Search

Introduction: This study aimed to investigate access to care and financial considerations associated with the endodontic treatment of immature permanent teeth., Methods: Surveys were distributed to endodontists (n = 2,457) and pediatric dentists (n = 3,974) in the United States. Data were analyzed using X 2 analysis and logistic regression. The level of significance was set to 0.05., Results: The response rate was 13% (n = 840). Respondent specialist groups were similar by age and years since specialty residency completion, but significantly different with regard to primary practice setting (eg private practice, Federally Qualified Health Center, hospital), (P = .001). The majority (91%) of respondents reported participation with dental insurance. Pediatric dentists (69%) were significantly more likely than endodontists (17%) to participate with public-payer dental insurance (P < .001). The majority of respondents (82%) indicated that patients reported economic factors (time or money) as a barrier to accessing endodontic treatment. Pediatric dentists were significantly more likely to consider economic factors when planning for treatment (P < .001). Pediatric dentists were more likely than endodontists to have the opinion that endodontic procedures for treatment of necrotic immature permanent teeth should cost less than root canal therapy (apexification, P < .001; regenerative endodontic procedures, P = .002). Pediatric dentists (33%) reported encountering barriers when attempting to refer their patients to an endodontist. Inability to find an endodontist that participates with dental insurance was the most frequently cited barrier., Conclusions: Limited clinician participation with dental insurance and gaps in insurance coverage for endodontic procedures appear to contribute to access to care barriers for pediatric patients., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)

Introduction: The aims were to investigate 1) the frequency of nonsurgical retreatment, root-end surgery, extraction, and further restorative treatment during a follow-up of 10-11 years after root filling and compare the frequencies according to tooth group and type of coronal restoration and 2) the timing of nonsurgical retreatment, root-end surgery, and extraction., Methods: Data were collected from the Swedish Social Insurance Agency's register. A search for treatment codes identified teeth root filled in 2009 and the type of coronal restoration (direct, indirect, and unspecified) registered within 6 months of root filling. The root-filled teeth were followed 10-11 years, and further interventions were recorded. Descriptive statistics and chi-square tests were used for statistical analysis., Results: In 2009, root fillings were registered for 215,611 individuals/teeth. Nonsurgical retreatment, root-end surgery, and extraction were undertaken in 3.5%, 1.4%, and 20% teeth, respectively. The frequency of further interventions varied with respect to tooth group and type of coronal restoration, but only slightly for endodontic retreatments. Further interventions, except for root-end surgery, were registered more often for molars and directly restored teeth (P < .001). The majority of endodontic retreatments were undertaken within 4 years, while extractions were evenly distributed over 10-11 years., Conclusions: The frequency numbers of nonsurgical retreatment and root-end surgery were low, despite 1 in 5 root-filled teeth registered as extracted. Further interventions were most common in molars and directly restored teeth. Endodontic retreatments were performed more often during the first 4 years., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)

Objectives: To assess and compare the survival rates of implant and root canal treatment as well as to investigate the effect of patient and tooth related variables on the treatment outcome in a large-scale population-based study., Methods: Dental records of patients who received root canal treatment and implant therapy were retrieved from the electronic records of the University of Minnesota School of Dentistry. Demographic characteristics, dental insurance status, socioeconomic status as well as medical history and tobacco use were recorded. The treatment outcome was included as a binary variable (survival/failure)., Results: A total of 13,434 records of patients who had implant (33.6%) or root canal therapy (66.4%) were included. The survival rate analysis and Kaplan-Meier table revealed the majority of the implants were removed within the first year (58.8%), while only 35.2% of the root canal treatments failed in the same time period. The overall survival rate was significantly (p < 0.001) higher for implant therapy (98.3%) compared to root canal treatment (72.7%). A statistically significant association was found between treatment (p 

Introduction: The protocols that endodontists implement for regenerative endodontic procedures (REPs) are unknown. The aim of this study was to examine current REP protocols among practicing endodontists in the United States., Methods: A Web-based survey was sent to 4060 active members of the American Association of Endodontists (AAE). A total of 850 participants completed the survey, representing a 20.9% response rate., Results: Responses indicated 60% reported having performed REPs; most performed 1 to 3 per year. The most commonly selected source (60.8%) for the clinical protocol was the "AAE Clinical Considerations for a Regenerative Procedure." Time constraints were the most common reason why 92.4% of respondents did not report their REP cases to the AAE.org database; additionally, 15.5% were unaware of it. Almost half (49.8%) of the participants reported they would attempt an REP on a patient of any age. The most commonly used irrigants were >3% sodium hypochlorite at the first appointment and EDTA at the scaffold formation appointment. As the intracanal medicament, 52.2% used calcium hydroxide, whereas 23.5% used triple antibiotic paste. At the scaffold formation appointment, 77.1% used a local anesthetic without a vasoconstrictor, and 94.3% used a blood clot as the scaffold. Mineral trioxide aggregate was the coronal barrier most often selected. Considering factors most likely to encourage the use of REPs in the future, 79.8% reported the availability of good candidates followed by 40.1% who desired better evidence., Conclusions: Based on the results of this survey, REP protocols appear to be heterogeneous and do not strictly conform to the "AAE Clinical Considerations for a Regenerative Procedure.", (Published by Elsevier Inc.)

Introduction: The volume-outcome relationships in failed root canal treatments (RCTs) are rarely studied. Thus, we aimed to examine the association of failed RCTs with dentist and institutional volumes., Methods: Ambulatory dental claims (2005-2010) of 1 million beneficiaries randomly selected from the National Health Insurance Research Database of Taiwan were used. This study is a population-based cohort study using a marginal Cox proportional hazards regression model in which the outcome variables cluster around individual patients. A total of 458,557 teeth that received first-ever RCT from 2005 to 2010 and were followed up until the end of 2010 were identified as the tooth cohort. These teeth were aggregated to 244,368 patients, 10,901 dentists, and 7122 institutions for analysis., Results: Dentists in the second, third, and highest quartiles all showed a significantly lower hazard ratio of failed RCTs than those with the lowest case volume, and their adjusted hazard ratios (aHRs) were 0.93, 0.92, and 0.90, respectively. Medical institutions in the second, third, and highest quartiles also showed a significantly lower hazard ratio of failed RCTs than those with the lowest case volume, and their aHRs were 0.93, 0.89, and 0.81, respectively. Teeth with a history of periodontitis also exhibited a significantly higher aHR of failure events. The use of rubber dams significantly reduced the rates of failed RCTs., Conclusions: Dentists and institutions with high care volumes tended to show good RCT outcomes. Such an effect was prominent and robust among dental institutions., (Copyright © 2017 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.)

Introduction: The effect of rheumatoid arthritis (RA) on the healing and pathophyisiology of apical periodontitis is unknown because there is no study in the literature evaluating the association of RA with the prevalence of periapical rarefying osteitis (PAR) and endodontic treatment. Therefore, the goal of this cross-sectional study was to evaluate the prevalence of PAR and root canal treatment in RA patients when compared with controlled individuals., Methods: Full-mouth radiographs of 131 individuals with RA were examined and compared with 131 controls that were sex and age matched exactly with the diseased group. The total number of teeth, presence or absence of root canal filling, quality of root canal filling, quality of restoration, and periapical status were recorded., Results: Overall, the prevalence of teeth with PAR was 4.0% in the diseased group and 3.5% in the control group (P > .05). The prevalence of root canal-treated teeth was 6.2% in the RA group and 5.6% in the control group (P > .05). Controls have significantly more teeth than those with RA (P = .027)., Conclusions: The prevalence of PAR and endodontic treatment was not significantly different in individuals with RA compared with control patients., (Copyright © 2017 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.)

