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Research Articles
Prevalence of apical periodontitis and quality of root canal treatment in an adult Kuwaiti sub-population: a cross-sectional study
Abdulrahman A. Alhailaa, Saad A Al-Nazhan, Mazen A Aldosimani
Restor Dent Endod 2024;49(2):e16.   Published online March 22, 2024
DOI: https://doi.org/10.5395/rde.2024.49.e16
AbstractAbstract PDFPubReaderePub
Objectives

This cross-sectional study evaluated the prevalence of apical periodontitis (AP) and the technical quality of root canal fillings in an adult Kuwaiti subpopulation using cone-beam computed tomography (CBCT) images.

Materials and Methods

Two experienced examiners analyzed 250 CBCT images obtained from Kuwaiti patients aged 15–65 years who attended government dental specialist clinics between January 2019 and September 2020. The assessment followed the radiographic scoring criteria proposed by De Moor for periapical status and the technical quality of root canal filling. Chi-square and Fisher’s exact tests were used for statistical analysis, with significance level set at p < 0.05.

Results

Among the 2,762 examined teeth, 191 (6.91%) exhibited radiographic signs of AP, and 176 (6.37%) had undergone root canal filling. AP prevalence in root canal-treated teeth was 32.38%, with a significant difference between males and females. Most of the endodontically treated teeth exhibited adequate root canal filling (71.5%).

Conclusions

The study demonstrated a comparable prevalence of AP and satisfactory execution of root canal treatment compared to similar studies in different countries.

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The status of clinical trials regarding root canal sealers
Ahmad AL Malak, Yasmina EL Masri, Mira Al Ziab, Nancy Zrara, Tarek Baroud, Pascale Salameh
Restor Dent Endod 2024;49(1):e5.   Published online January 15, 2024
DOI: https://doi.org/10.5395/rde.2024.49.e5
AbstractAbstract PDFPubReaderePub
Objectives

This study aimed to present the results and analyses of clinical trials, including updates on the different functions of root canal sealers.

Materials and Methods

In June 2023, we performed a comprehensive search of ClinicalTrials.gov to identify interventional clinical trials pertaining to root canal sealers. In total, 23 clinical trials conducted up to June 2023 were included in this study.

Results

Approximately half of the trials (11 out of 23) were completed, while none were terminated or withdrawn. Each included trial had a minimum of 10 participants, with 11 trials having more than 100 participants. None of the assessed trials provided outcomes, and the majority (17 out of 23) lacked associated publications. In terms of geographic distribution, the USA and Canada did not contribute to any root canal sealer trials.

Conclusions

This study highlights the lack of diversity in trial locations, the absence of reported results, and a scarcity of clinical trials examining the physicochemical properties of different sealers. Most published trials primarily focused on assessing the post-operative pain effect of these sealers, but no significant difference was found regarding post-operative pain control.

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Association between cigarette smoking and the prevalence of post-endodontic periapical pathology: a systematic review and meta-analysis
Néstor Ríos-Osorio, Hernan Darío Muñoz-Alvear, Fabio Andrés Jiménez-Castellanos, Sara Quijano-Guauque, Oscar Jiménez-Peña, Herney Andrés García-Perdomo, Javier Caviedes-Bucheli
Restor Dent Endod 2022;47(3):e27.   Published online June 13, 2022
DOI: https://doi.org/10.5395/rde.2022.47.e27
AbstractAbstract PDFPubReaderePub
Objectives

This systematic review and meta-analysis aimed to assess the association of cigarette smoking with the prevalence of post-endodontic apical periodontitis in humans.

Materials and Methods

We searched through PubMed/Medline, Web of Science, and Scopus from inception to December 2020. Risk of bias was performed by using the Newcastle-Ottawa Scale for cross-sectional, cohort, and case-control studies. We performed the statistical analysis in Review Manager 5.3 (RevMan 5.3).

