Search

Aim: This 60‐month prospective study aimed to evaluate tooth survival and healing rates after root canal treatment in patients taking bisphosphonates (BPs). Secondary outcomes were complications and clinical variables observed during and after treatment. Methods: Root canal treatment was performed using manual K‐file canal instrumentation and a carrier‐based filling technique with an epoxy resin‐based sealer. Teeth without adequate root/crown integrity were restored by trained operators at the tissue level (TL group) to prevent occlusal/mechanical stress and to enable periapical lesion healing without the risk of root fracture. Other teeth were restored with normal occlusal contacts (OC group). Healthy patients who had undergone one or more root canal treatments of the same type constituted the control group. The relationships of the following variables to survival and health status were examined (chi‐squared test and multivariate analysis, P = 0.05): age, gender, smoking habit, tooth location, treatment type, BPs treatment, BPs exposure, initial periapical index (PAI) and occlusal restoration. Survival curves were constructed using Kaplan–Meier analysis, with extraction serving as the end‐point. Results: In total, 65 patients with 109 root canal‐treated teeth who were taking BPs were included. At 60 months, data from 57 patients (52F, 5M; median age 65.7 ± 8.6 years) who had undergone 96 root canal treatments were analysed (drop‐out rate = 16.9%). The survival rate was 85%, and the success rate was 76%. The control group consisted of 46 patients (21F, 25M; median age 60.3 ± 7.2 years) who had undergone 102 root canal treatments. The survival rate was 88%, with 12 teeth lost during follow‐up. The success rate was 73%. In the BP group, 55 teeth were restored normally (OC group) and 41 teeth were restored at the tissue level (TL group). No difference in the success or survival rate was observed between the BP and control groups (P > 0.05). Univariate Kaplan–Meier analysis revealed that only tooth type significantly affected survival status in the BP group. The analysis revealed the clinical relevance of smoking, tooth location and initial PAI on patients' health status (P < 0.05). Conclusion: Root canal treatments and post‐endodontic restoration with tissue‐level filling procedures represent a safe approach for severely damaged teeth in patients receiving BPs having comparable results to root filled teeth restored with occlusal contacts and to the control group. [ABSTRACT FROM AUTHOR]

Abstract: Aim: This retrospective study explored survival and periapical healing outcomes in teeth root filled with Thermafil obturators. Methodology: Root canals of 213 teeth (94 subjects, mean age 48 ± 13 years), instrumented with a step‐down technique, irrigated with 5% NaOCl and 10% EDTA and filled with Thermafil and AH Plus sealer, were involved in a recall programme. Teeth were retrospectively re‐examined after 5 ± 1 years in a controlled environment. Clinical and radiographic data that were collected included the following: preoperative Periapical Index (PAI) score and signs/symptoms, treatment type, root filling length and presence/absence of voids, restoration type, follow‐up PAI score and signs/symptoms. Teeth were considered ‘healthy’ (PAI ≤ 2, no signs/symptoms) or ‘diseased’ (PAI ≥ 3, signs/symptoms present, retreated, extracted for endodontic reasons). Two PAI‐calibrated examiners assessed outcomes blinded to preoperative status. Bivariate and multilevel analyses were performed at level of patient and tooth (α = 5%). Results: Of 213 teeth treated, 187 (88%) survived and 26 were extracted, six (3%) for persistent endodontic infection (considered ‘diseased’), and 20 (9%) for root fracture, periodontal disease or coronal fracture (excluded from analysis). Whilst survival was significantly associated with tooth type (P = 0.015), type of treatment (P = 0.012) and pulpal/periapical diagnosis (P = 0.035), none of these variables were substantiated as survival predictors by the multilevel analysis. A total of 164 of 193 teeth (85%) were assessed as ‘healthy’, with significantly higher (chi‐square; P < 0.04) ‘healthy’ rates for teeth with PAI score ≤2 and root fillings of adequate length. Multilevel analysis identified PAI score ≤2 (P = 0.002) as the only predictor of periapical health. Conclusions: In this 5 ± 1 year retrospective assessment, survival and healing rates after root canal treatment with Thermafil root fillings were comparable to those previously reported for conventional root filling techniques. [ABSTRACT FROM AUTHOR]

