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Introduction: Tooth fracture is one of the most common traumatic maxillofacial injuries in dogs and cats. For fractures with pulp exposure occurring in functionally important teeth, the literature indicates that root canal treatment (RCT) is an effective therapy option that may be the remedy of choice before extraction. The most commonly reported fractures in the United States involve canine teeth; however, fractures of the maxillary fourth premolars are more common in Korea, where there are many small-and medium-sized dogs. RCT mechanically and chemically removes pulp tissue and bacteria (cleaning and shaping) from the infected root canal, and obturates the root canal with filling material to restore tooth functionality without inflammation. Various techniques, instruments, and materials used in humans have been modified for application in veterinary dentistry. Methods: This study analyzed the results of RCT of the maxillary fourth premolar in 120 small-and medium-sized dogs (weighing less than 25 kg) using three different sealers (silicone-based sealer, bioceramic sealer, and calcium hydroxidebased sealer) through a simple application of the single-cone technique. Results: The overall success rate of RCT in maxillary fourth premolars was 90.83%, with 8.33% no evidence of failure (NEF) and 0.83% failure. Discussion: There were no significant differences between the three different sealers. Furthermore, preexisting periapical lesion (PAL) was reconfirmed as a factor in reducing the success rate of RCT. In addition, the working length and master apical file of each root were analyzed in our study as a novel reference for endodontic veterinarians. [ABSTRACT FROM AUTHOR]

Background: Pain from temporomandibular disorders (TMDs) may mimic endodontic pain, but its prevalence in endodontic patients is unknown. Objectives: This cross‐sectional study investigated the prevalence of painful TMDs in patients presenting for endodontic treatment of a painful tooth. Contribution of TMD pain to the chief complaint and characteristics associated with TMD prevalence were also assessed. Methods: Patients reporting tooth pain in the 30 days before attending university clinics for nonsurgical root canal treatment or retreatment were enrolled. Before endodontic treatment, they completed questionnaires and a board‐certified orofacial pain specialist/endodontic resident diagnosed TMD using published Diagnostic Criteria for TMD. Log‐binomial regression models estimated prevalence ratios to quantify associations with patient characteristics. Results: Among 100 patients enrolled, prevalence of painful TMDs was 54%. In 26% of patients, TMD pain was unrelated to endodontic pain; in 20%, TMD contributed to their chief pain complaint; and in 8%, TMD was a sole aetiology for pain. TMD prevalence was associated with greater intensity, frequency and duration of the chief pain complaint; pain in more than one tooth; tenderness to tooth percussion and palpation; a diagnosis of symptomatic apical periodontitis; pain medication use; and psychological distress. Conclusion: A majority of patients with tooth pain seeking endodontic treatment had painful TMDs; one quarter had TMD as a component or sole cause of their pain. TMD prevalence was associated with more severe symptoms and signs of tooth pain and with psychological factors. The high frequency of TMD comorbidity warrants consideration in management of endodontic patients with history of toothache. [ABSTRACT FROM AUTHOR]

Nearly 100 million of the 170 million composite and amalgam restorations placed annually in the United States are replacements for failed restorations. The primary reason both composite and amalgam restorations fail is recurrent decay, for which composite restorations experience a 2.0–3.5‐fold increase compared to amalgam. Recurrent decay is a pernicious problem—the standard treatment is replacement of defective composites with larger restorations that will also fail, initiating a cycle of ever‐larger restorations that can lead to root canals, and eventually, to tooth loss. Unlike amalgam, composite lacks the inherent capability to seal discrepancies at the restorative material/tooth interface. The low‐viscosity adhesive that bonds the composite to the tooth is intended to seal the interface, but the adhesive degrades, which can breach the composite/tooth margin. Bacteria and bacterial by‐products such as acids and enzymes infiltrate the marginal gaps and the composite's inability to increase the interfacial pH facilitates cariogenic and aciduric bacterial outgrowth. Together, these characteristics encourage recurrent decay, pulpal damage, and composite failure. This review article examines key biological and physicochemical interactions involved in the failure of composite restorations and discusses innovative strategies to mitigate the negative effects of pathogens at the adhesive/dentin interface. © 2019 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater 107B:2466–2475, 2019. [ABSTRACT FROM AUTHOR]

