higher than adequate ones (p<0.01). Although endodontic treatments performed by undergraduate students do not appear to be unqualified compared to those performed by general practitioners, more emphasis must be placed on the technical quality of endodontic treatment to obtain better results.

Traumatic injuries of permanent teeth among 6- to 12-year-old Iraqi children: a 4-year retrospective study

PURPOSE

The purpose of this retrospective study was to identify the types, causes, and other factors associated with traumatic dental injuries (TDIs) in the permanent teeth of children in Mosul, Iraq.

METHODS

Data were collected from the dental records of 6- to 12-year-old children with TDIs who attended the Pediatric Dental Clinic at the Mosul University School of Dentistry between October 2006 and October 2010. The gathered data included: demographic information, when and where the injury occurred, type of dental injury, cause of injury, and the time elapsed between the TDI and dental care. Data were evaluated using the chi-square test.

RESULTS

A total of 294 children with TDIs were examined and treated. The highest frequency of TDIs was among 12-year-old children (29%), with more males being affected (P<.001). The most common type of injury was enamel-dentin fracture (56%). The most frequent cause of TDIs was falls (53%). The majority of the injuries happened outdoors (55%), and 37% of the cases occurred in the Fall. Only 5% of patients sought dental care within 24 hours of the injury.

CONCLUSION

This 4-year retrospective study showed that the majority of children with TDIs sought dental treatment after one month of the injury. Educating parents and teachers about the benefits of trauma prevention and immediate treatment of injuries is a must.

Dental needs and management of children with special health care needs according to type of disability

PURPOSE

The purpose of this study was to investigate the dental needs and management of special health care needs children in Rio de Janeiro, Brazil, according to the type of disability.

METHODS

Records of 428 0- to 19-year-old patients who received dental treatment at the Patients Special Care Needs Clinic (Department of Pediatric Dentistry and Orthodontics, School of Dentistry, Universidade Federal do Rio de Janeiro) from 1996-2009 were analyzed. Information about the type of disability, use of medication, dental exam findings, management during treatment, dental treatment performed, and follow-up examinations were collected. Children were divided into 2 groups: those with medical conditions and those with intellectual disability.

RESULTS

Patients with medical conditions used more medications and were older than those with intellectual disability. The most common dental treatments received were dental restorations (63%) and extractions (47%). There was no association between the type of disability and dental treatment needed. Children with intellectual disability were 3 times more likely to need general anesthesia and 7 times more likely to need physical restraint for dental care than the other group.

CONCLUSIONS

Children with intellectual disability have a greater chance of requiring advanced management techniques during dental treatment. The development of effective oral health programs is recommended as well as a specific education program for their parents.

Does a case completion curriculum influence dental students' clinical productivity?

The purpose of this study was to evaluate the effects of a new clinical curriculum on dental student productivity as measured by number of procedures performed in the student teaching practice. Harvard School of Dental Medicine adopted a new clinical education model for the predoctoral program in summer 2009 based upon a Case Completion Curriculum (CCC) rather than a discipline-based numeric threshold system. The two study groups (threshold group and case completion group) consisted of students who graduated in 2009 and 2010. Clinical performance was assessed by clinical productivity across five major discipline areas: periodontics, operative dentistry, removable prosthodontics, fixed prosthodontics, and endodontics. The relationships between the two study groups with regard to number of procedures performed by category revealed that the case completion group performed a significantly higher number of operative and removable prosthodontic procedures, but fewer periodontal and endodontic procedures (p≤0.03). No statistically significant difference in number of procedures was observed with fixed prosthodontic procedures between the two groups. Clinical productivity as a result of redesigning the clinical component of the curriculum varied in selected disciplines. The CCC, in which the comprehensive management of the patient was the priority, contributed to achieving a patient-based comprehensive care practice.

Radiographic assessments on prevalence and technical quality of endodontically-treated teeth in the Finnish population, aged 30 years and older

OBJECTIVE

To assess the prevalence and technical quality of endodontic treatment (ET) in Finland by panoramic radiography.

MATERIALS AND METHODS

As part of the Finnish nationwide Health 2000 Survey, panoramic radiographs of 5244 dentate subjects, aged 30-95 years, were analyzed. The criterion for a technically adequate ET was a distance from the root filling to the root apex of ≤3 mm.

