The assessment of the endodontically treated tooth

This paper reviews the assessment of success and failure following endodontic treatment and highlights the fact that many referrals for specialist management of endodontic failure do not take into consideration established guidelines in this important area.     

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

OBJECTIVE: The aim of this retrospective cohort study was to assess the association between background factors and future endodontic treatment due to caries in young permanent teeth. MATERIAL AND METHODS: The material comprised all 19-year-olds born in 1979 in a city in Sweden who had experienced endodontic treatment due to caries in permanent teeth (n=105) and a control group with no endodontic treatment. From dental records, the following independent variables were derived from age 7 to age 19: immigrant background, caries prevalence (DMFT values) at age 10, occurrence of dental anxiety, and missed or cancelled appointments before endodontic treatment. The outcome variable was presence or absence of endodontic treatment due to caries. Bivariate analysis and a multiple logistic regression model were used to analyse the data. RESULTS: In the bivariate analyses, all independent variables except cancelled appointments were statistically significantly associated with future endodontic treatment. Of these, immigrant background did not remain as a statistically significant factor in the multiple regression model. The highest odds ratios were 4.3 for >2 DMFT at age 10 and 4.1 for >20% missed appointments. CONCLUSION: In the present sample, with a relatively high proportion of individuals with an immigrant background, >2 DMFT at age 10, many missed appointments and dental anxiety were all risk indicators for future endodontic treatment due to caries up to age 19.     

Undergraduate endodontic teaching in the United Kingdom: an update

Anecdotal evidence and scientific surveys suggest that the quality of root canal treatment within the General Dental Services is often less than ideal. Six years ago, it was reported that endodontic teaching in the United Kingdom was given a low priority and that the time devoted to the laboratory practice of root canal treatment should be increased. In the following year, the European Endodontic Society (ESE) published guidelines for the teaching of Endodontology and made recommendations as to what should be included in the undergraduate curriculum. Shortly afterwards, the ESE published quality guidelines for endodontic treatment. The aim of this project was to determine the current pattern of undergraduate endodontic teaching within the dental schools of the UK. Data were gathered by questionnaire from all 14 undergraduate dental schools and supplemented with further detailed enquiries where necessary. The results were compared with that reported following an identical survey carried out previously. Although the ESE curriculum guidelines for endodontic teaching provide an overall framework for teaching, the results of this study confirmed that a number of topics were either not included or were covered only briefly. However, the average time devoted to the preclinical instruction of root canal treatment in the first clinical year had increased from 14 to 24 h, with additional time provided in subsequent years by the majority of schools. In most instances, staff teaching endodontology in the UK have no specialist training.     

BES Spring Scientific Meeting 2005 Research Poster

Aim To evaluate the impact of European Society of Endodontology curriculum guidelines on undergraduate teaching in the UK. Methodology A postal questionnaire was designed by two authors (WPS, GB) in 2003. This included open and closed questions relating to endodontic curricula and the impact of curriculum guidelines. This was sent with a cover letter to the thirteen UK undergraduate schools. Data harvest was completed a year after the initial questionnaires were sent. Responses were collated and analysed qualitatively and quantitatively. Results Eight (62%) questionnaires were returned. Analysis revealed divergence from aspects of curriculum guidelines. Guidelines were applied by seven schools. Four schools had not applied guidelines related to endodontic surgery as this was taught by Departments of Oral Surgery. One respondent stated that the established curriculum was too inflexible to allow application. There was wide variation in curriculum structure with combinations of outcome, competency and problem‐based learning. No schools had a separate department of Endodontology. All schools felt graduates should be competent at de‐novo treatment of single and multi‐rooted teeth. In general, competence was expected in single canal re‐treatment but not multi‐rooted teeth. Patient recruitment proved a major barrier to meeting guidelines. Number of cases to be completed by graduation ranged from 6 to 14 in total. Three schools felt that guidelines were not achievable citing lack of time, funds and appropriate staff. All schools provided operative techniques classes prior to clinical treatment. These ranged from 20 to 120 hours (mean 43, S.D. 35.24.). Cases completed in these classes varied. For single rooted teeth this ranged from one to six (mean 2.57). For multi‐rooted teeth this ranged from one to three (mean 2.14). Most schools had at least one faculty member with a special interest in Endodontology. In seven schools however, teaching was also carried out by staff with no special interest. Five schools did not have a separate endodontic clinic. Five respondents had undergraduate learning in outreach centres. Trauma teaching was mainly carried out by in Departments of Paediatric Dentistry. Conclusions There is wide variation in the delivery of endodontic curricula in the U.K. Whilst curriculum guidelines are available, there are barriers to delivering these. Consideration should be given to revision of guidelines in light of their evident inapplicability in some areas.     

