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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.

Background and Objectives: Large radicular cysts of the maxilla present a clinical challenge, as they may cause recurrent infection, severe alveolar bone loss and disruption of the nasal and maxillary sinus floors. The aim of this study was to evaluate the effect of previous root canal treatment on the clinical presentation of large maxillary radicular cysts. Materials and Methods: All cases of radicular cysts treated at the Oral and Maxillofacial Surgery Department of a tertiary public hospital over a period of six years (2012–2018) were evaluated. Histologically confirmed radicular cysts of the maxilla with a maximal dimension of over 15 mm were included. Demographic data of the patients, clinical presentation and radiographic features of the lesions were analyzed. Results: A total of 211 inflammatory cysts were treated in the study period, of these 54 histologically diagnosed radicular cysts in the maxilla were found to have a maximal dimension of over 15 mm. The mean age of patients with large maxillary radicular cysts was 43.3 years, 57.6% of which were male and 42.4% female. The lateral incisor was the most common tooth affected (46.3%). The mean size of the large radicular cysts was 25 mm. Then, 83.8% of the cysts were observed in teeth with previous endodontic treatment. Teeth without endodontic treatment presented clinically with significantly fewer acute symptoms in comparison to teeth with previous endodontic treatment. Conclusions: the vast majority (83.8%) of large maxillary radicular cysts were associated with endodontically treated teeth. Previous endodontic treatment was correlated to increased frequency of clinical symptoms.

Aim To assess retrospectively the clinical and radiographic outcomes of retrograde root canal retreatment (RRR) and to identify possible prognostic factors that may affect the outcome. Methodology Clinical records and radiographs were collected from patients who had undergone RRR between 2009 and 2016 and had a 1-year follow-up. All surgical procedures were performed by a single endodontist. The RRR technique involved minimal root-end resection and maximal length retrograde preparation using pre-bent ultrasonic files. Outcomes were categorized as complete, incomplete, uncertain or unsatisfactory healing based on clinical and radiographic findings. The complete and incomplete healing cases were pooled and considered as successes, while uncertain and unsatisfactory cases were considered failures. Prognostic factors were analysed using univariate analysis and multivariate logistic regression. Results In total, 575 patients with 721 teeth were included. The overall success rate was 91.8%. None of the prognostic factors (including age, gender, size of periapical radiolucency and isthmus presence) had a significant influence on the outcome (P > 0.05). Univariate analysis revealed tooth type had a significant influence on outcome (P = 0.008) with mandibular incisors having a significantly lower success rate (71.4%). Multivariate analysis using logistic regression revealed that the only variable with a significant association to the outcome was retrograde preparation length (P = 0.016, odds ratio = 1.299 (1.050, 1.607), C.I. = 95%)), i.e. the longer the retrograde preparation, the better the outcome. Conclusions Retrograde root canal retreatment was successful in 91.8% of cases. This predictable success rate was achieved while minimizing root-end resection and maximizing retrograde canal preparation length.

This study aimed to determine the bactericidal efficacy of sequential use of NaOCl pH 12 followed by acidified NaOCl pH 6.5, and compare it to that of either of these NaOCl solutions alone. E. faecalis biofilm was grown on standardized dentine specimens for four weeks. The specimens were randomly divided into four groups: (A) 4 min exposure to 0.9% saline solution (control), (B) 4 min exposure to 4% NaOCl pH 12, (C) 4 min exposure to 4% NaOCl pH 6.5, and (D) 2 min exposure to 4% NaOCl pH 12 followed by 2 min exposure to 4% NaOCl pH 6.5. The bactericidal activity was evaluated after the 4 min of contact time using confocal laser scanning microscopy. The volume ratio of red fluorescence to green and red fluorescence indicated the proportion of dead cells in the biofilm. The percent of dead cells in the saline solution group was significantly lower than those in the other groups. There was no significant difference between NaOCl pH 12 compared to NaOCl pH 6.5. The sequential use of NaOCl pH 12 followed by pH 6.5 significantly increased the percent of dead cells compared to both the samples exposed to either NaOCl pH 12 or pH 6.5. These results show that sequential irrigation protocol had a stronger bactericidal effect than the commonly used NaOCl pH 12.