Aim To test a novel calcium silicate cement mixed with a water-based gel (NeoMTA Plus) with regard to chemical-physical properties and apatite-forming ability. Methodology NeoMTA Plus (Avalon Biomed Inc. Bradenton, FL, USA; lot. 2014090301) and a commercial MTA-based material with similar properties (MTA Plus, Prevest Denpro Limited, Jammu, India; lot. 41001) were tested for ion-releasing ability, initial and final setting times, radiopacity, open and impervious porosity and apparent porosity, water sorption, weight loss, solubility, ability to nucleate calcium phosphates (CaP) after immersion in HBSS (Hank's Balanced Salt Solution) by ESEM-EDX and micro-Raman spectroscopy. The results were analysed statistically with the anova test ( P < 0.05). Results NeoMTA Plus had a prolonged setting time (315 min) and a satisfactory radiopacity (3.76 mm Al). Calcium and hydroxyl ion release was significantly greater and more prolonged in comparison with MTA Plus ( P < 0.05). Both NeoMTA Plus and MTA Plus had high values of open porosity and solubility. ESEM-EDX and micro-Raman confirmed the ability to nucleate calcium phosphates on their surface after immersion in HBSS. Conclusion NeoMTA Plus is a new calcium silicate-based cement for root filling with an adequate radiopacity and prolonged setting time. The ion release and CaP-forming ability could increase stability of the root filling and promote endodontic and periodontal tissue regeneration, enhancing the bioactivity and biocompatibility of the material. [ABSTRACT FROM AUTHOR]

Aim To investigate nondestructively the percentage of 3 D voids and marginal gaps in a pre-defined interface volume of interest ( VOI) within root fillings produced by Thermafil Obturators with either a hydrophobic epoxy-resin-based sealer ( AH Plus) or a hydrophilic flowable calcium-silicate sealer [mineral trioxide aggregate ( MTA) Flow]. Methodology Sixteen single root canals from extracted premolar teeth were prepared with Pro Taper rotary instruments, randomly allocated into two groups ( n = 8) and filled with size 30 Thermafil Obturators in association with AH Plus or MTA Flow sealers. The filled roots were stored at 37 °C in 5 mL of Hank's balanced salt solution ( HBSS) used to represent body fluids and scanned after 7 days and 6 months using a high-resolution micro- CT. From each root, images of 3000 sections were analysed in 3 D and binarized using a high-resolution micro- CT (4-μ resolution). The 3 D distribution of voids (porosity and marginal gaps) at the gutta-percha-sealer-dentine interface was detected through a threshold grey level and expressed as percentage of the 40-μ-thick pre-defined interface VOI (20 μ of interface dentine and 20 μ of gutta-percha/sealer). A method of analysis based on the root canal segmentation was used, and coronal, middle and apical thirds considered separately. The percentage of 3 D void volume was compared statistically using one-way anova (significance for P < 0.05). Environmental Scanning Electron Microscope with Energy Dispersive X-ray ( ESEM- EDX) analysis was performed on the surface of both sealers after soaking in HBSS. Results Micro- CT detected gaps at the dentine-sealer interface in both groups. Void volumes wider than 10.21 μm3 with 1.35 μm diameter were detected. Cul-de-sac-type voids (blind pores) and through-and-through voids (continuous pores) were discriminated. The apical thirds had a significantly lower 3 D void volume ( P < 0.05) than the middle and coronal thirds. The 3 D void volume reduced significantly ( P < 0.05) over time. ESEM- EDX analysis revealed that MTA Flow sealer created a dense apatite layer after 7 days of immersion in HBSS, whilst only sparse calcium phosphate deposits were detected on AH Plus even after 28 days. Conclusions Micro- CT proved to be a powerful nondestructive 3 D analysis tool for visualizing the porous internal microstructure of dental/endodontic materials at the interface with dentine. The proportion of voids was least in the apical third of root canals. Voids reduced over time in the presence of simulated body fluid. [ABSTRACT FROM AUTHOR]