Results

6 studies met the inclusion criteria for qualitative and quantitative synthesis. Statistical analysis of these studies suggests that there were no differences in the prevalence of post endodontic apical periodontitis (AP) when comparing non-smokers vs smoker subjects regarding patients (odds ratio [OR], 0.68; 95% confidence interval [CI], 0.31–1.49; I2 = 58%) and teeth (OR, 1.71; 95% CI, 0.99–2.93; I2 = 72%).

Conclusions

Our findings suggest that there was no association between cigarette smoking and post-endodontic apical periodontitis, as we did not find statistical differences in the prevalence of post-endodontic AP when comparing non-smokers vs smoker subjects. Therefore, smoking should not be considered a risk factor associated with endodontic failure.

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Case Report
The fate of overfilling in root canal treatments with long-term follow-up: a case series
Vito Antonio Malagnino, Alfio Pappalardo, Gianluca Plotino, Teocrito Carlesi
Restor Dent Endod 2021;46(2):e27.   Published online April 29, 2021
DOI: https://doi.org/10.5395/rde.2021.46.e27
AbstractAbstract PDFPubReaderePub

This study describes 6 cases of endodontic overfilling with successful clinical outcomes during long-term (up to 35 years) radiographic follow-up. Successful endodontic treatment depends on proper shaping, disinfection, and obturation of root canals. Filling materials should completely fill the root canal space without exceeding the anatomical apex. Overfilling may occur when the filling material extrudes into the periapical tissues beyond the apex. The present case series describes 6 root canal treatments in which overfilling of root canal sealer and gutta-percha accidentally occurred. Patients’ teeth were periodically checked with periapical radiographs in order to evaluate the outcomes during long-term follow-up. All cases showed healing and progressive resorption of the extruded materials in the periapex. The present cases showed that if a 3-dimensional seal was present at the apical level, overfilling did not negatively affect the long-term outcomes of root canal treatment.

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  • 7 Web of Science
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Review Article
Clinical efficacy of activated irrigation in endodontics: a focused review
Amelia Wan Tin Cheung, Angeline Hui Cheng Lee, Gary Shun Pan Cheung
Restor Dent Endod 2021;46(1):e10.   Published online January 26, 2021
DOI: https://doi.org/10.5395/rde.2021.46.e10
AbstractAbstract PDFPubReaderePub

Root canal debridement, which includes the removal of infected tissues and microbial biofilms, is considered the corner stone of root canal treatment. Chemical adjuncts play a multitude of functions in this regard, as tissue solvents, antimicrobial agents and for removing the smear layer. These adjuncts (irrigants) are usually delivered using a syringe and needle. With increasing knowledge of the complexity of root canal anatomy and tenacity of microbial biofilms, the need for strategies that potentiate the action of these irrigants within the root canal system cannot be overemphasized. Several such activated irrigation strategies exist. The aim of this review is to comprehensively discuss the different irrigant activation methods from the context of clinical studies.

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  • 14 Web of Science
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Research Article
Effects of endodontic treatment on salivary levels of CGRP and substance P: a pilot study
Hakan Arslan, Ezgi Doğanay Yıldız, Serhat Köseoğlu
Restor Dent Endod 2020;45(3):e40.   Published online July 14, 2020
DOI: https://doi.org/10.5395/rde.2020.45.e40
AbstractAbstract PDFPubReaderePub
Objectives

The aim of this study was to evaluate the effects of endodontic treatment on levels of substance P (SP) and calcitonin gene-related peptide (CGRP) in the saliva of patients with symptomatic apical periodontitis.

Materials and Methods

Twelve patients with mandibular molars with symptomatic apical periodontitis were enrolled in this study. An initial saliva sample was collected just before administration of anesthesia for root canal treatment, which was performed at the first visit. A second saliva sample was collected at a control visit 1 week after treatment. Salivary SP and CGRP levels were evaluated quantitatively using biochemical assays. The data were analyzed using Pearson correlation analysis, the paired samples t-test, and the Mann-Whitney U test (p = 0.05).

