Igor Tsesis

Diagnosis of Vertical Root Fractures in Endodontically Treated Teeth Based on Clinical and Radiographic Indices: A Systematic Review

INTRODUCTION The diagnosis of vertical root fracture (VRF) is at times complicated for lack of specific signs, symptoms, and/or radiographic features. The purpose of this study was to systematically search and evaluate the literature regarding the diagnostic accuracy of clinical signs and symptoms and radiographic indices for the diagnosis of VRF in endodontically treated teeth by means of a systematic review. METHODS An exhaustive literature search combined with strict inclusion and exclusion criteria was undertaken to identify clinical studies that assessed the diagnosis of VRF. RESULTS There is no substantial evidence regarding the accuracy of the clinical and radiographic indices for the diagnosis of VRF in endodontically treated teeth. CONCLUSIONS Evidence-based data concerning the diagnostic accuracy and clinical effectiveness of clinical and radiographic dental evaluation for the diagnosis of VRF in endodontically treated teeth are lacking. The need for evidence-based research efforts to elucidate the currently unknown situation is of utmost significance.

Outcome of Surgical Endodontic Treatment Performed by a Modern Technique: A Meta-analysis of Literature

INTRODUCTION Numerous studies dealing with the outcome of surgical endodontic treatment have been published. However, study design, treatment protocols, follow-up periods, and inclusion and exclusion criteria are extremely variable. Thus, variable and confusing results have been reported. The aim of the present study was to assess the outcome of surgical endodontic treatment performed with a modern technique and to evaluate factors influencing the outcome by means of a meta-analysis. METHODS An exhaustive literature search combined with strict inclusion and exclusion criteria was undertaken to identify prospective case series or randomized clinical trials that deal with surgical endodontic treatment. RESULTS A successful outcome in a follow-up of more than 1 year postoperatively was 91.6%. Age, gender, tooth type, root-end filling material, and magnification type had no significant effect on the proportion of success. CONCLUSIONS Surgical endodontic treatment done by using a modern technique is a predictable treatment. Additional large-scale prospective clinical studies are needed to evaluate possible predictors of success and failure.

Outcomes of Surgical Endodontic Treatment Performed by a Modern Technique: An Updated Meta-analysis of the Literature

INTRODUCTION Numerous studies on outcomes of surgical endodontic treatment have been published to date. However, study designs, treatment protocols, follow-up periods, and inclusion and exclusion criteria have been extremely heterogeneous. Thus, inconsistent and confounding results have been reported. The aim of this systematic review of the literature was to assess the outcomes of surgical endodontic treatment performed using a modern technique, and to evaluate factors potentially influencing the outcome. METHODS Strict inclusion and exclusion criteria were adopted in order to identify randomized clinical trials, controlled trials, and prospective case series that studied surgical endodontic treatments. Treatment success rates were pooled, and the effect of various factors on treatment outcomes was evaluated. RESULTS In a follow-up of 1 year postoperatively, a successful outcome was achieved in 89.0% of patients. The outcomes obtained in studies using an operative microscope versus an endoscope were not significantly different, but both magnification devices were associated with significantly better outcomes than loupes. The use of MTA and of an operative microscope was associated with better outcomes compared with other retrofilling materials or magnification devices, respectively. CONCLUSIONS Surgical endodontic treatment performed in a modern technique is a viable treatment option. The type of retrofilling material and magnification device may affect the outcome. Additional large-scale prospective clinical studies are needed to further evaluate possible predictors of success and failure.

