Outcomes of Primary Endodontic Therapy Provided by Endodontic Specialists Compared to Other Providers

Introduction: The objective of this study was to compare the outcomes of initial non-surgical root canal therapy (NSRCT) for different tooth types provided by both endodontists and other providers. Methods: Using an insurance company database, 487,476 initial NSRCT procedures were followed from the time of treatment to the presence of an untoward event indicated by Current Dental Terminology (CDT) codes for retreatment, apical surgery, or extraction. Population demographics were computed for provider type and tooth location. Kaplan-Meier survival estimates were calculated for 1, 5, and 10 years. Hazard ratios for provider type and tooth location were calculated using the Cox proportional hazards model. Analyses were performed using SAS 9.4 (Cary, NC). Results: The survival of all teeth collectively was 98% at 1 year, 92% at 5 years, and 86% at 10 years. Significant differences in survival based on provider type were noted for molars at 5 years, and for all tooth types at 10 years. The greatest difference discovered was a 5% higher survival rate at 10 years for molars treated by endodontists. This was further evidenced by a hazard ratio of 1.394 when comparing other provider’s success to endodontists within this ten-year molar group. Conclusions: These findings show that survival rates of endodontically teeth is high at ten years post treatment regardless of provider type. Molars treated by endodontists after 10 years have significantly higher survival rates than molars treated by non-endodontists

Impact of Delayed Completion of Previously Initiated Therapy and Provider Type on Outcomes of Root Canal Treatment

Objective:if the provider type influences long-term outcomes in instances where NSRCT has been previously initiated. The primary purpose of this study was to determine if the period of time between previously initiated therapy and the completion of non-surgical root canal treatment (NSRCT) influences long-term outcomes. The secondary purpose of this study was to determineMaterials/Methods: Enrollment and claims data from Delta Dental of Wisconsin from2002-2014 was analyzed. Teeth that received NSRCT within 6 months after completionof pulpal debridement or pulpotomy procedures (identified by Codes of DentalProcedures and Nomenclature) and within a continuous insurance coverage period wereincluded. Teeth that did not receive definitive restorations within 180 days followingcompletion of NSRCT were excluded. Teeth were followed from the time of treatment tothe presence of a CDT code representing untoward events, which include retreatment,apicoectomy, or extraction. The impact of tooth location, age at time of NSRCTcompletion, and provider type on the outcome was also examined using Univariate andMultivariable Cox proportional hazards models. A total of 7,488 NSRCTs were includedin the analysis. Results:. Molar teeth were associated with a greater risk of an untoward event than anterior teeth with an adjusted hazard ratio of1.52 (p\u3c0.029). An increase in the risk of failure was observed in teeth from patients that were 55 and older with an adjusted hazard ratio 2.15 (p\u3c0.001). A significantly lower adjusted hazard ratio of 0.68 (p\u3c0.001) was observed when treatment was initiated by a general dentist and completed by an endodontist when compared to treatment that was both initiated and completed by a general dentist.Conclusion: Delayed completion of NSRCT after previously initiated therapy was not associated with unfavorable outcomes.No statistically significant difference was found among the varying time intervals between initiation and completion of NSRCT Improved outcomes were noted when previously

Patient-centered endodontic outcomes: a narrative review.