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The aim of this study was to evaluate the antimicrobial activity of sodium and calcium hypochlorite utilising reciprocating instrumentation. Sixty root canals were inoculated with E. faecalis for 14 days. Samples were divided into six groups according to decontamination protocol: G1: no treatment, G2: distilled water, G3: 2.5% sodium hypochlorite, G4: 2.5% calcium hypochlorite, G5: 5.25% sodium hypochlorite and G6: 5.25% calcium hypochlorite. Instrumentation was performed with Wave One reciprocating system (Dentsply Sirona Endodontics, York, PA, USA) in groups G2 to G6. Colony‐forming units (CFUs) counting was performed and the data were subjected to Anova and Tukey (α  =  0.05). Group 1 and 2 showed the highest mean contamination, with a significant difference between them (P < 0.05). Groups 3, 4, 5 and 6 showed the lowest contamination means with no significant difference between them (P < 0.05). Sodium and calcium hypochlorite, in association with reciprocating instrumentation, can be an effective decontamination protocol in root canals infected with E. faecalis. [ABSTRACT FROM AUTHOR]

Aim: The aim of this study was to compare the effect of diode laser, endoActivator, and passive ultrasonics for smear layer removal at the apical third from root canals with 0.2% chitosan. Materials and Methods: A total of 40 mandibular premolars were decoronated to establish a working length of 12 mm and shaped with ProTaper rotary files up to size F3. In Group A, canals were irrigated with 1 ml of 0.2% chitosan. In Group B, canals were initially irrigated with 0.8 ml of 0.2% chitosan and the remaining 0.2 ml was activated with diode laser. In Group C, canals were irrigated with 1 ml of 0.2% chitosan which was activated with endoActivator. In Group D, canals were irrigated with 0.2% chitosan and activated with passive ultrasonics. All samples were finally flushed with 3 ml of distilled water. The percentage of smear layer removal was analyzed with a scanning electron microscope examination at ×1000 and ×3000. Data were analyzed using Statistical Package for the Social Sciences version 16.0 (SPSS Inc., Chicago, IL, USA) at a significance level of P < 0.05. Results: The mean value for Group B when compared to Group C for the removal of smear layer was higher, but there was no statistically significant difference between the two groups (P < 0.068 and P < 0.295). Both Group B and Group C showed a statistically significant difference (P < 0.001) when compared to Group A and Group D for the removal of smear layer. Conclusion: Diode laser and endoActivator with 0.2% chitosan proved better in the removal of the smear layer when compared to passive ultrasonic irrigation. [ABSTRACT FROM AUTHOR]

Aim: The purpose of this article is to determine the racial predilection of C-shaped canal configuration in a mandibular second molar. Background: Unusual root canal anatomy always poses a diagnostic and treatment challenge. Identification of such variation is important for the success of root canal treatment outcome. C-shaped canal configuration is such an aberrant morphology of molar teeth that vary in different population and is commonly seen in a mandibular second molar. Thus, knowledge of racial predilection of C-shaped canal configuration in different population for early diagnosis is obligatory. Materials and Methods: An exhaustive search was undertaken to identify published research articles related to C-shaped canal configuration in mandibular second molars. Forty-three research articles were analyzed which included 12,481 mandibular second molars. Chi-square test using value of P < 0.05 was performed to assess the statistical significance of this anomalous anatomic variation among the different population. Results: Statistical test revealed a significant variation between the Asian and nonAsian population. The highest incidence of racial predilection was observed in China (Asia) with 93.1%, and the minimum was observed in America with 2.7%. Conclusion: This research reported that racial predilection of C-shaped canal configuration in mandibular second molar varies significantly. [ABSTRACT FROM AUTHOR]

