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PubMed2006

Endodontic update 2006.

The past 10 years have witnessed more significant changes in the art and science of endodontics than the previous 100 years. This observation is no surprise, given that change is our only constant. The rate of change, however, has been anything but constant. The rate has accelerated so fast that all clinicians in the field of dentistry need a reliable source to guide us in what works. What works today in endodontics is the theme of this update. The discoveries and advancements in endodontic technology, instruments, and materials enable practitioners to achieve treatment outcomes that were previously considered unattainable. For example, in nonsurgical endodontic treatment, nickel titanium technology consistently can produce predictable radicular preparations that can be easily obturated. In nonsurgical re-treatment, the previous endodontic obturation attempt frequently can be removed and successfully re-treated largely because of enhanced vision and coaxial lighting from the operating microscope. Importantly, careful nonsurgical re-treatment usually can be accomplished without disruption to the existing restorations and without risk to ferrule integrity. In endodontic surgery underfilled foramina, and the isthmi between them, predictably can be connected and obturated with state-of-the-art miniature instruments. CLINICAL SIGNIFICANCE This article reviews the clinical endodontic breakthroughs encountered during the last decade and focuses on three primary topics: (1) finding canals; (2) following canals; and (3) finishing canals. Every day, dentists are faced with the interdisciplinary treatment planning question of to "save or not to save a tooth?" Dentists must routinely make the decision of whether to remove or restore the tooth based on biology, structure, function, esthetics, and value.(1) Occasionally, the endodontically treated tooth can be the weakest link in the restorative and esthetic sequence. This article examines the current state of endodontic technology, as well as the fundamentals of endodontic mechanics needed to achieve the most predictable endodontic outcome with the highest degree of success.

Dental Equipment↗
PubMed2001

Frequency and distribution of endodontically treated teeth and apical periodontitis in an urban Danish population.

AIM: The aim of this study was to investigate the prevalence of endodontically treated teeth and apical periodontitis (AP) in a Danish population. METHODOLOGY: From Aarhus County 614 individuals were radiographically examined, and the frequency of endodontic treatment and periapical status of all teeth were assessed. The year of birth of the subjects ranged from 1935 to 1975. The chi-squared test was used to determine the significance of differences between males and females and amongst age and tooth groups for the following parameters: AP, the number of endodontically treated teeth, and the number of endodontically treated teeth with AP. RESULTS: A total of 15 984 teeth were examined; of these 538 (3.4%) had AP and 773 (4.8%) had been endodontically treated. Of the endodontically treated teeth, 404 (52.2%) had AP. Females had more endodontically treated teeth than males; otherwise, no effect of gender was observed. Significantly more molars (P < 0.01) had been endodontically treated (8.1%) compared to premolars (5.4%) and anterior teeth (2.5%). The prevalence of AP in connection with molars was significantly (P < 0.01) higher (7.0%) than premolars (2.8%) and anterior teeth (1.5%). The prevalence of endodontically treated teeth and of teeth with AP gradually increased with age. CONCLUSIONS: The average number of teeth, the number of teeth with AP and the number of teeth with endodontic treatment in Danish adults were comparable to findings in other European countries. The frequency of endodontically treated teeth with AP was found to be high compared to that demonstrated in other epidemiological studies.

Adult↗
PubMed1992

Serum IgG reactive with oral anaerobic microorganisms associated with infections of endodontic origin.

Numerous species of bacteria have been implicated with infections of endodontic origin. The purpose of this study was to compare the levels of serum IgG antibodies reactive with a panel of 10 oral anaerobic microorganisms implicated in infections of endodontic origin. Serum samples were collected from 4 patient groups that included healthy patients without endodontic or periodontal disease, patients with chronic adult periodontal disease, patients with endodontic disease and patients with combined endodontic-periodontal disease. When Prevotella intermedia was allowed to react with sera from the 4 patient groups, significant pairwise differences were shown between the healthy group and each of the other 3 groups. In addition, there was a significant difference between the periodontal disease group and the combined endodontic-periodontal disease group. When Porphyromonas gingivalis was allowed to react with sera from the 4 patient groups, significant pairwise differences were shown between the healthy group and the periodontal disease group, the healthy group and the combined endodontic-periodontal disease group, the endodontic disease group and the periodontal disease group and the endodontic disease group and the combined endodontic-periodontal disease group. The results of this investigation support other studies that associate P. intermedia with both endodontic disease and chronic adult periodontal disease. The results also support studies that implicate P. gingivalis as a periodontopathogen.

