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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.

Aims: To assess knowledge and attitude towards antibiotics prescription and antimicrobial resistance among dentist in Saudi Arabia. Study Design: Cross-sectional, survey-based study. Place and Duration of Study: Sample: Saudi Arabia, between June 2020 and October 2021. Methodology: This is was a cross-sectional, survey-based study in Saudi Arabia. Data was collected using a predesigned self-administered online questionnaire. The survey was distributed to dentist and dental surgeons in Saudi Arabia. It included demographic data, Knowledge about antibiotics, Attitude towards antibiotics, prescription of antibiotics based on the clinical situation. Data were analyzed by the SPSS program, version 25 at a level of significance of 0.05. Results: A total of 208 study participants completed the survey questionnaire. The results showed that the half of study participants females. Moreover, more than half of the study participants were bachelor’s degree. Additionally, 21.2% of the study participants earned dental internship. However, the least proportion had the master’s degree or higher (4.3%).91.8% of the study respondents were general dentist compared to 2.9% were oral surgeon and the least portion 1% was endodontist. Conclusion: The use of antibiotics inappropriately was common, and the drivers of inappropriate practices were found as young age, male sex, higher education, and a negative attitude regarding antibiotic use.

Patient seeking orthodontic treatment in the present era comprises of both children and adults, thereby increasing the importance of multidisciplinary approach in orthodontics immensely. The interdisciplinary approach requires active involvement of various specialists like Prosthodontist, Oral and maxillofacial Surgeon, ENT surgeon, Paediatrician, Pedodontist, Endodontist, Periodontist, Audiologist, Physiotherapist etc. A combined interdisciplinary treatment approach will yield a result best suited for the patient as well as clinicians. Orthodontist in such Interdisciplinary treatment approach can play a primary or secondary role. So, the purpose of this article is to briefly summarize interdisciplinary approach for the management of dentofacial problems. Keywords: Interdisciplinary Orthodontics, Orthodontist, multidisciplinary approach in orthodontics

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.

In-depth knowledge of common and aberrant pulp morphology is essential for appropriate diagnosis and treatment planning prior to commencing root canal treatment. Radicular morphology of mandibular premolars has been extensively studied. Considerable variation in the number of canals and roots found in these teeth has been reported. Aim The purpose of this study is to investigate the root and root canal morphology of mandibular first premolar among Saudi Arabian subpopulation in Aseer using CBCT. Methods Cone-beam computed tomography images of Mandibular first premolar were taken from 166 patients which were referred to Armed Forces Hospitals Southern Region (AFHSR), Khamis Mushayt, Asir region Saudi Arabia. All the images were assessed by two Evaluators (An Endodontist and a Radiologist). Inter-examiner reliability was determined and was assessed by KAPPA value. Results The mandibular first premolar (n = 216) distributed as 120 teeth in female and 96 teeth in male. Out of the 120 teeth examined in female groups one canal was seen in 95 (79.2%) teeth, two canals in 19 (15.8%) teeth and three canals in 6 (5%) teeth where as in the Male group out of 96 teeth, 52 (54.1%) teeth showed one canal, 32 (33.3%) teeth with two canals whereas 12 (12.5%) teeth showed presence of three canals. Chi-Square test for mandibular first premolars demonstrated the chance of second canal in the mandibular first premolar more in male than female and these differences was statistically significant (P ≤ 0.05). Conclusion Endodontic therapy of mandibular premolars is a challenge for clinician because of their frequent morphological and anatomical abnormalities. Proper knowledge about number of root canals and canal configuration is a key to success in Endodontic. There is a great variability in different population regarding the root canal configuration in mandibular pre-molars. However, most studies state the mandibular first premolar has one root canal. Also, the most prevalent type of root canal found was Type I vertucci.

The COVID-19 pandemic has turned to be a huge international challenge. Being the part of dental care, we hold responsibilities both to the dental staff and our patients so that the cross infection of virus can be avoided. Since dentists mainly have to work inside the oral cavity, the whole dental team, staff and the technician are at the highest risk of getting affected by the virus. Not only they are at risk of getting infected but at the same time they can potentially transmit the virus. According to latest studies, the presence of virus in salivary secretion of many symptomatic as well as asymptomatic patients, the dental professionals especially Endodontist are at the greatest life threatening situation if they do not follow proper guidelines such as sterilization at their workplace. Till today no medicine manufacturing companies have come up with the proper treatment or vaccines which can protect dentist from contracting with the virus. In this pandemic situation, the general practicing dentist and the Endodontist must provide only emergency treatments so as to relieve pressure and pain. As this COVID continues, it is the responsibility of health care workers to come up with more definitive treatment plans that to stick on to just palliative care. This article aims to bring latest updates on treatment considerations in clinical practice in general. However, the article also includes the guidelines to be followed by the endodontist so as to limit the cross infection but at the same time relieve patient from dental pain or any dental disease. Keywords: Pandemic, Global emergency, COVID- 19, Sterilization, Endodontist, Infection control, Patient management.

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.

