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The aim of this study was to evaluate whether retreatment of root fillings was judged necessary or not and. which kind of retreatment was preferred among a group of general dental practitioners in Germany. A questionnaire comprising 19 cases of endodontically treated teeth with different case histories and several treatment options was sent to all general practitioners in Göttingen (Germany). The cases included teeth with periapical radiolucencies, pain, apical resorption, under- and overfilling, and unfilled root canals. Results obtained from 43 questionnaires returned indicate that non-intervention or further radiographic monitoring were preferred by the majority of general practitioners in 110 of 19 cases, even in the presence of periapical pathosis. Only five cases; were judged to require conservative endodontic retreatment and, in four cases, root resection. The results revealed large inter- and intra- individual discrepancies in the estimation of endodontic retreatment need. [ABSTRACT FROM AUTHOR]

Introduction: Alopecia areata is an autoimmune disease characterized by a small area of hair loss due to inflammatory reaction directed against hair follicles. The aim of this case report is to present the role of successful endodontic treatment in the therapy of alopecia areata. Case report: The patient is a 27-year-old male referred from the dermatologist for diagnostic procedures of possible dental infection associated with localized hair loss. According to the patient, the root canal treatment of tooth 24 was performed six months ago by a general dentist. The extra-oral examination revealed an alopecic area of an irregular shape, about 3 cm in diameter, located on the left occipital area. The suspected tooth 24 was slightly sensitive on palpation and percussion. The radiography confirmed the presence of inadequate root canal filling with apical periodontitis. The previous roots filling was removed and intra-canal medication over two weeks period was made. The obturation was performed by the lateral condensation technique, using AH Plus sealer (Dentsply DeTrey, Germany) and gutta-percha points. Results and conclusions: Six weeks after endodontic retreatment, first signs of clinical improvement have been observed. Close inspection revealed the appearance of new hair follicles at the site of alopecia areata. Bacterial infection related to poorly cleaned and obturated root canals may cause an inflammatory reaction of the host defense cells and consequently induce disease in distanced tissues. In this case, the endodontic retreatment and elimination of root canal infection gave positive results in the therapy of alopecia areata. [ABSTRACT FROM AUTHOR]

Background: The ESE previously published quality guidelines for endodontic treatment in 2006; however, there have been significant changes since not only in clinical endodontics but also in consensus and guideline development processes. In the development of the inaugural S3‐level clinical practice guidelines (CPG), a comprehensive systematic and methodologically robust guideline consultation process was followed in order to produce evidence‐based recommendations for the management of patients presenting with pulpal and apical disease. Aim: To develop an S3‐level CPG for the treatment of pulpal and apical disease, focusing on diagnosis and the implementation of the treatment approaches required to manage patients presenting with pulpitis and apical periodontitis (AP) with the ultimate goal of preventing tooth loss. Methods: This S3‐level CPG was developed by the ESE, with the assistance of independent methodological guidance provided by the Association of Scientific Medical Societies in Germany and utilizing the GRADE process. A robust, rigorous and transparent process included the analysis of relevant comparative research in 14 specifically commissioned systematic reviews, prior to evaluation of the quality and strength of evidence, the formulation of specific evidence and expert‐based recommendations in a structured consensus process with leading endodontic experts and a broad base of external stakeholders. Results: The S3‐level CPG for the treatment of pulpal and apical disease describes in a series of clinical recommendations the effectiveness of diagnosing pulpitis and AP, prior to investigating the effectiveness of endodontic treatments in managing those diseases. Therapeutic strategies include the effectiveness of deep caries management in cases with, and without, spontaneous pain and pulp exposure, vital versus nonvital teeth, the effectiveness of root canal instrumentation, irrigation, dressing, root canal filling materials and adjunct intracanal procedures in the management of AP. Prior to treatment planning, the critical importance of history and case evaluation, aseptic techniques, appropriate training and re‐evaluations during and after treatment is stressed. Conclusion: The first S3‐level CPG in endodontics informs clinical practice, health systems, policymakers, other stakeholders and patients on the available and most effective treatments to manage patients with pulpitis and AP in order to preserve teeth over a patient's lifetime, according to the best comparative evidence currently available. [ABSTRACT FROM AUTHOR]