Actinomyces↗
PubMed1984

One-visit endodontics.

I would like to conclude with some personal observations and comments on the use of single-visit endodontics in private practice based on my 12 years of experience utilizing this procedure. I cannot stress in strong enough terms that one-visit endodontics should not be undertaken by the novice. As an evolutionary philosophy of treatment, its use grows out of a full understanding of fundamental endodontic principles by the experienced practitioner. It is only after considering all of the indications and contraindications in each case on an individual basis, that a decision should be made as to whether or not it can be completed in a single visit. However, it is also important for the practitioner to have a clinical sense of what can be accomplished once the rubber dam has been placed and work commenced on the tooth. I submit to you that this very important clinical sense can be gained only after many years of clinical experience. Therefore, the endodontic competence of the practicing dentist becomes the overriding factor in determining the outcome of any one particular case. This is not to say that only a specialized few can and should perform this procedure. However, it does mean that a high degree of clinical skill is necessary to perform it in a successful manner. The performance of better endodontics in multiple visits will ensure success in single visits. Therefore, it is incumbent upon the individual practitioner to objectively evaluate his or her endodontic skills. The clinician should critically evaluate every aspect of his or her endodontic practice by determining the incidences of biomechanical errors such as ledging, perforations, overinstrumentation, broken instruments, interappointment flare-ups, and failures. For only after evaluating these areas will the clinician have an indication as to his or her level of endodontic skill and whether or not future study and practice need be done in one or more specific aspects of endodontic practice. Once a high level of competence is attained, one-visit endodontics can be successfully performed if well-skilled clinicians choose their cases carefully and adhere to basic endodontic principles.(ABSTRACT TRUNCATED AT 400 WORDS)

Clinical Competence↗
PubMed2003

Polymerase chain reaction detection of Propionibacterium propionicus and Actinomyces radicidentis in primary and persistent endodontic infections.

OBJECTIVE: Propionibacterium propionicus and the recently described species Actinomyces radicidentis have been isolated from infections of endodontic origin; nevertheless, the possibility exists that their actual prevalence may have been underestimated by culture. The purpose of our study was to assess the occurrence of these 2 species in different types of endodontic infections by using the sensitive 16S rDNA-based nested polymerase chain reaction approach. STUDY DESIGN: To detect these 2 species, nested polymerase chain reaction was performed directly in samples taken from primary endodontic infections associated with asymptomatic periradicular lesions, acute apical periodontitis, or acute periradicular abscesses and in samples from patients in whom endodontic therapy had failed. DNA was extracted from the samples and initially amplified by using universal 16S rDNA primers. In the second round of amplification, the first polymerase chain reaction products were used to detect a specific 16S rDNA fragment of either P propionicus or A radicidentis. RESULTS: P propionicus was detected in 6/21 (29%) root canal samples from teeth with chronic periradicular lesions, in 5/10 (50%) cases diagnosed as acute apical periodontitis, and in 7/19 (37%) pus samples aspirated from acute periradicular abscesses. Overall, this species was found in 18/50 (36%) samples taken from primary endodontic infections. Of the root canal samples obtained from root-filled teeth with chronic periradicular lesions, P propionicus was detected in 7/12 (58%) cases. A radicidentis was detected in 1/21 (5%) root canal samples from teeth with chronic periradicular lesions and in 1/10 (10%) cases of acute apical periodontitis. No pus sample yielded this species. In general, A radicidentis was detected in 2/50 (4%) samples taken from primary endodontic infections and in 1/12 (8%) root canal samples taken from patients in whom endodontic treatment had failed. CONCLUSIONS: P propionicus was found in a relatively large number of patients with primary and persistent endodontic infections. This strengthens the assumption that this bacterial species is an endodontic pathogen associated with different forms of periradicular diseases. In contrast, A radicidentis was only occasionally detected in the patients examined. The role played by this species in endodontic infections remains to be clarified.

Actinomyces↗
PubMedDate not supplied

A retrospective analysis of factors associated with the periapical status of restored, endodontically treated teeth.