Introduction: Current treatment options for immature permanent teeth with pulpal necrosis include both apexification and regenerative endodontics. The purpose of this study was to survey endodontists on the use of these 2 treatment options., Methods: Surveys were created by using Qualtrics and Teleform software and distributed by using the Salant and Dillman method. Endodontists (n = 1615) in 4 geographically and demographically diverse states, North Carolina, New York, Texas, and California, were surveyed. Data were analyzed by using descriptive statistics and χ 2 analysis. Level of significance was set at 0.05., Results: A 32.9% response rate was obtained. The majority of responders reported that apexification was the treatment of choice when considering the evidence base supporting the treatment (60%) and the predictability of treatment outcome (77.8%). Apexification was also the preferred treatment by 57.3% of respondents when asked to consider patient compliance, by 51.2% when considering the number of required patient appointments, and by 53.3% when considering the likelihood of tooth discoloration. Regenerative endodontics was reported as the preferred treatment by 89% of respondents when considering continued root development and by 66.7% when considering apical closure. The respondents' age and continuing education courses taken were significantly associated with their preferred treatment option., Conclusions: The results of our study indicate that endodontists consider both clinical and patient factors when treating immature teeth with pulpal necrosis. Increase in continuing education options may increase adoption of regenerative endodontic therapy., (Copyright © 2017 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.)

Introduction: The purposes of this retrospective study were to evaluate the clinical and radiographic outcomes of mineral trioxide aggregate apexification and revascularization in nonvital immature permanent teeth and to analyze factors influencing treatment outcome., Methods: Forty-six cases (29 cases of apexification and 17 cases of revascularization) were recruited into this study. Patients' preoperative and postoperative information was analyzed. Treatment outcomes were categorized as a success or failure and functional retention. Further root development was assessed in terms of the percentage changes in root length and root width., Results: The success rates of mineral trioxide aggregate apexification and revascularization were 80.77% and 76.47% and functional retention was 82.76% and 88.24%, respectively. Revascularization provided significantly greater percentage changes in root width (13.75%) in comparison with mineral trioxide aggregate (MTA) apexification (-3.30%). The mean percentage change of increased root length was 9.51% in the revascularization group and 8.55% in the MTA apexification group. Interestingly, revascularization showed various degrees of increased root length ranging from -4% to 58%. Fracture was the main cause of failure in MTA apexified teeth. All failed revascularized teeth presented with signs and symptoms of apical periodontitis caused by persistent infection., Conclusions: MTA apexification and revascularization provide a reliable outcome in the aspects of resolution of the disease and tooth functional retention. None of these treatments provides satisfactory predictable further root development., (Copyright © 2016 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.)

Introduction: Clinical information and diagnostic imaging are essential components of preoperative diagnosis. The aim of this study was to determine the influence of cone-beam computed tomographic (CBCT) imaging on clinical decision-making choices among different specialists (prosthodontists, endodontists, oral surgeons, and periodontists) in endodontic treatment planning. A secondary objective was to assess the self-reported level of difficulty in making a treatment choice before and after viewing a preoperative CBCT scan., Methods: In accordance with the endodontic case difficulty guidelines of the American Association of Endodontists, 30 endodontic cases with varying degrees of complexity were selected. Each case included clinical photographs, digital periapical radiographs, and a small-volume CBCT scan. In the first evaluation, examiners were given all the information of each case, except the CBCT scan. Examiners were asked to select one of the proposed treatment alternatives and assess the difficulty of making a decision. One month later, the examiners reviewed randomly the same 30 cases with the additional information from the CBCT data., Results: The CBCT scans only had a significant influence on the treatment plan when the endodontic case was classified as high difficulty (P < .05). The level of difficulty in choosing a treatment choice was significantly more difficult after viewing a preoperative CBCT scan (P < .05), with the exception of the endodontists (P = .033). After viewing the CBCT scan, the extraction option increased significantly (P < .05)., Conclusions: CBCT imaging has a substantial impact on endodontic decision making among specialists, particularly in high difficulty cases., (Copyright © 2016 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.)

Introduction: There have been many recent technical advances in modern endodontics that have the potential to affect treatment outcomes. Reports on treatment outcomes using contemporary techniques are relatively scarce, especially in the field of nonsurgical retreatment. The purpose of this study was to determine the success of nonsurgical root canal retreatment in molars using contemporary endodontic techniques., Methods: Sixty-three patients referred for retreatment in first molars were enrolled in the study. The retreatment procedures were performed by endodontic residents using a semistandardized treatment protocol. Patients were followed-up at 6, 12, and 24 months. Treatment outcomes were categorized into healed, healing, or nonhealing based on clinical and radiographic criteria. Healed and healing were considered as successes, and nonhealing was considered a failure. Outcomes were also evaluated using patient-centered criteria that included oral health-related quality of life scores and subjective chewing ability., Results: Fifty-two of the 63 patients were available for final analysis. Five cases (9.6%) were determined to be nonhealing at the last follow-up with new or persistent periapical lesions. Thirty-seven (71.2%) patients had complete resolution of apical periodontitis, and the remaining 10 (19.2%) remained asymptomatic and showed radiographic evidence of healing. Oral health-related quality of life scores and chewing ability improved significantly over time (P < .05), with the biggest increase observed within the first week of treatment completion., Conclusions: This study showed that endodontic retreatment using contemporary techniques significantly improved patients' quality of life and chewing ability over time, with a success rate of 90.4% after 2 years., (Copyright © 2016 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.)

Introduction: The objective of this study was to compare the outcomes of initial nonsurgical root canal therapy for different tooth types provided by both endodontists and other providers., Methods: By using an insurance company database, 487,476 initial nonsurgical root canal therapy procedures were followed from the time of treatment to the presence of an untoward event indicated by Current Dental Terminology codes for retreatment, apical surgery, or extraction. Population demographics were computed for provider type and tooth location. Kaplan-Meier survival estimates were calculated for 1, 5, and 10 years. Hazard ratios for provider type and tooth location were calculated by using the Cox proportional hazards model., Results: The survival of all teeth collectively was 98% at 1 year, 92% at 5 years, and 86% at 10 years. Significant differences in survival on the basis of provider type were noted for molars at 5 years and for all tooth types at 10 years. The greatest difference discovered was 5% higher survival rate at 10 years for molars treated by endodontists. A hazard ratio of 1.394 was found when comparing other providers' success with that of endodontists within this 10-year molar group., Conclusions: These findings show that survival rates of endodontically treated teeth are high at 10 years after treatment regardless of provider type. Molars treated by endodontists after 10 years have significantly higher survival rates than molars treated by non-endodontists., (Copyright © 2016 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.)

Introduction: The aims of this study were to analyze the distribution and characteristic features of cracked teeth and to evaluate the outcome of root canal treatments (RCTs) for cracked teeth. The prognostic factors for tooth survival were investigated., Methods: Over the 5-year study period, 175 teeth were identified as having cracks. Data were collected regarding the patients' age, sex, tooth type, location and direction of cracks, probing depth, pulp vitality, type of restoration, cavity classification, opposing teeth, and previous endodontic treatment history. Cracked teeth were managed via various treatment methods, and the 2-year survival rate after RCT was analyzed using the Kaplan-Meier method in which significance was identified using the log-rank test. Possible prognostic factors were investigated using Cox multivariate proportional hazards modeling., Results: One hundred seventy-five teeth were diagnosed with cracks. Most of the patients were aged 50-60 years (32.0%) or over 60 (32.6%). The lower second molar was the most frequently (25.1%) affected tooth. Intact teeth (34.3%) or teeth with class I cavity restorations (32.0%) exhibited a higher incidence of cracks. The 2-year survival rate of 88 cracked teeth after RCT was 90.0%. A probing depth of more than 6 mm was a significant prognostic factor for the survival of cracked teeth restored via RCT. The survival rate of root-filled cracked teeth with a probing depth of more than 6 mm was 74.1%, which is significantly lower than that of teeth with probing depths of less than 6 mm (96.8%) (P = .003)., Conclusions: Cracks were commonly found in lower second molars and intact teeth. RCT was a reliable treatment for cracked teeth with a 2-year survival rate of 90.0%. Deep probing depths were found to be a significant clinical factor for the survival of cracked teeth treated with RCT., (Copyright © 2016 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.)