IntroductionRoot canal treatment (RCT) success criteria inform us of the path to bony healing and of prognostic factors, but tell little about how the patient perceives, feels, or values RCT. Patients choose, undergo, and pay for RCT, they live with the result, and inform their community. The purpose of this narrative review was to appraise patient-centered outcomes of initial non-surgical RCT and nonsurgical retreatment, in adults.Materials and methodsPatient-centered RCT outcome themes were identified in the extant literature: quality of life, satisfaction, anxiety, fear, pain, tooth survival and cost. Narrative review was applied because the disparate themes and data were unsuited to systematic review or meta-analysis.ResultsApplication of the Oral Health Impact Profile (OHIP) demonstrated that disease of pulpal origin affects quality of life with moderate severity, primarily through physical pain and psychological discomfort, and that RCT results in broad improvement of quality of life. Satisfaction with RCT is extremely high, but cost is the primary reason for dissatisfaction. Anxiety and fear affect RCT patients, profoundly influencing their behaviors, including treatment avoidance, and their pain experience. Fear of pain is "fair" to "very much" prior to RCT. Pain is widely feared, disliked, and remembered; however, disease of pulpal origin generally produces moderate, but not severe pain. RCT causes a dramatic decrease in pain prevalence and severity over the week following treatment. Survival rates of teeth after RCT are very high; complication rates are low. Cost is a barrier to RCT, but initial costs, lifetime costs, cost effectiveness, cost utility, and cost benefit all compare extremely well to the alternatives involving replacement using implants or fixed prostheses.ConclusionDentists must strive to reduce anxiety, fear, experienced and remembered pain, and to accurately inform and educate their patients with respect to technical, practical and psychosocial aspects of RCT

Bioactive-glass in Endodontic Therapy and Associated Microsurgery

Bioactive-glass (B-G) has become a valuable adjunct to promote hard-tissue healing in many clinical situations and is of particular interest for endodontic care because of its biocompatibility, regenerative and antimicrobial properties as well as chemical composition that closely resembles the mineral make-up of human bone and dentine

Treatment Decisions Involving Teeth with Intrapulpal Cracks: A Survey of Endodontists

There is no universal protocol for diagnosing, treating and managing cracked teeth. The purpose of this survey was to investigate the use of traditional methods of crack detection and to explore how treatment decisions were made using an intrapulpal crack classification. The electronic survey was sent to 1115 active members of the American Association of Endodontists (AAE) and The Digital Office (TDO™) community. Comparisons were assessed using logistic or repeated-measures regression. The most often used diagnostic method was probing. When the crack involved one wall, 85% of respondents would complete root canal therapy \u3e 50% of the time or always. For two or more walls, the percentage dropped to 44%. When the crack involved the floor or orifices, 60% would not complete treatment. For necrotic teeth, 36% of respondents preferred extraction as opposed to 3% if vital. This survey illustrated the anecdotal nature of detection, diagnosis and management of cracked teeth

Vital pulp therapy versus endodontic treatment: a narrative revision

O principal objetivo de todos os procedimentos restauradores é manter a viabilidade da polpa dentária. Nas últimas décadas as técnicas minimamente invasivas têm sido amplamente adotadas. O objetivo deste estudo é definir a opção terapêutica mais adequada em dentes maturos, terapia pulpar vital ou o convencional tratamento endodôntico radicular. A pesquisa bibliográfica foi realizada na Pubmed, Medline, Scielo e no Google Académico. A evidência nesta revisão sugere que a proteção pulpar direta é um procedimento clinicamente efetivo para tratamento de dentes com cárie profunda e exposição pulpar. Embora sejam necessários mais estudos, as opções de tratamento apresentadas nesta revisão permitem mudar os protocolos e, dessa forma, melhorar a qualidade de vida dos pacientes.The major goal of all restorative procedures is to maintain the viability of the dental pulp. Over the last few decades, minimally invasive techniques have received wider acceptance. The aim of this study is to define the most suitable therapeutic option for a mature tooth, the vital pulp therapies or the conventional root canal treatment. The search for bibliographic material was done using Pubmed, Medline, Scielo and Academic Google. The evidence in this review suggests that direct pulp capping is a clinically effective procedure for treating teeth with deep caries and pathologically exposed pulps. Although many more studies are required, the treatment options presented here will change endodontic therapies and improve quality of life in patients

Root canal retreatment : a retrospective investigation using regression and data mining methods for the prediction of technical quality and periapical healing

