- Email: [email protected]
Good results with endodontic therapy
each group had correct diagnoses. The highest sensitivity was in the S group (80%) and the highest specificity was in the G and A groups (88%). The VI method for all groups had a sensitivity of 70.8% and a specificity of 86.7%. Statistically significant differences were also noted for the G and A groups between DD results and histologic control diagnoses. With use of the DD method, the A group had the lowest rate of correct diagnoses (77.2%) and the highest sensitivity (66.7%). The G group had the lowest sensitivity (43.9%) and the highest specificity (94.2%). The DIAGNOdent device had a combined sensitivity of 58.1% and specificity of 89.2%. Discussion.—The variability among dentists in diagnosing caries and making treatment decisions was evident in the results obtained. Neither method reviewed proved superior in terms of their sensitivity and specificity in detecting fissure caries. VI carried a relatively high sensitivity and DD a high specificity.
Clinical Significance.—Is it a cavity or not? Comparing traditional examination methods with DIAGNOdent in 3 groups of examiners, traditional methods produced higher sensitivity over DIAGNOdent, results at odds with other studies. Clinical judgment remains essential.
Fung L, Smales R, Ngo H, et al: Diagnostic comparison of 3 groups of examiners using visual and laser fluorescence methods to detect occlusal caries in vitro. Aust Dent J 49:67-71, 2004 Reprints available from RJ Smales, 19A Wattle St, Fullarton, Adelaide, South Australia 5063; e-mail: [email protected]
Endodontics Good results with endodontic therapy Background.—Endodontic treatments are highly successful in preserving teeth. Whether the expertise of the person performing the care has an impact on the outcome was tested, comparing the results of endodontic treatment performed by general dentists with the outcomes obtained when it is performed by specialists. Methods.—Chart review was performed on cases handled by 3 private general practices in 3 areas of Alabama. The general dentists performed some endodontic treatment and referred other cases to endodontists. The definition of success included having the treated tooth present 5 years after the date treatment began. The 5-year survival rates for endodontists were compared with those for general practitioners. Results.—Of 350 cases, 195 were cared for by generalists and 155 were referred to specialists. The generalists had a success rate of 89.7%, whereas the endodontists had a rate of 98.1%, which was significantly better. Most molars were referred to endodontists, who treated 62% of second
106 Dental Abstracts
molars and 55% of first molars. Endodontists also treated half the premolars and one third of the anterior teeth. Only 13 root fillings were overfilled. Underfills exceeding 2 mm were documented in 94 cases. Fifty-eight percent of the teeth with periapical inflammation serious enough to double the periodontal ligament width were treated by generalists. Thirty-six percent of calcified canals and 35% of curves were also handled by generalists. Discussion.—Teeth receiving endodontic therapy had a high rate of survival regardless of who did the therapy. However, when an endodontist performed the endodontic care, the rate of survival was significantly better than when a generalist did so. A few limitations of the study were noted. First, the process leading to tooth loss was not considered in the chart review, so some teeth may not have been lost as a result of who performed the endodontic care. Second, it is difficult to extrapolate data from only 3 practices. Overall, though, it was clear that the long-term survival rate for the endodontically treated teeth was equal to or better than that achieved with implants.
Clinical Significance.—Continuing education courses, extolling the simplicity of endodontic treatment that uses various systems, abound. This study showed a large difference in success between general dentists and endodontists. In deciding whether to treat or to refer, providers need to consider their proficiency as well as their commitment to detail.
Alley BS, Kitchens GG, Alley LW, et al: A comparison of survival of teeth following endodontic treatment performed by general dentists or by a specialist. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 98:115-118, 2004 Reprints available from P Eleazer, School of Dentistry, SDB 417, Univ of Alabama at Birmingham, 1530 Third Ave, South Birmingham, AL 35294-0007; e-mail: [email protected]
Evidence-Based Dentistry Full cast crowns and direct composite restorations equally effective Background.—The loss of coronal tooth structure is the principal factor leading to decreased strength in endodontically treated teeth. Therefore, coronal restoration is essential to long-term success. A randomized controlled clinical study was undertaken to determine the clinical success rate of endodontically treated premolars, comparing those having full cast crowns to those with direct composite restorations. Methods.—The controlled trial covered a period of 3 years and involved 117 subjects. Patients were randomly assigned to (1) endodontic treatment and restoration with adhesive techniques and composite or (2) endodontic treatment and restoration with adhesive techniques and composite, but a final restoration with full-coverage metal-ceramic crowns. The focus was on whether teeth with limited loss of tooth structure that had endodontic treatment and core buildup with adhesive techniques, fiber posts, and composites have failure rates and failure modes equivalent to those of teeth restored similarly with full crown coverage. The causes of failure were outlined as root fracture, post fracture, post decementation, clinical and/or radiographic evidence of marginal gap between tooth and restoration, and clinical and/or radiographic evidence of secondary caries contiguous with restoration margins.
Results.—Thirty participants withdrew, most in the same group. However, no significant differences in outcome were found between the 2 groups. Discussion.—The degree of tooth structure present is an important consideration in planning the final restorations of endodontically treated teeth. Teeth with minimal loss of coronal structure restored by means of adhesion techniques had results comparable to those restored with full coverage with metal-ceramic crowns.
Clinical Significance.—Contrary to conventional wisdom, this study reports similar treatment outcomes when endodontically treated premolars were restored with either full case coverage or fiber posts and composite restorations.
