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Objective: Healthcare providers of all disciplines are greatly affected by the opioid epidemic. In order to reduce the misuse of opioids in dentistry, we must understand its role in our profession. The aim of this study was to compare the opioid prescribing habits for the management of dental pain by periodontists, endodontists, and oral surgeons in the United States. The study investigated the factors associated with the opioid prescription practices of these dental specialists and identified the proportion of opioid prescriptions for each type of dental procedure provided. Methods: A 30-question anonymous survey using Qualtrics software was distributed electronically to periodontists, endodontists, and oral surgeons in the United States who had their email registered with the American Academy of Periodontology, American Association of Endodontists, and Accredited Advanced Education Programs in Oral Surgery member directory as of March 2020. The survey included questions about prescribing tendencies for specific procedures, rationale questions for choosing to prescribe or not to prescribe opioids, and demographic information. Results were analyzed using McNemar tests. Results: Emails were sent out to 4,528 periodontists, 3,962 endodontists, and 100 oral surgeons. A total of 574 responses from periodontists, 523 from endodontists, and 30 from oral surgeons were collected. Periodontists were significantly less likely to report prescribing opioids for less-invasive surgeries, such as extractions and crown lengthening, and more likely to prescribe for more complex procedures, such as ridge augmentation (p

Objectives: The management of endodontically treated teeth with apical periodontitis is debated among clinicians. The aim of this study was to evaluate treatment choices for endodontically treated teeth with different sizes of periapical lesions among endodontists, endodontics postgraduate students, general dental practitioners, and undergraduate students who had fulfilled their theoretical and clinical training in endodontics. Materials and methods: Periapical lesion images (no periapical lesion and 1-mm, 3-mm, and 5-mm periapical lesions) were formed on 4 different radiographs with a software program, and the survey included 16 radiographs that were emailed to 1881 participants. Treatment options included extraction, surgical or nonsurgical retreatment, and wait and see. The χ2 test was used to compare the responses of the participants. Results: The survey was returned by 1039 participants (55.23%). There were statistically significant differences among the responses of all participants for all cases (P < .05), except a case with a broken file and no lesion (P = .918). All participants decided to extract at an increased size from a 1-mm periapical lesion to a 5-mm periapical lesion. At all lesion sizes, general dental practitioners planned retreatment less when compared with other groups. Conclusions: This survey study showed that there was a positive correlation between endodontic education level and retreatment decision-making. Dentists who confront seemingly hopeless endodontically treated teeth such as an instrument fracture, a missing canal, or a large periapical lesion should consult with an endodontist before making the decision to extract the tooth.

Aim This report highlights the use of a seldom-used treatment modality to save a diseased multirooted tooth, as an alternative to extraction and implant. Background Root-resection therapy is a simple surgical procedure performed by an endodontist or periodontist to save a multirooted tooth with furcation involvement and/or defective root. Case description A 64-year-old female patient reported a strip perforation in the distobuccal (DB) root of the maxillary left first molar. The tooth had previously undergone endodontic treatment and had a well-fitted crown. After presenting the patient with treatment options and prognosis, a treatment plan of root amputation to save the tooth was formulated. A full mucoperiosteal flap was reflected. The DB root was amputated and GIC was placed to cover the root. Sutures were placed and the patient was given postoperative instructions. A follow-up was carried out with clinical examination, and periapical radiographs were taken at 10 months, 2 years, and 5 years after the procedure. The tooth was intact and functioning; no signs or symptoms were reported. Conclusion Root resection has a deserved place in the modern clinical management of endodontic lesions or injuries. Conventional conservative treatment plans can succeed with proper treatment planning, diagnosis, case selection, maintenance of oral hygiene, and meticulous follow-up. Clinical significance This case emphasizes a viable treatment procedure to manage teeth with compromised radicular or restorative presentations. Root resection is a venerable treatment option that is often ignored in the era of implants even though it shows favorable prognosis and success rates.

AIM To evaluate the outcome of surgical retreatment at four time points, that is 6, 12, 24 and 48 months post-operatively, and to search for prognostic factors that may affect the outcome. METHODOLOGY Clinical records and intraoral periapical radiographs were collected from patients who had undergone surgical retreatment between 2009 and 2015 and attended 6-, 12-, 24- and 48-month follow-up visits. Surgical retreatment was performed by one endodontist and involved minimal root-end resection and maximal length root-end preparation using prebent ultrasonic files. Outcomes were categorized as complete, incomplete, uncertain or unsatisfactory healing, based on clinical and radiographic findings. The complete and incomplete categories were pooled and considered successes, while uncertain and unsatisfactory outcomes were considered failures. Changes in healing outcome were analysed using the McNemar-Bowker test, and prognostic factors were analysed using univariate analysis. RESULTS The study cohort included 297 patients with 384 teeth. The overall success rate after 48 months was 90.6% compared with 88.5%, 93% and 92.4% after 6, 12 and 24 months respectively. Age, gender, presence of isthmus and length of canal preparation had no significant influence on the outcome. Lesion size and tooth type had a significant influence only after 6 and 12 months, respectively, with no significant differences at other time points. Fifty per cent of the teeth classified as unsatisfactory or uncertain healing at the 6 months follow-up improved to incomplete or complete healing after 12 months. None of the cases classified as unsatisfactory healing after 12 months subsequently improved, and only 2 cases that were classified as uncertain healing after 12 months improved after 24 months. CONCLUSIONS Surgical retreatment was found to be a predictable procedure with a high success rate of 90.6% after 4 years. Over the follow-up periods, only a minor regression in the success rate was found. The 12 months follow-up results closely indicated the long-term outcome of surgical retreatment.

Introduction Periapical images are routinely made in endodontics to support diagnosis and treatment decisions, but conventional imaging may not readily demonstrate inflammatory changes. This study aims to quantify disagreement in the radiologic interpretation of apical periodontitis/rarefying osteitis between 2 expert examiners and to determine if differences exist based on anatomic location. Methods We used 1717 pretreatment periapical images made before orthograde endodontic treatment as part of the Predicting Outcomes of Root Canal Treatment (PREDICT) study conducted within the National Dental Practice-Based Research Network. Periapical changes were assessed independently by 2 board-certified specialists, an oral and maxillofacial radiologist and an endodontist, blinded to other clinical information. If the examiners disagreed about whether a diagnosis of apical periodontitis/rarefying osteitis was justified, an adjudication was made by a third examiner. Results The overall prevalence of this radiologic diagnosis in the periapical images was 55%, and interexaminer agreement measured with the Cohen kappa statistic was calculated to be 0.56 (95% confidence interval, 0.52–0.60). Diagnostic disagreements between the 2 examiners occurred for 377 teeth (22%), with disagreements more frequent for jaw location (P = .038) and tooth type (P = .021). Differences between root number (P = .058) and jaw location and tooth groups (P = .069) were found not to be statistically significant. Conclusions The variability of diagnostic disagreements across anatomic location and tooth type may reflect the inability of periapical images to reveal bone changes masked by the complexity and density of overlying anatomic structures, a limitation that could potentially be overcome with the use of 3-dimensional imaging.

