Predicting intraoperative pain in emergency endodontic patients: clinical study

Abstract This prospective observational study sought to investigate the incidence of intraoperative pain (IOP) among emergency endodontic patients and to construct an IOP prediction model that includes preoperative pain level (PPL). All patients who underwent emergency endodontic treatment at Gazi University, Ankara, Turkey, during the spring term of 2016 were considered for inclusion in the study. Demographic and clinical variables and PPL were recorded. Local anesthesia was provided to all patients before beginning routine endodontic treatment. IOP was defined as the condition of requiring supplementary anesthesia before the working length was established and exhibiting persistent moderate or severe pain despite supplementary anesthesia. Data from 85% and 15% of 435 patients (178 men, 257 women; mean age: 35 years) were used to develop predictive models by multiple logistic regression analysis and to test external validity of the models, respectively. Two multiple logistic regression models achieved good model fits. Model 1 included age, pulpal diagnosis, and arc (p < 0.05). In addition to these variables, Model 2 included periapical diagnosis and PPL (p < 0.15). Models 1 and 2 showed accuracies of 0.76 and 0.75, sensitivities of 0.74 and 0.77, and specificities of 0.76 and 0.74, respectively for the modeling data (internal validity), and accuracies of 0.82 and 0.80, sensitivities of 0.83 and 0.67, and specificities of 0.81 and 0.81, respectively for the control data (external validity). The IOP incidence was 10.3%. IOP in patients undergoing emergency endodontic treatment can be successfully predicted by using models that account for demographic and clinical variables, including PPL.

Root and canal symmetry in the mandibular anterior teeth of patients attending a dental clinic: CBCT study

The aims of this study were to evaluate the number of roots/root canals in the mandibular anterior teeth of a Turkish population, to assess the relationship between gender or age and the frequency of two canals in a single root, and to determine the symmetry in root/root canal numbers between contralateral sides among patients. Cone-beam computed tomography images (n = 1128; 6253 teeth) taken at the Department of Dentomaxillofacial Radiology of the Faculty of Dentistry of Gazi University were examined by three observers and a supervisor, all of whom were blinded to patient gender and age. Axial, sagittal, and cross-sectional slices with a thickness of 1 mm were used. Numbers of roots and canals for each type of tooth were recorded. Most teeth had a single root and single root canal. Roots with two canals were more frequent in the incisors (14.9%, 17.2%, and 6.1% of the central incisors, lateral incisors, and canines, respectively). Teeth with two roots were more frequent in the canines (3.1%vs. 0% or 0.1%). Females more often had canines with double root canals (p < 0.001). When at least one tooth had two root canals, bilateral symmetry between contralateral teeth was found in 45.0%, 29.0%, and 28.0% of cases for central incisors, lateral incisors, and canines, respectively. Patients older than 56 years had fewer teeth with double root canals (p ≤ 0.001). A small proportion of the mandibular anterior teeth had two roots or root canals. Double root canals were mostly unilateral. Age and gender were associated with the number of root canals.

Evaluation of three instrumentation techniques at the precision of apical stop and apical sealing of obturation

OBJECTIVE: The aim of this study was to investigate the ability of two NiTi rotary apical preparation techniques used with an electronic apex locator-integrated endodontic motor and a manual technique to create an apical stop at a predetermined level (0.5 mm short of the apical foramen) in teeth with disrupted apical constriction, and to evaluate microleakage following obturation in such prepared teeth. MATERIAL AND METHODS: 85 intact human mandibular permanent incisors with single root canal were accessed and the apical constriction was disrupted using a #25 K-file. The teeth were embedded in alginate and instrumented to #40 using rotary Lightspeed or S-Apex techniques or stainless-steel K-files. Distance between the apical foramen and the created apical stop was measured to an accuracy of 0.01 mm. In another set of instrumented teeth, root canals were obturated using gutta-percha and sealer, and leakage was tested at 1 week and 3 months using a fluid filtration device. RESULTS: All techniques performed slightly short of the predetermined level. Closest preparation to the predetermined level was with the manual technique and the farthest was with S-Apex. A significant difference was found between the performances of these two techniques (p<0.05). Lightspeed ranked in between. Leakage was similar for all techniques at either period. However, all groups leaked significantly more at 3 months compared to 1 week (p<0.05). CONCLUSIONS: Despite statistically significant differences found among the techniques, deviations from the predetermined level were small and clinically acceptable for all techniques. Leakage following obturation was comparable in all groups.

Examination of gutta-percha cones for microbial contamination during chemical use

OBJECTIVE: The aim of this study was to evaluate the degree of microbial contamination in packaged gutta-percha cones before and during use in clinical conditions. MATERIAL AND METHODS: Sealed packages of #15-40 gutta-percha cones were opened under aseptic laboratory conditions. Two gutta-percha cones from each size were randomly drawn and added to tubes containing glass beads and 750 µL of saline. The tubes were vortexed, serially diluted and samples of 250 µL were cultured on agar plates. The plates were incubated at 37ºC for 3 days and colonies were counted. The initially sampled packages were distributed to 12 final year dental students. The packages were collected at the end of the first and the third clinical practice days and sampled as described above. RESULTS: Baseline microbial counts did not exceed 3 CFU. At the end of the first and the third day, additional contamination was found in five and three of the packages, respectively. The ratio of contaminated packages at the first day and the third day was not significantly different (z-test; p > 0.05). The numbers of microorganisms cultured at the first day (8 ± 9.9 CFU) and the third day (4.5 ± 8.3 CFU) were not significantly different (Wilcoxon signed-rank test; p > 0.05). No significant correlation was found between the number of filled root canals and cultured microorganisms at either the first day (Spearman's rho; r = 0.481, p = 0.113) or the third day (r = -0.034, p = 0.917). CONCLUSIONS: Gutta-percha cones taken directly from manufacturer's sealed package harbored microorganisms. Clinical use of the packages has been found to be associated with additional contamination of the gutta-percha cones. The counts of cultured microorganisms did not correlate well with the number of filled root canals.