Few recent surveys have examined the contemporary landscape of predoctoral endodontic education in the United States and Canada, but anecdotal reports suggest that current dental students have difficulty obtaining adequate clinical endodontic experiences. The aims of this study were to quantify the clinical endodontic experiences of current U.S. and Canadian dental students, to explore the issues surrounding their clinical endodontic competence, and to ask more broadly if current graduating dentists are competent to perform endodontic procedures. In August 2014, a hyperlink to a web-based survey with 27 questions was emailed to the 67 predoctoral endodontic directors of U.S. and Canadian dental schools using a list provided by the American Association of Endodontists. Out of these 67 possible participants, 40 responded, for a response rate of 60%. The findings were varied. The average 2014 graduate completed 5.9 (±2.4) root canal treatments on live patients, and 69% of the respondents voiced concern regarding a shortage of patient experiences. A majority (59%) of the respondents reported thinking that the supply of endodontic patients has decreased and that students have an inadequate supply of endodontic patients. This study found that a clear majority of predoctoral endodontics directors perceived a shortage of patient experiences for their students although, in reality, the number of completed clinical cases appeared to be unchanged since 1975. In addition, 36% of the respondents reported feeling that their 2014 graduates were not competent to perform molar endodontic treatment in their practices. [ABSTRACT FROM AUTHOR]

Introduction The purposes of this study were to examine the following in young adults residing in the United States: (1) the prevalence of teeth with root canal therapy (RCT) and teeth in need of RCT, (2) how frequently treatment practices associated with success as cited in the literature are found in posterior teeth with RCT, and (3) which treatment practices are associated with periradicular pathology. Methods Panoramic radiographs taken of all basic trainees entering the US Air Force in 2011 were evaluated in a 2-part review. A general survey of all radiographs was performed to determine the prevalence of teeth with and teeth in need of RCT. All panoramic radiographs that showed a posterior tooth with RCT were evaluated in detail to consider the presence and quality of cuspal coverage restorations, the quality of RCT, and the presence of periradicular pathology. Results A total of 35,811 panoramic images were evaluated. Ten percent of basic trainees had existing RCT, whereas 5% showed a need for RCT. The total number of posterior teeth with RCT was 3,455. Nearly half of these teeth had either no cuspal coverage or an unacceptable cuspal coverage restoration. Almost one third of the existing RCT was considered inadequate based on best treatment practices. Approximately 25% of teeth with RCT had periradicular pathology present. A strong correlation was found between the quality of RCT and the absence of periradicular pathology. Of RCT teeth deemed hopeless, 97.5% had no cuspal coverage restoration present. Conclusions Factors cited in the literature as being associated with success are lacking in the dental treatment of young adults residing in the United States. [ABSTRACT FROM AUTHOR]

Introduction: The aim of this in vitro study was to evaluate the effect of an experimental irrigation solution, containing two different concentrations of papain, Tween 80, 2% chlorhexidine and EDTA, on removal of the smear layer. Methods and Materials: Thirty-six single-rooted teeth were divided into two experimental groups (n=12) and two positive and negative control groups of six. The canals were prepared with BioRaCe instruments up to BR7 (60/0.02). In group 1, canals were irrigated with a combination of 1% papain, 17% EDTA, Tween 80 and 2% CHX; in group 2, canals were irrigated with a combination of 0.1% papain, 17% EDTA, Tween 80 and 2% CHX. In group 3 (the negative control), the canal was irrigated with 2.5% NaOCl during instrumentation and at the end of preparation with 1 mL of 17% EDTA was used; in group 4 (positive control), normal saline was used for irrigation. The amount of the remaining smear layer was quantified according to Hulsmann method using scanning electron microscopy (SEM). Data was analyzed by the Kruskal-Wallis and Mann-Whitney tests. Results: Two-by-two comparisons of the groups revealed no significant differences in terms of smear layer removal at different canal sections between the negative control group (standard regiment for smear layer removal) and 1% papain groups (P<0.05). Conclusion: Under the limitations of the present study, combination of 1% papain, EDTA, 2% chlorhexidine and Tween 80 can effectively remove smear layer from canal walls. [ABSTRACT FROM AUTHOR]

