Radiographic and Clinical Findings of Single-Visit Root Canal Treatments with Apical Enlargement in Necrotic Teeth: A Retrospective Cohort Study

Abstract

This study evaluated the long-term clinical outcomes of single-visit root canal treatments with apical enlargement on patients with necrotic pulp tissue retrospectively. A total of 137 teeth with necrotic pulp tissue which underwent single-visit root canal treatments were included. The root canals were shaped up until the apical constriction, which was determined by an apex locator. The outcomes were evaluated by two independent and calibrated endodontists clinically and radiographically. Teeth were dichotomized into healed ( PAI ≤ 2 , no signs or symptoms) and nonhealed ( PAI > 2 , with/without signs or symptoms) groups. Each patients’ preoperative PAI and lesion size were recorded to evaluate the preoperative periapical status as well as several other prognostic factors. Statistical analyses were performed ( p = 0.05 ) on ninety teeth. The mean observation time was 60 months. Out of ninety teeth, 87 (96.7%) were healed and 3 (3.3%) were nonhealed. No correlations were found between the prognostic factors and the outcomes ( p > 0.05 ). Cohen’s kappa and Gwet’s agreement coefficient scores between the preoperative PAI scores and preoperative lesion sizes showed good agreements, with values of 0.834 and 0.898, respectively. Apical enlargement is a viable treatment option for single-visit root canal treatments.

Intentional foraminal enlargement: a systematic review with bibliometric analysis

“…IFE instrumentation attempts to reduce microbial levels to those more favorable to wound healing and periapical repair, with previous studies reporting satisfactory outcomes with this treatment modality [16,17]. However, our findings showed a lack of consensus among the included studies with regard to the ideal IFE working length in order to achieve the best risk-benefit balance.…”

“…The 10 RCTs included in this study focused mainly on post-operative pain outcomes, leaving a persistent gap in scientific knowledge regarding the long-term success rates of this approach. The few observational studies exploring this only [16,17] The key limitation of this study was the difficulty associated with retrieving articles that were not available on the searched databases. The corresponding authors of 6 studies were contacted via e-mail, of which only 4 responded and provided us with the relevant articles.…”

“…The Journal of Endodontics had the maximum number of publications (n = 14) in this field [14,[32][33][34][35][36][37][38][39][40][41][42][43][44], followed by the International Endodontic Journal with 9 published studies [45][46][47][48][49][50][51]. Those two journals also had the highest impact factors in the field of endodontics The remaining 17 studies [16,[60][61][62][63][64][65][66][67][68][69][70][71][72][73][74][75] were published in 14 different journals that did not appear on any of the internationally relevant bibliographic lists or JCRs (Table III). Of the 55 studies included in this analysis, 36 were laboratory-based; 10 were randomized controlled trials (RCTs) with LoE = 2; 1 was a systematic review of RCTs (LoE = 1); 1 was a systematic review and meta-analysis of in vitro studies; 2 were cohort studies (LoE = 2); 2 were case-control studies (LoE = 3); and 3 were narrative literature reviews (LoE = 5).…”

“…Although some studies recommend a pre-determined working length that is 1.0 mm short of the apical foramen, others suggest one that extends up to or beyond the apical foramen itself in order to achieve improved debridement and disinfection of the apical portion of the root canal. This approach can also lead to more favorable outcomes [14][15][16], with previous studies reporting periapical healing rates of 96% [16,17]. In contrast, studies examining conventional instrumentation techniques (working length: 1.0 mm short of the apical foramen) reported a well-established success rate of 90-94% [16].…”

“…This approach can also lead to more favorable outcomes [14][15][16], with previous studies reporting periapical healing rates of 96% [16,17]. In contrast, studies examining conventional instrumentation techniques (working length: 1.0 mm short of the apical foramen) reported a well-established success rate of 90-94% [16]. The authors explained this outcome by means of a classic study [15] which showed that the connective tissues of the periodontal ligament could proliferate and invaginate into the interior of the root canal in case of apical overinstrumentation, suggesting disinfection of the cementum canal and apical foramen.…”