Fracture Resistance of Roots Obturated with Resilon and EndoREZ with Self-Adhesive Root Canal Sealers

<sec> <title>Objective:</title> This laboratory study aimed to evaluate the effect of self-adhesive root canal sealers on the fracture strength of root canals filled with Resilon or EndoREZ. </sec> <sec> <title>Materials and Methods:</title> A total of eighty extracted mandibular premolar teeth were selected in this in-vitro study. All teeth were instrumented using a crown-down technique by FlexMaster rotary NiTi files. Specimens were divided into 4 test groups (n = 20) according to the sealer material: RS; RealSeal, RSS; RealSeal SE, MS; MetaSeal, and CG; (control group) zinc oxide eugenol-based sealer. Each main group was distributed into two subgroups (n = 10) according to the filling material either Resilon or EndoREZ and gutta-percha (n = 20) in the control group. Each root was mounted in acrylic resin blocks and subjected to fracture in a universal testing machine. The load values at root specimens fractured were registered in Newton’s and the data were analyzed using two-way analysis of variance and the Tukey HSD test (α = 0.05). </sec> <sec> <title>Results:</title> The two-way analysis of variance analysis indicated that the filling material had a significant effect on the fracture strength of endodontically treated teeth (p < 0.05) but not the sealer materials (p≥.05). Higher mean fracture strength was recorded in MetaSeal and Resilon group (1281.90±200.34 N) and lower mean fracture strength was shown in RealSeal and EndoREZ group (847.55±191.04 N). </sec> <sec> <title>Conclusion:</title> Self-adhesive (fourth-generation) resin sealers increased the fracture strength of root teeth more than self-etching (third-generation) root canal sealers when used with EndoREZ points. </sec>

Vertical Root Fracture in Non-Endodontically and Endodontically Treated Teeth: Current Understanding and Future Challenge

A vertical root fracture (VRF) is a complex complication that usually leads to tooth extraction. The aim of this article is to review the prevalence, demography, distribution, diagnostic methods, etiology and predisposing factors, clinical features, radiographic characteristics and treatment strategies of VRFs in non-endodontically treated teeth (VRFNETT) and endodontically treated teeth (VRFETT). Search terms for each subject related to VRFNETT and VRFETT were entered into MEDLINE, PubMed and Google Scholar. Systematic reviews, retrospective cohort studies, demographic research, clinical studies, case reports and case series were reviewed. Most of the VRFs were found in patients older than 40 years old. Older populations were discovered in the non-endodontically treated VRF group when compared to the endodontically treated VRF group. Male patients were found at a greater prevalence than females in the non-endodontically treated VRF group. The initial occurrence of a VRF may accompany radiolucent lines within the root canal, unusual space between the canal wall and intracanal material, a widening of the PDL space along the periradicular surfaces, angular bony destruction, step-like bone defects, V-shaped diffuse bone defects, or root resorptions corresponding to the fracture line before the clear separation of the fractured fragment. The indicative clinical and radiographic signs of VRF included a coronally positioned sinus tract, deep-narrow periodontal defects, the displacement of a fractured fragment, periradicular radiolucent halos and the widening of the root canal space. Interestingly, VRFNETT are more often observed in the Chinese population. Some patients with multiple VRFs were observed, suggesting possible predisposing factors in genetics and tooth development. The management of a VRF usually involves a multidisciplinary approach. The common distribution and features of VRFNETT and VRFETT were elucidated to facilitate recognition and diagnosis. Besides extraction, variable therapeutic schemes, such as the repair of the VRF, root amputation and others reported in earlier literature, are available. A long-term prognosis study of the various therapeutic strategies is needed.

Endodontically Treated Maxillary Premolars Restored with Glass Fiber Post under All Ceramic Crown

Glass fiber posts and core are increasingly used in order to restore severely damaged endodontically treated teeth and particularly maxillary premolars that are prone to fracture. Their low modulus of elasticity which is similar to that of dentin allows the post to absorb stress and prevent root fracture. In addition, the glass fiber posts provide a natural hue by integrally bonding to the composite, thereby improving the aesthetics without compromising much on the strength. Various factors are involved in the longevity of such treatment option, remaining tooth structure seems to be the most important. Key words: glass fiber posts, premolars, endodontically treated teeth, composite resin, fracture resistance, crown, ferrule, failure .

Clinical Performance of Cast Metal and Fiber Post Retained Restorations in Endodontically Treated Teeth: A Systematic Review and Meta-Analysis

Purpose: The purpose of this systematic review was to assess the available literature to evaluate the clinical performance of different post systems for the rehabilitation of endodontically treated teeth (ETT). Clinical Significance: The loss of structural integrity of endodontically treated teeth usually requires the use of intra-radicular posts for the retention of the final restoration. The recent literature has reported controversial results regarding the clinical performance of different systems. Material and Methods: An electronic search restricted to the English language was performed up to May 31, 2020. Articles were selected if they met the following criteria: cohort studies and randomized clinical trials comparing the failure rate incidence between fiber and cast metal post, with a mean follow-up of 3 years. Results: 24 studies (14 cohort studies and 10 RCTs) published between 2000 and 2018 were included in this review. For cast metal posts, 210 cases were classified as failures (17.07%), and for fiber posts, 423 were classified as failures (10.6%). An unpaired t-test revealed that cast metal and fiber post values were not significantly different (p = 0.58) with the difference between means of 5.00 with 95% confidence of interval (-13.38 to 23.39). Four studies that presented cast metal and fiber posts groups were combined in the meta-analysis. There was no significant difference in the general failure analysis (risk ratio of 0.59 [95% CI: 0.30 to 1.18]; p = 0.13). Conclusions: Based on the present analysis results, the clinical performance of ETT restored with either cast metal- or fiber post-retained restorations presented similar results.