Aim: To determine the effect of blue thermal treatment on Reciproc (VDW, Munich, Germany) endodontic instruments and the amount of apically extruded debris during retreatment procedures., Methodology: Thirty extracted mandibular molar teeth having mesial roots with a degree of curvature less than 20° and having an initial apical size equivalent to a size 10 K-file were selected. The mesial roots of the teeth were removed from the cementoenamel junction to obtain a 15-mm root length. The mesiobuccal canals were prepared to size F2 using the ProTaper Universal system (Dentsply Sirona, Ballaigues, Switzerland), filled with gutta-percha and 2Seal (VDW) using the lateral compaction technique and then randomly divided into two groups (n = 15). The root fillings were removed with one of the following instruments using a crown-down preparation technique: M-Wire Reciproc or Reciproc Blue (both VDW). Apically extruded debris was collected in pre-weighed Eppendorf tubes. The Eppendorf tubes were then stored in an incubator at 70 °C for five days to evaporate the distilled water. The data were analysed using the Mann-Whitney U test (P = 0.05)., Results: Reciproc Blue (1.42 ± 0.4491 mg) extruded significantly less debris apically than M-Wire Reciproc (2.56 ± 1.0232 mg) (P < 0.05)., Conclusions: Blue thermal treatment of Reciproc instruments was associated with less debris extrusion during retreatment procedures., (© 2019 International Endodontic Journal. Published by John Wiley & Sons Ltd.)

Background: To examine post-operative pain (PP) after conventional irrigation and sonic activation methods, with and without laser disinfection in mandibular molars. Methods: Eighty patients with symptomatic apical periodontitis were included in this randomized clinical study. There were four study groups. In group 1, conventional irrigation only was applied. In group 2, a sonic irrigation activation system (EDDY (VDW, Munich, Germany)), was applied. In groups 3 and 4, irradiation with a 980-nm diode laser was performed, following irrigation with the conventional method and sonic irrigation activation system, respectively. The patients were instructed to record their PP and analgesic intake using a numerical rating scale 8, 24, 48 h and 7 days post-procedure. A chi-square test, Fisher's exact chi-square test and Fisher–Freeman–Halton exact test were used to assess qualitative data. Inter-group and intra-group parameters were assessed using the Kruskal–Wallis test and Wilcoxon's test at a significance level of p < 0.05. Results: There was no statistically significant difference among the groups in terms of age, sex, pre-operative pain, PP and analgesic intake (p > 0.05). Conclusions: The use of sonic irrigation activation system in the final irrigation protocol and irradiation with the 980-nm diode laser did not significantly reduce PP levels and analgesic intake. [ABSTRACT FROM AUTHOR]

Aim: To investigate and compare the prevalence of root canal fillings, apical periodontitis and endodontic treatment needs in a German subpopulation in 1944 and 2004, respectively. Methodology: Two hundred panoramic radiographs taken from 1994 and 2004, respectively, were evaluated using the Periapical Probability Index (PRI). The technical quality of the root canal fillings in terms of length and homogeneity was estimated. Minimum and maximum endodontic treatment needs were calculated. Statistical analysis was performed using the chi-square and Fisher exact test at P < 0.05. Results: There was a total of 4660 teeth without root canal fillings for radiographs taken in 1994 and 4244 teeth for those in 2004. In teeth without root canal fillings in 1994, the frequency of PRI 4 was 1.0% and PRI 5 was 1.2%. In 2004, PRI 4 was 1.1% and PRI 5 was 2.4%. The difference was not significant (P > 0.05). A total of 168 teeth (3.4%) in 1994 and 217 (4.8%) in 2004 were root canal filled and the difference was significant (P < 0.05). The frequency of PRI score 4 and 5 for the root canal-filled teeth was 8.5% and 26.1% for 1994, and 6.9% and 31.8% in 2004, respectively, The difference was not significant (P> 0.05). The percentage of short root canal fillings was 52.7% in 1994, and 50.8% in 2004. In 1994, 48.6% of the root canal fillings were scored as inhomogenous, and in 2004 the percentage was 40.6%. There were no significant differences concerning the radiographic quality of root canal fillings (P > 0.05). Endodontic treatment need was calculated as 3.7% of all teeth in 1994, and 4.6% in 2004. Retreatment need was calculated as 49.7% of canal-filled teeth for 1994 and 54.5% of root canal-filled teeth for 2004. Conclusion: The prevalence of apical periodontitis in root canal-filled teeth and the need for retreatment increased over the observation period. There were no significant improvements in the technical quality of endodontic treatment from 1994 and 2004. [ABSTRACT FROM AUTHOR]

