Search

Objectives: To assess the efficiency of AI methods in finding radiographic features in Endodontic treatment considerations. Material and methods: This review was based on the PRISMA guidelines and QUADAS 2 tool. A systematic search was performed of the literature on cases with endodontic treatments, comparing AI algorithms (test) versus conventional image assessments (control) for finding radiographic features. The search was conducted in PubMed, Scopus, Google Scholar and the Cochrane library. Inclusion criteria were studies on the use of AI and machine learning in endodontic treatments using dental X-rays. Results: The initial search retrieved 1131 papers, from which 24 were included. High heterogeneity of the materials left out a meta-analysis.The reported subcategories were periapical lesion, vertical root fractures, predicting root/canal morphology, locating minor apical foramen, tooth segmentation and endodontic retreatment prediction. Radiographic features assessed were mostly periapical lesions. The studies mostly considered the decision of 1–3 experts as the reference for training their models. Almost half of the included materials campared their trained neural network model with other methods. More than 58% of studies had some level of bias. Conclusions: AI-based models have shown effectiveness in finding radiographic features in different endodontic treatments. While the reported accuracy measurements seem promising, the papers mostly were biased methodologically.

Vital pulpabehandling utförs för att bevara pulpans försvarsfunktioner och därmed undvika pulpektomi och rotfyllning som kan vara tekniskt krävande och inte alltid ger önskat resultat. European Society of Endodontology (ESE) har publicerat ett positionsdokument avseende vitalbehandling av tänder med djupa karieslesioner vilket delvis överensstämmer med de nationella riktlinjerna i de nordiska länderna. Det finns svårigheter när det gäller att bedöma pulpans status i tänder med djupa karieslesioner. Så länge karieslesionen inte har nått pulpan rekommenderas behandlingar som utförs för att undvika exponering av pulpan, såsom stegvis exkavering. Å andra sidan, när pulpan exponerats på grund av karies, skiljer sig rekommendationerna något åt mellan ESE och de nationella riktlinjerna i de nordiska länderna. Detta beror troligen på avsaknad av evidens som talar för fördelar av den ena behandlingen framför den andra och på grund av svårigheterna att bedöma vilka exponerade pulpor som är irreversibelt skadade. Minimalinvasiva behandlingsstrategier som använder sig av nyligen utvecklade hydrauliska kalciumsilikatcement visar lovande resultat vid vitalbehandling av pulpa. Vital pulpabehandling vidareutvecklas och förändringar i de kliniska rekommendationerna är att förvänta., Vital pulp treatments (VPT) are performed to preserve the defense functions of the pulp, and thus to avoid pulpectomy and root filling, which can be technically demanding and do not always result in the desired outcome. The European Society of Endodontology (ESE) has published a position paper on VPT in teeth with deep carious lesions, which partly s to national guidelines in Nordic countries. There are unsolved difficulties in assessing the pulpal status in teeth with deep carious lesions. If the carious lesion has not reached the pulp, treatments performed to avoid pulp exposure, such as stepwise excavation, are recommended. On the other hand, when the pulp is exposed due to caries, the recommendations vary between the ESE and the national Nordic countries guidelines. This is most probably due to the lack of evidence favoring one treatment over the other, and due to difficulties in assessing, which exposed pulps are irreversibly damaged. Minimally invasive management strategies with recently developed hydraulic calcium silicate cements show promising results for VPTs aimed at avoiding root canal treatment. VPTs will be further developed and changes to clinical recommendations are anticipated.