Introduction: The aim was to assess survival in the Swedish population of teeth treated by nonsurgical root canal treatment during 2009., Methods: Data from the Swedish Social Insurance Agency were analyzed by Kaplan-Meier analysis to assess cumulative tooth survival during a period of 5-6 years of all teeth that were root-filled during 2009., Results: In 2009, 248,299 teeth were reported as root-filled. The average age of the patients at the time of the root filling was 55 years (range, 20-102 years). The teeth most frequently root-filled were the maxillary and mandibular first molars. During the 5- to 6-year period 25,228 of the root-filled teeth (10.2%) were reported to have been extracted; thus 223,071 teeth (89.8%) survived. Tooth survival was highest in the youngest age group (93.2%). The highest survival (93.0%) was for the mandibular premolars, and the lowest (87.5%) was for the mandibular molars. Teeth restored with indirect restorations within 6 months of the root filling had higher survival rates (93.1%) than those restored with a direct filling (89.6%)., Conclusions: In the adult population of Sweden, teeth that are root-filled by general practitioners under the tax-funded Swedish Social Insurance Agency have a 5- to 6-year survival rate of approximately 90%., (Copyright © 2016 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.)

Introduction: The study aimed to investigate the 5-year survival of root-filled posterior cracked teeth and its related factors., Methods: Two hundred patients who had root canal-treated posterior cracked teeth at the National Dental Centre were recalled for a 5-year review. Eighty-four patients who met the inclusion criteria were included in this study. The cases were managed following the treatment protocol for cracked teeth at the center. The data for analyses were obtained from the patients' clinical records. Statistical analyses were performed using SPSS 21.0 (SPSS Inc, Chicago, IL). The outcome measure was the presence of tooth at the time of the review., Results: At 5 years, 77 teeth "survived" (92%), and 7 teeth (8 %) were extracted. Patient demographics, tooth type and location, existing restoration, number and location of cracks, presence of pretreatment signs and symptoms, and initial pulpal and periapical diagnosis did not significantly affect the survival of the teeth. Univariate analysis showed that teeth with extension of the cracks onto the pulpal floor were more often extracted (odds ratio = 4.5, P = .07). Multivariable analyses found that extension of cracks onto the pulpal floor independently increased the odds of tooth loss by 11-fold (odds ratio = 11, P = .033), with other factors being held constant. The 5-year survival estimate in the absence and presence of crack extension onto the pulpal floor was 99% and 88%, respectively., Conclusions: Coronal cracks may be predictably treated, whereas radicular cracks increased the odds of the tooth being extracted., (Copyright © 2016 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.)

Aims: To assess patients with acute odontogenic maxillofacial infections (AOMIs), regarding their functional dentition and dental treatment needs, and identify factors explaining these outcomes., Methods: During a 1-year period, 160 patients with AOMIs were treated at the specialised dental care centre of Vilnius University. Both oral status and specific dental treatment needs were evaluated for each patient. For the restorative dental treatment need, we examined if patients needed fillings, crowns or bridges. Periodontal dental treatment needs were based only on the most severe cases, and patients were allocated either to a group for which periodontal treatment was recommended or to a group that did not need periodontal treatment. Based on these clinical assessments, four ratios for specific dental treatment needs (restorations, extractions, endodontic treatment and periodontal treatment) and two summative ratios (total dental treatment needs and presence of a functional dentition) were calculated. The questionnaire included variables from various domains., Results: Patients with AOMIs retained one-third of their functional dentition and the mean ± standard deviation of their total dental treatment needs was 46.0 ± 29.7%, of which 32.4 ± 17.1% related to the need for restorations. Higher dental treatment needs were associated with a low level of education, low income, irregular oral self-care, systemic diseases and self-treatment of acute dental conditions before seeking professional help., Conclusions: Patients with AOMIs retained one-third of their functional dentition, and almost half of their dentition were in need of dental treatment., (© 2015 FDI World Dental Federation.)

Introduction: A preliminary study done by a National Dental Practice-Based Research Network precursor observed that 44% of general dentists (GDs) reported always using a rubber dam (RD) during root canal treatment (RCT). This full-scale study quantified the use of all isolation techniques, including RD use., Methods: Network practitioners completed a questionnaire about isolation techniques used during RCT. Network enrollment questionnaire data provided practitioner characteristics., Results: One thousand four hundred ninety of 1716 eligible GDs participated (87%); 697 (47%) reported always using an RD. This percentage varied by tooth type. These GDs were more likely to always use an RD, do not own a private practice, perform less than 10 RCTs/month, and have postgraduate training., Conclusions: Most GDs do not use an RD all the time. Ironically, RDs are used more frequently by GDs who do not perform molar RCT. RD use varies with tooth type and certain dentist, practice, and patient characteristics., (Copyright © 2015 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.)

Objective: To investigate time trends in dental service provision., Methods: A random sample of Australian dentists was surveyed by mailed questionnaires in 1983-1984, 1993-1994, 2003-2004, and 2009-2010 (response rates 67-76%). The service rate per visit was collected from a log of services., Results: The rate of service provision per visit [rate ratio (RR)] increased from 1983-1984 to 2009-2010 for the service areas of diagnostic (RR=1.8; 1.6-1.9), preventive (RR=1.9; 1.6-2.1), endodontic (RR=2.1; 1.7-2.6), and crown and bridge (RR=2.9; 2.3-3.8), whereas prosthodontic services decreased (RR=0.7; 0.6-0.9)., Conclusions: The profile of services provided by dentists changed over the study period to include less emphasis on replacement of teeth and more on diagnosis, prevention, and retention of natural dentitions., (© 2014 FDI World Dental Federation.)

Introduction: The frequency of persistent pain 3-5 years after primary root canal therapy and its impact on the patient's perceived oral health-related quality of life was determined in a practice-based research network., Methods: All patients presenting to participating network practices who received primary root canal therapy and restoration for a permanent tooth 3-5 years previously were invited to enroll. Persistent pain was defined as pain occurring spontaneously or elicited by percussion, palpation, or biting. The patient also completed an oral health-related quality of life questionnaire (Oral Health Impact Profile-14)., Results: Sixty-four network practices enrolled 1323 patients; 13 were ineligible, 12 did not receive a final restoration, and 41 were extracted, leaving 1257 for analysis. The average time to follow-up was 3.9 ± 0.6 years. Five percent (63/1257) of the patients reported persistent pain, whereas 24 of 63 (38%) exhibited periapical pathosis and/or root fracture (odontogenic pain). No obvious odontogenic cause for persistent pain was found for 39 of 63 (62%). Teeth treated by specialists had a greater frequency of persistent pain than teeth treated by generalists (9.3% vs 3.0%, respectively; P < .0001). Sex, age, tooth type, type of dentist, and arch were not found to be associated with nonodontogenic persistent pain; however, ethnicity and a preoperative diagnosis of pulpitis without periapical pathosis were. Patients reporting pain with percussion tended to experience pain with other stimuli that negatively impacted quality of life including oral function and psychological discomfort and disability., Conclusions: These results suggest that a small percentage (3.1%) of patients experience persistent pain not attributable to odontogenic causes 3-5 years after primary root canal therapy that may adversely impact their quality of life., (Copyright © 2014 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.)

Introduction: The purpose of this study was 2-fold: (1) to investigate the critical time-lapse of endodontic intervention subsequent to various restorations and tooth surfaces and (2) to assess and compare the risk factors associated with the restorations, tooth surfaces, and endodontic treatment., Methods: A comprehensive computerized analysis of all dental school patients at the Case Western Reserve University School of Dental Medicine who received restorations from 2008-2013 was obtained. Inclusion and exclusion criteria were applied. The sample size was limited to teeth with endodontic treatment completed by the endodontic postgraduate dental clinic. Data collected included restoration type, restored tooth surfaces, tooth type, and the dates of restoration and subsequent endodontic treatment. A 2-sample paired t test (95% confidence interval, P < .05) and pair-wise comparison with Bonferroni corrections were implemented., Results: The mean time between restoration placement and resultant endodontic intervention was 270 days, with a mean difference of 247-294 days (P < .0001). Further analysis revealed composite resin was 1.91 times more likely than amalgam and 5.69 times more likely than crowns to cause resultant endodontic intervention. Teeth with 2 or more restorative surfaces required endodontic intervention (P < .001)., Conclusions: Of the patients who required endodontic treatment after restoration placement, the critical time-lapse was 9 months. Composite restorations and teeth with 2 or more restorative surfaces were significantly associated with endodontic treatment. From the results of the current study, we recommended that all dental practitioners should perform a thorough endodontic evaluation and diagnosis before, during, and after all restorative procedures., (Copyright © 2014 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.)

