Submucosal corticosteroids and pulpitis pain
Researchers determined that submucosal injections of dexamethasone and betamethasone reduced pain perception associated with pulpitis after root canal treatment and improved patients’ quality of life (QOL). They reported their findings in the May issue of Journal of Endodontics.
“Postoperative pain in endodontics is usually mild and does not last for more than 72 hours,” researchers wrote. “However, some patients suffer from continuous pain at moderate to severe levels, which might continue for several days, even after proper endodontic treatment.”
The aim of the study was to evaluate the effect of local infiltration of long-acting (LA) betamethasone and dexamethasone on pain and QOL after 1-visit endodontic treatment of teeth with a diagnosis of symptomatic irreversible pulpitis and a normal periapical radiographic condition. Researchers determined that no other studies to date have evaluated steroidal medicaments on decreasing pain after endodontic treatment.
Researchers designed a double-blind, randomized clinical trial with 3 parallel groups—0.7 milliliters submucosal dexamethasone, LA betamethasone, and a placebo—that followed Consolidated Standards of Reporting Trials guidelines. Participating patients were healthy people ranging from 20 through 50 years old, with a mean age of 32 years. Evaluated teeth underwent 1-visit endodontic treatment by 1 endodontist.
Inclusion criteria for teeth were teeth with a diagnosis of symptomatic and asymptomatic irreversible pulpitis and a normal periapical condition including periapical radiography with minimal widening of periodontal ligament, normal probing depth, no medical condition, no contraindication for administration of corticosteroids and injection of lidocaine with epinephrine, and absence of any dental implants in the quadrant under study.
Exclusion criteria were facial or oral paresthesia, pregnancy, breast-feeding, an unrestorable tooth, the presence of a crown on the tooth involved, 2-session treatments, overinstrumentation during root canal treatment, long-term use of corticosteroids, false-positive cases of vitality test with necrosis discovered after gaining access to the tooth, and cases requiring intrapulpal injection to promote anesthesia.
To conduct their study, researchers identified 242 patients for inclusion in the study but ultimately evaluated only 197 owing to people who dropped out for various reasons. Researchers followed patients for 7 days—67 patients in the placebo group, 66 in the LA betamethasone group, and 64 in the dexamethasone group. Patients used questionnaires to mark their level of pain and QOL before treatment and at 6-, 12-, 24-, 48-, and 72-hour and 7-day postoperative intervals. Questionnaire tools included a visual analog scale and a postoperative QOL assessment.
“Dexamethasone was the best medication for patients with the maximum severity of pain in the study groups during the 7-day period,” researchers wrote. “However, LA betamethasone was the best choice in the patients with very severe pain on the day after treatment, which resulted in analgesia for 7 days.”
Of other significance, researchers determined that the medications were more effective in the maxilla than in the mandible and patients experienced less pain in the maxilla, which might be attributed to the high density of the mandible, preventing diffusion of the medication.
The researchers determined that the medications prevented unnecessary loss of teeth and improved patients’ quality of life. “Therefore, it is recommended that these injections be performed routinely for treatment of the current status of patients who are likely to have moderate to severe pain after treatment,” researchers wrote.
Read the original article here or contact the ADA Library & Archives for assistance.
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Untreated canals, apical periodontitis and CBCT
Researchers determined that clinicians should examine limited field-of-view cone-beam computed tomographic (CBCT) images before any retreatment to identify missed root canals that might be related to failed endodontic cases. They published their findings in the April 2016 issue of Journal of Endodontics.
“The importance of locating all existing canals within the root system to achieve optimal prognosis has been discussed by many, and potential negative effects of untreated canals on endodontic prognosis have been debated,” researchers wrote. “Overwhelming evidence of missed canals in failed cases requiring endodontic retreatment has been reported previously. However, to date, the incidence of missed canals and its effect on endodontic prognosis have not been reported.”
As such, the researchers designed a retrospective cohort study to evaluate the incidence of missed canals in endodontically treated teeth in the greater Philadelphia, Pennsylvania, patient population and the effect untreated canals may have on endodontic prognosis.