AIM To prospectively investigate the outcome of partial pulpotomy after 1 year, using a hydraulic calcium silicate cement (HCSC) on symptomatic cariously exposed pulps in adult teeth. To compare the traditional American Association of Endodontists (AAE) pulpitis classification with the recently proposed Wolters classification system in predicting the likelihood of treatment failure. METHODOLOGY Sixty-two symptomatic adult teeth with deep and extremely deep carious lesions were classified according to the Wolters (mild/moderate/severe pulpitis) and the traditional pulpitis classification (reversible/irreversible pulpitis). Eleven teeth were excluded intraoperatively as there was no pulp exposure after non-selective caries removal. The remaining 51 teeth, regardless of diagnosis, were treated by partial pulpotomy, pulpal lavage with 2.5% sodium hypochlorite solution, haemostasis and HCSC application (Biodentine™) as a pulp capping material. A permanent restoration was placed during a second appointment 1-2 weeks later. Preoperative tenderness to percussion (TTP), bleeding time and material setting time were recorded as was preoperative and postoperative tooth colour under standardized conditions. Clinical review occurred at regular intervals with clinical/radiographic analysis at 12 months. Chi-square analysis and Fisher's exact test assessed different outcomes amongst the diagnostic categories; the Kruskal-Wallis and Wilcoxon rank-sum test assessed influence of pulp bleeding time, TTP or variation in setting time (p

Background: The decision to save a compromised tooth is a major challenge among dentists and may vary among those with different areas of specialization. Objective: The objective of this study was to determine the influencing factors that play a role in decision-making trends when choosing whether or not to save a compromised tooth, either through endodontic treatment or extraction and implant placement. Methods: In this cross-sectional study, a questionnaire was administered to a convenience sample to assess decision-making within different dental specialties among various dental schools in Saudi Arabia. Participants were stratified into four groups based on clinical specialties, including endodontists (n = 45, 23.9%), periodontists (n = 51, 27.1%), prosthodontists (n = 55, 29.3%), and oral and maxillofacial surgeons (n = 37, 19.7%). The data of 188 participants were analyzed using Chi-square tests, with significance at p ≤ 0.05. Results: Endodontists were significantly more likely than other specialists (p ≤ 0.002) to decide to retain a compromised tooth rather than place an implant. In difficult prosthetic cases, faculty surgeons were significantly more likely to place an implant than other specialists (p ≤ 0.01). Conclusion: The assessment of decision-making trends demonstrated that retention of the natural tooth by endodontic and restorative treatments was preferred over extraction and implant placement. Increased prosthetic complexity shifted this preference towards implant placement. This study provides a basis to help identify factors contributing to decision-making among dental professionals; these factors could improve existing guidelines to ensure a successful practice.

The aim of this case series was to describe the endodontic management of 3 immature permanent teeth that sustained traumatic injuries and subsequently presented with complete ingrowth of mineralized tissue into the canal space. Ingrowth of bone/mineralized tissue into the canal has been considered a poor long-term outcome with an inherent risk of ankylosis. In cases 1 and 2, no endodontic treatment was undertaken, except for emergency management requiring splinting. The cases were followed for 36 and 23 months, respectively. No ankylosis was evident over the review period, and normal teeth eruption was apparent. In case 1, the tooth was treated orthodontically and was responsive to pulp sensibility testing. In both cases, there was an appearance of an internal periodontal ligament–like space on the inner root wall of the canal. In case 3, 2 years postinjury, pulp necrosis and apical periodontitis occurred, and the tooth was managed with regenerative endodontic treatment consistent with the European Society of Endodontology and the American Association of Endodontists guidelines/recommendations for a regenerative procedure. The case was followed for 8 years after regenerative endodontic treatment. No ankylosis was noted with normal eruption of the teeth. The tooth was responsive to pulp sensibility testing despite the ingrowth of mineralized tissue, which was confirmed clinically.

Background: The aim of this study was to evaluate the radiographic technical quality of root fillings and the incidence of iatrogenic errors in treatments performed by endodontists and dentists.Methods: 1135 radiographic records of endodontic treatments performed by endodontists and dentists were qualified to be further investigated. Radiographs were assessed by two independent endodontists. The length and the density of the obturations and iatrogenic errors were investigated. Chi-square tests were used for statistics.Results: According to iatrogenic errors; the presence of instrument fractures was significantly higher in the endodontists, and likewise, in the mesiobuccal canals of the mandibular teeth (p0.05).Conclusion: The results of this retrospective study show that the canal treatment performed by endodontists were better in terms of the quality of the root canal filling than dentists., Amaç: Bu çalışmanın amacı, endodontistler ve dişhekimleri tarafından yapılan kanal tedavilerinde kök kanal dolgusununradyografik teknik kalitesini ve iyatrojenik hataların sıklığınıdeğerlendirmektir. Gereç ve Yöntemler:Endodontistler ve diş hekimleri tarafındanyapılan 1135 adet kök kanal tedavisi yapılan dişlerin röntgen kaydı çalışmayadahil edildi. Radyograflar iki uzman tarafından, kök kanal dolumlarınınboyu, radyoopasitesi ve iatrojenikhataların varlığı olacak şekilde değerlendirildi. Istatistiksel olarak ki-karetesti kullanılarak analiz yapıldı. Bulgular:İatrojenik hatalara göre; enstrümankırıklarının varlığı endodontistlerde ve benzer şekilde mandibular dişlerinmeziyobukkal kanallarında anlamlı olarak daha yüksek görüldü (p0.05). Sonuçlar:Bu retrospektif çalışmanın sonuçlarına göre,endodontistler tarafından uygulanan kök kanal tedavisinin, kök kanal dolgusukalitesi bakımından dişhekimlerinden daha iyi olduğunu göstermektedir.Anahtar Kelimeler:endodontist,diş hekimi, radyografik değerlendirme, retrospektif çalışma, iatrojenik hata

Pain is a common symptom in endodontic conditions, but differential diagnostic procedures are often needed to exclude other pain origins. General dentists and endodontists thus need to be aware of alternative painful orofacial conditions, and be able to identify them. The new International Classification of Orofacial Pain (ICOP, 2020) is the first comprehensive classification that uniquely deals with orofacial pain. The ICOP is a hierarchical classification, modelled on the International Classification of Headache Disorders (ICHD-3) and covers pain in dentoalveolar and anatomically related tissues, muscle pain, temporomandibular joint (TMJ) pain, neuropathic pain affecting cranial nerves, pain resembling primary headaches, and idiopathic pain in the orofacial region. A description of each condition is given, and structured diagnostic criteria for each condition are proposed based on research data when available. This narrative review aims to (i) give an overview and brief explanation of the ICOP system, (ii) describe and give examples of how it can be of use to general dentists and endodontists with special attention to differential diagnosis of tooth pain, and (iii) highlight how endodontic research can contribute to validation and improvement of the classification. A comparison to other classification and diagnostic systems is also included.

