Endodontics - A Quarterly Newsletter on Dental SpecialtiesJADA Specialty Scan

Rubber dams and endodontic outcomes

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Overwhelming evidence shows that using rubber dams during root canal treatment (RCT) improves infection control and treatment efficacy. A recent Taiwanese study also showed that patients whose dentists use rubber dams during RCT may retain more natural teeth.

Published in the November 2014 issue of the Journal of Endodontics, the study analyzed the cases of 517,234 teeth that had received initial RCT between 2005-2011 and were tracked until the end of 2011. The database included medical claims of 1 million randomly selected patients from Taiwan’s national health insurance 2005 beneficiaries.

A total of 77,489 of the teeth received initial root canal treatment with a rubber dam and 439,745 did not. Scientists identified teeth that were extracted after RCT during the follow-up period.

After an average observation period of 3.43 years, the survival probability of teeth when initial RCT was performed using rubber dams was 90.3 percent, significantly greater than the 88.8 percent observed among those treated without rubber dams. After adjusting for potentially confounding factors — age, sex, tooth type, hospital level, tooth scaling frequency and systemic diseases — the tooth extraction hazard ratio for the teeth that received RCT with rubber dams was still significantly lower.

Authors reported what they described as “a relatively low rubber dam usage prevalence,” of 15.0 percent in their study, compared with a previously reported prevalence of 16.5 percent in Taiwan.

“There is a lack of direct evidence showing that the use of rubber dams improves the outcome of endodontic treatment, and the execution of controlled clinical trials to investigate this issue is not practical because of ethical concerns,” authors said.

They called out previous research that found that many dentist-related factors may influence rubber dam usage, including postgraduate training, the treated tooth, the number of root canal fillings completed per month, the operator’s attitude and experience.

“The use of a rubber dam during RCT could provide a significantly higher survival rate after initial RCT,” authors concluded. “The result supports that rubber dam usage improves the outcomes of endodontic treatments.”



Consulting Editor: Dr. Susan Wolcott
Diplomate, American Board of Endodontics

Periodontal disease bacteria and endodontic infection

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Using an alternative molecular technique for studying complex bacterial communities, scientists at Capital Medical University in Beijing, China, learned that many of the same organisms found in diseased root canals were also found in adjacent periodontal pockets. They published their findings in the October 2014 issue of the Journal of Periodontology.

The relationship between periodontal and pulpal disease has long been the subject of speculation. It is known that toxins and microbial agents in the pulp space can induce periodontal inflammation through lateral and accessory canals, but the effects that irritants from the periodontal space have on the pulp is less clearly defined.

Findings from earlier research have led authors to hypothesize that the periodontal pocket may be a source of root canal infection, but these studies used conventional culture methods and investigated only cultivable microbes.

Compared with conventional culture methods, an alternative molecular technique called polymerase chain reaction (PCR)-based denaturing gradient gel electrophoresis (DGGE) has further advantages, study authors reported. Among them is the potential to enable investigators to survey entire bacterial communities without cultivation.

To investigate, they combined the technique with sequencing analysis to identify the entire microbial population obtained from root canals and subgingival plaque samples of 20 molars with combined periodontal-endodontic disease. DNA was extracted for PCR-based DGGE, cloning and sequence analysis. Scientists aimed to identify the predominant microflora from the root canals and compare them with those from the adjacent periodontal pockets of the same teeth.

Among results, scientists observed that every organism detected in the root canal samples also could be found in the flora of the adjacent periodontal pocket, with one exception. The most prevalent bacteria in both samples were Filifactor alocis, Parvimonas micra, Porphyromonoas gingivalis, and Tannerella forsythia.

“The high similarity in the identities of the organisms recovered from both RCs and PPs suggests that the PP may be a source of these RC infections,” authors concluded.

They also said the predominant species of bacteria may play a role in the development of combined periodontal-endodontic lesions. They called for further investigations to clarify the factors that lead to pulpal changes as a result of periodontal disease.


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Restorative placement and endodontic therapy

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Research that offers a new way of predicting which patients are most likely to need endodontic therapy and when they’ll need it was published in the December 2014 issue of the Journal of Endodontics.

