The impact of an enhanced infection control protocol on molar root canal treatment outcome – a randomized clinical trial

Abstract

Aim To evaluate the effect of an enhanced infection control protocol on root canal treatment outcomes and on microbial load within root canals after chemomechanical preparation. Methodology A total of 144 molar teeth from 139 healthy patients receiving primary root canal treatment were block randomized to a standard protocol (StP) or an enhanced infection control protocol (EnP). Both treatment arms adhered to current best practice recommendations, while the EnP comprised additional steps that included replacing rubber dams, gloves, files, all instruments and surface barriers at the time of canal filling to reduce the chances of iatrogenic contamination. Patients and radiographic examiners were blinded to the protocol used. Intracanal microbial samples were taken at baseline (S1) and after completion of chemomechanical preparation (S2). Microbial 16S rDNA copy numbers were enumerated by quantitative polymerase chain reaction (qPCR). Cone beam computed tomography (CBCT) scans were taken before treatment and at one‐year follow‐up. The outcome was assessed clinically and radiographically using CBCT by logistic regression modelling. Results At one‐year follow‐up, 115 teeth were analysed (54 in StP and 61 in EnP). The percentage of favourable outcomes assessed by CBCT was 85.2% in the EnP and 66.7% in the StP. The odds of 12‐month success was three times higher in the EnP group compared with the StP group (OR=2.89; p=0.022, CI: 1.17 – 7.15). The median bacterial reads were reduced from 8.1×103 in S1 samples to 3.5×103 in the StP group and from 8.6×103 to 1.3×103 in the EnP group. The enhanced protocol significantly reduced bacterial counts in pre‐canal filling samples when compared to the standard protocol (p=0.009). Conclusions The implementation of a facile, enhanced infection control protocol in primary root canal treatment resulted in less detectable bacterial DNA before canal filling and significantly more successful outcomes at one year.

The effect of Patient’s Race on the Outcome of Endodontic treatments: a pooled analysis of 1 year recall data from four Cone Beam Computed Tomography outcome studies

“…This is a retrospective analysis of data collected from four prospective clinical outcome studies which were pooled including two studies on primary root canal treatments 24,25 and two endodontic retreatment studies 7,26 All patients included in these studies were referred to Guys Dental Hospital (blanked for refereeing purpose) for the management of primary or secondary endodontic disease.…”

“…All patients underwent a full assessment including routine medical and dental history, pain history and a soft and hard tissue examination. Digital periapical radiographs (Pas) and CBCT scans were taken for all cases preoperatively and 12 months after treatment as described in the original papers [24][25][26][27] . Data regarding race (both patient and operator), patient medical history, root length and root curvature, were extracted from patients dental records and the likely socio-economic status of the patient was determined via the index of multiple deprivation (IMD) 28 .…”

“…All received appropriate training and standardization before the start of the studies. Where indicated, teeth were restored with cuspal coverage restorations within one month of the completion of the root canal treatment by the endodontic residents 7 or by the referring dentists [24][25][26] Outcome assessment…”

“…Both primary root canal treatments and retreatments were completed in one visit, or two visits with an interappointment calcium hydroxide medication, using a standardized protocol 7,24−26 (see appendix 1protocol) consistent with European Society of Endodontology guidelines 30 or an additional enhanced infection protocol 25 . Operative procedures were undertaken by 35 Endodontic residents, of which 14 were white and 21 were Asian or from other ethnic minorities under the direct supervision of specialist endodontic staff at Guy's and St Thomas' NHS foundation Trust, London, UK, none of the operators was black, as no black endodontic resident was attending the programme.…”

Radioimaging in the Evaluation of the Therapeutic Effect of the Vegetable Extract Obtained from Epilobium Parviflorum Schreb

“…Working length was determined using an electronic apex locator (Denjoy Joypex 5, Skysea) and confirmed with a digital periapical radiograph. Canal preparation was performed in a crown-down approach using rotary instruments (ProTaper ® Gold; Dentsply Sirona) at 300 RPM and a maximum torque of 4N to a size F2 master apical size, whenever possible [33].…”