Introduction: It is well-known that the usage of rubber dams during root canal treatment (RCT) improves infection control and treatment efficacy and protects patients. However, the effect of rubber dam usage on endodontic outcomes remain uncertain. The aim of the present study was to investigate whether rubber dam usage affects the survival rate of initial RCT using a nationwide population-based database., Methods: A total of 517,234 teeth that received initial RCT between 2005 and 2011 met the inclusion criteria and were followed until the end of 2011. Univariate and multivariate Cox proportional hazards models were used to estimate the effects of rubber dam usage on the risk of tooth extraction after initial RCT., Results: Of the 517,234 teeth, 29,219 were extracted, yielding a survival rate of 94.4%. The survival probability of initial RCT using rubber dams after 3.43 years (the mean observed time) was 90.3%, which was significantly greater than the 88.8% observed without the use of rubber dams (P < .0001). After adjusting for age, sex, tooth type, hospital level, tooth scaling frequency per year after RCT, and systemic diseases, including diabetes and hypertension, the tooth extraction hazard ratio for the RCT with rubber dams was significantly lower than that observed for RCT without rubber dams (hazard ratio = 0.81; 95% confidence interval, 0.79-0.84)., Conclusions: The use of a rubber dam during RCT could provide a significantly higher survival rate after initial RCT. This result supports that rubber dam usage improves the outcomes of endodontic treatments., (Copyright © 2014 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.)

Objective: The purpose of this study was to estimate the prevalence of periradicular lesions in HIV-infected Brazilian patients and to assess the correlation of several factors with the periradicular status., Method: One hundred full-mouth periapical radiographs were evaluated. A total of 2,214 teeth were evaluated for the presence of periradicular lesions, caries lesions, coronal restorations, pulp cavity exposure and endodontic treatment., Results: The prevalence of periradicular lesions was 46%. There were no significant differences between individuals with or without periradicular lesions with respect to their socio-demographic status, habits, laboratory data and route of HIV infection. However, the presence of a periradicular lesion was statistically correlated with the number of teeth with endodontic treatment (p = 0.018), inadequate endodontic treatment (p = 0.025), images suggesting pulp cavity exposure (p = 0.002) and caries lesions (p = 0.001)., Conclusions: The prevalence of periradicular lesions in HIV-infected individuals was 46% and was not related to HIV infection.

Introduction: The purposes of this study were to examine the following in young adults residing in the United States: (1) the prevalence of teeth with root canal therapy (RCT) and teeth in need of RCT, (2) how frequently treatment practices associated with success as cited in the literature are found in posterior teeth with RCT, and (3) which treatment practices are associated with periradicular pathology., Methods: Panoramic radiographs taken of all basic trainees entering the US Air Force in 2011 were evaluated in a 2-part review. A general survey of all radiographs was performed to determine the prevalence of teeth with and teeth in need of RCT. All panoramic radiographs that showed a posterior tooth with RCT were evaluated in detail to consider the presence and quality of cuspal coverage restorations, the quality of RCT, and the presence of periradicular pathology., Results: A total of 35,811 panoramic images were evaluated. Ten percent of basic trainees had existing RCT, whereas 5% showed a need for RCT. The total number of posterior teeth with RCT was 3,455. Nearly half of these teeth had either no cuspal coverage or an unacceptable cuspal coverage restoration. Almost one third of the existing RCT was considered inadequate based on best treatment practices. Approximately 25% of teeth with RCT had periradicular pathology present. A strong correlation was found between the quality of RCT and the absence of periradicular pathology. Of RCT teeth deemed hopeless, 97.5% had no cuspal coverage restoration present., Conclusions: Factors cited in the literature as being associated with success are lacking in the dental treatment of young adults residing in the United States., (Published by Elsevier Inc.)

Introduction: In the United States almost 70% of root canal treatment (RCT) is performed by general dentists (GPs), yet little is known about their treatment protocols., Methods: A paper survey was mailed to 2000 United States GPs with questions about the types of endodontic cases treated, routine treatment protocols, use of newer technologies, and endodontic continuing education (CE)., Results: Completed surveys were returned by 479 respondents (24%). GPs who perform RCT (84%) reported providing anterior (99%), bicuspid (95%), and molar (62%) RCT and retreatment (18%). Rubber dam was used always (60%), usually (16%), sometimes (13%), and never (11%). Newer technologies used by GPs included digital radiography (72%), magnification (80%), electronic apex locator (70%), and nickel-titanium rotary instrumentation (74%). Compared with GPs with >20 years of experience, those in practice for ≤10 years were more likely to use rubber dam (P < .05), nickel-titanium rotary instrumentation (P < .001), apex locators (P < .001), and magnification (P < .01); in contradistinction, GPs in practice >20 years were more likely to perform retreatments (P < .05). Women were less likely to perform retreatment or molar RCT (both P < .05). GPs with >5 hours of CE were more likely to use rotary instrumentation (P < .001), irrigant activation devices (P < .01), and apex locators (P < .001) and perform molar RCT (P < .001) and retreatment (P < .05), but no more likely to use rubber dam., Conclusions: Recent GP graduates (≤10 years) were more likely to adopt new technologies and use rubber dam than those who practiced for >20 years. More experienced GPs were more likely to take on complicated cases than those with fewer years of practice. There was no association between hours of CE and compliance with rubber dam usage., (Copyright © 2014 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.)

Objectives: Predicting the tooth survival is such a great challenge for evidence-based dentistry. To prevent further tooth loss of partially edentulous patients, estimation of individualized risk and benefit for each residual tooth is important to the clinical decision-making. While there are several reports indicating a risk of losing the abutment teeth of RPDs, there are no existing reports exploring the cause of abutment loss by multifactorial analysis. The aim of this practice-based longitudinal study was to determine the prognostic factors affecting the survival period of RPD abutments using a multifactorial risk assessment., Methods: One hundred and forty-seven patients had been previously provided with a total of 236 new RPDs at the Osaka University Dental Hospital; the 856 abutments for these RPDs were analyzed. Survival of abutment teeth was estimated using the Kaplan-Meier method. Multivariate analysis was conducted by Cox's proportional hazard modelling., Results: The 5-year survival rates were 86.6% for direct abutments and 93.1% for indirect abutments, compared with 95.8% survival in non-abutment teeth. The multivariate analysis showed that abutment survival was significantly associated with crown-root ratio (hazard ratio (HR): 3.13), root canal treatment (HR: 2.93), pocket depth (HR: 2.51), type of abutments (HR: 2.19) and occlusal support (HR: 1.90)., Conclusion: From this practice-based longitudinal study, we concluded that RPD abutment teeth are more likely to be lost than other residual teeth. From the multifactorial risk factor assessment, several prognostic factors, such as occlusal support, crown-root ratio, root canal treatment, and pocket depth were suggested., Clinical Significance: These results could be used to estimate the individualized risk for the residual teeth, to predict the prognosis of RPD abutments and to facilitate an evidence-based clinical decision making., (Copyright © 2013 Elsevier Ltd. All rights reserved.)

Introduction: This study aimed to determine the most suitable estimates of the event date for Kaplan-Meier (K-M) survival analysis for the assessment of endodontic treatment outcomes. Survival probability computed using the Weibull accelerated failure time (WAFT) models based on interval-censored data was used for comparison., Methods: A sample of root canal-treated teeth was included for survival analysis using the K-M and WAFT models. Treatment outcomes were categorized for the presence or absence of periapical healing and tooth survival. For the K-M analysis, the following time estimates between a visit when failure was diagnosed and the preceding visit were tested: the one-quarter point (T1), the half-way point (T2), the three-quarter point (T3), the date of diagnosis (T4), and the geometric mean (T5)., Results: The survival curve plotted from T2 consistently showed the least discrepancies in trend when compared against the WAFT curve. Those curves generated from T1 to T5 were significantly different from each other for periapical healing but not for tooth survival., Conclusions: T2 is the most reliable date for K-M analysis for measuring endodontic outcomes, especially when periapical healing is concerned. T4 would be a reasonable estimate for assessing tooth survival. Further research aiming at appropriate statistical exercise with simulations followed by proper goodness of fit tests should be considered., (Copyright © 2013 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.)

