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Aim: Previous endodontic research has provided limited understanding of the prevalence and roles of haemolytic and non‐haemolytic Enterococcus faecalis strains in root filled teeth. This study aimed to determine the prevalence of these strains in root filled teeth with periradicular lesions and investigate their associated virulence factors. Methodology: A total of 36 root canal samples were collected from 36 subjects. The prevalence of E. faecalis was determined using culture and PCR methods. Antibiotic susceptibility of haemolytic and non‐haemolytic E. faecalis strains was assessed using the broth dilution assay. The cytokine stimulation in periodontal ligament (PDL) cells and neutrophil migration were evaluated using real‐time PCR and migration assay, respectively. Cell invasion ability of the strains was assessed using a cell culture model. Additionally, the virulence gene expression of the haemolytic and non‐haemolytic strains was investigated using real‐time PCR. The Mann–Whitney U and Spearman's ρ tests were used to examine the significant difference between the two strains and to analyse the correlation between phenotype and gene expression, respectively. Results: Enterococcus faecalis was detected in 33.3% and 88.9% of samples by culture and real‐time PCR, respectively. Haemolytic strains were found in 36.4% of subjects. Non‐haemolytic strains exhibited susceptibility to erythromycin and varying susceptibility to tetracycline, while all haemolytic strains were resistant to both antibiotics. Haemolytic strains significantly upregulated the expression of IL‐8, OPG and RANKL in PDL cells (p <.05). Notably, the fold increases in these genes were higher: IL‐8 (556.1 ± 82.9 vs. 249.6 ± 81.8), OPG (2.2 ± 0.5 vs. 1.3 ± 0.2) and RANKL (1.8 ± 0.3 vs. 1.2 ± 0.1). Furthermore, haemolytic strains had a greater effect on neutrophil migration (68.7 ± 15.2% vs. 46.9 ± 11.4%) and demonstrated a higher level of internalization into oral keratinocyte cells (68.6 ± 0.4% vs. 33.8 ± 0.5%) (p <.05). They also showed enhanced expression of virulence genes associated with haemolysin, surface proteins, collagen‐binding and aggregation substances. Gelatinase activity was only detectable in non‐haemolytic strains. Conclusions: This study revealed that haemolytic strains E. faecalis possessed enhanced abilities in host invasion and a higher abundance of virulence factors, suggesting their potential contribution to more severe disease manifestations. [ABSTRACT FROM AUTHOR]

Abstract Objective The aim of this study was to explore the influence of a framing effect in retreatment decision‐making of a root‐filled tooth with asymptomatic apical periodontitis (AP). Method Two variants of a questionnaire were created in which the factual information about a root filled with AP was identical. The options in the first variant were framed in favor to wait and see (FW) and those in the other variant were framed in favor of retreatment (FR) Two hundred and forty‐eight volunteers were by chance given one of the two versions and were asked to choose between having retreatment or to wait and see. Results Of the 125 participants given the FW version, 69 (55.2%) chose to wait and see while out of the 123 participants who were given the FR version, 38 (30.9%) made the alike choice (p = .0002). Conclusion A framing effect is likely to play an essential role in endodontic retreatment decision‐making of root‐filled teeth with asymptomatic apical periodontitis.

Objective: The aim of this study was to explore the influence of a framing effect in retreatment decision‐making of a root‐filled tooth with asymptomatic apical periodontitis (AP). Method: Two variants of a questionnaire were created in which the factual information about a root filled with AP was identical. The options in the first variant were framed in favor to wait and see (FW) and those in the other variant were framed in favor of retreatment (FR) Two hundred and forty‐eight volunteers were by chance given one of the two versions and were asked to choose between having retreatment or to wait and see. Results: Of the 125 participants given the FW version, 69 (55.2%) chose to wait and see while out of the 123 participants who were given the FR version, 38 (30.9%) made the alike choice (p =.0002). Conclusion: A framing effect is likely to play an essential role in endodontic retreatment decision‐making of root‐filled teeth with asymptomatic apical periodontitis. [ABSTRACT FROM AUTHOR]

