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Aim: Post‐operative pain may occur after non‐surgical root canal treatment (NSRCT). The root filling technique and choice of sealer may be contributing factors. This randomized controlled clinical trial compared post‐operative pain and analgesics intake after NSRCT using a sealer‐based obturation technique (SBO) with single‐cone gutta‐percha and calcium silicate sealer (CSS) versus a warm‐vertical compaction (WVC) technique with gutta‐percha and a resin‐based sealer (RBS). Methodology: This study was designed as a parallel‐two arm, double‐blind, randomized superiority clinical trial registered at www.clinicaltrials.gov (NCT04753138). Patients referred for NSRCT fulfilling the inclusion criteria participated in this study. Pre‐operative periapical radiographs and CBCT scans were taken and numerical rating scale (NRS) pain scores were recorded. Upon completion of canal instrumentation, participants were randomly allocated to either Group SBO: SBO with CSS or Group WVC: Warm‐vertical compaction with RBS. Post‐operative pain and analgesics intake were recorded at 1, 3 and 7 days after endodontic treatment completion. Non‐parametric Mann–Whitney U and Friedman tests and a generalized estimating equation were used to assess differences in pain scores between the groups, within each treatment group at different time points and for correlations, respectively. Results: The study included 195 participants (212 teeth). One participant declined to submit the NRS form. Therefore, 194 participants (211 teeth) were included in the final analysis (99.5% response rate). No statistically significant differences in post‐operative pain or analgesic intake existed between the two groups at any time point (p >.05). Age, pre‐operative pain, apical diagnosis and post‐operative analgesic intake were significantly related to post‐operative pain (p <.05). Conclusions: Sealer‐based obturation technique with CSS was associated with similar post‐operative pain levels and analgesics intake as WVC with RBS. Regarding post‐operative pain, SBO with CSSs may be a suitable clinical alternative. [ABSTRACT FROM AUTHOR]

Aim: To evaluate clinical and radiographic outcome of endodontic microsurgery in through‐and‐through periapical lesions at 1‐year and 5‐year follow‐up with adjunct use of platelet‐rich plasma (PRP). Methodology: Thirty‐two patients with large through‐and‐through periapical lesions were randomized in platelet‐rich plasma (PRP) group and control group. Two‐dimensional (2D) healing was evaluated with Molven's criteria and three‐dimensional (3D) healing with modified PENN 3D criteria. Healing at resection plane (R), apical area (A), buccal cortex (BC), palatal cortex (PC) and overall bone healing (B) was assessed using CBCT scans. The volume of lesion was measured using ITK‐Snap software. The analysis included comparison of 1‐ to 5‐year intragroup (Friedman test/McNemar test) and intergroup scoring (Chi‐square/ Mann–Whitney test). Logistic regression analysis was performed to determine the effect of various factors on healing at 5 years. Results: Out of 32 patients/59 teeth evaluated after 1‐year of endodontic microsurgery, 24 patients/44 teeth reported at 5 ‐ year follow‐up. Healing assessment with modified PENN 3D criteria revealed improvement in overall success rate of 66.7% at 1 year to 83.3% at 5 years, with no deterioration in any healing category. PRP group exhibited significantly better 3D healing than control group; both at 1 year (84.6% vs. 45.5%) and 5 years (100% vs. 63.6%). A significantly higher number of completely healed teeth were observed in PRP group than the control group at 5 years with respect to R, BC and B parameters. A volume reduction of 88% (91.4% PRP, 84% control) was depicted at 1 year and 94% (97.1% PRP, 91.1% control) at 5 years. None of the recorded factors including age, gender, size of lesion, preoperative swelling and sinus, histology of lesion, use of PRP, tooth location, preoperative buccal bone had significant effect on 3D healing at 5 years. Conclusions: This 5‐year study suggested improvement in 3D radiographic healing of large through‐and‐through periapical lesions from 1 to 5 years with no deterioration in any healing parameter in both control and PRP groups. The additional use of PRP led to significantly better healing in such lesions. RACB index using CBCT allows better estimation of healing at resected, apical and cortical plane over modified PENN 3D or Molven's criteria. [ABSTRACT FROM AUTHOR]