I indeværende litteraturgennemgang har jeg kigget på tilstedeværende litteratur både vha. søgeord på pubmed og gennem litteraturlister i andre studier. Inden resultatgennemgangen har jeg gennemgået kort, hvad den gode rodbehandling er, generelt om indirekte og direkte restaureringer samt konsekvenser ved tandtab som følge af forkert terapeutisk beslutning. I resultatsektionen har jeg set på faktorer i forbindelse med tandoverlevelsen af rodbehandlede tænder. Specifikt for patienten: alder, køn og systemiske sygdomme. Her så jeg, at stigende alder, det mandlige køn og forekomsten af systemiske sygdomme som hjerte-kar-sygdomme og hypertension, gav en stigende tanddødelighed. Faktorer som behandlerens erfaring viste en påvirkning på overlevelsen i nogle studier og ikke i nogle andre, hvor antallet af nødbesøg på 2 eller flere ifm. udførelse af rodbehandlingen havde negativ effekt på tandoverlevelsen, og hvor antallet af besøg oversteg 4 sås også negativ effekt. Herefter fandt jeg i resultaterne en række tandspecifikke faktorer og deres påvirkning. Tandens placering i tandrækken havde negativ påvirkning på overlevelsen, jo mere distalt i tandrækken, tanden stod. Antallet af approksimale kontakter havde en positiv effekt på tandoverlevelsen, hvis der var flere kontakter. Tandens efterfølgende funktion var der delte meninger om, hvor nogle mente, at en efterfølgende funktion som protesebærende tand eller bropilletand øgede dødeligheden, hvor andre ikke kunne finde samme sammenhæng. Ved mængden af resttandsubstans fandt jeg, at et øget antal af vægge og tilstedeværelse af ferrule øger tandoverlevelsen. I forhold til forekomsten af infraktioner viste forfatterne, at tænderne bør restaureres med indirekte restaureringer, for at øge tandoverlevelsen. Den pulpale og periapikale status har før vist en dårligere overlevelse, men resultaterne har sidenhen ikke kunne reproduceres. Nogle forfattere fandt ikke en påvirkning på overlevelsen af den rodbehandlede tand som følge af den, In this literature review, I have looked at existing literature both using search terms on PubMed and through literature lists in other studies. Before the results review, I have briefly reviewed what good root canal treatment is, generally about indirect and direct restoration as well as the consequences of tooth loss because of an incorrect therapeutic decision. In the results section, I have looked at factors specific to the patient: age, gender, systemic diseases. Where increasing age, the male gender and the occurrence of systemic diseases such as cardiovascular diseases and hypertension, results in an increasing dental mortality. Factors such as the practitioner's experience had no effect on survival, where the number of emergency visits in relation to the root canal had a negative effect if the number exceeded 5 or more visits. I then found in the results several tooth-specific factors and their influence. The position of the tooth in the tooth row had a negative effect on survival, the more distally in the tooth row the tooth was. The number of proximal contacts had a positive effect if there were more. There were divided opinions on the tooth's subsequent function, with some believing that a subsequent function such as a denture-bearing tooth or bridge tooth increased mortality, while others could not find the same correlation. Regarding the amount of residual tooth substance, I found that an increased number of walls and presence of ferrule increases tooth survival. Regarding the incidence of infractions, the authors showed that they should be restored with indirect restorations to increase tooth survival. The pulpal and periapical status previously showed poorer survival, but the results have since been unable to be reproduced. Some authors did not find an effect on the survival of the root-treated tooth due to the apical extension of the root filling, while other authors found that a root filling that was as long as or slightly shorter than the root had

Objectives: The objective was to examine the effect of giving Artificial Intelligence (AI)-based radiographic information versus standard radiographic and clinical information to dental students on their pulp exposure prediction ability. Methods: 292 preoperative bitewing radiographs from patients previously treated were used. A multi-path neural network was implemented. The first path was a convolutional neural network (CNN) based on ResNet-50 architecture. The second path was a neural network trained on the distance between the pulp and lesion extracted from X-ray segmentations. Both paths merged and were followed by fully connected layers that predicted the probability of pulp exposure. A trial concerning the prediction of pulp exposure based on radiographic input and information on age and pain was conducted, involving 25 dental students. The data displayed was divided into 4 groups (G): GX-ray, GX-ray+clinical data, GX-ray+AI, GX-ray+clinical data+AI. Results: The results showed that AI surpassed the performance of students in all groups with an F1-score of 0.71 (P < 0.001). The students’ F1-score in GX-ray+AI and GX-ray+clinical data+AI with model prediction (0.61 and 0.61 respectively) was slightly higher than the F1-score in GX-ray and GX-ray+clinical data (0.58 and 0.59 respectively) with a borderline statistical significance of P = 0.054. Conclusions: Although the AI model had much better performance than all groups, the participants when given AI prediction, benefited only ‘slightly’. AI technology seems promising, but more explainable AI predictions along with a 'learning curve' are warranted.