Objectives This study aimed to evaluate endodontists’ treatment approaches during the novel coronavirus disease (COVID-19) pandemic. Materials and Methods Web-based 16-question survey was sent to members of the Turkish Endodontic Society via social media and email between May 5 to 25, 2020, to obtain information about the members’ demographic characteristics and treatment approaches of seven cases considering COVID-19. The cases represented different endodontic diseases such as symptomatic apical periodontitis, chronic apical periodontitis, acute apical abscess, asymptomatic and symptomatic cases required retreatment, third molar tooth with endodontic symptoms, and symptomatic irreversible pulpitis. Statistical Analysis Statistical analysis was performed using a Chi-square test. The statistical significance was set at α = 0.05. Results Of the 203 respondents, 65.5% were females and 34.5% were males, 62.6% were endodontists and 37.4% were PhD students, 68% worked at a university, 21.2% worked at private clinics, and 10.8% worked at public clinics. Frequency of going to work was mostly once a week (31%). Most commonly performed treatments were “acute apical abscess (32.2%)” and “symptomatic irreversible pulpitis (30.8%).” The respondents most frequently preferred “to prescribe antibiotics and/or painkillers and postpone the treatment” in cases 1 and 6, “to follow-up” in cases 2 and 5, “to extract the tooth” in case 4, and “to start endodontic treatment but postpone the treatment by placing antibacterial medicament into the root canals” in cases 3 and 7 (p < 0.05). Conclusion During a pandemic, the general treatment approach for endodontic emergencies should be to eliminate acute symptoms and minimize the risk of transmission.

Background This study assesses and compares the knowledge level of endodontists (ENDs) and general dental practitioners (GPs) from Brazil and United States of America (USA) in the diagnosis and treatment of internal and external inflammatory root resorptions through periapical radiographic (PA) and cone beam computed tomography (CBCT) examinations. Material and Methods A cross-sectional online questionnaire-based survey was presented to the volunteers containing questions regarding personal and professional profile, as well as three clinical cases of internal and external inflammatory root resorption. A series of multiple-choice questions about the diagnosis and treatment options were surveyed. The data collected was analysed by the Chi-square test with Yates correction with a significance level of 5 %. Results Most answers were considered adequate when all three questions about the diagnosis and all two questions relating to the treatment were answered accurately. A total of 374 dentists answered the survey (n: 229 from Brazil vs. 145 from USA) being 41% END and 59% GP. END presented higher level of knowledge than GP regarding to diagnosis and treatment of inflammatory root resorptions both in Brazil and USA (p

An immature tooth with necrotic pulp and periapical pathology imposes a great difficulty to the endodontists. The case becomes more difficult when the clinician comes across a rare presentation of tooth morphology. Endodontic treatment options for such teeth consist of conventional apexification procedures. This article demonstrates the recent concept of mineral trioxide aggregate (MTA) apical plug technique, for the management of a single rooted immature second molar with a single continuous canal. Keywords: Apexification, apical plug, mineral trioxide aggregate, necrotic teeth with immature apices. Abbreviations: CH-Calcium Hydroxide, MTA-mineral trioxide aggregate.

Root resorption of the tooth is defined as a pathologic or physiologic process resulting in loss of hard tissue such as root dentin, cementum and bone. Root resorption is of two types external and internal root resorption. Management of internal root resorption has always been a challenge to the endodontists. It may occur in cases with chronic pulpal inflammation, following caries or due to traumatic injuries. Prevalence of internal root resorption is more in anterior teeth, because of their susceptibility to trauma. For successful treatment outcome early diagnosis, removal of the cause, proper treatment of the resorbed root is mandatory. This paper summarizes the management of internal root resorption through two cases of non-perforating and perforating internal resorption, which were successfully managed and showed good healing after a follow up of 6 months to 1 year. Keywords: Root resorption, Nonperforating internal root resorption, Perforating internal root resorption.

Background and Objective. Management of immature permanent teeth exhibiting necrotic pulp is clinically challenging. An appropriate diagnosis, case selection, and good management ensure good outcomes. The objective of this review reviews all up-to-date data in regard to endodontic regeneration therapy in the management of immature permanent teeth with necrotic pulp and which conducts are most used and appropriate for this procedure in human and animal investigations. Materials and Methods. The electronic databases PubMed and Google Scholar were used to search the literature for relevant studies after applying specific inclusion and exclusion criteria. Studies that fulfilled both the inclusion and exclusion criteria were included in this systematic review. The search was conducted by two independent reviewers following the PRISMA guidelines. Results. Only 46 studies that fulfilled both the inclusion and exclusion criteria, which were conducted within the last 10 years, were included in this systematic review. These studies investigated different aspects of regenerative endodontic therapy including different types of scaffolds, intracanal medications, pulpal space/barriers, root maturation stage, follow-up duration, and updated studies on their use in the management of immature necrotic permanent teeth. Conclusions. This review concluded the compiled data observed that endodontic regenerative therapy was more efficient in treating immature necrotic permanent teeth and offered a greater advantage that should lead to wider acceptance among endodontists for effective results compared to different treatment options. However, more clinical trials with a standardized protocol and defined clinical, radiographic, and histopathological outcomes with longer follow-up periods are warranted.

Planning a course of treatment for periodontally compromised patients is a multidisciplinary approach. The goal of treatment should aim at achieving the physiologic form, esthetics, and function of all teeth and also to stabilize the tooth mobility by splinting if the teeth are to be preserved. Hence, replacing a missing tooth in a periodontally compromised patient involves the joint collaboration of periodontist, prosthodontist, and endodontist, and, at times, orthodontists are involved to achieve the treatment goal. This case presents management of missing tooth in periodontally compromised patients (periodontal prosthetic ptients) using indirect fiber-reinforced prosthesis which acts as periodontal prosthesis.

Toothache is almost always caused by odontogenic toothache, but diagnosis is more difficult in the case of nonodontogenic toothache. We report a case of simultaneous occurrence of odontogenic and nonodontogenic toothache. This manuscript presents a case report for a 35-year-old woman who visited our Orofacial and Head Pain Clinic with the chief complaint of continuous dull pain in left maxillary molar teeth region. It was concluded to be a case of simultaneous odontogenic toothache and nonodontogenic toothache. It was successfully treated by an endodontist and an orofacial pain specialist. The endodontist performed root canal treatment against odontogenic toothache caused by apical periodontitis using a dental operating microscope. The presence of a trigger point (TP) resulting in tooth pain was inferred. A trigger point injection (TPI) was administered by orofacial pain specialist, and toothache relief was confirmed. Myofascial pain was diagnosed definitively. After confirming that the toothache had resolved at multiple TPIs, a crown prosthesis was placed. Following the application of crown prosthesis, we were concerned but did not find recurrence of toothache from myofascial pain due to increased occlusal force. This case suggests that there is no single cause of chronic pain and that multiple causes must be considered for diagnosis, suggesting the need for treatment by multiple specialists.

