Validation of self-reported history of root canal treatment in a southern Brazilian subpopulation

The aim of this study was to assess self-reported history of root canal treatment (SRHRCT) as a method for detecting the presence of root canal treatment (RCT) and apical periodontitis (AP) in a southern Brazilian subpopulation. In this cross-sectional study, 136 military police officers from the city of Porto Alegre, Brazil, were included. The participants were interviewed and full-mouth periapical radiographs were taken. A calibrated examiner determined the presence of RCT and AP by applying standardized criteria. The diagnostic accuracy of SRHRCT was calculated separately for RCT and AP. Accuracy, sensitivity, specificity, positive and negative predictive values (+PV and -PV), efficiency, and positive and negative likelihood ratios (+LR and -LR) were estimated. The mean age of the participants was 34.1 ± 10.4 years and 88.2% were males. Overall, SRHRCT demonstrated high sensitivity and specificity for RCT, but not for AP: sensitivity (RCT = 0.960, AP = 0.757) and specificity (RCT = 0.835, AP = 0.631). The estimated values for PV and LR were: +PV (RCT=0.777, AP=0.396), -PV (RCT = 0.972, AP = 0.890), +LR (RCT = 5.853, AP = 2.057), and -LR (RCT = 0.046, AP = 0.383). SRHRCT proved to be a good predictor of the presence of RCT, but a weak predictor of AP in this subpopulation

Partial caries removal in permanent teeth : 5-year follow-up

Este é um estudo de acompanhamento de cinco anos de um ensaio clínico randomizado controlado multicêntrico, que teve como objetivo avaliar a efetividade de uma abordagem alternativa no tratamento de lesões de cárie profundas em comparação ao tratamento expectante (TE). O tratamento alternativo consistiu na remoção parcial de tecido cariado (RPTC) e restauração em sessão única. A amostra incluiu molares com lesões chegando até metade interna de dentina e sem lesão periapical ao exame radiográfico, resposta positiva ao teste frio, negativa ao teste de percussão e ausência de dor espontânea. Estes foram randomicamente atribuídos ao grupo teste (RPTC) ou controle (TE). Os pacientes do grupo teste receberam remoção incompleta de tecido cariado e restauração em amálgama ou resina composta em uma sessão. Os pacientes do grupo controle, após remoção incompleta do tecido cariado, receberam capeamento pulpar indireto com cimento de hidróxido de cálcio e restauração temporária com cimento de óxido de zinco e eugenol modificado na primeira sessão. Após mediana de tempo de 90 dias, a cavidade era reaberta para remoção da dentina cariada remanescente e restauração em resina composta ou amálgama. O desfecho avaliado no estudo foi a vitalidade pulpar, determinada pela sensibilidade positiva ao teste térmico, negativa ao teste de percussão e ausência de alteração periapical ao exame radiográfico. Os dados de sobrevivência foram analisados através do modelo de regressão de Weibull com termo de fragilidade. As demais associações foram realizadas pelo teste do qui-quadrado. Foram executados 299 tratamentos, sendo 152 RPTC e 147 TE, em pacientes com idade entre 6 e 53 anos. Durante 5 anos de acompanhamento, 229 dentes foram avaliados. Foram observadas taxas de sucesso de 79% para o grupo teste e 56% para o grupo controle (p<0,001). Foram encontradas associações significativas entre sucesso e tratamento, número de faces restauradas e região. O desfecho foi favorável quando o tratamento foi RPTC comparado com TE; quando 1 face foi restaurada, em comparação com 2 ou mais; e quando a região Centro-Oeste foi comparada à região Sul. Foi encontrada associação significativa entre o número de faltas dos pacientes nas consultas de acompanhamento e sucesso, tendo maior número de insucessos entre aqueles que faltaram 3-4 consultas em comparação com os que faltaram de 0-2 (p=0,015). Os pacientes da região Sul caracterizaram-se como mais faltosos que os da região Centro-Oeste (p=0,00). Os resultados sugerem que a RPTC pode ser alternativa viável no tratamento de lesões profundas de cárie. Não parece haver a necessidade de uma segunda consulta para reabertura e nova remoção de tecido cariado como demanda o tratamento expectante para que a vitalidade pulpar seja mantida.This study is a 5-year follow-up to a multicenter randomized clinical trial which aimed to evaluate the effectiveness of an alternative treatment to stepwise excavation (SW) in the management of deep caries lesions. This treatment consisted of partial caries removal (PCR) and tooth restoration in a single session. The sample included molars with caries lesions reaching the inner half of dentin and no periapical lesion in radiographic exam, positive response to cold test, negative to percussion test and absence of spontaneous pain. These teeth were randomly assigned to test (PCR) or control (SW) groups. Patients from the test group received partial caries removal and tooth restoration in amalgam or resin composite in one session. Patients from the control group received incomplete caries removal, indirect pulp capping with calcium hydroxide cement and temporary filling with a modified zinc oxide-eugenol cement. After a median time of 90 days, the tooth was reopened for removal of the remnant decayed tissue and then restored with amalgam or resin composite. The outcome stipulated was pulp vitality, which was determined by positive response to cold test, negative response to percussion test and absence of periapical lesion in radiographic exam. Survival data was analyzed using the Weibull regression model with frailty term. Other analyses were done using the chi-square test. In total, 299 treatments were conducted (152 PCR; 147 SW), in patients with ages varying from 6 to 53 years. Through 5 years of follow-up, 229 teeth were evaluated. Survival rates were 79% for the PCR group and 56% for the SW group (p<0.001). Statistically significant associations were found between outcome and treatment, number of restored surfaces and region. The outcome was favorable when treatment was PCR, compared to SW; when one surface was restored, compared to 2 or more; and when the Midwest region was compared to the South. Association was found between outcome failure and number of absences to follow-up appointments. Patients who failed to show to 3-4 follow-up appointments had significantly more treatment failures than those who missed 0-2 appointments (p=0.015). Patients from the South region were also significantly more absent than those in the Midwest (p=0.00). The present results suggest that PCR can be considered as a viable option in treating deep caries lesions. There is no apparent need to reopen the cavity for further caries removal to preserve pulp vitality