Recommendations for using regenerative endodontic procedures in permanent immature traumatized teeth

Abstract –  The regeneration of immature permanent teeth following trauma could be beneficial to reduce the risk of fracture and loss of millions of teeth each year. Regenerative endodontic procedures include revascularization, partial pulpotomy, and apexogenesis. Several case reports give these procedures a good prognosis as an alternative to apexification. Care is needed to deliver regenerative endodontic procedures that maintain or restore the vitality of teeth, but which also disinfect and remove necrotic tissues. Regeneration can be accomplished through the activity of the cells from the pulp, periodontium, vascular, and immune system. Most therapies use the host’s own pulp or vascular cells for regeneration, but other types of dental stem cell therapies are under development. There are no standardized treatment protocols for endodontic regeneration. The purpose of this article is to review the recent literature and suggest guidelines for using regenerative endodontic procedures for the treatment of permanent immature traumatized teeth. Recommendations for the selection of regenerative and conventional procedures based on the type of tooth injury, fracture type, presence of necrosis or infection, periodontal status, presence of periapical lesions, stage of tooth development, vitality status, patient age, and patient health status will be reviewed. Because of the lack of long‐term evidence to support the use of regenerative endodontic procedures in traumatized teeth with open apices, revascularization regeneration procedures should only be attempted if the tooth is not suitable for root canal obturation, and after apexogenesis, apexification, or partial pulpotomy treatments have already been attempted and have a poor prognosis.     

Barriers to improving endodontic care: the views of NHS practitioners.

AIMS: Concerns have been expressed about the technical quality of NHS endodontic treatment. Bringing performance into line with guidelines for good practice needs to be underpinned by an understanding of barriers to compliance. To this end, our research involved an exploratory investigation of the factors influencing the behaviour of general dental practitioners in their practice of endodontics. MATERIALS AND METHODS: Subjects 12 dental practitioners, representative of varying levels of professional experience and status, and of compliance with good practice guidelines. Data collection In-depth interviews, following a topic guide. Analysis Identification, abstraction and charting of major themes. FINDINGS: Informants' responses suggested that general dental practitioners' endodontic practice is influenced by a complex web of factors. A key barrier to high quality treatment is the NHS remuneration scheme. Undergraduate and postgraduate education and training are also highly influential on practice. Dentists reported employing a range of strategies to manage the time-cost tensions imposed by the remuneration system. Perceived deficiencies in the content and delivery of postgraduate training were highlighted by our informants. CONCLUSIONS: There was a perception among our informants that the NHS fee structure needs to be revised. Their views suggest that a system which rewards quality rather than volume may be more appropriate, but, we believe, such a system would need to take into account efficiency as well as effectiveness. Modification of the current system of postgraduate training in endodontics is also indicated by the views expressed in the interviews. From the diversity of views and from a critical review of the literature, we conclude that flexibility is the key note in changing practice, with no single strategy likely to be universally appropriate.     

Work experience influences treatment approaches in endodontics: a questionnaire survey among dentists in Western Norway

Objectives: To collect information on endodontic treatment procedures among dentists in the public dental service (PDS) in Western Norway and relate this information to their work experience.

Materials and methods: A survey comprised of 35 questions related to personal information, frequency of endodontic treatment, endodontic procedures and treatment principles was distributed electronically to 187 dentists in PDS in two counties of Western Norway.

Results: The response rate was 74%, and 130 dentists participated. Among them, 57.0% had completed their education less than 13 years ago, and almost all were below 39 years old (95%). The majority (81.0%) had graduated in Norway. Stepwise caries excavation in primary and permanent teeth and direct pulp capping in primary teeth were more frequently performed by dentists with less than 13 years from graduation. Routine use of rubber dam was high among the responders (87%). However, use of rubber dam and master-cone radiograph uptakes were more frequent among the younger dentists. The majority used rotary instrumentation systems, and almost all participants followed the current guidelines for use of antibiotics in endodontics.

