Treatment of pulpal and apical disease: The European Society of Endodontology (ESE) S3‐level clinical practice guideline

Abstract

BackgroundThe ESE previously published quality guidelines for endodontic treatment in 2006; however, there have been significant changes since not only in clinical endodontics but also in consensus and guideline development processes. In the development of the inaugural S3‐level clinical practice guidelines (CPG), a comprehensive systematic and methodologically robust guideline consultation process was followed in order to produce evidence‐based recommendations for the management of patients presenting with pulpal and apical disease.AimTo develop an S3‐level CPG for the treatment of pulpal and apical disease, focusing on diagnosis and the implementation of the treatment approaches required to manage patients presenting with pulpitis and apical periodontitis (AP) with the ultimate goal of preventing tooth loss.MethodsThis S3‐level CPG was developed by the ESE, with the assistance of independent methodological guidance provided by the Association of Scientific Medical Societies in Germany and utilizing the GRADE process. A robust, rigorous and transparent process included the analysis of relevant comparative research in 14 specifically commissioned systematic reviews, prior to evaluation of the quality and strength of evidence, the formulation of specific evidence and expert‐based recommendations in a structured consensus process with leading endodontic experts and a broad base of external stakeholders.ResultsThe S3‐level CPG for the treatment of pulpal and apical disease describes in a series of clinical recommendations the effectiveness of diagnosing pulpitis and AP, prior to investigating the effectiveness of endodontic treatments in managing those diseases. Therapeutic strategies include the effectiveness of deep caries management in cases with, and without, spontaneous pain and pulp exposure, vital versus nonvital teeth, the effectiveness of root canal instrumentation, irrigation, dressing, root canal filling materials and adjunct intracanal procedures in the management of AP. Prior to treatment planning, the critical importance of history and case evaluation, aseptic techniques, appropriate training and re‐evaluations during and after treatment is stressed.ConclusionThe first S3‐level CPG in endodontics informs clinical practice, health systems, policymakers, other stakeholders and patients on the available and most effective treatments to manage patients with pulpitis and AP in order to preserve teeth over a patient's lifetime, according to the best comparative evidence currently available.

Factors associated with the outcome of root canal treatment—A cohort study conducted in a private practice

“…The execution and reporting of outcome studies has evolved immensely during the recent years. Although the methodology of the present study met the recommendations for this type of study at the beginning of the study in 2008 (European Society of Endodontology, 2006; Friedman et al., 2003; Ng et al., 2007; Ng, Mann, & Gulabivala, 2008; Ng, Mann, Rahbaran, et al., 2008), the methodology has evolved over the long study period of 13 years and the present study does not live up to the expected standards of more recent studies (Duncan et al., 2023). All RCT were performed by a single endodontist.…”

CBCT in contemporary endodontics

“…Subtle periapical changes noted on CBCT scans in root-filled asymptomatic teeth with apparently normal periapical tissues on PAR and no other clinical indicators of disease (e.g., parulides) may not necessarily indicate the presence of apical pathosis, 4,60 and therefore caution is recommended against using CBCT as the sole deciding factor for whether intervention is indicated.…”

“…The current guidelines for the use of CBCT emphasise the balance between ionising radiation dose with benefits on patient outcomes, adhering to the principles of limiting exposure to levels 'as low as reasonably achievable' (ALARA) or 'as low as diagnostically acceptable' (ALADA). [1][2][3] The main guidelines are those released by the European Commission, 1 the European Society of Endodontology (ESE), 2,4 and a joint position paper released by the American Academy of Oral and Maxillofacial Radiology (AAOMR) and the American Association of Endodontists (AAE). 3 However, there remains contention about the indications for CBCT when balanced against the risks.…”

Exploring wound management in dental pulp: Utilizing single‐cell RNA sequencing for global transcriptomic analysis in healthy and inflamed pulpal tissues

“…3 The investigation into wound management in dental pulp signifies a substantial advancement in the discipline of endodontics, as it combines the accuracy of contemporary technology with the complexities of cellular biology. 4,5 Central to this investigation is the application of single-cell RNA sequencing, a potent technique that enables a comprehensive transcriptomic examination of both healthy and inflamed pulpal tissues on a global scale. By illuminating the molecular foundations of pulp biology, this method offers unparalleled insights into the cellular reactions that occur in the context of well-being, illness, and recovery.…”