Introduction: This cross-sectional study determined the prevalence of apical periodontitis in 1086 root canal-treated teeth from an urban Colombian population and evaluated the association of several factors with the periradicular status., Methods: Periapical radiographs were used for analyses, and teeth were classified as healthy or diseased according to the periradicular status. Other factors were also evaluated for their association with the periradicular conditions, including gender, quality of both endodontic treatment and coronal restoration, apical level of filling, and presence of post restoration., Results: Fifty-one percent of the treated teeth were classified as healthy. Only 33% of the teeth had endodontic treatment rated as adequate. The quality of both endodontic treatment and coronal restoration significantly influenced the periradicular conditions (P < .001). Combined data revealed that teeth with both adequate endodontic treatment and adequate restorations showed significantly better periradicular status than the other combinations (P < .01), except for teeth with adequate treatment and inadequate restoration (P = .08). Canals filled up to 0-2 mm short of the apex had a significantly higher number of teeth rated as healthy than overfilled or underfilled cases (P = .02). Regression analysis showed that the quality of endodontic treatment was the most significant factor influencing the periradicular status (P < .001). Gender and presence of post restoration had no association with the periradicular conditions., Conclusions: Data from this Colombian population showed a relatively high prevalence of apical periodontitis in root canal-treated teeth. This was largely due to an equally high prevalence of treatments performed under substandard technical quality. The quality of the endodontic treatment was the most determinant factor for healthy periradicular status., (Copyright © 2013 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.)

Background: Practice guidelines historically have recommended postponing dental care after ischemic vascular events. The authors examined an administrative data set to determine whether dental procedures increased patients' risk of experiencing a second vascular event., Methods: The authors examined a data set of 50,329 participants in the Medicare Current Beneficiary Survey to identify those who had had a vascular event (n = 2,035) and a second event (n = 445) while in the survey. They used Cox proportional hazards regression to study associations between dental procedures performed within 30, 60, 90 or 180 days after a first event and the risk of experiencing a second vascular event., Results: Dental procedures of any kind, and invasive procedures considered separately, were not associated with patients' risk of experiencing second vascular events across all periods examined. Most hazard ratios associated with dental procedures were less than 1.0, although none differed significantly from 1.0., Conclusions: The authors found that community-dwelling Medicare beneficiaries who underwent dental procedures within 30 to 180 days after an ischemic vascular event, including those that produce a bacteremia consistently, were not at an increased risk of experiencing a second event., Clinical Implications: The results of this study suggest that clinicians should reassess historical recommendations that dental care in this population be postponed for as long as six months after an ischemic vascular event.

Introduction: The present study was conducted with the aim to assess the extraction and retention incidence of endodontically treated teeth with an uncertain prognosis after endodontic referral and to evaluate the factors related to the decision-making process., Methods: Two hundred seventy-five permanent teeth were clinically and radiographically evaluated by 3 experienced endodontists. The type of tooth, age and sex of the patients, the motive of referral, and the main chief complaint were the initial recorded data. The associations between extraction reasons and the patients' age and sex or tooth type were analyzed using the chi-square test., Results: Of the 275 teeth examined, 217 (79%) were finally extracted. The remaining 58 (21%) teeth were endodontically retreated and restored. A questionable clinical status was the main motive for endodontic referral (57.1%). The teeth most extracted were maxillary molars (36.2%) followed by mandibular molars (32.9%). The most prevalent reason for extraction was nonrestorable caries (37.1%). The majority of the teeth retained in the oral cavity needed surgical periodontal or endodontic management., Conclusions: The most frequent reason responsible for the fate of endodontically treated teeth is the pronounced loss of dental tissues. Endodontic referral may aid in the survival of some carefully selected cases of endodontically treated teeth., (Copyright © 2012. Published by Elsevier Inc.)

Unlabelled: The aim was to evaluate retrospectively the influence on restoration longevity of a repair and to evaluate longevity of repaired restorations., Materials and Methods: In a practice, 1202 amalgam and 747 composite resin restorations were placed. 407 restorations failed (amalgam 293, composite 114), 246 restorations were repaired with composite resin using an etch-and-rinse technique. Of repaired restorations reason for failure and number of surfaces of original restoration, repair date, and date of patients' last visit were recorded. Whenever a new treatment was necessary, this was considered failure. Data were analysed by Kaplan-Meier statistics and log-rank tests (p<0.05). A multi-variate Cox-regression analysis was conducted on results for variables number of surfaces, repair reason, and repaired material., Results: 133 amalgam restorations (57% due to fracture) and 113 composite restorations (62% due to caries) were repaired. 151 of 246 repaired restorations (61%) were still in service without further intervention after 4.8 years. The annual failure rates for repaired amalgam and composite restorations was 9.3% and 5.7% after 4 years (log-rank, p=0.001). Restorations that were repaired due to fracture had a lower survival than restorations that were repaired due to caries (log-rank, p=0.006). The Cox-regression showed influence of the gender but no significant influence of material or reason for repair, indicating that the findings are a consequence of joint negative influences of investigated variables., Conclusion: The present study shows that repairs can enhance the longevity of dental restorations considerably. Moreover, repairs on restorations failing due to caries have a better prognosis compared to repairs on restorations failing due to fracture., (Copyright © 2012 Elsevier Ltd. All rights reserved.)

Introduction: Cross-sectional studies describe the health status of a population and measure the prevalence of disease or treatment. Neither the prevalence of periapical radiolucency, a surrogate for disease, nor the prevalence of root canal treatment have been subjected to a systematic review, which is the highest level of clinical evidence. The purpose of this study was to conduct a systematic review and meta-analysis of the prevalence of periapical radiolucency and nonsurgical root canal treatment., Methods: Inclusion/exclusion criteria were used for defined searches in MEDLINE and EMBASE. Title lists were scanned and abstracts were read to determine utility. Articles meeting the inclusion/exclusion criteria were analyzed for heterogeneity. Weighted mean percentages were calculated for the prevalence of overall periapical radiolucency, root canal treatment, and apical radiolucency in both treated and untreated teeth., Results: Defined searching produced 11,491 titles. Thirty-three articles were included. Most patient samples represented modern populations from countries with high or very high human development indices. Meta-analysis was performed on 300,861 teeth. Of these, 5% had periapical radiolucencies, and 10% were endodontically treated. Of the 28,881 endodontically treated teeth, 36% had periapical radiolucencies; however, cross-sectional studies cannot distinguish between healing and failing cases. Of the 271,980 untreated teeth, 2% had periapical radiolucencies. The technical quality of root canal treatment was decried by most authors of the included studies., Conclusions: The prevalence of periapical radiolucency was very high, broadly equivalent to 1 radiolucency per patient. The prevalence of teeth with root canal treatment was very high, broadly equivalent to 2 treatments per patient. Billions of teeth are retained through root canal treatment., (Copyright © 2012 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.)

Introduction: This cross-sectional study evaluated the prevalence of apical periodontitis (AP) and endodontic treatment in type 2 diabetic individuals as compared with nondiabetics from an adult Brazilian population., Methods: Full-mouth radiographs from 30 type 2 diabetic and 60 age- and sex-matched nondiabetic individuals were examined, and the presence of AP lesions in untreated and root canal-treated teeth was recorded. The number of teeth and the prevalence of root canal treatment were also evaluated., Results: AP was significantly more present in teeth from diabetic individuals (98/652, 15%) than in nondiabetic controls (162/1,368, 12%) (P = .05). A separate analysis of untreated and treated teeth revealed that significance was mostly because of the prevalence of AP in untreated teeth, which was 10% in diabetics and 7% in nondiabetics (P = .03). No significant difference between diabetics and nondiabetics was observed for the other parameters under study, including the prevalence of AP in root canal-treated teeth, the number of teeth in the oral cavity, the number of treated teeth per individual, the number of individuals with at least 1 AP lesion or 1 root canal treatment, and the number of teeth with AP per individual (P > .05)., Conclusions: AP was significantly more prevalent in untreated teeth from type 2 diabetics. This suggests that diabetes may serve as a disease modifier of AP in the sense that individuals with diabetes can be more prone to develop primary disease. However, findings do not confirm that diabetes may influence the response to root canal treatment because treated teeth had no increased prevalence of AP when compared with controls., (Copyright © 2012 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.)