Objectives: This study aimed to investigate patterns and risk factors related to the feasibility of achieving technical quality and periapical healing in root canal non-surgical retreatment, using regression and data mining methods. Methodology: This retrospective observational study included 321 consecutive patients presenting for root canal retreatment. Patients were treated by graduate students, following standard protocols. Data on medical history, diagnosis, treatment, and follow-up visits variables were collected from physical records and periapical radiographs and transferred to an electronic chart database. Basic statistics were tabulated, and univariate and multivariate analytical methods were used to identify risk factors for technical quality and periapical healing. Decision trees were generated to predict technical quality and periapical healing patterns using the J48 algorithm in the Weka software. Results: Technical outcome was satisfactory in 65.20%, and we observed periapical healing in 80.50% of the cases. Several factors were related to technical quality, including severity of root curvature and altered root canal morphology (p<0.05). Follow-up periods had a mean of 4.05 years. Periapical lesion area, tooth type, and apical resorption proved to be significantly associated with retreatment failure (p<0.05). Data mining analysis suggested that apical root resorption might prevent satisfactory technical outcomes even in teeth with straight root canals. Also, large periapical lesions and poor root filling quality in primary endodontic treatment might be related to healing failure. Conclusion: Frequent patterns and factors affecting technical outcomes of endodontic retreatment included root canal morphological features and its alterations resulting from primary endodontic treatment. Healing outcomes were mainly associated with the extent of apical periodontitis pathological damages in dental and periapical tissues. To determine treatment predictability, we suggest patterns including clinical and radiographic features of apical periodontitis and technical quality of primary endodontic treatment

A Novel Decisionâ Making Process for Tooth Retention or Extraction

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/141780/1/jper0476.pd

Root canal retreatment: a retrospective investigation using regression and data mining methods for the prediction of technical quality and periapical healing

Objectives: This study aimed to investigate patterns and risk factors related to the feasibility of achieving technical quality and periapical healing in root canal non-surgical retreatment, using regression and data mining methods.&nbsp;Methodology: This retrospective observational study included 321 consecutive patients presenting for root canal retreatment. Patients were treated by graduate students, following standard protocols. Data on medical history, diagnosis, treatment, and follow-up visits variables were collected from physical records and periapical radiographs and transferred to an electronic chart database. Basic statistics were tabulated, and univariate and multivariate analytical methods were used to identify risk factors for technical quality and periapical healing. Decision trees were generated to predict technical quality and periapical healing patterns using the J48 algorithm in the Weka software. Results: Technical outcome was satisfactory in 65.20%, and we observed periapical healing in 80.50% of the cases. Several factors were related to technical quality, including severity of root curvature and altered root canal morphology (p&lt;0.05). Follow-up periods had a mean of 4.05 years. Periapical lesion area, tooth type, and apical resorption proved to be significantly associated with retreatment failure (p&lt;0.05). Data mining analysis suggested that apical root resorption might prevent satisfactory technical outcomes even in teeth with straight root canals. Also, large periapical lesions and poor root filling quality in primary endodontic treatment might be related to healing failure.&nbsp;Conclusion: Frequent patterns and factors affecting technical outcomes of endodontic retreatment included root canal morphological features and its alterations resulting from primary endodontic treatment. Healing outcomes were mainly associated with the extent of apical periodontitis pathological damages in dental and periapical tissues. To determine treatment predictability, we suggest patterns including clinical and radiographic features of apical periodontitis and technical quality of primary endodontic treatment

European Society of Endodontology position statement : endodontic management of traumatized permanent teeth

This position statement represents a consensus of an expert committee convened by the European Society of Endodontology (ESE) on the endodontic management of traumatized permanent teeth. A recent comprehensive review with detailed background information provides the basis for this position statement (Krastl et al. 2021, International Endodontic Journal, ). The statement is based on current scienti?c evidence as well as the expertise of the committee. Complementing the recently revised guidelines of the International Association of Dental Traumatology, this position statement aims to provide clinical guidance for the choice of the appropriate endodontic approach for traumatized permanent teeth. Given the dynamic nature of research in this area, this position statement will be updated at appropriate intervals.Peer reviewe