Intentional Replantation – The novel technique for the management of separated instrument in apical third of tooth: A case report

Intentional replantation is a procedure in which an intentional tooth extraction is performed followed by reinsertion of the extracted tooth into its own alveolus. In this article, intentional replantation is described and discussed as a treatment approach for failed root canal treatment with broken instrument periapically in mandibular second molar.

Numerical analysis of WaveOne Gold and 2Shape endodontic files during root canal treatment

This study aims to develop and analyse a finite element model of the endodontic nickel-titanium (NiTi) instrument during the root canal treatment (RCT). The 3D model of the tooth and the endodontic instrument has been created using computer-aided design software. The nonlinear explicit dynamic analysis in the CAE package (ANSYS) has been used to analyse the mechanical behaviour of endodontic instruments such as total deformation, equivalent elastic strain, and equivalent stress during canal preparation. The mechanical behaviour of three commercially available endodontic NiTi alloy instruments such as WaveOne Gold (WOG), 2Shape 1 (TS1) and 2Shape 2 (TS2) endodontic files was evaluated using FEA. Consequently, the effect of deformation, equivalent stress and equivalent elastic strain on endodontic files during cleaning and shaping are investigated and compared. The results show that the total deformation and equivalent elastic strain are maximum in the TS1 endodontic file in comparison to TS2 and WOG files. Graphical abstract [Formula: see text]

Managing Curvatures in an Atypical Mandibular Third Molar: “Radix Paramolaris”

Third molars are known for morphological variations and atypical anatomy. Although these teeth pose difficulty in root canal treatment due to limited accessibility however, retaining third molars has gained importance in the present scenario due to their crucial role in serving as an abutment or in auto transplantation cases. This case report presents a case of Radix Paramolaris in mandibular third molar with severe curvatures of root canals in different planes and discusses its management with controlled memory files and tactile-controlled activation technique. Keywords: Radix Paramolaris, Curved canals, Controlled memory files, Tactile-controlled activation technique.

Radiographic outcome of root canal treatment in dogs: 281 teeth in 204 dogs (2001–2018)

OBJECTIVE To evaluate the radiographic outcome of root canal treatment (RCT) in dogs and compare outcomes with those reported for a previous study performed at the same institution in 2002. ANIMALS 204 dogs representing 281 teeth that underwent RCT. PROCEDURES The medical record database of a veterinary teaching hospital was searched to identify dogs that underwent RCT between 2001 and 2018. Only dogs that had undergone at least 1 radiographic recheck appointment a minimum of 50 days after RCT were included in the study. Dental radiographs were reviewed. Treatment was considered successful if the periapical periodontal ligament space was within reference limits and preexisting external inflammatory root resorption (EIRR), if present, had stabilized. Treatment was considered to show no evidence of failure (NEF) if preoperative EIRR had stabilized and any preoperative periapical lucency (PAL) remained the same or had decreased in size but had not completely resolved. Treatment was considered to have failed if EIRR or a PAL developed after RCT, if a preoperative PAL increased in size, or if preexisting EIRR progressed. RESULTS Follow-up time ranged from 52 to 3,245 days (mean, 437 days). RCT was classified as successful for 199 (71%) teeth, NEF for 71 (25%) teeth, and failed for 11 (4%) teeth. CONCLUSIONS AND CLINICAL RELEVANCE Results showed that almost 2 decades after RCT outcome in dogs was first evaluated, during which time numerous advances in dental materials and techniques had been made, the success rate of RCT was virtually unchanged.

Reframing Perceptions in Restorative Dentistry: Evidence-Based Dentistry and Clinical Decision-Making

Objectives. The worldwide interest of both dentists and patients in esthetic dentistry has affected decision-making in dental practice. The aim of this study was to investigate contemporary dental practice in restorative dentistry and the relationship between evidence-based dentistry in caries research and decision-making in clinical practice in restorative dentistry. Methods. The study was conducted through a structured questionnaire distributed randomly at the Jordanian Dental Association registered dentists in Jordan. The questionnaire aimed to clarify the degree of knowledge and practice of evidence-based dentistry in caries research the dentists hold regarding clinical decision-making in restorative dentistry. Results. The majority of the surveyed dentists (77%) treat teeth with irreversible pulpitis with root canal treatment rather than vital pulp therapy. 13.8% routinely insert a post and 23% routinely crown the tooth after root canal treatment regardless of the remaining tooth structure. Badly damaged teeth are treated with full crowns in 72% of the cases. Regarding Hollywood smile or smile makeover, the majority of dentists choose conservative approaches, and implants were the first choice to replace missing teeth for 93.8% of the surveyed dentists. Conclusion. A higher degree of implementation of evidence-based dentistry in clinical decision-making was found in Prosthetic Dentistry than in Endodontics. Yet, the gap between evidence-based data and clinical practice needs bridging. More emphasis on communicating these data to educators to integrate them into the dental curriculum is a must.