Introduction: This study aimed to investigate the incidence of cone-beam computed tomography (CBCT) associated with endodontic procedures during 2009 in South Korea and to retrospectively evaluate information from CBCT with large field of view (FOV), which is popular in South Korea., Methods: The Health Insurance Review and Assessment agency, which reviews all medical and dental expenses covered under the Korean National Health Insurance (NHI) system, was queried for data on the nationwide number of CBCTs associated with some treatment procedures. To compare digital periapical radiography and CBCT retrospectively, 470 roots of 257 root canal-infected teeth were enrolled., Results: In total, 13,209 cases of NHI-covered CBCT were performed in South Korea during 2009, excluding cases for implant restoration and orthodontics. In total, 1253 and 95 CBCT cases were combined with root canal length measuring and apicoectomy, respectively. In a retrospective comparison, CBCT with large FOV provided more information about the presence of apical periodontitis, distortion of cortical bone, and identification of root compared with digital periapical radiography., Conclusions: CBCT with large FOV is useful in nonsurgical endodontic treatment and provides more information compared with digital periapical radiography., (Copyright © 2012 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.)

Aim:  To determine the prevalence of apical periodontitis (AP) and the frequency of root canal treatment in a sample of Spanish adults., Design:  A descriptive cross-sectional study., Setting:  Barcelona, Spain., Participants:  A total of 397 adult subjects, 49% males and 51% females., Methods:  Digital panoramic radiographs were used. Periapical status was scored according to the periapical index. Results were analysed statistically using the chi-squared test and logistic regression., Results:  Radiographic signs of AP in one or more teeth were found in 135 patients (34%). The prevalence of AP was significantly higher in males (42.3%) than females (26.1%) [odds ratio (OR)=2.1; 95% confidence interval (95% CI)= 1.4-3.2; P= 0.0007]. At least one root-filled tooth (RFT) was found in 233 patients (59%). Twenty-six per cent of subjects with RFT had at least one RFT with AP. The prevalence of AP increased with age (P < 0.05). Patients with RFT showed a higher prevalence of AP (42%) relative to patients without RFT (23%) (OR = 2.4; 95% CI = 1.5-3.7; P = 0.00013). Adjusting for age, gender and teeth number, endodontic status remained significantly associated with periapical status (OR = 2.3; 95% CI = 1.4-3.6; P = 0.0005)., Conclusions:  Both the prevalence of AP and the frequency of root canal treatment are high among Spanish adults. AP affects more frequently RFT relative to untreated teeth. Patients with one or more RFT have a greater likelihood of having AP than patients without RFT., (© 2012 FDI World Dental Federation.)

Background: The publication of the 2009 American Academy of Orthopedic Surgeons' (AAOS') guidelines for antibiotic prophylaxis after joint replacement (arthroplasty) has renewed debate concerning appropriate prophylaxis for dental patients. The authors examined an administrative data set to assess whether dental procedures were associated with prosthetic joint infections (PJIs)., Methods: Using data for the years 1997 through 2006 from the Medicare Current Beneficiary Survey (MCBS), the authors identified participants who had undergone total joint arthroplasty and those who had experienced a PJI. They explored associations between dental procedures and subsequent PJIs by using time-to-event analyses (N = 1,000). A nested case-control study included case participants who had had PJIs (n = 42) and matched control participants who had had total arthroplasty but had no PJIs (n = 126). The authors calculated hazard ratios (HRs) and odds ratios (ORs)., Results: Control participants (people without PJIs) were more likely than were case participants (those with PJIs) to have undergone an invasive dental procedure, though this trend was not statistically significant in either the time-to-event analysis (HR = 0.78; 95 percent confidence interval [CI], 0.18-3.39) or the case-control analysis (OR = 0.56; 95 percent CI, 0.18-1.74). Only four of 42 case participants had undergone an invasive dental procedure in the 90 days before the infection occurred. Consideration of all dental procedures yielded similar results., Conclusions: Dental procedures were not associated significantly with subsequent risk for PJIs, although this study's power was somewhat low. The clinical importance of prophylactic antibiotics in dentistry for patients who have undergone joint arthroplasty, therefore, may be questioned., Clinical Implications: These results support the view that the 2009 AAOS Information Statement on antibiotic prophylaxis for people with prosthetic joints should be reconsidered for patients in that population who are receiving oral health care.

Objectives: To determine the frequency and distribution of 975 teeth in need of endodontic treatment in an Argentine patient pool and to compare the results with previously published surveys., Methods: Of the 975 teeth from 860 individuals (age range 7-86 years) were endodontically treated during 2007 by postgraduate students enrolled in a specialisation programme in Endodontics. All patients were examined clinically and radiographically. For each case, information was collected in a questionnaire including location of the affected tooth, age and gender and reasons for endodontic treatment. Data were analysed by the Student t-test, the Fisher exact test, and the chi-square test with a significance of P < 0.05., Results: Of the 975 treated teeth, 543 (55.69%) were maxillary and 432 (44.30%) mandibular teeth. 635 (65.13%) were from females and 340 (34.87%) from males. Significant differences were found between the maxillary and mandibular arch (P = 0.01). Molars and premolars required significantly more frequent endodontic treatment than canines and incisors (P < 0.001). The most frequently treated tooth was the mandibular right first molar (9.12%) followed by the mandibular left first molar (7.07%). The most frequently diagnosed pathosis was irreversible pulpitis (36.00%), pulp necrosis (30.80%), apical periodontitis or the presence of easily discernible periapical radiolucent areas (27.20%). Caries (59.18%) and failure of previous endodontic treatment (26.97%) were responsible for most of the affected teeth., Conclusions:   Comparison with previous surveys revealed that more females than males received endodontic treatment and that mostly molars and premolars were in need of endodontic treatment. The high number of root filled teeth requiring retreatment is in agreement with a pattern similar to that observed in other countries and supports the need for more specialists in endodontics in the Republic of Argentina., (© 2011 FDI World Dental Federation.)

Objective: The objective of this study was to investigate the prevalence of periapical lesions by evaluating the periapical status and to evaluate the relationship between the technical quality of endodontic treatments and presence of periapical lesions in a Turkish subpopulation., Study Design: A total of 11,542 teeth of 438 patients were radiographically evaluated. Presence of endodontic treatment and obturation levels, coronal restorations, and degree of root canal curvature angles were noted. Apical status was assessed by the Periapical Index Scores (PAI). The χ(2) test was used for statistical analysis., Results: Among all teeth, 179 (1.55%) had endodontic treatment and 189 (1.63%) had periapical lesions. Of 179 endodontically treated teeth, 68 (37.99%) had periapical lesions. The prevalence of periapical lesions was found to be significantly high among underfilled teeth (P < .001). In most underfilled teeth, the presence of severe curvatures was particularly of interest. Prevalence of inadequate coronal restorations was significantly high among the teeth with periapical lesions, whether endodontically treated or not (P < .001)., Conclusions: The findings of the present study indicate that considerable effort should be spent by dental practitioners to improve the technical quality of root canal fillings., (Copyright © 2011 Mosby, Inc. All rights reserved.)

