Microbiological evaluation of one- and two-visit endodontic treatment of teeth with apical periodontitis: a randomized, clinical trial

The antimicrobial efficacy of endodontic procedures performed in one-visit (including a 10-min intraappointment dressing with 5% iodine-potassium-iodide) was compared with a two-visit procedure (including an interappointment dressing with calcium-hydroxide paste). Teeth with apical periodontitis (n = 96) were randomly assigned to either group. Root canal sampling and culturing were performed before and immediately after instrumentation, and after medication. Initial sampling demonstrated the presence of microorganisms in 98% of the teeth. Postinstrumentation sampling showed reduction of cultivable microbiota. Antibacterial dressing further reduced the number of teeth with surviving microbes. In the postmedication samples, residual microorganisms were recovered in 29% of the one-visit teeth and in 36% of the two-visit treated teeth. No statistically significant differences between the groups were discerned. It was concluded that from a microbiological point of view, treatment of teeth with apical periodontitis performed in two appointments was not more effective than the investigated one-visit procedure.     

Outcome of one-visit and two-visit endodontic treatment of necrotic teeth with apical periodontitis: a randomized controlled trial with one-year evaluation

The choice of one-visit versus two-visit root canal therapy for necrotic teeth with apical periodontitis is a source of current debate. The primary objective of this randomized controlled clinical trial was to compare radiographic evidence of periapical healing after root canal therapy completed in one visit or two visits with an interim calcium hydroxide/chlorhexidine paste dressing. Ninety-seven patients met the inclusion criteria and consented to participate in this study. Patients were randomly assigned to either the one-visit or two-visit group, and root canal therapy was performed with a standardized protocol. Patients in the two-visit group received an intracanal dressing of calcium hydroxide/chlorhexidine paste. Sixty-three patients, 33 in the one-visit group and 30 in the two-visit group, were evaluated at 12 months. The primary outcome measure was change in apical bone density by using the periapical index (PAI). Secondary outcome measures were proportion of teeth healed or improved in each group. Both groups exhibited equally favorable periapical healing at 12 months, with no statistically significant differences between groups.     

Autotransplanted teeth with early-stage endodontic treatment: a radiographic evaluation

Autotransplantation of teeth has been performed for many years and with varying degrees of success. The present report concerns the long-term results of autotransplantation of 36 teeth with completed root formation. Endodontic treatment was started before or within 12 weeks after transplantation. At the final check-up 32 teeth were present, 24 of them without signs of inflammation, replacement, or internal resorption. Careful radiographic examination during the follow-up period and adequate therapeutic measures with inter alia renewed endodontic treatment are of importance for successful autotransplantation.     

一次性和多次性根管治疗应用于根尖周炎的临床评价

目的评价根管治疗一次法和多次法对无症状根尖周炎疗效的影响,探讨一次性根管治疗的适应症。方法选取无症状根尖周炎的患牙160颗,分层随机法分为两组,分别采用一次法和多次法完成根管治疗。所有患牙均使用镍钛机动根管器械预备,牙胶冷侧方加压法充填根管。比较两组术后疼痛发生情况,根据患者主观症状、临床表现和术前术后X线片评价疗效。结果一次法和多次法在术后疼痛、根管治疗效的差异上没有统计学意义。结论一次性根管治疗应用于无症状根尖周炎的患牙是可行的,但要注意控制适应症。     

Bacteria recovered from teeth with apical periodontitis after antimicrobial endodontic treatment

