Prevalence of and factors affecting post-obturation pain in patients undergoing root canal treatment

AIM: This longitudinal, prospective study (1) investigated the prevalence of post-obturation pain after root canal treatment and (2) evaluated the influence of factors affecting the pain experience. METHODOLOGY: Twenty practitioners, comprising general dental practitioners, MSc graduates and Endodontists, participated in this study. The patient sample (n = 415) was derived from consecutive patients attending the practitioners' surgeries for root canal treatment on a single tooth. Demographic, medical history, preoperative and intra-operative data as well as pain experience on day 1 and day 2 after root canal obturation were recorded. Intensity of pain experienced was recorded on a visual analogue scale (VAS) of 0-5. The data were analysed using logistic regression models. RESULTS: The prevalence of post-obturation pain within 48 h after treatment was 40.2% (n = 167) but less than 12% of patients experienced severe pain (VAS 4 or 5) on either day 1 or day 2. The factors that significantly influenced post-obturation pain experience were: gender (OR = 0.434, P < 0.001), tooth type (OR = 1.733, P = 0.007), size of periapical lesion (OR = 0.493, P = 0.004), history of post-preparation pain (OR = 4.110, P = <0.001) or generalized swelling (OR = 3.435, P = 0.005) and number of treatment visits (OR = 2.604, P < 0.001). CONCLUSIONS: The prevalence of post-obturation pain was high (40.2%). The important prognostic determinants of post-obturation pain were female, molar tooth, size of periapical lesion smaller than 3 mm, history of post-preparation pain or generalized swelling and single-visit treatment.     

54例持续性根尖周炎的显微根尖外科手术1年疗效观察

目的评价显微根尖手术治疗54例持续性根尖周炎病例的短期临床疗效。方法对54例持续性根尖周炎病例进行显微根尖手术,包括翻瓣、去骨、根尖周刮治、根尖切除,使用超声器械倒预备,三氧化矿物凝聚体（MTA）作为倒充填材料,术后定期复查,通过临床和X线片检查和测量,评价术后疗效。结果54例持续性根尖周炎病例术后1年随访,治愈者31例（57.41％）,改善者19例（35.19％）,失败者4例（7.41%）。根据患者性别、年龄、牙位分布、根尖周暗影的最大直径和根尖周病变组织病理分类分别统计显微根尖手术的疗效,组间差异均无统计学意义（P>0.05）。结论显微根尖手术明显提高持续性根尖周病变的治疗成功率。     

Prevalence of and factors affecting postpreparation pain in patients undergoing two-visit root canal treatment

AIM: This longitudinal, prospective study (i) investigated the prevalence of postpreparation pain during root canal treatment and (ii) evaluated the influence of factors affecting the pain experience. METHODOLOGY: Twenty practitioners, comprising general dental practitioners, MSc graduates and endodontists, participated in this study. The patient sample (n=272) was derived from consecutive patients attending the practitioners' surgeries for a two-visit root canal treatment on a single tooth. Demographic, medical history, preoperative and intraoperative data as well as pain experience on days 1 and 2 after root canal preparation were recorded. Intensity of pain experienced was recorded on a visual analogue scale (VAS) of 0-5. The data were analysed using logistic regression models. RESULTS: The prevalence of postpreparation pain within 48 h after treatment was 64.7% (n=176), but less than 10% of patients experienced severe pain (VAS 4 or 5) on either day 1 or day 2. The presence of preoperative pain (OR=2.841, P<0.001), tooth type (OR=2.008, P=0.009), systemic steroid therapy for other medical reasons (OR=0.181, P=0.023) and preoperative swelling (OR=2.433, P=0.040) were the only factors to significantly influence postpreparation pain experience. CONCLUSIONS: The prevalence of postpreparation pain was high, and the important prognostic determinants were presence of preoperative pain, tooth type, systemic steroid therapy and preoperative swelling.     

Prevalence and quality of endodontic treatment in an urban adult population in Norway

Abstract There are few studies on the prevalence of chronic apical periodontitis and endodontic treatment in society. In this study, the periapical status of a representative sample of 35-year-olds in Oslo, Norway was studied by analyses of orthopantomograms and intraoral radiographs. The study also included quality assessment of root fillings and a correlation between quality and periapical status. Of the 3917 teeth evaluated, 133 (3.4%) were endodontically treated and 54 (1.4%) presented a periapical pathosis. More than half of these were associated with root-filled teeth. Endodontic treatment was considered successful with normal periapical structures in 64% of the cases. However, only 41% of the root fillings were of optimal quality, terminating 1–2 mm from the radiographic apex. Based on a survey of orthopantomograms, it was estimated that 30% of the subjects investigated presented an endodontic treatment need. The prevalence of endodontic treatment among 35-year-olds was unchanged from 1973 to 1984.     