Background: The prevalence of root filled teeth (RFT) worldwide will inform about the amount of clinical activity of dentists dedicated to treat endodontic disease. Objectives: To carry out a systematic review with meta‐analysis answering the following question: What is the prevalence of RFT around the world? The percentage of people with at least one RFT was also investigated. Methods: A systematic review including population‐based studies using the following databases: PubMed, EMBASE and Scielo. Studies related to prevalence of RFT were included. The outcome of interest of the study was the prevalence of RFT. The meta‐analyses were calculated with the Open Meta Analyst software to determine the global prevalence of RFT. Subgroups analyses were performed comparing geographical distribution, radiographic method and year of the study (classified in 20th or 21th century). The prevalence of people with at least one RFT was also analysed. Results: Seventy‐four population‐based studies fulfilled the inclusion criteria. Twenty‐eight, forty‐four and two studies reported high, moderate and low risk of bias, respectively. No obvious publication bias was observed. Prevalence of RFT was estimated with 1 201 255 teeth and 32 162 patients. The calculated worldwide prevalence of RFT was 8.2% (95% CI = 7.3%–9.1%; p <.001). The global prevalence of people with at least one RFT was 55.7% (95% CI = 49.6%–61.8%; p <.001). In 20th century, the prevalence of RFT was 10.2% (95% CI = 7.9%–12.5%; p <.001), whereas in the 21st century the overall calculated prevalence of RFT was 7.5% (95% CI = 6.5%–8.6%; p <.001). Brazilian people (12%) and the European population (9.3%) showed the highest prevalence of RFT. In Europe, 59.6% (95% CI = 52.4%–66.8%) of people has at least one RFT. Conclusions: This review showed that root canal treatment is a very common therapy throughout the world. More than half of the studied population have at least one RFT. A limitation of the present study is that most of the studies did not consider random sampling for population selection. Registration: PROSPERO Systematic review registration number: (CRD42022329053). [ABSTRACT FROM AUTHOR]

This narrative review will focus on a number of contemporary considerations relating to the restoration of root filled teeth and future directions for research. Clinicians are now more than ever, aware of the interdependence of the endodontic and restorative aspects of managing root filled teeth, and how these aspects of treatment are fundamental to obtaining the best long‐term survival. To obtain the optimal outcomes for patients, clinicians carrying out endodontic treatment should have a vested interest in the restorative phase of the treatment process, as well as an appreciation for the structural and biomechanical effects of endodontic‐restorative procedures on restoration and tooth longevity. Furthermore, the currently available research, largely lacks appreciation of occlusal factors in the longevity of root filled teeth, despite surrogate outcomes demonstrating the considerable influence this variable has. Controversies regarding the clinical relevance of minimally invasive endodontic and restorative concepts are largely unanswered with respect to clinical data, and it is therefore, all too easy to dismiss these ideas due to the lack of scientific evidence. However, conceptually, minimally invasive endodontic‐restorative philosophies appear to be valid, and therefore, in the pursuit of improved clinical outcomes, it is important that the efficacies of these treatment protocols are determined. Alongside an increased awareness of the preservation of tooth structure, developments in adhesive bonding, ceramic materials and the inevitable integration of digital dentistry, there is also a need to evaluate the efficacy of new treatment philosophies and techniques with well‐designed prospective clinical studies. [ABSTRACT FROM AUTHOR]

This case report describes palatal wall direct restoration with the stamp technique in Twenty-eight-year-old patient. The procedure was completed with the silicone index, transparent silicon and composite resin. After 5 years function patients was satisfied with the obtained functional result and had a wish to improve the adjacent tooth aesthetics.

Vertical root fracture (VRF) is a common reason for the extraction of root filled teeth. The accurate diagnosis of VRF may be challenging due to the absence of clinical signs, whilst conventional radiographic assessment is often inconclusive. However, an understanding of the aetiology of VRFs, and more importantly, the key predisposing factors, is crucial in identifying teeth that may be susceptible. Thorough clinical examination with magnification and co‐axial lighting is essential in identifying VRFs, and although CBCT is unable to reliably detect VRFs per se, the pattern of bone loss typically associated with VRF can be fully appreciated, and therefore, increases the probability of correct diagnosis and management. The prevalence of VRFs in root filled teeth is significantly greater than in teeth with vital pulps, demonstrating that the combination of loss of structural integrity, presence of pre‐existing fractures and biochemical effects of loss of vitality is highly relevant. Careful assessment of the occlusal scheme, presence of deflective contacts and identification of parafunctional habits are imperative in both preventing and managing VRFs. Furthermore, anatomical factors such as root canal morphology may predispose certain teeth to VRF. The influence of access cavity design and root canal instrumentation protocols should be considered although the impact of these on the fracture resistance of root filled teeth is not clearly validated. The post‐endodontic restoration of root filled teeth should be expedient and considerate to the residual tooth structure. Posts should be placed 'passively' and excessive 'post‐space' preparation should be avoided. This narrative review aims to present the aetiology, potential predisposing factors, histopathology, diagnosis and management of VRF and present perspectives for future research. Currently, there are limited options other than extraction for the management of VRF, although root resection may be considered in multi‐rooted teeth. Innovative techniques to 'repair' VRFs using both orthograde and surgical approaches require further research and validation. The prevention of VRFs is critical; identifying susceptible teeth, utilizing conservative endodontic procedures, together with expedient and appropriate post‐endodontic restorative procedures is paramount to reducing the incidence of terminal VRFs. [ABSTRACT FROM AUTHOR]

