Apical Periodontitis – Is treatment with modern root canal instrumentation more effective?

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In this blog Thibault Colloc looks at a review of comparing the effectiveness of contemporary root canal instrumentation compared with conventional stainless-steel instruments in terms of clinical and patient-related outcomes. The review includes 9 studies (6 RCTs and 3 retrospective clinical studies) and was one of a series designed to inform guidelines for the European Society of Endodontics.

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How common is root canal treatment?

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This review of prevalence of root filled teeth in the adult population worldwide included 76 observational studies. The findings suggest that 8.2% (95%CI; 7.3% to 9.1%) of teeth has been root filled and that 55.7% (95%CI; 49.6% to 61.8%) of people had at least one tooth root filled.

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Primary root canal treatment success rates

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Thiis review of the outcomes of primary root canal treatment (RoCT) in studies published since 2003 included 42 studies (15 RCTs, 14 prospective cohorts and 13 retrospective studies. While pooled success rates were high the quality of the included studies was limited and the studies were conducted in an academic or private practice environment.

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Intracanal cryotherapy in root canal treatment

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This review of the effect of intracanal cryotherapy in reducing postoperative pain after instrumentation or obturation in root canal treatment included 8 RCTs. The findings suggest that suggests that intracanal cryotherapy in the form of cold saline irrigation as the final irrigant significantly reduces pain between 6 and 24 hours after root canal therapy.

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Occlusal reduction: Does it reduce post endodontic pain?

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This review of the effect of occlusal reduction on post-operative pain following root canal treatment included 7 RCTs. While the findings suggest that occlusal reduction may reduce post endodontic pain the quality of the available evidence is very low so teh findings should be viewed cautiously.

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Guideline: Antibiotics for Dental Pain and Swelling

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This new guideline from the American Dental Association is about the the appropriate use of systemic antibiotics for the urgent management of symptomatic irreversible pulpitis with or without symptomatic apical pulpitis, pulp necrosis and symptomatic apical periodontitis and pulp necrosis and localized acute apical abscess.

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Antibiotics and toothache

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Only 2 RCTs are included in this Cochrane review update of the effects of systemic antibiotics on adults with symptomatic apical periodontitis or acute apical abscess providing insufficient evidence of effectiveness.

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Insufficient evidence to determine the effect of systemic antibiotics on adults with symptomatic apical periodontitis or acute apical abscess

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The recommended treatment for apical periodontitis or acute apical abscess is removal of the source of inflammation or infection by local, operative measures ie tooth extraction or pulp extirpation possibly in combination with the incision and drainage of any swelling present. Antibiotics are only recommended where there is evidence of spreading infection or systemic symptoms.   [read the full story…]

Patients showed a preference to retain a tooth affected by apical periodontitis

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Apical periodontitis (AP) is a common dental problem and can be treated by root canal treatment (RoCT) or extraction.  The aim of this survey for to explore patients’ preferences for management of a tooth affected by AP, when considering its retention via RoCT, its extraction without replacement, or its replacement with an implant supported crown [read the full story…]