Incidence of Endodontic Failure Cases in the Department of Conservative Dentistry and Endodontics, DY Patil School of Dentistry, Navi Mumbai.

INTRODUCTION:  Endodontic and restorative treatment goal is to restore occlusion and normal function of a tooth and provide stability to the dental arch. Root canal bacterial infection and apical periodontitis profoundly impact the management and outcome of endodontic treatments. The crucial goal of nonsurgical root canal therapy (NSRCT) is the mechanical removal of infected tissues and the chemical killing of bacteria. The present study assessed the outcomes and factors associated with the failure of primary endodontic treatment. METHODS:  A total of 250 teeth from 219 patients (104 male and 146 female) were examined in the Conservative Dentistry and Endodontics department, who reported symptomatic root canal-treated teeth. Data through clinical examination and radiographic examination was recorded on a proforma designed for the study of each patient regarding endodontic failure. RESULTS:  According to the type of tooth maximum number of teeth that were reported with failure are the molars (67.6%), followed by premolar (14.0%), incisor (12.8%), and lastly, canines (5.6%). Based on the location of affected teeth, the maximum teeth that presented with failed root canal treatment were from mandibular posteriors (51.2%), followed by maxillary posteriors (31.60%), maxillary anterior (13.2%), mandibular anterior (4.0%). CONCLUSION:  Endodontic failures were mostly found in underfilled root canals and poorly sealed post-endodontic coronal restoration and strong association with peri-apical radiolucency.

Management of Endodontic Flare-Up in the Presence of Periapical Radiolucency: Case Report and Overview.

Flare-ups following root canal therapy (RCT) are of significant concern in dentistry. They are characterized by the occurrence of pain or swelling during or even after a root canal procedure. They affect a considerable proportion of cases, up to 16% and occasionally even 50%, and they often necessitate unscheduled appointments. Whenever a flare-up occurs within hours or days following RCT, it demands emergency treatment. Flare-ups can be attributed to multiple factors, including mechanical, chemical, and microbial causes. Identifying these factors beforehand and utilizing the expertise of clinicians can help better manage patients after the procedure and assure a long-term successful outcome. It has been observed that retreatment cases with periapical periodontitis treated in a single appointment have higher flare-up rates. Despite the prevalence and the impact of flare-ups, the endodontic community has yet to adopt scientifically validated and approved preventive measures to manage and prevent flare-ups. Hence, in this case report, the ethical letter was approved (TUCDREC/250923). It provides insight into the management of an interappointment flare-up with an overview.

Retrograde peri-implantitis: incidence and possible co-existing factors: a retrospective analysis.

OBJECTIVES: To evaluate the incidence of retrograde peri-implantitis (RPI) generally and the incidence of RPI with an endodontic-treated adjacent tooth and/or a periapical radiolucency. METHOD: The retrospective case-control study included the follow-up periapical images of single dental implants. Two calibrated graduate endodontic residents evaluated simultaneously the presence of RPI and the adjacent teeth status (a previous root canal treatment (RCT) and the periapical status). RESULTS: Six hundred and eleven dental implants were included in this study. Twenty-three implants with RPI were detected (the incidence of RPI was 3.7%). Thirty-one adjacent teeth to the implants with RPI were recognized. Out of them, seven teeth had a previous RCT and periapical radiolucency or no RCT and periapical radiolucency. The odds ratios for RPI in an implant with periapical radiolucency or with RCT at the adjacent tooth are 6.67 (95% CI 2.7-16.5), P < 0.05; and 0.11 (95% CI 0.007-1.9), P > 0.05 respectively. CONCLUSIONS: Based on periapical radiographs, the RPI incidence was 3.7% in the present study. The incidence of RPI increased in cases with adjacent teeth that had periapical radiolucency. Previous RCT in teeth adjacent to implants without apical radiolucency is not correlated with RPI.

Evaluating the presence of IAN injury in patients with juxta-apical radiolucency after third molar surgery: a retrospective cohort study.