Tooth- and Patient-Related Conditions May Influence Root Canal Treatment Indication

Aim. To investigate predisposing aspects related to the indication for root canal treatment (RCT) at Dental Schools of Brazil. Methods. Data of 207 patients referred to endodontic treatment at undergraduate Dental Schools of Brazil were collected over a period of 8 months. Patient-related data included age, gender, first dental visit, tooth brushing frequency, number of remaining teeth, and previous endodontic treatment, and tooth-related information regarding number, type, and location in the mouth of teeth that need RCT, waiting time for the endodontic treatment, endodontic diagnosis, pain report, and dental crown condition was collected for each participant. Bivariate analysis (Chi-square test; p < 0.05 ) associated gender and tooth/patient-related conditions. Poisson regression analysis compared multiple endodontic need and exposure variables. Results. Patients were mainly comprised of women (65.2%), aged 18–39 years (69.6%). Previous RCT was significantly more prevalent in women when compared to men p = 0.005 . First dental visit at later moment (after 20 years of age) demonstrated 400% greater prevalence of multiple RCT demand when compared to patients that attended the dental office at age below seven years p = 0.032 . Most of the patients presented only one tooth needing RCT (80.2%), mainly premolars (44.9%). Interestingly, women underwent more RCT in maxillary teeth p = 0.016 and significantly contributed with their report to the diagnosis process when compared to men p = 0.014 . Regarding dental crown condition, 45.4% of all teeth registered unsatisfactory restorations, which were more pronounced in female patients p = 0.018 . Unsatisfactory restorations or dental caries had 75% and 82%, respectively, less prevalence of multiple RCT indication when compared to sound dental crown p = 0.001 . Conclusions. RCT was undertaken more frequently in young female adults’ premolars presenting unsatisfactory restorations. First dental visit, number of teeth with previous endodontic treatment, tooth group, and dental crown condition were significantly associated with the necessity of multiple endodontic treatments.

The analysis of research methods and results on resistance of nickel-titanium endodontic instruments to torsion load: the systematic review

Relevance. The objective of this study was to analyze current data concerning research methods and results on resistance of nickel-titanium endodontic instruments to torsion load in order to minimize complications of dental root canal treatment. The use of the nickel -titanium endodontic instruments is a special importance to ensure high-quality dental root canal treatment; it prevents the further contamination of the canals with microorganisms. However, these instruments can form a fracture under torsional load which leads to further complications.Aim. The analysis of research methods and results on resistance of nickel-titanium endodontic instruments to torsion load for minimization complications.Materials and methods. A series of publications in the electronic databases such as Google Scholar, Pub Med was analyzed in the course of a systematic review of the literature. The articles dealing with nickel-titanium endodontic instruments and torsion load that directly influences the quality of dental root canal treatment were included in the paper.Results. 73 articles were viewed during the review. Having analyzed the literature for inclusion criteria, the total number of publications has become 51. There were 16 main methods which demonstrated the influence of torsion load on endodontic instruments. These methods were summarized in the Table 1.Conclusions. As regards literature data, there are a various number of methods which converge to one conclusion: nickel-titanium instruments cannot fully resist torsion load. Fracture is caused approximately in 0,5-5% of cases.

SURVIVAL RATES OF IMPLANTS COMPROMISING ADJACENT TEETH AND THE ASSOCIATED COMPLICATIONS: AN OPG RETROSPECTIVE STUDY.

Purpose: This retrospective study evaluated the survival rates of implants compromising adjacent teeth and the associated complications. Methodology: Medical records and orthopantomographic images of 1,132 patients and 1,478 implants were retrospectively analyzed. Finally, 96 patients (52 females, 44 males) with 111 malpositioned implants were included in the study. The mean follow-up of the study was 32 ± 14 months. The patients were divided into two core groups: 1) adjacent teeth and dental implants were considerably close but tangent to each other (TAN), and 2) dental implant cutting the roots of the adjacent tooth (CUT). In addition, the CUT group was divided into two subcategories considering the possible cause of malangulation as angled implant (AI) or angled adjacent tooth (AT). Damage to adjacent teeth, future treatment requirements, and the survival rates of the implants were recorded. Results. Among the 111 implants, 4 (3.6%) implants failed, all of which belonged to the CUT category and the AI subgroup. Among the 88 preoperatively vital adjacent teeth, root canal treatment was performed in 18 (20.5%) teeth, whereas 2 (2.3%) teeth were extracted due to malpositioned implanting in follow-ups. Conclusions. The placement of implants too close to the adjacent teeth and even cutting direction did not have a statistically significant effect on the survival rates of implants. However, this could cause adjacent teeth to undergo unnecessary root canal treatment or extraction. Clinical relevance. Patients with malpositioned adjacent teeth or dilacerated root(s) adjacent to the edentulous area are at a higher risk for malpositioned implant complications. Most implant malposition complications are observed in the first premolar region (37% cases). Therefore, more attention should be given while placing implants in the first premolar region.

Impact of Adjunctive Laser Irradiation on the Bacterial Load of Dental Root Canals: A Randomized Controlled Clinical Trial

Successful root canal treatment depends on the adequate elimination of pathogenic bacteria. This study evaluated the effectiveness of a novel 445-nm semiconductor laser in reducing bacteria after chemomechanical root canal treatment. Microbiological specimens from 57 patients were collected after emergency endodontic treatment, in the following sequence: 1, removal of the temporary filling material; 2, chemomechanical treatment; 3, rinsing with sodium hypochlorite (3%) along with one of three adjuvant protocols (n = 19 in each group). The adjuvant procedures were: (a) sodium hypochlorite rinsing alone (3%); (b) laser irradiation; (c) combined sodium hypochlorite rinsing and laser irradiation. The diode laser was set to 0.59 W in continuous-wave mode (CW) for 4 × 10 s. After the flooding of the root canal with saline, specimens were collected using paper points and analyzed microbiologically. Statistically significant reductions in the bacterial load were observed in all three groups (p < 0.05): 80.5% with sodium hypochlorite rinsing alone and 58.2% with laser therapy. Both results were lower than with the combination of sodium hypochlorite rinsing and 445-nm laser irradiation, at 92.7% (p < 0.05). Additional disinfection of the root canal can thus be achieved with 445-nm laser irradiation after conventional chemical disinfection with sodium hypochlorite solution.