Prevalence of apical periodontitis and results of endodontic treatment in middle-aged adults in Norway

Abstract The present investigation based on a random sample of 50-year-olds from Oslo, Norway, indicate a prevalence of apical periodontitis of 3.5% of the teeth present. Forty-four percent of the endodontically treated teeth presented with a radio-graphically detectable periapical radiolucency. There was a statistically significant negative correlation between the quality of the root fillings evaluated and prevalence of apical periodontitis.     

Cross-sectional evaluation of post-operative pain and flare-ups in endodontic treatments using a type of rotary instruments

Abstract

Aim. The purpose of this clinical study was to evaluate the general incidence of post-operative pain and flare-ups in patients who were endodontically treated by two endodontics specialists using rotary instruments (Hero 642, Micro Mega, France) with the same treatment protocol. Methods. Records of 382 teeth belonging to 268 patients treated by two endodontics specialists during a 6-month period were kept and evaluated. Post-operative pain between treatment visits was categorized using a pre-established scoring system. Ninety-five patients were males, whereas 173 were females. Results. Pulpal necrosis without periapicalpathosiswas determined as the most common indication for endodontic treatment (21.7%) followed by irreversible pulpitis and re-treatment without periapical lesions (18.3%, 18.3%, respectively). The general prevalence of post-operative pain and flare-ups was determined as 8.1%, whereas cases that could be classified as real flare-ups which were severe and required an unscheduled visit (scores 2 and 3) comprised 3.4% of the cases. No statistically significant correlation was determined between gender and post-operative pain and flare-up (p = 0.05). There was a significant correlation between number of appointments and the presence of pain and flare-ups. Teeth undergoing multiple visits had a higher risk of developing post-operative pain and flare-ups compared to those with single appointments with a statistical significance (p = 0.03). Conclusions. Teeth with pre-operative pain were more prone to developingpost-operative pain and discomfort with a statistically significant difference (p = 0.02). While no significant correlation was determined between tooth vitality and pain and flare-ups (p = 0.5), a statistically significant relationship existed between the presence of a periapicalpathosisand post-operative pain and flare-ups. Cases with a periapical lesion had a higher risk of developingpain and flare-upscompared to those with no periapical involvement (p = 0.0001). Future studies may focus on the influence of rotary instrumentation systems in more specific groups of cases. Meanwhile; microbiological as well as psychological aspects of flare-ups are topics that warrant further investigation.     

Prevalence of apical periodontitis and results of endodontic treatment in an adult, Portuguese population

The present epidemiological study is derived from a random sample of 322 residents of the Porto area, aged 30-39 years. Prevalence of apical periodontitis and results of endodontic treatment were evaluated from orthopantomograms, available from 179 of a total of 197 individuals attending for examination. The results indicated a prevalence of apical periodontitis in 27% of this population. The quality of a majority (54%) of the 69 root fillings observed were found to be inadequate, (i.e. short and/or poorly condensed), but only 15 (22%) of the endodontically treated teeth presented with apical periodontitis.     

Reducing fear of pain associated with endodontic therapy

AIM: To provide subjects with positive information about endodontic treatment (ET) to reduce fear of pain associated with ET. METHODOLOGY: A large sample (n = 437) was randomly allocated to read one of five informative paragraphs and afterwards asked to complete two questionnaires (dental anxiety and fear of dental pain). The paragraphs consisted of dental information obtained from patient brochures. One (experimental) paragraph consisted of positive information about pain during ET. Analysis of variance followed by post hoc analysis was used to detect differences in mean score. RESULTS: Subjects who were given the positive information regarding ET indicated they were less fearful of pain associated with ET. CONCLUSIONS: The clinical implication of this experiment is that patients should be accurately informed about pain associated with ET. In this way, the patient may be more at ease before and during treatment, decrease avoidance behaviour and make decisions regarding treatment choice, based on common sense rather than fearful expectations.     

