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PubMed1993

Prevalence and technical standard of endodontic treatment in a Swedish population. A longitudinal study.

The aims of this thesis were to study longitudinally the tooth mortality, prevalence and technical standard of endodontic treatment as well as the endodontic treatment need in a Swedish population. Furthermore, the prevalences of teeth with crowns and posts were studied as well as the prevalence of apical periodontitis in such teeth, to see if these treatments affected the apical status. Finally, the reasons for and incidence of tooth mortality were investigated to see if the reasons for extractions were correlated to endodontic status, crown or post therapy, respectively. The interobserver variation between the two observers taking part in the investigation was also studied and found to be acceptable. The material consisted of full mouth radiographic surveys from 200 patients examined twice with an interval of 5-7 years. It was found that tooth losses were evenly distributed in the different age-groups and that molars were lost more often than teeth in the frontal region. Furthermore, endodontically treated teeth were lost more often than other teeth and the quality of the root filling affected the risk of tooth losses. Teeth with screw posts were lost more frequently than other teeth, while crowned teeth did not run a higher risk of being lost than teeth without crowns. Caries, including pulpitis and apical periodontitis, was the main reason for tooth extractions. There was a great need for endodontic treatment in the population examined, and the technical standard of the root fillings was poor. A slight improvement in quality of endodontic treatment was evident at the second examination. However, the technical standard was still poor. It is concluded that it is important that dentists in general practice should be better trained in performing endodontic treatment, and that research efforts should be made to find better and simpler methods for endodontic treatment.

Adult↗

PubMed2006

Endodontic treatment in an American Indian population: a 10-year retrospective study.

An epidemiological study of a regional population of Native Americans receiving treatment from 1991 to 2000 (n = 5460) was conducted via electronic survey. The objectives were to identify factors affecting the retention of endodontically treated teeth and to determine frequencies of endodontic care. Multiple factors were assessed. Analyses utilized chi(2) and frequency tests. The results indicated that endodontists tend to complete most posterior teeth and retreatment cases, while generalists tended to complete anterior teeth, primary endodontic therapy, and to restore immediately. Patients with multiple systemic diseases (p = 0.0225) and diabetes (p < 0.0001) experienced decreased retention of endodontically treated teeth and increased retreatment (p = 0.0109) by endodontists. Patients treated by general dentists experienced increased retention for female patients (p = 0.0066), immediate restoration of the treated tooth (p = 0.0212), and decreased retention with a history of hypertension (p = 0.0036) and diabetes (p = 0.0033). This study suggests that diabetes and/or hypertension, delayed or no restoration, and increasing age, may all contribute to decreased retention of endodontically treated teeth, but that immediate postendodontic restoration may enhance retention. In the early era, very few cases of molar endodontics were completed, and one could infer that there were greater numbers of posterior teeth extracted because of this fact. This demonstrates how a combination of providers can provide a broader range of clinical endodontic services, supporting an Indian Health Service goal of providing the highest level of oral health care possible.

Adolescent↗

PubMed2006

Demographic characteristics of endodontic practice sites in the United States.

Few studies have addressed the demographic characteristics of dental practice sites including endodontic practice sites. This study investigated the demographic characteristics of endodontic practice sites in the United States. Demographic data and endodontic practices were organized by zip codes and analyzed using discriminant analysis. The demographic characteristics associated with zip codes that contained an endodontic practice were determined versus the characteristics of zip codes that did not contain an endodontic practice. The resulting model correctly classified 93.7% of the 30,171 zip code areas based upon the presence or absence of an endodontic practice. The variables most closely associated with a zip code containing an endodontic practice included: number of dental practices (nonendodontic), population size, percent of adult population with a college degree, size of employed population, projected population growth (2005 to 2010), percent of population over 64 years old, and median housing value.

Adult↗

PubMed2003

Assessment of the resistance to fracture of endodontically treated molars restored with amalgam.

