This prospective study evaluated the effect of immediate functional loading (IFL) of full coverage prosthesis on the clinical and radiographic outcome of nonsurgical endodontic therapy (NSET) ...performed on mandibular molar tooth with pulp necrosis and asymptomatic apical periodontitis.INTRODUCTIONThis prospective study evaluated the effect of immediate functional loading (IFL) of full coverage prosthesis on the clinical and radiographic outcome of nonsurgical endodontic therapy (NSET) performed on mandibular molar tooth with pulp necrosis and asymptomatic apical periodontitis.In twenty subjects, standardized two visit NSET was performed in bilateral mandibular first molar teeth (split-mouth model) with a diagnosis of pulp necrosis and asymptomatic apical periodontitis exhibiting a radiographic periapical index (PAI) score ≥3. In each subject, the non-vital bilateral mandibular first molar teeth were randomized to either of two groups that is IFL group (immediate functional loading) or NFL group (functional loading after a time interval of six months). Provisional full coverage prostheses were provided within seven days after completion of endodontic therapy. The cases were followed up clinically and radiographically at six and twelve months. Radiographs were assessed for periapical healing based on PAI scores which were dichotomized as healed (PAI score ≤2) or non-healed (PAI score ≥3). The data was compared using Chi-square and Fischer's exact tests.METHODSIn twenty subjects, standardized two visit NSET was performed in bilateral mandibular first molar teeth (split-mouth model) with a diagnosis of pulp necrosis and asymptomatic apical periodontitis exhibiting a radiographic periapical index (PAI) score ≥3. In each subject, the non-vital bilateral mandibular first molar teeth were randomized to either of two groups that is IFL group (immediate functional loading) or NFL group (functional loading after a time interval of six months). Provisional full coverage prostheses were provided within seven days after completion of endodontic therapy. The cases were followed up clinically and radiographically at six and twelve months. Radiographs were assessed for periapical healing based on PAI scores which were dichotomized as healed (PAI score ≤2) or non-healed (PAI score ≥3). The data was compared using Chi-square and Fischer's exact tests.A recall rate of 100% was achieved at the end of twelve months. All teeth in IFL group and NFL group were clinically asymptomatic. On an inter-group comparison between the proportion of teeth healed and non-healed (radiographic), there was significant difference (p<0.05).RESULTSA recall rate of 100% was achieved at the end of twelve months. All teeth in IFL group and NFL group were clinically asymptomatic. On an inter-group comparison between the proportion of teeth healed and non-healed (radiographic), there was significant difference (p<0.05).Immediate functional loading of full coverage prosthesis in endodontically treated mandibular molar tooth with pulp necrosis and asymptomatic apical periodontitis delayed periapical healing.CONCLUSIONImmediate functional loading of full coverage prosthesis in endodontically treated mandibular molar tooth with pulp necrosis and asymptomatic apical periodontitis delayed periapical healing.
Aim
The aim of this cone‐beam computed tomography (CBCT)‐based study was to evaluate the outcome of nonsurgical root canal treatment (RCT) performed for the management of large cyst‐like periapical ...lesions (LCPL) and to identify the predictive factors affecting healing.
Methodology
Fifty‐four subjects (77 permanent maxillary anterior teeth) with LCPL (>10 mm) of endodontic origin were included. A single operator performed standardized multi‐visit RCT. Patients were clinically and radiographically examined at 6, 12 months, and a CBCT scan was taken at 24 months. Two independent blinded evaluators measured the pre‐ and postoperative volume of periapical lesions on CBCT scans using ITK snap software (version 3.8.0‐beta‐20181028‐win64). The outcome was assessed as a percentage change in lesion volume and dichotomized as success (resolved/reduced) or failure (unchanged/enlarged). Ten preoperative (gender; age; intraoral draining sinus, soft tissue swelling, tooth discoloration, pulp canal obliteration, open apex, root resorption, cortical bone defect and lesion volume) and four intraoperative (apical extent and density of root filling; number of treatment visits and type of root filling) predictive factors were observed. Bivariate and stepwise multivariable linear regression analysis was performed to identify independent predictors affecting treatment outcomes. The significance level was set at 5%.