Purpose: to study the influence of the extent of root canal enlargement on the resistance of tooth to vertical root fracture. Bovine teeth were used (n = 20) from which experimental cylindrical samples were fabricated and divided into two groups according to root canal diameter. The sampled were subjected to vertical static load in universal testing machine until vertical root fracture occurrence. Average values of maximal load were fixed in each group. Mann-Witney test was used in SPSS Statistics program to assess the significance of differences between groups. Average load values for the group with smaller were 438,60 ± 29,84 kgf (median was 437,88 kgf) and in the group with larger canal diameter were 293,21 ± 68,23 kgf (median was 301,79 kgf). The differences between groups were statistically significant (p = 0,001). It was shown that the extent of root canal influences on the resistance of the root to fracture.

This position statement on the restoration of root filled teeth represents the consensus of an expert committee, convened by the European Society of Endodontology (ESE). Current clinical and scientific evidence, as well as the expertise of the committee, have been used to develop this statement. The aim is to provide clinicians with evidence‐based principles for decision‐making on the choice of restoration following the completion of root canal treatment. By discussing the evidence in relation to key topics regarding post‐endodontic restoration, a series of clinical recommendations are made. The scientific basis of the recommendations made in this paper can be found in a recently published review article (Bhuva et al. 2021, International Endodontic Journal, https://doi.org/10.1111/iej.13438). It is the intention of the committee to update this statement as further evidence emerges. [ABSTRACT FROM AUTHOR]

The purpose of the present study was to investigate the survival rate of root filled teeth in general dentistry in a Swedish county and to identify risk predictors with a significant influence on the survival rate. This is a retrospective 6-year follow-up study on 1642 recall patients with 1720 teeth root filled in general dentistry in the Public Dental Service in the county of Stockholm, Sweden. Background variables were collected from the database at baseline as potential predictors of tooth loss. The outcome variables were extraction during the 6-year follow-up period and the reason for the extraction. Stepwise Cox regression analysis was adopted in order to investigate the influence of the potential risk predictors on the risk for tooth extraction. Nine percent of the root filled teeth were lost after 6 years. The most frequent reason for tooth loss was fracture and/or cracks (58%). The survival rate of the root filled teeth increased significantly for younger patients, root filled teeth with metal crowns (96%) and high quality of the root filling (93%). The survival rate differed significantly between tooth groups with the lowest survival for molars (83%). Composite fillings were significantly associated with lower quality of the root fillings. Ninety-one percent of the root filled teeth survived after 6 years. The survival rate was significantly higher for teeth with root-fillings of high quality and metal crowns as well as for root filled teeth in younger patients. The lowest survival rate was found for molars. [ABSTRACT FROM AUTHOR]

Aim: To identify dominant microorganisms in root filled teeth with apical periodontitis by Pan‐PCRs in comparison with a culture‐dependent approach, focusing on fungal species profiling. Methodology: The root filling material (gutta‐percha) removed from 42 teeth with periapical radiolucencies undergoing root canal retreatments was analysed by molecular genetics techniques. Real‐Time Pan‐PCRs were conducted for the diagnosis of predominant bacteria (targeting 16S rDNA) and fungi (targeting ITS1‐2 region). Identification of microorganisms was performed by Sanger sequencing of the PCR products and BLAST analysis. Additionally, subgingival plaque samples were collected and cultured to review the composition of the microbial flora. The McNemar test and the repeated measures anova were used for statistical analyses (significance level was set at P < 0.05). Results: Overall, 42/42 plaque samples had bacterial growth, whereas 32/42 gutta‐percha samples had bacterial growth with a dominance of Streptococcus spp. (12/42) and Enterococcus faecalis (9/42). The mean number of bacterial taxa per gutta‐percha sample was 1.6 cultivatable taxa, significantly lower than in the plaque sample that had six taxa/sample (P < 0.001). Fungus‐specific cultures were negative for gutta‐percha samples, and only one plaque sample had growth of a fungus. In total, 36/42 plaque samples were positive in bacterial Pan‐PCRs. In bacterial Pan‐PCRs of 31/42 gutta‐percha samples, dominant microorganisms were identified including Streptococcus spp. (5/42) and E. faecalis (4/42). Moreover, in 7/42 gutta‐percha samples, DNA of bacteria which are difficult‐to‐cultivate in microbiology routine culture (Acinetobacter,Pyramidobacter,Bacteroidetes,Synergistes,Atopobium and Pseudoramibacter) was found. DNA of Candida spp. was detected in 5/42 root canals by fungal Pan‐PCR (1/5) and genus‐specific Candida‐PCR (5/5). Conclusions: Pan‐PCR assays remain appropriate as a broad‐range approach for the detection of a dominant pathogen in gutta‐percha samples which have less diverse microbial composition. The molecular genetic Pan‐PCR approach has the advantage of detecting microorganisms that are as‐yet‐uncultivable or difficult‐to‐cultivate and should be therefore complement conventional microbiological diagnostics. [ABSTRACT FROM AUTHOR]