To conduct their study, the researchers included all CBCT images from patients at the Department of Endodontics at the University of Pennsylvania in Philadelphia, Pennsylvania, obtained from January 2013 through July 2015. Two researchers evaluated all axial, sagittal, and coronal slices of each scan and viewed them with software provided with the CBCT unit. They included all root canal–treated premolars and molars in the study. They defined unfilled canals appearing from cementoenamel junction to apex, including canals splitting from a main canal at coronal, mid, or apical one-third, as missed or untreated canals. They diagnosed periapical lesions when they detected disruption of the lamina dura and the low-density area associated with the radiographic apex was at least 2 times the width of the periodontal ligament space. To assess the relationship between missed canals and occurrence of apical periodontitis, they used the Fisher exact probability and odds ratio tests.
Among their findings, they found that the overall incidence of missed canals was 23.04%, and that the incidence of missed canals was highest in maxillary molars at 40.1% and lowest in the maxillary premolars at 9.5%. The study revealed that missed canals had “significant difference in lesion prevalence.”
The researchers cautioned that, although findings suggest that CBCT images are highly accurate for detecting apical periodontitis, clinicians must take extra care when evaluating these imaged tissues, particularly images revealing small changes, as histologic verification is still insufficient.
Read the original article here or contact the ADA Library & Archives for assistance.
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Diagnosis, management of transverse root fractures
A comprehensive dental literature review article published online May 21 in Dental Traumatology offers clinical guidance on the diagnosis and management of transverse root fractures.
The article defines a root fracture as a fracture of a tooth that involves dentin, cementum, and the pulp. Root fractures, the author wrote, may occur in any direction or orientation and are generally classified as either vertical fractures (usually also involving the crown) or transverse (often called horizontal) root fractures.
The article only discusses transverse root fractures. Its stated aim is to review the relevant literature regarding such root fractures in the permanent dentition and to provide guidelines for their management.
The article describes root fractures as requiring clinicians to have a thorough understanding of their etiology, healing responses, diagnosis, management, and prognosis. “Root fractures are not a very common injury to the teeth with studies reporting the proportion of root fractures amongst all dental injuries to range from 1.2% to 7.0% in the permanent dentition.”
Outcomes are said to be linked to the patient’s age, any degree of displacement of the coronal fragment, and the location and orientation of the fracture.
The article is divided into an introduction followed by sections on classification of root fractures, responses to fractures, prognosis, examination and diagnosis of root fractures, emergency management, and follow-up management.
Key overall points made in the article include that more apically located fractures have a better prognosis, while teeth with supracrestally located root fractures tend to have a worse prognosis. Also, fractures located in the apical and middle one-thirds and those subcrestally located in the coronal one-third of the root tend to have a good prognosis and usually need little, if any, treatment.
Root fractures in which the pulp is still viable require long-term monitoring and overall should be conservatively managed unless they are supracrestally located, according to the guidance. “Monitoring of root-fractured teeth over time is essential to determine the healing response and to assess whether the pulp survives or not,” the author wrote. “In some cases, the pulp in the coronal fragment may necrose and become infected, thus requiring root canal treatment but this should only be done to the fracture line.“
Also, as prognosis for pulp recovery is generally good, the guidelines advise that root canal treatment at emergency appointments should not occur.
The author closed the article by briefly addressing the instances for which root canal treatment is warranted, declaring that root canal treatment is only required in about one-quarter of the cases, as most pulps remain viable after root fractures.
Read the original article here or contact the ADA Library & Archives for assistance.
Regenerative endodontic therapy and tooth discoloration
A case series outlining different approaches in managing discoloration after regenerative/revitalization endodontic therapy (RET) aims to provide guidance to clinicians using the increasingly popular therapy to treat immature teeth with necrotic pulps. The article was published online May 25 in International Endodontic Journal.
“Despite the plethora of publications assessing different primary outcomes of RET, post-treatment side effects have not been well documented,” researchers wrote. “A recent survey questionnaire of UK pediatric dental specialists reported … post-RET crown discolouration to be the most reported sequelae (78% of respondents).”