STATEMENT OF PROBLEM: Controversy exists concerning the preferred type of final restoration of endodontically treated molars regarding their resistance to fracture under occlusal load. PURPOSE: The aim of this study was to assess the resistance to fracture of endodontically treated molars with various degrees of tooth structure loss restored with amalgam under simulated occlusal load. MATERIAL AND METHODS: . The study teeth consisted of 90 noncarious, nonrestored molars stored in physiological saline solution. The teeth were endodontically treated and randomly divided into 9 experimental groups of 10 specimens each with various degrees of tooth loss, ranging from a conservative endodontic access to removal of all cusps. All teeth were restored with a standardized technique to their original contour with amalgam. Each specimen was mounted onto a specialized jig for loading at the central fossa at a 30-degree angle to the long tooth axis. The resistance to fracture, under continuous compressive force at a cross-head speed of 2 mm/minute, was applied by a universal testing machine and was recorded. One-way analysis of variance with Scheffé contrast was used to statistically compare the differences between the groups at significance level P<.05. RESULTS: One-way analysis of variance showed that the group with a conservative endodontic access (1137.6 +/- 311.6 N) and the group with removal of all cusps (1261.4 +/- 195.1 N) presented a significantly higher resistance to fracture when compared with the other groups (P<.05). There was no significant difference in resistance to fracture under the simulated load between the other 7 groups, which ranged from 655.8 +/- 229.4 to 906.3 +/- 168.1 N (P>.05). CONCLUSION: Within the limitations of this study, the endodontically treated molars with a conservative endodontic access or after removal of all cusps that were restored to their original contour with amalgam presented the highest resistance to fracture under a simulated occlusal load.

Analysis of Variance↗

PubMed2000

Influence of coronal restorations on the periapical health of endodontically treated teeth.

The purpose of the study was to evaluate a possible relationship between the quality of the coronal restoration, the root canal obturation and the periapical status of endodontically treated teeth. Full mouth series of radiographs from randomly selected patient charts at the Dental Faculty, University of Oslo were examined. A total of 1001 endodontically treated teeth restored with a permanent restoration were evaluated independently by two examiners. According to a predetermined set of radiographic criteria, the technical quality of the root filling of each tooth was scored as either good (GE) or poor (PE), and the technical quality of the coronal restoration was scored as good (GR) or poor (PR). The root and the surrounding structures were then evaluated and according to the periradicular findings, the treatment was categorized as success or failure. The success rate for all endodontically treated teeth was 67.4% (n = 1001). Teeth with root canal posts had a success rate of 70.7% (n = 527) and teeth without posts had a success rate of 63.6% (n = 472). The two groups with technically good endodontics had the highest success rates. In combination with technically good restorations the success rate was 81% (GE + GR, 81%) and combined with technically poor restorations the success rate was 71% (GE + PR, 71%). The two groups with technically poor endodontics combined with either good restorations or poor restorations had significantly lower success rates (PE + GR, 56% and PE + PR, 57%). The technical quality of the endodontic treatment as judged radiographically was significantly more important than the technical quality of the coronal restoration when the periapical status of endodontically treated teeth was evaluated.

Chi-Square Distribution↗

PubMed2001

A prognostic model for assessment of the outcome of endodontic treatment: Effect of biologic and diagnostic variables.

OBJECTIVE: Many biological variables, endodontic treatment factors, and restorative considerations have been suggested in the literature to affect the outcome of endodontic treatment. However, few attempts have been made recently to study these variables further. The purpose of this study was to identify the biologic and endodontic treatment-associated variables that are most predictive of treatment outcome for conventional endodontic therapy and to determine the magnitude of risk these variables pose on the outcome. STUDY DESIGN: The population of this historical prospective cohort study comprised a total of 200 teeth with 441 root canals. Diagnostic and treatment information was abstracted from the original patient records. An endodontic follow-up examination was conducted 4 +/- 0.5 years after obturation. Each tooth/root was analyzed according to 3 indices of periradicular status at 2 time points. The main outcome measure was the presence of apical periodontitis. The criteria used for evaluation of the outcome were modified from Strindberg. Data were subjected to univariate and multivariate analysis. Logistic regression models were fit by using various clinical measures to determine which combination of biologic and treatment-associated factors best predicted treatment outcome. RESULTS: The preoperative pulp diagnosis, the periapical diagnosis, the preoperative periapical radiolucency size, and the sex of the patients were revealed, by means of univariate analysis, to exert a significant influence on endodontic treatment outcome (P <.05). In the logistic regression model, the strongest effect on postoperative healing was the presence and magnitude of preoperative apical periodontitis. In the presence of this variable, no other factor contributed value to the prediction. The correct prediction of this model was 74.7% (P <.05). CONCLUSION: The major biologic factors influencing the outcome of endodontic treatment appear to be the extent of microbiological insult to the pulp and periapical tissue, as reflected by the periapical diagnosis and the magnitude of periapical pathosis.