Survival of endodontically treated permanent teeth among children: a retrospective cohort study

Background Outcome studies of nonsurgical root canal treatment (NSRCT) in permanent teeth of children are scarce. This study investigated survival and assessed the variables associated with failure of endodontically treated teeth (ETT) in 6- to 18-year-olds. Methods Records of subjects who received NSRCT at age 6–18 years at Boston University between 2007 and 2015 were assessed for the occurrence of untoward events. Kaplan–Meier survival curves were used to investigate the survival of ETT in the total sample. Adjusted hazard ratios (aHRs) and 95% confidence intervals (CIs) were estimated. Results The analysis included 341 patients (424 ETT). Kaplan–Meier survival curves differed according to age at treatment (log-rank P = 0.026), with survival being the lowest among the youngest age group. The estimated 5-year survival probability was 80% for 15- to 18-year-olds, 64.8% for 12- to 14-year-olds and 46.4% for 6- to 11-year-olds. Compared to age at treatment of 15–18 years, age at treatment of 6–11 years (aHR: 2.19, 95% CI 1.02–4.67) and 12–14 years (aHR: 2.02, 95% CI 1.15–3.55) was associated with an increased risk of ETT failure. In the total study sample, the estimated cumulative survival probability was 93.3% at 12 months, 88.0% at 24 months, 76.2% at 36 months, 71.0% at 48 months, and 69.1% at 60 months. Conclusions In children, ETT are more likely to survive when NSRCTs are performed at an older age.

Pathognomonic Combination of Clinical Signs for Diagnosis of Vertical Root Fracture: Systematic Review of the Literature

Introduction: Vertical root fracture (VRF) is a root-canal treatment complication and is a major reason for extraction of the root-canal-treated teeth. The diagnosis of VRF can be complicated because of absence of specific signs, symptoms, and radiographic features. A combination that includes the presence of deep pocket and a sinus tract in root-canal-treated tooth was proposed as a pathognomonic for VRF. The purpose of this study was to systematically search and evaluate the literature regarding the correlation between the clinical signs considered pathognomonic for the diagnosis of VRF, with the actual reference standard by means of systematic review of the literature. Methods: A systematic search of the literature was performed to identify studies evaluating the clinical signs considered pathognomonic for the diagnosis of VRF. The following databases were searched: Medline (PubMed), Scopus, and Cochrane Central. The identified studies were subjected to strict inclusion and exclusion criteria. Results: Initially, 1141 possible relevant articles were identified. After title and abstract screening, 40 articles were subjected to a full-text evaluation, 3 articles met the inclusion criteria and contained data regarding the prevalence of the pathognomonic combination in VRF’s-confirmed teeth. The presence of deep pocket and a sinus tract in endodontically treated teeth was found in 28% of the cases. Conclusion: To date, the current scientific knowledge regarding the correlation between the clinical symptoms considered pathognomonic for VRF diagnosis in the root-canal-treated tooth and the actual reference standard is quite low.

Severity of Extrinsic Black Stain and prevalence of Dental Caries

Background: Teeth discoloration is one of the most common problems among individuals nowadays. It can be caused by a variety of circumstances and can result in cosmetic problems as well as low self-esteem and dental caries. Hence the present was conducted to investigate the correlation between the severity of Black stains and the prevalence of caries, number of missing teeth, crowns, restorations, and Endodontically-treated teeth in adult patients at Riyadh Elm University Dental Clinics. Materials and Methods: The study consisted of 84 participants with age ranging from 18 to 60 years, with no gender preference. The subjects included in the study had not received any professional teeth scaling and polishing at least 6 months prior to the examination. Participants with an anterior fixed partial denture or any kind of restoration anteriorly with more than two incisors crowns or more than two missing incisors for each quadrant were excluded. Clinical examination was done by the single investigator who was calibrated by practicing it on 5 patients. Results: In the present study majority 64 (76.2%) of the participants aged between 18-32yrs, more than half 50 (59.5%) of them were male and the rest of them were female 34 (40.5%). A high percentage of subjects 34 (40.5%) were having a university level of education. Age, gender showed significant association with Intensity, extensity and composite scores of stains (p<0.05). Income was associated statistically significantly with extensity of stains (p<0.05). A correlation was found between the patient decayed teeth number and stains; however, this relation wasn’t statistically significant. The study found that endodontically treated teeth had a statistically significant link between its number increase and the extent and intensity of stains. Conclusion: From the present study it was concluded that age and gender was statistically associated with intensity, extensity and composite scores and income also had an impact on extensity of stains. More investigation is recommended to gain more understanding of the correlations of dark stains.