Aim: To (i) investigate the frequency and characteristics of pain and discomfort associated with root filled teeth in adult patients regularly attending the Public Dental Service in Örebro County, Sweden; (ii) assess the association between symptoms and clinical and radiographic findings; and (iii) explore the impact of pain and discomfort from root filled teeth on daily life. Methodology: Patient records of adult patients (≥20 years) scheduled for routine check‐ups in April 2015 were screened to identify individuals with root filled teeth; all patients with ≥1 root filled tooth were asked to participate. The examination comprised of clinical and radiographic examinations and questionnaires on general health, on pain symptoms from root filled teeth and on the impact of pain on daily activities. In a general estimating equation (GEE), examination findings and patient‐related factors were independently analysed in relation to the outcome 'presence of pain'. Results: In total, 550 patients with 1256 root filled teeth participated. Fifty‐three patients (9.6%) experienced pain or discomfort from 62 (4.9%) root filled teeth. Lower age, percussion tenderness and apical tenderness were significantly associated with pain (P > 0.001 to P = 0.044). The average pain intensity was 2.1 on a (0–10) Numeric Rating Scale, and average duration was 28.4 months. The impact on daily life was low. Conclusions: On average, pain associated with root filled teeth was of mild intensity, >2 years of duration and had low impact on daily life. Although the significantly associated clinical findings may indicate apical periodontitis as the most probable explanation in some teeth, the origin of pain from root filled teeth remains partly unexplained. [ABSTRACT FROM AUTHOR]

Previous studies have found an association between the outcome of root canal treatment (RCT) and diabetic status. This systematic review and meta‐analysis aimed to analyse the potential relationship between diabetes and the occurrence of extracted root filled teeth (RFT). The clinical PICO question was as follows: in adult patients with RFT, does the absence or presence of diabetes influence the prevalence of RFT extraction? The key words used in the systematic search were as follows: (Diabetes OR Diabetes Mellitus OR Hyperglycaemia OR Diabetic) AND (Endodontic OR Endodontics OR Endodontic Treatment OR Root Canal Treatment OR Root Canal Preparation OR Root Canal Therapy OR Root Filled Teeth OR Endodontically Treated Teeth) AND (Extraction OR Retention OR Survival OR Success OR Failure OR Outcome). The primary outcome variable was odds ratio (OR) for the frequency of extracted RFT in diabetics and healthy subjects. The method of DerSimonian–Laird with random effects was used to calculate the overall OR. Three hundred titles were identified, and three studies achieved the inclusion criteria. Data from 54 936 root canal treatments, 50 301 in nondiabetic control subjects and 4635 in diabetic patients, were analysed. The calculated overall odds ratio (OR = 2.44; 95% CI = 1.54–3.88; P = 0.0001) implies that diabetics had a significantly higher prevalence of extracted RFT than healthy nondiabetic subjects. The results of available studies indicate a significant relationship between DM and increased frequency of nonretained root filled teeth. Diabetes mellitus should be considered an important preoperative prognostic factor in root canal treatment. [ABSTRACT FROM AUTHOR]

Aim To investigate referrals to a specialist clinic in endodontics in relation to previously root filled teeth and to determine how many of these teeth had a history of symptoms and the extent to which antibiotics were prescribed. Methodology The total number of referrals to the specialist clinic in endodontics in Gothenburg, Sweden, in 2011 was investigated retrospectively by means of patient records. The endodontic status together with the presence or absence of symptoms was registered. The following variables were also examined: gender, age, tooth number and lower or upper jaw. Additionally for root filled teeth, the type of restoration, the technical quality of the root filling and the presence of apical periodontitis were registered. The use of antibiotics was examined for all of the included teeth. Statistical analysis was performed using generalized estimating equation methods applied to univariable and multivariable logistic regression. Results A total of 1117 patient records were investigated, including 1341 referred teeth. Pain and/or swelling were recorded for 658 (54.3%) teeth. Symptoms were significantly more associated with females (P < 0.0001) and molar teeth (P < 0.0001). Seven hundred twenty-nine (54.4%) of the referred teeth were root filled, and of these, 377 (56.0%) were associated with pain and/or swelling. Root filled teeth restored with a post and core were less frequently related to symptoms (P = 0.009). One hundred sixty-two (22.3%) root filled teeth were treated with antibiotics, which was significantly more frequent than for non-root filled teeth (P < 0.0001). Also, root filled teeth with an adequate root filling were significantly associated with more frequent antibiotics prescriptions (23.8%) than root filled teeth with an inadequate root filling (17.0%) (P = 0.0010). Conclusion Root filled teeth constituted the majority of cases referred to this specialist clinic in endodontics. The majority of these teeth were associated with symptomatic conditions, and antibiotics were prescribed to approximately 20% of the patients referred for a root filled tooth. The findings suggest that symptomatic root filled teeth may be a substantial clinical problem in general dentistry and contribute to avoidable prescription of antibiotics. [ABSTRACT FROM AUTHOR]

