Browsing by Subject "Endodontics"
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Item Bacterial Chemotaxis And Biofilm Formation Genes In Primary And Secondary Endodontic Infections: A Whole-Metagenome Shotgun-Based Study.(2023-08) Mansour, DinaPurpose: To identify genes encoding the bacterial chemotaxis and biofilm formation pathway in primary and secondary root canal infections using whole genome shotgun sequencing. Materials and Methods: Thirty-seven samples from patients with primary and secondary root canal infections were evaluated using Shotgun sequencing. The distribution were assessed of bacterial species and functional genes, including genes encoding for chemotaxis and biofilm pathway. Libraries were made using 1⁄4 Nextera XT reations and sequencing was done on the Novaseq with a target of 15-20M reads per sample. Taxonomic and functional annotations were made using MetaPhIAn3 and HUMAnN3. The Mann Whitney test was used to compare differences in gene abundance between primary and secondary infections. Results: The study identified 19 chemotaxis and 77 biofilm genes. Prevalent bacteria with chemotaxis genes were Fusobacterium nucleatum (62%), Pseudopropionibacterium propionicum (21.6%), Selenomonas sputigena (10.8%), Desulfobulbus oralis (8.1%), and Campylobacter curvus (8.1%). Top chemotaxis genes included K10540: methyl-galactoside transport system substrate-binding protein (26/37) 70%, K10439 ribose transport system substrate-binding protein (21/37) 56%, K03413: two-component system, chemotaxis family, response regulator CheY (19/37) 51%, K02556: chemotaxis protein MotA (16/37) 43%, K02557 chemotaxis protein MotB (14/37) 37%. The prevalent bacteria encoding biofilm genes were Fusobacterium nucleatum (45.9%), Desulfobulbus oralis (8.1%), Campylobacter curvus (24.3%), Selenomonas sputigena (13%), and Eubacterium infirmum (43%). The top biofilm-related genes were K00688: starch phosphorylase (30/37) 81%, K00975: glucose-1-phosphate adenylyltransferase (30/37) 81%, K03092: RNA polymerase sigma-54 factor (23/37) 62%,K07173: S-ribosylhomocysteine lyase (24/37) 64%, K00640: serine O-acetyltransferase (23/37) 62%. Heatmap figures illustrated the abundance of these genes in the samples. Conclusion: Bacteria carrying chemotaxis and biofilm pathway genes included Fusobacterium nucleatum, Pseudopropionibacterium propionicum, Selenomonas sputigena, Desulfobulbus oralis, and Campylobacter curvus. The study provides valuable insights into potential targets for future research and treatment in root canal infections.Item A comparison of Pharmaceutical regiments following first stage root canal treatment(2015-08) Lewis, RileyAIM: The purpose of this clinical trial was to investigate the analgesic efficacy of four oral medication groups on postoperative endodontic pain after first stage root canal treatment. The four groups will be Methodology: Patients presenting to the University of Minnesota emergency graduate endodontic clinic experiencing pain greater than or equal to 3/10 were considered potential condidiates. 22 patients were included based on an established inclusion criteria. Following administration of local anaestheisa, a pulpectomy was performed. The patients were administered the following at 4 hour time intervals: (1) 2 doses of Placebo; (2) 2 800mg doses of Ibuprofen; (3) 2 800mg Ibuprofen with Vicodin 325/7.5mg; (4) 1 dose of 550mg Anaprox DS (Naproxen) and 1 dose of Placebo. Patients recorded pain intensity following treatment on a visual analogue scale, Heft parker scale and a baseline four-point category pain scale before and immediately after treatment, then one hour after the initial dose of medication, and one hour after the second dose of medication. The following day, pain was recorded at breakfast, lunch, dinner and bedtime. Results: At about 24 hours, 27% had moderate to severe pain. All patients showed significant pain reduction after initial root canal therapy. The ibuprofen group showed a rebound in pain the following day. Males had more rebound pain compared to females. Anaprox DS and the combination of Ibuprofen and Vicodin showed the most pain reduction at all time periods. In our study, the results suggested that pulp vitality had little effect on post operative pain. Conclusion: Primary endodontic treatment will greatly decrease the pain felt by the patient. High doses of Ibuprofen followed by an abrupt stop might lead to a rebound in pain. Tooth vitality did not seem to affect post operative discomfort, nor did patient gender. More research using this model and analgesic combination is necessary to ensure statistically significant results.Item Comparisons of the shaping abilities of three NiTi file systems using rotational versus reciprocal movements(2014-08) Peterson, Tyler Blaine, DDSIntroduction: The purpose of this study was to determine if there were any differences in shaping abilities between three NiTi file systems when using rotational