Acute Disease↗

PubMed2001

Effect of prophylactic amoxicillin on endodontic flare-up in asymptomatic, necrotic teeth.

The purpose of this prospective, randomized, double-blind, placebo-controlled study was to determine the effect of prophylactic amoxicillin on the occurrence of endodontic flare-up in asymptomatic, necrotic teeth. Seventy patients participated and had a clinical diagnosis of an asymptomatic, necrotic tooth with associated periapical radiolucency. One hour before endodontic treatment, patients randomly received either 3 g of amoxicillin or 3 g of a placebo control in a double-blind manner. After endodontic treatment, each patient received: ibuprofen; acetaminophen with codeine (30 mg); and a 5 1/2-day diary to record pain, swelling, percussion pain, and number and type of pain medication taken. The results demonstrated 10% of the 70 patients had a flare-up characterized by moderate-to-severe postoperative pain or swelling that began approximately 30 h after endodontic treatment and persisted for an average of 74 h. Of the seven patients who had flare-ups, 4 were in the amoxicillin group and 3 were not. Prophylactic amoxicillin did not significantly (p = 0.80) influence the endodontic flare-up. We concluded that a prophylactic dose of amoxicillin before endodontic treatment of asymptomatic, necrotic teeth had no effect on the endodontic flare-up.

Acetaminophen↗

PubMed2003

Incidence of endodontic treatment: a 48-month prospective study.

The purpose of this study was to determine the incidence of endodontic services provided to participants in a longitudinal cohort study. The "Florida Dental Care Study" was a prospective cohort study using a representative baseline sample of 873 dentate adults. An in-person interview and clinical dental exam were conducted at baseline, 24, and 48 months after baseline, with telephone interviews every 6 months between those times. Dental record information was abstracted afterward. Thirteen percent of participants received at least one endodontic procedure after baseline. Endodontic services constituted approximately 2% of all dental procedures performed. Conventional root canal therapy comprised 94% of the endodontic services and was approximately evenly distributed among anterior teeth, premolars, and molars. Retreatment and apicoectomy each accounted for 3% of the endodontic procedures. The most common self-reported reasons for the dental visit in which a root canal occurred were "toothache," "abscess," and "dental sensitivity." A significant percentage of persons received some type of endodontic treatment in this diverse adult sample. Dental abscesses or toothaches were the main reason(s) for endodontic treatment, but not all persons with these conditions during follow-up sought dental treatment of any variety.

Aged↗

PubMed2005

Detection of bacteria in endodontic samples by polymerase chain reaction assays and association with defined clinical signs in Italian patients.

BACKGROUND/AIMS: The presence of selected bacteria (Enterococcus faecalis, Porphyromonas gingivalis, Prevotella intermedia, Tannerella forsythensis, Treponema denticola) in infected root canals was studied using polymerase chain reaction (PCR) assays, and the association of bacteria with clinical signs of endodontic disease was assessed. The null hypothesis, that no difference could be observed between clinical signs of apical periodontitis and a specific bacterial strain, was tested. METHODS: Microbial samples were obtained from 62 teeth in 54 patients with endodontic disease. For each tooth, clinical data including patient symptoms were collected. Teeth were categorized by diagnosis as having acute apical periodontitis (AAP, teeth with clinical symptoms but no periapical radiolucency, n=22), chronic apical periodontitis (CAP, teeth with radiolucency but no clinical symptoms, n=15) or exacerbated apical periodontitis (EAP, teeth with symptoms and radiolucency, n=25). Seventy-one percent of cases were primary endodontic infections, and 29% were recurrent ('secondary') endodontic infections (failing cases). PCR assays were used to detect the presence of the selected bacteria. RESULTS: T. denticola and E. faecalis were each detected in 15 of 62 samples (24%), P. gingivalis in 8 samples (13%), P. intermedia in 5 samples (8%), and T. forsythensis in 4 samples (7%). T. denticola was detected in 56% of teeth with EAP. E. faecalis was found in 60% of teeth with CAP and in 72% of teeth with secondary infection. Statistical analysis demonstrated an association of CAP and secondary endodontic infection with the presence of E. faecalis. (P<0.01). EAP was associated with the presence of T. denticola (P<0.01). CONCLUSION: T. denticola was associated with symptomatic endodontic disease in the presence of apical bone resorption. E. faecalis was associated with treatment failures. We suggest that these species may play critical roles in endodontic pathology.

