Failure of endodontic treatment: The usual suspects
TL;DR: The most common causes of endodontic failure are reviewed along with radiographic examples to avoid or minimize the most fundamental of reasons leading to endodentic failure.
Abstract: Inappropriate mechanical debridement, persistence of bacteria in the canals and apex, poor obturation quality, over and under extension of the root canal filling, and coronal leakage are some of the commonly attributable causes of failure. Despite the high success rate of endodontic treatment, failures do occur in a large number of cases and most of the times can be attributed to the already stated causes. With an ever increasing number of endodontic treatments being done each day, it has become imperative to avoid or minimize the most fundamental of reasons leading to endodontic failure. This paper reviews the most common causes of endodontic failure along with radiographic examples.
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TL;DR: The use of rotary instrumentation in primary teeth results in marked reduction in the instrumentation time and improves the quality of obturation.
Abstract: Objective In permanent dentition, different rotary systems are used for canal cleaning and shaping. Rotary instrumentation in pediatric dentistry is an emerging concept. A very few studies have compared the efficiency of rotary instrumentation for canal preparation in primary teeth. Hence, this study was performed to compare the obturation quality and instrumentation time of two rotary files systems - Protaper, Mtwo with hand files in primary molars. Materials and methods Forty-five primary mandibular molars were randomly allotted to one of the three groups. Instrumentation was done using K-files in Group 1; Protaper in Group 2; and Mtwo in Group 3. Instrumentation time was recorded. The canal filling quality was assessed as underfill, optimal fill, and overfill. Statistical analysis was done using Chi-square, ANOVA, and post hoc Tukey test. Results No significant difference was observed in the quality of obturation among three groups. Intergroup comparison of the instrumentation time showed a statistically significant difference between the three groups. Conclusion The use of rotary instrumentation in primary teeth results in marked reduction in the instrumentation time and improves the quality of obturation.
88 citations
Cites background from "Failure of endodontic treatment: Th..."
...The success of an endodontic procedure depends on the proper mechanical debridement and obturation quality.[14] There are many in vitro studies done in primary teeth comparing different rotary instrumentation systems with manual instrumentation....
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TL;DR: Microorganisms associated with endodontic failure have in common the following proprieties, which make them able to escape the disinfection measures: the ability to form a biofilm, to locate in areas unreachable to root canal instrumentation techniques, synergism, and the able to express survival genes and activate alternative metabolic pathways.
Abstract: Background The main cause of endodontic failure is the persistence of microorganisms that cause an intraradicular or extratradicular infection and that become resistant to disinfection measures. The objective of this review is to identify the microbiota associated with endodontic failure, as well as the reasons why these microorganisms are capable of surviving basic disinfection measures. Material and methods Systematic search of scientific articles in the databases PubMed with the following keywords "Endodontic Infections", "Endodontic Microbiology", "Endodontic Failure", "Enterococcus Faecalis", "Endodontics Retreatment" was carried out. Case reports and articles with publication date prior to 2000 were not included in this review. Results Most authors highlight E. faecalis as the main microorganism associated with endodontic failure, nevertheless there are recent studies that isolate, to a greater extent, other bacteria such as Fusobacterium nucleatum and Propionibacterium. Discussion These microorganisms have in common the following proprieties, which make them able to escape the disinfection measures: the ability to form a biofilm, to locate in areas unreachable to root canal instrumentation techniques, synergism, the ability to express survival genes and activate alternative metabolic pathways.
86 citations
Cites background from "Failure of endodontic treatment: Th..."
...All this can occur as a result of improper preparations of the canals, fillings with lack of apical sealing, filtration in the restoration of the clinical crown, untreated canals, as well as iatrogenies such as apical transport, small access cavities, perforations, false pathways, instruments fractures etc, (1)....
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...Histologically, however, a complete repair of the periapical structures with absence of inflammatory cells must be produced (1)....
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01 Jan 2014
TL;DR: HAL as discussed by the authors is a multi-disciplinary open access archive for the deposit and dissemination of scientific research documents, whether they are published or not, which may come from teaching and research institutions in France or abroad, or from public or private research centers.
Abstract: HAL is a multi-disciplinary open access archive for the deposit and dissemination of scientific research documents, whether they are published or not. The documents may come from teaching and research institutions in France or abroad, or from public or private research centers. L’archive ouverte pluridisciplinaire HAL, est destinée au dépôt et à la diffusion de documents scientifiques de niveau recherche, publiés ou non, émanant des établissements d’enseignement et de recherche français ou étrangers, des laboratoires publics ou privés. Le soin pulpaire chez l’enfant Constance Renaud
80 citations
Cites background from "Failure of endodontic treatment: Th..."