Partial caries removal in permanent teeth : 5-year follow-up

Este é um estudo de acompanhamento de cinco anos de um ensaio clínico randomizado controlado multicêntrico, que teve como objetivo avaliar a efetividade de uma abordagem alternativa no tratamento de lesões de cárie profundas em comparação ao tratamento expectante (TE). O tratamento alternativo consistiu na remoção parcial de tecido cariado (RPTC) e restauração em sessão única. A amostra incluiu molares com lesões chegando até metade interna de dentina e sem lesão periapical ao exame radiográfico, resposta positiva ao teste frio, negativa ao teste de percussão e ausência de dor espontânea. Estes foram randomicamente atribuídos ao grupo teste (RPTC) ou controle (TE). Os pacientes do grupo teste receberam remoção incompleta de tecido cariado e restauração em amálgama ou resina composta em uma sessão. Os pacientes do grupo controle, após remoção incompleta do tecido cariado, receberam capeamento pulpar indireto com cimento de hidróxido de cálcio e restauração temporária com cimento de óxido de zinco e eugenol modificado na primeira sessão. Após mediana de tempo de 90 dias, a cavidade era reaberta para remoção da dentina cariada remanescente e restauração em resina composta ou amálgama. O desfecho avaliado no estudo foi a vitalidade pulpar, determinada pela sensibilidade positiva ao teste térmico, negativa ao teste de percussão e ausência de alteração periapical ao exame radiográfico. Os dados de sobrevivência foram analisados através do modelo de regressão de Weibull com termo de fragilidade. As demais associações foram realizadas pelo teste do qui-quadrado. Foram executados 299 tratamentos, sendo 152 RPTC e 147 TE, em pacientes com idade entre 6 e 53 anos. Durante 5 anos de acompanhamento, 229 dentes foram avaliados. Foram observadas taxas de sucesso de 79% para o grupo teste e 56% para o grupo controle (p<0,001). Foram encontradas associações significativas entre sucesso e tratamento, número de faces restauradas e região. O desfecho foi favorável quando o tratamento foi RPTC comparado com TE; quando 1 face foi restaurada, em comparação com 2 ou mais; e quando a região Centro-Oeste foi comparada à região Sul. Foi encontrada associação significativa entre o número de faltas dos pacientes nas consultas de acompanhamento e sucesso, tendo maior número de insucessos entre aqueles que faltaram 3-4 consultas em comparação com os que faltaram de 0-2 (p=0,015). Os pacientes da região Sul caracterizaram-se como mais faltosos que os da região Centro-Oeste (p=0,00). Os resultados sugerem que a RPTC pode ser alternativa viável no tratamento de lesões profundas de cárie. Não parece haver a necessidade de uma segunda consulta para reabertura e nova remoção de tecido cariado como demanda o tratamento expectante para que a vitalidade pulpar seja mantida.This study is a 5-year follow-up to a multicenter randomized clinical trial which aimed to evaluate the effectiveness of an alternative treatment to stepwise excavation (SW) in the management of deep caries lesions. This treatment consisted of partial caries removal (PCR) and tooth restoration in a single session. The sample included molars with caries lesions reaching the inner half of dentin and no periapical lesion in radiographic exam, positive response to cold test, negative to percussion test and absence of