Adult↗

PubMed1998

Formaldehyde evaluation from endodontic materials.

The purpose of this study was to measure the amount of formaldehyde released from three types of endodontic sealing cement (AH-Plus, EZ-Fill, and AH-26). Formaldehyde release was analyzed using High Performance Liquid Chromatography, which could detect as low as 0.25 ppm. The data was tabulated after two runs. The two paste system of AH-Plus endodontic sealing cement had the least amount of formaldehyde release (0.00039%, 3.9 ppm). This was followed by EZ-Fill (0.054%, 540 ppm) endodontic cement and AH-26 (0.1347%, 1347 ppm) endodontic cement which yielded the greatest formaldehyde release. Both of these cements (EZ-Fill and AH-26 endodontic filling cements) are based on a powder-liquid mix. The relative minute amounts of formaldehyde released by the endodontic cements studied (AH-Plus and EZ-Fill) warrant their use as endodontic sealing cements.

Bismuth↗

PubMed2002

[Influence of post-core on the strength of endodontically treated and crowned teeth].

OBJECTIVE: To investigate the influence of post-core structure on the strength of endodontically treated and crowned teeth with or without a 2.0 mm dentine ferrule. METHODS: A total of 60 recently extracted human maxillary central incisors were endodontically treated and randomly divided into five groups of 12. They were given following treatments: Group A, endodontically treated; Group B, endodontically treated and crowned (PFM); Group C, cast metal post-core with 2.0 mm dentine ferrule and crowned (PFM); Group D, cast metal post-core with no dentine ferrule and crowned (PFM); Group E, prefabricated post and composite core with 2.0 mm dentine ferrule and crowned (PFM). All specimens were stored at 100% humidity at room temperature for 30 days before testing. Each specimen was in a special jig on the MTS 810 universal material testing machine and subjected to a load at a 135-degree angle to the long axis until failure, with crosshead speed of 0.02 cm/minute. Analysis of variance followed by the Newman-Keuls pairwise multiple comparison tests was used to compare the results. RESULTS: There was a statistically significant difference between different restorative methods. The cast metal post-core with 2.0 mm dentine ferrule and crowned teeth had the highest fracture strength (1793.59 +/- 387.93N), followed by endodontically treated intact teeth (1466.68 +/- 240.11N). No significant difference in the fracture strength was found among the other three groups (958.49 +/- 286.02N; 992.98 +/- 291.00N; 994.94 +/- 285.04 N). There was a statistically significant difference in the fracture resistance between crowned teeth with and without 2.0 mm dentine ferrule (P < 0.01). CONCLUSIONS: Not all post-core structure could improve the strength of endodontically treated teeth. The dentine ferrule can effectively improve the fracture resistance of endodontically treated and crowned teeth.

Biomechanical Phenomena↗

PubMed2004

Endodontic diagnosis. Mystery or mastery?

UNLABELLED: Review of 6 clinical distinctions: (1) Symptom: "anything under the sun." DIAGNOSIS: pulp exposure. Duplicate: clinical or radiographic pulp exposure evidence. TREATMENT: endodontics or pulp cap under strict protocol conditions. (2) Symptom: "cold." DIAGNOSIS: hyperemia. Duplicate: ice. TREATMENT: pulp protection or endodontics. (3) Symptom: "heat." DIAGNOSIS: pulpitis. Duplicate: heat. TREATMENT: pulpotomy for multirooted teeth or pulpectomy for single-rooted teeth. Schedule endodontic completion. (4) Symptom: "I recently had a toothache and now it is gone." DIAGNOSIS: necrosis. Duplicate: Electric Pulp Test and ice are negative. TREATMENT: endodontics. (5) Symptom: "I had a toothache awhile back and now it is gone." DIAGNOSIS: LEO. Duplicate: Electric Pulp Test, ice, and test cavity are negative. TREATMENT: endodontics. (6) Symptom: "It really hurts to touch my tooth." DIAGNOSIS: percussion. Duplicate: may or may not have a LEO and may or may not have cellulitis. TREATMENT: reduce occlusion, access cavity, water chew, and schedule to finish endodontics. If these tests are carefully performed, then they are objective and the doctor does not have to be in a subjective situation. A newfound sense of endodontic diagnostic mastery is experienced. Perhaps the best way to summarize the simplicity of this clinical diagnostic scheme is to quote Sherlock Holmes: "Nothing is more deceptive than the obvious."