RESULTS

Sixty-one per cent of subjects had one or more teeth with ET. ET was more prevalent in older subjects and among women. Of all teeth (n = 120 250), 7% had had ET, the percentages being greatest for molars and premolars. Technical quality was adequate in 47% of all ET, in 71% of anterior teeth, in 51% of premolars and in 25% of molars.

CONCLUSIONS

Prevalence and technical quality of endodontic treatment in Finland are comparable to that reported elsewhere, but are still calling for improvement in endodontic treatment, especially regarding molars.

Apical periodontitis in association with the quality of root fillings and coronal restorations: a 14-year investigation in young Greek adults

PURPOSE

To examine the possible association between the presence of apical periodontitis (AP) and the quality of endodontic treatment and coronal restoration over a time period of 14 years.

MATERIALS AND METHODS

1781 panoramic radiographs of freshmen cadets, taken between the years 1995-2008 were included in this study. The periapical status was evaluated using the Periapical Index (PAI) scoring system. The chisquare test and logistic regression analysis were used to examine associations between apical disease and the quality of both the root filling and the coronal restoration.

RESULTS

62.3% of the examined teeth demonstrated AP. The number of root-filled teeth and the prevalence of AP were found to be higher in OPGs taken between 1995 and 2001 than those taken between 2002 and 2008. Both the quality of the coronal restoration and the quality of the root filling (length and lateral seal) were found to be correlated with the presence of AP, but the factor most significantly associated seemed to be the coronal restoration (OR = 0.404, 95% CI: 0.174-0.940).

CONCLUSION

The quality of the endodontic treatment in young Greek adults was poor but improved over the years. Both the quality of the endodontic treatment and coronal restoration appeared to affect the periapical status of the treated teeth. The factor that probably most determined the periapical health was the quality of the coronal restoration.

Root-filled teeth and recurrent caries-a study of three repeated cross-sectional samples from the city of Jönköping, Sweden

OBJECTIVE

The aim of the study was to test the hypothesis that root-filled teeth are at a higher caries risk than non-root-filled teeth.

MATERIALS AND METHODS

Two sub-samples from epidemiologically obtained data collected in 1983, 1993 and 2003 in the city of Jönköping, Sweden, were analysed. All the participants were examined clinically and radiographically and the type of filling and the presence or absence of caries were recorded. Sub-sample 1 comprised 832 individuals (9202 teeth) aged 20-70 years with at least eight premolars/molars. In sub-sample 2, 163 subjects (577 teeth) with only one or two decayed tooth surfaces and at least one tooth with full crown coverage were analysed.

RESULTS

Logistic regression analysis found that root-filled teeth were predictive of recurrent caries when controlling for the type of restoration in sub-sample 1 (OR = 1.68; 1.41-2.0; CI 95%) and sub-sample 2 (OR = 2.20; 1.07-4.52; CI 95%).

CONCLUSION

In support of the suggested hypothesis, the data revealed a significant association between root-filled teeth and recurrent caries.

Prevalence of apical periodontitis and factors associated with the periradicular status

AIM

The present study aimed at assessing the prevalence of apical periodontitis and identifying the factors associated with apical periodontitis, particularly the influence of the quality of root canal fillings and coronal restorations on the periradicular status.

METHODOLOGY

The study population consisted of adult patients, men and women, seeking routine dental care at the Endodontic Clinic in the school teaching hospital between September 2006 and July 2008. For each patient complete oral examination and periapical radiographs were made for pathological teeth. All teeth were assessed individually. AP was diagnosed according to defined criteria, other variables were root fillings, coronal fillings, trauma and caries. The odds ratio and 95% confidence interval were used to calculate the risk of apical periodontitis related to tooth-specific risk indicators on the presence of apical periodontitis. A multiple logistic regression model to control for confounders and to determine their independent association with apical periodontitis was used also.

RESULTS

AP was detected on teeth (63.79%). The prevalence of apical periodontitis in root canal-treated teeth was 39.5%. Of the dental variables caries, trauma, inadequate root fillings and inadequate restoration were significantly associated with AP.

CONCLUSION

The prevalence of AP in this study group was higher than in other populations. The probability of AP increased significantly after root canal treatment and coronal filling and was closely associated with the quality of the filling.