Results

The postoperative salivary level of SP was significantly lower than the preoperative level (p = 0.005). However, the postoperative salivary level of CGRP was similar to the preoperative level (p = 0.932). Visual analog scale (VAS) scores of patients' subjective pain were found to be positively correlated with salivary levels of SP (r = 0.421; p = 0.040). No statistically significant correlations were observed between salivary levels of CGRP and VAS scores for patients' subjective percussion tenderness (p = 0.533) or VAS scores for patients' subjective pain (p = 0.459).

Conclusions

According to the results of the present study, salivary SP levels may be used as an objective indicator in the diagnosis and assessment of the degree of pain in endodontic diseases.

Trial Registration

Thai Clinical Trials Registry Identifier: TCTR20161228001

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Case Report
Endodontic approach in a replanted tooth with an immature root apex and chronic apical periodontitis: a case report
Graziela Garrido Mori, Bruna Souza Andrade, Marina Bardelli Araujo
Restor Dent Endod 2020;45(3):e29.   Published online May 21, 2020
DOI: https://doi.org/10.5395/rde.2020.45.e29
AbstractAbstract PDFPubReaderePub

This study describes the clinical steps taken in the treatment of a patient who had an avulsed right upper central incisor that presented with incomplete root development and chronic apical periodontitis. A 7-year-old boy was referred from a private dentist to a dental office specializing in endodontics. The tooth had remained in a dry environment for 20 minutes, and tooth replantation was performed at an emergency appointment. After clinical and radiographic examinations, root canal decontamination was performed, followed by several changes in intracanal calcium hydroxide medication. Blood clot formation was attempted, but bleeding within the root canal was insufficient; therefore, we opted for an intracanal medication change to stimulate mineralized tissue formation in the apical region. Root obturation was performed 45 days after the last change of intracanal medication, and clinical, radiographic, and tomographic follow-up examinations were performed at 3, 6, 18, and 40 months after the endodontic intervention. The increase in thickness and length of the root structure and the absence of root resorption were verified through follow-up examinations. Therefore, it was concluded that the procedures used were successful for tooth replantation.

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Research Articles
Effect of QMix irrigant in removal of smear layer in root canal system: a systematic review of in vitro studies
Margaret Soo Yee Chia, Abhishek Parolia, Benjamin Syek Hur Lim, Jayakumar Jayaraman, Isabel Cristina Celerino de Moraes Porto
Restor Dent Endod 2020;45(3):e28.   Published online May 21, 2020
DOI: https://doi.org/10.5395/rde.2020.45.e28
AbstractAbstract PDFPubReaderePub
Objectives

To evaluate the outcome of in vitro studies comparing the effectiveness of QMix irrigant in removing the smear layer in the root canal system compared with other irrigants.

Materials and Methods

The research question was developed by using Population, Intervention, Comparison, Outcome and Study design framework. Literature search was performed using 3 electronic databases PubMed, Scopus, and EBSCOhost until October 2019. Two reviewers were independently involved in the selection of the articles and data extraction process. Risk of bias of the studies was independently appraised using revised Cochrane Risk of Bias tool (RoB 2.0) based on 5 domains.

Results

Thirteen studies fulfilled the selection criteria. The overall risk of bias was moderate. QMix was found to have better smear layer removal ability than mixture of tetracycline isonomer, an acid and a detergent (MTAD), sodium hypochlorite (NaOCl), and phytic acid. The efficacy was less effective than 7% maleic acid and 10% citric acid. No conclusive results could be drawn between QMix and 17% ethylenediaminetetraacetic acid due to conflicting results. QMix was more effective when used for 3 minutes than 1 minute.

Conclusions

QMix has better smear layer removal ability compared to MTAD, NaOCl, Tubulicid Plus, and Phytic acid. In order to remove the smear layer more effectively with QMix, it is recommended to use it for a longer duration.