This case series assessed the outcome of nonsurgical endodontic treatment completed through retained full coverage restorations (FCRs) in a board-certified endodontist private practice. The number of cases completed by the first author was 153.All cases were performed following a standardized protocol for treatment and restoration depending on the type of FCR. Number of cases that showed up for 2- to 4-year follow-up was 127, with 83% recall rate. The age range of patients was 33-95 years, with mean age of 54.734 years. The mean recall time was 2.448 years. FCRs and their distribution were as follows: 4 anterior teeth, 14 premolars, and 109 molars. There were 103 nonsurgical root canal treatments and 24 retreatments. Patients who presented for recall had 74 porcelain fused to metal crowns, 17 zirconia crowns, 15 abutments of porcelain fused to metal bridges, 14 lithium disilicate crowns, 5 gold crowns, 1 full metal crown, and 1 gold onlay.There were no endodontically related failures. Six cases failed; 3 were due to vertical root fractures, 1 was due to horizontal root fracture, and 2 were due to extensive recurrent caries causing restorative failure. The percentage of healed cases following the American Association of Endodontists outcome criteria adopted in 2004 with intact retained FCR was 95.3%.The results suggest predictable favorable outcomes for nonsurgical endodontic treatment through FCR following the proposed protocol for diagnosis, treatment, and restoration.

Objectives: To test the ability of platelet-rich plasma clinically and radiologically for pulp regeneration of immature teeth with apical periodontitis. Material and Methods: An experimental study was conducted From (March/2018-July/2020) 12 upper central immature incisors with acute apical periodontitis and necrotic pulp from six patients receiving regenerative endodontic treatment using concentrated platelets rich plasma were performed by the same endodontist at Mediclinic Middle East Hospitals. Informed consent, including explanation of risks and alternative treatments or no treatment were prepared and filled by the patient parents. The therapeutic protocol was involved accessing the pulp chamber; irrigation copiously with sodium hypochlorite; applying calcium hydroxide as intracanal medicament and a provisionally sealing it after 4 weeks. The canal was cleaned, dried and injected with concentrated platelets rich plasma which serve as a scaffold for pulp regeneration. MTA was used to seal the chamber before final filling with composite. Evaluations: All teeth were monitored clinically (mobility, palpation, percussion, and sensitivity cold test) and radiographically. Results: Twenty months follow-up all teeth showed resolution of periapical radiolucencies, continued root development with positive response to sensitivity cold test and no discoloration. Conclusion: The results of this study confirmed the previous finding that pulp regeneration can be gained by using cPRP successfully Keywords Immature teeth; Necrosis; cPRP; Regeneration.

Resorption is a condition associated with either a physiologic or a pathologic process that results in loss of substance from a tissue such as dentin, cementum or alveolar bone”. It is of great concern to the endodontists. Early diagnosis, removal of the cause, proper treatment and reinforcement of the resorbed root is mandatory for achieving success. This paper present a case report of successful conservative management of internal resoption in maxillary incisor. Keywords: Calamus, Endoactivator, Internal resoption, Pink tooth, Thermoplastized obturation.

IntroductionRoot canal treatment, including pulp removal, mechanical and chemical cleaning, and canal filling is an important part of a dentist's job. This study aimed to evaluate the quality and success rate of root canal therapy performed by dentistry students in the Department of Endodontics, School of Dentistry, Birjand University of Medical Sciences, Birjand, Iran.MethodsThis retrospective study was conducted from 2014 to 2017. In total, 62 students were randomly divided into two equal groups of males and females. For each tooth, four radiographs, including the periapical images of the initial radiograph, master apical file, master cone, and final obturation radiographs, were reviewed under the supervision of an endodontist. The investigated technical errors included transport, ledge, perforation, underfilling, overfilling, and presence of void and broken instrument. Data were analyzed in SPSS software (Version 22). A P-value less than 0.05 was considered statistically significant.ResultsAccording to the results, only 79.3% of the students committed at least one type of root healing error, and there was no significant difference between males and females regarding the overall prevalence of error (P=0.12). However, errors, such as underfill, broken instrument, and transport were more common among males; moreover, void and perforation errors were slightly more prevalent among females. It should be noted that this difference was not statistically significant.ConclusionsThe results of the present study can help identify the weaknesses of treatment in order to improve the quality of root canal treatment, especially regarding student gender in the School of Dentistry affiliated to Birjand University of Medical Sciences, Birjand, Iran.

This review aimed to report the outcome of contemporary transplantation of mature and immature teeth and its correlation with various procedural factors. The success rate of immature tooth transplantation was around 90% with successful revascularization. The teeth with root development stage of 3 or 4 show the most favorable outcome, which are the teeth with almost full root formation and open apical foramina. Mature teeth have a lower prognosis than immature teeth after transplantation and patients over 45 years old and extraoral time over 15 min caused significantly more failures. Transplantation of mature donor teeth and immature donor teeth can be a good alternative to other prosthetic methods and best performed by the endodontist, if the indications are there. This is true, especially for young adults, who lost their permanent tooth due to fracture or severe caries, both physically and psychologically.

Over 2500 articles and 200 reviews have been published on the bioactive tri/dicalcium silicate dental materials. The indications have expanded since their introduction in the 1990s from endodontic restorative and pulpal treatments to endodontic sealing and obturation. Bioactive ceramics, based on tri/dicalcium silicate cements, are now an indispensable part of the contemporary dental armamentarium for specialists including endodontists, pediatric dentists, oral surgeons andfor general dentists. This review emphasizes research on how these materials have conformed to international standards for dental materials ranging from biocompatibility (ISO 7405) to conformance as root canal sealers (ISO 6876). Potential future developments of alternative hydraulic materials were included. This review provides accurate materials science information on these important materials. STATEMENT OF SIGNIFICANCE: The broadening indications and the proliferation of tri/dicalcium silicate-based products make this relatively new dental material important for all dentists and biomaterials scientists. Presenting the variations in compositions, properties, indications and clinical performance enable clinicians to choose the material most suitable for their cases. Researchers may expand their bioactive investigations to further validate and improve materials and outcomes.

The clinical dentistry and endodontic procedures involve very technique-sensitive procedures, therefore exposing the operator to risks of causes not only damage to patients but also leads to malpractice. Among various disciplines of dentistry, endodontics-related cases witness the most frequently filed malpractice claims. This is due to the fact that the endodontic treatment procedures involve operative and surgical procedures, using a variety of medicaments and techniques. The endodontic procedural errors can be preoperative errors (such as incorrect diagnosis and misinterpretation), intraoperative errors including root canal and pulp chamber perforations, ledge formation leading to apical transportation or zipping, hypochlorite accidents, and fracture of instruments. More critically, failure to use rubber dam may result in inhalation or ingestion of endodontic instruments. Under such circumstances, the endodontist may have to face legal consequences. Due to the increased healthcare load and patients’ awareness, it is important to know the legal ramifications of adverse effects, failed restorations, or other complications, to avoid any legal ramifications of endodontic procedures and associated techniques. Therefore, precautions must be taken to prevent any postsurgical complications, patient complaints, and/or failures. For this purpose, the operator must consider ethical principles and adhere strictly to the standards of healthcare while performing the diagnosis and treatment. A referral toward a specialist or consultant endodontist is always an appreciable option and should be considered in the best interest of the patient. The aim of the article is to highlight various aspects of malpractice in clinical endodontics, and associated materials and challenges. In addition, commonly occurring operating errors during endodontic treatment, possible consequences, precautions, and management have been discussed.