Introduction of implants into postdoctoral endodontic residency programs

The purpose of this study was to survey the directors of postdoctoral endodontic programs in the United States to ascertain their attitudes and approaches regarding incorporation of implants into the endodontic curriculum. We hypothesized that program directors would agree that implant training should be incorporated into the endodontic curriculum. We also hypothesized that they would all prefer apical surgeries and retreatment over implants when plausible. A twenty-item online survey was emailed to all fifty-two postdoctoral endodontic program directors in the United States. A 100 percent response was received. The results showed that 78.6 percent agreed that implant training should be incorporated, 85.7 percent preferred the didactic approach, and 42.9 percent preferred clinical implant training. One hundred percent preferred apical surgeries and retreatment over implants when plausible, and 53.8 percent did not prefer implants over endodontic treatment for teeth with a questionable prognosis. This survey indicates that implant training has been incorporated into postdoctoral endodontic programs and that the Commission on Dental Accreditation standards are being met. The trend may be to become more hands-on in the future if program directors believe there is a need to provide training in actual placement of implants.

Periapical and endodontic status of type 2 diabetic patients in Catalonia, Spain: a cross-sectional study

INTRODUCTION

The aim of this study was to investigate radiographically the prevalence of apical periodontitis (AP) and endodontic treatment in a sample of adult type II diabetic patients and control subjects.

METHODS

In a cross-sectional study, the radiographic records of 50 adult patients reporting a history of well-controlled type 2 diabetes mellitus (DM) (study group) and 50 age- and sex-matched subjects who reported no history of DM (control group) were examined. Periapical status of all teeth was assessed using the periapical index score.

RESULTS

The average number of teeth per patient in the diabetic and control groups was 21.9 and 24.6 teeth, respectively (P = .012). AP in one or more teeth was found in 37 diabetic patients (74%) and in 21 control subjects (42%) (odds ratio = 3.9, P = .002). One or more root-filled teeth were found in 35 (70%) and 25 (50%) of diabetic and control subjects, respectively (odds ratio = 2.3, P = .043). Among diabetic patients with root-filled teeth, 16 (46%) had AP affecting at least one treated tooth. Among controls with root-filled teeth, 6 (24%) had AP affecting at least one treated tooth (P > .05). Adjusting for teeth number, multivariate logistic regression analysis showed that periapical status (odds ratio = 3.3, P = .0071) and the number of root-filled teeth (odds ratio = 1.7; P = .0035) were significantly associated with diabetic status.

CONCLUSIONS

The results showed that in adult patients, type 2 DM is significantly associated with an increased prevalence of AP and endodontic treatment.

The prevalence of persistent pain after nonsurgical root canal treatment

OBJECTIVE

To investigate the prevalence of persistent pain of neuropathic origin after nonsurgical root canal treatment and to determine its characteristics, location, and severity utilizing a self-reported validated postal survey.

METHOD AND MATERIALS

A modified version of the Self-Administered Leeds Assessment of Neuropathic Symptoms and Signs (S-LANSS) survey was mailed to 2,338 adult subjects who received a single-tooth nonsurgical root canal treatment at the University of Illinois at Chicago College of Dentistry Postgraduate Endodontics Clinic over a 4-year period. Two-hundred and fifty (10.7%) completed surveys were returned. Descriptive analysis, Pearson correlation to determine correlations between the S-LANSS scores and variables of interest, and t tests for group comparisons of the S-LANSS score were performed. Statistical significance was determined at P<.05.

RESULTS

The prevalence of persistent pain of neuropathic origin among respondents after receiving single-tooth nonsurgical root canal treatment was 7% with the average pain reported as 7.2 on a visual analogue scale (where 0 is no pain and 10 is pain as severe as it could be). Neuropathic pain was more common in middle-aged (mean 50.6 years of age) individuals with no sex predilection and occurred more frequently in the mandibular arch without any differences attributable to the number of canals treated. Also, the majority of subjects most frequently endorsed their pain experiences as abnormal sensitivity to touch and pain when the area is pressed or rubbed.

CONCLUSION

Dental providers need to recognize and understand the differences between nociceptive and neuropathic pain. Understanding these concepts will assist in preventing inappropriate, irreversible, and unnecessary interventions.

Heavy consumption of dental services among Finnish adults

OBJECTIVE

To compare treatment of heavy and low users of dental services among adults in the Public Dental Service (PDS) in one of the biggest cities in Finland and to identify reasons for heavy use and to suggest improvements to care provision.

