Value of root-filled teeth in maintaining a functional dentition for life

Gulabivala, K; Ng, Yuan-Ling

doi:10.1038/s41415-019-0313-8

Cited by 6 publications

(5 citation statements)

References 181 publications

(224 reference statements)

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“…The effect of the steps upto and including “mechanical preparation” of the canal(s) on the microbiota has been tested using “neutral” irrigants such as water or saline; such studies show that negative cultures were achieved in 31% (range 0%–79%) (weighted pooled average) of the cases. The use of sodium hypochlorite (concentration range 0.5%–5.0%) irrigation during the steps upto and including ‘mechanical preparation’, increased the frequency of negative cultures immediately after debridement to 52% (range 13%–95%) (weighted pooled average) (Gulabivala & Ng, 2019a, 2019b).…”

Section: Outcomes Of Non‐surgical Root Canal Treatmentmentioning

confidence: 99%

“…The currently deprecated cotton wool dressing underneath the access restoration serves as a useful diagnostic aid for leakage into the tooth by sign‐posting the location and extent of staining (Gulabivala & Ng, 2014), whereas other alternatives (Sattar et al, 2017) are not as useful in this context. The use of inter‐appointment, antibacterial intra‐canal dressings, increased the frequency of negative cultures at the subsequent visit to an average of 71% (range 25%–100%) (weighted pooled average) of cases (Gulabivala & Ng, 2019a, 2019b).…”

Section: Outcomes Of Non‐surgical Root Canal Treatmentmentioning

confidence: 99%

“…New cost‐economic pressures posed a threat to the survival of the endodontic discipline again from the 1990s, this time through treatment planning decisions centering on the question of whether to “save the tooth” or “extract and replace” it with an apparently more predictable implant‐supported crown (Torabinejad & Goodacre, 2006). The science of evidence‐based practice belatedly averted ongoing irrational options‐appraisals leaning towards extraction of savable teeth (Doyle et al, 2006; Gulabivala & Ng, 2019b; Iqbal & Kim, 2006; Kim & Solomon, 2011; Pennington et al, 2009). Once again, the pendulum has swung firmly back in favour of maintaining restorable teeth through predictable endodontic management (Sadowsky, 2021).…”

Section: Introductionmentioning

confidence: 99%

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Factors that affect the outcomes of root canal treatment and retreatment—A reframing of the principles

Gulabivala

2023

Int Endodontic J

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This paper undertakes a broad and comprehensive synthesis of relevant clinical, biological, biomechanical, technical and healthcare services data to understand the factors affecting outcomes of periapical healing after root canal (re)treatment. The medical and dental evidence‐based era (1980–present) is contextualized with the earlier evidence drive in endodontics (1911–1940) triggered by the focal infection era. The current evidence‐based approach has a sharper focus on evidence quality and derivation of practice guidelines. Contrary views question whether guideline‐driven, or expertise‐development‐driven endeavours would best serve outcome improvement in society. The endodontic discipline functions in a broad healthcare framework and sustains industrial, economic and trend pressures that may be deemed to influence outcomes. The nature of root canal treatment and the challenges in determining the factors that affect its outcomes is discussed. The factors potentially affecting periapical healing after root canal treatment are classified into pre‐operative, intra‐operative and postoperative groups. These categories subsume multiple elements with interactive influences, creating a complex picture, further confounded by some apparently surprising, counter‐intuitive and contradictory findings. The technical versus biological conundrum in root canal treatment continues to cause cognitive dissonance. However, due reflection and cross‐discipline‐synthesis resolve the apparent data conflicts into a very simple, consistent and plausible picture of how root canal treatment works and the key factors that affect periapical healing. Root canal retreatment is considered mainly in the context of its differences from primary treatment as the majority of factors influencing outcomes are common to both. The exceptional difference is that retreatments have a proportionately reduced probability of healing by virtue of compromised apical root canal ramification access or modified host/infection interactions. Root canal (re)treatment outcomes are dominantly influenced by the nature of prior dynamic host/infection interaction (pre‐operative patient factors) and how the direction of this dynamic is influenced by two factors: (1) the active efficacy of the operators' root canal treatment protocol to sustain a microbial ecological shift (intra‐operative treatment factors) and dampen periapical inflammation; and (2) the passive ability of the functional tooth (and its restoration margin) to maintain its integrity to resist infection reversal (postoperative restorative factors).