Aim Methodology Results Conclusions To evaluate whether supplemental information from CBCT changed long‐term prognosis for teeth with external cervical resorption (ECR) compared to periapical (PA) images. Furthermore, to assess predictive findings in PA images and evaluate which findings in CBCT affected the long‐term prognosis of teeth with ECR.One hundred and ninty‐four patients, mean age 41.2, range 13–81, having 244 teeth with ECR were included. An initial long‐term prognosis determined either good or poor was established based on intraoral images. Afterwards, the patients underwent CBCT, and final long‐term prognosis was decided. From the PA images and CBCT, ECR using Heithersay's classification system, pulp involvement and extension of ECR was assessed. In CBCT, the number of surface lesion(s) was additionally assessed. Descriptive statistics evaluated changes in long‐term prognosis after CBCT. Logistic regression analyses tested if findings in PA images and CBCT affected the long‐term prognosis.Based on CBCT, out of 244 teeth the long‐term prognosis was assessed to be poor for 173 (70.9%) teeth and good for 71 (29.1%) teeth. The long‐term prognosis changed in 76 (31.1%) teeth after CBCT; 5 (2.0%) changed from poor to good, and 71 (29%) changed from good to poor long‐term prognosis. In 81 (33.2%) teeth the H‐class increased, and in 10 (4.1%) teeth the H‐class decreased after assessing CBCT. In 70 (28.7%) teeth, there was a change from no pulp involvement to involvement of the pulp after CBCT; eight (3.3%) teeth changed in the opposite direction. H‐class 2 and 4 in PA images significantly increased the probability for a change in long‐term prognosis compared to an H‐class 3 (p < .05). H‐class 4, pulp involvement, ECR in the oral 1/3 of the root, and more than two surface lesions seen in CBCT significantly influenced a poor long‐term prognosis (p < .05).Supplemental information from CBCT changed long‐term prognosis in almost one third of teeth with ECR. In most cases, the long‐term prognosis changed from good to poor. H‐class 3 in PA images had a significant influence on change in long‐term prognosis. Several findings in CBCT influenced a poor long‐term prognosis. [ABSTRACT FROM AUTHOR]

Aim: To evaluate the indication of the endodontic treatment for vital intact teeth with the root apex involved in large radicular cystic lesions of endodontic origin. Methodology: This prospective cohort study enrolled healthy participants with radicular cysts of endodontic origin and with the root apex of vital intact teeth involved in the bone defect, as determined by cone beam computed tomography (CBCT). Thirty‐two sound vital teeth were analysed by thermal (TPT) and electric pulp tests (EPT) before surgery (T0) and 1 week (T1), 2 weeks (T2), 3 months (T3) and 6 months (T4) post‐surgery. Student's t‐test (p <.05) was used to compare the EPT values at baseline and T4. anova (p <.05) was used to analyse the EPT variations for all maxillary and mandibular teeth. McNemar test (p <.05) was used to compare the results according to variation in EPT values gathering by variation, no variation and no response. Results: At T1, 75 and 65.7% of teeth responded positively whilst 25 and 34.3% did not respond to EPT and TPT, respectively. The variation of the EPT values between T0 and T1 was observed for 50.0% of teeth, whilst no variation was noticed in 25.0% of teeth. At T4, 90.6 and 87.5% of teeth responded positively whilst 9.4 and 12.5% did not respond to EPT and TPT, respectively. At T4, variation of the EPT values between T0 and T4 was observed for 28.1%, whilst no variation was noticed in 62.5% of teeth. There were no statistical differences in EPT results between T0 and T4 (p >.05), but significant differences were observed for EPT values between T1 and T4 (p <.05), and between mandibular and maxillary teeth. The pulp sensibility of maxillary teeth worsened after surgery, before reverting progressively to T0 values, whilst no statistically significant differences were observed for mandibular teeth at the different time points. Conclusions: These data support the inconsistence of the prophylactic endodontic treatment in healthy vital teeth with apex involvement in large cystic lesions of endodontic origin. Post‐surgery follow‐up with TPT and EPT is recommended to assess pulp status. [ABSTRACT FROM AUTHOR]