METHOD

All adults who attended the PDS in Espoo (pop. 227,500) in 2004 were allocated to a group (n = 3,173) who had made six or more dental visits and a comparison group (n = 22,820) who had three or fewer dental visits. The data were obtained from the patient register of the PDS. A sample of 320 patients was randomly selected from each group. Information on age, gender, number and types of visits, oral health status, treatment provided and fees paid was collected from treatment records.

RESULTS

10.5% of the adults were found to be heavy users and their treatment made up 31.6% of all adult dental visits. The proportion of men was greater among heavy users and the heavy users were on average 6.6 years older than the low users. The mean total treatment time for heavy users was 5.5 hours and 2.0 hours for low users. Heavy users had more untreated and treated caries and more periodontal pockets than low users. Restorative, endodontic and prosthetic treatment needs characterised the heavy user group, while the low users most often received restorative and periodontal treatment only.

CONCLUSIONS

Our study indicates that complicated treatment needs of heavy users and lack of experience among the caregivers in dealing with them resulted in high numbers of dental visits for individual patients. The PDS should offer appropriate continuing education for its oral health care teams and organize a referral system offering specialist care for difficult endodontic, periodontal and prosthetic treatments.

Impact of diabetes mellitus, hypertension, and coronary artery disease on tooth extraction after nonsurgical endodontic treatment

INTRODUCTION

Limited prospective data are available on the long-term prognosis of teeth receiving nonsurgical root canal treatment (NSRCT) in patients with systemic diseases including diabetes mellitus (DM), hypertension (HT), and coronary artery disease (CAD). This prospective study aimed to elucidate the impact of systemic diseases on the risk of tooth extraction after NSRCT.

METHODS

A total of 49,334 NSRCT teeth were randomly selected from databank in October 2003 and were followed for 2 years for tooth extraction after NSRCT. Cox proportional hazards model was used to estimate the risk of tooth extraction after NSRCT.

RESULTS

Of the 49,334 teeth, 1592 (3.2%) were extracted during the 2-year follow-up period, yielding a 2-year tooth retention rate of 96.8%. We found that DM (hazard ratio [HR], 1.79), HT (HR, 1.75), and CAD (HR, 1.70) were significant risk factors for tooth extraction after NSRCT (all P values <.0001) in univariate Cox proportional analyses. After adjustment for age, gender, and tooth type in multivariate analyses, DM (HR, 1.29) and HT (HR, 1.18) remained as independent risk factors (both P values <.05). Simultaneous possession of 2 diseases of DM, HT, and CAD was a significant and robust predictor for an increased long-term risk of tooth extraction after NSRCT (P for trend <.001).

CONCLUSIONS

An increased risk of tooth extraction after NSRCT is significantly associated with DM, HT, and CAD individually. Moreover, the constellation of systemic disease burden also manifests the importance in addition to other potential confounders.

Review of outcomes from a change in faculty clinic management in a U.S. dental school

Dental schools use a variety of clinic management models with the goals of promoting patient care, student education, and fiscal responsibility. In 2004, the University of the Pacific Arthur A. Dugoni School of Dentistry transitioned to a more generalist model with these goals in mind. The purpose of this study was to evaluate the outcomes of this clinic model change relative to the quantity of specific procedures completed by students. The quantity of procedures completed by each student from the classes of 1995 through 2009 were compiled from our electronic clinic management system and analyzed. The post-transition group (2004-09) showed a greater number of completed oral diagnosis and treatment planning and root planing procedures per student compared to the pre-transition group (1995-2003), but fewer crowns, root canals, operative procedures, and dentures. Because the higher procedure numbers were for low-cost procedures, our transition to a generalist model did not necessarily enhance clinic income but may support student learning and enhanced patient care.

Endodontic treatment completion following emergency pulpectomy

AIM

Emergency pulpectomy is frequently performed to relieve pain experienced by patients following acute episodes of endodontic pain, or to limit the risks of infection or possible root resorption following traumatic pulpal exposures. The aim of this study was to examine subsequent patient attendance for completion of root canal treatment following pulpectomy procedures in a dental emergency unit.