Algeng orsök bráðra heimsókna til tannlæknis er meinafræðilegar breytingar sem eiga upptök sín í kviku eða umrótarvefjum. Til að hægt sé að veita ásættanlega bráðaþjónustu er mikilvægt að tannlæknir hafi góða þekkingu á greiningu og mismunargreiningu. Vegið mat á sjúkrasögu, klínísk skoðun og nauðsynleg röntgenrannsókn skipta verulegu máli fyrir greiningu. Ekki ætti að beita ífarandi aðgerðum án þess að greining liggi fyrir. Helstu markmið við bráðameðferð eru gjarnan verkjastilling og að ná tökum á hugsanlegri sýkingu. Parasetamól hentar vel við vægum til meðalmiklum verkjum. Nota skal bólgueyðandi verkjalyf (NSAID-lyf) í stað parasetamóls eða sem viðbótarlyf ef bólga er til staðar. Ef miklir verkir eru til staðar eða ef nægileg verkjastilling næst ekki með ofangreindum aðferðum er mælt með viðbótarmeðferð með ópíóíðum. Til að stöðva framgang sýkingar skal í byrjun íhuga að skera á bólgu, opna inn á krónu og hleypa grefti út gegnum rótargöng, eða fjarlægja tönnina. Sýklalyf skal einungis nota ef sýkingin dreifir sér eða hefur áhrif á almennt heilbrigði sjúklings. Ef þörf er á sýklalyfjameðferð skal byrja á að gefa penisillín V (ef sjúklingur er með ofnæmi fyrir PcV skal nota klindamýsín)., Pathology originating from the pulp or periradicular tissue is a common cause for emergency visits to dental clinics. Having a good knowledge of diagnostics and differential diagnostics is of crucial importance for adequate emergency care. Of great importance for the diagnosis is a weighted assessment of the anamnesis, the clinical examination and the required X-ray examination. Without diagnosis, no invasive procedures should be performed. The treatment in the acute situation may in many cases be focused on pain relief and possible infection control. Suitable analgesics for mild to moderate pain is paracetamol. If there is an inflammatory component, non-steroidal anti-inflammatory drugs (NSAIDs) should be used as an alternative or as a supplement. In case of severe pain or if sufficient pain relief is not achieved, supplementation with opioids is recommended. For infection control, incision of any swelling, trepanation of the crown and drainage through the root canals or extraction should be considered in the first instance. The indication for antibiotics is limited to when the general condition is affected or if the infection is spreading. In cases where antibiotic treatment is considered, penicillin V (clindamycin when PcV allergy) is a first-line drug.

Aim: This historical prospective cohort study of the adult population of Sweden is based on data from a national registry: the primary aim was to evaluate the long-term survival of teeth after periradicular surgery. A secondary aim was to identify factors predictive of extraction within 10 years of registration of periradicular surgery. Methodology: The cohort consisted of all individuals who had undergone periradicular surgery to treat apical periodontitis, as reported to the Swedish Social Insurance Agency (SSIA) in 2009. The cohort was followed until 31 December 2020. Subsequent registrations of extractions were collected for Kaplan–Meier survival analyses and survival tables. The patients' sex, age, dental service provider and tooth group were also retrieved from SSIA. Only one tooth per individual was included in the analyses. Multivariable regression analysis was used and p <.05 was considered statistically significant. The reporting guidelines STROBE and PROBE were followed. Results: After data cleaning, and exclusion of 157 teeth, 5622 teeth/individuals remained for analysis. The mean age of the individuals at the time of the periradicular surgery was 60.5 years (range 20–97, standard deviation 13.31); 55% were women. At the end of the follow-up, that is, up to 12 years, a total of 34.1% of the teeth had been reported as extracted. The multivariate logistic regression analysis, based on follow-up data at 10 years after registration of the periradicular surgery, included 5548 teeth, of which 1461 (26.3%) had been extracted. Significant associations between the independent variables tooth group and dental care setting (both p <.001) and the dependent variable extraction were found. The highest odds ratio (OR) for extraction applied to tooth group: compared to maxillary incisors and canines, mandibular molars were at greatest risk of extraction (OR 2.429, confidence interval 1.975–2.987, p <.001). Conclusions: After periradicular surgery in predomin

Aim: This historical prospective cohort study of the adult population of Sweden is based on data from a national registry: the primary aim was to evaluate the long-term survival of teeth after periradicular surgery. A secondary aim was to identify factors predictive of extraction within 10 years of registration of periradicular surgery. Methodology: The cohort consisted of all individuals who had undergone periradicular surgery to treat apical periodontitis, as reported to the Swedish Social Insurance Agency (SSIA) in 2009. The cohort was followed until 31 December 2020. Subsequent registrations of extractions were collected for Kaplan–Meier survival analyses and survival tables. The patients' sex, age, dental service provider and tooth group were also retrieved from SSIA. Only one tooth per individual was included in the analyses. Multivariable regression analysis was used and p <.05 was considered statistically significant. The reporting guidelines STROBE and PROBE were followed. Results: After data cleaning, and exclusion of 157 teeth, 5622 teeth/individuals remained for analysis. The mean age of the individuals at the time of the periradicular surgery was 60.5 years (range 20–97, standard deviation 13.31); 55% were women. At the end of the follow-up, that is, up to 12 years, a total of 34.1% of the teeth had been reported as extracted. The multivariate logistic regression analysis, based on follow-up data at 10 years after registration of the periradicular surgery, included 5548 teeth, of which 1461 (26.3%) had been extracted. Significant associations between the independent variables tooth group and dental care setting (both p <.001) and the dependent variable extraction were found. The highest odds ratio (OR) for extraction applied to tooth group: compared to maxillary incisors and canines, mandibular molars were at greatest risk of extraction (OR 2.429, confidence interval 1.975–2.987, p <.001). Conclusions: After periradicular surgery in predominant