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Antimicrobial efficacy of QMix on Enterococcus faecalis infected root canals: a systematic review of in vitro studies
Benjamin Syek Hur Lim, Abhishek Parolia, Margaret Soo Yee Chia, Jayakumar Jayaraman, Venkateshbabu Nagendrababu
Restor Dent Endod 2020;45(2):e23.   Published online March 11, 2020
DOI: https://doi.org/10.5395/rde.2020.45.e23
AbstractAbstract PDFPubReaderePub
Objectives

This study aimed to summarize the outcome of in vitro studies comparing the antibacterial effectiveness of QMix with other irrigants against Enterococcus faecalis.

Materials and Methods

The research question was developed by using population, intervention, comparison, outcome, and study design framework. The literature search was performed using 3 electronic databases: PubMed, Scopus, and EBSCOhost until October 2019. The additional hand search was performed from the reference list of the eligible studies. The risk of bias of the studies was independently appraised using the revised Cochrane Risk of Bias tool (RoB 2.0).

Results

Fourteen studies were included in this systematic review. The overall risk of bias for the selected studies was moderate. QMix was found to have a higher antimicrobial activity compared to 2% sodium hypochlorite (NaOCl), 17% ethylenediaminetetraacetic acid (EDTA), 2% chlorhexidine (CHX), mixture of tetracycline isonomer, an acid and a detergent (MTAD), 0.2% Cetrimide, SilverSol/H2O2, HYBENX, and grape seed extract (GSE). QMix had higher antibacterial efficacy compared to NaOCl, only when used for a longer time (10 minutes) and with higher volume (above 3 mL).

Conclusions

QMix has higher antibacterial activity than 17% EDTA, 2% CHX, MTAD, 0.2% Cetrimide, SilverSol/H2O2, HYBENX, GSE and NaOCl with lower concentration. To improve the effectiveness, QMix is to use for a longer time and at a higher volume.

Trial Registration

PROSPERO International prospective register of systematic reviews Identifier: CRD42018096763

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Review Article
Age-dependent root canal instrumentation techniques: a comprehensive narrative review
Michael Solomonov, Hyeon-Cheol Kim, Avi Hadad, Dan Henry Levy, Joe Ben Itzhak, Oleg Levinson, Hadas Azizi
Restor Dent Endod 2020;45(2):e21.   Published online March 4, 2020
DOI: https://doi.org/10.5395/rde.2020.45.e21
AbstractAbstract PDFPubReaderePub

The aim of this article was to review age-dependent clinical recommendations for appropriate root canal instrumentation techniques. A comprehensive narrative review of canal morphology, the structural characteristics of dentin, and endodontic outcomes at different ages was undertaken instead of a systematic review. An electronic literature search was carried out, including the Medline (Ovid), PubMed, and Web of Science databases. The searches used controlled vocabulary and free-text terms, as follows: ‘age-related root canal treatment,’ ‘age-related instrumentation,’ ‘age-related chemo-mechanical preparation,’ ‘age-related endodontic clinical recommendations,’ ‘root canal instrumentation at different ages,’ ‘geriatric root canal treatment,’ and ‘pediatric root canal treatment.’ Due to the lack of literature with practical age-based clinical recommendations for an appropriate root canal instrumentation technique, a narrative review was conducted to suggest a clinical algorithm for choosing the most appropriate instrumentation technique during root canal treatment. Based on the evidence found through the narrative review, an age-related clinical algorithm for choosing appropriate instrumentation during root canal treatment was proposed. Age affects the morphology of the root canal system and the structural characteristics of dentin. The clinician’s awareness of root canal morphology and dentin characteristics can influence the choice of instruments for root canal treatment.

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Case Report
A case report of multiple bilateral dens invaginatus in maxillary anteriors
Shin Hye Chung, You-Jeong Hwang, Sung-Yeop You, Young-Hye Hwang, Soram Oh
Restor Dent Endod 2019;44(4):e39.   Published online October 21, 2019
DOI: https://doi.org/10.5395/rde.2019.44.e39
AbstractAbstract PDFPubReaderePub