METHODS

The treatment records of 574 patients who had each received an emergency pulpectomy at the Casualty Clinic of the University Dental School and Hospital, Cork, Ireland were reviewed. The influence of age, gender, etiology, tooth type, and month in which the pulpectomy was performed on subsequent completion of endodontic treatment was examined.

RESULTS

Of 574 patients, 39% (n = 224) returned to have endodontic treatment completed, 11% (n = 63) returned to have the tooth extracted, and 50% (n = 287) did not return for completion of the endodontic treatment. Cases were monitored up to five years following pulpectomy. Using a multinomial regression model, tooth type, etiology, and month in which the treatment was performed were found to be statistically significant predictors (p < 0.05) of endodontic treatment completion in the Cork University Dental School and Hospital.

CONCLUSIONS

Proper patient selection and pre-treatment counseling are important considerations when planning emergency pulpectomies to avoid inappropriate use of resources and manpower.

Endodontic and implant algorithms

Dental professionals are often faced with challenges when formulating a treatment plan for patients presenting with a compromised tooth. A common dilemma involves the decision between tooth retention using endodontic treatment with crown restoration, and extraction and an implant-borne restoration. In this article the authors evaluate the 2 treatment modes, and observe that because outcomes are similar with both treatments, decisions should be based on the patient's informed decision concerning restorability, costs associated with the procedures, esthetics, potential adverse outcomes, and ethical factors.

Outcomes of root canal treatment in Dental Practice-Based Research Network practices

This study sought to quantify the incidence of root canal treatment (RCT) failure and identify its predictors in root canals that were performed or referred by general dentistry practices in a practice-based research network (PBRN). This retrospective cohort study involved 174 endodontically treated teeth. Mean duration from initial therapy to follow-up was 8.6 years. Permanent restorations were ultimately placed in 89% of teeth, although 18% of teeth were ultimately extracted anyway. Receiving a permanent restoration was a significant predictor of treatment failure (in other words, patients who did not receive a permanent restoration were more likely to experience RCT failure), whether failure was determined clinically or radiographically. This study of PBRN practices suggests a higher failure rate compared with studies that utilized highly controlled environments or populations with high levels of dental insurance.

[Survey of general dental practitioners in Abidjan on the use of the operatory field in dentistry]

Rubber dam is a standard operatory field in operative dentistry and endodontics. It is undoubtedly the most certain way to insure the success of therapeutics acts. Its use by Abidjan practitioners has been the subject of our study which aim is to underline the place of rubber dam in daily practice. Our investigations show that rubber dam is totally absent from practitioners acts. Generally cotton rolls constitute the most frequent mean used by practitioners to isolate the tooth in operative dentistry and endodontics. Only 23.9% of them associate saliva sucking up. Some cases of aspiration and swallowing file by accident by patients have been highlighted. Those results lead us to recommend the systematic use of rubber dam as the mean of efficiency and security which cannot be ignored in our practice.

Dental treatment profile of New Zealand Defence Force personnel

OBJECTIVE

To evaluate the dental treatment provided over one year to serving personnel and new entrants in the New Zealand Defence Force (NZDF).

METHOD

Dental treatment data from 4,380 personnel in the 12 months following their last annual dental examination were retrieved and evaluated from electronic data archives. These included all treatment provided for 2000 randomly-selected regular serving personnel and for all 2380 new entrants entering the Service in the years 2005 and 2006.

RESULTS

Treatment data were recorded for 1770 (88.5%) of the 2000 serving personnel in the year following their last dental examination. Excluding examinations and radiographs, treatments averaged 2.3 per person. Amalgam and composite restorations contributed 40%, preventive and oral hygiene services 44%, and tooth extractions 6% of treatments; the "other" category amounted to 10% of treatments. For the 2380 new entrants, treatment data were recorded for 1959 (82.3%) during their first year of service. Treatments averaged 3.6 per person; amalgam and composite restorations contributed 58%, preventive and oral hygiene services 25%, and extractions 10%. The remaining 10% of treatment items recorded comprised a diverse range of procedures.

CONCLUSIONS

The level of treatment provided was low for both serving personnel and new entrants. Ninety percent of teeth were present and functional. Amalgam and composite restorations, preventive care and oral hygiene procedures made up the majority of treatment provided.

The prognosis of root canal therapy: a 10-year retrospective cohort study on 411 patients with 1175 endodontically treated teeth

PURPOSE

To evaluate the 10-year prognosis of consecutively endodontically treated or retreated teeth and to investigate some of the prognostic factors which could predict the long-term outcome of endodontic therapy.