BACKGROUND: Juxta-apical radiolucency (JAR) has been presented as a radiographic sign, suggestive of the IAN injury through third molar surgery. This study aimed to evaluate the relation of JAR with IAN injury in cone-beam computed tomography (CBCT) images and to determine whether the presence of JAR is related to tooth angulation, proximity to the mandibular canal, position to the IAN, and thinning of the cortical plates. METHODS: Of an initial sample of 545 mandibular third molars, a total of 75 JAR+ and 75 JAR- teeth were evaluated by CBCT. We assessed the relationship between the presence of JAR in cone-beam computed tomography (CBCT) images and the presence of IAN injury after mandibular third molar surgeries. Moreover, we investigated whether the presence of IAN injury is related to tooth angulation, proximity to the mandibular canal, position to the IAN, and thinning of the cortical plates. Descriptive statistics, Chi-square test, and Fisher's exact test were performed for statistical analysis. RESULTS: A significant relationship was found between JAR and temporary IAN injury (P = 0.036). However, there was no case of permanent IAN injury. IAN injury showed no significant relationship with the tooth angulation, position to IAN and proximity to the mandibular canal, lingual cortical plate thinning, sex, and age. CONCLUSIONS: JAR is generally in contact with the mandibular canal, and some degree of cortical thinning can be found in most cases. In this study, JAR was significantly related to temporary IAN injury. JAR may increase the risk of nerve injury during the surgical removal of third molars.

Implants placed into alveoli with periapical lesions: an experimental study in dogs.

OBJECTIVE: To histologically analyze the effect of a curettage of the granulation tissue on healing at implants installed immediately after the extraction of teeth presenting periapical lesions. MATERIAL AND METHODS: In seven dogs, the dental pulp was removed from the pulp chamber and from the root canals of the right and left third and the fourth mandibular premolars and of the left second premolar. The chambers were left opened and, after 3 months, apical lesions were present, and the premolars were extracted. One alveolus each premolar was selected and, before implant installation, the apical lesions of two alveoli were curetted (curettage group) while the other three were not treated (no-treatment group). The second right premolar was also extracted (Negative control group). Six implants each dog were installed, and a fully submerged healing was allowed. Four months after, biopsies were collected, and histological analyses were performed. RESULTS: The proportions of new bone at the entire body of the implant was 70.2 ± 10.7% at the no-treatment group, 72.1 ± 14.8% at the curettage group, and 69.6 ± 3.7% at the negative control group. The respective new bone proportion at the apical aspect of the implants was 68.4 ± 17.5%, 61.5 ± 27.3%, and 78.1 ± 5.7%. None of the differences among the various groups were statistically significant. No inflammatory infiltrates were seen in the apical region. CONCLUSIONS: In this experimental study, it is concluded that the removal of the granulation tissue seems not to be necessary to obtain a proper osseointegration of implants installed immediately after the extraction of teeth presenting a periapical lesion.

Juxta-apical radiolucency and relations with surrounding structures on cone-beam computed tomography.

The aim of this study was to investigate the incidence of juxta-apical radiolucency (JAR) and its relations with surrounding structures using cone-beam computed tomography (CT). A total of 215 cone-beam CT images was analysed retrospectively to record the presence, site, and size of the JAR, and the relations between the JAR and the mandibular canal, buccal or lingual cortical plates, tooth position, and condition of root apex. Descriptive analyses were made, and relations between the categorical variables were tested with the chi squared test. JAR was detected in 71 (33%) (5 bilateral and 66 unilateral) of 215 patients (378 mandibular third molars) on cone-beam CT images. It was most commonly seen mesial to the tooth (43%) and above the third molars (55%), and was least common lingual to the tooth (3%) and at the distoangular third molar (3%) (p = 0.005). There was no significant relation between the JAR and the mandibular canal, but JAR was most likely to be detected superiorly to the mandibular canal (59% of cases). JAR can be seen and evaluated with cone-beam CT. It was most commonly seen mesial to the tooth and above the third molar. No significant relation was found between JAR and the mandibular canal, cortical plate, or condition of the apex. Future studies on the assessment of JAR should be done with a larger sample size as prospective cone-beam CT studies.

Is juxta-apical radiolucency a reliable risk factor for injury to the inferior alveolar nerve during removal of lower third molars?

The aim of this study was to find out if juxta-apical radiolucency (JAR) is a reliable risk factor for injury to the inferior alveolar nerve (IAN) during removal of lower third molars. We designed a cohort study of patients whose dental panoramic tomograms (DPT) had shown JAR before complete removal of lower wisdom teeth. The outcome variable was postoperative permanent neurosensory disturbance of the IAN. A total of 39 patients (50 lower third molars) were identified and screened for permanent neurosensory disturbance. None reported any permanently altered sensation 18 months after the operation. Based on our group, the presence of JAR does not seem to be a reliable predictor of the risk of permanent injury to the IAN during removal of lower third molars.

Influence of Endodontic Treatment and Coronal Restoration on Status of Periapical Tissues: A Cone-beam Computed Tomographic Study.

