- Email: [email protected]
Survival of root-filled teeth
The checklist analysis revealed large differences in the symptomatology of the two conditions with respect to pain duration, pain on cold, and the sensation that the tooth was too high. Based on these findings a decision tree was constructed with splits according to pain on cold, awareness of the tooth as too high, and pain duration. SAP was associated with an absence of pain on cold stimulation. SAP was correctly identified in 72% of the teeth that felt too high and had hurt for less than 1 week. The sensitivity of the tree was 95% and its specificity 31%. Positive predictive value was 67%. Discussion.—SAP is a more critical condition than SIP and should definitely be identified as early as possible. It can be differentiated from SIP by its lack of pain when exposed to cold stimuli, by a sense that the tooth is too high, and by a duration of pain of less than 1 week.
Clinical Significance.—SAP can be diagnosed in accordance with the decision tree beginning with its absence of pain on cold stimulation in a severely painful tooth. Since SAP is a much more serious condition than SIP, being able to narrow down the diagnosis quickly is important.
Rechenberg D-K, Held U, Burgstaller JM, et al: Pain levels and typical symptoms of acute endodontic infections: A prospective observational study. BMC Oral Health 16:61, 2016 Reprints available from D Rechenberg, Dept of Preventive Dentistry, Periodontology and Cariology, Ctr of Dental Medicine, Univ of Z€ urich, Switzerland, Plattenstrasse 11, CH-8032 Z€ urich, Switzerland; e-mail: [email protected]
Survival of root-filled teeth Background.—In the 1970s the Swedish National Dental Insurance Scheme covered all dental treatment without limitation. However, for patients requiring highcost treatment, treatment plans had to be submitted to local health insurance offices for approval. A sample of root-filled teeth in a Swedish population requiring highcost dental care was selected for follow-up after 20 years to evaluate the survival and periapical status of the teeth and identify factors that affected survival and normal periapical status at follow-up. Methods.—The 104 study participants came from four local health insurance districts and had submitted treatment plans, including radiographs, for approval of high-cost dental treatment in 1977. In 1998 a clinical and radiographic follow-up evaluation was done, noting the status of 449 teeth that had been identified as root filled at baseline. Measurements included tooth survival and periapical status. Variables that were considered included tooth type, type of restoration, type of post used, quality of root filling, baseline periapical status, marginal bone loss, and caries status. Results.—No significant differences in age- or genderrelated factors were noted between the 104 patients who had follow-up clinical examination, the 73 patients who were interviewed by telephone only, and the 85 patients who could not be contacted, among whom were 30 patients who had died. At baseline the patients had ranged
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Dental Abstracts
in age from 21 to 70 years, making the age range 41 to 90 years at follow-up. Mean numbers of remaining teeth were 21.1 at baseline and 16.8 at follow-up. Mean numbers of endodontically treated teeth were 4.5 at baseline and 4.6 at follow-up. Mean numbers of teeth that had been root filled and nonroot filled were 1.7 at baseline and 1.6 at follow-up. Ninety-six percent and 98% of the patients had one or more endodontically treated teeth at baseline and follow-up, respectively. At baseline the 471 endodontically treated teeth included 12 teeth that had pulpotomy, 5 that had apical surgery and retrofilling, and 5 teeth with complications; these were excluded, leaving a root-filled group of 449 teeth available for the study. Two hundred ninety of the 449 root-filled teeth remained at follow-up, with 11% having been retreated, 35% extracted, and 52% having no further endodontic intervention. Significantly more teeth with completely filled root canals and with normal periapical status at baseline had survived. Significant negative relationships were noted between tooth survival and tooth type, caries, marginal bone loss, type of restoration, and type of post used; these factors were therefore significantly related to tooth extraction. Further analysis indicated mandibular molar, maxillary premolar, prefabricated posts other than screw posts, marginal bone loss of a third of the root length or greater, caries, and apical periodontitis (AP)
demonstrated significant associations with and had low odds ratio for tooth survival. The odds for survival were three times higher for root-filled teeth restored with amalgam than for those with laboratory-fabricated crowns, either cast or porcelain.
Nearly half of the AP-affected teeth had not been treated at baseline but more than half of these persisted after 20 years.
