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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 predominantly elderly people in Sweden, approximately three‐quarters of the teeth are retained over a 10‐year period. The type of tooth is associated with extraction: mandibular molars are at greater risk of extraction than maxillary incisors and canines. [ABSTRACT FROM AUTHOR]

The aim of this case report was to show the concept of guided endodontics in a maxillary first molar with limited interocclusal space. Guided endodontics involves merging cone-beam computed tomographic imaging and a surface scan of the tooth in order to create a guide to perform a drill path into the seemingly obliterated root canal. In the molar region, the interocclusal space is often too small to accommodate the guide, bur, and handpiece at once, and, therefore, a modified approach is presented. A 52-year-old man was referred because the dentist had failed to localize the distobuccal root canal of a maxillary molar (#3) associated with apical pathosis. After reopening and rubber dam placement, a glide path was established for both the palatal first mesiobuccal root canal and the second mesiobuccal using a size 10 hand file and coronal flaring. Further instrumentation to the working length was achieved by reciprocating file size 25. All 3 canals were temporarily filled with calcium hydroxide. For the distobuccal root canal, guided endodontics was chosen in order to avoid further impairment of the tooth because negotiation of the canal failed even with the use of the operating microscope. Following the merged data obtained from the cone-beam computed tomographic and surface scans, a translucent SICAT Optiguide (SICAT, Bonn, Germany) was constructed containing a sleeve representing the proper direction of a drill path in order to reach the distobuccal root canal. The access cavity was temporarily filled with a composite material made for light-curing. Before light curing, the Optiguide was replaced on the teeth, and a steel pin was pressed through the sleeve and the composite whereby the proper drill path direction was transferred into the composite. After polymerization and removal of the Optiguide and pin from the composite base sleeve, the guided drilling could be performed. This case report is the first on guided access preparation in a molar with pulp canal obliteration and limited interocclusal space. The demand for more interocclusal space was solved by transforming the virtual drill path into a composite-based intracoronal guide. The use of digital technology was essential. [ABSTRACT FROM AUTHOR]

Summary: Background: After root canal treatment, a choice is made between different coronal restorations which in the long run could affect the survival of the tooth. Objective: To compare demographic characteristics between individuals choosing an indirect coronal restoration (crown, inlay/onlay) and individuals choosing other restorations after completion of a root filling. Methods: The cohort consisted of all root‐filled upper first molars that were reported to the tax‐funded Swedish Social Insurance Agency (SSIA) during 2009. After registration of the root filling, any subsequent coronal restorations within 2 years were identified. The crown group consisted of individuals registered with an indirect coronal restoration and the restoration group was the remaining individuals with a direct coronal restoration or lacking registration. Demographic data (gender, disposable income, age, educational level, civil status and country of birth) were received from Statistics Sweden or the SSIA. Statistical analyses included chi‐square test, t test and logistic regression analysis. P < 0.05 was considered statistically significant. Results: An indirect coronal restoration was received by 7806 individuals (21.9%), and 27 886 individuals (78.1%) received a direct restoration. All demographic variables except gender differed significantly between groups. Logistic regression analysis found significant associations for all demographic variables and the registration of an indirect restoration except for country of birth and gender. Conclusions: The identified demographic differences between individuals choosing to restore their newly root‐filled teeth with an indirect restoration compared to those receiving other restorations may indicate that the tax‐funded Swedish dental insurance fails to provide dental care on equal terms for Swedish citizens. [ABSTRACT FROM AUTHOR]

Aim. The purpose of this study was to investigate the scanning and segmentation precision of surface models of molars for the detection of small volumes, such as the reduced pulp cavity; formation of mineral deposits; detection of narrow root canals and to improve the clinical and morphological understanding of the number of root canals and their configuration. Methods. Eighteen human molars were scanned using X-ray micro-computed tomography. The reconstruction of the surface models had a precision of <1 voxel, using three-dimensional software and quantitative color mapping. In order to relate the measurements to changes over time the size of the pulp chambers was classified in two well-defined groups. Results. The mineral deposits were more evenly distributed in small pulp chambers than in large, but complete root canal calcification was never observed. No difference was observed in the material with respect to the presence of intra-radicular connections. In upper molars, a second mesiobuccal canal (mb2) frequency of 91% was found. The difference in length between the first mesiobuccal canal (mb1) and mb2 was <1 mm. The number of root canals could be related to the number of root cones. Conclusion. In summary, three-dimensional surface models were made with a high precision; an increased accumulation of mineral deposits was noted in molars with small pulp chambers and combined with the consistent pattern of intra-radicular connections, the potential endodontic treatment complexity is underlined in such cases. Finally, an improved understanding of root canal prevalence was reached, when merging well-defined definitions on root morphology and clinical classification systems. [ABSTRACT FROM AUTHOR]

There is a gap between the endodontic outcome that can be achieved and the outcome observed on the basis of worldwide general dental practitioner data. The quality of root canal treatment (RCT) is shaped by the dentist's knowledge, attitude, and skills, but it may also be influenced by the patient's demands and degree of satisfaction. The topic has only been sparsely investigated. Although dental health has increased over the years in Denmark, the number of performed root fillings has also increased, probably because the number of tooth extractions have declined and more molar teeth have been treated. Caries appears to be the main cause for performing RCT and a preventive approach by employing stepwise excavation may reduce RCT, but this strategy does not remove the gap. Factors influencing RCT quality could be the status on adoption of nickel-titanium rotary technology, more focus on infection control (rubber dam use, knowledge of factors important for prognosis), as dentists often think that they are good at doing RCT, but often perform inadequately, an alteration of clinician's awareness of their performance in the context of dental practices, seems warranted. Finally, the development of new preventive modalities for pulp and apical inflammation are crucial. [ABSTRACT FROM AUTHOR]