There are limited data regarding the scope of practice of Endodontists in Australia. The aim of this study was to investigate the scope of practice of Endodontists and Endodontic Registrars in Western Australia. The study comprised a three-part survey relating to demographics, clinical factors and materials and equipment. The response rate was 70.6%. Compared to the public sector, clinicians in the private sector treated on average twice as many patients per day, twice as many trauma cases per year and, as a proportion of all cases, four and a half times as many apical surgical procedures. These aspects were all statistically significantly different. Other aspects were similar to previous studies within Australia and from other countries.

The spread of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has resulted in millions of confirmed cases and hundreds of thousands of deaths. Despite all efforts to contain the spread of the disease, the number of infections and deaths continue to rise, particularly in some regions. Given its presence in the salivary secretions of affected patients, and the presence of many reported asymptomatic cases that have tested positive for COVID-19, dental professionals, including Endodontists, are at high risk of becoming infected if they do not take appropriate precautions. As of today, there are no predictable treatments or approved vaccines that can protect the public and healthcare professionals from the virus; however, there is speculation that a vaccine might be available sometime in 2021. Until then, general dentists and Endodontist will need to be able to treat emergency patients in order to relieve pressure on emergency clinics in hospitals or local community hubs. In addition, as the pandemic continues, strategies to manage patients will need to evolve from a palliative to a more permanent/definitive treatment approach. In this article, an update on the treatment considerations for dental care in general is provided, as well as a discussion on the available endodontic guidelines reported in the literature. Recommendations on clinical management of endodontic emergencies are proposed.

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.

Objective: To determine the factors of endodontic referral from general dental practitioners in Turkey. Methods: A questionnaire containing 39 questions was designed to determine the need for referral to endodontists and the factors that influenced the decision to refer a patient to the endodontist. The survey was sent by e-mail to be registered dentists in a database of the Turkish Dental Association, and only unequivocal responses were included in calculating the percentage data. The categorical data were analyzed with a chi-square test, and the results were presented as frequency and percentage. The significance threshold for all tests was set at p

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.

Recent research indicates 20% of dentists to experience a high degree of stress, physical pain and distress, and insomnia, which is associated with loss of productivity, both in quantity and quality. Physical distress and pain, but also difficulties with colleagues, demanding patients or loss of productivity are clearly associated with the prevalence of stress. Stress complaints are often recognised too late. 2 fictitious cases from the daily practice of occupational health experts/ergonomists are discussed. The first case concerns a 45-year-old dentist who was referred to an occupational health expert regarding severe fatigue, listlessness and a sense of loss of control. After the occupational health expert had inventoried his full workload, it was shown not to have increased. With the help of relaxation therapy, a professional organiser and an organisational and business psychologist, the dentist was able to return to work full time after 9 months. In the second case, a 55-year-old endodontist presented with neck pain. The occupational health expert/ergonomist observed postural problems and stress. The client reported she suffered from fatigue. The endodontist did not acknowledge these stress issues and wanted to address improvement of posture in particular, which was effective. The occupational health expert was nevertheless able to introduce measures to reduce stress and fatigue; after some time, the endodontist enjoyed her return to work.Recent onderzoek geeft aan dat 20% van de tandartsen een hoge mate van stress en fysieke pijn en ongemak ervaart en slecht slaapt, wat wordt geassocieerd met een verlies aan productie, zowel kwalitatief als kwantitatief. Te zien is dat fysiek ongemak en pijn, maar ook moeite met collega’s, lastige patiënten of productieverlies samenhangen met het vóórkomen van stressklachten. Vaak worden klachten te laat herkend. Vanuit de dagelijkse praktijk van 2 arbeidsdeskundigen/ergonomen worden 2 fictieve casussen besproken. Het gaat om een 45-jarige tandarts die was doorverwezen naar een arbeidsdeskundige wegens ernstige vermoeidheid, lusteloosheid en het gevoel van controleverlies. Nadat de arbeidsdeskundige de totaalbelasting van zijn werk had vastgesteld bleek dat deze niet was toegenomen. Met behulp van ontspanningstherapie, een opruimcoach en een bedrijfs- en organisatiepsycholoog kon de tandarts na 9 maanden weer volledig zijn werk hervatten. In een tweede casus meldde een 55-jarige endodontoloog zich met nekklachten. De arbeidsdeskundige/ergonoom nam bij haar een verkeerde houding en spanning waar. De cliënt vertelde dat ze last had van vermoeidheid. De endodontoloog erkende deze stressklachten niet en wilde voornamelijk inzetten op verbetering van houding, hetgeen lukte. Desondanks wist de arbeidsdeskundige enkele zaken om spanning en vermoeidheid te verminderen; na enige tijd ging de endodontoloog weer met plezier naar het werk.