...Tabassum et Khan ont référencé en 2016 les “usual suspects” responsables de ces échecs en endodontie, causant à terme le développement ou la persistance d’une pathologie périapicale : fractures instrumentales, canaux trop faiblement ou même non instrumentés, obturations insuffisantes ou à l’inverse au delà de l’apex (5)...
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TL;DR: F3 had proven to exhibit potential antibacterial and antibiofilm activity in a controlled release pattern consequently, they can be used as an intra-canal medication.
Abstract: The aim of this study is to prepare and evaluate the antibacterial and antibiofilm activity of ciprofloxacin (CIP) loaded PLGA nanoparticles (F2) and CIP-PLGA nanoparticles coated with chitosan (F3...
77 citations
Cites background from "Failure of endodontic treatment: Th..."
...Failure of root canal treatment is mainly attributed to eradication of bacteria and incomplete disinfection of the complex root canal system, which will inevitably lead to persistent apical periodontitis (Tabassum & Khan, 2016)....
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TL;DR: The aim of the present article is to review various biomimetic approaches used to replace lost or damaged dental tissues using restorative biomaterials and tissue-engineering techniques.
Abstract: Biomimetic has emerged as a multi-disciplinary science in several biomedical subjects in recent decades, including biomaterials and dentistry. In restorative dentistry, biomimetic approaches have been applied for a range of applications, such as restoring tooth defects using bioinspired peptides to achieve remineralization, bioactive and biomimetic biomaterials, and tissue engineering for regeneration. Advancements in the modern adhesive restorative materials, understanding of biomaterial–tissue interaction at the nano and microscale further enhanced the restorative materials’ properties (such as color, morphology, and strength) to mimic natural teeth. In addition, the tissue-engineering approaches resulted in regeneration of lost or damaged dental tissues mimicking their natural counterpart. The aim of the present article is to review various biomimetic approaches used to replace lost or damaged dental tissues using restorative biomaterials and tissue-engineering techniques. In addition, tooth structure, and various biomimetic properties of dental restorative materials and tissue-engineering scaffold materials, are discussed.
71 citations
References
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TL;DR: This study investigated the role of infection on the prognosis of endodontic therapy by following-up teeth that had had their canals cleaned and obturated during a single appointment, highlighting the importance of completely eliminating bacteria from the root canal system before obturation.
Abstract: This study investigated the role of infection on the prognosis of endodontic therapy by following-up teeth that had had their canals cleaned and obturated during a single appointment. The root canals of 55 single-rooted teeth with apical periodontitis were thoroughly instrumented and irrigated with sodium hypochlorite solution. Using advanced anaerobic bacteriological techniques, post-instrumentation samples were taken and the teeth were then root-filled during the same appointment. All teeth were initially infected; after instrumentation low numbers of bacteria were detected in 22 of 55 root canals. Periapical healing was followed-up for 5 years. Complete periapical healing occurred in 94% of cases that yielded a negative culture. Where the samples were positive prior to root filling, the success rate of treatment was just 68%--a statistically significant difference. Further investigation of three failures revealed the presence of Actinomyces species in each case; no other specific bacteria were implicated in failure cases. These findings emphasize the importance of completely eliminating bacteria from the root canal system before obturation. This objective cannot be reliably achieved in a one-visit treatment because it is not possible to eradicate all infection from the root canal without the support of an inter-appointment antimicrobial dressing.
1,235 citations
"Failure of endodontic treatment: Th..." refers background in this paper
...[4] The role of bacteria in periradicular infection has been well established in literature and endodontic treatment will be afflicted with a higher chance of failure if microorganisms persist in the canals at the time of root canal obturation.[5] Bacteria harbored in root canal areas such as isthmuses, dentinal tubules and ramifications may evade disinfectants....
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TL;DR: The purpose of this study was to evaluate the relationship of the quality of the coronal restoration and of the root canal obturation on the radiographic periapical status of endodontically treated teeth.
Abstract: The purpose of this study was to evaluate the relationship of the quality of the coronal restoration and of the root canal obturation on the radiographic periapical status of endodontically treated teeth. Full-mouth radiographs from randomly selected new patient folders at Temple University Dental School were examined. The first 1010 endodontically treated teeth restored with a permanent restoration were evaluated independently by two examiners. Post and core type restorations were excluded. According to a predetermined radiographic standard set of criteria, the technical quality of the root filling of each tooth was scored as either good (GE) or poor (PE), and the quality of the coronal restoration similarly good (GR) or poor (PR). The apical one-third of the root and surrounding structures were then evaluated radiographically and the periradicular status categorized as (a) absence of periradicular inflammation (API) or (b) presence of periradicular inflammation (PPI). The rate of API for all endodontically treated teeth was 61.07%. GR resulted in significantly more API cases than GE, 80% versus 75.7%. PR resulted in significantly more PPI cases than PE, 30.2% versus 48.6%. The combination of GR and GE had the highest API rate of 91.4%, significantly higher than PR and PE with a API rate of 18.1%.