Aim: The aim of this study was to compare the canal transportation, canal centering ability, and time taken for preparation of curved root canals after instrumentation with ProFile GT Series X (GTX) files, Revo-S files, twisted files, and Mtwo files by using cone-beam computed tomography (CBCT). Materials and Methods: Forty mesiobuccal canals of mandibular molars with an angle of curvature ranging from 20 to 40 were divided according to the instrument used in canal preparation into four groups of 10 samples each: GTX (group I), Revo-S (group II), twisted file (group III), and Mtwo (group IV). The teeth were instrumented according to manufacturer's guidelines, with all groups being prepared to size 30, 0.06 taper master apical file. Canals were scanned using an i-CAT CBCT scanner (Imaging Science International, Hatfield, PA, USA) before and after preparation to evaluate the transportation and centering ratio at 3 mm, 5 mm, 7 mm, 9 mm, and 11 mm from the apex. The data collected were evaluated using one-way analysis of variance (ANOVA) with Tukey's honestly significant difference (HSD) test. Results: Twisted file system showed significantly least canal transportation and highest canal centering ability values as compared to GTX, Revo-S, and Mtwo file systems. Overall, GTX, Revo-S, and Mtwo showed comparable results with respect to canal transportation and centering ability. Conclusion: The innovative method of manufacturing the TF system resulted in superior shaping ability in curved canals, with the instruments remaining more centered and producing less canal transportation than GTX, Revo-S, and Mtwo file systems. [ABSTRACT FROM AUTHOR]

Purpose: To assess the opinions of dental professionals working within the Delta Dental insurance system regarding the predictability of initial endodontic treatment, expected long-term outcome and the importance of placing a coronal coverage after completion of treatment. Methods: An eight-item questionnaire was distributed among participants attending a continuing education course. The questionnaire included four items on practice profile and demographics and four multiple-choice questions regarding participants' opinions on endodontic treatment outcome. Results: 51% of participants responded that the expected retention rate of teeth 5-10 years after endodontic treatment was more than 90%. Sixty-eight percent of participants responded that the need for additional treatment was expected to occur within the first 3 years after initial endodontic treatment. 87% of participants responded that placing coronal coverage after completion of endodontic treatment was very important for long-term tooth retention. Ninety-three percent of participants responded that overall, endodontic treatment was a predictable procedure with long-term tooth retention rate. Statistically significant associations were found between (1) year of experience and expected rate of retention (P< 0.01 ); (2) participants' years of experience and their responses regarding the need for additional treatment (P< 0.05); and (3) their opinions that endodontic treatment was a predictable procedure with long-term tooth retention rate (P< 0.05 ). [ABSTRACT FROM AUTHOR]

Abstract Hagge MS, Wong RDM, Lindemuth JS. Effect of three root canal sealers on the retentive strength of endodontic posts luted with a resin cement. International Endodontic Journal , 35 , 372–378, 2002. Aim This investigation examined what effect three different sealers had on retention of endodontic posts (Parapost) luted with a resin cement (Panavia 21 OP). Methodology Sixty-four single-rooted teeth were decoronated, filed, cleaned, and shaped with a size 5 Gates–Glidden drill and 0.12 taper G.T. rotary instrumentation (Dentsply/Tulsa Dental). Teeth were then divided into four groups of 16 each. Group 1 was not obturated, and served as a control. The other three groups were obturated with gutta-percha using a different sealer for each group. Group 2 used a eugenol containing sealer (Kerr Pulp Canal Sealer), group 3 a resin sealer (AH-26), and group 4 a calcium hydroxide sealer (Sealapex). After 1 week’s storage at 100% humidity, 10-mm deep post spaces were prepared with a size 6 Gates–Glidden drill, and size 5 Paraposts were cemented. Following 48 h of storage, samples were mounted in a PVC pipe with acrylic, and the posts were removed vertically using a universal testing machine at 1 mm min- , with data recorded in kilograms. Results The mean values of force required to remove the posts were: group 1 = 61.80, SD = 16.21; group 2 = 43.14, SD = 14.66; group 3 = 48.54, SD = 17.84; group 4 = 53.52, SD = 18.77. Using anova and Bonferroni tests, group 1 demonstrated significantly greater mean retention strength values than group 2, but no other significant differences existed between groups. Conclusion The chemical formulation of root canal sealers did not significantly affect the retention of endodontic posts luted with resin cement. [ABSTRACT FROM AUTHOR]