MATERIALS AND METHODS

This retrospective cohort study included any patient who had endodontically treated or retreated teeth from 1986 to 1998 by a single operator in a private practice. Outcome measures were clinical and radiographic success assessed by the operator, radiographic success assessed by an independent outcome assessor and complications evaluated 10 years after treatment. Descriptive statistics, life table, Kaplan-Meier and Cox regression analyses for success were fitted.

RESULTS

A total of 411 patients with 1175 endodontically treated teeth were identified. Ten years after treatment 102 patients (24.8%) with 223 (19.0%) teeth were lost at the follow-up. The number of teeth that were originally treated and retreated were 704 and 471, respectively. Thirty-two teeth (2.7%) had one complication, which was successfully treated. A total of 988 (84.1%) teeth were considered a complete success, 46 (3.9%) a partial success, 52 (4.4%) a partial failure and 68 (5.8%) had to be extracted according to the treating clinician. For 21 teeth (1.8%) there was no follow-up information. The radiographic healing of 1086 teeth was evaluated by an independent assessor: 980 (90.2%) showed complete healing, 52 (4.8%) improvement, and 54 (5.0%) no change or worsening. The life-table analysis showed 93% of teeth surviving at 10 years after endodontic treatment. There were no differences for survival rates between teeth treated for the first time and those that were retreated (Kaplan-Meier). Teeth retreated because of symptoms or for a periapical/lateral radiolucency were more likely to fail.

CONCLUSIONS

Approximately 7% of endodontically treated teeth were extracted 10 years after treatment. Symptoms and radiolucency of teeth needing retreatment may be important predictors for failure.

Racial differences in baseline treatment preference as predictors of receiving a dental extraction versus root canal therapy during 48 months of follow-up

OBJECTIVE

This study aimed to test hypotheses that: a) treatment preference as stated at baseline predicts subsequent receipt of extraction (EXT) versus root canal treatment; and b) racial differences in treatment preference at baseline account for racial differences in receipt of these treatments during follow-up.

METHODS

Data were taken from the Florida Dental Care Study This stratified random sample included at baseline 873 subjects, all of whom were 45-years-old or older, reported race as non-Hispanic African American or non-Hispanic white, and had at least one tooth. At baseline, participants were asked about past dental care characteristics, history of or current presence of various dental diseases and conditions, and sociodemographic circumstance. An EXT/root canal treatment "CHOICE" scenario was also queried at baseline. Predisposing, enabling, and need factors were tested as predictors of EXT/root canal treatment received during follow-up. Bivariate multivariable logistic regression analyses quantified associations between the outcomes (EXT/root canal) and the predictors.

RESULTS

Receipt of EXT or root canal treatment during follow-up was strongly related to race even after people with mobile teeth at baseline were excluded from the analysis. Certain baseline factors (tooth mobility, periodontal attachment level, and ability to pay an unexpected dental bill) strongly predicted EXT/root canal treatment receipt during follow-up, although significant race effects remained; however, including "CHOICE" removed the race effect.

CONCLUSIONS

Baseline treatment preference strongly predicts subsequent receipt of EXT versus root canal treatment. Racial differences in treatment received during follow-up were explained by baseline racial differences in treatment preference, tooth mobility, and periodontal status.

Pattern of endodontic treatment in children in a Nigerian tertiary hospital

OBJECTIVES

The aim of this study was to determine the frequency and reasons for endodontic treatment in patients aged 16 years and below seen at the Paedodontic clinic of the Department of Child Dental Health of the Lagos University Teaching Hospital.

METHODS

Dental records of patients aged 16 years and below treated for various dental problems at the Paedodontic clinic of the Lagos University Teaching Hospital between January 2006 and December 2007 were reviewed to select cases that received endodontic treatment. The survey was conducted to determine the frequency of endodontic treatment for each tooth in the maxilla and mandible, the reasons for endodontic treatment and type of endodontic treatment performed in each tooth. Data on age, sex, endodontically treated teeth, reasons for endodontic treatment and date of treatment was retrieved from the patients' dental records.

