Journal of Dental Science and Medicine
Open Access

Instrumentation by hand; Procedure for the teeth; Instrumentation for rotors; Keeping your teeth; Effect of treatment

Introduction

The elimination of inflamed and infected pulpal tissue is the goal of root canal therapy (RCT), which creates an environment that encourages healing and halts the progression of periapical pathology [1]. Periapical mending supports the drawn out maintenance of utilitarian, endodontically treated teeth.

Endodontics is particularly interested in RCT outcomes. During endodontic outcome assessment, dental clinicians must have the appropriate skill and judgment to determine whether RCT is successful. After a root-filled tooth has been exposed to various functional activities over time, endodontic success is determined. Specific criteria must be used when evaluating such success. Quite, covering standards have been utilized in various examinations [2]. Misdiagnosis and unnecessary retreatment have been caused by inconsistent endodontic success classification, which ranges from strict radiographic healing to taking into account a symptomless and clinically functional tooth. The varying durations of postoperative review, the criteria used to classify outcomes, radiographic evaluation, and clinical experience have been cited as the causes of the varying success rates that have been reported in the literature [3].

After at least four years of monitoring, the European Society of Endodontology (ESE) has established guidelines that use both clinical and radiographic parameters to classify treatment outcomes as “favourable,” “uncertain,” or “unfavorable.” It has been suggested that the dentist’s (objective) and the patient’s (subjective) assessments of endodontic success should be used to evaluate it. The dentist examines both the clinical and radiographic evidence during the assessment [4]. The patient’s evaluation centers on the tooth’s survival, or the tooth remaining asymptomatic and functional in the dentition. Although this is not a sufficient biological goal of treatment, the patient finds it satisfactory. As an indicator of endodontic success, tooth survival is defined as the tooth remaining in the oral cavity for at least one year following the initial RCT. On the other hand, tooth failure is defined as the tooth being extracted at any time during treatment. In modern tooth conservation, long-term survival following RCT is a high priority.

The impact of recent advancements in canal preparation techniques on endodontic success has only been the subject of a few retrospective studies. According to ESE recommendations, extended patient followup for continued evaluation of root-filled teeth for a minimum of four years is required to determine endodontic success in relation to preparation techniques. Thus, the purpose of this study was to determine endodontic success five years after RCT; Short-term results had been published previously. In the evaluation following the use of either manual or rotary instrumentation techniques during RCT, two measures—treatment outcome as classified by the ESE and tooth survival over a 5-year review period—were utilized.

Materials and Procedures

This study is a follow-up to a randomised controlled noninferiority trial with a parallel-group design that was conducted at the Restorative Dental Clinics of Lagos University Teaching Hospital, Nigeria, following institutional ethical approval and the allocation of numbers for the trial and follow-up study. This subsequent review observes Merged Guidelines of Detailing Preliminaries (Partner) rules. As additional resources, the CONSORT flow diagram and checklist are provided.

Prior clinical trial eligibility criteria

Adult patients who presented consecutively, met the single-visit RCT inclusion criteria, and signed written consent were recruited [5]. Anterior, premolar, or first molar teeth (maxillary or mandibular) without pain or mild to moderate preoperative pain met the inclusion criteria; diagnosed as having nonvital pulpitis with no periapical involvement, an uncomplicated coronal fracture, or apical periodontitis with periapical radiolucency of less than 2 mm. teeth that hurt a lot; periapical abscess or weeping canals; teeth that are compromised by periodontal disease; teeth with internal and external root resorption, calcified canals, and roots that curve too much; unrestorable teeth; cases of retreatment from RCT; patients who were uncooperative or had medical issues were also excluded from the study.

Sample size determination and randomization

This study was a follow-up to a previous one and used the formula for comparing two independent proportions from a previous study to determine the sample size of teeth in each group. Alpha-error was set at 0.05, and power was set at 80%. The required sample size for each group was increased to account for attrition and include both single-rooted and multi-rooted teeth.

Two aspiring endodontists carried out the randomization procedure. The tooth was assigned at random to either of the two groups after each participant fulfilled the inclusion requirements. To ensure objectivity and maintain an equal sample size, patients who required RCT for more than two teeth were randomly assigned, one on each side on the left and right.