Abstract Aim This study was undertaken to determine the incidence of root fractures during post removal, as well as the methods used and the success rates achieved with various post removal devices and techniques. Methodology Patient records from a specialist endodontic practice were examined. A total of 1600 teeth from which posts were removed were identified. These teeth had no preoperative signs or symptoms to suggest root fractures. The incidence of root fractures was determined and a subset of 234 patient records were examined in detail to determine the methods used to remove different types of posts. Results Only one tooth fractured during post removal (0.06%) and all posts were successfully removed, typically in about 3 min. Most cast posts were removed with an Eggler post remover but some dislodged when the crown was removed; ultrasonics was used occasionally. Most parallel-sided posts were removed with ultrasonics and threaded posts were unscrewed. The Masserann kit and ultrasonics were combined to remove fractured cast posts and some parallel-sided posts. Conclusions This study indicates that, with good case selection, post removal is a predictable procedure. If appropriate techniques and devices are used for the particular type of post being removed, then root fracture is a rare occurrence. [ABSTRACT FROM AUTHOR]

Tebore, an almost 500 pound Bengal tiger, is a star attraction at a small, private children's zoo in Visalia, California, This beautiful tiger, with its characteristic bright colored fur is frequently taken on field trips to primary schools where he is petted and hugged by children, including mentally-retarded children. To minimize a potential puncture-tear injury from the canines, the owner and the zoo's veterinarian requested that the four fangs be reduced in length and root canal treatment for the remaining tooth structure completed. Root treatment was preferred to extraction because the animal is also used to make television commercials when it has to look ferocious.

Introduction: The Air Force Dental Service has established evidence-based treatment standards for endodontics, including 3-dimensional filling of the canal system, cuspal coverage restoration of endodontically treated posterior teeth, and use of rubber dam. The purpose of this retrospective study was to determine the effect of these standards on outcomes of initial posterior root canal treatments (RCTs) completed by Air Force (AF) and civilian dentists with and without accredited postgraduate training., Methods: Treatment and follow-up radiographs of AF members who had an initial posterior RCT completed in 2011 were evaluated. A survey of all radiographs was performed to determine the (1) RCT obturation quality, (2) healing of periapical pathosis, and (3) presence and quality of cuspal coverage restorations., Results: A total of 2262 RCTs were examined, with 1960 RCTs meeting inclusion criteria for at least 1 evaluation category. For RCT obturation quality, 1810 RCTs were evaluated, and 96.0% were considered adequate. For cuspal coverage restorations, 1856 RCTs were evaluated, and of these 2.7% were inadequately restored. Healing of periapical pathosis was 91.5% and 85.7% for AF and referred civilian providers, respectively. Survivability was 94.4% for endodontists, 95.3% for AF general dentists with additional training, 87.9% for AF general dentists without additional training, and 78.4% for civilian general dentists. Overall, survivability was 94.1% for a follow-up period ranging up to 47 months, with a mean of 27 months., Conclusions: In this retrospective, radiographic analysis, evidence-based practices as followed in the Air Force Dental Service and accredited postgraduate training resulted in improved treatment outcomes., (Published by Elsevier Inc.)

Introduction: A 2009 American Association of Endodontists survey of dentists in general practice (GPs) to assess their perceptions and understand the factors associated with referrals to endodontists was the first of its kind. The American Association of Endodontists repeated the survey in 2012 to update our understanding of the referral behavior of GPs by reexamining the effects of endodontist characteristics and professional behavior and the role of GP demographics and perceptions in determining referrals to endodontists., Methods: Researchers conducted a cross-sectional study that included a quantitative online survey of 786 GPs in the United States (14% of 5737 initially opened invitations) from November 1-13, 2012., Results: Ninety-four percent of the GPs had positive perceptions of endodontists, but they referred only 43% of patients who required root canal treatment to endodontists. The perception that endodontists are partners in patient care and endodontic services are worth the cost was strongly related to the likelihood of referring (P < .05). GPs rated referring patients back for restorative treatment (95%, n = 734), timely follow-up of reports and images (94%, n = 726), and patient scheduling accommodation (91%, n = 707) as effective ways to build partnerships. Gender and years in practice moderated the relationships between several predictors (eg, communication, value of treatment, and expertise) and the likelihood of referring., Conclusions: There are concrete actions that endodontists can take and segments of the GP population that can be targeted to successfully address the issue of increasing referrals. However, examining the role of endodontist actions and GP perceptions and demographics is just the beginning in addressing the relationships involved in referral behavior., (Copyright © 2014 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.)