Objective: The assessment of inter- and intrarater reliability usually involves more than one level of nesting structures in the collected data, where repeated observations are made by multiple raters. Most approaches, however, are not designed to accommodate both inter- and intrarater reliability jointly, not to mention further difficulties arising when modeling with dichotomous responses. The multiple sources of dependence because of nesting structures and the existence of covariates can result in complexity in inference., Study Design and Setting: We first establish the equivalence between correlation and kappa under common positive correlation models for multiple raters and then apply a Bayesian generalized linear mixed-effects model to interpret simultaneously both types of reproducibility through different annotations of similarity. In addition to marginal correlations, the correlated random effects among raters are adopted to infer similarity between raters, whereas the correlation for random time effects may contribute to test-retest reliability., Results: This model accounts for individual covariates and random effects because of subjects, raters, and time, and it covers a wide variety of data structures and types. An application of endodontic radiographic examinations is illustrated., Conclusion: This Bayesian hierarchical correlation model offers a wide applicability, flexibility, and feasibility in modeling inter- and intrarater reliability together., (Copyright © 2011 Elsevier Inc. All rights reserved.)

Introduction: The aim of this study was to investigate the relationship between smoking and the prevalence of apical periodontitis and root canal treatment in hypertensive patients., Methods: In a cross-sectional study, the records of 100 hypertensive patients, 50 smokers and 50 nonsmokers, were examined. Periapical status of all teeth was assessed by using the periapical index score., Results: Apical periodontitis in 1 or more teeth was found in 92% of smoker patients and in 44% of nonsmoker subjects (P=.000; odds ratio [OR], 16.8; 95% confidence interval [CI], 4.6-61.3). One or more root-filled teeth were found in 58% and 20% of smoker and nonsmoker subjects, respectively (P < .01; OR, 5.5; 95% CI, 2.3-13.5). Among smoker hypertensive patients, 6% of the teeth had apical periodontitis, whereas in the nonsmoker subjects, 2% of teeth were affected (P < .01; OR, 3.3; 95% CI, 2.0-5.4). The percentage of root-filled teeth in the smoker and nonsmoker groups was 3.6% and 1.2%, respectively (P < .01; OR, 2.9; 95% CI, 1.6-5.5)., Conclusions: The prevalence of apical periodontitis and root canal treatment was significantly higher in smoker hypertensive patients compared with nonsmoker subjects., (Copyright © 2011 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.)

Introduction: The aim of this study was to investigate radiographically the prevalence of apical periodontitis (AP) and endodontic treatment in a sample of adult type II diabetic patients and control subjects., Methods: In a cross-sectional study, the radiographic records of 50 adult patients reporting a history of well-controlled type 2 diabetes mellitus (DM) (study group) and 50 age- and sex-matched subjects who reported no history of DM (control group) were examined. Periapical status of all teeth was assessed using the periapical index score., Results: The average number of teeth per patient in the diabetic and control groups was 21.9 and 24.6 teeth, respectively (P = .012). AP in one or more teeth was found in 37 diabetic patients (74%) and in 21 control subjects (42%) (odds ratio = 3.9, P = .002). One or more root-filled teeth were found in 35 (70%) and 25 (50%) of diabetic and control subjects, respectively (odds ratio = 2.3, P = .043). Among diabetic patients with root-filled teeth, 16 (46%) had AP affecting at least one treated tooth. Among controls with root-filled teeth, 6 (24%) had AP affecting at least one treated tooth (P > .05). Adjusting for teeth number, multivariate logistic regression analysis showed that periapical status (odds ratio = 3.3, P = .0071) and the number of root-filled teeth (odds ratio = 1.7; P = .0035) were significantly associated with diabetic status., Conclusions: The results showed that in adult patients, type 2 DM is significantly associated with an increased prevalence of AP and endodontic treatment., (Copyright © 2011 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.)

Introduction: Cemental tears often show characteristics mimicking a periapical or periodontal lesion. This leads to difficulty in the early diagnosis of cemental tears., Methods: In this multicenter study, 71 teeth with cemental tears being confirmed by direct inspection or histological examination were included. For each case, demographic data, dental history, clinical and radiographic findings, and the results of exploratory surgery were recorded and analyzed., Results: Maxillary or mandibular incisors (76.1%) were most frequently affected by cemental tears. Univariate analysis of predisposing factors found that teeth with cemental tears occurred more commonly in men (77.5%) and patients older than 60 years of age (73.2%). Analysis of clinical characteristics showed that teeth with cemental tears were prone to have abscess formation (66.2%), a deep pocket >6 mm (73.2%), positive vitality test (65.3%), healthy antagonist teeth (84.3%), and moderate to severe attrition (77.9%). About 56.3% of cemental tears could be detected on preoperative radiographs. Further analysis of radiographic findings showed that teeth with cemental tears were more likely to have periodontal bone destruction (85.9%) or periapical bone destruction (64.8%)., Conclusions: Endodontists and dentists may avoid misdiagnosis and unnecessary treatment of teeth with cemental tears if they can properly evaluate the radiographs and pulp vitality of teeth as well as know the predisposing factors and clinical characteristics of teeth with cemental tears in advance., (Copyright © 2011 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.)

Objective: We aimed to compare an Amsterdam subpopulation's current prevalence of root canal fillings and associated periapical radiolucencies with a similar patient sample from 1988., Study Design: An Amsterdam subpopulation was evaluated for missing teeth, restorations, quality of endodontic treatment, and periapical radiolucency., Results: A total of 178 radiographs were evaluated and 4594 teeth were examined. Of these, 324 (7%) exhibited widening of the apical periodontal ligament or periapical radiolucency and 224 (4.8%) had been endodontically treated. A total of 118 teeth (2.5%) had radiographic signs of apical periodontitis. Of these lesions, 54 (45.7%) were linked to endodontically treated teeth (24.1% of endodontically treated teeth). Inadequate root canal fillings were frequent (55.8%). Apical radiolucency was significantly higher in these teeth than in adequately root-filled teeth., Conclusion: Findings indicate that the periapical status in an Amsterdam subpopulation has not improved over almost 2 decades., (Copyright © 2011 Mosby, Inc. All rights reserved.)

Introduction: The outcome predictors identified with data from periapical radiographs (PA) and cone-beam computed tomography (CBCT) scans might not be the same. This retrospective study evaluated various factors that might affect the outcome of root canal therapy., Methods: In total, 115 teeth (143 roots) with vital pulps were endodontically treated and followed up 2 years after treatment. Multivariate logistic regression was performed on the data from PA or CBCT to analyze outcome predictors., Results: At recall, PA detected periapical lesions in 18 roots (12.6%), as compared with 37 on CBCT images (25.9%). The length and density of root filling determined by PA and CBCT were often different (p < .001). Overall, 20 of the 25 short root fillings (80%) diagnosed by PA appeared as flush fillings on CBCT images. PA revealed 23 root fillings (16.1%) with voids, as compared with 66 on CBCT images (46.2%). When findings from PA were analyzed, density and apical extent of root filling were identified as predictors (p < .05). When findings from CBCT were analyzed, density of root filling and quality of coronal restoration influenced the outcome significantly (p ≤ .001), whereas gender, tooth type, root curvature, number of visits, CBCT-determined apical extent of root filling, and use as abutment did not (p > .1)., Conclusions: Treatment outcome, length and density of root fillings, and outcome predictors as determined with CBCT scans might not be the same as corresponding values determined with PA., (Copyright © 2011 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.)

Objective: The aims of this study were to understand if practicing dentists appreciate the difference in criteria for success used in the endodontic and implant literature, to evaluate the perceived outcome of implant therapy compared with endodontic treatment, and to evaluate current and projected utilization of implant and endodontic treatment., Study Design: A 16-question survey was distributed to 648 dentists who graduated from the University of Connecticut Dental School over the past 30 years., Results: The response rate was 47%. Forty-nine percent of respondents did not know that different criteria are used in the literature to evaluate implant and root canal treatment. Thirty percent of respondents thought root canal treatment of teeth with necrotic pulp was superior to implants, and only 16% thought retreatment was preferable., Conclusion: A shift in utilization toward implant treatment was not found; however, a perceived superior outcome of implant compared with endodontic treatment does exist among the dental community., (Copyright © 2011 Mosby, Inc. All rights reserved.)