938 citations
"Failure of endodontic treatment: Th..." refers result in this paper
...The importance of a good quality coronal restoration was also emphasized by Ray and Trope in their study[17] and later, their work was replicated by another retrospective study performed on 1001 endodontically treated teeth....
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TL;DR: The purpose of this paper is to discuss the aetiology of the failure of root canal treatment, particularly in cases of well-treated root canals, and indications for the treatment of endodontic failures.
Abstract: Siqueira JF, Jr. Aetiology of root canal treatment failure: why well-treated teeth can fail (Literature review). International Endodontic Journal , 34 , 1‐10, 2001. Literature review Root canal treatment usually fails when the treatment is carried out inadequately. However, there are some cases in which the treatment has followed the highest standards yet still results in failure. In most of the cases, the endodontic failure results from persistent or secondary intraradicular infection. Extraradicular infections may also be implicated in the failure of some cases. In addition, it has been claimed that a few cases can fail because of intrinsic or extrinsic nonmicrobial factors. The purpose of this paper is to discuss the aetiology of the failure of root canal treatment, particularly in cases of well-treated root canals. Indications for the treatment of endodontic failures are also discussed.
839 citations
"Failure of endodontic treatment: Th..." refers background in this paper
...[19] However, the fractured instrument itself has less to do with failure because most of the times, the success is only affected when a concomitant infection is present.[3] A clinical investigation on relationship of broken rotary instruments to endodontic case prognosis confirmed that in the absence of any preoperative infection and periradicular changes, a separated instrument is most likely not to affect the prognosis....
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...However, failure ensues when the endodontic treatment falls short of the standard clinical principles.[3]...
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TL;DR: In this paper, the authors carried out meta-analyses to quantify the influence of the clinical factors on the efficacy of primary root canal treatment and to identify the best treatment protocol based on the current evidence.
Abstract: Aims (i) To carry out meta-analyses to quantify the influence of the clinical factors on the efficacy of primary root canal treatment and (ii) to identify the best treatment protocol based on the current evidence.
Methodology The evidence for the effect of each clinical factor on the success rate (SR) of primary root canal treatment was gathered in three different ways: (i) intuitive synthesis of reported findings from individual studies; (ii) weighted pooled SR by each factor under investigation was estimated using random-effect meta-analysis; (iii) weighted effect of the factor under investigation on SR were estimated and expressed as odds ratio for the dichotomous outcomes (success or failure) using fixed- and random-effects meta-analysis. Statistical heterogeneity amongst the studies was assessed by Cochran’s (Q) test. Potential sources of statistical heterogeneity were investigated by exploring clinical heterogeneity using meta-regression models which included study characteristics in the regression models.
Results Out of the clinical factors investigated, pre-operative pulpal and periapical status were most frequently investigated, whilst the intra-operative factors were poorly studied in the 63 studies. Four factors were found to have a significant effect on the primary root canal treatment outcome, although the data heterogeneity was substantial, some of which could be explained by some of the study characteristics.
Conclusions Four conditions (pre-operative absence of periapical radiolucency, root filling with no voids, root filling extending to 2 mm within the radiographic apex and satisfactory coronal restoration) were found to improve the outcome of primary root canal treatment significantly. Root canal treatment should therefore aim at achieving and maintaining access to apical anatomy during chemo-mechanical debridement, obturating the canal with densely compacted material to the apical terminus without extrusion into the apical tissues and preventing re-infection with a good quality coronal restoration.
659 citations
TL;DR: It was concluded that the standardized endodontic technique led to an improvement in the technical standard of the root fillings, and that the technique may be used regularly in all groups of teeth.
514 citations
"Failure of endodontic treatment: Th..." refers background in this paper
...Most of the studies done on the effect of fractured instruments have demonstrated the minimal influence on the success rate of the treatment.[9,18,19] The stage of instrumentation at which the instrument breaks can have an effect on the prognosis....
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...The disinfection and obturation of the part of canal distal to the fractured instrument becomes difficult possibly leading to the presence of persistent infection in that area.[19] However, the fractured instrument itself has less to do with failure because most of the times, the success is only affected when a concomitant infection is present....
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