Conclusions: In general, dentists in PDS follow the current endodontic treatment guidelines. However, it seems that the more recently graduated dentists perform more endodontic procedures and tend to adhere more to the taught principles regarding rubber dam use and radiograph uptakes.     

Immediate implant placement: treatment planning and surgical steps for successful outcomes

Diagnosis and treatment planning are key factors in achieving successful outcomes after placing and restoring implants placed immediately after tooth extraction. The efficacy of immediate implant placement has been established and shown to be predictable if reasonable guidelines are followed. Some or all of the following suggestions, depending on individual circumstances, should be considered when evaluating a patient for dental implants: thorough medical and dental histories, clinical photographs, study casts, periapical and panogram radiographs as well as a linear tomography or computerised tomography of the proposed implant sites. Reasons for tooth extraction include but are not limited to: insufficient crown to root ratios, remaining root length, periodontal attachment levels, periodontal health of teeth adjacent to the proposed implant sites, unrestorable caries, root fractures with large endodontic posts, root resorption, teeth with deep furcation invasions being considered as abutments for fixed partial dentures and questionable teeth in need of endodontic retreatment.     

Incidence of endodontic therapy after complete or partial coverage glass-ceramic restorations with a follow-up time of over 30 years: A prospective clinical study

Statement of problemLong-term clinical data are lacking on the comparison of the incidence of endodontic therapy in adhesively luted complete and partial coverage glass-ceramic restorations, as well as on the effect of technique and clinical variables.PurposeThe purpose of this prospective clinical study was to assess the long-term incidence of teeth requiring endodontic therapy after receiving either complete or partial coverage glass-ceramic restorations.Material and methodsParticipants requiring single anterior complete, posterior complete, or posterior partial (inlay or onlay) coverage restoration, or a combination of these on a vital tooth were recruited from a clinical private practice. Only the participants who chose glass-ceramic partial and complete coverage restorations without the need of endodontic therapy were included in the study. The overall clinical performance of these glass-ceramic restorations was assessed by clinical factors determined at recall. The effect of various clinical parameters (type of restoration, dental arch, tooth position in the dental arch, age and sex of participant, and ceramic thickness) was evaluated by using Kaplan–Meier survival curves to account for attrition bias and other reasons for failure. The statistical significance of differences between parameters was determined by using the log rank test (α=.05).ResultsA total of 1800 participants requiring 4511 glass-ceramic anterior and posterior restorations were evaluated. The mean age of the participants at the time of restoration placement was 62 (range 20 to 99 years, 710 men and 1090 women). Of 4511 restorations, 1476 were anterior complete coverage, 2119 posterior complete coverage, and 916 posterior partial coverage. Endodontic therapy after restoration placement was needed for 76 restorations (10 anterior complete, 50 posterior complete, and 16 posterior partial). The total time at risk was 50 436 years providing an estimated need for endodontic therapy risk of 0.15% per year. The estimated 35-year cumulative survival was 97.36%. The majority of endodontic treatments (67%, 52/76) occurred in the first 5 years.The estimated cumulative survival of anterior complete coverage, posterior complete coverage, posterior partial inlay, and posterior partial onlay restorations was 98.89% (n=1476, 10 endodontic treatments), 96.38% (n=2119, 50 endodontic treatments), 96.78% (n=553, 11 endodontic treatments), and 98.53% (n=363, 5 endodontic treatments), respectively. Statistically significant differences occurred between anterior complete coverage, posterior complete coverage, and posterior partial coverage inlay restorations, with a higher incidence in posterior complete coverage and posterior partial inlay restorations (P<.05). First molars had the highest rate of endodontic therapy after restoration in both arches. Age and restoration thickness were significant factors, recording statistically higher number of endodontic treatments in participants >52 years and restorations with all surfaces ≥1 mm (P<.05). Other clinical variables, dental arch and sex of the participants, were not significantly related to endodontic treatments (P>.05).ConclusionsThe clinical performance of 4511 units over 30 years in service was excellent, with the estimated cumulative survival of 97.36%. Posterior complete coverage and posterior partial inlay restorations had a significantly higher need for endodontic therapy than anterior complete coverage restorations. Their overall clinical performance relative to endodontic treatment was excellent with a cumulative survival of 96.38% and 96.78% over 30 years. There was no difference in the endodontic treatment rate between posterior complete and partial coverage restorations. Thickness of the restoration affected the endodontic treatment rate, with ≥1 mm resulting in higher incidence. The age of the participants influenced the endodontic treatment rate, with higher incidence in the >52-year age group. Other confounding clinical variables did not have a significant effect on the endodontic treatment rate.     

