Influence of increased patient age on longitudinal outcomes of root canal treatment: a systematic review.

OBJECTIVES: To conduct a systematic review of longitudinal endodontic outcomes in elders. BACKGROUND: Negative opinions about the prognosis of non-surgical root canal treatment (NSRCT) in elders affect decisions made by patients and dentists. Patient, caregiver and dentist attitudes and behaviours may interact to decrease the provision of NSRCT. Critical examination of the available evidence through systematic review could provide objective data to assist patients, caregivers, healthcare providers and third-party payers in making decisions about the efficacy of NSRCT in elders and provide a robust foundation for the health promotion of NSRCT in elders. METHODS: Inclusion/exclusion criteria were used for defined searches in MEDLINE and Cochrane CENTRAL. Title lists were scanned, and abstracts read to determine utility; articles meeting inclusion/exclusion criteria were analysed. Data were extracted and compiled into a table of evidence. RESULTS: Defined searching produced 3605 titles; 24 articles were included, nine prospective and 15 retrospective. Overall study quality was good. Patient samples mostly represented modern populations from countries with very high human development indices. Over 17 430 teeth were included. Meta-analysis was not attempted due to heterogeneity in reporting. All 24 included papers demonstrated that increased patient age did not decrease the success or survival rates of NSRCT. CONCLUSIONS: This systematic review of longitudinal NSRCT outcomes demonstrated that increased patient age did not decrease the success of NSRCT. Patient age is not a prognostic factor for NSRCT. Age should not be considered by dentists or patients when making NSRCT decisions.

Anxiety Related to Nonsurgical Root Canal Treatment: A Systematic Review.

INTRODUCTION: Anxiety is an emotion characterized by feelings of tension, worried thoughts, and physical changes. Dental anxiety has been associated with pain, fear, care avoidance, and more invasive treatments including nonsurgical root canal treatment (NSRCT). The very words root canal are deeply embedded in societal consciousness. Better understanding of dental anxiety may prevent treatment avoidance. The purpose of this study was to conduct a systematic review of NSRCT-associated anxiety. METHODS: Inclusion/exclusion criteria defined MEDLINE, Cochrane Library, psychINFO, manual, and citation searches. Title lists and abstracts were read to determine utility; data were extracted, summarized, and compiled into an evidence table, and meta-analyses were performed. RESULTS: Defined searching produced 835 titles; 36 articles were included, mostly representing modern populations from countries with very high human development indices. Major sources of heterogeneity included differing study aims, outcome measures, clinical settings, locations, operators, sample selection, and sample size. Meta-analysis of 18 articles including 1989 subjects gave a pretreatment anxiety rating of 39 (standard deviation, 9) on a normalized 100-point scale. Meta-analysis of 4 articles including 232 subjects gave a post-treatment anxiety rating of 27 (standard deviation, 5) on a normalized 100-point scale, representing a 30% reduction. A L'Abbe plot of 5 studies also showed that anxiety decreased after NSRCT. Limited data indicated that gender, age, and prior NSRCT experience influenced NSRCT-associated anxiety. NSRCT-associated anxiety was ranked high among dental treatments, often close to oral surgery. CONCLUSIONS: NSRCT-associated anxiety was generally moderate. Anxiety decreased after NSRCT. Limited evidence suggested that anxiety is influenced by patient and treatment factors.

Prevalence of root canal treatment and periapical radiolucency in elders: a systematic review.