I forbindelse med nødbehandling er det vigtigt at lindre smerte, at få kontrol over infektionen og at lægge en plan for den videre behandling. En korrekt diagnose forudsætter en god anamnese, klinisk undersøgelse og røntgenop- tagelser. Hvis pulpa ikke er inficeret, er konservativ behandling som fx gradvis ekskavering at foretrække. Hvis pulpa er inficeret og har irreversibel inflammation, er der behov for invasiv endodontisk behandling. Hvis der er begrænset tid til rådighed, kan man nøjes med en oplukning, også i tilfælde med nekrose, men kun hvis der ikke er hævelse eller pus. Antibiotikum skal kun ordineres, hvis der er systemisk påvirkning, og kun i kombination med endodontisk behandling., Pathological changes originating from the pulp or periradicular tissue is a common cause for emergency visits to dental clinics. Having a good knowledge of diagnostics and differential diagnostics is of crucial importance for adequate emergency care. Of great importance for the diagnosis is a weighted assessment of the anamnesis, the clinical examination and the required X-ray examination. Without diagnosis, no invasive procedures should be performed. The treatment in the acute situation may in many cases be focused on pain relief and possible infection control. Suitable analgesics for mild to moderate pain is paracetamol. If there is an inflammatory component, non-steroidal anti-inflammatory drugs (NSAIDs) should be used as an alternative or as a supplement. In case of severe pain or if sufficient pain relief is not achieved, supplementation with opioids is recommended. For infection control, incision of any swelling, trepanation of the crown and drainage through the root canals or extraction should be considered in the first instance. The indication for antibiotics is limited to when the general condition is affected or if the infection is spreading. In cases where antibiotic treatment is considered, penicillin V (clindamycin when PcV allergy) is a first-line drug.

En vanlig orsak till att patienter söker för akuta besvär från munhålan är patologi utgående från pulpa eller periradikulär vävnad. Att ha god kännedom om diagnostik och differentialdiagnostik är av avgörande betydelse vid omhändertagandet. I många fall är tandsmärta ett svar på bakteriellt inducerad pulpainflammation eller på en efterföljande infekterad rotkanal associerad med akut periapikal inflammation. Givet bristen på tid kan målet med akutbehandling vara begränsat till att uppnå smärtlindring eller infektionskontroll samt en plan för ett uppföljningsbesök., Pathology originating from the pulp or periradicular tissue is a common cause for emergency visits to dental clinics. A good knowledge of diagnostics and differential symptoms is crucial for adequate emergency care. A weighted assessment of the anamnesis, the clinical examination and associated X-ray examination are also important contributors to the diagnosis, without which, no invasive procedures should be performed. Treatment in the acute situation often focuses on pain relief and potential infection control. A suitable analgesic for mild to moderate pain is paracetamol. If there is an inflammatory component, non-steroidal anti-inflammatory drugs (NSAIDs) should be used as an alternative or supplement. In cases of severe pain or if sufficient pain relief is not achieved, inclusion of opioids are recommended. For infection control, incision of any swelling, trepanation of the crown and drainage through the root canals or extraction should be considered in the first instance. The indication for antibiotics is limited to when the general condition is affected or if the infection is spreading. In cases where antibiotic treatment is considered, penicillin V (clindamycin when PcV allergy) is a first-line drug.

Vitaalin pulpan hoidon tarkoituksena on säilyttää pulpan puolustustoiminnot sekä välttää juurihoito, joka voi olla teknisesti haastava eikä aina onnistu toivotusti. ESE (European Society of Endodontology) on julkaissut suosituksen liittyen vitaalin pulpan hoitoon hampaissa, joissa on syviä kariesvaurioita. Suositus on osittain yhteneväinen Pohjoismaissa käytössä olevien kansallisten suositusten kanssa.

Vitale pulpabehandlinger udføres med henblik på at bevare pulpas forsvarsfunktioner og undgå pul- pektomi og rodfyldning, som kan være teknisk ud- fordrende og ikke altid fører til det ønskede resultat. The European Society of Endodontology (ESE) har publiceret en statusrapport om vital pulpabehand- ling i tænder med profunde carieslæsioner, som i et vist omfang stemmer overens med de nationale retningslinjer i de nordiske lande. Der er stadig pro- blemer med at vurdere pulpas tilstand i tænder med profunde carieslæsioner. Så længe carieslæsionen ikke har nået pulpa, anbefales behandlinger, der sigter på at undgå pulpaeksponering, fx gradvis eks- kavering. Men når pulpa er eksponeret på grund af caries, er der ikke overensstemmelse mellem anbefalingerne fra ESE og de nordiske landes na- tionale retningslinjer. Dette skyldes sandsynligvis manglende evidens for bedre effekt af én behand- ling frem for andre samt vanskeligheder med at afgøre, hvornår pulpa er irreversibelt beskadiget. Minimalt invasive behandlingsstrategier med ny- udviklede hydrauliske calciumsilikatcementer har vist lovende resultater af vital pulpabehandling med henblik på at undgå rodkanalbehandling. Konceptet er under stadig udvikling, og man må forvente, at de kliniske anbefalinger på sigt bliver ændret.