Mannocci F, Bertelli E, Sherriff M, et al: Survival rates similar with full cast crowns and direct composite restorations: In patients with endodontically treated premolars are full cast crowns more effective than direct composite restorations? EBD 5:45, 2001 Reprints available from F Mannocci, Via Gemignani 3, 56015 Riglione, Pisa, Italy; e-mail: [email protected]
Volume 50 • Issue 2 • 2005 107
Clinical Significance.—Is it a cavity or not? Comparing traditional examination methods with DIAGNOdent in 3 groups of examiners, traditional methods produced higher sensitivity over DIAGNOdent, results at odds with other studies. Clinical judgment remains essential.
Fung L, Smales R, Ngo H, et al: Diagnostic comparison of 3 groups of examiners using visual and laser fluorescence methods to detect occlusal caries in vitro. Aust Dent J 49:67-71, 2004 Reprints available from RJ Smales, 19A Wattle St, Fullarton, Adelaide, South Australia 5063; e-mail: [email protected]
Endodontics Good results with endodontic therapy Background.—Endodontic treatments are highly successful in preserving teeth. Whether the expertise of the person performing the care has an impact on the outcome was tested, comparing the results of endodontic treatment performed by general dentists with the outcomes obtained when it is performed by specialists. Methods.—Chart review was performed on cases handled by 3 private general practices in 3 areas of Alabama. The general dentists performed some endodontic treatment and referred other cases to endodontists. The definition of success included having the treated tooth present 5 years after the date treatment began. The 5-year survival rates for endodontists were compared with those for general practitioners. Results.—Of 350 cases, 195 were cared for by generalists and 155 were referred to specialists. The generalists had a success rate of 89.7%, whereas the endodontists had a rate of 98.1%, which was significantly better. Most molars were referred to endodontists, who treated 62% of second
106 Dental Abstracts
molars and 55% of first molars. Endodontists also treated half the premolars and one third of the anterior teeth. Only 13 root fillings were overfilled. Underfills exceeding 2 mm were documented in 94 cases. Fifty-eight percent of the teeth with periapical inflammation serious enough to double the periodontal ligament width were treated by generalists. Thirty-six percent of calcified canals and 35% of curves were also handled by generalists. Discussion.—Teeth receiving endodontic therapy had a high rate of survival regardless of who did the therapy. However, when an endodontist performed the endodontic care, the rate of survival was significantly better than when a generalist did so. A few limitations of the study were noted. First, the process leading to tooth loss was not considered in the chart review, so some teeth may not have been lost as a result of who performed the endodontic care. Second, it is difficult to extrapolate data from only 3 practices. Overall, though, it was clear that the long-term survival rate for the endodontically treated teeth was equal to or better than that achieved with implants.
Clinical Significance.—Continuing education courses, extolling the simplicity of endodontic treatment that uses various systems, abound. This study showed a large difference in success between general dentists and endodontists. In deciding whether to treat or to refer, providers need to consider their proficiency as well as their commitment to detail.
Alley BS, Kitchens GG, Alley LW, et al: A comparison of survival of teeth following endodontic treatment performed by general dentists or by a specialist. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 98:115-118, 2004 Reprints available from P Eleazer, School of Dentistry, SDB 417, Univ of Alabama at Birmingham, 1530 Third Ave, South Birmingham, AL 35294-0007; e-mail: [email protected]
Evidence-Based Dentistry Full cast crowns and direct composite restorations equally effective Background.—The loss of coronal tooth structure is the principal factor leading to decreased strength in endodontically treated teeth. Therefore, coronal restoration is essential to long-term success. A randomized controlled clinical study was undertaken to determine the clinical success rate of endodontically treated premolars, comparing those having full cast crowns to those with direct composite restorations. Methods.—The controlled trial covered a period of 3 years and involved 117 subjects. Patients were randomly assigned to (1) endodontic treatment and restoration with adhesive techniques and composite or (2) endodontic treatment and restoration with adhesive techniques and composite, but a final restoration with full-coverage metal-ceramic crowns. The focus was on whether teeth with limited loss of tooth structure that had endodontic treatment and core buildup with adhesive techniques, fiber posts, and composites have failure rates and failure modes equivalent to those of teeth restored similarly with full crown coverage. The causes of failure were outlined as root fracture, post fracture, post decementation, clinical and/or radiographic evidence of marginal gap between tooth and restoration, and clinical and/or radiographic evidence of secondary caries contiguous with restoration margins.
Results.—Thirty participants withdrew, most in the same group. However, no significant differences in outcome were found between the 2 groups. Discussion.—The degree of tooth structure present is an important consideration in planning the final restorations of endodontically treated teeth. Teeth with minimal loss of coronal structure restored by means of adhesion techniques had results comparable to those restored with full coverage with metal-ceramic crowns.
Clinical Significance.—Contrary to conventional wisdom, this study reports similar treatment outcomes when endodontically treated premolars were restored with either full case coverage or fiber posts and composite restorations.
Mannocci F, Bertelli E, Sherriff M, et al: Survival rates similar with full cast crowns and direct composite restorations: In patients with endodontically treated premolars are full cast crowns more effective than direct composite restorations? EBD 5:45, 2001 Reprints available from F Mannocci, Via Gemignani 3, 56015 Riglione, Pisa, Italy; e-mail: [email protected]
Volume 50 • Issue 2 • 2005 107