Introduction: Long-term predictability of restored endodontically treated teeth is important for the decision of tooth retention versus extraction and implant placement. The purpose of this study was to validate the hypothesis that preoperative factors can predict the long-term prognosis of molars requiring endodontic and restorative treatment for future prognostic investigations., Methods: A clinical database was searched for molar endodontic treatments with crown placement and a minimum of 4-year follow-up. Charts of 42 patients with 50 individual treatments were randomly selected. Information concerning crown lengthening; periodontal diagnosis; attachment loss; furcation involvement; mobility; and internal, external, or periradicular resorption was recorded. Radiographs from treatment initiation and follow-up were digitalized. The presence of apical periodontitis was evaluated. Available ferrule was calculated from bitewing radiographs using CAD software (AutoCAD; Autodesk, Cupertino, CA). The resulting data, age, sex, and times of restoration and follow-up were analyzed for correlation with the presence of apical radiolucency at follow-up and the following four possible outcome scenarios: "no event," "nonsurgical retreatment," "surgical retreatment," or "extraction" using Spearman rank order correlation analysis., Results: Patients' ages ranged from 19 to 87 years, 22 were male and 20 female, and 48 teeth (96.0%) were retained at follow-up. Of those, 44 (88.0%) were without intervention ("no event"), and four (8.0%) underwent surgical or nonsurgical retreatment. Two teeth (4.0%) had been extracted. Significant positive correlations existed between "untoward events" (any form of retreatment or extraction) and "prognostic value according to periodontal status" (p = 0.047) and "attachment loss" (p = 0.042)., Conclusion: The only preoperative factors significant for the prognosis of restored endodontically treated molars were related to periodontal prognostic value and attachment loss. It can be concluded that it may be difficult to predict the prognosis of molars in need for endodontic treatment and restoration from prognostic factors not related to periodontal disease., (Copyright © 2011 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.)

Objective: The aim of this study was to evaluate the prevalence and distribution of apical periodontitis and endodontic treatment in a Jordanian subpopulation., Study Design: Digital panoramic radiographs of 294 patients who were assessed at Caritas Association between January and September 2008 were evaluated. The coronal and periapical status of all visible teeth were evaluated according to the criteria proposed by de Moor et al., Results: Of the 294 subjects assessed, 83.7% had apical periodontitis and 63.3% had endodontically treated teeth. Of the 7,390 teeth assessed, 11.6% had apical periodontitis and 5.7% were endodontically treated. A correlation was found between apical periodontal lesions and endodontically treated teeth. Endodontic treatment was inadequate in 72.4% of the endodontically treated teeth, of which 87.0% had apical periodontitis. No difference in the number of endodontically treated teeth or the presence of apical periodontitis was found between male and female subjects (P > .05)., Conclusions: The results of this study indicate that there is a relatively higher prevalence of apical periodontitis compared with those of many other countries. High percentage of endodontically treated teeth was inadequate and associated with periapical pathosis, indicating a poor quality of endodontic treatment., (Copyright © 2011 Mosby, Inc. All rights reserved.)

Introduction: Limited prospective data are available on the long-term prognosis of teeth receiving nonsurgical root canal treatment (NSRCT) in patients with systemic diseases including diabetes mellitus (DM), hypertension (HT), and coronary artery disease (CAD). This prospective study aimed to elucidate the impact of systemic diseases on the risk of tooth extraction after NSRCT., Methods: A total of 49,334 NSRCT teeth were randomly selected from databank in October 2003 and were followed for 2 years for tooth extraction after NSRCT. Cox proportional hazards model was used to estimate the risk of tooth extraction after NSRCT., Results: Of the 49,334 teeth, 1592 (3.2%) were extracted during the 2-year follow-up period, yielding a 2-year tooth retention rate of 96.8%. We found that DM (hazard ratio [HR], 1.79), HT (HR, 1.75), and CAD (HR, 1.70) were significant risk factors for tooth extraction after NSRCT (all P values <.0001) in univariate Cox proportional analyses. After adjustment for age, gender, and tooth type in multivariate analyses, DM (HR, 1.29) and HT (HR, 1.18) remained as independent risk factors (both P values <.05). Simultaneous possession of 2 diseases of DM, HT, and CAD was a significant and robust predictor for an increased long-term risk of tooth extraction after NSRCT (P for trend <.001)., Conclusions: An increased risk of tooth extraction after NSRCT is significantly associated with DM, HT, and CAD individually. Moreover, the constellation of systemic disease burden also manifests the importance in addition to other potential confounders., (Copyright © 2011 American Association of Endodontists. All rights reserved.)

Introduction: The effect of endodontic involvement on tooth loss has not been quantified, so the present study aimed to assess this relationship after controlling for other relevant risk factors for tooth loss., Methods: We analyzed data from 791 participants (18,798 teeth) in the Veterans Affairs Dental Longitudinal Study. Potential tooth-level and person-level covariates were fitted into marginal proportional hazards models, including both apical radiolucencies (AR) and root canal therapy (RCT) status as time-dependent variables. Survival curves were plotted for teeth according to their AR and RCT status., Results: Both current AR and RCT status were associated with increased risk of tooth loss (P < .01), after controlling for baseline levels of periodontal disease, caries, tooth type, number of proximal contacts, number of teeth, age, education, and smoking history. Root canal filled (RCF) teeth seemed to have better survival than non-RCF teeth among teeth with AR but worse survival than non-RCF teeth among teeth without AR., Conclusions: Endodontic involvement was associated with tooth loss, controlling for other potential risk factors. Additional prospective studies are needed to provide better evidence as to the impact of endodontic involvement on tooth loss., (Copyright © 2010 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.)

Objectives: This study aimed to investigate the prevalence of apical periodontitis among root canal-treated teeth in an urban South Korean population and evaluate prognostic factors for periapical radiolucency and its symptoms., Study Design: The periapical status of 896 root canal-treated teeth was evaluated by using digital panoramic radiography. Five prognostic factors were analyzed: length and density of the root filling, presence of crown restoration, probability of unilateral bite, and presence of missing canals., Results: The prevalence of apical periodontitis among root canal-treated teeth in the study population was 22.8%, and 29.3% of these teeth had received dental treatment for pain relief. Evaluation of the prognostic factors indicated that inadequacy of endodontic treatment was more predictive of apical periodontitis than the absence of a crown restoration., Conclusion: Inadequate root filling length appeared to be the most important prognostic factor related to apical periodontitis and its acute symptoms among root canal-treated teeth., (Copyright © 2010 Mosby, Inc. All rights reserved.)

Introduction: The purpose of this study was to investigate the prevalence of apical periodontitis and endodontic treatment in hypertensive patients and control subjects without hypertension., Methods: In a cross-sectional study, the records of 40 hypertensive patients and 51 control subjects were examined. Periapical status of all teeth was assessed by using the periapical index score., Results: Apical periodontitis in 1 or more teeth was found in 75% of hypertensive patients and in 61% of control subjects (P = .15; odds ratio, 1.94; 95% confidence interval, 0.78-4.81). One or more root-filled teeth were found in 45% and 39% of hypertensive and control subjects, respectively (P > .0.5). Among hypertensive patients 5.2% of the teeth had apical periodontitis, whereas in the control subjects 4.2% of teeth were affected (P > .05). The percentages of root-filled teeth in the study and control groups were 3.1% and 1.8%, respectively (P > .05). Among hypertensive patients 65% of root-filled teeth had apical periodontitis, whereas in the control subjects 43% of the root-filled teeth were associated with apical periodontitis (P > .05)., Conclusions: The prevalence of apical periodontitis and endodontic treatment was not significantly different in hypertensive patients compared with control subjects without hypertension., (Copyright © 2010 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.)

The objective of this prospective clinical study was to evaluate the incidence of flare-ups (pain and/or swelling requiring endodontic interappointment and emergency treatment) and identify the risk factors associated with their occurrence in patients who received endodontic treatment from June 2006 to June 2007 at the endodontics clinic of the São Paulo Dental Association (APCD), Jardim Paulista branch, São Paulo, Brazil. The incidence of flare-ups was 1.71% out of 408 teeth that had received endodontic therapy. Statistical analysis using the chi-squared test (P < .05) indicated a direct correlation between the flare-up rate and the presence of a periradicular radiolucency., (Copyright © 2010 Mosby, Inc. All rights reserved.)