The purpose of this study was to compare the effectiveness of self-adjusting file (SAF), XP-endo finisher (XP), passive ultrasonic irrigation (PUI) and conventional syringe and needle irrigation (SNI) in the removal of Ca(OH)2 from an artificial groove. Eighty mandibular incisors with single oval canals were prepared to size 40/0.04 and split longitudinally. A standardised groove was prepared in the apical third and filled with Ca(OH)2. The root halves were reassembled and divided into two control groups (n = 4) and four experimental groups (n = 18) according to the removal methods used. The amount of residual Ca(OH)2 was evaluated using a four-grade scoring system. The differences among the groups were analysed using the Kruskal–Wallis test (P

Introduction The aim of this study was to systematically review and evaluate the literature regarding the prognosis of altered sensation after extrusion of root canal filling materials and the possible factors influencing it. Methods A systematic search of the literature was performed to identify studies that reported on altered sensation after extrusion of root canal filling materials during endodontic treatments. The articles were evaluated for their relevance based on strict inclusion criteria, and the identified suitable articles were subject to data extraction and analysis. Results Initially, 109 possibly relevant articles were identified. After screening and full-text evaluations, 28 articles that met the inclusion criteria were analyzed, reporting on a total of 84 patients with altered sensation after extrusion of root canal filling materials. All the included studies, except 1 case series, were case reports. Under the limited available data, the extracted data showed that 91% of the patients had fully or partially recovered over time. Most of the cases in the lower molars as well as most of the cases in which the obturation was performed using paraformaldehyde-containing sealer or cases in which an immediate treatment was not performed did not fully recover. Conclusions The current scientific knowledge regarding the prognosis of nerve injuries caused by overextruded endodontic materials relies primarily on case reports. Within the limitations of the published data, it seems that the tooth locations, types of extruded materials and the obturation technique, and treatment after the injury may affect the nerve injury prognosis.

Background This study presents a series of 18 cases of cracked non-endodontically treated teeth that were diagnosed following the placement of adjacent implant-supported rehabilitation. These findings could suggest a possible cause/related events. Results Most of the cases occurred in female patients (61%), over 50 years old (78%, with an average age of 59 years). Nine (50%) of the cracked teeth were molars, 7 (39%) were mandibular premolars, and 2 (11%) were incisor teeth. Most of the cracked teeth (61%) had an amalgam restoration, 50% had deep periodontal pockets, and 78% had vital pulps. In 78% of patients, multiple implants were placed (with an average of 3 implants per patient). The time from implant loading to the diagnosis of a crack was longer than 1 year in 78% of cases. Conclusions The most common patient profile found in this series was a woman over 50 years old, having a cracked mandibular premolar tooth, which was diagnosed more than 1 year after reconstruction based on multiple adjacent implants. Additional clinical studies are warranted in order to shed light on this potential complication.

The long-term dynamics of periapical lesions in endodontically treated teeth is not fully elucidated, thus presenting a clinical dilemma regarding the need for an intervention. The aim of the study was to retrospectively evaluate the long-term dynamics of periapical lesions that were left without intervention in endodontically treated teeth.Periapical status surveys of patients treated in a public dental clinic were retrospectively evaluated for the presence of periapical lesions in endodontically treated coronally restored teeth. The dynamics of the included periapical lesions was evaluated based on the periapical index (PAI) score changes between 2 consecutive periapical surveys of at least a 4-year interval. The influence of various factors on lesion dynamics was statistically evaluated.The study cohort consisted of 74 patients with a total of 200 endodontically treated teeth having periapical lesions that fulfilled the inclusion criteria. Fifty-seven (28.5%) lesions remained unchanged, 103 (51.5%) lesions worsened (PAI score increased), and 40 (20%) lesions improved (PAI score decreased). Poor root canal filling and poor restoration were found to adversely affect the long-term dynamics of the periapical lesions (P.05). Age, sex, and the presence of a post had no statistically significant influence on lesion dynamics (P.05).Poor root canal filling and poor restoration may adversely affect the long-term dynamics of periapical lesions that are left without intervention in endodontically treated teeth. Therefore, in cases of poor root canal filling or poor restoration, further intervention may be indicated.

Aim To examine whether local anaesthesia is required for treating teeth with necrotic pulps (TNP) and retreatment cases (RCs) associated with periapical lesions. Methodology Root canal treatment was performed in TNP and RCs without the administration of local anaesthesia. Patients were assured that if they experienced pain, local anaesthesia would be provided. Eighty canals, 40 TNP and 40 RCs, were included in the study. Two length measurements were performed: one using an electronic apex locator (EAL), which was defined as the electronic length (EL), and the second, the length at which the patient first reported that a size 15 file was touching the periapical tissues, which was defined as the periodontal length (PL). The difference between these two measurements (Δ = PL − EL) was the parameter studied. Statistical analysis was conducted using two-way anova and paired t-tests. Working length (WL) was defined in this study as being 0.5 mm short of the EL. Results EL was shorter than PL in 96% of cases. The mean difference between measurements was 0.78 (±0.11) mm in the TNP group and 0.63 (±0.15) mm in the RC group; the difference was not significant. The distances between the WL and PL were thus 1.28 and 1.13 mm, respectively. In none of the 80 canals did the patient experience any pain, either during the measurements or during the instrumentation procedures. Conclusions When EALs are used, local anaesthesia may not be required for root canal treatment in teeth with necrotic pulps and retreatment cases associated with periapical lesions.