versus reciprocal movements in simulated S-shaped canals, as well as compare the time required to complete canal preparations.Methods: One hundred twenty S-shaped canals were filled with ink and pre- instrumentation images were obtained using a stereomicroscope. Experimental canal preparations where completed using K3XF in rotary movement, K3XF in reciprocal movement, Twisted File (TF) in rotary movement, TF in reciprocal movement, ProTaper Next (PTN) in rotary movement, and PTN in reciprocal movement. Pre-instrumentation and post-instrumentation images were superimposed, and standardized for area difference measurements. Pre-instrumentation and post-instrumentation area differences were measured in seven defined regions and the mean differences were compared between the experimental instrumentation groups. Time required to complete canal preparations was recorded for each group for comparisons.Results: Statistical analysis showed there were significant differences between NiTi file systems, instrumentation movement type, as well as time to complete canal preparations. The TF file system performed better in shaping abilities than the PTN file system followed by the K3XF file system in a majority of the defined areas measured. The TF file system performed the best in reciprocal motion in all defined regions compared to the TF in rotary motion. Reciprocal motion was better in shaping ability compared to rotary motion in a majority of the defined areas measured. The K3XF file system in reciprocal motion completed canal preparations quicker than the K3XF file system in rotary motion. Conclusions: Differences were found between K3XF, TF, and PTN file systems in regards to shaping abilities, rotatory versus reciprocal motions, and canal preparation times.Item Dimensional Changes of ProRoot white Mineral Trioxide Aggregate, EndoSequence Root Repair Material, and Biodentine During Setting Using Digital Image Correlation(2016-09) Zedler, AmberIntroduction: Dimensional changes in the materials used for root end fillings could enhance or weaken the seal of the filling. The purpose of this study is to quantify and compare the dimensional changes of ProRoot white Mineral Trioxide Aggregate (Dentsply Tulsa Dental Specialties, Johnson City, TN), EndoSequence Root Repair Material (Brassler, Savanah, GA), and Biodentine (Septodont, Cambridge, ON, Canada) in a simulated root end model during setting of the respective materials. Methods: Dimensional changes of the experimental materials in simulated root ends were measured using digital image correlation. Results: The white MTA demonstrated shrinkage was from 0.86% to 2.98%, with a mean of 1.84% and standard deviation of 0.61%. Shrinkage of Biodentine was measured to be 0.43% to 1.88%, with a mean of 1.30% shrinkage and standard deviation of 0.42%. The ERRM expanded from 0.17% to 2.56%, with a mean of 1.23% and a standard deviation of 0.88%, with all samples demonstrating expansion. Conclusions: The water available during the setting of Mineral Trioxide Aggregate, EndoSequence Root Repair Material, and Biodentine has an effect on the dimensional changes of the material. White MTA and Biodentine have previously been shown to expand with adequate hydration, but may shrink in an environment that is drier.Item The Effect Of Rotary Instrumentation On Dentin Thickness In The Danger Zone Of The Maxillary 1St Molar: A Cbct Analysis(2020-08) Heyse Jr, JeffreyPURPOSE: To quantitively measure initial and remaining dentin wall thickness in the danger zone of the second mesiobuccal (MB2) canal of extracted human maxillary first molars after rotary instrumentation using cone beam computed tomography (CBCT) imaging. MATERIAL AND METHODS: Each tooth was scanned multiple times after instrumentation by files of increasing taper. Repeated- measures ANOVA and post hoc Tukey test were used to compare the changes in the remaining wall thickness. RESULTS: The preoperative dentin thickness in the danger zone of the MB2 area had a mean of 0.82 +/- .17mm. Multiple comparison test found significant levels of mean dentin removal in the danger zone for all groups. CONCLUSION: The Sx orifice opener does significantly reduce the remaining dentin thickness removing an average of 32% of the dentin in the distal wall. There is a safe area of dentin thickness toward the mesial wall of the MB2 danger zone.Item Glide path preparation of nine instrument Systems and their effect on final canal area in simulated canals(2013-08) Goerig, David CharlesIntroduction: This study evaluated glide path preparation of nine instrument systems in simulated s-shaped canals and the preparation's effect, if any, on the two-dimensional surface area after final instrumentation to a clinically relevant size. Methods: One hundred S-shaped canals were filled with ink and preinstrumentation images were obtained using a stereomicroscope. Glide path preparation was performed by an endodontic resident