PURPOSE: The purpose of this study was to explore possible associations between prosthodontic, occlusal, endodontic, and periodontal factors and the endodontic status of endodontically treated teeth. MATERIALS AND METHODS: Forty-six patients who had received endodontic treatment followed by a fixed restoration for at least one of their teeth were recalled and examined clinically and radiographically according to a predetermined set of evaluation criteria. A total of 89 teeth were included, and data obtained included assessments of the coronal restoration and post and core, occlusal contact relationships, a number of endodontic parameters, and periodontal status of the study teeth. For the latter assessment, 54 contralateral teeth were available for purposes of comparison. Teeth were grouped into those with and without periapical radiolucencies, and differences between the groups, with respect to all parameters, were analyzed by logistic regression. RESULTS: Three factors were significantly associated with the presence of radiolucency: confirmed occlusal contact, by virtue of the tooth being either involved in group function or the only contact in working-side and protrusive movements, and endodontic filling and crown margins of poor quality. None of the other independent variables showed significant associations with the dependent variable of periapical radiographic appearance. Contralateral teeth had better periodontal conditions than restored study teeth. CONCLUSION: The finding that a good-quality endodontic filling and crown margin improve endodontic outcome corroborates many other similar reports; however, with occlusal contact shown to be associated with failing endodontic treatment, the range of factors that may influence endodontic outcome appears to have widened.

Adult↗
PubMed2006

The potential association between smoking and endodontic disease.

The aim of this review was to analyse the literature to assess the possibility of an association between smoking and endodontic disease and the prognosis of endodontically treated teeth. The review of the prognosis of endodontically treated teeth involved taking account of any potential associations with smoking and endodontic disease and marginal periodontitis, and smoking and prosthodontic outcomes. In addition, the role of smoking in implant failure and surgical wound healing was analysed with a view to drawing parallels regarding the possible implications of smoking on the outcome of surgical endodontics. A MEDLINE and Cochrane library search including smoking and various endodontic keyword searches identified three papers which discussed the variables, and did not just mention them separately in the text. The literature demonstrates a paucity of evidence relating smoking with endodontic disease and prognosis, but nevertheless presents evidence of a possible influence on the prognosis of endodontically treated teeth in smokers and a likely increase in surgical complications. The possible merits of a smoking cessation protocol prior to surgical endodontics are also discussed.

Dental Implants↗
PubMed2004

National survey of endodontics in general dental practice in France.

The purpose of this paper was to gather both qualitative and quantitative information on endodontic treatments performed by French dental practitioners, and to identify the factors influencing the duration of endodontic procedures. A questionnaire was addressed in a two-rounds distribution to 2000 dentists selected by the quotas method in the whole country. A total of 790 (39.5%) questionnaires containing useful information were returned. The duration of endodontic treatment increases according to the number of roots to treat. The pulpal preoperative status has an influence on the duration of treatment, which is longer for a tooth with a necrotic pulp. Three variables strongly influence the duration of endodontic treatment: the number of patients attended per day, the number of appointments required for this treatment and the presence of a wage earner in the office. Continuing education also seems to be a variable having some influence on the duration of treatment. Financial considerations are also taken into account and there was general agreement that the current remuneration system of the French Health National Insurance is inadequate. Further, when one compares the total cost of an endodontic treatment with the fees fixed by the Health Insurance, it is clear that such procedures afford no positive financial return for a majority of practitioners. Moreover, the return becomes even more negative for teeth with a necrotic pulp. The findings presented in this study constitute the first stage of the medico-economic analysis concerning the endodontic practices in France. Prospective studies to gather precise information on the duration of endodontic treatments and a cost-analysis of endodontic practices could assist in the decision making process for practitioners or for the policy makers in the formulation of policies regarding application and reimbursement of endodontic treatment.

Appointments and Schedules↗
PubMed2006

Endodontic treatment outcome: survey of oral health care professionals.