Chávez de Paz LE, Dahlén G, Molander A, Möller Å, Bergenholtz G . Bacteria recovered from teeth with apical periodontitis after antimicrobial endodontic treatment. International Endodontic Journal, 36 , 500–508, 2003. Aim To determine whether there is a pattern for certain bacteria to remain after chemo‐mechanical treatment of root canals in teeth with apical periodontitis. Methodology Consecutive root‐canal samples of 200 teeth receiving root‐canal treatment, referred from general practitioners and endodontic specialists for analyses of cultivable microbes, were studied prospectively. To be included, samples had to be taken at a treatment session subsequent to the one at which endodontic therapy was initiated. All samples were from teeth that either presented with clinical or radiographic evidence of apical periodontitis or both. Bacteriological findings were linked to clinical and radiographic parameters including status of the root canal prior to treatment, namely, vital pulp, necrotic pulp or root filled. Results A total of 248 strains were isolated from 107 teeth giving bacterial growth. Gram‐positives predominated (85%). Lactobacillus spp. (22%), nonmutans streptococci (18%), and Enterococcus spp. (12%) were the most common isolates. Gram‐negative anaerobes were relatively sporadic. Large radiographic bone lesions, persistent pain and use of intracanal calcium hydroxide dressing correlated with bacterial presence (P < 0.05). Conclusions Once established, nonmutans streptococci, enterococci and lactobacilli appear to survive commonly following root‐canal treatment of teeth with clinical and radiographical signs of apical periodontitis.     

Bacterial quantification in teeth with apical periodontitis related to instrumentation and different intracanal medications: a randomized clinical trial

The antibacterial efficacy of intracanal medication with calcium hydroxide [Ca(OH)2], 2% chlorhexidine gel (CHX), and a combination of both [Ca(OH)2/CHX] was assessed in teeth with chronic apical periodontitis. Thirty-three canals were instrumented, randomly divided into three groups, and medicated with either Ca(OH)2, CHX, or Ca(OH)2/CHX. Bacteriological samples obtained from the operative field and the root canals before (S1) and after instrumentation (S2) in the first treatment session, and after medication (S3) in the second session 1 week later, were assessed for bacterial growth, observed by turbidity and in agar plates, and viable colony-forming unit (CFU) counts. Bacterial growth and CFU counts decreased significantly from S1 to S2 (Mann-Whitney, p<0.05). Differences in growth and counts between S2 to S3 were not statistically significant for all three intracanal medication groups. It was concluded that the antibacterial efficacy of Ca(OH)2, CHX, and Ca(OH)2/CHX was comparable.     

Radiographic evaluation of apical periodontitis and endodontic treatment results: a computer approach

Chronic apical periodontitis is diagnosed primarily by radiography. Whereas subjective, chairside evaluations of radiographs have serious limitations as regards accuracy of endodontic diagnosis, digitalization of radiological data allows quantification of the information obtained. In clinical practice, digitalization may improve the diagnostic sensitivity and reduce the radiation dose; in clinical endodontic research, digitalization of radiographs provides a means of unbiased and quantitative assessment of apical periodontitis. Automated measurements of the radiographic density of the periapical area have been applied in a study of the effect of different endodontic sealers on the healing of apical periodontitis. Changes in radiographic density could be detected as early as 3 weeks after completion of endodontic treatment, and the computer-based analyses provided numeric values for the progression of the healing process in the periapical region.     

Clinical and radiographic evaluation of platelet-rich fibrin for revascularization of necrotic immature permanent teeth: A controlled clinical trial

BackgroundIdeal management of necrotic immature permanent teeth to close the blunderbuss apical opening still of challenge and debate.Objectiveclinical and radiographic evaluation of platelet rich fibrin (PRF) for revascularization of necrotic immature permanent teeth.Method28 single-rooted necrotic immature permanent teeth from 28 children (7–13 years old) assigned into two main groups (contaminated and uncontaminated). Teeth of each group divided randomly into two subgroups according to type of treatment; PRF subgroup (experimental) and calcium hydroxide apexification subgroup (control). Clinical and radiographic evaluations assessed at baseline, 3, 6, and 9 months.Resultsall subgroups showed clinical success of 100%. Radiographic results presented a significant difference in all intervals regarding root length, diameter of apical foramen and radiographic root area (RRA) in PRF subgroups. Regarding root length, significant difference was for PRF subgroup at 3rd interval in group I. Diameter of apical foramen showed significant differences for PRF subgroups at 2nd and 3rd intervals. RRA revealed significant differences for PRF subgroups in both groups at 2nd and 3rd intervals.Conclusionsplatelet-rich fibrin revascularization and calcium hydroxide apexification were successful clinically. Radiographically, platelet-rich fibrin showed significant quantitative measurements than calcium hydroxide apexification regarding all parameters.     

