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JADA Specialty Scan - Endodontics
Endodontics - A Quarterly Newsletter on Dental SpecialtiesJADA Specialty Scan

Regenerative endodontic procedures and alkaline materials

Researchers reviewed the properties and applications of alkaline materials as applied to regenerative endodontic procedures (REP) and published their findings in the December issue of Materials.

REP, introduced in 2001, provides a biologically-based framework that enables further root maturation than previously possible with traditional methods for the treatment of immature teeth with pulp necrosis and underdeveloped roots, according to the researchers. They noted that REPs have been described as a “paradigm shift.”

“Regenerative endodontics has gained increased attention in the provision of biologically based treatment in teeth with arrested root development,” the researchers wrote. “… With advances in stem cell-based pulp tissue engineering, it is possible that REPs will be increasingly incorporated into clinical practice.”

REP has 3 main clinical aspects to consider as basic to regenerative endodontic protocol. They are disinfection of the root canal system, provision of a scaffold in the form of a blood clot that forms after laceration of the periapical tissue to induce bleeding and introduce mesenchymal stem cells within the root canal, and an adequate coronal seal to prevent reinfection.
Materials that are integral parts of current REP clinical protocols include alkaline irrigants (sodium hypochlorite), medicaments (calcium hydroxide), and bioceramic materials (mineral trioxide aggregates [MTA] or Biodentine). Each exerts different biological properties that can influence outcomes, researchers wrote.

They reviewed these materials and reviewed other alkaline materials used in REPs, identified through a systematic literature review, including calcium-enriched material and EndoSequence Bioceramic Putty—both with similar biological properties and sealing abilities as MTA.

The researchers concluded that alkaline biomaterials are the essential components of a successful REP treatment regimen. They identified sodium hypochlorite, calcium hydroxide, MTA, and Biodentine as chief among REP biomaterials.

They stated that sodium hypochlorite in lower concentrations is preferable over those used for conventional endodontic protocols to reduce deleterious effects on stem cells of the apical papilla. Calcium hydroxide, they noted, supports further root development when applied in the coronal one-half of the root canal. They advised that MTA is associated with crown discoloration when used as an intracanal barrier and that Biodentine appears to stain dentin less, but they cautioned that more studies are needed to determine efficacy and long-term effects.

“As our knowledge in pulp biology and dental biomaterials advances, the treatment of immature permanent teeth with necrotic pulp will be improved accordingly,” researchers wrote.

Read the original article here.


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

Endodontic failures and related factors

Turkish investigators examined reasons for failure of endodontically-treated teeth and whether there were associations between these reasons and patients’ personal characteristics and other factors in a cross-sectional study published in the January issue of Journal of Endodontics.

Working out of the Selcuk University, Faculty of Dentistry, Department of Oral Diagnosis and Radiology and the Department of Endodontics in Konya, Turkey, over a 17-month period, the investigators analyzed 1,000 endodontically failed teeth.

Patients’ personal characteristics considered in the study included age, sex, level of education, and smoking status. Researchers also considered tooth type and locations, reasons for failure and extraction, and post type endodontic permanent coronal restorations.

The following situations indicated failure: clinical problems such as percussion, palpation, swelling, sinus tract, fracture, marginal leakage, and loss of coronal restoration or radiographic problems, such as an unhealed periapical lesion (after 4 years), insufficient obturation, and perforation/stripping. Results showed statistically significant differences between reasons for failure.

To assess associations between reasons for failure, tooth, and patient, researchers used x2 analysis.

Of the 1,000 teeth assessed, 28.1% (n = 281) were extracted, 66% (n = 660) were re-treated, and 5.9% (n = 59) were treated with apical surgery.

Researchers concluded that endodontically treated teeth that failed were extracted most often for prosthetic reasons (40.8%). Endodontic and restorative reasons were most frequently seen (43.9%, n = 439), and orthodontic reasons were least frequently seen (0.1%, n = 1). Also, mandibular first molars failed most frequently, while maxillary third molars failed least frequently. Of significance, researchers determined that the study’s results indicate that teeth are more likely to fail when lacking appropriate and sufficient coronal restoration after root canal treatment.

Differences in level of education (P < .01) and smoking status (P < .01) appeared to significantly affect reason for failure. Age and sex also appeared to significantly affect reason for failure (P < .01).

