SIE Congress: Between foundations and innovations the past is improved to look at the future of Endodontics

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Survival study on teeth after successful endodontic surgical retreatment: influence of crown height, root length, crown-to-root ratio and tooth type

Aim: To assess the influence of the crown height, root length, crown-to-root ratio, and tooth type on the survival of teeth subjected to surgical endodontic retreatment and classified as periapically healed. Methodology: A single operator performed endodontic microsurgery interventions between 2008 and 2018 on teeth with refractory apical periodontitis. The present analysis selected the teeth classified as ‘‘complete periapical healing’’ according to the scale suggested by Molven. The postoperative periapical radiographs and those taken at the last recall visit were analysed by two independent calibrated examiners, who measured crown height and root length in a blind manner. The crown-to-root ratio was calculated as the ratio of the two variables. The level of inter- and intra-operator agreement was tested with Bland—Altman plots with 95% limits of agreement. An independent statistician conducted a survival analysis using Kaplan—Meier plots and a log-rank test (a = 0.05) to assess the significance of the differences among the subgroups defined by the following criteria: (a) crown height median; (b) root length median; (c) crown-to-root ratio <1 vs. >1; (d) crown-to-root ratio median; (e) single-rooted teeth vs. multi-rooted teeth. Results: At the end of the analysis, 42 patients were evaluated, each one contributing to the study with a single tooth. The mean follow-up period was 4.2 2.4 years. Survival estimates were significantly improved for the teeth with roots longer than 8 mm, in comparison with that with shorter roots ( p < 0.05). There were no statistically significant differences among the remaining considered subgroups. Conclusions: Under the conditions of this retrospective study, teeth with longer residual roots after apical surgery exhibited better chances of survival when compared to teeth with roots shorter than 8 mm. The other considered variables did not seem to affect the survival of apically resected teeth.

Home management of crown fractures of two central incisors complicated by exposure of the pulp

Aim: As dental trauma is an unpredictable event, the patient is sometimes unable to receive dental care immediately in case of tooth fracture complicated by exposure to the pulp. It is conceivable that a long wait may favor bacterial contamination that can lead to necrosis of the pulp. The aim of this paper is to present a clinical case in which the pulp has been protected domiciliary to reduce post-traumatic hypersensitivity and the risk of pulpal necrosis. Materials and methods: In the presented clinical case, the nail polish was used as an emergency material for the direct capping of the pulp of two fractured incisors. In thisway itwas possible to protect the pulp and seal the dentinal tubules for 5 days, such it is the time between trauma and therapy. Results: application of the nail polish led to a reduction in hypersensitivity; at 2-year follow-up both teeth were still vital. Conclusions: Based on this experience, it is suggested the possibility to recommend the use of nail polish as a protective material for the pulp and for reducing symptoms in case of complicated and uncomplicated fractures, if the dentist is consulted by telephone and the patient is not in condition to reach it quickly.

Ludwig's angina: a case report with a 5-year follow-up

Aim: Ludwig’s angina is a rare aggressive infection, often of dental origin, characterized by a rapid spread of cellulitis in the submandibular and sublingual spaces. Ludwig[42TD$DIF]’s angina is potentially fatal, if it obstructs the airways and if it is not treated with appropriate antibiotic therapy. Summary: The case report describes the diagnosis and the management of a Ludwig[42TD$DIF]’s angina caused by an endodontic infection in a 16 years-old female patient. The infection has been caused by a decay of the second lower right molar. After hospitalization and systemic antibiotic therapy, in accordance with the patient and the parents endodontic and restorative treatments of the tooth were performed. After 3 and 5 years, the radiological examination revealed no periapical lesions around right lower second molar and the presence of lamina dura. Key learning points: This aggressive infection may often be undervalued and this may cause dangerous consequences to the patient[43TD$DIF]’s life. The infection can be prevented by periodic dental care and interventions, which can avoid odontogenic infections. In the case of Ludwig’s angina, early diagnosis is fundamental to save the patient’s life. After the initial antibiotic therapy and once the life of the patient is no longer at risk, an appropriate endodontic therapy can be considered a valid therapy for this disease.