INTRODUCTION: This cross-sectional study determined the prevalence of apical radiolucency in 1290 root canal-treated teeth and the correlation between endodontic treatment quality and the presence of coronal restorations with apical radiolucency using cone-beam computed tomographic imaging. METHODS: Cone-beam computed tomographic scans were analyzed, and teeth were classified as healthy or diseased according to the periapical status. Other factors were also evaluated for their association with the apical diagnosis including sex, quality of endodontic treatment, presence of coronal restorations and posts, and apical level of filling. RESULTS: Of the treated teeth, 48.83% were classified as healthy. Only 55.11% of the teeth had endodontic treatment rated as adequate. The quality of endodontic treatment and the presence of coronal restoration were statistically correlated with the presence or absence of an apical radiolucency (P < .0001). Combined data revealed that teeth with both adequate endodontic treatment and the presence of coronal restoration showed significantly better apical status than the other combinations (P < .001). Canals filled up to 0-2 mm short of the apex had a significantly higher number of teeth rated as healthy compared with overfilled or underfilled cases (P = .001). The presence of a post was not found to be a statistical significant factor (P = .81). CONCLUSIONS: Data showed a relatively high prevalence of apical radiolucencies in root canal-treated teeth. The quality of the endodontic treatment, the presence of coronal restoration, and apical extent of the root canal filling were significantly associated with healthy apical tissues.

Prevalence of referral reasons and clinical symptoms for endodontic referrals.

OBJECTIVES: To investigate the prevalence of different primary reasons for endodontic referrals and the clinical symptoms of the referred cases. MATERIALS AND METHODS: Clinical data of total endodontic treatment cases (1,014 teeth) including endodontic referral cases (224 teeth) between January 1, 2010 and December 31, 2012, at Kangdong Sacred Heart Hospital, were investigated retrospectively. The one major reason for referral, the clinical symptoms, and the resulting treatment procedures of referral cases were recorded. The percentages of clinical symptoms of the endodontic referral cases and the total endodontic treatment cases were compared by χ(2) test for each symptom. RESULTS: Persistent pain was the most frequent reason for endodontic referral (29.5%), followed by presence of gingival swelling and sinus tract (24.1%), and apical radiolucency (12.9%). Referrals in cases involving endodontic difficulties such as canal calcification, broken instruments, post, perforation, and resorption were less than 5.0%, respectively. The percentages of four major clinical symptoms of pain, apical radiolucency, previous endodontic treatment, and gingival swelling and sinus tract were significantly higher in the endodontic referral cases than those in the total endodontic cases (p = 0.001). Among the included referral cases, 72.8% were treated with nonsurgical endodontic treatment only. Teeth other than the referred teeth were diagnosed as the origin of the problem in 5.8% of the referrals. CONCLUSIONS: The high prevalence of pain, apical radiolucency, previous treatment, and gingival swelling and sinus tract in endodontic referral cases suggest that these symptoms may be what general practitioners consider to be difficult and refer to endodontists.

Prevalence of referral reasons and clinical symptoms for endodontic referrals

OBJECTIVES: To investigate the prevalence of different primary reasons for endodontic referrals and the clinical symptoms of the referred cases. MATERIALS AND METHODS: Clinical data of total endodontic treatment cases (1,014 teeth) including endodontic referral cases (224 teeth) between January 1, 2010 and December 31, 2012, at Kangdong Sacred Heart Hospital, were investigated retrospectively. The one major reason for referral, the clinical symptoms, and the resulting treatment procedures of referral cases were recorded. The percentages of clinical symptoms of the endodontic referral cases and the total endodontic treatment cases were compared by chi2 test for each symptom. RESULTS: Persistent pain was the most frequent reason for endodontic referral (29.5%), followed by presence of gingival swelling and sinus tract (24.1%), and apical radiolucency (12.9%). Referrals in cases involving endodontic difficulties such as canal calcification, broken instruments, post, perforation, and resorption were less than 5.0%, respectively. The percentages of four major clinical symptoms of pain, apical radiolucency, previous endodontic treatment, and gingival swelling and sinus tract were significantly higher in the endodontic referral cases than those in the total endodontic cases (p = 0.001). Among the included referral cases, 72.8% were treated with nonsurgical endodontic treatment only. Teeth other than the referred teeth were diagnosed as the origin of the problem in 5.8% of the referrals. CONCLUSIONS: The high prevalence of pain, apical radiolucency, previous treatment, and gingival swelling and sinus tract in endodontic referral cases suggest that these symptoms may be what general practitioners consider to be difficult and refer to endodontists.