RESULTS

A total of 2376 patients were seen during the period of survey, out of which 260 (11%) patients received endodontic treatment of three hundred teeth comprising 194 mandibular teeth and 106 maxillary teeth. The primary lower second molar (26%) was the most frequently endodontically treated tooth followed by the permanent lower first molar (22%). All the primary and permanent molars were endodontically treated due to caries while 62.5% and 60% of permanent and primary central incisors respectively were endodontically treated due to caries. The other infrequent reasons for endodontic treatment were trauma (5.3%) and failed root canal treatment (1.3%).

CONCLUSION

The primary lower second molar was the most frequently (26%) treated endodontically and the major reason (93.3%) for endodontic treatment was caries. Only 5.3% of the endodontically treated teeth were due to trauma.

Case series: a clinical study of 27 cases of dentoalveolar root fractures in children and adolescents

AIM

This was to assess fracture type, treatment delay, splinting periods and various treatment methods on periradicular healing of root fractures in a group of patients attending a Paediatric Dentistry clinic.

METHODS

Records and radiographs of children with root-fractured teeth, referred during 1999-2003, were assessed.

STATISTICS

Correlation analysis was performed using Spearman rank test.

RESULTS

There were 27 root-fractured teeth in 20 patients aged between 8-18 years. One root-fracture occurred in 13 patients (65%) and 7 (35%) had two root-fractured teeth; all maxillary teeth and the most affected teeth were central, followed by lateral, incisors. Only 4 patients were seen on the day of the trauma. The commonest cause of injury was a fall (12 patients), followed by collisions, bicycle and motorcycle accidents. Treatments consisted of: splinting, splinting+pulp therapy, extraction of coronal fragment accompanied with orthodontic interventions and restorative procedures, and surgical operations. Healing was related to treatment delay, location and type of fracture, and splinting time. Statistical analysis showed significant correlations only between healing type and splinting time.

CONCLUSIONS

Preventive educational programs concerning traumatic dental injuries are needed in Turkey and mandatory use of mouthguards and preventive use of helmets with bicycles and motorcycles.

Endodontic treatment in young permanent teeth. Prevalence, quality and potential risk factors

National epidemiologic data on oral health in children and adolescents in Sweden are restricted to caries, such as the number of decayed and filled teeth (DFT) and decayed and filled surfaces (DFS). Information about more complicated and time-consuming procedures such as endodontic treatment is scarce. The aims were to study the prevalence, quality and potential risk factors for endodontic treatment in young permanent teeth. The material consisted of dental records and radiographs. The subjects were all 19-year-olds born in 1979 (paper I-III) and all 15-year-olds born in 1990 (paper IV) belonging to the public dental clinics in Malmo. Paper III also included a control group.

A systematic review on the outcome of surgical vs non-surgical procedure for the retreatment of periapical lesions

The most common therapeutical options for the retreatment of teeth with periapical pathosis are orthograde treatment and periapical surgery. The aim of this review was to evaluate the outcomes of surgical versus non-surgical retreatment, in order to provide clinicians with evidence-based information for decision making process. Articles were retrieved by electronic search strategy and traditional searching. Articles were selected based on strict inclusion criteria. The first criterion was the success of retreatment, as determined by clinical and radiographic criteria. The outcomes were further dichotomized according to functionality criteria. Two randomized trials (RCTs) were found. One hundred and twenty-six teeth were followed up after one year, and 82 after 4 years. The success rate for surgical treatment after one year was slightly better than non-surgical: 90.7% vs 80.6%, respectively, according to functional criteria. At the four-year evaluation (40 surgically treated and 42 non-surgically treated cases from 1 RCT) the outcomes were similar. A higher early post-operative discomfort was reported for surgically treated cases. There is no apparent advantage of using a surgical or non-surgical approach for the retreatment of periapical lesions in terms of long-term outcome. The choice between the two procedures should rely upon factors other than the mere treatment outcome, such as patient's initial clinical situation, patient's preference, operator's experience and skill, complication risk, technical feasibility, and overall treatment cost. More well-designed RCTs should be performed with a large sample size and at least 4 years follow-up, using modern instrumentation and materials, to detect a true difference in the long term between the outcomes of the two alternative treatments, if any exists.

A 20-year follow-up study of endodontic variables and apical status in a Swedish population

AIM

To re-examine a population after 20 years and evaluate changes in prevalence of endodontic treatment and apical periodontitis, as well as the technical quality of root fillings.

