The outcome of endodontic treatment using an enhanced infection protocol in specialist practice.

Objectives This study aims to determine the outcome of primary root canal treatment with specific enhanced infection control protocol. The secondary aim was to compare percentages of successful outcomes in this study with a previous study undertaken by the same operator using both periapical radiograph (PR) and cone beam computed tomography (CBCT).Materials and methods Root canal treatment of 110 teeth in 95 patients carried out by a single operator using an enhanced infection control procedure (disinfection of gutta percha before obturation, changing of gloves after each intraoperative radiograph and also before the start of the root canal obturation). PR and CBCT scans of 94 teeth in 87 patients were assessed 12 months after completion of primary root canal treatment and compared with their respective pre-treatment (diagnostic) PR and CBCT scans. Healing was assessed by a consensus panel consisting of two calibrated examiners. Comparison of the PR and CBCT images for 'healed' and/or 'healing' outcomes was performed using McNemar's test.Results The 'healed' rate (absence of periapical radiolucency) was 89.4% using PR and 78.7% for CBCT (p <0.046). This rate increased to 95.7% for PR and 92.6% for CBCT when the 'healing' group (reduced size of periapical radiolucency) was included (p <0.046).Conclusion The frequent changing of gloves during the course of endodontic treatment and disinfection of gutta percha points before obturation, together with the use of contemporary rotary files, resulted in a high success rate of primary root canal treatment compared to similar clinical studies conducted previously.

Diagnosis and Management of Traumatic Dental Injuries Using Intraoral Radiography and Cone-beam Computed Tomography: An In Vivo Investigation.

INTRODUCTION: The aim of this study was to compare periapical radiographs (PRs) and upper standard occlusal (USO) radiographs with cone-beam computed tomographic (CBCT) imaging on clinicians' confidence in the diagnosis and management of traumatic dental injuries (TDIs). METHODS: This study included 35 maxillary anterior teeth from 25 patients with at least 1 PR (parallax view) and a CBCT scan. Fourteen patients also had a USO radiograph. Ten examiners selected a diagnosis and treatment plan, which were compared with a reference standard. Sensitivity, specificity, positive and negative predictor values, and receiver operating characteristic analysis were used to determine the diagnostic accuracy. RESULTS: CBCT imaging exhibited significantly higher sensitivity than both conventional radiographic techniques combined (PRs and PRs + USO radiographs) for all diagnoses (TDI: 99% vs 84%, lateral luxation: 80% vs 34%, extrusions: 92% vs 42%, and cortical plate fracture: 58% vs 1%) other than horizontal root fractures in which the results were close to statistical significance (88% vs 69%). CBCT imaging was significantly more accurate for all diagnoses (TDI: 91% vs 70%, lateral luxations: 83% vs 61%, extrusive luxations: 92% vs 68%, alveolar cortical plate fractures: 78% vs 48%, and horizontal root fractures: 93% vs 82%). Examiners had the most confidence with CBCT imaging and the least confidence in diagnosing using PRs + USO radiographs than with PRs alone. Agreement with management plans was significantly better using CBCT imaging compared with PRs and PRs + USO radiographs. CONCLUSIONS: CBCT imaging improved the clinical diagnosis of TDIs. The addition of USO radiographs to PRs did not improve the diagnosis of TDIs in this investigation. CBCT imaging improved confidence in the diagnosis of TDI cases and treatment planning compared with conventional radiography.