A Scoping Review of 4 Decades of Outcomes in Nonsurgical Root Canal Treatment, Nonsurgical Retreatment, and Apexification Studies—Part 2: Outcome Measures

Azarpazhooh, Amir; Sgro, Adam; Cardoso, Elaine; Elbarbary, Mohamed; Lighvan, Nima Laghapour; Badewy, Rana; Malkhassian, Gevik; Jafarzadeh, Hamid; Bakhtiar, Hengameh; Khazaei, Saber; Oren, Ariel; Gerbig, Madeline; He, Helen; Kishen, Anil; Shah, Prakesh S.

doi:10.1016/j.joen.2021.09.019

Cited by 29 publications

(30 citation statements)

References 43 publications

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“…Although a recent scoping review reported on the outcomes of endodontic treatments (Azarpazhooh et al, 2022), the review reported here is the first to adopt the health intervention taxonomy to summarize outcomes into a format compatible with COS development covering the breadth of VPTs.…”

Section: Discussionmentioning

confidence: 99%

Outcomes reporting in systematic reviews on vital pulp treatment: A scoping review for the development of a core outcome set

Cushley

Duncan²,

Lundy

et al. 2022

Int Endodontic J

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Background: A large number of research reports on vital pulp treatment (VPT) has been published over the last two decades. However, heterogeneity in reporting outcomes of VPT is a significant challenge for evidence synthesis and clinical decision-making. Objectives:To identify outcomes assessed in VPT studies and to evaluate how and when outcomes are measured. A subsidiary aim was to assess evidence for selective reporting bias in the included studies. The results of this review will be used to inform the development of a core outcome set (COS) for endodontic treatments. Methods: Multiple healthcare bibliographic databases, including PubMed/ MEDLINE, Ovid EMBASE, Scopus, Cochrane Database of Systematic Reviews and Web of Science were searched for systematic reviews published between 1990 and 2020, reporting on VPT. Screening, data extraction and risk of bias assessment were completed independently by two reviewers. Outcomes' information was extracted and aligned with a healthcare taxonomy into five core areas: survival, clinical/physiological changes, life impact, resource use and adverse events.Results: Thirty-six systematic reviews were included, 10 reporting on indirect pulp capping or selective caries removal, nine on direct pulp capping, eight on pulpotomy and nine on combined VPTs. There was considerable variation in the outcomes reported in these reviews and their included studies. Clinician-reported outcomes were used considerably more often than patient-reported outcomes. A range of instruments and time points were used for measuring outcomes. Several of the reviews were assessed as having low risk of selective reporting bias, but many did not specifically report this domain, whilst others did not provide risk of bias assessment at all. Discussion: Considerable variation in selection of outcomes and how and when they are measured and reported was evident, and this heterogeneity has implications for evidence synthesis and clinical decision-making. Conclusions:Whilst there is a lack of consistency, several potentially important outcomes for VPT, including pulp survival, incidence of post-operative pain and Year Country Journal name VPT modality reported Outcomes reported in review

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Section: Discussionmentioning

confidence: 99%

Outcomes reporting in systematic reviews on vital pulp treatment: A scoping review for the development of a core outcome set

Cushley

Duncan²,

Lundy

et al. 2022

Int Endodontic J

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“…Several periodontal prognostic models were developed and evaluated [ 9 , 10 , 19 ], but they might not depict the comprehensive individual tooth prognosis with their limited consideration for endodontic and restorative aspects [ 20 ]. While ample studies have reported the prognosis of initial endodontic therapy, the reported prognosis is diverse and difficult to interpret by clinicians due to their heterogeneities in outcome measurements, criteria, and classification along with a lack of pre-, intra-, and postoperative clinical and radiographic data [ 21 , 22 ]. Nevertheless, the presence of preoperative PARL was reported as a major indicator of endodontic postoperative healing or failure [ 23 ].…”

Section: Discussionmentioning

confidence: 99%

Comparison Study of Diagnosis and Treatment Planning for Dental Infections between Dental Students and Practitioners

Jones

Kim

et al. 2022

Healthcare

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This study aimed to access the knowledge in diagnosing dental infections and the practice in treatment planning for the affected teeth among dental practitioners (DPs) and senior (final-year) students. A survey questionnaire containing two cases (Case A; periodontal abscess and Case B; periapical abscess) with four questions per case was delivered to potential participants. Fifty-nine DPs voluntarily participated in the survey. For senior students, the case study was a part of their course requirements; one of the two cases (either Case A or B) was randomly assigned to the 126 seniors. The distribution of responses was significantly different between the DP and senior groups except for the diagnosis of Case B (Fisher’s exact test; p = 0.05). Only 31% of the participants diagnosed Case A as periodontal abscess; most of them selected periodontal surgery as the first treatment option. Despite a high agreement in diagnosing Case B, the choice of treatment was significantly different; the most frequent treatment option was extraction (51%) from the DP group and root canal retreatment (57%) from the senior group. The study revealed that the diagnosis of periodontal abscess was more challenging than that of periapical abscess among dental professionals.

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“…The lack of clinical trials is inevitably coupled to the studied outcomes. Prevention or healing of apical periodontitis is the primary outcome of interest in clinical endodontology (Azarpazhooh et al, 2022; Ørstavik, 2019), but easier‐to‐measure surrogate end‐points are usually preferred in experimental studies in order to shorten the post‐operative observation period or to conduct the experiments in a laboratory. The reduction of the intracanal microbial load is the most relevant surrogate end‐point, and there is evidence that it is correlated to the healing of apical periodontitis, at least to some extent (Sjögren et al, 1997).…”

Section: Current Problemsmentioning

confidence: 99%

Present status and future directions – irrigants and irrigation methods

2022

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Irrigation is considered the primary means of cleaning and disinfection of the root canal system. The purpose of this review was to set the framework for the obstacles that irrigation needs to overcome, to critically appraise currently used irrigants and irrigation methods, to highlight knowledge gaps and methodological limitations in the available studies and to provide directions for future developments. Organization of bacteria in biofilms located in anatomic intricacies of the root canal system and the difficulty to eliminate them is the main challenge for irrigants. Sodium hypochlorite remains the primary irrigant of choice, but it needs to be supplemented by a chelator. Delivery of the irrigants using a syringe and needle and activation by an ultrasonic file are the most popular irrigation methods. There is no evidence that any adjunct irrigation method, including ultrasonic activation, can improve the long‐term outcome of root canal treatment beyond what can be achieved by instrumentation and syringe irrigation. It is necessary to redefine the research priorities in this field and investigate in greater depth the penetration of the irrigants, their effect on the biofilm and the long‐term treatment outcome. New studies must also focus on clinically relevant comparisons, avoid methodological flaws and have sufficiently large sample sizes to reach reliable conclusions. Future multidisciplinary efforts combining the knowledge from basic sciences such as Chemistry, Microbiology and Fluid Dynamics may lead to more effective antimicrobials and improved activation methods to bring them closer to the residual biofilm in the root canal system.

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A Scoping Review of 4 Decades of Outcomes in Nonsurgical Root Canal Treatment, Nonsurgical Retreatment, and Apexification Studies—Part 2: Outcome Measures

Cited by 29 publications

References 43 publications

Outcomes reporting in systematic reviews on vital pulp treatment: A scoping review for the development of a core outcome set

Outcomes reporting in systematic reviews on vital pulp treatment: A scoping review for the development of a core outcome set

Comparison Study of Diagnosis and Treatment Planning for Dental Infections between Dental Students and Practitioners

Present status and future directions – irrigants and irrigation methods

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