Pathology is the science of how a tissue changes during the process of the disease. The pathology is of important knowledge for understanding subsequent treatment concepts of a disease. In the cariology field, pathological features of caries are often presented using tooth sections, whereby the sequence and spread can be monitored. It is optimal to describe such changes using thin undecalcified tooth sections as an overview can be given of both enamel demineralization and pulp-dentine reactions. Also, an optimal understanding is achieved if the clinical status of carious lesion activity is known. Different studies using human teeth have shown the principle changes in progressive stages of carious lesions; the growth of the enamel lesion reflects the growth condition of the cariogenic biofilm. Surprisingly, the pulp (the odontoblast) is aware of the cariogenic stimuli even before mineral alteration has taken place within the dentine. The microorganisms mainly invade the dentine during enamel cavitation. In this chapter, the current improvement of knowledge on advanced carious lesions has been assessed in detail both histologically and radiographically. From a radiographic point of view, well-defined deep and extremely deep carious lesions and their difference are presented. Recent advances in artificial intelligence (AI) in medicine have raised the possibility of increasing the accuracy and speed of histopathological examination techniques. However, the literature involving AI-based histopathological features of hard and soft dentinal tissue pathologic changes is still scarce.

För att minska kunskapsluckorna inom odontologin krävs samarbete mellan lärosätena. Det ger även möjlighet till akademisk meritering, vilket är angeläget då antalet seniora forskare med behörighet för forskningshandledning i Sverige är färre än någonsin. EndoReCo (Endodontic Research Collaboration) är ett skandinaviskt forskningsnätverk i endodonti som kan ta del av just dessa fördelar.

Aims (a) The aim of this study was to investigate both the formation of dense connective tissue within the dental pulp, and its association with pulpal inflammation in teeth with advanced carious lesions; and (b) to investigate in vitro whether inflammation affects the expression of markers related to chondrogenesis/osteogenesis in pulp cells. Materials and methods Radiology and Histology: Forty-six teeth with advanced carious lesions were radiographically investigated for intra-pulpal radiodense structures. Specimens were processed for histology and stained with haematoxylin/eosin and proteoglycan-specific stains. The intra-pulpal connective tissue was scored as pulp stones or ectopic connective tissue. Cell culture: pulpal cells from human third molars (n = 5) were cultured in chondrogenic medium +/- TLR2/4 agonists. Expression of the genes IL6, TLR2/4, SOX9, COL1A1, COL2A1, TGFB1, RUNX2 and ALPL was assessed by qPCR. Proteoglycan content within cultures was assessed spectrophotometrically. Results Radiodense structures were discovered in about half of all pulps. They were associated with ectopic connective tissue (chi(2) = 8.932, p = .004, OR = 6.80, 95% CI: [1.84, 25.19]) and with pulp stones (chi(2) = 12.274, df = 1, p < .001, OR = 22.167, 95% CI: [2.57, 200.00]). The morphology of the ectopic tissue resembled cartilage and was associated with inflammatory infiltration of the pulp (chi(2) = 10.148, p = .002, OR = 17.77, 95% CI: [2.05, 154.21]). After continuous stimulation of cultured cells with TLR2/4 agonists, the expression of two inflammatory markers increased: IL6 at Days 7 (p = .020) and 14 (p = .008); TLR2 at Days 7 (p = .023) and 14 (p = .009). Similarly, expression of chondrogenic markers decreased: SOX9 at Day 14 (p = .035) and TGFB1 at Day 7 (p = .004), and the osteogenic marker COL1A1 at Day 7 (p = .007). Proteoglycan content did not differ between unstimulated and stimulated cells. Conclusions Ectopic connective tissue resembling cartilage ca