Intervention and postoperative assessment of the prior clinical trial

The previous clinical trial’s intervention and postoperative evaluation included a thorough history and physical exam, electric pulp tests, tooth percussion, and radiographic examinations [6]. Waterway readiness was performed after access depression planning and working length assurance utilizing either a manual step-back strategy with treated steel K-documents or ProTaper General revolving records by nonstop rotational instrumentation in a crown-down way utilizing a X-Brilliant In addition to endo engine (Dentsply Maillefer). Each group used the same amount of irrigating solution—2.5 percent sodium hypochlorite (Reckitt Benckiser), 30 milliliters per canal—and RC Prep for post-canal preparation to get rid of the smear layer. In the event of apical extrusion of gutta-percha (GP), when GP did not fill the entire length of the canal, or in cases where the filling already had voids, a post-obturation radiograph was taken immediately. To eliminate interoperator bias, all treatments and procedures were carried out by a single operator in accordance with the Declaration of Helsinki’s ethical guidelines.

For the current follow-up study, two independent evaluators— endodontists—were blinded to the groupings when assessing treatment outcomes. Cohen’s kappa values, which ranged from 0.88 to 0.94 for all measured criteria, demonstrate that pre-calibration of evaluators resulted in satisfactory intra- and interexaminer agreements.

The outcome of the treatment

The outcome of the treatment was based on tooth survival and ESE5 guidelines. Utilizing the Universal Pain Assessment Tool (Wong-Baker FACES Pain Rating Scale), a pain rating was obtained. Miller’s index was used to measure and grade the patient’s level of tooth mobility [7]. A periapical radiograph, as is typical for routine endodontic evaluation, was used for the radiographic assessment. To check for periapical lesions, a modified PAI scoring system was utilized. When the PAI score was three or higher, a tooth was considered to have a periapical lesion. A ruler was used to measure the largest horizontal and vertical width in millimeters to determine the size of any radiolucency. To determine whether radiolucency was a new postoperative lesion or a preexisting lesion that had remained the same size, decreased, or increased, radiographic findings from the six-month, one-year, fouryear, and five-year follow-up periods were compared to those from the preoperative period. The PAI score for multi-rooted teeth was higher than that of their roots. When there was disagreement among the evaluators, the radiograph was discussed until either a higher score was adopted or a consensus was reached. Regardless of the PAI score, teeth that did not exhibit any signs or symptoms were deemed functional and thus successful.

The survival of a tooth was regarded as evidence that a tooth was still present twelve months or more after the RCT. If a tooth was extracted at any point during treatment, it was considered a failure [8]. When the tooth was asymptomatic and had radiologic evidence of a normal periodontal ligament space, the ESE rated the treatment outcome as “favourable.” The presence of radiographic evidence revealing a periapical lesion that has remained the same size or has only decreased in size within four years of monitoring was defined as an “uncertain” outcome. If the tooth was symptomatic, there were signs of ongoing root resorption, a subsequent radiographic lesion was found, or a previous periapical lesion got bigger or didn’t go away after four years of monitoring, the outcome was deemed “unfavorable.”

Statistical analyses

IBM SPSS, version 23.0 (IBM Corporation) was used for the statistical analyses. For categorical variables, frequency and proportion were used in descriptive analysis, while for numerical variables, mean and standard deviation were used. Pearson chi-square, Fisher exact test, and, where applicable, 2-sided linear-by-linear association were utilized for statistical analysis of the data. The Pearson correlation coefficient was used to see how much of a correlation there was between the treatment outcome, postoperative clinical and radiographic findings, and preparation technique [9]. The log-rank test and Kaplan–Meier survival analysis were used to visualize and compare the instrumentation technique-based tooth survival probabilities.