Brazilian HIV-Infected Population: Assessment of the Needs of Endodontic Treatment in the Post–Highly Active Antiretroviral Therapy Era

IntroductionThe effects of highly active antiretroviral therapy (HAART) on the prevalence of endodontic diseases in HIV-infected individuals have not been reported.MethodsThe purpose of this study was to determine and compare sex, age, need for root canal treatment, CD4 and CD8 lymphocyte counts, HIV viral load, and antiretroviral therapy in 222 HIV-infected individuals who were monitored at an HIV Reference Center in Brazil.ResultsOne hundred sixty-six patients comprised the studied population; the rate of the need for endodontic treatment was 14.5%. There was a positive correlation between the CD4 + T-cells count (<500 cell/ mm³) and the need for endodontic treatment, but there was no statistical difference between the need for endodontic treatment and the HIV viral load or the CD4+/CD8+ ratio in T-cell counts. Of the population that needed endodontic treatment, 79.2% was taking the HAART regimen, and the majority of the studied population was female.ConclusionWe found that those HIV-infected individuals needing endodontic treatment had a lower CD4 + T-cell count, which probably correlated with a lower adherence to the HAART regimen.     

Success of root canal therapy in HIV-positive patients

This retrospective study evaluated the success rate of root canal therapy in 157 HIV-positive patients who had undergone nonsurgical endodontic treatment in a dedicated clinic between 1998 and 2004. Dental records and radiographs were reviewed and information concerning age, gender, medical history, anti-retroviral medication, treatment dates, and follow-up evaluation was compiled. All root canal treatment was performed following the clinical guidelines of the American Association of Endodontists. A single practitioner who was responsible for seeing all of the patients at the six-month recall examination reviewed radiographs. Success was defined as the absence of pain and swelling as well as the absence of the periapical lesion (or a reduction in size compared to its preoperative radiographic size). At the six-month postoperative evaluation, a success rate of 90% was observed in the study group. No statistically significant differences were noted when the success of the root canal therapy was related to the symptomatic clinical presentation, the antiretroviral therapy, or the viral load.     

Locating the MB2 canal in relation to MB1 in Maxillary First Molars using CBCT imaging

The aim of this study is to determine the location of MB2 in maxillary first molars in relation to the MB1 using the cone‐beam computed tomography (CBCT) imaging. In this retrospective study, electronic health records’ system was utilised to identify patients who acquired CBCT for the maxillary first molar as an imaging adjunct to their endodontic treatment. Data were evaluated, and statistical analysis was performed. For the initial treatment cases, the distance from MB1 to MB2 was 2.06 ± 0.52 mm. This did not change significantly for cases that were being retreated. Statistically significant differences were observed between the distances from MB1 to MB2 in males vs. female teeth with males demonstrating longer distances as compared to females. Variations in anatomy exist between patients but this study established some guidelines for clinicians to locate the MB2 canal orifices. This could potentially help with treating these teeth with minimal failure rates.     

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.     

Quality of life of patients with endodontically treated teeth: A systematic review

This systematic review aimed to appraise the quality of life of patients with restored endodontically treated teeth. The Preferred Reporting Items for Systematic Reviews and Meta‐Analyses guidelines were employed. The specific PEO question was as follows: population: patients who were healthy individuals ≥18 years old and required endodontic treatment; exposure: endodontic treatment with a coronal restoration with at least 6 months in occlusal function; and outcome: quality of life of patients. Databases were searched in conjunction with hand searching of reference lists of endodontic textbooks, endodontic‐related journals, and relevant articles from electronic searching. Six articles met the inclusion criteria. Most studies concluded that non‐surgical root canal therapy improved patients’ quality of life. The effect of operator type yielded conflicting results. Only one paper compared endodontic treatment with implant placement, and it showed similar patient‐centric outcome with a high level of patient satisfaction. Current research is still limited, and further studies are warranted.     