using FlexoFiles, FlexoFiles mounted in M4 safety handpiece, rotary EndoMagic instruments, rotary K3 instruments, rotary PathFiles instruments, rotary Pre Shaper instruments, rotary ScoutRace instruments, rotary V-Glide instruments, and rotary X-Plorer instruments. Preinsturmentation and postflaring images were superimposed and S-Shaped canals were measured for deviation in both curves. All Blocks were instrumented with K3XF to a final apical size of 35/0.04. Surface areas of preinstrumentation and postinstrumentation images were measured to obtain a percent change for each block and the mean percent change was compared amount groups. Results: The mean difference of material removed from the apical curvature demonstrated no significant difference between the nine groups (p=0.3408), whereas there was a significant difference in means between the groups in the coronal curvature (p<0.0001). Comparison of the percent change in mean surface area amongst the groups before and after instrumentation with K3XF were not statistically significant (p= 0.1782). Conclusions: A variety of methods may be employed to obtain a glide path with minimal deviation from the original canal space and that the method used may not have much influence of the final canal shape.Item In vitro comparison of PFM crown retention following endodontic access and subsequent restoration: amalgam, composite, amalgam with composite veneer, and fiber post with composite(2014-08) Brezinsky, Scott Aaron, DDS.Introduction: An in vitro investigation of crown retention following endodontic access on molar porcelain fused to metal (PFM) crowns and subsequent restoration using amalgam, composite, amalgam + composite, or fiber post + composite.Methods: 40 human extracted molars were mounted in acrylic resin and prepared for PFM crowns. PFM crowns were fabricated, cemented with zinc phosphate, and the force to displace each crown was measured with a tensile-testing machine before and after endodontic access preparations. The endodontic access area, crown preparation axial wall, and preparation surface area was measured for each sample for comparison. The crowns were then recemented and access openings restored with either amalgam or composite before displacement force was remeasured. The restorative material was removed from each access opening, access area measured, and restored again (amalgam with composite or fiber post with composite) for displacement force to be re-measured. To compare for retention without a restored access opening, 13 randomly selected samples were removed of the restorative material, recemented and crowns again removed. Paired T test was used to compare the means of displacement between groups. One-way analysis of variance (ANOVA) was used to compare the mean outcome measure within the groups. Results: Statistical analyses showed retention following unfilled access was significantly lower than intact crowns. Amalgam, composite, amalgam + composite, and fiber post + composite increased retention beyond the original value. There was no statistical difference between amalgam and composite materials nor amalgam + composite from fiber post + composite. Qualitative results indicate that the restorative material remains in the crown following displacement regardless of the material used to restore the access. Conclusions: The results from this study suggest that an endodontic access cavity decreases retention of a PFM. However, subsequent restoration with amalgam, composite, amalgam + composite, or post + composite may increase the original retention of the crown.Item An In Vitro Study Of Ph Changes With Endosequence Bc Root Repair Material Fast Set Putty In Simulated Resorptive Defects(2018-08) Kickertz, KatieOne of the challenges to endodontic treatment is external inflammatory root resorption, a destructive process which destroys the radicular portion of the tooth when under pathologic states. Treatment has traditionally been via long-term placement of an intracanal medicament of calcium hydroxide. Calcium hydroxide is antimicrobial, able to dissolve tissue, inhibit resorption and induce hard tissue formation. It has an alkaline pH, which disrupts bacterial cell wall metabolism. Cons to its use include potential for tooth fracture and multiple appointments needed for effect on the resorption process. The purpose of this study was to compare in vitro the effects of intracanal placement of Endosequence BC RRM Fast Set Putty and calcium hydroxide on hydroxol ion diffusion through dentin of teeth with simulated root surface cavities, mimicking external resorptive lesions. The goal was to determine if Endosequence BC RRM Fast Set Putty is a conceivable alternative to calcium hydroxide in cases of external inflammatory resorptive lesions.Item Long-term Outcome of Patients with Persistent Pain Following Root Canal Treatment: The National Dental Practice-Based Research Network(2018-05) Hryvenko, IrynaAbout 10% of