This study assessed the opinion of oral health care professionals regarding the predictability of initial endodontic treatment, expected long-term outcome and the importance of placing a coronal coverage after completion of treatment. An eight-item questionnaire was distributed among oral health care professionals. There were 49% of participants who responded that the expected retention rate of teeth 5 to 10 yr after endodontic treatment was more than 90%, whereas 44% responded that such retention rate was between 70 to 80%. The majority of the participants also responded that the need for additional treatment, such as retreatment, apical surgery or extraction, was expected to occur within the first 3 yr after endodontic treatment if initial treatment has failed. About 87% of participants responded that placing coronal coverage after completion of endodontic treatment in premolars and molars was very important for long-term tooth retention and 92% responded that overall, endodontic treatment was a predictable procedure with long-term tooth retention rate. Statistically significant associations were found between years of experience and expected rate of retention for both the total group of respondents (p < 0.001) and for general practitioners when examined separately (p < 0.002). Statistically significant associations were only found for general practitioners between years of experience and their responses regarding the need for additional treatment (p < 0.05) and overall predictability of endodontic treatment (p < 0.02). A trend was found between the professionals' years of experience and their opinion regarding the importance of coronal coverage. Of the group who had more than 20 yr of experience, about 87% considered coronal coverage to be very important for long-term tooth retention. In conclusion, it appears that most clinicians participating in this study consider endodontic therapy to be a predictable procedure with long-term tooth retention rate. Their opinions also reflect the variations that currently exist in the literature regarding the reported outcome of endodontic treatment.

Adult↗
PubMed1998

Endodontic therapy in the veterinary patient.

Standard root canal therapy is more clearly described as conventional endodontics. Most modern endodontic treatment involves removal of the irreversibly damaged pulp followed by cleaning and shaping of the root canal space and subsequent filling, or obturation, with a semisolid material and a sealer. A general increase in awareness of the benefits of veterinary endodontics has created a rise in the demand for endodontic procedures that help to retain the teeth longer. This article on endodontic therapy includes endodontic anatomy, diagnosis of endodontic disease, pulpectomy techniques of access preparation, canal preparation and filling the canal, partial coronal pulpectomy, and treatment of the open apex. Familiarity of the techniques covered in this article and with advances in veterinary endodontics have become necessary for the veterinary dental practitioner.

Animals↗
PubMed2002

Private practicing endodontists: production of endodontic services and implications for workforce policy.

The methods and techniques used by private practicing endodontists to provide patient care are at the core of endodontic workforce policy. Productivity influences both the amount of care provided and the required number of practicing endodontists in the future. Data was collected from practicing endodontists in order to characterize the technical methods of producing endodontic services. This data was then used to develop a statistical model for use in assessing the national endodontic workforce conditions in the United States. A survey was mailed to a random sample of 2,075 private practicing endodontists in the United States based on membership files from the American Association of Endodontists and the American Dental Association. The overall survey consisted of three means of data collection: (1) a survey about the endodontic practice as a whole; (2) a survey about the endodontist; and (3) patient encounter forms used when collecting detailed endodontic procedure data for a single day in the practice. The model was used to obtain a projection of 4,016 endodontists in the year 2005 and 4,671 practicing endodontists in 2010 required to meet the projected demand for endodontic care. The model and survey data provide valuable information to practicing endodontists for use in identifying critical elements used to render care, how the elements are combined in the practice of endodontics, and the minimum number of endodontists required to provide a given volume of endodontic care.

Adult↗
PubMed1982

Evaluation and clinical management of previous endodontic therapy.

Endodontic recall studies and clinical experience have resulted in more universal criteria for acceptable and unacceptable endodontic treatment. Before the initiation of restorative treatment on teeth previously treated endodontically, the prosthodontist should evaluate the quality of endodontic treatment to assure that it will provide a risk-free, permanent, solid foundation for the future restorative work. Lack of symptoms alone does not indicate success of endodontic treatment. Radiographic evaluation is also not sufficient. The prosthodontist should use a thorough and combined evaluation of the endodontic history, radiographic evaluation, and tooth and tissue examination, as well as physically assess the treatment of all canals and their seals. As a rule, endodontics of questionable quality should be retreated by way of the canal. The removal of defective restorations is done to facilitate the retreatment effort and assure the soundness of tooth structure. Following retreatment, the tooth is restored and healing of the patient is followed up. Surgical endodontics is avoided unless retreatment is first attempted or the quality of previous root canal therapy is acceptable or the canal obstructed.