Background During endodontic treatment, endodontists must be aware of the various factors that may decrease or increase blood pressure. This study aimed to assess the mean percentages of systolic, diastolic, and arterial blood pressure (MSBP, MDAP, MABP) reduction in patients with vital irreversible pulpitis in teeth and who were treated at three visits to endodontists in three age groups (20-34 years, 35-50 years, 51-65 years). Materials and methods A total of 100 teeth with vital irreversible pulpitis from 100 patients were included. All patients underwent 3 visits for endodontic treatment. The 1st visit included removal of vital pulp tissue and a determination of working length, the 2nd visit included canal preparation and widening, and at the 3rd visit the canal was obturated and sealed by gutta percha and sealer. Blood pressure for all patients was checked and documented once before starting treatment and three times during treatment at different intervals during all visits. Results There were significantly higher percentage reductions in MSBP, MDBP, and MABP at the 1st visit for endodontic treatment in comparison to other visits (2nd and 3rd) for all patients. Additionally, there were significantly higher percentage reductions in MSBP, MDBP, and MABP at the 1st visit for endodontic treatment in comparison to other visits in males and females, for all age groups, both anesthesia injection-type groups (infiltration and block), and all treated tooth types except mandibular anterior teeth, and there were nonsignificant differences among groups. However, there were nonsignificant differences in MSBP, MDBP, and MABP between males and females, between infiltration and block injection groups and in relation to teeth types at all visits. Conclusions The reduction of blood pressure in patients undergoing endodontic treatment of vital teeth with irreversible pulpits is common, especially at the 1st visit for pulp extirpation.

Introduction: Cone beam computed tomography (CBCT) is used as a diagnostic tool, which aids in deciding the treatment plan in various fields of dentistry. In endodontics, CBCT is a useful tool in diagnosing apical periodontitis, resorptions, perforation, root canal morphology, traumatic injuries, and voids. The objective of this study was to evaluate the knowledge attitude and practice in diagnosing and interpreting the endodontic treatment using CBCT among the endodontists. Materials and Methods: A cross-sectional questionnaire survey was conducted among endodontists. Overall, 97 participants were included in the survey and the questionnaire containing 15 closed-ended questions was administered to the participants. Descriptive statistics were used to analyze the data. Results: On analyzing the response to the questionnaire, it was found that out of 97 participants, 24 had professional experience of more than 10 years. About 57% of participants preferred using digital radiographic technique for diagnosis. Majority of them were aware that CBCT is used for identifying location, size, and extent of periapical lesions. About 46% of participants stated that in detecting voids, CBCT was thrice significant compared with periapical radiography. According to 31% of the endodontists, CBCT was not reliable to detect vertical root fracture. It was found that 63% of the endodontists said they have not undergone any training or workshop in CBCT. Conclusion: This research study revealed that adequate training and skills are required in interpreting CBCT in endodontic treatment procedure among endodontists.

Context: Postoperative pain control after endodontic treatment is important to maintain patient comfort. Aim: The aim of this prospective clinical study was to evaluate the postoperative symptomatology of endodontic treatments performed in a single session, with or without photodynamic therapy (PDT), using Reciproc #40 file in necrotic unirradicular anterior teeth. Materials and Methods: In a prospective clinical study, 40 teeth indicated for endodontic treatment were treated by a single endodontist according to a preestablished protocol. The teeth were randomly divided into two groups (n = 20): control group (CG) and laser group (LG). After 24 h, 72 h, and 1 week of endodontic treatment, patients' pain symptomatology was evaluated through a Visual Analog Scale (VAS) ranging from 0 to 10, in which 0 corresponds to no pain and 10 indicates extreme pain. In both workgroups, similar protocols were used for instrumentation with the Reciproc system (R40), irrigation with 2.5% sodium hypochlorite, and filling by the gutta-percha plastification technique, in which the CG did not use PDT, and the LG used PDT after the instrumentation sequence. After the visit, the patients were given a prescription for ibuprofen 400 mg to be taken every 6 h if they experienced pain. Results: The results of the study, analyzing the VAS, did not show any difference in pain symptoms between the groups at 24 h, 72 h, and 1 week (P > 0.05). Conclusions: It was concluded that there was no statistical difference between the groups.

Aim The aim of this study is to survey the opinion of endodontists in the United States regarding their approach to treatment of cracked teeth. Materials and methods A survey assessing the opinions of 3,500 endodontists in the United States was administered over a 4-week period. It consisted of a hypothetical clinical case and eight different treatment scenarios. Participants were asked to select one of the two treatment options: (A) informing the patient of the presence of a crack, reinforcing the tooth, and continuing with endodontic treatment; and (B) extraction of the tooth followed by replacement with an implant supported crown or fixed partial denture. Results When the crack extended across the distal marginal ridge with no associated probing depths, 92.65% endodontists preferred to continue with endodontic treatment and reenforcing the tooth. When the crack extended across the distal marginal ridge and was associated with a probing depth of 6 mm, 80% preferred extraction of the tooth. When the crack extended across the mesial marginal ridge up to the orifice of the mesiolingual canal with no associated probing depth, 82.78% preferred to continue with the treatment. When the crack was associated with a 6-mm probing depth, 83.79% preferred tooth extraction. When the crack extended across the mesial marginal ridge and down into the mesiolingual canal with/without associated probing depth, 91.13% and 63.54% preferred tooth extraction, respectively. When the crack involved both mesial and distal marginal ridges and extended across the pulp chamber, 79.74% preferred tooth extraction. When a split tooth was presented, 98.48% preferred tooth extraction. Conclusion It appears that the presence of a 6-mm periodontal pocket is considered an important factor by most American endodontists when deciding whether to preserve the cracked tooth or extract it. Clinical significance There is no consensus among dentists regarding the best approach to treat cracked teeth. Conclusive studies evaluating clinical approaches of endodontists regarding treatment of cracked teeth are lacking. Therefore, surveyed opinion of endodontists in the United States regarding their approach to treatment of cracked teeth was done to try to reach the best clinical decision regarding this dilemma.

Objectives: The main aim of this study was to compare how general dental practitioners (GDPs), endodontists and prosthodontists diagnose, prognosticate, and treat cracked teeth. The secondary aim was to highlight factors influencing GDPs’ referral practices of cracked teeth to specialists. Materials and methods: Questionnaires were used to collect information from GDPs, prosthodontists, and endodontists, on their use of diagnostic methods to identify cracked teeth, prognostication, and their management and referral practices for cracked teeth. Descriptive statistics were used to summarize the quantitative data. Pearson's Chi-Square test or Fisher's Exact test was applied to categorical variables while Kruskal-Wallis or Spearman's correlation coefficient was applied to continuous variables (p Results: 207 dentists responded, resulting in a response rate of 83.5%. Endodontists used more diagnostic tools as compared to prosthodontists and GDPs. For pulpally involved cracked teeth, endodontists were more likely to recommend root canal treatment (RCT) and cuspal coverage compared to extraction, followed by prosthodontists then GDPs. Main reasons for referral of cracked teeth to specialists include uncertainty in diagnosis, difficulty in crack visualization after endodontic access, and cracked teeth indicated for RCT. Conclusion: GDPs, prosthodontists, and endodontists differ in terms of their diagnosis, prognostication, and treatment of cracked teeth. GDPs refer cracked teeth to specialists due to challenges faced in diagnosis and treatment. Future research and education are required to provide evidence-based guidelines in the management of cracked teeth so that patients with cracked teeth can receive standardized care.