Rodfyldningens længde har sammen med tandens periapikale status en signifikant betydning for behandlingsresultatet, hvorfor det er vigtigt med en optimal rodfyldningslængde. Litteraturen foreslår forskellige pejlemærker for det endelige rodmål, herunder den apikale konstriktion, den apikale foramen og cement-dentin-grænsen. Det viser sig, at den apikale konstriktion giver de mest optimale forhold for heling, hvorfor den apikale konstriktion er i fokus i dette speciale. Litteraturen præsenterer forskellige metoder til bestemmelse af det endelige rodmål, herunder den elektrometriske og radiografiske metode, som hhv. udnytter den elektriske apekslokator og røntgenbilleder. Begge metoder er forbundet med fordele og ulemper, dog fremhæver litteraturen, at den elektrometriske metode er mere nøjagtig. Specialet har således til formål at undersøge nøjagtigheden bag den elektrometriske versus radiografiske metode til bestemmelse af den apikale konstriktion vha. apekslokatorerne Propex II og Raypex 6. Forskellen i præcisionen af Propex II og Raypex 6 samt det endelige rodmål bestemt jævnfør producentens anvisning og kalibreringsmetoden undersøges ligeledes. Specialet er baseret på et ex-vivo studie på 10 ekstraherede overkæbe molarer. Hertil blev tænderne lukket op, biomekanisk udrensning jf. standard protokol i den palatinale kanal udført og det endelige rodmål bestemt ved ovennævnte måder. Tænderne blev afslutningsvist inspiceret under stereomikroskop til lokalisering af fillængden ift. den apikale konstriktion. Baseret på Wilcoxon Signed Rank Test viste undersøgelsen, at der ikke var en signifikant forskel mellem den elektrometriske og radiografiske metode og heller ikke mellem de nævnte apekslokatorer eller hvorvidt producentens anvisning eller kalibreringsmetoden anvendes. Inspektion under stereomikroskop bekræftede i alle 10 tilfælde en tæt relation til den apikale konstriktion ved den elektrometriske måling., The root filling length has together with the preoperative diagnosis a significant influence on the treatment outcome. This explains why it’s important to have an optimal working length. The literature proposes different landmarks for the endodontic working length, including the apical constriction, apical foramen and cemento-dentinal-junction (CDJ). It appears that the apical constriction promotes for better healing, therefore apical constriction is in focus in this thesis. The literature introduces different methods for determining the working length, including the electrometric and radiographic method which utilizes the electronic apex locator and x-rays respectively. Hence, this thesis was carried out to examine the precision of the electrometric and radiographic method in terms of locating the apical constriction. The difference in precision for Propex II and Raypex 6 apex locators and the working length determined by following the manual instructions and the calibrating method was examined too. Ex-vivo study on 10 extracted maxillary molars was conducted. Endodontic access was prepared, biomechanical instrumentation in the palatal root was conducted following the standard protocols and the working length was determined by all abovementioned methods. The study samples were finally analyzed for actual working length with a stereo microscope to locate the file tip according to the apical constriction. Based on a Wilcoxon Signed Rank Test the study demonstrated that there was no statistical significant difference between the electrometrical and radiographic method, neither between the two apex locators nor whether the manual instructions or the calibrating method was used in terms of working length determination. Inspection under microscope showed close proximity to the apical constriction for all samples by the electrometrical method.

Maintaining healthy pulp tissue and preventing apical periodontitis form the basis of minimally invasive, biologically based vital pulp treatment (VPT). This chapter aims to analyse current evidence on VPT, including the defensive response of the dentine-pulp complex to irritation and the diagnosis and management of teeth with deep carious lesions and pulp exposures. The American Association of Endodontists endorsed the currently accepted classification of pulpal disease in 2013, describing pulpitis as either reversible or irreversible depending on clinical signs and symptoms. An indirect pulp therapy addresses the excavation of deep carious dentine aiming to avoid pulp exposure. Although several factors influence the outcome of VPT, a principle determinant is the preoperative inflammatory state of the pulp, with carious pulpal exposures generally having a less favourable outcome than traumatic or mechanical exposures. Notably, in extremely deep carious lesions, there is ‘radiographic evidence of caries penetrating the entire thickness of the dentine with certain pulp exposure’.

En ny metodik «guidet endodonti», der sammenkobler overfladescanning med en 3-dimensionel røntgenskanning, conebeam-computeriseret tomografi (CBCT), introduceres med særlig henblik på endodontisk indikation, det vil sige lokalisation af den radiologisk delvise eller komplette oblitererede rodkanal. Teknikken er primært anvendt i frontregionen i forbindelse med enten traume-kompromitterede tænder eller generelt ved ældre patienter, hvor der også kan ses delvis eller komplet obliteration. Årsag og forekomst af obliteration af rodkanalen gennemgås kort. De kliniske erfaringer og komplikationsmuligheder omtales ved konventionel endodontisk oplukning af tænder med obliteration, og hvor indikationen er rodinfektion med radiologisk apikal opklaring til følge. Ved «guidet endodonti» skal både en overfladeskanning og en CBCT-skanning benyttes til den virtuelle forberedelse af den planlagte udboring af roden. Teknikken i forbindelse med en guidet udboring af en tand med radiologisk obliteration gennemgås, og desuden omtales muligheden for at anvende teknikken til molarer. Sidstnævnte er relevant, eftersom de fleste rodbehandlinger i dag udføres på molarer. Kliniske studier der sammenligner konventionelle oplukningsscenarier med den guidede teknik er dog stadig relevante.

3D endodontic guide or endoguide is a template fabricated to guide drills into pre-planned positions for localization and exploration of root canal orifices or bone trephination and root end resection. It is method of static navigation in Endodontics. Using specialized software, the cone beam computed tomography (CBCT) data and corresponding intra-oral/model surface scan data are superimposed in specialized software and virtual drill path is created to explore pulp canal obliteration (PCO) and three-dimensional (3D) printing is done. As very few companies have customized software for endodontic guide planning and designing, implant softwares are used This chapter explains important aspects of endodontic guide, terminologies, guide planning and designing with software.