Clinical Competence↗
PubMed2005

Long-term survival of endodontically treated molars without crown coverage: a retrospective cohort study.

STATEMENT OF PROBLEM: Teeth are weakened after endodontic treatment and should, ideally, be crowned, especially posterior teeth. However, this is not always possible. Information about the longevity of endodontically treated teeth without crown coverage may assist in selecting appropriate treatment modalities. PURPOSE: The aims of this cohort study were to evaluate the survival rate for endodontically treated molars without crown coverage and to identify possible related factors. MATERIAL AND METHODS: A total of 220 endodontically treated permanent molar teeth in 203 subjects on a waiting list for fixed prosthodontic treatment at the Faculty of Dentistry-Mahidol University, Thailand, were included. Follow-up data were derived from a clinical examination and review of the dental record and radiographs. Subjects were not included in the study if teeth had provisional crowns, definitive restorations with cuspal coverage, or with dowel and core and/or crown restorations. The outcome evaluated was defined as a failure if there were negative findings in the condition of a tooth that required a restoration, tooth repair, or extraction. Tooth loss due to endodontic and periodontal reasons was excluded. The independent variables assessed were patient age, gender, location (maxilla or mandible), the existence of an opposing dentition and adjacent teeth, remaining tooth structure, and types of restorative material. Kaplan-Meier analysis with a 95% confidence level was used to calculate the survival probability, and a log-rank test was used to determine whether significant differences existed. RESULTS: Overall survival rates of endodontically treated molars without crowns at 1, 2, and 5 years were 96%, 88%, and 36%, respectively. With greater amounts of coronal tooth structure remaining, the survival probability increased. Molar teeth with maximum tooth structure remaining after endodontic treatment had a survival rate of 78% at 5 years. Restorations with direct composite had a better survival rate than conventional amalgam and reinforced zinc oxide and eugenol with polymethacrylate restorations. CONCLUSION: Within the limitations of this study, the amount of remaining tooth structure and types of restorative material have significant association with the longevity of endodontically treated molars without crown coverage.

Acrylic Resins↗
PubMed2003

Orascopic visualization technique for conventional and surgical endodontics.

AIM: To present a technique of integrating fibre optic orascope and rod-lens endoscope for visualization in conventional and surgical endodontic treatments. SUMMARY: Innovative advancements in fibre optic and rod-lens endoscope technology have allowed for the development and evolution of orascopic endodontics. The use of orascopy in conventional and surgical endodontic treatments has enabled the endodontist to become more discerning about the endodontic aetiology and the treatment procedures. Orascopy is a procedure that uses an orascope or a rod-lens endoscope for visualization in the oral cavity. An orascope is made up of fibre optics and an endoscope is made up of glass rods. Orascopic endodontics is the use of orascopy for visualization in conventional or surgical endodontic treatment. A 0.8 mm lens diameter, 0 degree, 10K fibre optic orascope and a 4 mm lens diameter, 30 degree, 4 cm rod-lens endoscope are used for visualization in conventional endodontics. The 2.7 mm lens diameter, 70 degree, 3 cm long rod-lens endoscope is used for visualization in surgical endodontics.

Endoscopes↗
PubMed1997

Periapical status, quality of root canal fillings and estimated endodontic treatment needs in an urban German population.

The objective of this study was to determine the periapical status and the quality of root canal fillings and to estimate the endodontic treatment needs in a German population. Clinical and radiographic data and the operative procedures performed were evaluated on 323 patients coming to a dental surgery in Stuttgart, Germany, in 1993. In 182 individuals at least one tooth exhibited a root canal filling, a necrotic pulp or an irreversible pulpitis. Out of the 7897 teeth examined, 215 (2.7%) had a root canal treatment (category A), 122 being non-endodontically treated (1.5%) did not respond to the sensitivity test (category B) and 53 (0.7%) were diagnosed as having irreversible inflamed pulp tissue (category C). The prevalence of teeth associated with radiographic signs of periapical pathosis was 61% in the group of root canal filled teeth and 88% in the group of pulpless and non-endodontically treated teeth. Using the level and the density of the root canal filling as criteria for evaluating the technical standard, only 14% of the endodontic treatments of non-apicectomized teeth were qualified as adequate. The minimal endodontic treatment need is 2.3% related to all examined teeth when the root canal filled teeth with clinical symptoms of periapical periodontitis (category A) and those of categories B and C are included. The real endodontic treatment need is suggested to be larger when considering that the technical quality of the obturation is poor in most symptomless endodontically treated teeth associated with a periapical lesion. In the case of retreatment of these teeth, the endodontic treatment need would then be calculated at 3.7%.