The researchers compared the outcomes of their study with similar studies in the literature, most of them retrospective studies that focused only on a small sample size and the specific reasons for extraction of endodontically treated teeth. “Because this is an important topic requiring further evaluation, our research focused not only on extraction but also included most of the reasons for the failure of endodontically-treated teeth within a larger sample size,” they wrote.

Read the original article here.


Simplify obturation while improving reliability
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Pulpotomy versus root canal treatment pain and outcomes

In a randomized controlled trial, Indian researchers compared and evaluated postoperative pain and success rates after pulpotomy and root canal treatment (RCT). They published their findings in the December issue of Journal of Endodontics.

RCT is the preferred treatment for teeth with deep carious lesions that reach the pulp, though the best treatment approach remains controversial, the authors wrote. They described RCT as having certain disadvantages, including being time consuming, expensive, and requiring multiple visits, making the teeth susceptible to fractures due to loss of tooth structure.

“It has been proposed that age might be a limiting factor in determining success of vital pulp therapy in permanent teeth with carious exposures,” the researchers wrote. “However recent studies have observed success rates ranging from 82% to 95% using modern restorative materials in mature permanent teeth, thereby suggesting that pulpotomy can be a useful alternative to RCT in adults.”

Researchers wrote that a careful search of the literature revealed only 1 study that directly compared the success rate of pulpotomy with RCT in mature permanent teeth. Also, the studies they found relating to pulpotomy mostly were either retrospective, case series, or case reports, with mean quality scores ranging from 7 through 10.

In conducting their study, researchers aimed to evaluate clinical and radiographic success as the primary outcome measures and pain intensity and reduction as the secondary outcome measures in adult patients with cariously exposed mature permanent molars. They included 54 symptomatic patients in the study, and followed 50 patients over an 18-month period. Patients returned every 3 months for clinical and radiographic examination and evaluation of the restorations.

Overall treatment success in the pulpotomy group was 85% compared with 87.5% in the RCT group, with researchers calling the difference “nonsignificant” (P > .05).

“The mean postoperative pain scores were statistically significantly lower for the pulpotomy group, indicating more symptomatic relief in the pulpotomy group,” the researchers stated.

Researchers concluded that coronal pulpotomy can be an alternative to RCT to treat and manage permanent teeth with deep carious lesions but no apical periodontitis.

Read the original article here.

Endo hands-on course receives accolades from endodontists and GPs

“Best CE course I have attended in a very long time. Very hands-on!”
— Arnie Mann, DDS, endodontist, Lewes, DE

“Great course, great instructors! Thank you! I do recommend it to every dentist.”
— Tatiana Kurudimova, DMD, Southampton, PA

“My favorite course thus far in my career. I feel much more comfortable treating difficult endo cases.”
— William Seefried, DMD, Philadelphia, PA

Complete info can be found here.

Register now for AAE’s 2018 annual meeting April 25-28 in Denver

Interested in learning the latest in endodontic research, techniques, and treatment approaches? Attend the American Association of Endodontists’ annual meeting, AAE18, in Denver, April 25-28.

Educational tracks include hot topics and controversies, endodontic surgery, endodontics without limits, and interdisciplinary care. Hear from world-renowned speakers addressing diagnostic dilemmas, challenging clinical cases, and current trends in endodontic treatment.

The meeting also includes the largest endodontic exhibit hall and special events, including keynote speaker Aron Ralston, adventurer, best-selling author of “Between a Rock and a Hard Place,” and inspiration for the film “127 Hours.” For more information and to register, visit


Endodontic instrumentation
3D root canal instrumentation: Learn how to maintain the original canal anatomy while thoroughly cleaning the canal. Watch the short endodontic video to see just how easy and effective a 2-step instrumentation system can be. Click here to view.


JADA+ Specialty Scans and JADA+ Scans

JADA+ Specialty Scans and JADA+ Scans are quarterly newsletters updating dentists on the latest research in selected specialties and disciplines in dentistry. ADA Publishing and the consulting editors from the represented specialties and disciplines aggregate and summarize research from previously published materials, each item attributed to its publication of origin. JADA+ Scan specialties and disciplines include endodontics, oral pathology, orthodontics, pediatric dentistry, periodontics, prosthodontics, radiology, cosmetic/esthetic and osseointegration. The ADA has engaged the specialty organizations in these areas as well as its own Science Institute and Division of Legal Affairs to assist with these newsletters. View past issues here.

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