Post-operative symptoms and healing after endodontic treatment of infected teeth using pulsed Nd: YAG laser

Abstract— Forty-four teeth in 38 patients, diagnosed with chronic apical periodontitis, were endodontically treated. Root canals were shaped using a step-back technique with 5% NaOCl and 3% H₂O₂ as irrigants. In half of the teeth the canal terminus was irradiated with pulsed Nd:YAG laser (1 W, 15 pps, 1 s). All canals were then obturated with laterally condensed gutta-percha points and sealer, and final radiographs were obtained. Occurrence of spontaneous pain was recorded 1 day after treatment. Percussion pain was recorded after 1 week, and then at 3 and 6 months after treatment. Radiographic follow-up was performed at 3 and 6 months. Percussion pain was significantly less ( P >0.05) in the laser-treated group than in the control group, both 1 week and 3 months after treatment. Other differences between the groups were not significant. These results suggested that the clinical application of pulsed Nd: YAG laser might be advantageous for the treatment of infected root canals.     

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在牙体牙髓病治疗过程中,有效的局部麻醉技术是减轻患者疼痛的重要手段,也是确保治疗顺利进行的基本保障。本文对牙体牙髓治疗中局部麻醉的相关问题做一介绍,并针对牙髓治疗中局麻方法和局麻药物的选择给出建议。     

Prevalence of apical periodontitis and the quality of endodontic treatment in an adult Belarusian population

AIM: To estimate the prevalence of teeth with apical periodontitis (AP) and technically failed root fillings in an adult Belarusian population. METHODOLOGY: Panoramic radiographs of all 1423 patients over 15 years of age not seeking emergency dental care, and attending the Dental School of the Belarusian Medical University for the first time during the period from 1 January to 31 December 2001 were examined. The quality of root fillings was scored according to criteria of length proposed by De Moor et al. [International Endodontic Journal 33 (2000) 113] and the periapical status of all teeth (except third molars) was categorized on the basis of presence or absence of radiographic signs of AP. The data were analysed using the chi-square test and odds ratio. RESULTS: Radiographs indicated that 8632 teeth (22% in the maxilla; 21% in the mandible) were missing leaving a total of 31,212 teeth to be assessed. Twenty per cent of the teeth had some filling material in the root canal(s). AP was found in 1141 subjects (80%) and 12% of the teeth. AP was more frequently associated with molar teeth (23%) than premolar (14%), canine (4%) and incisor teeth (6%). AP was diagnosed in 45% of root filled teeth, the remaining cases with AP had not been root filled. Statistical analysis showed that the probability of radiological detection of AP in root filled teeth was 25-fold higher than when the root canals had not been filled (chi2 = 8636.04, P < or = 0.001, odds ratio with 95% confidence intervals: 23.01 < 25.17 < 27.45). Periapical radiolucencies with adequately filled root canals occurred significantly less often than with teeth in which the root canal was filled more than 2 mm from radiographic apex or when filling material was extruded through the apex. CONCLUSION: The prevalence of AP in all age groups in Belarus was higher than in other populations. The probability of AP increased significantly after root canal treatment and was closely correlated with the quality of the root filling.     

Histopathological profile of surgically removed persistent periapical radiolucent lesions of endodontic origin

Aim  To determine the types of periapical lesions associated with root filled teeth with persistent periapical pathosis that required surgical treatment based on specific inclusion and exclusion criteria.
Methodology  Periapical lesions from a consecutive clinical sample of 100 patients were examined histopathologically to determine a definitive diagnosis.
Results  Females were more represented ( n  = 56), the average age was 46.5 years and there were no age differences between gender or lesion type. A diagnosis of periapical granuloma was the most common finding with a similar number present in females ( n  = 40) and males ( n  = 37). A cyst was present in 18% of the cases with a majority of females ( n  = 12) represented in the sample. Evidence of foreign material, with an appearance consistent with endodontic sealer materials, was seen in 25 periapical granulomas, two cysts and one scar. Two periapical scars were seen, one had a history of apicectomy and amalgam root-end filling while the other was associated with extruded root filling material.
Conclusions  By using defined clinical inclusion and exclusion criteria a predictable clinical diagnosis of a persistent periapical lesion due to endodontic origin can be reliably made. Periapical granulomas and cysts were the most common periapical lesions of endodontic origin associated with persistent periapical pathosis with the overall incidence of periapical cysts similar to previous studies. The presence of endodontic material in a high proportion of periapical lesions suggests a cause-effect association with the inference that clinicians should employ canal preparation techniques that limit apical extrusion of material.     