Of the 268 root-filled teeth available for analysis, normal periapical status was noted in 221 at follow-up, with a significantly greater frequency of normal status for those with normal status at baseline than for those with AP at baseline. Of the 143 root-filled teeth with AP at baseline, 60 (42%) were not treated for AP. Of these 60 teeth, 41% had healed AP and 58% had persistent AP. Factors shown to correlate with normal periapical status at follow-up included several with a negative relationship— tooth type, periapical status, marginal bone loss, quality of root filling, caries, and type of post used. These were significantly associated with AP. Further analysis indicated that significant negative associations were noted between normal periapical status at follow-up and baseline factors of mandibular molar, maxillary premolar, marginal bone loss at or exceeding a third of the root length, and inadequate root filling quality.
Clinical Significance.—Tooth type, AP status, and severe marginal loss were important factors to be considered when calculating tooth survival and normal periapical status after longterm follow-up. Many of the teeth with AP were left untreated at the initial treatment, and more than half of them were present after 20 years. These outcomes are important in determining the significant considerations for clinicians faced with teeth that require root filling.
Discussion.—Survival for the root-filled teeth after 20 years was 65%. A third of the remaining teeth had sound periapical condition without further treatment.
Petersson K, Fransson H, Wolf E, et al: Twenty-year follow-up of root filled teeth in a Swedish population receiving high-cost dental care. Int Endod J 49:636-645, 2016 Reprints available from K Petersson, Dept of Endodontics, Faculty of € Univ, SE-205 06 Malmo €, Sweden; e-mail: Odontology, Malmo [email protected]
Esthetics Maxillary incisor shape esthetics Background.—In a smile, the dominant teeth shown are the maxillary incisors. The shape of these anterior teeth influences smile esthetics, as does crown shape. As patients become more aware of their dental appearance, they are demanding an esthetic appearance in addition to better function and absence of disease. The morphology of the maxillary anterior teeth is the product of ovoid, square, and triangular shapes, with variations being squaretapering, ovoid tapering, reverse-tapering, ovoid-square, ovoid-reverse-tapering, and square-reverse-tapering. The teeth shapes are classified into these basic forms based on the facial outline of the crowns and their mesio-distal and gingivo-incisal contours. The influence of the maxillary incisor shape of an individual on perceived smile esthetics was investigated. Methods.—A photograph of a female smile displaying just her maxillary teeth was digitally altered to produce different incisor shapes: square (S), ovoid (O), triangular
(T), tapered-ovoid (TO), and square-tapering (ST). A group consisting of 30 dentists, 30 technicians, and 30 patients was asked to rank the images from the most attractive to the least attractive. Results.—Fifty percent of the participants ranked the TO image as the most attractive (Fig 4) and 36.7% rated the O image as most attractive (Fig 10). The least attractive
Fig 4.—Image for tapered ovoid incisors (TO). (Courtesy of Hussain A, Louca C, Leung A, et al: The influence of varying maxillary incisor shape on perceived smile aesthetics. J Dent 50:12-20, 2016.)
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Clinical Significance.—SAP can be diagnosed in accordance with the decision tree beginning with its absence of pain on cold stimulation in a severely painful tooth. Since SAP is a much more serious condition than SIP, being able to narrow down the diagnosis quickly is important.
Rechenberg D-K, Held U, Burgstaller JM, et al: Pain levels and typical symptoms of acute endodontic infections: A prospective observational study. BMC Oral Health 16:61, 2016 Reprints available from D Rechenberg, Dept of Preventive Dentistry, Periodontology and Cariology, Ctr of Dental Medicine, Univ of Z€ urich, Switzerland, Plattenstrasse 11, CH-8032 Z€ urich, Switzerland; e-mail: [email protected]
Survival of root-filled teeth Background.—In the 1970s the Swedish National Dental Insurance Scheme covered all dental treatment without limitation. However, for patients requiring highcost treatment, treatment plans had to be submitted to local health insurance offices for approval. A sample of root-filled teeth in a Swedish population requiring highcost dental care was selected for follow-up after 20 years to evaluate the survival and periapical status of the teeth and identify factors that affected survival and normal periapical status at follow-up. Methods.—The 104 study participants came from four local health insurance districts and had submitted treatment plans, including radiographs, for approval of high-cost dental treatment in 1977. In 1998 a clinical and radiographic follow-up evaluation was done, noting the status of 449 teeth that had been identified as root filled at baseline. Measurements included tooth survival and periapical status. Variables that were considered included tooth type, type of restoration, type of post used, quality of root filling, baseline periapical status, marginal bone loss, and caries status. Results.—No significant differences in age- or genderrelated factors were noted between the 104 patients who had follow-up clinical examination, the 73 patients who were interviewed by telephone only, and the 85 patients who could not be contacted, among whom were 30 patients who had died. At baseline the patients had ranged