patients report persistent pain 6 months after root canal treatment (RCT). Little is known about the longer-term outcomes of such patients, their additional care, or factors associated with chronification of their persistent pain. We aimed to measure the longer-term outcomes of patients found to have persistent pain at 6 months and assess for characteristics that differed among patients whose persistent pain continued at 3-years post-RCT versus those whose pain resolved. Finally, we explored long-term pain outcomes of the available specific diagnoses that had been derived for the persistent pain at 6 months after RCT. Forty-five patients previously found to have persistent pain 6 months following RCT from the National Dental Practice Based Research Network were approached for a 3-year follow-up, and 27 participated (60%) in the survey. Frequency of self-reported pain (occurring ≥1day(s) in the past month with an average intensity of ≥1/10), its impact on the ability to carry out daily activities, and additional utilization of healthcare were measured. Differences in patient-, pain-, tooth-, dentist-related characteristics were assessed between those patients who continued to experience persistent pain and those whose pain resolved by the 3-year follow-up. Pain outcomes were also assessed in the light of the specific diagnoses derived for the persistent pain by a board-certified endodontist and an orofacial pain practitioner at 65±41 days (~8 months) post-RCT using the data available from the nested study on patients in Midwest region. Five (19%) patients met criteria for pain at 3.4 years (range: 3.1-3.9) post-RCT, which was moderate in intensity, occurred for about 3 days in the preceding month, and for only one patient, kept them from usual activities and work. Patients whose persistent pain resolved since 6-month follow-up received similar amounts of additional care within each follow-up time window as those whose pain continued. Yet, cumulatively over the 3 years, 4/5 (80%) patients whose pain continued received dental care with no reduction in average pain intensity. Longer duration of pre-operative pain and higher intensity and interference of persistent pain at 6 months were found among patients with pain chronification. Specific diagnoses for the persistent pain at 6 months after RCT were available for 15/27 (56%) patients and included odontogenic (6), temporomandibular disorder (TMD) (5), mixed odontogenic-TMD (1), persistent dento-alveolar pain disorder (1), and pain-free by the time of evaluation (2). Ten (77%) out of the 13 examined patients improved over the 3 years regardless of the diagnosis or treatment. Eleven (85%) of them had TMD and/or headache either as co-morbid unrelated diagnoses (6, 46%) or the causes (6, 46%) of the persistent tooth pain. Chronicity of persistent pain at 3 years post-RCT was infrequent. Most patients improved without additional treatments, and those who received additional care did not necessarily have reduced pain. Our preliminary study indicates that chronification of pain may be associated with characteristics previously identified to be related to chronification of pain. Patients presenting for initial RCT and suffering persistent pain after it might need to be carefully evaluated and managed for various orofacial pain conditions mimicking or co-existing with odontogenic pain to improve short- and long-term treatment outcomes.Item Post-Operative Pain Following Treatment Using the Gentlewave System: A Randomized Controlled Trial(2019-08) Grigsby, DarylINTRODUCTION: Cleaning and shaping are necessary to allow for the delivery of irrigants and medicaments to the apical third of the canal. Standard treatment irrigation generally uses a conventional needle and some frequency of sonic activation. The GentleWave® system (GWS) (Sonendo, Inc, Laguna Hills, CA) combines irrigant delivery with Multisonic activation. The aim of this randomized clinical trial was to determine if the GWS significantly decreases the incidence and intensity of post-operative pain. METHODS: Patients used a numerical rating scale (NRS) to record their pain level at the six-hour timepoint before treatment. All participants were randomly divided into two groups and were blind to the treatment they received. The standard (control) group received endodontic treatment with conventional side-vented needle irrigation and ultrasonic activation. The 2nd group received treatment with the GWS. Following treatment, patients used an NRS to record their pain level at six, 24, 72, and 168 hours RESULTS: 72.2% of standard treatment patients and 83.3% of GWS patients experienced at least one occurrence of post-operative pain. The highest pain intensity level for both treatments occurred at the six-hour post-treatment timepoint. The mean pain intensity for standard treatment was 23.22 (+/- 25.38) and for GWS treatment intensity = 11.56 (+/- 9.94) (p = 0.0826). All pain decreased