This study investigated the use of cone‐beam computed tomography (CBCT) by endodontists in Germany and Switzerland. Sixty‐eight German endodontic specialists (G‐ES), 22 Swiss endodontic specialists (CH‐ES) and 95 dentists with a German Master of Science in endodontics (MSc) were invited to participate. Data on the timing of diagnostic assessments, endodontic case difficulty and indications for CBCT use were collected by questionnaire. The frequencies of pre‐, intra‐ and postoperative use of periapical radiography and CBCT were analysed by case difficulty level. In high difficulty cases, access to a CBCT device was significantly associated with the frequency of both pre‐ and intraoperative CBCT use. The type of endodontic qualification had a significant impact on the rate of preoperative CBCT use in high difficulty cases. German endodontic specialists used preoperative CBCT more frequently than CH‐ES and MSc. Our findings show that CBCT is a valuable imaging tool for endodontists, particularly in high difficulty cases. [ABSTRACT FROM AUTHOR]

Abstract: Objectives: The total body of evidence finds fluoride varnish effective to prevent caries. However, most trials were conducted in high‐risk populations, with more recent trials on low‐risk groups finding a lower efficacy. We aimed to assess the cost‐effectiveness of fluoride varnish application in clinic setting in populations with different caries risk. Methods: A mixed public‐private‐payer perspective in the context of German health care was performed using a lifetime Markov model. Effectiveness data were derived from an update of the most recent systematic Cochrane review and synthesized in three different risk groups according to control group caries increment via random‐effects meta‐analysis. Varnish was assumed to be applied twice yearly between age 6 and 18 years. Teeth with carious defects would be treated restoratively and could experience further follow‐up treatments. Costs were deduced from German fee item catalogues. Monte Carlo microsimulations were used for to analyse lifetime treatment costs and caries increment (Euro/Decayed, Missing, Filled Teeth (DMFT)). Results: In low‐risk groups, fluoride varnish was nearly twice as costly and minimally more effective (293 Euro, 8.1 DMFT) than no varnish (163 Euro, 8.5 DMFT). The incremental cost‐effectiveness ratio (ICER) was 343 Euro spent per avoided DMFT. The ICER was lower in medium‐risk (ICER 93 Euro/DMFT) and high‐risk groups (8 Euro/DMFT). Conclusions: Application of fluoride varnish in the clinic setting is unlikely to be cost‐effective in low‐risk populations. There is the need to either target high‐risk groups or to provide fluoride varnish at lower costs, possibly in nonclinic settings. [ABSTRACT FROM AUTHOR]

Aim: To evaluate the effectiveness of a solvent (eucalyptol) in improving filling material removal from canals connected by isthmuses, and the additional cleaning effect of a finishing instrument., Methodology: The mesial canals from 32 mandibular molars (Vertucci's type II morphology) were instrumented and filled with the single-cone technique using Reciproc R25 gutta-percha points (VDW, Munich, Germany) combined with Sealer 26 (Dentsply, Petrópolis, RJ, Brazil). Each root was then subjected to retreatment using the Mtwo instrument system (VDW), with or without a solvent (n = 16 per group). The volume of filling material in the canals was assessed by micro-computed tomographic (micro-CT) scans taken before and after retreatment. Canals with remnants of filling material received a supplementary procedure with the XP-endo Finisher R instrument (FKG Dentaire, La Chaux-de-Fonds, Switzerland), with or without eucalyptol, and another micro-CT scan was taken. All retreatment procedures were performed inside a cabinet under a controlled temperature (37 °C). Filling material removal was evaluated in the 5-mm apical canal system for the canal+isthmus space or the isthmus alone. Statistical analyses were performed to compare the removal of filling material with and without eucalyptol, and after a supplementary approach with XP-endo Finisher R. The level of significance was set at 5% for all statistical tests (P < 0.05)., Results: The amount of filling material removed from the canal+isthmus with Mtwo instruments was 83.2% when no solvent was used and 83.8% using the solvent (P > 0.05). When the isthmus area was evaluated separately, most specimens were associated with a reduction in the filling material, with no significant difference between the groups with or without using a solvent (P > 0.05). The supplementary step with XP-endo Finisher R significantly improved removal of filling material from both canal and isthmus area (P < 0.05), regardless of the use of a solvent (P > 0.05)., Conclusion: The use of eucalyptol did not improve filling material removal from Vertucci's type II molar mesial canals and isthmuses. XP-endo Finisher R significantly enhanced removal of filling material from the canals and isthmuses., (© 2018 International Endodontic Journal. Published by John Wiley & Sons Ltd.)