The present report presents a case of dens invaginatus (DI) in a patient with 4 maxillary incisors. A 24-year-old female complained of swelling of the maxillary left anterior region and discoloration of the maxillary left anterior tooth. The maxillary left lateral incisor (tooth #22) showed pulp necrosis and a chronic apical abscess, and a periapical X-ray demonstrated DI on bilateral maxillary central and lateral incisors. All teeth responded to a vitality test, except tooth #22. The anatomic form of tooth #22 was similar to that of tooth #12, and both teeth had lingual pits. In addition, panoramic and periapical X-rays demonstrated root canal calcification, such as pulp stones, in the maxillary canines, first and second premolars, and the mandibular incisors, canines, and first premolars bilaterally. The patient underwent root canal treatment of tooth #22 and non-vital tooth bleaching. After a temporary filling material was removed, the invaginated mass was removed using ultrasonic tips under an operating microscope. The working length was established, and the root canal was enlarged up to #50 apical size and obturated with gutta-percha and AH 26 sealer using the continuous wave of condensation technique. Finally, non-vital bleaching was performed, and the access cavity was filled with composite resin.

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Research Articles
Comparison of postoperative pain intensity after using reciprocating and continuous rotary glide path systems: a randomized clinical trial
Mehmet Adıgüzel, Koray Yılmaz, Pelin Tüfenkçi
Restor Dent Endod 2019;44(1):e9.   Published online February 12, 2019
DOI: https://doi.org/10.5395/rde.2019.44.e9
AbstractAbstract PDFPubReaderePub
Objectives

The aim of this study was to compare postoperative pain intensity after root canal treatment with One G (OG) vs. R-Pilot (RP) files used for glide path preparation.

Materials and Methods

Ninety-three single-canaled mandibular premolar teeth with asymptomatic non-vital pulp were randomly assigned into 3 groups (n = 31): OG, RP, or without glide path (WGP). After creating the glide path, the root canals were prepared using sequential Mtwo rotary files to size 30/0.05. One endodontic specialist carried out single-visit endodontic treatment. The patients were asked to rate the severity of postoperative pain on a visual analogue scale at 24, 48, and 72 hours after the visit. They were also asked to record their intake of prescribed analgesics taken. The data were analyzed using the χ2, Friedman, Kruskal-Wallis, and Mann-Whitney U tests.

Results

In all 3 groups, postoperative pain decreased significantly at each time interval (p < 0.05). At 24 hours, the OG group had less postoperative pain than the WGP group (p < 0.05). However, no significant difference was found between the RP group and the others. No statistically significant difference was found among the WGP, OG, and RP groups in postoperative pain intensity at 48 or 72 hours or in analgesic tablet intake at the 3 assessed time intervals.

Conclusions

The OG group had less postoperative pain than the WGP group in the first 24 hours. The OG and RP systems were similar regarding postoperative pain intensity and analgesic intake.

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The top 10 most-cited articles on the management of fractured instruments: a bibliometric analysis
Lora Mishra, Hyeon-Cheol Kim, Naomi Ranjan Singh, Priti Pragati Rath
Restor Dent Endod 2019;44(1):e2.   Published online December 26, 2018
DOI: https://doi.org/10.5395/rde.2019.44.e2
AbstractAbstract PDFPubReaderePub
Objectives

The purpose of this research was to identify the top 10 most-cited articles on the management of fractured or broken instruments and to perform a bibliometric analysis thereof.

Materials and Methods

Published articles related to fractured instruments were screened from online databases, such as Web of Science, Scopus, PubMed, and ScienceDirect, and highly cited papers, with at least 50 citations since publication, were identified. The most-cited articles were selected and analysed with regard to publication title, authorship, the journal of publication, year, institution, country of origin, article type, and number of citations.

Results

The top 10 most-cited articles were from various journals. Most were published in the Journal of Endodontics, followed by the International Endodontic Journal, and Dental Traumatology. The leading countries were Australia, Israel, Switzerland, the USA, and Germany, and the leading institution was the University of Melbourne. The majority of articles among the top 10 articles were clinical research studies (n = 8), followed by a basic research article and a non-systematic review article.

Conclusions

This bibliometric analysis revealed interesting information about scientific progress in endodontics regarding fractured instruments. Overall, clinical research studies and basic research articles published in high-impact endodontic journals had the highest citation rates.