Adolescent↗
PubMed1999

Clinical judgement and decision making in endodontics.

Clinical judgement in endodontics consists of much more than diagnosis and treatment planning for the affected tooth. The issues involved in clinical judgement and decision making can be summarised by three questions: 1. Is endodontic treatment appropriate for the patient? Endodontic treatment should be undertaken only as part of an agreed, comprehensive treatment plan that takes into account patient concerns as well as objective clinical findings. 2. How difficult is the endodontic treatment? The difficulty of the case should be balanced with the skill and experience of the dentist, in deciding whether to manage the case in general practice or to refer the patient to an endodontist. The use of a standard form for assessing the difficulty of each endodontic case will aid in consistent, systematic assessment of patients. An example of such a form is provided. 3. What is the prognosis for the tooth? The outcome of endodontic treatment depends not only on the endodontic treatment but on other factors such as restorability and periodontal status. The prognosis will be compromised by procedural problems and by restorative and periodontal factors. In all but routine cases, the steps involved in decision making may be more complex and less easily resolved than the practical clinical aspects of endodontic therapy.

Clinical Competence↗
PubMed2003

The effect of diabetes mellitus on endodontic treatment outcome: data from an electronic patient record.

BACKGROUND: The authors used a custom-built electronic record system to investigate endodontic diagnostic and treatment outcome data in patients with and without diabetes. METHODS: The medical histories and endodontic treatment data for nonsurgical endodontic patients treated in predoctoral and postgraduate specialty clinics were entered into an electronic record system. A total of 5,494 cases (including 284 cases in patients with diabetes) were treated, and 540 cases (including 73 cases in patients with diabetes) had follow-up data two years or more postoperatively. The authors performed univariate and multivariate analyses to determine important factors affecting endodontic diagnosis and treatment outcome. RESULTS: Patients with diabetes had increased periodontal disease of teeth with endodontic involvment compared with patients who did not have diabetes. There was a trend toward increased symptomatic periradicular disease in patients with diabetes who received insulin, as well as flareups in all patients with diabetes. Two years or longer postoperatively, 68 percent of cases followed were successful. Older age, the absence of preoperative lesions, the presence of permanent restorations and longer postoperative evaluation periods all were associated with a successful outcome. A multivariate analysis showed that in cases with preoperative periradicular lesions, a history of diabetes was associated with a significantly reduced successful outcome. CONCLUSIONS: Patients with diabetes have increased periodontal disease in teeth involved endodontically and have a reduced likelihood of success of endodontic treatment in cases with preoperative periradicular lesions. CLINICAL IMPLICATIONS: Patients with diabetes who are treated endodontically should be assessed carefully and be treated with effective antimicrobial root canal regimens, particularly in cases with preoperative lesions.

Acute Disease↗
PubMed2004

Periodontal-endodontic interdisciplinary treatment--a case report.

Periodontal-endodontic lesions pose a difficult diagnostic and therapeutic challenge to the dental practitioner. A careful diagnostic examination consisting of a thorough patient and dental history, comprehensive clinical examination, and use of appropriate dental radiographs is necessary to arrive at a proper diagnosis of the periodontal-endodontic lesion. Despite these measures, it is not always possible to make an accurate diagnosis, which is imperative to provide the proper therapy in the correct treatment sequence. In some instances, endodontic or periodontal therapy alone may suffice; however, in other instances, a combination of endodontic and periodontal therapy may be required to successfully treat the case. In this article, classifications of periodontal-endodontic lesions are discussed, including the appropriate treatment and correct treatment sequence for each classification. Prognosis of periodontal-endodontic lesions depends on the diagnosis, treatment, and chronicity of the lesion, as well as the duration of periodontal involvement. A clinical case is presented in which a periodontal endodontic lesion has been successfully treated with a combination of conventional endodontic therapy and regenerative periodontal surgery.

Alveolar Bone Loss↗