spontaneous pain. These teeth were randomly assigned to test (PCR) or control (SW) groups. Patients from the test group received partial caries removal and tooth restoration in amalgam or resin composite in one session. Patients from the control group received incomplete caries removal, indirect pulp capping with calcium hydroxide cement and temporary filling with a modified zinc oxide-eugenol cement. After a median time of 90 days, the tooth was reopened for removal of the remnant decayed tissue and then restored with amalgam or resin composite. The outcome stipulated was pulp vitality, which was determined by positive response to cold test, negative response to percussion test and absence of periapical lesion in radiographic exam. Survival data was analyzed using the Weibull regression model with frailty term. Other analyses were done using the chi-square test. In total, 299 treatments were conducted (152 PCR; 147 SW), in patients with ages varying from 6 to 53 years. Through 5 years of follow-up, 229 teeth were evaluated. Survival rates were 79% for the PCR group and 56% for the SW group (p<0.001). Statistically significant associations were found between outcome and treatment, number of restored surfaces and region. The outcome was favorable when treatment was PCR, compared to SW; when one surface was restored, compared to 2 or more; and when the Midwest region was compared to the South. Association was found between outcome failure and number of absences to follow-up appointments. Patients who failed to show to 3-4 follow-up appointments had significantly more treatment failures than those who missed 0-2 appointments (p=0.015). Patients from the South region were also significantly more absent than those in the Midwest (p=0.00). The present results suggest that PCR can be considered as a viable option in treating deep caries lesions. There is no apparent need to reopen the cavity for further caries removal to preserve pulp vitality

Validation of self-reported history of root canal treatment in a southern Brazilian subpopulation

Abstract The aim of this study was to assess self-reported history of root canal treatment (SRHRCT) as a method for detecting the presence of root canal treatment (RCT) and apical periodontitis (AP) in a southern Brazilian subpopulation. In this cross-sectional study, 136 military police officers from the city of Porto Alegre, Brazil, were included. The participants were interviewed and full-mouth periapical radiographs were taken. A calibrated examiner determined the presence of RCT and AP by applying standardized criteria. The diagnostic accuracy of SRHRCT was calculated separately for RCT and AP. Accuracy, sensitivity, specificity, positive and negative predictive values (+PV and -PV), efficiency, and positive and negative likelihood ratios (+LR and -LR) were estimated. The mean age of the participants was 34.1 ± 10.4 years and 88.2% were males. Overall, SRHRCT demonstrated high sensitivity and specificity for RCT, but not for AP: sensitivity (RCT = 0.960, AP = 0.757) and specificity (RCT = 0.835, AP = 0.631). The estimated values for PV and LR were: +PV (RCT=0.777, AP=0.396), -PV (RCT = 0.972, AP = 0.890), +LR (RCT = 5.853, AP = 2.057), and -LR (RCT = 0.046, AP = 0.383). SRHRCT proved to be a good predictor of the presence of RCT, but a weak predictor of AP in this subpopulation