Aim To assess the prevalence of apical periodontitis in the Finnish population aged 30 years and older and relate it to the technical quality of root filling by the type of tooth. Methodology As part of the Finnish nationwide Health 2000 study, panoramic radiographs were used of the dentate subjects ( n = 5335) aged 30-95 years (mean 50.2 years) to assess the apical and endodontic status of their teeth ( n = 120635). Apical periodontitis ( AP) was recorded when the periodontal ligament space was more than double in width, or loss of lamina dura or a periapical radiolucent lesion was seen. Technically, adequate root fillings had a gap of 0-3 mm from the apex; all others were defined as inadequate. Statistical methods included chi-square tests and anova. Risk of AP was estimated as cross-product odds ratio and its 95% confidence interval. Results Teeth with AP occurred in 27% of the dentate subjects being more prevalent in subjects with root filled teeth than in those without (39% vs. 9%; P < 0.001; OR = 6.3; 95% CI 5.3, 7.4). AP was more prevalent in men than in women (31% vs. 23%). At a tooth level, AP was most frequent in mandibular molars with inadequate root fillings. For all root filled teeth, an inadequate root filling doubled the risk of AP for both women ( OR = 2.0; 95% CI 1.7, 2.4) and men ( OR = 2.5; 95% CI 2.1, 2.9). Conclusions AP occurred principally in subjects and teeth with root fillings. Inadequate root fillings doubled the risk of AP. An improvement in the technical quality of root canal treatment is essential. [ABSTRACT FROM AUTHOR]

Background: Micro-organisms are the primary causative agents of endodontic infections. Phenotype based procedures for bacterial identification has certain drawbacks especially, when investigating the microbiota of root-filled teeth. Thus, more sensitive methods like Polymerase chain reaction (PCR) can provide results that are more accurate and reliable for the microbial prevalence in the root filled teeth. Aim: In this study, we have investigated twenty symptomatic root-filled teeth with chronic apical periodontitis for the prevalence of Enterococcus faecalis and Candida albicans in the root filled teeth associated with symptomatic cases with or without periradicular lesions. Materials and Methods: Microbiological samples were taken from the canals immediately after removal of previous gutta percha cones using aseptic techniques. After removal of root canal filling, samples were obtained with paper points placed in the canal. Paper points were transferred to a cryotube containing "Tris EDTA" buffer and immediately frozen at −20°C. Results: By PCR amplification of the samples using taxon specific primers, E. faecalis was found to be prevalent species, detected in 65% of the cases and C. albicans was detected in 35% of cases. Conclusion: The results of the study shows that geographical influence and dietary factors might have some role to play in the prevalence of the species like C. albicans and presence of E. faecalis confirming the assertion of previous culture-dependent and independent approaches for the microbiological survey of root filled teeth.

Objectives: To compare fracture characteristics of root-filled teeth with variable cavity design restored with a low shrinkage silorane and methacrylate-based resin composite. Methods: 77 extracted maxillary premolars were divided randomly into seven groups: (Group 1) intact teeth; (Groups 2-4) MOD plus endodontic access with the buccopalatal width of the occlusal isthmus equals one third of the intercuspal width; (Groups 5-7) MOD plus endodontic access with the buccopalatal width of the occlusal isthmus equals one half of the intercuspal width. Groups 2 and 5 were left unrestored, Groups 3 and 6 were restored with a silorane-based resin composite (Filtek P90) and Groups 4 and 7 with a methacrylatebased resin composite (Z250). Teeth were loaded in a universal testing machine; load and fracture patterns were recorded and compared statistically using 2-way ANOVA and t-test for pairwise comparisons and 1-way ANOVA with Dunnett test for multiple comparisons. Results: Unrestored teeth became progressively weaker with more extensive preparations, Group 5 (unfilled) showed the lowest fracture load among the groups (71 ± 22 N, P < 0.001). Restorations increased the fracture strength of unrestored teeth regardless of cavity size (P < 0.001), but was still significantly weaker than sound teeth, with no significant difference between silorane and methacrylate groups. Failure of restored teeth was mostly adhesive at the tooth restoration interface. Conclusions: Silorane-based resin composite have no superior strengthening effect over the conventional methacrylate-based resin composite in restoration of root filled teeth. Both materials showed similar fracture patterns. Clinical significance: Root filled teeth are considerably weakened via restorative and endodontic procedures. A direct adhesive restoration will aid in preserving tooth structure as far as it provides enough strength. [ABSTRACT FROM AUTHOR]