Teeth with calcific metamorphosis pose a challenge to the endodontist in achieving proper access, identification, and debridement of the root canal. With the conventional technique, radiographs and bur orientation have dictated the access cavity preparation, which leads to the removal of more sound tooth structure and iatrogenic errors. To overcome these issues, the recent diagnostic imaging techniques such as cone beam computed tomography followed by three-dimensional fabrication of template have been proposed, which aid the clinician to accurately locate and negotiate the obliterated canal. The present case report describes the importance of conservative access cavity preparation with the use of the guided endodontic technique for the treatment of calcified canals in the maxillary central incisor.

3D Printing refers to a class of technology that can automatically construct 3-dimensional physical models from Computer Aided Design (CAD) data. Reduction of product development cycle time is a major concern in industries for achieving competitive advantage. Endodontic dentistry is the dental specialty concerned with the study and treatment of the dental pulp, and generally diagnose tooth pain and perform root canal treatment and other procedures relating to the interior of the tooth. This article, therefore, aims on being an assistive methodology in endodontics by applying 3D printing in order to reduce the strain involved in the tooth restoration process.

Introduction Although intraoral radiographs are foundational for diagnosis and planning treatment in dentistry, the resulting 2-dimensional image varies in interpretation requiring judgment. Cone-beam computed tomographic imaging provides a more detailed 3-dimensional image that may affect treatment recommendations. This study aimed to determine the basis for CBCT recommendations and the effect on diagnosis and treatment planning. Methods The study involved a sample of 45 cases that presented for endodontic treatment, 30 with a CBCT scan on record and 15 without. For phase 1, all 45 cases were reviewed by 3 examiners without access to the CBCT scans. For phase 2, 4 months later, the 3 examiners reanalyzed the 30 cases, this time with the associated CBCT scan. Intra- and interexaminer agreements were recorded and analyzed. Also, the recommendations for CBCT were compared with the American Association of Endodontists/American Academy of Oral and Maxillofacial Radiology joint statement. Results Interexaminer agreement in phases 1 and 2 was 65% and 72%, respectively. For endodontic diagnoses, there was a 19% change in the pulpal diagnosis category when CBCT imaging was added, whereas there was a 30% change in the apical category. The selections changed in 55% of the cases when determining etiology and in 49% of the cases when making recommendations. CBCT imaging was recommended 78.8% of the time when the case had a CBCT on record versus 33% of the time in cases without. Conclusions CBCT imaging has a significant effect in determining the etiology of endodontic pathoses and in recommending treatment. Furthermore, CBCT imaging is not overprescribed in the endodontic department, and the faculty members adhere to the American Association of Endodontists/American Academy of Oral and Maxillofacial Radiology recommendations.

Introduction This study evaluated the influence of cone-beam computed tomography (CBCT) on endodondists' level of confidence in their diagnosis of endodontic cases and their treatment plans. Methods Twenty clinical cases with periapical radiographs and small-volume CBCT scans were classified according to the American Association of Endodontists guidelines. Information was provided on patient clinical history, and both extraoral and intraoral examinations were simulated. Fifteen endodontists filled out 2 questionnaires. In the first (Q1), the clinical description and a periapical radiograph were presented, followed by the questions. Thirty days later, they answered a second questionnaire (Q2) containing the same clinical description and CBCT. Their confidence in diagnosis and treatment planning was analyzed before and after receiving the tomographic images. Responses were recorded on a 5-point Likert scale, and the Wilcoxon test was used to investigate before and after levels of confidence in diagnosis and treatment planning. Results The CBCT images influenced confidence in diagnosis and treatment planning of endodontic cases classified as complex (Wilcoxon test; P ≤ .05). There was a substantial change in the treatment planned in both moderate and complex cases after CBCT. Case complexity did not affect the participants' decision to request complementary information through CBCT. Conclusions In complex cases, CBCT increased endodontists' confidence to diagnose and plan treatment, when compared with periapical radiographs. Endodontists tended to recommend intervention when periapical images were supplemented with CBCT. CBCT proved to be an imaging method that influences endodontists' preoperative evaluation and treatment choice.

Aim: The present study aimed at comparing clinical, radiographical, and histological findings in chronic periapical lesions such as cysts, granuloma, and abscess. Methodology: The present study was conducted on 148 teeth having chronic inflammatory periapical lesions with or without nonsurgical endodontic treatment. Endodontic surgery was performed by single trained endodontist. After surgical endodontic treatment, biopsy sections of teeth were assessed histologically. All slides stained with hematoxylin/eosin and Gomori trichrome for light microscopy assessment. Results: Out of 148 teeth, 41 had chronic inflammatory lesions, 34 had inflammatory cysts, and 25 had indefinite lesions. Chronic inflammatory lesions assessed histologically found chronic apical periodontitis in 86 cases and inflammatory cysts in 62 cases. The difference was significant (P < 0.05). Out of 86 cases of chronic apical periodontitis confirmed clinical radiographically, 64% found positive, whereas 36% were not histologically. Out of 62 cases of inflammatory cysts confirmed clinically and radiographically, 78% found positive while 36% were not histologically. Out of 25 indefinite lesions, 56% found chronic inflammatory lesions while 44% found inflammatory cyst. Conclusion: There was significant disagreement in clinical radiographic as well as histological diagnosis.

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.