Root canal retreatment: a retrospective investigation using regression and data mining methods for the prediction of technical quality and periapical healing

Abstract Objectives This study aimed to investigate patterns and risk factors related to the feasibility of achieving technical quality and periapical healing in root canal non-surgical retreatment, using regression and data mining methods. Methodology This retrospective observational study included 321 consecutive patients presenting for root canal retreatment. Patients were treated by graduate students, following standard protocols. Data on medical history, diagnosis, treatment, and follow-up visits variables were collected from physical records and periapical radiographs and transferred to an electronic chart database. Basic statistics were tabulated, and univariate and multivariate analytical methods were used to identify risk factors for technical quality and periapical healing. Decision trees were generated to predict technical quality and periapical healing patterns using the J48 algorithm in the Weka software. Results Technical outcome was satisfactory in 65.20%, and we observed periapical healing in 80.50% of the cases. Several factors were related to technical quality, including severity of root curvature and altered root canal morphology (p<0.05). Follow-up periods had a mean of 4.05 years. Periapical lesion area, tooth type, and apical resorption proved to be significantly associated with retreatment failure (p<0.05). Data mining analysis suggested that apical root resorption might prevent satisfactory technical outcomes even in teeth with straight root canals. Also, large periapical lesions and poor root filling quality in primary endodontic treatment might be related to healing failure. Conclusion Frequent patterns and factors affecting technical outcomes of endodontic retreatment included root canal morphological features and its alterations resulting from primary endodontic treatment. Healing outcomes were mainly associated with the extent of apical periodontitis pathological damages in dental and periapical tissues. To determine treatment predictability, we suggest patterns including clinical and radiographic features of apical periodontitis and technical quality of primary endodontic treatment.

Disinfection and outcome of root canal treatment using single-file or multifile systems and Ca(OH)2 medication

Abstract This clinical study reports on the antibacterial effects and outcome of endodontic treatment using either a single-file or a multifile system, associated with calcium hydroxide interappointment medication. The root canals of single-rooted teeth with apical periodontitis were treated by using either Reciproc or BioRaCe instrument systems, 2.5% NaOCl irrigation, and calcium hydroxide medication. Bacteriological samples taken before preparation and immediately before obturation were evaluated for total bacterial counts by quantitative real-time polymerase chain reaction (qPCR). Patients were followed up and the treatment outcome was assessed by clinical and radiographic criteria. Decreasing lesions were classified as success in a lenient criterion or failure in a rigid one. Bacteria were detected in all initial samples (47 cases) and were significantly reduced after treatment in both groups (p<0.001). In the Reciproc and BioRaCe groups, 7/25 (28%) and 11/22 (50%) root canals yielded negative qPCR results before obturation, respectively (p>0.05). Quantitative bacterial reduction was similar between groups (p>0.05). The success rate in the BioRaCe group was 95.5% and 77% in the loose and rigid criterion, respectively. In the Reciproc group, corresponding figures were 88% and 76%. Differences in outcome were not significant (p>0.05). No diseased case showed negative qPCR results for bacteria. A difference of >1 Log10 counts was observed between healed and diseased cases. Root canal treatments of teeth with apical periodontitis using a single-file or a multifile system for preparation, associated with NaOCl irrigation and calcium hydroxide interappointment medication, showed similar antibacterial effectiveness and success rate.