Patients and clinicians have many ways of describing restorative success, including freedom from sensitivity or additional dental intervention. Scientists at Case Western Reserve University recognized the need for post-restoration endodontic intervention as a perceived complication or failure.  

Conducting a literature search, they found a range of methodologies, observation periods, patient recall rates and incidence of endodontic treatment after the placement of various restorations—and found no studies reporting on a coexisting post-restoration risk period for endodontic intervention.

What is the pulpal deterioration risk period following to various restorations and tooth surfaces? Are various restorations and tooth surfaces somehow associated more with endodontic treatment? And how do they compare in this way?

To learn the critical timeframe between the placement of various restorations and endodontic intervention and to investigate the likelihood by restoration type, the scientists pursued a retrospective study. They included the cases of patients who had composite resins, amalgams, build-ups and all fixed full coverage crowns from January 2008 through December 2013. They performed an additional, separate search to include those teeth that underwent nonsurgical root canal therapy after the restoration was placed.

The dates of restoration and endodontic intervention for a total of 813 teeth that met the criteria were paired, and the time-lapse between the two computed.

Results showed that the average time between restoration placement and endodontic intervention was 270 days. Of the restorations observed, scientists found composites to be most strongly associated with endodontic intervention. “Composite resin was 1.91 times more likely than amalgam and 5.69 times more likely than crowns to cause resultant endodontic intervention,” authors reported. The risk of subsequent endodontic therapy also increased for patients having greater than two tooth surfaces restored.

Among discussion topics, authors said the study results agree with earlier research showing that patients and clinicians should not dismiss amalgam.

Of the teeth studied, 54 percent were composite resin and 13 percent were amalgams. Although the scientists studied more composites than amalgams, they said the study findings are important because of the increased demand for esthetics.


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AAE newsletter debuts

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Standard of practice in contemporary endodontics is the topic of the American Association of Endodontists’ latest newsletter, ENDODONTICS: Colleagues for Excellence.

Created to help any dentist provide successful endodontic treatment, this newsletter highlights new and emerging technologies in instrumentation, magnification and imaging aimed at treating and salvaging the natural dentition with consistent outcomes.

The newsletter also explains the importance of evaluating case difficulty, maintaining proper treatment records and adopting proven technologies that improve the quality of endodontic care and meet current accepted standards.



Endodontic meeting set for Seattle in May

Registration opens in January for the American Association of Endodontists’ 2015 annual meeting to take place in Seattle May 6 – 9.  

AAE15 includes educational tracks titled Future Directions in Non-Surgical Root Canal Treatment, Managing the Practice of Tomorrow, Surgical Endodontics – What Lies Ahead, and Where Will Biology and Technology Take Endodontics.

The meeting will kick off with keynote speaker Dr. Michio Kaku, theoretical physicist, renowned futurist and popularizer of science.



Discount offered on ADA root canal brochure

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Now through Jan. 20, the ADA is offering members a patient education brochure on understanding root canal treatment at a 15 percent discount.

Members can order “Root Canal Treatment” (W117, new Spanish version, W244) through the ADA Catalog, using promo code 14363E.  The eight-panel brochure is available in packets of 50 for $27; retail price $40.50. Discounts also are available at higher quantities.

The brochure explains the benefits of endodontic treatment from start to finish, helping patients understand the tooth-saving benefits of root canal with step-by-step illustrations. It also encourages patients to return for a permanent restoration.

Members can preview this and other ADA brochures online at adacatalog.org. Orders can be placed online or by calling the ADA Member Service Center at 1-800-947-4746.

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What is Specialty Scan?

This is one in a series of quarterly newsletters updating dentists on selected specialties in dentistry. Information presented is aggregated and summarized from previously published materials, each item attributed to its publication of origin. This issue of JADA Specialty Scan focuses on endodontics, the fourth in the series on this topic for 2014. Other Specialty Scan issues are devoted to periodontics, orthodontics, oral and maxillofacial radiology and prosthodontics. The ADA has engaged the specialty organizations in these areas as well as its own divisions of Science and Legal to assist with these newsletters. We welcome your feedback on this and all Specialty Scan issues.

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