Introduction The long-term survival of endodontically treated teeth is an issue of high priority focus in modern restorative dentistry. In available literature, survival is generally high and comparable with implants. For more compromised teeth treated in a specialist clinic, survival rate may be lower. This retrospective study aimed to investigate the 10-year survival rate of teeth treated in a public endodontic specialist clinic. Methods From a database of 15,000 examined teeth, 420 teeth in 330 patients were randomly selected and included. Available potential preoperative, intraoperative, and postoperative prognostic factors were registered. Ten-year tooth survival was recorded by scrutinizing records and by contacting referring dentists and patients. Results The overall Kaplan-Meier estimated 10-year survival rate was 81.5% (95% confidence interval [CI], 76.7%–85.5%). Placement of a crown, adjusted hazard ratio 0.27 (95% CI, 0.12–0.61), P = .0016, and age-adjusted hazard ratio 1.31 per 10 years (95% CI, 1.11–1.55), P = .0012, were significant independent predictors for estimated survival rate. Seventy-three teeth (17.4%) in 69 patients were extracted during the 10-year follow-up period. The declared reason for extraction was related to endodontic diagnoses in only 5 of the cases (6.8%). Conclusions Approximately 80% of the teeth treated at this specialist clinic in endodontics survived at least for 10 years. Teeth in young persons and teeth restored with a crown postoperatively survived significantly better. To further explore the importance of the postoperative restoration in endodontically treated teeth, randomized controlled trials need be carried out. [ABSTRACT FROM AUTHOR]

Aim To assess the long-term outcome of root filled teeth in a general adult population examined in 1997, 2003 and 2008. Methodology The study provides longitudinal, observational information on endodontic status for 327 randomly selected individuals from a general Danish population receiving three consecutive full-mouth radiographic examinations. The association between root filling quality, periapical disease and the long-term outcome of the root filling and the root filled tooth was assessed using GEE methodology and tests for trend. Results Overall 13% of the root filled teeth had been extracted, 12% had received a revision of the root filling and 42% of root filled teeth present in 2008 had apical periodontitis ( AP) after the 10-year follow-up period. The probability of persistent AP was higher if the root filling was either short or long ( P = 0.001), if there were voids ( P < 0.001), or if there were radiographic signs of overhang or open margin of the restoration ( P = 0.01). Further, the probability of extraction was high if there were radiographic signs of overhang or open margin of the restoration ( P = 0.008) and if the overall root filling quality was inadequate (test for trend, P = 0.03). Conclusions The root filling quality primarily affected the risk of persistent AP and to a smaller extent the risk of extraction, whereas the quality of the coronal restoration primarily affected the risk of extraction and to a smaller extent the risk of persistent AP. If adjusted for AP present at the initial examination, the associations were less pronounced both in relation to extraction and persistence of AP. [ABSTRACT FROM AUTHOR]

Background: Micro-organisms are the primary causative agents of endodontic infections. Phenotype based procedures for bacterial identification has certain drawbacks especially, when investigating the microbiota of root-filled teeth. Thus, more sensitive methods like Polymerase chain reaction (PCR) can provide results that are more accurate and reliable for the microbial prevalence in the root filled teeth. Aim: In this study, we have investigated twenty symptomatic root-filled teeth with chronic apical periodontitis for the prevalence of Enterococcus faecalis and Candida albicans in the root filled teeth associated with symptomatic cases with or without periradicular lesions. Materials and Methods: Microbiological samples were taken from the canals immediately after removal of previous gutta percha cones using aseptic techniques. After removal of root canal filling, samples were obtained with paper points placed in the canal. Paper points were transferred to a cryotube containing "Tris EDTA" buffer and immediately frozen at -20°C. Results: By PCR amplification of the samples using taxon specific primers, E. faecalis was found to be prevalent species, detected in 65% of the cases and C. albicans was detected in 35% of cases. Conclusion: The results of the study shows that geographical influence and dietary factors might have some role to play in the prevalence of the species like C. albicans and presence of E. faecalis confirming the assertion of previous culture-dependent and independent approaches for the microbiological survey of root filled teeth. [ABSTRACT FROM AUTHOR]