Pulp canal obliteration (PCO) is characterized by the deposition of hard tissue within the root canal space. This chapter gives a brief account of the significant characteristics of the partially and complete pulp canal obliteration of anterior teeth. Workflow of static guidance for nonsurgical endodontic treatment has been described in detail along with case reports. Review of literature of published case reports has been delineated. Clinical application of endodontic guide and canal scouting technique are crucial for successful guide endodontic case.

BACKGROUND: Traditionally, cavitated carious lesions and those extending into dentine have been treated by 'complete' removal of carious tissue, i.e. non-selective removal and conventional restoration (CR). Alternative strategies for managing cavitated or dentine carious lesions remove less or none of the carious tissue and include selective carious tissue removal (or selective excavation (SE)), stepwise carious tissue removal (SW), sealing carious lesions using sealant materials, sealing using preformed metal crowns (Hall Technique, HT), and non-restorative cavity control (NRCC).OBJECTIVES: To determine the comparative effectiveness of interventions (CR, SE, SW, sealing of carious lesions using sealant materials or preformed metal crowns (HT), or NRCC) to treat carious lesions conventionally considered to require restorations (cavitated or micro-cavitated lesions, or occlusal lesions that are clinically non-cavitated but clinically/radiographically extend into dentine) in primary or permanent teeth with vital (sensitive) pulps.SEARCH METHODS: An information specialist searched four bibliographic databases to 21 July 2020 and used additional search methods to identify published, unpublished and ongoing studies. SELECTION CRITERIA: We included randomised clinical trials comparing different levels of carious tissue removal, as listed above, against each other, placebo, or no treatment. Participants had permanent or primary teeth (or both), and vital pulps (i.e. no irreversible pulpitis/pulp necrosis), and carious lesions conventionally considered to need a restoration (i.e. cavitated lesions, or non- or micro-cavitated lesions radiographically extending into dentine). The primary outcome was failure, a composite measure of pulp exposure, endodontic therapy, tooth extraction, and restorative complications (including resealing of sealed lesions).DATA COLLECTION AND ANALYSIS: Pairs of review authors independently screened search results, extracted

Prevention of apical periodontitis begins with the evaluation of whether the pulp can be preserved or not. Endodontics as a discipline holds the key for providing optimal “pulpal care”. This chapter deals with the dilemma of correctly diagnosing the pulpal status in deep caries. It addresses the biological platform for understanding why the dentine pulp complex is able to produce a hard tissue barrier. Deep lesions with risk of pulp exposure during caries removal should be better defined by added information on progression stage and penetration depth, lesion activity and estimated length of progression time. Caries is the common reason for performing root canal treatments, particularly in vital cases, and is a main cause of pulp inflammation. Based on published data, it is possible to make simulated scenarios for establishing a cost-effectiveness analysis of various vital pulp therapies.

Introduction: The knowledge of patient-centered outcomes concerning the consequences of root canal treatment in daily life is limited. The treatment option is often tooth extraction with possible prosthetic replacement. This study aimed to achieve a greater understanding of the patient perspective by evaluating the effect of root canal treatment in terms of quality of life and quality-adjusted life year (QALY) weights in comparison with patients who underwent tooth extraction. Methods: Patients with either root canal treatment or extraction were recruited from 6 clinics in the general public dental service during a predetermined period of 8 weeks. Three different instruments were used: the Oral Health Impact Profile evaluating the oral health–related quality of life (OHRQOL), the EQ-5D-5L evaluating health-related quality of life (HRQOL) and QALY weights, and a disease-specific questionnaire evaluating satisfaction regarding the root canal treatment. The evaluation was assessed at the initiation of treatment and after 1 month. Patient-based and tooth-specific characteristics were obtained from the dental records. Results: Eighty-five patients were included. The distribution between sexes was even, with 43 women and 42 men. The mean age was 51.1 years. Forty-eight patients (56.5%) had a tooth extraction, and 37 patients (43.5%) initiated root canal treatment. The response rate for the questionnaire at baseline was 95.3%, and at the 1-month follow-up, it was 74.1%. Two relevant and comparable groups were obtained after exclusion of the extracted third molars (n = 20), resulting in 65 patients for further analyses. At follow-up, the patients who initiated root canal treatment registered a significant improvement in perceived HRQOL according to the QALY weights (P =.02 and P <.01, respectively). Patients initiating root canal treatment reported generally high satisfaction. Conclusions: A cohort of patients either initiating root canal treatment or tooth extraction