METHODOLOGY

One hundred and fifteen out of an original 200 patients living in the northern part of Sweden were re-examined with a full mouth radiographic survey after 20 years. Frequencies of root canal treated teeth, apical periodontitis and quality parameters of root fillings were registered.

RESULTS

The frequency of root canal treated teeth increased significantly (P < 0.05) from 13.9% at the first investigation to 17.7% after 20 years. There was also a statistically significant increase (P < 0.05) in teeth with apical periodontitis from 3.3% to 6.8%. Apical periodontitis both in connection with root canal treated teeth and teeth without endodontic treatment, had increased during the follow-up period. Even though the quality of the root fillings had improved, there was no corresponding improvement of the apical status in teeth with root fillings.

CONCLUSIONS

There is still a great need for endodontic treatment in the Swedish population, and no improvement in apical health was found during this 20-year follow up.

The differential diagnosis of toothache from other orofacial pains in clinical practice

BACKGROUND

Teeth are a common and obvious source of orofacial pain. There is a risk that endodontic treatment may be initiated in patients that do not have pulp or periapical pathosis.

METHODS

A retrospective survey of a sample of patients referred for endodontic treatment was analysed to determine the accuracy of the diagnosis and to identify non-dental cases. A separate prospective study of complex non-dental orofacial pain cases was performed to determine which cases had previously received dental treatment.

RESULTS

Seventy-seven (88 per cent) of 88 patients referred for endodontic treatment had been correctly diagnosed with solely endodontic problems. Eight (9 per cent) had endodontic plus other orofacial pain problems and three (3 per cent) had no endodontic problems but other orofacial pain problems. Forty-four (44 per cent) of 100 non-dental orofacial pain patients had previously received either extractions or endodontics.

CONCLUSION

Dentists need to carefully evaluate all toothache patients to ensure that the diagnosis is correct prior to the initiation of irreversible treatment.

Background factors associated with endodontic treatment due to caries in young permanent teeth

OBJECTIVE

The aim of this retrospective cohort study was to assess the association between background factors and future endodontic treatment due to caries in young permanent teeth.

MATERIAL AND METHODS

The material comprised all 19-year-olds born in 1979 in a city in Sweden who had experienced endodontic treatment due to caries in permanent teeth (n=105) and a control group with no endodontic treatment. From dental records, the following independent variables were derived from age 7 to age 19: immigrant background, caries prevalence (DMFT values) at age 10, occurrence of dental anxiety, and missed or cancelled appointments before endodontic treatment. The outcome variable was presence or absence of endodontic treatment due to caries. Bivariate analysis and a multiple logistic regression model were used to analyse the data.

RESULTS

In the bivariate analyses, all independent variables except cancelled appointments were statistically significantly associated with future endodontic treatment. Of these, immigrant background did not remain as a statistically significant factor in the multiple regression model. The highest odds ratios were 4.3 for >2 DMFT at age 10 and 4.1 for >20% missed appointments.

CONCLUSION

In the present sample, with a relatively high proportion of individuals with an immigrant background, >2 DMFT at age 10, many missed appointments and dental anxiety were all risk indicators for future endodontic treatment due to caries up to age 19.

An Epidemiologic Study of Tooth Retention After Nonsurgical Endodontic Treatment in a Large Population in Taiwan

In this study, tooth retention and untoward events were assessed over a 5-year follow-up period for 1,557,547 teeth receiving nonsurgical root canal treatment (NSRCT) in Taiwan in 1998. We found that 1,446,199 (92.9%) of teeth receiving NSRCT were retained in the oral cavity 5 years after treatment and that a total of 111,348 (7.1%) of the studied teeth were extracted. Untoward events occurred in 159,680 (10.3%) teeth during the 5-year follow-up period. Of this small subpopulation, nonsurgical retreatment was performed for 50,587 teeth (31.7%), apical surgery was performed on 4,502 (2.8%) teeth, and extractions were performed on 104,591 (65.5%) teeth. Approximately 40% of the nonsurgical retreatments and 81% of the apical surgeries occurred in the first follow-up year. However, the yearly incidence of tooth extractions was nearly even within the 5-year study period. We conclude that NSRCT is a valuable dental procedure because of the high rate (92.9%) of tooth retention 5 years after NSRCTs in Taiwan.