Results
A recall rate of 88% was achieved. The success rate of RCT was 82.2% (8.9% resolved, 73.3% reduced). Median lesion volume reduction was 75% (IQR 61%–93%). No pre‐ or intra‐operative factors were related to treatment failure. However, presence of preoperative cortical bone defect (palatal versus no cortical defect, β = −51.5; 95% CI: −86.9 to −16, p = .006) and apical extent of obturation (long versus flush, β = −27.2; 95% CI: −53.8 to −0.6, p = .04) were negatively associated with reduction in lesion volume (%).
Conclusion
Large cyst‐like periapical lesions may be successfully managed with RCT. Preoperative cortical bone defect and apical extent of obturation may negatively influence osseous healing.
Aim
To assess the influence of occlusal and proximal deep carious lesions on the outcome of full pulpotomy performed in mandibular teeth with pulpal diagnosis of symptomatic partial irreversible ...pulpitis.
Methodology
Eighty deep carious mandibular molar teeth with clinical and radiographic diagnosis of symptomatic partial irreversible pulpitis without periapical rarefaction from patients of either gender between the age of 16–35 years were included. Depending upon the location of deep carious lesion, the teeth were distributed equally into occlusal (n = 40) and proximal caries groups (n = 40). Full pulpotomy was performed under local anaesthesia and aseptic conditions. The pulp tissue was removed until the root canal orifices, and 2.5% sodium hypochlorite (NaOCl) was applied to arrest pulpal bleeding. Mineral trioxide aggregate (MTA) was compacted over the radicular pulp. Teeth were restored with resin‐modified glass ionomer cement (RMGIC) and bulk‐fill composite resin. Pre‐ and post‐operative pain was assessed at 24, 48 and 72 h using a 11‐point Numerical Rating Scale (NRS). Patients were followed at 6 and 12 months for clinical and radiographic evaluation. Asymptomatic teeth without any radiographic evidence of periapical rarefaction were considered successful. The data were analysed using the Shapiro–Wilk W test, two‐sample Wilcoxon rank‐sum test, Pearson chi‐square test, Fisher's exact test and Kappa coefficient. The significance level was predetermined at p < .05.
Result
An intergroup comparison revealed that the pre‐ and post‐operative pain scores at 24, 48 and 72 h were not significantly different (p > .05). At the end of follow‐up period (12 months), success of full pulpotomy in occlusal and proximal caries group was 95% and 92.5%, respectively (p = .644). For both groups, the combined success rate of full pulpotomy was 93.75%.
Conclusion
The site of carious lesions (i.e., occlusal or proximal) did not affect the clinical and radiographic outcome of full pulpotomy performed in mature permanent mandibular teeth with symptomatic partial irreversible pulpitis.
Aim: Lack of unanimity in decision-making regarding the management of deep caries and exposed pulp has been highlighted by several questionnaire-based studies from various geographic regions. There ...is no research available in the Indian setting. The aim of the present study was to evaluate the perspectives of the Indian Endodontic Society and Indian Association of Conservative Dentistry and Endodontics members using an online questionnaire. Methods: An online structured questionnaire of 17 questions was mailed to 200 members based on the periapical radiographs of two cases (18 and 55 years of age) highlighting deep carious lesions and normal periapex in a mandibular molar. Each case had three hypothetical scenarios based on pulpal symptoms, i.e., asymptomatic pulp, reversible, and irreversible pulpitis, respectively. Results: A response rate of 65.5% (n = 131) was achieved. Nonselective caries removal was chosen by 40% and 36% of the participants in young patients with asymptomatic pulp and reversible pulpitis. On pulpal exposure, direct pulp capping was chosen by a majority of the members (66% and 54%, respectively) in a young patient. For irreversible pulpitis, pulpectomy was favored by 70%. In an older patient, less vital pulp therapy and more pulpectomy were preferred. The symptoms and patient age significantly altered treatment decisions, as determined by Chi-square and Fisher’s exact tests ( P < 0.05). Conclusion: There was a lack of agreement in managing deep carious lesions. There was partial awareness of the management of exposed pulp.