Comparison of digital with conventional radiography in detection of vertical root fractures in endodontically treated maxillary premolars: an ex vivo study

OBJECTIVE The purpose of the present study was to compare the diagnostic ability of conventional intraoral film radiography and a charged-coupled device (CCD) sensor in detecting vertical root fractures (VRF) in endodontically treated single-rooted extracted human maxillary premolars. STUDY DESIGN The study consisted of 60 extracted single-rooted endodontically treated maxillary premolars: 30 with clinically confirmed VRF (experimental group) and 30 with no VRF (control group). An intraoral CCD sensor and conventional Kodak Insight Film were used. Two observers evaluated the digital and conventional radiographs twice with an interval of 4 weeks. Specificity and sensitivity for each radiographic technique were calculated and subjected to statistical analysis. Kappa values were calculated for intra- and interobserver agreement. Fishers exact test was used to evaluate detection of VRF. The overall differences in sensitivity and specificity between radiographic techniques were evaluated by McNemar test. RESULTS The specificity of the digital system was significantly better (P = .016) for the second observer at the first reading. There were no significant differences in sensitivity and specificity for both observers between the 2 systems for other readings (P > .05). CONCLUSIONS No difference was found between the intraoral CCD sensor and conventional radiography in detecting vertical root fractures for single rooted maxillary premolars ex vivo.

Effect of Guided Tissue Regeneration on the Outcome of Surgical Endodontic Treatment: A Systematic Review and Meta-analysis

INTRODUCTION The use of guided tissue regeneration (GTR) techniques has been proposed as an adjunct to endodontic surgery in order to promote bone healing. Studies assessing the added benefits of GTR for the outcome of endodontic surgery are significantly variable in their treatment protocols, follow-up periods, and inclusion criteria, thus generating inconsistent and confusing results. The aim of this study was to evaluate the influence of GTR on the outcome of surgical endodontic treatment by means of a systematic review of the literature and meta-analysis. METHODS An exhaustive literature search combined with strict inclusion and exclusion criteria was undertaken to identify clinical studies that assessed the added benefit of GTR in endodontic surgery. RESULTS A trend of better outcome was found when GTR was used compared to control cases, but the results were not statistically significant. Lesion size, lesion type, and membrane type were identified as factors significantly affecting the outcome of GTR versus control cases. GTR techniques favorably affected the outcome of surgical endodontic treatments in cases of large periapical lesions and through-and-through lesions. A favorable outcome was found when using a resorbable membrane over using a nonresorbable membrane or graft alone. CONCLUSIONS GTR techniques may improve the outcome of bone regeneration after surgical endodontic treatments of teeth with certain lesions. Additional large-scale prospective clinical studies are needed to further evaluate possible benefits of GTR techniques in endodontic surgery.

Taurodontism: an Endodontic Challenge. Report of a Case

Taurodontism is a morphoanatomical change in the shape of a tooth, which usually occurs in multirooted teeth. An enlarged body and pulp chamber, as well as apical displacement of the pulpal floor, are characteristic features. Endodontic treatment of a taurodont tooth is challenging, because it requires special care in handling and identifying the number of root canals. A case of endodontic treatment of a maxillary first molar with taurodontism is presented.

Risk Management in Endodontics

INTRODUCTION Endodontic claims are the most frequently filed malpractice claims in dentistry. The aim of this study was to categorize and review errors and complications related to endodontic procedures that resulted in legal actions against the treating practitioner. METHODS All dental malpractice complaints reported to the Medical Consultants International Company (MCI) in Israel between the years 1992-2008 were retrospectively analyzed according to a structured form. All complaints were categorized as either financial risk bearing (eg, justified) or financial non-risk bearing (eg, nonjustified). The treatment errors that were found in the files were categorized according to phases of treatment: preoperative, intraoperative, and postoperative errors. RESULTS A total of 720 complaints were analyzed including 520 complaints (72.2%) that were found to be justified and 200 complaints (27.8%) that were judged as not justified. Most of the treatment errors occurred during the intraoperative phase. In lower anterior teeth and in cases involving more than 1 tooth, significantly more errors were found during instrumentation and root canal filling (P < .05). There was a similar distribution of operator errors and of negative outcomes for teeth with elective endodontic treatment and teeth with endodontic treatment as a result of a pathologic process. CONCLUSIONS The technical skills of the dental practitioners performing root canal treatments require improvement. All possible risks and complications should be considered and explained to the patient before treatment.