Endodontic malpractice claims in Denmark 1995-2004

Aim To study the reasons for and outcome of malpractice claims handled by the regional and national Danish Dental Complaint Boards (DCB) from 1995 to 2004. Specific attention was paid to endodontic claims. Three hypotheses were explored: endodontic malpractice claims are frequent, they are mostly due to technical shortcomings and male dentists are overrepresented. Methodology The reasons for the claims were classified and assigned to at least one of 14 categories. Cases assigned to the ‘endodontic treatment’ category were further sub‐categorized, and reasons for malpractice were examined. An age and gender analysis of dentists and complaining patients was performed only on data obtained from the endodontic cases. Results Overall, 3611 malpractice claims were registered. In 43% of the cases the dentist was judged to be guilty of malpractice. In the majority of the appealed cases the original verdict was affirmed (62.2%) by the national DCB. After crown & bridge treatment (23%) endodontic treatment was the next frequent malpractice claim (13.7%), in which ‘technical complications or incorrect treatment’ was the most frequent sub‐categorization (28.4%). Reasons for endodontic malpractice verdicts were related to root filling quality, the use of a paraformaldehyde product and instrument fracture. Male dentists were most often involved in an endodontic claim, and the majority of complainants were females. Conclusions Endodontic malpractice claims were relatively common in Denmark. Perceived technical shortcomings dominated the patients′ complaints concerning root canal treatment. Male dentists and female patients were overrepresented indicating a gender influence on aspects of the doctor‐patient communication important for liability claims.     

Association of crown discoloration and pulp status in traumatized primary teeth

Abstract – The aim of the present study was to determine the association of tooth discoloration in traumatized primary teeth with clinical and radiographic signs of pulp necrosis, and pulp status at the time of endodontic access. Clinical and radiographic data from dental reports of the 47 patient charts of the Trauma Patient Care Program were used totaling 55 teeth that underwent endodontic treatment following the protocol of the Federal University of Santa Catarina (Brazil). The following data were collected: gender, age of child at time of trauma; crown discoloration; abscess and/or fistula; periapical bone rarefaction and/or pathological root resorption; and pulp status at the time of endodontic access. The Chi‐square test and logistic regression were used in the statistical analysis. The associations between crown discoloration and gender, age, tooth, type of trauma, clinical alteration, and radiographic alteration were not statistically significant. There was a significant association between crown discoloration and pulp necrosis at the time of endodontic access (χ² = 7.672; P < 0.05). Traumatized primary teeth with crown discoloration had a fivefold greater likelihood of exhibiting pulp necrosis than teeth without crown discoloration (95% CI: 1.5–17.1). Thus, a significant association was found between crown discoloration and pulp necrosis in traumatized primary teeth.     

The development of referral guidelines for dentists referring children for extractions under general anaesthesia

OBJECTIVE: To develop a set of guidelines for referral of children for simple extractions under general anaesthesia and to determine if services providing general anaesthetic extractions comply with the guidelines. DESIGN: The guidelines were developed with reference to published literature and experts in the field. Patient's records were used to determine the compliance with the guidelines. SETTING: Community dental services in the North West of England in 2000. SUBJECTS: One hundred and ninety six sets of patient records of children attending to have teeth extracted under general anaesthesia were studied. RESULTS: The mean age of the 196 children was 6.8 years (SD = 2.5 years) and ranged from 2.7 to 15.8 years. Caries was the prime reason for extractions (182; 93b). Of the 196 children who received a general anaesthetic, 103 (53%) dentists had complied with the general anaesthetic referral guidelines whilst 93 (47%) had not. There was wide variation in compliance across 11 trusts in the North West of England. The lowest compliance was 25% and the highest 93%. CONCLUSION: This study has demonstrated that there can be considerable agreement amongst a group of experts on what constitutes clear justification for extracting teeth under general anaesthesia. However there can be marked variation in compliance with these guidelines.     