Regenerative endodontic procedure (REP) is a progressive treatment modality for immature permanent teeth with necrotic pulp. The ambiguousness about the predictability of REP outcome in relation to complete disinfection of the root canal system and the occurrence of discoloration still exists. The aim of this retrospective study was to analyze two treatment protocols on clinical success rate, radiographic root development and the occurrence of discoloration. Eighteen patients were treated by a single operator by either treatment protocol according to the American Association of Endodontists (AAEP, n = 9) or a modified protocol (MP, n = 9) with the use of 5% sodium hypochlorite and sandblasting. Patients were followed up after 3, 6, 9, 12, 18 and 24 months and clinical success, radiographic root development and the occurrence of discoloration were assessed. The clinical success of MP was significantly higher in two years follow-up (p = 0.015), but the change in radiographic root area was higher for AAEP (p = 0.017) and the occurrence of discoloration was higher in AAEP (p = 0.029). The use of 5% sodium hypochlorite for a longer period of time leads to a higher success rate. The sandblasting of the access cavity reduces the occurrence of discoloration.

Anupama Ramachandran,1 Sulthan Ibrahim Raja Khan,2 Manal Al-maslamani,3 Jagan Kumar Baskaradoss4 1Department of Conservative Dentistry & Endodontics, Chettinad Dental College & Research Institute, Tamil Nadu, India; 2Restorative & Endodontics, Department of Restorative & Prosthetic Dental Sciences, College of Dentistry, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia; 3Department of Restorative Sciences, Faculty of Dentistry, Kuwait University, Safat, Kuwait; 4Department of Developmental and Preventive Sciences, Faculty of Dentistry, Kuwait University, Safat, KuwaitCorrespondence: Jagan Kumar BaskaradossDepartment of Developmental and Preventive Sciences, Faculty of Dentistry, Kuwait University, P.O. Box: 24923, Safat, 13110, KuwaitTel +965 2463-6807Fax +965 25326049Email drjaganb@gmail.comBackground: The etiology, presentation and management of traumatic dental injuries (TDIs) vary significantly between the adult and the younger population. Most epidemiological studies on TDIs have focused on the pediatric age group. This study aims to report and compare the distributions of TDIs among adults in a sub-population in India.Methods: This prospective observational study was performed on 1562 consecutively selected patients (1218 males and 344 females) from a university dental hospital in India, between July 2014 and June 2018. The clinical examinations were performed by a single trained and calibrated endodontist. Only TDIs to anterior teeth were recorded (canine to canine in the maxilla and mandible) and classified using a modified version of the World Health Organization’s (WHO’s) classification. Periapical and panoramic radiographs were taken for all the subjects.Results: A total of 1562 patients aged between 20 and 73 years, with a mean age of 36 years, were examined during the study period. The total number of teeth with TDIs was 3044. Males (78%) clearly outnumbered the females (22%) in all the age groups. The most common type of injury occurring in both the genders is uncomplicated crown fractures (male=31.0% and female=36.6%). Avulsion injuries are more likely to be seen by a dentist within 1 hour post-trauma. About two-third of the TDIs were caused by road traffic accidents (RTAs) followed by falls in about 20% of the patients.Conclusion: Uncomplicated crown fracture was the most commonly observed type of TDI, and RTAs were the primary cause of TDI.Keywords: adults, dental injuries, trauma

Introduction: Bonding plays an integral role in adhesion of the resin restoration to the tooth structure. Bonding to the denting possesses a greater challenge than bonding to the enamel. Following the correct protocol based of scientific evidence is hence highly imperative for the longevity of the restoration. The present study was conducted with the aim to compare and assess the protocols followed for application of dent in bonding agent amongst general dentists and Endodontists in Chennai. Materials and Method: The present cross-sectional survey was carried out amongst a total of 384 dental practitioners with an equal representation of general dentist and Endodontists in Chennai. Data was collected using a self-designed questionnaire and was assessed using descriptive statistical analysis and chi square test. Results: The study showed that 52.6% practitioners used rubber dam isolation only some times. Prior to restoration, 49.2% practitioners preferred complete removal of the smear layer. Etch and rinse total etch technique was the protocol followed by majority of the practitioners. Majority of the practitioners applied one or two layers of bonding agent and cured it for 20 seconds. There was lack of awareness regarding the intensity of the curing light amongst 33.6% practitioners. A majority of 94.3% practitioners felt the need for knowledge upgradation. Conclusion: The study concluded that while some dental practitioners aptly follow the bonding protocols, there is still the need to upgrade knowledge regarding the more recent adhesives and their bonding protocols.

There aren't any generally accepted guidelines for the restoration of an endodontically treated tooth. With a questionnaire among dental general practitioners and endodontists, several restorative treatment options for endodontically treated molars and premolars were identified. The questionnaire inventoried the influence of various parameters on treatment preferences. For each case, additional questions were put about material choice, cuspal coverage and the use of root canal posts. Both groups identified the vertical root fracture as the most common reason for extraction. The dentist general practitioner waited longer than the endodontist to make a permanent restoration in the case of apical periodontitis. Treatment preferences were found to be the same for premolars and molars. In the case of premolars, a root canal post was indicated more often and the location of the wall (bearing/non-bearing) influenced the choice of cuspal coverage. Of the dentist general practitioners and endodontists, 51-53% and 75-94%, respectively, preferred a partial over a full crown preparation in the case of single-walled teeth.Er is geen algemeen aanvaarde praktijkrichtlijn voor de restauratie van een endodontisch behandeld gebitselement. Met een enquête onder Nederlandse tandarts-algemeen practici en tandarts-endodontologen zijn diverse restauratieve behandelkeuzes bij endodontisch behandelde (pre)molaren in kaart gebracht. De vragenlijst inventariseerde de invloed van verschillende parameters op de behandelvoorkeur. Per casus werden verdiepende vragen gesteld over de materiaalkeuze, knobbeloverkapping en het gebruik van een wortelstift. Beide groepen noemden de verticale wortelfractuur als meest voorkomende reden van extractie. Tandarts-algemeen practici wachtten langer dan tandarts-endodontologen met het vervaardigen van een definitieve restauratie bij een parodontitis apicalis. Er bleek geen verschil in voorkeur voor het type restauratie tussen een premolaar of molaar. Bij premolaren werd wel vaker een wortelstift geïndiceerd en was de locatie van de wand (dragend/niet-dragend) van invloed op de keuze voor knobbeloverkapping. Van de tandarts-algemeen practici en tandarts-endodontologen verkozen respectievelijk 51-53% en 75%-94% een partiële boven een volledige kroonpreparatie voor enkelwandige gebitselementen.

