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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., (Copyright © 2015 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.)

Background: The purpose of this study was to determine whether differences exist in disinfection protocols between endodontists and general dentists., Methods: The authors sent an invitation to participate in a Web-based survey to 950 dentists affiliated with the Spanish Board of Dentistry. Participants responded to 9 questions about irrigation protocols and other factors related to disinfection during root canal therapy., Results: A total of 238 (25.05%) study participants successfully completed and returned the surveys. Among these participants, 50% were general dentists and 50% were endodontists. The authors found no statistically significant differences in respondents' first choice of an irrigant solution (that is, sodium hypochlorite), but they noted statistically significant differences in the protocols used by general dentists and by endodontists in relation to the concentration of sodium hypochlorite (P = .0003), the use and type of irrigant used to remove the smear layer (P = 5.39 × 10(-10)), the use of adjuncts to irrigation (P = 5.98 × 10(-8)), the enlargement of the apical preparation when shaping a necrotic tooth (P = .001), and the maintenance of apical patency throughout the debridement and shaping procedure (P = .04)., Conclusions: General dentists and endodontists embrace different disinfection protocols. The results of the survey demonstrated that endodontists keep up to date with protocols published in the literature, whereas general dentists use protocols learned during their dental training. Both groups of clinicians should be aware of the importance of disinfection techniques and their relationship to treatment outcomes., Practical Implications: Controlling microorganisms during a root canal treatment, especially in cases with necrotic pulp, is essential to improve treatment outcomes. Clinicians should update their protocols and also consider referring patients to a specialist when their protocols are based on traditional techniques, especially in those cases with necrotic pulp., (Copyright © 2015 American Dental Association. Published by Elsevier Inc. All rights reserved.)

The present in vivo study was designed to evaluate the efficacy of apical negative pressure irrigation (ANP), passive ultrasonic irrigation (PUI) and positive pressure irrigation (PP) in the reduction of intracanal bacteria of dogs' teeth with pulp necrosis and apical periodontitis. Eighty root canals were randomly distributed into 3 experimental and 2 control groups according to the irrigation delivery system: group ANP (n=20), group PUI (n=20), group PP (n=20), group PC (positive control - sterile saline irrigation; n=10) and group NC (negative control - vital pulps not subjected to bacterial inoculation; n=10). The first sample (S1) was collected at baseline, and the second sample (S2) was collected after the disinfection protocols. All samples were seeded in culture media for anaerobic bacteria. CFU counts were analyzed statistically by the Kruskal-Wallis, Dwass-Steel-Critchlow-Fligner post-hoc and Chi-square followed by Tukey like multiple comparisons for proportions (α=0.05). All experimental groups were effective in reducing Gram-positive bacteria compared with PC (p<0.05). Regarding the reduction of Gram-negative bacteria, group ANP was significantly better than PP (p<0.05). No statistically significant difference could be found between PP and PUI (p>0.05). In dog's teeth with apical periodontitis, the use of ANP and PUI can be considered promising disinfection protocols as both delivery systems promoted a significant bacterial reduction.

Introduction: The use of cone-beam computed tomography (CBCT) in endodontics for diagnosis, treatment planning, and follow-up has been extensively reported in the literature. Compared with the traditional spiral computed tomography, high-resolution limited CBCT results in a fraction of the effective absorbed dose of radiation. However, it should be prescribed only after weighing the cost of radiation exposure with the benefit of the diagnostic information that can be obtained from the scan., Methods: The purpose of this article is to discuss the application and advantages of intraoperative CBCT in endodontics, while reducing radiation exposure during complex endodontic procedures., Results: In cases of increased difficulty or intraoperative complications such as complex anatomy, dystrophic calcifications, root resorptions, perforations, and root fractures, it is prudent to consider the use of CBCT with its inherent diagnostic value and limited radiation exposure., Conclusions: The benefits of the added diagnostic information provided by intraoperative CBCT images in select cases justify the risk associated with the limited level of radiation exposure., (Copyright © 2013 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.)

Dens invaginatus is a dental anomaly that may give rise to many complex anatomical forms. The complexity of the internal anatomy creates clinical challenges directly related to debridement, disinfection, and the subsequent sealing of the canal system. Additionally, conventional periapical radiographs provide limited information regarding the anatomical configuration. The use of cone beam computed tomography allows for 3-dimensional diagnosis and treatment planning, with the subsequent development of conservative approaches with predictable outcomes. The purpose of this paper was to present 2 cases of dens invaginatus type III, both diagnosed and treatment planned using cone beam computed tomography technology and approached conservatively to treat the necrotic spaces while maintaining the pulp's vitality.