Resumo Este estudo clínico relata os efeitos antibacterianos e o resultado de tratamentos endodônticos usando um sistema de instrumentação de instrumento único ou de múltiplos instrumentos, associado à medicação intracanal com hidróxido de cálcio. Os canais radiculares de 80 dentes unirradiculares com lesão perirradicular foram tratados com os sistemas Reciproc ou BioRaCe, irrigação com NaOCl a 2,5% e medicação com pasta de hidróxido de cálcio por 7 a 10 dias. Amostras bacteriológicas foram colhidas antes do preparo e imediatamente antes da obturação e examinadas quanto à contagem total de bactérias pela reação em cadeia da polimerase em tempo real quantitativa (qPCR). Os pacientes foram acompanhados e o resultado do tratamento foi avaliado por critérios clínicos e radiográficos (índice periapical). Os casos com lesões que diminuíram mas não desapareceram foram classificados como sucesso em um critério leniente ou fracasso em um critério rígido. Quarenta e sete pacientes estavam disponíveis para avaliação bacteriológica e de resultados. Bactérias foram detectadas em todas as amostras iniciais desses casos e foram significativamente reduzidas após o tratamento nos dois grupos (p<0,001). Nos grupos Reciproc e BioRaCe, os canais radiculares apresentaram resultados negativos na qPCR em 7/25 (28%) e 11/22 (50%) casos antes da obturação, respectivamente (p>0,05). A redução bacteriana foi semelhante entre os grupos (p>0,05). O período médio (mediana) de acompanhamento foi de 20,5 (18,5) meses para BioRaCe e 17,4 (18) meses para Reciproc (p>0,05). No grupo BioRaCe, a taxa de sucesso foi de 95,5% e 77% nos critérios leniente e rígido, respectivamente. No grupo Reciproc, os valores correspondentes foram 88% e 76%. As diferenças no resultado não foram estatisticamente significativas (p>0,05). Nenhum caso de doença pós-tratamento mostrou resultados negativos de qPCR para bactérias. Foi observada uma diferença >1 Log10 nas contagens bacterianas entre os casos curados e doentes. O tratamento do canal radicular de dentes com lesão perirradicular utilizando um sistema de instrumento único ou múltiplos no preparo, associado à irrigação com NaOCl e medicação entre consultas com hidróxido de cálcio, mostrou eficácia antibacteriana e taxa de sucesso semelhantes.

Terapia endodóntica en pacientes adultos mayores ¿qué debemos tener en cuenta? / Endodontic therapy in elderly patients, what should we consider?

De acuerdo con la tendencia mundial, el número de personas de 60 años y más va en aumento. Este crecimiento demográfico de la población, el aumento de las expectativas de vida de las personas y la tendencia a la disminución de pacientes edéntulos, produce una mayor demanda de procedimientos endodónticos en la población anciana. Es fundamental que el odontólogo conozca la fisiología del envejecimiento para poder abordar, en forma eficaz, el tratamiento en los pacientes pertenecientes a este grupo etario. Se ha descripto que los tejidos dentales sufren cambios a lo largo de la vida; entre ellos, la reducción del número de fibroblastos, de odontoblastos, de vasos sanguíneos y de fibras nerviosas; el aumento de fibras colágenas, de masas calcificadas, aposición de cemento, de dentina secundaria y de dentina de reparación. El objetivo del presente trabajo es realizar una revisión bibliográfica en relación a los cambios que presentan la pulpa dental, la dentina y el cemento, relacionados con el proceso de envejecimiento y sus posibles dificultades al momento de realizar el tratamiento endodóntico; sin olvidar cómo pueden inferir en el éxito del tratamiento las posibles patologías sistémicas que presentan los pacientes a consecuencia de la edad (AU)

According to the world trend, the number of people aged 60 and over is increasing. This demographic growth of the population, the increase in people's life expectancies and the tendency to decrease edentulous patients, produces a greater demand for endodontic procedures in the elderly population. It is essential that the dentist knows the physiology of aging to be able to effectively address the treatment in patients belonging to this age group. It has been described that dental tissues suffer changes throughout life, including the reduction of the number of fibroblasts, odontoblasts, blood vessels and nerve fibers; the increase of collagen fibers, calcified masses, apposition of cement, secondary dentin and repair dentin. The objective of the present work is to carry out a bibliographic review in relation to the changes that the dental pulp, dentine and cement have in relation to the aging process and its possible consequences in the endodontic treatment; without forgetting how it can infer in the success of the treatment the possible systemic pathologies that patients present as a result of age (AU)