Effectiveness of single- versus multiple-visit endodontic treatment of teeth with apical periodontitis: a systematic review and meta-analysis

Aim The clinical question this review aimed to answer is: does single‐visit root canal treatment without calcium hydroxide dressing, compared to multiple‐visit treatment with calcium hydroxide dressing for 1 week or more, result in a lower healing (success) rate (as measured by clinical and radiographic interpretation)? Methodology CENTRAL, MEDLINE, EMBASE and HEALTH STAR databases were used. Reference lists from identified articles were scanned. A forward search was undertaken on the authors of the identified articles. Papers that had cited these articles were also identified through Science Citation Index to identify potentially relevant subsequent primary research. Review methods The included studies were randomized controlled clinical trials (RCTs) comparing healing rate of single‐ and multiple‐visit root canal treatment in humans. The outcome measured was healing of radiographically detectable lesions. Data in those studies were independently extracted. Results Only three RCTs were identified and included in the review, covering 146 cases. Sample size of all three studies was small; none demonstrated a statistically significant difference in healing rates. Risk differences of included studies were combined using the inverse variance‐weighted method (RD_Pooled = ?6.3%; 95% CI: ?20.3–7.8). Conclusion Based on the current best available evidence, single‐visit root canal treatment appeared to be slightly more effective than multiple visit, i.e. 6.3% higher healing rate. However, the difference in healing rate between these two treatment regimens was not statistically significant (P = 0.3809).     

Radiographic follow-up of periapical status after endodontic treatment of teeth with and without apical periodontitis

Objectives

The aim was to assess objectively the rate of changes in periapical status after endodontic treatment in relation to preoperative radiographic status (Periapical Index Score, PAI) and to tooth type.

Material and methods

Radiographic data from a total of 1,410 teeth in seven prospective clinical studies was pooled. The periapical status was evaluated blindly using the PAI scoring system. The longest follow-up period was 4 years; intervals between controls varied from 3 months to 1 year.

Results

Teeth with preoperative PAI score 1 maintained excellent periapical health throughout. Teeth with preoperative PAI score 2 showed some impairment in health over the first 6 months, but improved to approach 95 % healthy teeth at 2 years of observation. Teeth with PAI 3–5 at the start showed significant improvement at 3 months; 27 % were considered healthy (PAI 1 or 2) increasing to 41 % after 1 year. Improvement of periapical status was slower in PAI groups 4 and 5 compared with PAI 3 during the first year. After 2 years, improvement continued similarly in all preoperative PAI 3–5 groups of teeth. Upper lateral incisors showed the poorest healing rate.

Conclusions

Healing of pre-existing periapical lesions is most pronounced from 3 months to 2 years. Teeth with initially healthy periapical structures predictably maintain good periapical health. Maxillary teeth, especially lateral incisors, showed poorer healing rates than mandibular teeth.

Clinical relevance

Radiographic healing rates may vary among tooth groups within the dentition. Periapically healthy teeth that are root filled may not need postoperative controls.     

Symptomatic and asymptomatic apical periodontitis associated with red complex bacteria: clinical and microbiological evaluation

In this study, the association of red complex (RC) bacteria that include Treponema denticola, Tannerella forsythia and Porphyromonas gingivalis with acute, exacerbated or chronic apical periodontitis was evaluated. Seventy-one patients with periapical disease were evaluated by clinical examination and microbiological samples obtained from the root canals were analyzed by a polymerase chain reaction assay. Twenty-one (29.6%) samples were positive for RC bacteria, with T. denticola, T. forsythia and P. gingivalis being detected in 14 (19.7%), 10 (14.1%) and 6 (8.5%) samples, respectively. RC bacteria were mainly associated with acute apical periodontitis (29.2%) and phoenix abscess (63.2%), while they were only sporadically detected (7.1%) in patients with chronic apical periodontitis. Generally, RC bacteria were associated with pain and a higher frequency of intracanalar/intrasulcular pus drainage. Involvement of RC bacteria in symptomatic periapical disease should be suspected in the presence of particularly severe clinical pain and pus drainage.