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Section: Outcomes Of Non‐surgical Root Canal Treatmentmentioning

confidence: 99%

Section: Outcomes Of Non‐surgical Root Canal Treatmentmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Factors that affect the outcomes of root canal treatment and retreatment—A reframing of the principles

Gulabivala

2023

Int Endodontic J

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“…Before endodontic treatment is commenced, assessment of the remaining tooth structure is important to determine if the tooth can be adequately restored again (4). This procedure is called ‘tooth investigation’ (3).…”

Section: Introductionmentioning

confidence: 99%

Assessment of bacterial and dye penetration through post/crown interim restorations while under simulated masticatory load

Abbott

2021

Aust Endodontic J

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The aim was to compare two temporary cements to determine which resisted bacterial and dye penetration under temporary posts/cores/crowns subjected to simulated masticatory function. Forty-six single canal human tooth roots were prepared for posts/crowns. A cotton pellet and Cavit were placed in each post space. Temporary posts/cores/crowns were cemented with Intermediate Restorative Material (IRM) (n = 23) or Tempocem (n = 23). Specimens were sterilised, then immersed in a mixture of Streptococcus gordonii and India ink, and subjected to 4 weeks simulated mastication. Dye penetration was assessed by visually inspecting the cotton pellets. Bacterial penetration was determined by placing the pellets into sterile broth and by plating them onto agar plates to confirm S. gordonii growth. There was no statistically significant difference between the cements and the dependent variables of bacterial and dye penetration. Hence, both cements are good options to cement temporary posts/cores/crowns during endodontic treatment of anterior teeth.

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“…Endocrowns were described by Bindl & Mormann in 1999 11 as adhesive endodontic crowns for the restoration of root treated posterior teeth with complete loss of coronal hard tissue. Gulabivala & Ng, 2019 12 defined endocrowns as monolithic composite or ceramic endocrowns which incorporates a dowel extension into the pulp chamber for retention (refer Figure 1, Figure 2). Similarly, Fages & Bennasar in 2013 13 describes endocrown with a retention cavity into the pulp chamber without involving the root canals and a circular equi-gingival or supra-gingival butt margin in an attempt to preserve enamel for better retention and, which is then bonded using an adhesive technique.…”

Section: Introductionmentioning

confidence: 99%

Comparing endocrown restorations on permanent molars and premolars: a systematic review and meta-analysis

et al. 2020

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Objectives: The objective of this systematic review was to evaluate the success of endocrown restorations on molars in comparison with endocrown restorations on premolars.Registration number: The methodology for this review is registered with the Prospero database (CRD42019149543).Data sources: MEDLINE, EMBASE, Dentistry and Oral Sciences source and The Cochrane CENTRAL were searched through January 2020 supplemented with hand searching of additional relevant journals.Data selection and Data extraction: Two independent reviewers screened studies against predefined inclusion criteria and extracted data. Data analysis: Narrative analysis was carried out and random effects meta-analysis was performed where possible.Results: Out of the selected eight studies reported success rate of endocrown restoration in molars varied from 72.7% to 99.57% and in premolars ranged from 68.75% to 100% with a follow-up range of 3 to 19 years. The pooled odds ratio and 95% confidence intervals for failure rates in molars compared to premolars in four studies selected for meta-analysis were 1.096 (95% CI:0.280, 4.292).Conclusions: These findings showed similar success rates, and no difference in the rate of endocrown failures between molars and premolars, thus suggesting that premolars may be considered suitable candidates for endocrowns. However, the findings should be interpreted with caution due to methodological limitations of the included studies. Further better quality and specifically designed controlled trials directly comparing the clinical performance of endocrowns on molars and premolars are required.

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Value of root-filled teeth in maintaining a functional dentition for life

Cited by 6 publications

References 181 publications

Factors that affect the outcomes of root canal treatment and retreatment—A reframing of the principles

Factors that affect the outcomes of root canal treatment and retreatment—A reframing of the principles

Assessment of bacterial and dye penetration through post/crown interim restorations while under simulated masticatory load

Comparing endocrown restorations on permanent molars and premolars: a systematic review and meta-analysis

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