Data sources Embase, MEDLINE, Web of Science, Trip Pro, Cochrane Library, the International Clinical Trials Registry Platform and ClinicaTrials.gov, including a grey literature search. Study selection Randomised or quasi-randomised clinical trials (RCT). Data extraction and synthesis Two reviewers screened independently and extracted data separately with focus on study and population characteristics, treatment, pulp capping materials and clinical and radiographical outcome measures. Incremental cost effective ratios were collated. Results Seventeen studies reported in 21 articles were included. Three were completed trials and one ongoing trial comparing (partial/full) pulpotomy with other interventions for vital pulp therapy. The remaining 13 studies compared hydraulic calcium silicate cements with calcium hydroxide. Only three studies were considered as low risk of bias, except for performance bias (the inherent impossible task of blinding the clinician). Five trials comparing the capping materials were the basis of a quantitative synthesis. No cost-effectiveness studies were found. Conclusions Firm evidence has not been reached with respect to pulpotomy being the preferred intervention substituting root canal treatment; however better pulpotomy outcomes were reported when hydraulic calcium silicate cements are used, when compared to procedures where calcium hydroxide was used.

Aim: To report the precision of guided access cavity preparations in relation to demographical and dental variables in 50 patients. Methodology: This observational study was carried out during the period 2014–2017. The patients were consecutive referrals to a private endodontic practice. The inclusion criteria were as follows: (i) pulp space obliteration associated with signs of apical periodontitis (PAI score >3 or sensitive to percussion, (ii) teeth with pulp space obliteration in need of a post, where the referring dentist had attempted or failed to negotiate the obliterated root canal (and it was not possible to negotiate using the operating microscope within a reasonable time frame) and (iii) a surgical intervention was not justified. A published methodology for guided endodontics was used. Measures on demographical and previous dental history were analysed and related to drill path precision, being evaluated on radiographs as optimal (centre of the root canal) or acceptable (peripheral/tangential). The chi-square test was used for analyses of correlation between predictor variables and binary logistic regression analysis using backward elimination with degree of obliteration, guided access cavity preparation depth and precision as dependent variables. Significance level was 0.05. Results: Thirty-one female (median age 65 year) and 19 males (median age 69 year) were enrolled. Overall, 88% (n = 44) of the teeth had pulp space obliteration associated with signs of apical periodontitis, whereas the remaining teeth were in need of a post. The pulp space obliterations were longer in maxillary compared with mandibular teeth (P = 0.024). The performance of the drill path in mandibular teeth versus maxillary teeth resulted in a significantly greater number of optimal precision scores (P = 0.033), and when a previous attempt at access and canal negotiation had occurred versus no attempt (P = 0.009). Even in cases with the worst outcome, the technique was still suc

Bacterial biofilm infections often involve aggregates of bacteria heterogeneously distributed throughout a tissue or on a surface (such as an implanted medical device). Identification of a biofilm infection requires direct visualization via microscopy, followed by characterization of the microbial community by culturing or sequencing-based approaches. A sample, therefore, must be divided prior to analysis, often leading to inconsistent results. We demonstrate a combined approach, using scanning electron microscopy and next-generation shotgun sequencing, to visually identify a biofilm and characterize the microbial community, without dividing the sample. A clinical sample recovered from a patient following a dental root-filling procedure was prepared and visualized by scanning electron microscopy. DNA was then extracted from the sample several years later and analyzed by shotgun sequencing. The method was subsequently validated on in vitro cultures of Pseudomonas aeruginosa biofilm. Between 19 and 21 different genera and species were identified in the clinical sample with an estimated relative abundance greater than 1% by two different estimation approaches. Only eight genera identified were not associated with endodontic infections. This provides a proof-of-concept for a dual, microscopy and sequencing-based approach to identify and characterize bacterial biofilms, which could also easily be implemented in other scientific fields.

Objective: To systematically review the quality of evidence of available in vitro solubility studies on endodontic sealers according to prespecified evidence criteria. Material and methods: This systematic review was based on the PRISMA guidelines and the AMSTAR measurement tool. A systematic duplicate search of the literature on endodontic sealer solubility studies was conducted in PubMed and Embase databases (until 18 October 2017). Mapping terms to subject headings and free text terms were used and combined with hand searching before exclusion of duplicates. Studies specifically dealing with endodontic sealer solubility were selected. The evidence level was graded (low, medium or high) independently by two investigators following systematic data extraction in pilot forms, which was based on prespecified evidence criteria and the modified CONSORT checklist for in vitro studies on dental materials. Results: The search retrieved 1053 articles, from which 88 were assessed in full. From the 63 articles retained in the final analysis, 11 were classified as having moderate and 52 as low quality of evidence (0 high). The studies graded as low had low sample size (n < 10) and/or insufficient details to allow replicability. Most of the studies did not conform to the modified CONSORT checklist and did not include parameters considered relevant in the prespecified criteria. Conclusions: Existing in vitro studies on the solubility of endodontic sealers do not demonstrate a high quality of evidence. Most of these studies do not present systematic reporting nor employ relevant parameters prespecified in our evidence criteria.