Aim: This study investigated the adoption of cone‐beam computed tomography (CBCT) by dentists and endodontists around the world, including their preferences in endodontic CBCT usage. Methodology: An online questionnaire surveyed dental association members in Australia and New Zealand, and endodontic association members in Australia, Britain, Canada, Italy, New Zealand and the USA, about their CBCT training history, considerations in acquisition/interpretation, access to and usage of CBCT, preferred scan interpreter, and preferred endodontic scan settings. Data were analysed with Chi‐squared, independent sample t‐tests, Cochran's Q and McNemar's tests. Results: Responses from 578 endodontic specialists or postgraduates (Group E) and 185 non‐endodontic dentists (Group NE) were included. Continuing professional education (CPE) was the most common source of CBCT training (69.2%). Factors considered in CBCT acquisition/interpretation included beam hardening (75.4%), radiation exposure (61.1%) and patient movement (58.3%). Group E reported higher CBCT usage (90.8%) than Group NE (45.4%, p <.001) and greater workplace access to CBCT (81.1% vs. 25.9%, p <.001). Scans were interpreted by the respondent in most workplace scans (83.3%) and externally taken scans (60.5%); Group E were significantly more likely to interpret themselves than Group NE. Small field of view (83.6%) and high resolution (86.6%) were most preferred as settings for endodontic CBCTs; Group NE were less likely to choose these settings. There were some geographic variations within Group E. Conclusions: CBCT training was most commonly acquired via CPE. Endodontic respondents reported very high CBCT usage and access in the workplace. There are educational implications regarding CBCT limitations, appropriate applications and interpretation. [ABSTRACT FROM AUTHOR]

Aim: Several factors influence the condition of the periapical tissues associated with root filled teeth. The primary objective of this study was to retrospectively evaluate the extent and speed of bone healing of large periapical lesions associated with nonsurgical root canal treatment or retreatment. The secondary objective was to analyse the relationship between the time to complete healing when analysed using cone beam computed tomography (CBCT) and other possible predictors that affect healing. Methodology: Seventy‐nine patients were treated during the years 2013–2020 with large periapical lesions of endodontic origin (10–15 mm) as observed on intraoral periapical radiographs (IOPAR) were included. IOPAR and CBCT were available before treatment and during the follow‐up (IOPAR every 6 months and CBCT every 12 months). The volume of periapical lesions was calculated by OsiriX Lite software. Variables such as initial volume of the lesion, age, gender, type of treatment or type of root canal filling were compared to identify the differences between healed and unhealed lesions. Pearson's Chi‐square test was used for categorical variables, the t‐test for age and the Wilcoxon test for initial volume of the lesion. The association between time to healing and the variables was assessed using univariate analysis and multivariate analysis. The Wilcoxon test was used to observe the association of healing time with categorical variables and the correlation index was measured with the quantitative variables. Results: Of the 79 cases analysed, 60 lesions (76%) were completely healed as verified by CBCT in a mean healing time of 19 months, of which 60% healed fully between 12 and 18 months. Increase in age of patient and larger initial volume of the lesion were associated with a significantly longer healing time (p <.001). Gender, filling material and type of treatment did not have a significant effect on the healing process (p >.05). Conclusions: Clinicians should be aware that periapical lesions in older patients and larger areas of bone loss take longer to heal. CBCT monitoring of large periapical lesions is critical and it can help clinicians in the decision‐making process. [ABSTRACT FROM AUTHOR]