Introduction: Up-to-date studies comparing endodontic treatment versus implant-supported prosthesis have shown similar clinical outcome and survival rates. However, no data are available comparing both treatment modalities based on the patient's perception of quality of life. This study was designed to qualitatively describe and compare the quality of life of patients with restored, single endodontically treated teeth versus patients with single implant-supported fixed prostheses., Methods: Forty-eight patients agreed to participate in the study (n = 24 from each treatment modality). Of those, 37 actually participated in the study: 17 were endodontically treated and 20 had an implant-supported prosthesis. Patients in each of the two groups were randomly selected from the Graduate Endodontics and Graduate Periodontics Departments, respectively. Six focus group discussions (n = 3 per treatment group) were held and audio-recorded for subsequent thematic analysis. Data were analyzed to identify common themes within each category and compared to assess any differences in quality of life between the two treatments. Additionally, a quality of life survey, the shortened version of the Oral Health Impact Profile (OHIP-14), was given before the discussion group and the responses analyzed., Results: The results obtained from this study show similar overall OHIP scores and show a high rate of satisfaction with both treatment modalities. Content analysis of the discussion groups revealed several themes and subthemes. The major themes were importance of overall health, financial implications of the treatments, perception of the treatments and its outcomes, time since treatment, and follow-up dental visits., Conclusions: The results help identify patients' perception and concerns with each treatment modality and assist the clinician and patient in the selection of an optimal treatment for their given situation. In addition to the prognosis and outcomes, clinicians should consider patients' perceptions and preferences as well as the influence each therapy may have on their quality of life, both short- and long-term. Overall, all the participants in this study were pleased with the treatment received and expressed a clear message to save their natural dentition whenever possible., (Copyright © 2011 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.)

Endodontic treatment of third molars often becomes part of comprehensive treatment plans, as it represents a more conservative and less invasive approach than its therapeutic alternatives. The frequency of anatomic variations in mandibular molars, particularly root canal configuration, requires 2 periapical radiographs from different angles. Upon reading and interpretation of the radiographs, the clinician should consider the anatomy and level of difficulty of the endodontic procedure and refer the patient to an endodontist, if deemed necessary. The present article discusses the successful treatment and preservation of a mandibular third molar with 5 root canals, as well as methods for its clinical management.

Aim: To present a case report in which the pulp of two bilateral mandibular premolars with dens evaginatus were revascularized using a modified novel technique to avoid undesired crown discolouration., Summary: Recently, regeneration of necrotic pulps has become an alternative conservative treatment option for young permanent teeth with immature roots and is a subject of great interest in the field of endodontics. This novel procedure exploits the full potential of the pulp for dentine deposition and produces a stronger mature root that is better able to withstand the forces than can result in fracture. However, the current protocol has potential clinical and biological complications. Amongst them, crown discolouration, development of resistant bacterial strains and allergic reaction to the intracanal medication. In the case presented, a modified technique to avoid undesired crown discolouration was applied sealing the dentinal tubules of the chamber, thus avoiding any contact between the tri-antibiotic paste and the dentinal walls., Key Learning Points: * Sealing the dentinal tubules of the chamber prevents the undesirable crown discolouration produced by tri-antibiotic medication whilst maintaining the revascularization potential of the pulp. * Further research is warranted to seek an alternative infection control protocol capable of preventing possible allergic reactions and development of resistant strains of bacteria, as well as a biological material capable of inducing angiogenesis and allow a more predictable scaffold and tissue regeneration.

Background: Dens invaginatus is a rare dental anomaly that may give rise to many complex anatomical forms. The complexity of the internal anatomy may create challenges for the complete removal of the diseased pulpal tissue and the subsequent sealing of the canal system., Case Description: The authors discuss the modification of the internal anatomy under the operating microscope, allowing the clinician better access to treat predictably the canal system with conventional or alternative techniques., Conclusion and Clinical Implications: Considering the anatomical variations and the challenges that a dens invaginatus may present, a practitioner may consider a modification of the internal anatomy of the canal system to gain better access for proper instrumentation, disinfection and sealing of the root canal system using conventional or contemporary techniques.

Anatomical and morphological variations in teeth may affect the success and prognosis of endodontic therapy. The reported data regarding such variations in the maxillary central incisors are limited. This article presents a case of endodontic retreatment in unusually long maxillary central incisors.