Dental Pulp Diseases↗

PubMedDate not supplied

[Indications for the treatment of bone rarefactions of endodontic origin].

Bone rarefactions arising from dental lesions are commonly thought to be sustained by the microbiol component or by the toxins spread out into the surrounding bone by the disintegrated pulp. In thise case endodontic therapy is the only one capable of obtaining a full recovery. In our opinion the most suitable endodontic procedure is that described by Schilder: with his technique infact a great deal of substantial results can be achieved. Bone rarefactions are to be surgically treated only when endodontic therapy does not guarantee the complete removal of microrganisms and that of the tissue debris arising from the disintegrating pulp possibly located in the root's area. This event may occur in the following circumstances: 1) fracture of endodontic instruments; 2) partial filling with cement or any other not removable material; 3) misleading endodontic therapy (distored roads or circular steps); 4) a peculiar anatomy of the dental rost such as that resulting when the apex bears a drop or a trumpet-like appearance; 5) bent roots, very hardly treated; 6) when a dry root's dent cannot be obtained because of the presence of large and continually secreting cysts. Bone rarefactions should then be treated by surgical procedures such as apicectomy backward filling of the root's canal and root's apex locking with direct view of the apex. Apicectomy should only be visualized asd a surgical transport of the apex from a point where the apex is open to an other where is apex is completely filled up by the endodontic treatment. Surgical procedure of the backward filling of the root's canal should be followed only when the root's canal unapproachability does not allow any endodontic treatment such as that suggested by Schilder. Finally surgical procedure to fill up the root's canal with direct view of the apex results from the combination of two surgical treatments: 1) the filling up of the root's canal (Schilder procedure), and 2) the modelling of the root's canal up to a point where the last one is hermetically sealed. This result can be achieved removing the apex when it bears a drop or trumpet-like appearance or the transported apex foramen. It can also be obtained by removing the wounded apex or the radicular canal when it is unapproachable along the 2 or 3 distal mms. and finally ad dry root's canal when it remains wet by the continuous secretion of the liquid material endowed in the cystic cavity.

Bone Cysts↗

PubMed1994

[A clinical study of endodontic flare-ups].

The purpose of this study was to investigate the clinical variables influencing endodontic flare-ups. Three hundred and thirteen teeth receiving endodontic treatment at the Endodontic Department, Chang Gung Memorial Hospital were studied from December 1992 to February 1993. Among them, 21 teeth with significant pain and 9 with apical swelling were noted after the first appointment of treatment. Three teeth with persistent pain and one with apical swelling were also found one week after completion of endodontic therapy. The results showed significant improvement of clinical symptoms and signs one week after completion of endodontic treatment in comparison with pretreatment and after the first appointment (p < 0.025). The factors such as presence of pretreatment complaints, periapical lesions and vital pulp had significant effects on the incidence of endodontic flare-ups after the first appointment of treatment (P < 0.025). In contrast, patients' sex, the number of visits, and whether this was a retreatment case or not had no significant effect on the frequency of these endodontic flare-ups.

Acute Disease↗

PubMed2026

Influence of endodontic access on the fracture resistance, retention and microleakage of full-coverage restorations in vitro: A systematic review and meta-analysis.