The aim of this cone-beam computed tomographic study was to evaluate the association between the mesiobuccal root canal configuration (RCC), interorifice distance (IOD), and the corresponding root ...length of a permanent maxillary first molar tooth.
One hundred cone-beam computed tomographic scans obtained from the computerized data bank of the institute were studied. The IOD between the first mesiobuccal and second mesiobuccal canal was measured in the axial section where the second mesiobuccal canal was first visualized. The root length was measured from the cementoenamel junction to the root apex in the coronal and sagittal section. The associations of these parameters with the RCC (based on Vertucci’s classification) were evaluated.
The predominant RCC was observed to be Vertucci type II (89%). The mean root length with this configuration was 11.19 ± 1.35 mm. In type IV RCC, the mean root length was 9.13 ± 0.52 mm. A statistically significant association was established between the root length and RCC (P < .05). In roots with type II and type IV RCC, the mean IOD was 2.58 ± 0.04 mm and 2.62 ± 0.1 mm, respectively. No statistically significant relation was established between the IOD and the type of RCC (P > .05).
The length of the mesiobuccal root is an important anatomic parameter for predicting the type of RCC in the permanent maxillary first molar tooth.
The main objective of a root canal sealer is to provide a fluid tight seal. The purpose of this systematic meta-analysis was to determine the relative toxicity of commonly used root canal sealers ...like zinc oxide eugenol, calcium hydroxide, and resin-based sealers.
An online search was conducted in peer-reviewed journals listed in PubMed, Cochrane, EBSCO, and IndMed databases between 2000 and 2012). Statistical analysis was carried out by using analysis of variance (ANOVA) followed by post-hoc comparison by Bonferroni method. The comparison between toxicity at 24 h and between 3 and 7 days was done by using paired t-test for each sealer.
At 24 h, the relative biotoxicity of the three sealers reported was insignificant (P- value 0.29), but the difference in toxicity was found significant (P < 0.001) after 3 days.
Calcium hydroxide sealer and zinc oxide eugenol were found to be significantly biotoxic as compared to resin-based sealers after 3 days.
ABSTRACT
Aim:
This study aimed to assess the shape, size, symmetry, and location of mental foramen (MF) in relation to mandibular dental and skeletal landmarks using cone-beam computed tomography ...(CBCT).
Methods:
This retrospective observational study was performed on 135 CBCT images of 74 males (mean age 36.16 ± 13.49 years) and 61 females (mean age 37.13 ± 13.53 years). Two independent observers performed the morphometric measurements of MF using CBCT images using Invivo software. Independent t-test and Mann–Whitney test were employed to evaluate the gender differences. A comparison of categorical data was performed using Chi-square test. Intraclass correlation coefficient and Kappa statistics were used to assess interobserver reliability.
Results:
The most common horizontal and vertical location of MF was the long axis of the second premolars (52.2%) and below the bicuspid root apices (70%), respectively. The most common shape was round (56.6%). Significant gender differences were observed for the MF size (mean width 0.35 mm larger in males), the distance of MF to lower border of mandible (16.10 ± 1.77 mm in males and 14.81 ± 1.48 mm in females), and MF to pogonion (28 ± 2.13 mm in males and 26.62 ± 1.98 mm in females). The horizontal and vertical locations were bilaterally symmetrical in 67.4% and 79.26% of subjects, respectively.
Conclusion:
Right and left sides of the mandible require separate evaluations since there are differences in the location of the MF on each side. Gender differences were observed in location of MF in the relation to skeletal landmarks. Nevertheless, skeletal landmarks are reliable for locating the MF.
This retrospective study analyzed the 12-month pulp sensibility (cold and electric) test response after mineral trioxide aggregate (MTA) full pulpotomy in mature permanent teeth with symptomatic ...irreversible pulpitis.
