The effect of an intraorifice barrier and base under coronal restorations on the healing of apical periodontitis: a randomized controlled trial

Abstract

Aim To evaluate the effect of intraorifice barriers and bases on the healing of apical periodontitis following root canal treatment in mandibular molars. Methodology A total of 120 permanent mandibular molars with necrotic pulps and periapical radiolucencies (PAI score ≥ 3) were recruited. Root canal treatment was performed in all teeth using a standard protocol, following which they were randomly allocated to one of the three treatment groups: intraorifice barrier group: coronal 3‐mm gutta‐percha was removed and replaced with glass–ionomer cement (GIC) barrier. The floor of the pulp chamber was then sealed with 2‐mm‐thick GIC base followed by final composite resin restoration; base group: received 2‐mm‐thick GIC base before placement of composite resin restoration; and control group: had pulp chamber entirely filled with composite resin only. Follow‐up was done at 3, 6, 9 and 12 months. Combination of clinical and radiographic parameters were used to assess treatment outcome. The data were analysed using Kruskal–Wallis, chi‐square and Wilcoxon signed‐rank tests and logistic regression analysis. Results At the end of 12 months, the base group had the most favourable healing (97.1%), whilst the control group had the least favourable healing (83.8%). The intraorifice barrier group had healing of 92.1%. However, there was no significant difference in healing between groups at the end of the follow‐up period (P > 0.05). Additional subgroup analysis revealed a nonsignificant effect of periodontal status and root filling level on periapical healing. Conclusion The use of an additional barrier under permanent restorations did not significantly improve the outcome of primary root canal treatment in posterior teeth after 12 months. However, its influence in the long term requires further evaluation.

Comparative evaluation of complete and partial pulpotomy in mature permanent teeth with symptomatic irreversible pulpitis: A randomized clinical trial

“…In the present study, the two teeth which failed had only occlusal lesions, associated with intact restorations and healthy periodontium at the time of failure. Moreover, an excellent seal obtained by the use of MTA as a pulpotomy agent (Parirokh & Torabinejad, 2010) and overlaid dual layer of restoration (Kumar et al, 2020) minimised the chances of leakage being a cause. Thus, these failures maybe attributable to the inability to determine the correct preoperative pulpal inflammatory status with current diagnostic methods.…”

Effect of an Intraorifice Barrier on Endodontically Treated Teeth: A Systematic Review and Meta-Analysis of In Vitro Studies

“…Another option to be considered is the resin-modified glass-ionomer cement that can be easier to place, and its antibacterial activity is also associated with the light-curing by the release of benzine bromine and benzine iodine. One randomized clinical trial [ 71 ] evaluated the outcomes of primary root canal treatment using glass-ionomer cement as an intraorifice barrier for twelve months, and no difference was observed in periapical healing of apical periodontitis; however, it is feasible to say that the follow-up time of twelve months is insufficient to observe expressive failures in dental restorations [ 72 ], and thus, endodontic treatment failure due to the lack of an intraorifice barrier providing an additional seal could not be investigated in this timeframe. In the metanalysis, the glass-ionomer cement was able to reduce microleakage when compared to the control group with no barriers.…”

Outcomes of primary root canal therapy: An updated systematic review of longitudinal clinical studies published between 2003 and 2020

“…The analytic sample for the meta-regression analysis included 17 studies under 'loose' criteria and 27 studies under 'strict' criteria. Thirteen studies were excluded due missing data on the analysed co-variates (Angerame et al, 2017;Aqrabawi et al 2006;Arya et al, 2017;Dorasani et al, 2013;Demirci & Çalışkan, 2016;Hale et al, 2012;Kumar et al, 2020;Llena et al, 2020;Ozer & Aktener, 2009;Restrepo-Restrepo et al, 2019;Sarin et al, 2016;Verma et al, 2019;Verma et al, 2020). Table 4 presents results of the meta-regression analysis to account for sources of heterogeneity.…”

“…obturation techniques (Ozer & Aktener, 2009); different apical preparation sizes (Saini et al, 2012); irrigation activation (Verma et al, 2020); types of irrigation (Kist et al, 2017;Tang et al, 2015); root filling materials (Demirci & Çalışkan, 2016); instrumentation type (Angerame et al, 2017;de-Figueiredo et al, 2020); concentration of irrigation solutions (Verma et al, 2019); intraorifice barrier (Kumar et al, 2020). Eighteen (42.86%) studies were 'low'…”