BACKGROUND: Endodontic access through retained full-coverage restorations (FCRs) is a preferred option for patients because of its high cost-effectiveness. However, the clinical performance of FCRs after repaired access cavity remains insufficiently characterized. This systematic review investigates the effects of endodontic access cavity preparation through retained FCRs on fracture resistance, retention, and microleakage based on in vitro studies. METHODS: A comprehensive search was performed in PubMed, Web of Science, and Scopus databases. Studies investigating the influence of endodontic access on the fracture resistance, retention, and microleakage of FCRs were included. Two independent reviewers conducted study selection, data extraction, and risk-of-bias assessment using the QUIN tool. Meta-analysis was employed to estimate fracture resistance and retention, with sensitivity analysis and subgroup evaluation also performed. Microleakage was summarized qualitatively. RESULTS: Twentythree studies were included: fracture resistance (n = 15), retention (n = 5), and microleakage (n = 3). Endodontic access significantly reduced fracture resistance for zirconia (p = 0.0002) and lithium disilicate (LD) restorations (p = 0.007), but not for resin-matrix ceramic (RMC) restorations (p = 0.25). Abutment tooth type contributed to heterogeneity within the LD and RMC subgroups. Retention was significantly reduced when access cavities were left unrepaired (p = 0.03), whereas appropriate repair protocols restored or enhanced retention relative to baseline. Accelerated aging increased microleakage in retained FCRs. Surface pretreatments and flowable resin liners tended to reduce microleakage, but findings were inconsistent. CONCLUSIONS: Endodontic access significantly reduces fracture resistance of zirconia and LD FCRs, whereas RMC restorations show no significant change. Appropriate repair protocols can restore or improve retention, potentially exceeding original values. Limited evidence suggests that effective sealing is achievable with appropriate materials. However, well-designed and in-vivo researches are needed to provide more detailed clinical guidance. CLINICAL SIGNIFICANCE: When performing endodontic access through retained FCRs, reduced fracture resistance must be carefully considered for zirconia and LD restorations, while RMC restorations may be exempt from this concern. Loss of retention with access can be restored after repair. Surface pretreatment and flowable resin liners help decrease microleakage.

Humans↗

PubMed2001

Endodontic instruments for root canal therapy.

This article on endodontic instrumentation includes endodontic instruments and techniques of root-canal preparation of teeth in veterinary patients. Familiarity with instruments covered in this article and with advances in veterinary endodontics has become necessary for the veterinary dental practitioner who wishes to practice dentistry using current techniques. Veterinary endodontic techniques that help to retain the teeth longer are increasing in demand as an option to extracting damaged teeth. Endodontic treatment involves removal of the irreversibly damaged pulp, followed by cleaning and shaping of the root canal space using endodontic instruments and subsequent filling, or obturation, with a semisolid material and a sealer.

Animals↗

PubMed2002

Quality of life and satisfaction outcomes of endodontic treatment.

The purpose of this study was to assess quality of life and satisfaction in relation to endodontic treatment in two Canadian populations and the association of these outcomes with the treatment providers' level of training (generalist or endodontist). New patients aged 25 to 40, presenting at the dental faculties in Toronto and Saskatoon were screened. Patients with radiographically identifiable endodontic treatment were invited for interviews conducted using a questionnaire that measured changes in quality of life after endodontic treatment and semantic differential scales that measured satisfaction with endodontic treatment. Data were analyzed using Chi-square, multiple and logistic regression (p < 0.05), and Mann-Whitney U test (p < 0.02). Subjects reported preoperative factors (e.g., pain, sleep disturbances) impacting quality of life, which improved after endodontic treatment, significantly more in the Toronto than in the Saskatoon population. Satisfaction was significantly better when endodontic treatment was provided by endodontists.

Adult↗

PubMed1997

Effectiveness of an endodontic diagnosis computer simulation program.

The effectiveness of a recently developed endodontic diagnosis computer simulation program was examined. Third-year dental students (n = 90) in three successive academic classes were given a pre-test in endodontic diagnosis before any endodontic instruction, and then received ten lectures on diagnostic techniques, endodontic pathology, and radiographic interpretation. The students were subsequently divided into three equal groups not differing statistically on their pre-test results. The first group used an endodontic computer simulation program containing fifteen patient simulations for one hour. The second group had a small-group seminar aiming to cover the same material as in the computer program in the same time period. The third group (control) had no further instruction. The three groups then took a post-test to evaluate their diagnostic knowledge in endodontics. The improvement of scores from pre- to post-test in the three groups were statistically different (p = 0.018). The simulation group students improved significantly more than the seminar group (p = 0.05) and the Control Group (p = 0.0024). Difference in improvement between the seminar group and the control group was not statistically significant (p = 0.20). Students were able to cover more cases on average using the simulation program than were covered in the seminar (t-test, p < 0.0001).

Computer Simulation↗