The aim was to find out the preferences of dentists in Iraq regarding strategies of carious tissue removalin management of deep carious lesions (CR) in asymptomatic teeth and how demographics (sex, years ofexperience, qualification, specialty, place of work) influences these preferences. An online questionnaireof two months duration was constructed and distributed randomly via social media (Facebook). Thequestionnaire’ questions investigated the demographics, CR (included non-selective removal to hard dentine(NS), stepwise (SW) and selective (SE) removal). 238 dentists participated in the study, 164 (69%), 56(23.5%) and 18 (7.5%) of respondents prefer NS, SW and SEremoval, respectively. Significantly both GDPand males prefer NS more than Endodontists and females (P

Background A Case Difficulty Assessment Form was designed for use in endodontic curricula, and to assist practitioners with treatment planning, referral and recording. The aim of this study was to determine how endodontic case difficulty factors influence the operating time of single-visit nonsurgical endodontic treatments under general anesthesia. Methods Data on 198 single-visit endodontic treatments (80 anterior teeth, 43 premolars, and 75 molars) performed under general anesthesia by a specialized practitioner were obtained from 119 special needs patients (mean [SD] age = 30.7 [14.7] years). Total duration of operation was analyzed with relation to demographic and dental factors and American Association of Endodontists (AAE) Case Difficulty Assessment factors. Mann–Whitney U test, t-test, and Kruskal–Wallis test were used to assess relationships between operating time and confounding factors (p Results High difficulty cases required significantly longer time to complete operations than treatments of minimal-to-moderate difficulty regardless of tooth type (p Conclusions A higher level of case difficulty contributed to increased duration of endodontic treatment under general anesthesia indicating that Endodontic Case Difficulty Assessment Form is useful for predicting the duration of nonsurgical endodontic treatment. Among many factors, complicated anatomic features of the treated teeth increased case complexity and extended operating time.

A healthy adult male patient presented himself, 11 days after a fixed orthodontic appliance was placed, with a sudden pink discoloration of the dental crown of tooth 21. The emergency dentist on call diagnosed the discoloration as non-painful peri-apical periodontitis, partly on the basis of a radiograph, and recommended endodontic treatment of tooth 21. Prior to endodontic treatment, the patient was first seen by the orthodontist who had initiated treatment. Tooth 21 was investigated and reacted normally to percussion and palpation but did not react to the cold test. The patient was referred to an endodontist who made the likely diagnosis: 'Transient apical breakdown'. No endodontic treatment was carried out and the orthodontic treatment was not interrupted. Six weeks after the discoloration appeared, visible recovery was evident.Een gezonde volwassen man presenteerde zich, 11 dagen nadat er vaste orthodontische apparatuur was geplaatst, met een plotseling optredende roze coronale verkleuring van gebitselement 21. De dienstdoende spoedtandarts diagnosticeerde de verkleuring, mede naar aanleiding van een röntgenopname, als een niet pijnlijke parodontitis apicalis en indiceerde een endodontische behandeling van gebitselement 21. Voordat de endodontische behandeling zou worden begonnen, werd de patiënt eerst gezien door de orthodontist bij wie de behandeling was gestart. Gebitselement 21 werd onderzocht en reageerde normaal op percussie en palpatie, maar reageerde niet op de koudetest. De patiënt werd naar een endodontoloog verwezen. Die stelde de vermoedelijke diagnose: ‘Transiënt apical breakdown’. Er vond geen endodontische behandeling plaats en de orthodontische behandeling werd niet onderbroken. Zes weken na het optreden van de verkleuring was er sprake van zichtbaar herstel.

This article shows the follow-up of several cases of maxillary sinusitis of dental (usually endodontic) origin, with different manifestations, diagnostic challenges, and outcomes.Cases from 14 patients from 3 countries and treated by 7 different endodontists are presented, all of them with inflammatory sinus changes represented by mucositis, osteoperiostitis, and/or partial/full obstruction. All cases showed dental and/or sinus signs/symptoms that resolved after dental management. In 13 cases, the sinus condition had an endodontic origin, 4 of them concurrently with periodontal involvement. In 1 case, sinusitis was caused by trauma to the face. All cases but 1 had a satisfactory response of the periradicular tissues and maxillary sinus to treatment that consisted of root canal therapy, root amputation, extraction, or trauma management.The successful management of most cases reported in this article emphasizes the importance of endodontics as a specialty engaged in saving teeth and promoting health not only in the oral cavity but also in other areas that may be affected by infections of endodontic origin, including the maxillary sinus.

The knowledge of biofilm and its eradication from the root canal system are of utmost importance in the clinical practice of an endodontist. Various treatment strategies and protocols have been demonstrated and discussed by numerous clinicians and researchers, on these models, that play an important role in the treatment outcome . Once a biofilm model is developed by considering various factors, several methods can be used to assess the biofilms formed on these models. This review discusses the importance of biofilm models in endodontics, types of biofilm models and factors associated with developing and the methods to evaluate these models.

The severe acute respiratory syndrome of the new coronavirus, SARS CoV-2, which became a pandemic, was first reported in Wuhan, Hubei, China, in December 2019. It can cause mild symptoms, but in some cases, it can cause serious complications, leading to death. The disease spreads through aerosol droplets and has an estimated incubation period between 2 and 14 days (a period in which the patient has high potential to infect other people). Endodontists have a high risk of exposure to COVID-19 when compared to other health professionals, since most of the work involves the generation of aerosols and care for patients in emergency situations, such as symptomatic irreversible pulpitis, symptomatic apical periodontitis, acute apical abscess and traumatic dental injuries, is imperative. Thus, this critical review addresses considerations about endodontic care in times of pandemic, whose emergencies imply a real need for treatment, as well as the care that must be adopted to minimize risks for both professionals and patients who seek the resolution of their clinical pain conditions.

Pulp stones (PSs) are calcified masses that can be found in the pulp cavity of any deciduous or permanent tooth. They can be observed in healthy, diseased, and even unerupted or impacted teeth. Calcifications within the pulp may lead to a poorer outcome of a root canal procedure, as they can block access to the root canals, and hinder their subsequent cleaning and shaping. The paper describes 4 clinical cases of denticles located in the coronal and radicular pulp. Therapeutic methods of PS removal with different techniques and instruments are discussed. Specialist root canal treatment (RCT) was performed in aseptic conditions with the use of long-shank rose-head burs and an endodontic ultrasonic device under the magnification of a dental operative microscope (OM). During endodontic treatment, all PSs were totally removed, which allowed the further preparation, and finally obturation of the canal system. The use of modern diagnostic and therapeutic methods - three-dimensional (3D) diagnostic radiology, endodontic techniques, such as ultrasounds used during the removal of PSs and the irrigation of the canals, and the thermoplastic methods of canal obturation - can provide good results of treatment of this pathology. The removal of PSs from the pulp cavity is a complex and difficult procedure, requiring skill, dexterity, and appropriate equipment and facilities. The clinical approach introduced in this paper allows endodontists to avoid potential complications like perforation, the unnecessary removal of hard tissues or the weakening of the tooth structure.