Editorial

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Apical preparation size after repetitive pecking to the working length using different endodontic file systems

Aim: The purpose of this study was to determine and evaluate the apical preparation size resulting from different pecking times to the working length (WL) with five different file systems. Materials and methods: Fifty standard simulated endodontic J-shaped blocks were instrumented using ProTaper NEXT (PTN), WaveOne (WO), WaveOne Gold (WOG), OneShape (OS) and the Self- Adjusting File (SAF) (n = 10) with different pecking times (1, 2 and 4) to the WL. For the SAF group, instrumentation was done till WL according to the time, i.e. 1, 3 and 4 min. On completion of each stage, silicone impression material was used to take canal impressions for comparison and evaluation of the apical size preparation, using a stereomicroscope. Two-way analysis of variance was applied to determine differences between groups and pecking times. Results: After four pecking times, a significant increase was observed in the apical diameter of four test groups compared to SAF (P < 0.05), which was not associated with increased apical preparation at all times. Conclusion: A greater apical enlargement occurs with increasing pecking times; however, SAF instrumentation exhibits the minimum changes in the apical preparation after 1, 3 and 4 min. WO, WOG and OS are able to prepare the apical size similar to their tip at a single peck to the WL.

Canal transportation caused by one single-file and two multiple-file rotary systems: A comparative study using cone-beam computed tomography

Aim: This ex-vivo study aimed to compare canal transportation in mesio-buccal canal of mandibular first molars prepared with Mtwo and Revo-S multi-file and Neoniti single-file nickel[18TD$DIF]—titanium (Ni—Ti) rotary systems using cone-beam computed tomography (CBCT). Methodology: CBCTscans were obtained from 60 extracted mandibular first molars and the teeth were randomly divided into three groups. Mesio-buccal canal of mesial root was prepared with Revo-S, Neoniti or Mtwo rotary systems according to the instructions of the manufacturers. Postoperative CBCT scans were also obtained. A single operator performed canal preparations while another operator blinded to the group allocation of teeth did the measurements. Data were analyzed using SPSS 20. The mean and standard deviation (SD) of the amount of canal transportation were calculated and compared between the groups using the Friedman test ([19TD$DIF]P 0.05). Results: No significant difference was noted in canal transportation among the groups in the middle and apical third ([20TD$DIF]P > 0.05). The rotary single-file instrument caused significantly greater canal transportation in the coronal third. Conclusion: No significant difference exists among different rotary systems in the amount of canal transportation caused in the middle and apical third of the mesio-buccal canal in mandibular first molars. Although all rotary files caused some degrees of canal transportation, the rotary single-file instrument caused significantly greater canal transportation than the multiple-file sequences in the coronal third.

Comparison of shaping ability of ProTaper Next and 2Shape nickel—titanium files in simulated severe curved canals

Aim: To evaluate the centering ability of ProTaper Next (PTN) and 2Shape (TS) nickel—titanium (NiTi) instruments in terms of maintaining the original root canal configuration in a simulated tooth with severe curvature. Methodology: Twenty standardized simulated curved root canals were prepared to an apical size of 0.25 mm using PTN and TS (n = 10 canal/group) nickel-titanium files. A gig was constructed to enable reproducible image acquisition using a photographic camera. Pre- and post-instrumented images were recorded and superimposed using a computer software. The ability of the instruments to remain centered in the canal was determined by calculating a centering ratio at three independent points of the simulated canal: coronal, middle and apical third of the curvature, using a computer software. Statistical analysis was performed using one-way analysis of variance (ANOVA) followed by independent sample t-test at 5% significance level. Results: No significant difference was found between the two systems (p > 0.05). At the apical third, the mean centering ratio was significantly higher than the centering ratio of the coronal and the middle thirds in both TS and PTN (p < 0.05). Conclusions: There were no significant differences in the centering ability of the ProTaper Next and 2Shape systems in simulated severe curved canals. Both systems exhibited some degree of transportation, especially in the apical third.