Rapid Chairside Microbial Detection Predicts Endodontic Treatment Outcome

Abstract

<jats:p>Background. The aim of this longitudinal, one-year cohort study was to explore the hypothesis that fluorescence sampling of the root canal space prior to obturation could predict the outcome of root canal treatment (RCT). Methods. Sixty-five teeth underwent primary RCT and were followed up clinically and radiographically. The outcome was determined radiographically with periapical radiographs (PR) and cone beam computed tomography (CBCT) scans. Results. Success at 12 months was predictable based on the fluorescence score. When the fluorescence score (defined as the percentage of signal over total signal including background) was lower than 67, there was a 4.5 times (Odds ratio (OR) = 0.028; 95% confidence interval (CI): 0.003, 0.291, p = 0.001) greater chance of success (90% overall). When the readings were above this threshold, the success rate was 20%. Conclusion. A chairside sampling method is able to predict the outcome of RCT, through the use of paper point sampling and fluorescence staining. This has reduced the prevalence of persistent infections by guiding the optimum time for obturation. ClinicalTrials.gov trial NCT03660163.</jats:p>

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

“…This increased sensitivity can result in the detection of apical periodontitis in cases where radiographic examination suggests complete resolution (strict criteria of success) or reveal enlarged lesions in cases where the reduction of the size of radiographic radiolucency (loose criteria of success) is considered. Despite Wu et al's call in 2009 for increased outcome reporting using CBCT imaging, in this updated review, only 4 of the 42 included studies used CBCT imaging for follow-up evaluation (Knight et al, 2020;Restrepo-Restrepo et al, 2019;Verma et al, 2020;Zavattini et al, 2020). For consistency, when both radiographic and CBCT outcomes were reported, only the outcomes based on radiographic evaluation were included for analysis in this review.…”

“…For consistency, when both radiographic and CBCT outcomes were reported, only the outcomes based on radiographic evaluation were included for analysis in this review. Radiographic and CBCT outcomes were reported for 2 studies (Knight et al, 2020; Zavattini et al, 2020). For those studies, the success rates of CBCT analysis were lower than those reported after radiographic evaluation.…”

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

“…Regardless of the sampling technique, the use of a negative culture result to inform progress of treatment has a positive impact on treatment outcome. More recently, alternative bacterial tests, such as, fluorescent vital dye has been tested for use as a rapid chair-side root canal microbial detection method to predict periapical healing with promising results (Knight et al, 2020). The evidence shows the value of such a quality-control measure to return root canal treatment to a biological fold.…”

A critical analysis of research methods to study clinical molecular biomarkers in Endodontic research

“…Other simple and potentially useful biomarker assays have been proposed in the form of rapid fluorescence tests in conjunction with paper points (Herzog et al, 2017 ). Pre‐commercial set‐ups have been used to check whether a root canal system is sufficiently decontaminated to be filled (Knight et al, 2020 ).…”