Magnification devices for endodontic therapy

Background: After the introduction of microsurgical principles in endodontics, involving new techniques for root canal treatment, there has been a continuous search for enhancing the visualization of the surgical field. It would be interesting to know if the technical advantages for the operator brought in by magnification devices like surgical microscope, endoscope and magnifying loupes, are also associated with advantages for the patient, in terms of improvement of clinical and radiographic outcomes. Objectives: The purpose of this systematic review was to evaluate and compare the effects of endodontic treatment performed with the aid of magnification devices versus endodontic treatment without magnification devices. We also aimed at comparing among them the different magnification devices used in endodontics (microscope, endoscope, magnifying loupes). Search strategy: The Cochrane Oral Health Group Trials Register, CENTRAL, MEDLINE and EMBASE were searched with appropriate search strategies. Handsearching included nine dental journals. The bibliographies of relevant clinical trials and relevant articles were checked for identifying studies outside the handsearched journals. Seven manufacturers of instruments in the field of endodontics and/or endodontic surgery, as well as the authors of the identified randomized controlled trials (RCTs) were contacted in order to identify unpublished or ongoing RCTs. There were no language restrictions. The last electronic search was conducted on 2nd April 2009, and the last handsearching was undertaken on 31st January 2009. Selection criteria: All randomized and quasi‐randomized trials comparing endodontic therapy performed with or without using one or more types of magnification device, as well as randomized and quasi‐randomized trials comparing two or more magnification devices used as an adjunct to endodontic therapy were considered. Data collection and analysis: Screening of studies and data extraction were conducted independently and in duplicate. The Cochrane Collaboration statistical guidelines were to be followed for data synthesis. Main results: No trial could be included in the present review. All of the prospective trials that were identified, all dealing with endodontic surgery, had to be excluded for various reasons. Only one RCT was identified comparing three magnificators (magnifying loupes, surgical microscope, endoscope) in endodontic surgery. No RCT was found that compared the outcome of endodontic therapy using or without using a given magnification device. Authors’ conclusions: No objective conclusion can be drawn from the results of this review as no article was identified in the current literature that satisfied the criteria for inclusion. It is unknown if and how the type of magnification device affects the treatment outcome, considering the high number of factors that may have a significant impact on the success of endodontic surgical procedure. This should be investigated by further long‐term RCTs with large sample size. Technical advantages of magnificators have been widely reported in low evidence level studies, but they should be systematically addressed to know if there can be the clinical indication for using a given magnification device for specific clinical situations, such as for molar teeth, or if they can all be used interchangeably. Well‐designed RCTs should also be performed to determine the true difference in terms of treatment success rates between using or not using a magnification device in both conventional and surgical endodontic treatment, if any exist. Plain language summary: Magnification devices for endodontic therapy. There are no data to draw a sound conclusion on the effect of adopting either a microscope, an endoscope, or magnifying loupes for better visualization in endodontic therapy, in terms of clinical outcomes. Though the use of magnification devices has often been associated with technical advantages for the operator and with an improved management of the root canal due to a better visualization of the operative field, it still has to be demonstrated that their use may lead to an improved treatment success rate. More long‐term well‐designed randomized trials with a large sample size are urgently needed to address the issues of the present review.     

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.     

Decision making process by senior residents of Saudi Board in restorative dentistry for nonsurgical endodontic retreatment: A retrospective study

BackgroundDespite the general guidelines for retreatment, differences in decision making exist for secondary endodontic treatment and may be related to many factors including education, clinical experience, dentist specialty, patient preferences and economic resources. Aim of the study was to evaluate the decision making of the Saudi Board in Restorative Dentistry (SBRD) senior residents in the endodontic retreatment of molar teeth as per the scientific guidelines of the American Association of Endodontists (AAE) and also to identify the causes of retreatment and measure how far they become deviated from their taught retreatment principles and inter-individual variability.Materials and methodsCase histories have been obtained from the files of cases treated in the SBRD Resident Comprehensive Case Archives in the SCHS from 2003 to 2015 in Riyadh region. The cases were only confined to Complex I and Complex II cases according to RDITN (Restorative Dental Index of Treatment Need), and seen by R3 and R4 residents only. Residents’ diagnosis was recorded as well as their treatment plan and any given notes regarding their decisions to retreat. Differences between the two groups (R3 and R4) residents and within the same group, regarding endodontic retreatment decisions and reasons for their treatment options were analyzed using Chi-Square test and Fisher’s Exact test.ResultsThe majority of residents in both R4 and R3 groups followed the recommended guidelines. R3 residents preferred to retreat all cases while R4 chose ‘no to retreat’ in few cases. Although R4 residents preferred nonsurgical retreatment more than R3 residents, the difference was insignificant. R4 residents preferred ‘no therapy’ or ‘follow up’ more frequent than R3 residents. Members of the R3 residents agreed more or less with each other as did those of the R4 residents without significant inter-individual variations within each group regarding the choice of retreatment).ConclusionsR4 residents appeared more likely, although not significant, to choose no retreatment or follow up than R3 residents. Conventional nonsurgical retreatment had the highest selection by both R3 and R4 residents. No significant inter-individual variations within each group regarding the choice of retreatment. There is a need to establish evidence based guidelines for more uniform management of failed root treated teeth.