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Case Reports
Radix mesiolingualis and radix distolingualis: a case report of a tooth with an unusual morphology
Gurudutt Nayak, Himanshu Aeran, Inderpreet Singh
Restor Dent Endod 2016;41(4):322-331.   Published online July 14, 2016
DOI: https://doi.org/10.5395/rde.2016.41.4.322
AbstractAbstract PDFPubReaderePub

Variation in the root and canal morphology of the maxillary first molars is quite common. The most common configuration is 3 roots and 3 or 4 canals. Nonetheless, other possibilities still exist. The presence of an additional palatal root is rather uncommon and has been reported to have an incidence of 0.06 - 1.6% in varying populations studied. Whenever two palatal roots exist, one of them is the normal palatal root, the other is a supernumerary structure which can be located either mesiolingually (radix mesiolingualis) or distolingually (radix distolingualis). This case report describes successful endodontic treatment of a maxillary first molar with radix mesiolingualis and radix distolingualis. Identification of this variation was done through clinical examination along with the aid of multiangled radiographs, and an accurate assessment of this morphology was made with the help of a cone-beam computed tomography imaging. In addition to the literature review, this article also discusses the epidemiology, classifications, morphometric features, guidelines for diagnosis, and endodontic management of a maxillary first molar with extra-palatal root.

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Misdiagnosis of florid cemento-osseous dysplasia leading to unnecessary root canal treatment: a case report
Jong-Ki Huh, Su-Jung Shin
Restor Dent Endod 2013;38(3):160-166.   Published online August 23, 2013
DOI: https://doi.org/10.5395/rde.2013.38.3.160
AbstractAbstract PDFPubReaderePub

This case report demonstrates an unnecessary endodontic treatment of teeth with florid cemento-osseous dysplasia (FCOD) due to a misdiagnosis as periapical pathosis and emphasizes the importance of correct diagnosis to avoid unnecessary treatment. A 30-year-old woman was referred to our institution for apicoectomies of the mandibular left canine and both the lateral incisors. The periapical lesions associated with these teeth had failed to resolve after root canal treatment over a 3-year period. Radiographic examinations revealed multiple lesions on the right canine, the second premolar, and both first molars as well as the anterior region of the mandible. Based on clinical, radiographic and histological evaluations, the patient condition was diagnosed as FCOD. The patient has been monitored for 2 years. To avoid unnecessary invasive treatment, accurate diagnosis is essential before treatment is carried out in managing FCOD.

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Original Article
The effect of calcium hydroxide on post-treatment pain
Wook Nam, Sang-Hyuk Park, Gi-Woon Choi
J Korean Acad Conserv Dent 2006;31(2):86-95.   Published online March 31, 2006
DOI: https://doi.org/10.5395/JKACD.2006.31.2.086
AbstractAbstract PDFPubReaderePub

The purpose of this clinical study is to assess whether calcium hydroxide as an intracanal medication affects post-treatment pain in teeth especially odontogenic pain which comes from inflammation of the pulp and periradicular tissues when compared with no intracanal medication.

From 213 patients who has been treated 237 root canals due to significant pain (moderate-to-severe), we recorded their age, sex, treated tooth, degree of pain, pre-operative states of the tooth. We classified patients into 2 test group; Group 1 (not gain intracanal Ca(OH)2), Group 2 (gain intracanal Ca(OH)2). Through the survey from the patients, we let them write down the occurrence and degree of post-treatment pain in 4hours, 2days, 7days after treatment as none, mild, moderate or severe. The followings were evaluated; the overall incidence of flare-ups, the overall incidence of post-treatment pain in each group at each time period, the incidence of post-treatment pain in each group at each time period as related to pre-operative states of the teeth. These were compared statistically with Chi-square analysis (p < 0.05).

Under the condition of this investigation, no difference was observed in the incidence of post-treatment pain between the two groups. Therefore, Ca(OH)2 as intracanal medication had no effect on preventing or decreasing the post-treatment pain.

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