Delayed endodontic and orthodontic treatment of cross-bite occurring after luxation injury in permanent incisor teeth

Abstract A case is presented in which combined endodontic and orthodontic therapy was performed in traumatically injured teeth 12 months after an accident. Calcium hydroxide treatment was used to halt any possible resolution during orthodontic treatment. The teeth were repositioned in a desirable manner without any complication by orthodontic treatment. Root canal obturation was accomplished after the completion of active orthodontic treatment. Recall examination 12 months after completion of root canal treatment showed clinical and radiographic evidence of healing.     

Long-term evaluation of endodontic and periodontal treatment

One hundred and ninety-five teeth in 35 patients with periodontitis who had received both endodontic and periodontal treatment were evaluated 9 years after endodontic treatment and 8 years after periodntal treatment. Some 91.4% of cases were well maintained and 8.6% showed a deterioration in their periodontal condition. Twelve of the 195 teeth with endodontic treatment were lost, eight for periodontal codition. Twelve of the 195 teeth with endodontic treatment were lost, eight for periodontal reasons, three as a result of fracture and one because of caries, and the periodontal condition of 10 teeth had worsened. An apical lesion formed on one tooth. The results indicate that the risk of endodontic failure in this group of 195 teeth is very low, and that there is little risk of tooth loss for periodontal reasons, provided that the patients receive suppportive periodontal treatment.     

Regression of a lesion resembling pyogenic granuloma after endodontic treatment

A rare case of regression of a lesion resembling pyogenic granuloma after endodontic treatment of a maxillary lateral incisor in a 16-year-old female patient is reported. After clinical and radiographic examination, the maxillary right lateral incisor was endodontically treated in two visits. At the second visit, clinical regression of the exophytic lesion was evident and the size of this lesion had been greatly decreased, so was not biopsied. After 3 weeks, the exophytic lesion had totally disappeared. This case report indicates that surgical excision of exophytic lesions resembling pyogenic granuloma is not necessary in all situations.     

An assessment of endodontic treatment completion rate in a University‐based student clinic and the factors associated with incomplete treatment

Incomplete endodontic treatment is potentially a public health issue. The aim of this retrospective study was to evaluate the endodontic treatment completion rate at a University student clinic and to identify the factors associated with completion rates. The records of all patients who commenced an endodontic treatment (code 415) from January 2015 to December 2015 were extracted. A total of 783 records were available for analysis of which 86% received complete endodontic treatment. Maxillary first molars were significantly associated with incomplete endodontic treatment (IET). Patients requiring an additional visit (code 455) were 1.5 times more likely to have an IET. The endodontic treatment completion rate at the School of Dentistry at the University of Queensland is higher than those reported in other international university‐based student clinics. Focus group surveys of students and supervisors are required to identify the reasons for higher IET with maxillary first molars and code 455.     

Comparative evaluation of postoperative pain after using endodontic needle and EndoActivator during root canal irrigation: A randomised controlled trial

The purpose of this study was to evaluate and compare the postoperative level of pain after activation of irrigants using EndoActivator with conventional needle irrigation during root canal therapy. In this prospective randomised clinical trial, 72 symptomatic irreversible pulpitis patients were selected. Based on block randomisation after routine root canal preparation, patients were assigned to two groups. In group EN, procedures were performed with endodontic irrigating needle (n = 36) while group EA received activation using EndoActivator (n = 36) in the final irrigation protocol. All the participants were called through phone at 8, 24 and 48 h to analyse pain score using visual analogue scale. Those patients who developed pain were prescribed ibuprofen 200 mg. Pain score and frequency of tablet intake were recorded and statistically analysed. Results showed that group EA resulted in significantly less postoperative pain and analgesics intake than group EN. In conclusion, within the limitations of this study, the activation of irrigants using EndoActivator can be considered an effective method for reducing postoperative pain.     

Healing of periapical lesions of pulpless teeth after endodontic treatment with controlled asepsis

Abstract Using a careful anaerobic bacteriological technique, bacteria were shown to be eliminated from infected root canals before the endodontic treatment was finished by root filling. Healing of the periapical lesions of the teeth was followed for 2–5 yr. The majority of the 79 lesions healed completely or decreased in size in such a way that they could be expected to heal. In 5 cases there was no or only an insignificant decrease in the size of the lesions. Two of these lesions were shown to contain bacteria of the species Actinomyces or Arachnid. In another case there were dentin chips in the periapical tissue. Periapical lesions which fail to heal in spite of careful bacteriological monitoring of the endodontic treatment may in some cases be due to an establishment of the bacteria outside the root canal in the periapical tissue. In these sites, the bacteria are inaccessible to conventional endodontic treatment.