Abstract: Objective: To evaluate the open laminate technique using glass ionomer cements (GIC) in association with a low shrink composite for restoring root filled premolars. Methods: Extensive MOD cavities plus endodontic access and root filling were performed in intact extracted maxillary premolars. Three restoration types were evaluated: (1) resin composite alone; (2) resin-modified GIC (RM-GIC) open laminate plus resin composite; (3) conventional GIC open laminate plus resin composite (n =8 for all groups and tests). Three tests were conducted to assess restorations: (A) inward cusp deflection during light curing, using DCDTs; (B) fracture strength using a ramped oblique load at 45° to the long axis in a servohydraulic testing machine in comparison with intact and unrestored teeth; (C) proximal marginal leakage using methylene blue dye and the effect of thermocycling. Data were analysed using 1-way ANOVA for cuspal deflection and fracture strength and Fisher''s exact test for leakage. Results: Laminate restorations resulted in significantly less cuspal deflection compared with resin composite (4.2±1.2μm for RM-GIC and 5.1±2.3μm for conventional GIC vs. 12.2±2.6μm for composite, P <0.001). Fracture strength was not significantly different among all groups. Failure with all restorations was predominantly adhesive at the tooth-restoration interface. The two laminate groups showed significantly better marginal seal than composite alone, but sealing ability of conventional GIC deteriorated after thermocycling. Conclusions: Laminate restoration of root filled teeth had beneficial effects in terms of reducing cuspal deflection and marginal seal, with acceptable fracture strength. [Copyright &y& Elsevier]

Soares CJ, Roscoe MG, Castro CG, Santana FR, Raposo LHA, Quagliatto PS, Novais VR. Effect of gamma irradiation and restorative material on the biomechanical behaviour of root filled premolars. International Endodontic Journal, 44, 1047-1054, 2011. Abstract Aim To investigate ex vivo the influence of gamma irradiation therapy and restorative material on fracture resistance, fracture mode and strain of root filled human premolars. Methodology Sixty extracted human maxillary premolar teeth were randomly divided into six groups ( n = 10) determined by two study factors: (i) restorative materials: sound teeth, root filled teeth restored with composite resin, root filled teeth restored with amalgam; (ii) gamma irradiation: irradiated (subjected to 60 Gy of gamma irradiation in daily increments of 2 Gy) and nonirradiated. For the strain gauge test, two strain gauges per sample were attached on the buccal and palatal cusp surfaces ( n = 5). Strain values were recorded during loading of 0-150 N. Fracture resistance ( N) was assessed in a mechanical testing machine ( n = 10). Strain gauge for each cusp and fracture resistance data were analysed by two-way anova (3 × 2) followed by the Tukey's honestly significant difference test (α = 0.05). The failure mode was evaluated using an optical stereomicroscope and classified according to the location of the failure. Results Gamma radiation therapy significantly reduced the fracture resistance of intact teeth. The strain was higher for teeth restored with amalgam than for those restored with composite resin. The teeth restored with composite resin had similar strain values to sound teeth. Nonirradiated teeth had more restorable failures than irradiated teeth. Conclusions Gamma irradiation significantly reduced fracture resistance and increased cusp strain. The use of composite resin resulted in better biomechanical behaviour than amalgam for restoring root filled teeth whether or not they were submitted to radiotherapy. [ABSTRACT FROM AUTHOR]

Objective: To compare fracture characteristics of root-filled teeth with variable cavity design and resin composite restoration.Methods: 80 extracted intact maxillary premolars were divided randomly into eight groups; (1) intact teeth; (2) unrestored MOD cavity; (3) unrestored MOD cavity plus endodontic access through the occlusal floor; (4) unrestored MOD plus endodontic access with axial walls removed; (5) MOD restored with resin composite; (6) MOD plus endodontic access, resin composite; (7) MOD plus extensive endodontic access, resin composite; (8) MOD plus extensive endodontic access, GIC core and resin composite. A ramped oblique load was applied to the buccal cusp in a servohydraulic testing machine. Fracture load and fracture patterns were recorded. Fracture loads were compared statistically using 1-way ANOVA, with Dunnett test for multiple comparisons.Results: Unrestored teeth became progressively weaker with more extensive preparations. Endodontic access confined within the occlusal floor did not significantly affect strength compared to an MOD cavity. Loss of axial walls weakened teeth considerably [292+80N vs 747+130N for intact teeth]. Restoration increased the strength of prepared teeth particularly in teeth without axial walls. Teeth with a GIC core were not significantly weaker than intact teeth [560+167N]. Failures were mostly adhesive at the buccal interface, with the fracture propagating from the buccal line angle of the occlusal floor (MOD and MOD plus access groups) or of the proximal box (axial wall removed).Conclusions: Direct restorations increased fracture resistance of root filled teeth with extensive endodontic access. Both restored and unrestored teeth showed similar fracture patterns. [ABSTRACT FROM AUTHOR]