INTRODUCTION: Neither the prevalence of periapical radiolucency (PARL), a surrogate for disease, nor the prevalence of non-surgical root canal treatment (NSRCT) in elders have been subjected to systematic review. The purpose of this study was to conduct systematic review and meta-analysis of the prevalence of PARL and NSRCT in elders. METHODS: Inclusion/exclusion criteria were used for defined searches in MEDLINE and Cochrane CENTRAL. Title lists were scanned and abstracts read to determine utility; articles meeting the criteria were analyzed. Weighted mean percentages were calculated for prevalence of PARL, NSRCT, and PARL in both teeth with and without NSRCT. RESULTS: Defined searching produced 3576 titles; 29 prevalence articles were included. Patient samples mostly represented modern populations from countries with very high human development indices. Meta-analyses were performed on up to 74 000 elders' teeth. For those aged 65+, the prevalence of all teeth with NSRCT was extremely high, 21%; the prevalence of all teeth with PARL was quite high, 7%; the prevalence of PARL in NSRCT teeth was high, 25%; and the prevalence of PARL in untreated teeth was surprisingly high, 4%. In elders, the prevalence of NSRCT and PARL separately increased with age; whereas, PARL in NSRCT teeth decreased with age. CONCLUSIONS: In comparison to general adult populations, elders had: a much higher prevalence of NSRCT, a higher prevalence of PARL, a lower prevalence of PARL in NSRCT teeth, and a higher prevalence of PARL in untreated teeth. Teeth saved through NSRCT were preferentially retained by elders.

Anesthetic efficacy of meperidine in teeth with symptomatic irreversible pulpitis.

Achieving adequate pulpal anesthesia in mandibular teeth is always a challenge. Supplementary injections and using drugs in combination are some methods implemented to overcome this hurdle. In this randomized clinical trial, use of meperidine in conjunction with lidocaine in intraligamentary injection did not exhibit significant improvement in anesthesia.

Accuracy of an open-tray implant impression technique with 3 splinting materials: an in vitro study.

This study compared the accuracy of impressions using 3 types of splinting materials: a pattern acrylic resin (Group 1), an acrylic resin (Group 2), and a dual-cured composite resin (Group 3). A total of 60 impressions (n = 20) were made. Implant positions were compared against the master model using a coordinate measuring machine with ANOVA comparison (P = 0.05). The minimum and maximum differences in the x axis were found in Groups 2 and 3, respectively. For the y axis, Groups 2 and 1 showed the minimum and maximum differences, respectively. The minimum and maximum differences in the z axis were found in Groups 3 and 1, respectively. All differences in the axes were statistically significant (P < 0.05). These findings indicated that the composite resin demonstrated better accuracy than the other tested splinting materials.

Patient-centered endodontic outcomes: a narrative review.

INTRODUCTION: Root canal treatment (RCT) success criteria inform us of the path to bony healing and of prognostic factors, but tell little about how the patient perceives, feels, or values RCT. Patients choose, undergo, and pay for RCT, they live with the result, and inform their community. The purpose of this narrative review was to appraise patient-centered outcomes of initial non-surgical RCT and nonsurgical retreatment, in adults. MATERIALS AND METHODS: Patient-centered RCT outcome themes were identified in the extant literature: quality of life, satisfaction, anxiety, fear, pain, tooth survival and cost. Narrative review was applied because the disparate themes and data were unsuited to systematic review or meta-analysis. RESULTS: Application of the Oral Health Impact Profile (OHIP) demonstrated that disease of pulpal origin affects quality of life with moderate severity, primarily through physical pain and psychological discomfort, and that RCT results in broad improvement of quality of life. Satisfaction with RCT is extremely high, but cost is the primary reason for dissatisfaction. Anxiety and fear affect RCT patients, profoundly influencing their behaviors, including treatment avoidance, and their pain experience. Fear of pain is "fair" to "very much" prior to RCT. Pain is widely feared, disliked, and remembered; however, disease of pulpal origin generally produces moderate, but not severe pain. RCT causes a dramatic decrease in pain prevalence and severity over the week following treatment. Survival rates of teeth after RCT are very high; complication rates are low. Cost is a barrier to RCT, but initial costs, lifetime costs, cost effectiveness, cost utility, and cost benefit all compare extremely well to the alternatives involving replacement using implants or fixed prostheses. CONCLUSION: Dentists must strive to reduce anxiety, fear, experienced and remembered pain, and to accurately inform and educate their patients with respect to technical, practical and psychosocial aspects of RCT.