Background. The main goal of root canal treatment is the prevention or treatment of apical periodontitis, which leads to the preservation of natural teeth. Traditionally, root canal treatment is carried out in a number of visits, using extra disinfecting agents in addition to irrigant used during cleaning and shaping procedures that primarily aim to reduce or eliminate microorganisms and their byproducts. from the root canal system before it is obtained. Recent advances in Endodontic technology, attracting dental experts and endodontists to perform root canal treatment in one visit. Numerous studies evaluate the effectiveness of single-versus multiple-appointment root canal treatment have been published, which reported no significant differences in effectiveness (healing rates) between these two treatment regimens. Purpose : preservation of the integrity of the molar teeth that have symptomatic complaints by taking proper care with a short visit time. Caset : A 21-year-old woman presents with concern in her lower left tooth, the patient tells that the tooth had been treated before at the dentist when she was a child. On clinical examination there is a composite restoration in occlusal tooth # 36, non vital teeth. On periapical radiology there are radiopaque on pulp chamber and a diffuse radiolucent area in the apical area of tooth # 36, then the diagnosis then determined Previously initiated therapy with asymptomatic apical periodontitis. Case Management : Tooth # 36 treated with one visit root canal treatment, Treatment is continued with fiber post installation and crown, patients no longer complain of pain after treatment. Teeth function normally again. Conclusion: One visit root canal treatment can successfully eliminate patient complaints and restore tooth function.

The aim of this study was to assess the differences, if any, between general dental practitioners (GDPs) and endodontists, in the diagnosis and treatment of endodontic emergencies during the worldwide outbreak of COVID-19. An online questionnaire was randomly sent by social media to clinicians in different countries from 24 April, 2020 to May 4, 2020. The survey consisted of a series of questions about demographic characteristics, endodontic emergency diagnoses, approaches to prevent aerosol formation, drug prescriptions in case of symptomatic irreversible pulpitis, and the ways in which dentists managed endodontic emergencies during the COVID-19 lockdown. A total of 1,058 dentists responded to the questionnaire; 344 (32.6%) of the participants were endodontists. Slightly less than half of the participants (n = 485, 45.8%) worked during the lockdown, but only 303 participants (28.6%) treated endodontic cases/emergencies. The responses showed agreement between endodontists and GDPs regarding the diagnosis of symptomatic irreversible pulpitis (SIP), symptomatic apical periodontitis (SAP), reversible pulpitis, and asymptomatic irreversible pulpitis (AIP). SIP and SAP were considered an emergency, whereas reversible pulpitis and AIP were not considered an emergency (p > 0.05). Non-aerosol-generating procedures and treatment approaches differed between the groups (p < 0.05). One-third of the participants did not use rubber dam (p > 0.05). Ibuprofen and amoxicillin-clavulanic acid were the most frequently prescribed drugs for pain associated with SIP. In conclusion, the most relevant findings in our survey were the differences between endodontists and GDPs in diagnosis, precheck triage, deep caries excavation procedures, and endodontic emergency pain relief strategies.

The misuse of antibiotics in dentistry is a serious concern especially in regards to the emergence of antibiotic resistance. The objective of the study was to evaluate the appropriateness of antibiotics prescriptions by Lebanese dentists to patients with endodontic abscesses and their compliance with the guidelines of the American Association of Endodontists (AAE) and the European Society of Endodontology (ESE). The treating dentists recorded clinical information from 127 patients diagnosed with acute or chronic endodontic abscess. The information also included the type of antibiotic prescribed, dosage, and duration of the prescription. Prescriptions were not given to 14/20 patients with an acute endodontic abscess despite the presence of an indication to prescribe. All the prescriptions given to patients with an acute endodontic abscess were inappropriate according to the ESE and AAE guidelines. Antibiotics were also prescribed unnecessarily to 17/42 patients with a chronic endodontic abscess. This study concluded that antibiotics prescriptions by Lebanese dentists for the management of endodontic abscesses were inappropriate. Penicillin V potassium (VK) was not available in Lebanon when the study was conducted. Only broad-spectrum antibiotics were prescribed. This finding raises concerns about the emergence of antibiotic resistance.

The aim of this study is to evaluate the knowledge, attitude, and perception of radiation hazard and preventive measures among dental undergraduate students, general practitioners, endodontic postgraduate students, and endodontists in Saudi Arabia. Multiple choice questions questionnaires were distributed among undergraduate and endodontic postgraduate dental students, general practitioners, and endodontists in the colleges of dentistry in Saudi Arabia, government hospitals, and private clinics. The questionnaire included sociodemographic data, assessment of the knowledge of radiation physics and biology, assessment of the practice of dental radiography, and assessment of knowledge of radiation protection. Chi-square test was used for individual and multiresponse analysis. Level of statistical significance was set at P≤0.05. Three hundred and twenty-nine responded to the questionnaire. More than half of the respondents agreed that dental X-ray is hazardous to health (60.79%), and 68.1% were familiar with ALARA (as low as reasonably achievable) principle. However, only 34% are familiar with the recommendations of the National Council on Radiation Protection (NCRP) and International Commission on Radiological Protection (ICRP). The use of lead apron and thyroid collar for patients’ protection from X-ray radiation was practiced among endodontic postgraduate students more frequently as well as those who are proactive in the academic field. Undergraduate students, endodontic postgraduate students, and endodontists in the academic field were the most aware towards radiation reduction measures. The use of the preventive measures needs to be emphasized more among general practitioners, endodontic postgraduate students, and endodontists especially in governmental hospitals and private sectors.

Background This study, by using a variable-controlled survey model, sought to compare clinical decisions made by dentists with different clinical backgrounds in South Korea regarding teeth with apical periodontitis and to identify factors that influenced decision-making. Methods A questionnaire with 36 questions about identical patient information, clinical signs, and symptoms was filled out by participants. Each question referred to a radiograph that had been manipulated using computer software in order to control tooth-related factors. Participants were instructed to record their demographic information and choose the ideal treatment option related to each radiograph. Simple and multivariable logistic regression analyses (p p Results Participants mostly preferred saving the teeth over extraction. This preference was highest among the endodontists, followed by other specialists and GDPs. Extractions were significantly preferred for molars, teeth with previous root canal fillings, and those with apical lesions greater than 5 mm. Conclusions This study suggests that dentists’ decision-making regarding teeth with apical periodontitis was associated with their work experience and specialty and influenced by tooth position, root canal filling status, and size of the apical lesion. Clinical relevance This survey revealed that clinical decision-making related to teeth with apical periodontitis was affected by dentists’ specialty and work experience and by tooth-related factors, such as tooth position, root canal filling status, and size of the apical lesion.

Background: This study aimed to evaluate the use of artificial teeth for endodontic training for dental students. Materials and Methods: The following aspects of the artificial teeth were approved by the endodontists in Isfahan University of Medical Science: internal and external anatomy; coronal pulp chambers regarding their size, shape, and canal path; the root canals regarding their size, shape, and position; filling the pulp chamber and root canals by considering the texture, quantity, color, and ease of handling; and resin hardness and visualization of the radiographic image. Results: The results showed favorable opinions regarding the internal and external anatomy, coronal pulp chamber, root canal (s), handling, and radiographic imaging. The contents of the pulp space and hardness of the teeth were satisfactory. Conclusion: The artificial teeth tested have the potential to replace the natural teeth in preclinical training.