The article describes dental materials linked to severe tooth crown discoloration before presenting details of 3 RET-related pediatric cases of crown discoloration. The authors wrote that a link exists between use of minocycline and mineral trioxide aggregate (MTA) and that some articles in the dental literature, therefore, report replacing MTA with other antibiotics or replacing antibiotics with calcium hydroxide.
“Discolouration following RET is primarily associated with the antibiotics used in root canal disinfection and the material used to establish the coronal seal,” the authors wrote. “Therefore, the current guidelines recommend substituting MTA with a bismuth-free MTA, in addition to using bi-antibiotic paste.”
The article discusses management of 3 cases of discoloration after RET, including highlighting limitations and providing advice for improving esthetic outcomes in the growing child patient until “more definitive restorative management options are possible.”
The cases include a 15 year-old girl who experienced trauma to tooth no. 11 3 days before she sought treatment after colliding with a lamp post; a 9-year-old boy in need of management for tooth no. 22; and a 14-year-old girl treated after developing a draining sinus affecting tooth no. 21.
In each case, clinicians worked with the patients to provide interventions that improved tooth color to levels the patients deemed acceptable.
The authors noted that local and regional laws governing use of whitening products in children may complicate use of such products in treating discoloration after RET, specifically noting the European 2011 Cosmetic Products Safety Amendment Regulations.
Points of the article that the authors identified as key include appropriately warning patients before obtaining treatment consent that discoloration after RET is highly likely, a number of methods that consider material choices and their methods of use may reduce crown discoloration after RET, and carbamide peroxide bleaching and direct composite veneers offer effective, low risk conservative discoloration management.
Read the original article here or contact the ADA Library & Archives for assistance.
Essential Dental Seminars announces additional dates and national courses in your area
Essential Dental Seminars two-day seminars helps dentists better understand how to tackle those tough endodontic cases. These intense courses focus on hands-on techniques, gives the attendees the opportunity to learn from leading endodontists and educators. Attendees will “learn by doing” in this newly renovated and upgraded hands-on facility.
For complete information, course dates and dozens of attendee testimonials, please visit www.essentialseminars.org.
Endodontics CE in San Francisco
With over 350 CE courses being offered at ADA FDI 2019 the scientific program offers attendees a wide selection of specialty courses to choose from. Join us in San Francisco September 4-8 and consider registering for the following Endodontic courses:
- 6167 — The Endo-Antral Connection: Maxillary Sinusitis and Endodontic Disease
- 7156 — Endodontics in General Practice- How Can We Achieve Optimal
Register today at ADA.org/meeting.
ADA CE Online Courses
Need CE? ADA CE Online has hundreds of hours of CE that you can earn from the comfort of your own home. Too many to choose from? Take them all! Get unlimited access to the entire ADA CE online library, including JADA, for one year from purchase. Access anywhere, anytime. With new courses being added every month, you’ll never run out of education opportunities. Group subscriptions are also available, check it out now!
Explain how root canal can save a tooth
Most patients need guidance to understand the specifics of root canal, such as why the pulp needs to be removed and why merely extracting the tooth is not the best answer. The ADA’s time-tested brochure, “Root Canal Treatment Can Save Your Tooth,” conveys these points in a patient-friendly way, with step-by-step illustrations. The brochure also motivates patients to follow through with a permanent restoration.
“Root Canal Treatment Can Save Your Tooth” is an 8-panel brochure sold in packs of 50. Brochure sample can be viewed here. The brochure is also available in Spanish or personalized versions. To order, call 800.947.4746 or go to adacatalog.org. Readers who use the code 19433E before August 9 can save 15 percent on all ADA Catalog products.
Episode 1 of Endo Voices is now available
In the first episode of Endo Voices by the American Association of Endodontists, we take a deep dive into the practices and philosophy of restorative endodontics, highlighting the restorative dynamic and its significance within endodontics. We sit down with well-respected and influential endodontic superstars, Drs. Marga Ree and Rick Schwartz, both with years of experience as restorative dentists before committing to careers in endodontics. Listen and subscribe at aae.org/endovoices.
The consulting editor for JADA+ Specialty Scan — Endodontics is Dr. Susan Wood, Diplomate, American Board of Endodontics. |
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