Kishor Gulabivala explores the latest endodontic research and summarises everything you need to know here.
Long term outcomes of full pulpotomy in permanent molars for patients treated in a single, short session under special conditions
Authors: Linas N, Decerle N, Munoz-Sanchez ML, Faulks D, Collado V, Nicolas E, Hennequin M and Cousson PY.
Published: Journal of Endodontics 2020 Aug 13
Reference: doi: 10.1016/j.joen.2020.08.003
Aims
Endodontic procedures for patients requiring treatment in a single, short session need validating.
This study aims at evaluating the long-term outcome of full pulpotomy in permanent molars performed with reinforced zinc oxide-eugenol cement (Intermediate Restorative Material (IRM R). It immediately restored using stainless steel crowns under general anaesthesia (GA).
Methodology
The absence of clinical signs and symptoms and the evolution of the Peri-Apical Index between the treatment date (T0) and the longest follow-up time (T1) were used to grade pulpotomy outcome as ‘effective’, ‘uncertain’ or ‘ineffective’.
Impact of different criteria on pulpotomy outcome was tested (aetiology of lesion, tooth maturity, endodontic difficulty related to coronal shape and root canal shape, and endodontic difficulty related to radiographic root canal appearance).
Results
As a result, 608 teeth (338 patients) were treated in a single session with IRM R full pulpotomy and stainless steel preformed crowns. And 263 (143 patients) were evaluated after a median follow-up period of 24 months.
Overall, 89% of pulpotomies were effective. And 7.6% were of uncertain outcome and 3.4% were ineffective. No tested criteria influenced the rate of effectiveness.
Conclusions
Long-term outcomes of IRM R pulpotomy are similar to those of calcium silicate based-cement pulpotomy observed in the literature.
This procedure should not be restricted to patients treated under GA however, as it is relevant for all special conditions that impose the provision of endodontic treatment in a single, short session, such as dental care emergencies during humanitarian crises or pandemic periods.
Survival rate after endodontic treatment in general dentistry for cracked teeth with different coronal restorations
Authors: Nguyen Thi W and Jansson L.
Published: Acta Odontologica Scandinavica 1-6, 2020 Oct 26
Reference: doi.org/10.1080/00016357.2020.1834615
Aims
The aim of this study was to analyse the survival rate of cracked teeth after endodontic treatment.
The secondary aim was to compare the survival rate of cracked teeth restored with composite filling/crown and those restored with a full crown.
Methodology
The study was conducted retrospectively from three general dental clinics in Stockholm, which are all part of the national dental service organisation.
Two-hundred patients with teeth receiving endodontic treatment due to symptomatic cracks were included. The patient data range from year 2001 to 2016.
Results
The mean age of the patients was 48 years (range 29-69). Fifty-five per cent had cracks located above the pulpal cavity, 11% within the pulpal cavity and 3% located in the root canal.
Cracks were located most commonly on the proximal surfaces. The survival rate for teeth with cracks was 68% and 54% after five and 10 years, respectively.
Survival rate was significantly higher (97%) for cracked teeth receiving a full crown after endodontic treatment compared to teeth restored with either a composite filling or composite crown.
Conclusions
The overall survival rate for cracked teeth was 68% after five years, while it was significantly higher for cracked teeth restored with a full crown.
The results suggest within the limitations of this study that cracked teeth should be restored with a full crown after endodontic treatment.
Root canal treatment of compromised teeth as alternative treatment in patients receiving bisphosphonates: 60-month results of a prospective clinical study
Authors: Zamparini F, Pelliccioni GA, Spinelli A, Gissi DB, Gandolfi MG and Prati C
Published: International Endodontic Journal 2020 Sep 09
Reference: doi:10.1111/iej.13405
Aims
This 60-month prospective study aimed to evaluate tooth survival and healing rates after root canal treatment in patients taking bisphosphonates (BPs).
Secondary outcomes were complications and clinical variables observed during and after the treatment.
Methodology
Root canal treatment was performed using manual K-file canal instrumentation, a carrier-based filling technique and epoxy resin-based sealer.
Teeth without adequate root/crown integrity were restored by trained operators at the tissue level (TL group) to prevent occlusal/mechanical stress and to enable periapical lesion healing without the risk of root fracture. Other teeth were restored with normal occlusal contact (OC group).
Healthy patients who had undergone one or more root canal treatments of the same type constituted the control group.
The relationships of the following variables to survival and health status were examined (chi-squared test and multivariate analysis, p=0.05): age, gender, smoking habit, tooth location, treatment type, BPs treatment, BPs exposure, initial periapical index (PAI) and occlusal restoration.
Survival curves were constructed using Kaplan-Meier analysis, with extraction serving as endpoint.
Results
In total, 65 patients with 109 root canal treated teeth who were taking BPs were included.
At 60 months, data from 57 patients (52F, 5M; median-age 65.7+/-8.6years) who had undergone 96 root canal treatments were analysed (drop-out rate=16.9%). The survival rate was 85% and the success rate was 76%.
The control group consisted of 46 patients (21F, 25M; median-age 60.3+/-7.2years) who had undergone 102 root canal treatments. And the survival rate was 88%, with 12 teeth lost during follow-up. Success rate was 73%. In the BPs group, 55 teeth were restored normally (OC group). 41 teeth were restored at the tissue level (TL group).
No difference in the success or survival rate was observed between the BP and control groups (p>0.05).
Univariate Kaplan-Meier analysis revealed that only tooth type significantly affected survival status in the BP group.
The analysis revealed the clinical relevance of smoking, tooth location and initial PAI on patients’ health status (p<0.05).
Conclusions
Root canal treatments and post-endodontic restoration with tissue level filling procedures represent a safe approach for severely-damaged teeth in patients receiving bisphosphonates having comparable results to occlusal contact and control group.
This article first appeared in Endodontic Practice magazine. You can read the latest issue here.
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