with time after the six-hour post-treatment time point (p < 0.0000001237). CONCLUSION: There was no significant difference in the incidence or intensity of post-operative pain following either treatment group. However, both groups reported a statistically significant decrease in pain with time.Item Preoperative Factors Associated With Anesthesia Failure For Patients Undergoing Non-Surgical Root Canal Therapy; A National Dental Practice-Based Research Network Dpbrn Study(2020-08) Weitz, DustinABSTRACT Introduction: Providing effective local anesthesia is a critical component of the RCT treatment. Patients and providers are more satisfied if local anesthesia is successful. The aim of this study was to analyze data collected by The National Dental Practice-Based Research Network (DPBRN) during non-surgical root canal therapy to identify preoperative factors associated with local anesthesia failure during treatment in the private practice setting. Methods: The DPBRN, consisting of 46 general dentists and 16 endodontists from five geographic areas, enrolled 708 patients in the study, an analysis of patients treated in one visit vs. multiple was done finding no statistical difference in failure rates between the groups in any model. To standardize the treatment rendered, patients treated in multiple appointments were excluded from the study, patients who had general anesthesia, IV sedation or oral sedation were also excluded. Not all survey questionnaires were completely filled out, patients with missing data for a given variable were noted as missing in the analysis. Three methods for defining anesthesia failure: Method 1-patient reported level of numbness, Method 2-provider reported quality of anesthesia, and Method 3-provider reported use of supplemental anesthesia after initial injections required to obtain adequate anesthesia during the procedure. Numerous pre-operative factors were investigated and differences between failure groups, for each failure measure, were estimated by chi-square tests of independence for categorical variables and t-tests for numeric variables. A stepwise linear regression model using AIC statistic as fitness criteria for each method was created to identify variables associated with failure outcomes. The regression models give odds ratios for factors associated anesthesia failure. Results: Overall anesthesia failure rates were 4.90%, 14.61% and 29.96% for Methods 1, 2 and 3 respectively. Method 1 found provider experience, diabetes, current smoking habit, patient expected outcome of treatment, sharp pain, and spontaneous pain to be significant when analyzed individually. The regression model found provider experience, diabetes, preoperative fear, number of days in pain, sharp pain, spontaneous pain and severe pain to be significantly correlated with anesthesia failure. Method 2 found provider type, diabetes, pain interference in recreational and social activities, pain provoked by stimulus, pain made worse by stress, percussion sensitivity, biting sensitivity, and presence of a sinus tract to be significant when analyzed individually. The regression model found provider experience, provider type, diabetes, and pain interfering in recreation and social activities to be significantly correlated with anesthesia failure. Method 3 found provider type, patient age, pain interference with daily activities, sharp pain, pain provoked by stimulus, maxillary vs mandibular, presence of a periapical radiolucency, responsiveness with cold, lingering pain with cold, and pulp vitality confirmed with bleeding upon access to be significant when analyzed individually. The regression model found provider experience, provider type, patient income from $10,000-29,000, diabetes and pain interfering in recreational and social activities to be significantly correlated with anesthesia failure. Conclusions: The results from this study generally agree with prior studies finding that symptomatic teeth with vital pulps have more anesthesia failures. Patient self-reported history of diabetes was found to lead to more anesthesia failures in multiple models; further research is needed to understand the mechanism of anesthesia failure related to diabetes. Multiple models found results related to provider experience and provider training found that more experienced providers and those with higher levels of training had significantly fewer anesthesia failures. Pulpal anesthesia is more difficult to achieve than soft tissue anesthesia. Prior research reveals oral surgery departments are responsible for anesthesia training in most dental school and endodontic departments are not involved; the results of this study indicate that endodontic departments should be involved in a team approach with oral surgery departments regarding local anesthesia training in dental schools to shorten the learning curve for providers. Keywords: Endodontics, Local Anesthesia, Practice Based Research Network