Abstract: Tooth discoloration varies in etiology, appearance, localization, severity, and adhesion to tooth structure. It can be defined as being extrinsic or intrinsic on the basis of localization and etiology. In this review of the literature, various causes of tooth discoloration, different bleaching materials, and their applications to endodontically treated teeth have been described. In the walking bleach technique the root filling should be completed first, and a cervical seal must be established. The bleaching agent should be changed every 3–7 days. The thermocatalytic technique involves placement of a bleaching agent in the pulp chamber followed by heat application. At the end of each visit the bleaching agent is left in the tooth so that it can function as a walking bleach until the next visit. External bleaching of endodontically treated teeth with an in-office technique requires a high concentration gel. It might be a supplement to the walking bleach technique, if the results are not satisfactory after 3–4 visits. These treatments require a bonded temporary filling or a bonded resin composite to seal the access cavity. There is a deficiency of evidence-based science in the literature that addresses the prognosis of bleached nonvital teeth. Therefore, it is important to always be aware of the possible complications and risks that are associated with the different bleaching techniques. [Copyright &y& Elsevier]

Hommez GMG, Verhelst R, Claeys G, Vaneechoutte M, De Moor RJG.Investigation of the effect of the coronal restoration quality on the composition of the root canal microflora in teeth with apical periodontitis by means of T-RFLP analysis.International Endodontic Journal,37, 819–827, 2004.To investigate the effect of the radiographic and clinical quality of coronal restorations on the composition of the root canal flora of teeth with necrotic pulps and teeth with root fillings associated with apical periodontitis.Twenty-eight necrotic pulps and 35 root filled canals with signs of apical periodontitis were studied. Both the coronal filling (presence of radiographically or clinically deficient margins and/or secondary caries) and the root filling (homogeneity and length) were scored. Bacterial root canal samples were taken with sterile paper points under rubber dam and using measures to prevent contamination. A DNA-based nonculture bacterial identification technique was used, namely terminal restriction fragment length polymorphism (T-RFLP) analysis.Twelve samples were negative for bacterial DNA. A total of 33 different terminal restriction fragments (TRFs) were detected. TheFusobacterium nucleatum/Streptococcus mitisgroup was the most frequently encountered TRF. The mean number of TRFs per necrotic pulp was 6.2 and 5.8 for the groups with acceptable and unacceptable coronal restorations, respectively. This difference was not significant. In the root filled group, these values (respectively, 5.2 and 8.6) were statistically significantly different (P < 0.05). The following parameters in root filled teeth had no significant influence on the mean numbers of TRFs detected: the length and homogeneity of the root filling and the type of tooth (anterior–premolar–molar).T-RFLP allowed the rapid assessment of bacterial biodiversity in root canal samples. The technique revealed the presence of bacteria that have rarely been described in the root canals of teeth with apical periodontitis. Biodiversity in the root filled group was high, as compared with culture-dependent studies where monoinfections were more frequently reported. Only in root filled teeth did defective coronal restorations have a statistically significant influence on the mean numbers of detected TRFs per sample. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to determine the frequency of endodontic treatment in an adult Ukrainian population in relation to the age and its distribution depending on the type of the teeth., Patients and Methods: Materials and methods: A total of 435 digital panoramic radiographs of adults (aged 18 to 72 years) were examined. A tooth was qualified as root filled (endodontically treated), if radiopaque root-filling material was determined in the pulp chamber and/or in the root canals. Pearson's chi-squared test (χ2) and Spearman's rank correlation were applied for data analysis., Results: Results: It was revealed that 82.5% of patients had previously received endodontic treatment of the teeth. The overall percentage of root filled teeth in adult dentition is 12.08%. The analysis of the rate of endodontically treated teeth in different age groups identified an increasing of treated teeth with age - from 5.2% in the youngest cohort (18-19 years old) to 24.9% in the oldest cohorts. It was revealed that 822 teeth (14.2%) on maxilla and 569 (9.9%) on the mandible were endodontically treated. Most often root filled teeth were first mandibular molars (39.3%), first maxillary molars (26.7%) and second maxillary premolars (20.4%). Much lower rate of endodontic treatment were considered in lower mandibular incisors and canines (0.7%, 0.9% and 1.5% respectively)., Conclusion: Conclusions: A total of 82.5% examined adults had one or more endodontically treated teeth in this study. The obtained results prove the necessity of prevention of carieswith special emphasis on the first maxillary and mandibular molars, and maxillary second premolars, which have significantly higher frequency of root canal treatment in comparison to other teeth groups.