Prevalence and Associated Periodontal Status of Teeth with Root Perforation: A Retrospective Study of 2,002 Patients' Medical Records

INTRODUCTION Various procedures along the course of an endodontic treatment may lead to perforations. The prognosis of perforated teeth depends on perforation location, perforation size, and time from occurrence. The aim of this study was to retrospectively evaluate the prevalence of root perforations and associated pathological changes in the adjacent periodontal tissues. METHODS Full periapical status surveys and medical records of 2,002 patients with a total of 56,175 teeth were evaluated. RESULTS Of a total of 5,048 root canal-treated teeth, 116 root perforations were identified in 101 patients. Associated pathological changes in the adjacent periodontal tissues were identified in 81 teeth with perforations. The patients age, perforation location and size, and tooth type significantly influenced the occurrence of perforation associated periodontal damage. CONCLUSIONS When a perforation occurs, the main treatment goal is to prevent long-lasting injury to the periodontium. Better knowledge of the prevalence of perforations and their possible predictors may assist the clinician in the prevention and treatment of iatrogenic root perforations.

The Diagnostic Efficacy of Cone-beam Computed Tomography in Endodontics: A Systematic Review and Analysis by a Hierarchical Model of Efficacy

INTRODUCTION The aim of this study was to evaluate the diagnostic efficacy of cone-beam computed tomographic (CBCT) imaging in endodontics based on a systematic search and analysis of the literature using an efficacy model. METHODS A systematic search of the literature was performed to identify studies evaluating the use of CBCT imaging in endodontics. The identified studies were subjected to strict inclusion criteria followed by an analysis using a hierarchical model of efficacy (model) designed for appraisal of the literature on the levels of efficacy of a diagnostic imaging modality. RESULTS Initially, 485 possible relevant articles were identified. After title and abstract screening and a full-text evaluation, 58 articles (12%) that met the inclusion criteria were analyzed and allocated to levels of efficacy. Most eligible articles (n = 52, 90%) evaluated technical characteristics or the accuracy of CBCT imaging, which was defined in this model as low levels of efficacy. Only 6 articles (10%) proclaimed to evaluate the efficacy of CBCT imaging to support the practitioners decision making; treatment planning; and, ultimately, the treatment outcome, which was defined as higher levels of efficacy. CONCLUSIONS The expected ultimate benefit of CBCT imaging to the endodontic patient as evaluated by its level of diagnostic efficacy is unclear and is mainly limited to its technical and diagnostic accuracy efficacies. Even for these low levels of efficacy, current knowledge is limited. Therefore, a cautious and rational approach is advised when considering CBCT imaging for endodontic purposes.

Diagnosis of artificially induced external root resorption using conventional intraoral film radiography, CCD, and PSP: an ex vivo study.

OBJECTIVE To compare diagnosis of artificially induced external root resorption cavities using conventional intraoral film radiography (Kodak Insight), CCD sensor (Sopix wireless) and PSP sensor (Orex Digident). STUDY DESIGN Two mandibles were obtained from cadavers and teeth extracted from their alveolus. Artificial external root resorptions were simulated using ISO 0.5 mm, 0.8 mm, and 1.2 mm diameter round burs by drilling to the entire depth in different locations at the cervical, middle, and apical thirds of the proximal and buccal root surfaces of 6 teeth in increasing order. Conventional and digital radiographs were obtained from 3 different views of each tooth in 3 steps (small = 0.5 mm; medium = 0.8 mm; and large = 1.2 mm diameter round burs). Three observers examined all images for the presence of resorption cavities. In the first session, each image was evaluated separately; in the second, examiners had access to all views. Data were statistically analyzed using 4-way analysis of variance. Pair-wise comparison between receptors, projection views, size, and location were made by Tukey test. RESULTS Higher proportions of correct readings were obtained with the conventional film (Kodak Insight) and CCD receptor compared with the PSP receptor used in this study (PSP < CCD <or= Film; P < .001). Best results were obtained when examiners had access to all views. Most difficult locations in determining true diagnosis were the apical regions. Highest correct readings were obtained at the proximal cervical regions. CONCLUSION Conventional intraoral film and CCD sensor produced similar results in diagnosing simulated external root resorption.