The records of 120 subjects from 3 completed and 1 ongoing clinical study on MTA full pulpotomy were retrieved. Ninety-six first and second mandibular molar teeth with a diagnosis of symptomatic irreversible pulpitis that underwent a single-visit MTA full pulpotomy and had completed a 12-month clinical, radiographic, and pulp sensibility (cold and electric) test follow-up were included. The data were analyzed using the Fisher exact test, the Pearson chi-square test, and the McNemar test. The significance level was predetermined at P < .05.
A higher percentage of teeth (94.7%) responded to the electric pulp test in comparison with the cold test (13.5%) (P < .05). Sex-based responses to the electric pulp test (P > .05) and the cold test were similar (P > .05). The age-based response was similar for the electric pulp test (P > .05) but was significant for the cold test (P < .05). The tooth quadrant (left and right), the tooth (mandibular first and second molar), and the location of restoration (proximal or occlusal) did not influence the response of either the electric pulp test (P > .05) or the cold test (P > .05). At the 1-year follow-up, all the teeth that were classified as clinically and radiographically successful responded to the electric pulp test; however, only 13 teeth responded to the cold test (P = .00).
The majority (94.7%) of the teeth that underwent MTA full pulpotomy responded to the electric pulp test at a 1-year time interval.
Introduction: Evidence-based endodontics improves patient care by combining clinical competence, research, and patient values. This review critically assessed scientific studies at an Indian national ...endodontic conference.
Materials and Methods: Scientific research papers presented at the 30th National Endodontic Conference of the Indian Endodontic Society 2022 were categorized according to the area of interest and the level of evidence. Cuzick's test for trend was utilized to compare the level of evidence of the abstracts at the National Endodontic Conference (n = 396) and those published from the 20th European Society of Endodontology Biennial Congress 2022 (n = 91).
Results: Endodontics (n = 265, 64.6%) was the most examined domain, followed by diagnosis (n = 49, 12.4%), restorative dentistry (n = 46, 11.6%), and miscellaneous (n = 45; 11.6%). Root canal disinfection (n = 64, 16.1%) was the most prevalent subcategory, followed by endodontic instruments and apparatus (n = 40, 10.1%) and restorations (n = 36, 9%). Laboratory and animal (nonhuman) studies dominated the national conference abstracts (n = 219, 55.3%), followed by level VI (n = 108; 27.2%), level III (n = 40; 10.1%), and level II (n = 23, 5.9%). There was no significant difference between the national and international conference levels of evidence (P = 0.318).
Discussion: National and international conferences lack laboratory-to-clinical translation. Researchers must do high-quality, relevant, nonredundant evidence-based research.
Conclusion: New studies should use evidence-based research to efficiently address valid research questions and provide predictable and high-quality patient treatment.
The management of traumatic dental injury aims at functional and esthetic rehabilitation. After luxation injury, a displaced tooth must be replaced into its normal position as soon as possible. ...Incorrect tooth repositioning can cause discomfort to the patient and compromise the outcome. This report documents a novel digital technology–based approach for the management of teeth following luxation injury with displacement. A 25-year-old female reported 2 days after traumatic dental injury to her maxillary right central incisor tooth #8. After clinical and radiographic examination, a diagnosis of lateral luxation of tooth #8 was made. The preoperative high-resolution cone-beam computed tomography (CBCT) image data set confirmed palatal luxation of tooth #8 with fractured and displaced labial cortical plate. The CBCT data were imported into a medical image processing software program, and a segmentation tool was used to segment the fractured cortical plate, luxated tooth, and alveolar process. The socket is reconstructed by realigning fractured cortical bone over the alveolar process and repositioning the tooth in the virtual planning software. A three-dimensional (3D) guiding template was designed over the repositioned tooth and adjacent teeth and printed. This 3D printed guide was used for the repositioning of luxated tooth #8 and stabilizing it during the splinting procedure. This technique of using CBCT and 3D guide for repositioning is an objective, precise, and predictable approach. The 3D printed model of the dental arch after virtual tooth alignment can be used by the dentist to determine the exact splint length and contour before splinting.
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