Results

Characteristics of the participants and treated teeth

The results of this study are the analysis of 90 root-treated teeth from 77 patients who were followed up from the trial that was previously reported. After the six-month review, 18 patients with 30 teeth decided not to continue participating [10]. As a result, a total of 30 teeth were lost after the 6-month examination, and no more lost during the subsequent 5-year examination. The relocation of some participants, while others chose not to continue participating, was linked to the reasons for the dropouts in both groups. According to the primary clinical trial, there was no significant difference between the two groups’ preoperative clinical and radiographic parameters. 37 men with 43 treated teeth and 40 women with 47 treated teeth made up the sample; They ranged in age from 18 to 62, with a mean age of 30.6 10.99 years.

All of the teeth in the follow-up study received treatment seven months after the post-six-month review. Including tooth survival, the clinical, radiographic, and treatment outcomes are presented.

Clinical outcome

Prior to treatment, fifty-eight (64.4%) of the 90 teeth experienced mild or moderate pain [11]. After the six-month checkup, there was no pain; However, during the four-year review period, one tooth in each group experienced pain. Eleven teeth had grade I mobility prior to treatment, and grade I mobility was observed in one tooth (manual group) after treatment at all review periods, with the exception of the final review. Preoperative percussion tenderness in fifty percent of the 90 teeth was completely resolved at the six-month follow-up appointment. At the four-year review and the final review, there were recurrences in two teeth and one tooth, respectively. There were no other symptoms noted.

Radiographic outcome

Preoperative periapical radiolucency affected 14 (32.6%) and 10 (21.3%) teeth in the manual and rotary groups, respectively, on radiographs. At the 6-month (P =.038) and 1-year (P =.033) follow-ups, the manual group still had significantly more radiolucent teeth than the rotary group. Radiolucency was measured at six-month and one-year reviews, and there were moderate and significant correlations between preparation technique and radiolucency. Over the course of the five years, the radiolucency subsided gradually, with the exception of three teeth that consistently presented with radiolucency of the same size.

Treatment outcomes

During the various review periods, the most favorable outcomes were recorded for the complicated coronal fracture and the irreversible pulpitis [12]. Generally speaking, a better result was noted when rotating instrumentation was utilized contrasted with manual instrumentation. At the six-month and one-year reviews, this difference was statistically significant. At 6-month and 1-year reviews, there were moderate and significant correlations between preparation method and treatment outcome. By the end of the review, both groups had similar teeth with good results.

Discussion

According to the ESE, endodontic success or failure can only be fully determined four years after treatment. This backs up the report’s assertion that, despite the fact that an RCT may appear successful immediately following treatment, a minimum of a four-year review is essential for conclusiveness. To determine endodontic success, this study used a long-term evaluation [13]. In RCT, longevity is a major consideration, and tooth survival addresses this issue. Treatment outcome, which takes into account periapical healing, is the clinician’s more objective view of success, whereas tooth survival is a patientcentered measure of endodontic success.

During the post-6-month and 1-year review periods, the rotary group outperformed the manual group significantly (P .05). Long-term outcomes did not, however, differ significantly between the groups (P >.05). Both rotary and manual instruments had similar 5-year survival rates and high favorable outcomes. This supports the base of a 4-year suggestion to discover endodontic achievement [14]. Similar results were found in a retrospective study, with a significantly better shortterm outcome following rotary RCT than manual RCT. There may be evidence of less debris extrusion and faster per apical healing in the rotary group, which may account for the improved outcome. Apical debris extrusion, which is more common with hand instruments, may result in an inflow of blood and exudate that encourages intraconal bacteria to multiply more, making the chronic per apical lesion even worse. The groups in this study all had a similar 5-year survival rate, which is consistent with a retrospective study that used tooth survival as a success criterion in technique groups after a long-term follow-up.

At the conclusion of the previous short-term clinical trial, all pain was gone, and this study started with no pain. However, at the final review after four years, one participant from each group experienced mild pain that had completely subsided [15]. The patient was unable to recall periodontal causes or occlusal trauma during the review both of which could account for the mild pain and are unrelated to previous pulpal or periapical pathology.

Conclusion

After a single-visit RCT, it was found that the rotary instrumentation method was more effective at promoting post-endodontic healing at the short-term review periods than the manual instrumentation method; However, after a prolonged 5-year monitoring period, the survival rates and favorable outcomes of both groups were comparable.

Acknowledgement

None

Conflict of Interest

None

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