50
Dental Abstracts
in age from 21 to 70 years, making the age range 41 to 90 years at follow-up. Mean numbers of remaining teeth were 21.1 at baseline and 16.8 at follow-up. Mean numbers of endodontically treated teeth were 4.5 at baseline and 4.6 at follow-up. Mean numbers of teeth that had been root filled and nonroot filled were 1.7 at baseline and 1.6 at follow-up. Ninety-six percent and 98% of the patients had one or more endodontically treated teeth at baseline and follow-up, respectively. At baseline the 471 endodontically treated teeth included 12 teeth that had pulpotomy, 5 that had apical surgery and retrofilling, and 5 teeth with complications; these were excluded, leaving a root-filled group of 449 teeth available for the study. Two hundred ninety of the 449 root-filled teeth remained at follow-up, with 11% having been retreated, 35% extracted, and 52% having no further endodontic intervention. Significantly more teeth with completely filled root canals and with normal periapical status at baseline had survived. Significant negative relationships were noted between tooth survival and tooth type, caries, marginal bone loss, type of restoration, and type of post used; these factors were therefore significantly related to tooth extraction. Further analysis indicated mandibular molar, maxillary premolar, prefabricated posts other than screw posts, marginal bone loss of a third of the root length or greater, caries, and apical periodontitis (AP)
demonstrated significant associations with and had low odds ratio for tooth survival. The odds for survival were three times higher for root-filled teeth restored with amalgam than for those with laboratory-fabricated crowns, either cast or porcelain.
Nearly half of the AP-affected teeth had not been treated at baseline but more than half of these persisted after 20 years.
Of the 268 root-filled teeth available for analysis, normal periapical status was noted in 221 at follow-up, with a significantly greater frequency of normal status for those with normal status at baseline than for those with AP at baseline. Of the 143 root-filled teeth with AP at baseline, 60 (42%) were not treated for AP. Of these 60 teeth, 41% had healed AP and 58% had persistent AP. Factors shown to correlate with normal periapical status at follow-up included several with a negative relationship— tooth type, periapical status, marginal bone loss, quality of root filling, caries, and type of post used. These were significantly associated with AP. Further analysis indicated that significant negative associations were noted between normal periapical status at follow-up and baseline factors of mandibular molar, maxillary premolar, marginal bone loss at or exceeding a third of the root length, and inadequate root filling quality.
Clinical Significance.—Tooth type, AP status, and severe marginal loss were important factors to be considered when calculating tooth survival and normal periapical status after longterm follow-up. Many of the teeth with AP were left untreated at the initial treatment, and more than half of them were present after 20 years. These outcomes are important in determining the significant considerations for clinicians faced with teeth that require root filling.
Discussion.—Survival for the root-filled teeth after 20 years was 65%. A third of the remaining teeth had sound periapical condition without further treatment.
Petersson K, Fransson H, Wolf E, et al: Twenty-year follow-up of root filled teeth in a Swedish population receiving high-cost dental care. Int Endod J 49:636-645, 2016 Reprints available from K Petersson, Dept of Endodontics, Faculty of € Univ, SE-205 06 Malmo €, Sweden; e-mail: Odontology, Malmo [email protected]
Esthetics Maxillary incisor shape esthetics Background.—In a smile, the dominant teeth shown are the maxillary incisors. The shape of these anterior teeth influences smile esthetics, as does crown shape. As patients become more aware of their dental appearance, they are demanding an esthetic appearance in addition to better function and absence of disease. The morphology of the maxillary anterior teeth is the product of ovoid, square, and triangular shapes, with variations being squaretapering, ovoid tapering, reverse-tapering, ovoid-square, ovoid-reverse-tapering, and square-reverse-tapering. The teeth shapes are classified into these basic forms based on the facial outline of the crowns and their mesio-distal and gingivo-incisal contours. The influence of the maxillary incisor shape of an individual on perceived smile esthetics was investigated. Methods.—A photograph of a female smile displaying just her maxillary teeth was digitally altered to produce different incisor shapes: square (S), ovoid (O), triangular
(T), tapered-ovoid (TO), and square-tapering (ST). A group consisting of 30 dentists, 30 technicians, and 30 patients was asked to rank the images from the most attractive to the least attractive. Results.—Fifty percent of the participants ranked the TO image as the most attractive (Fig 4) and 36.7% rated the O image as most attractive (Fig 10). The least attractive
Fig 4.—Image for tapered ovoid incisors (TO). (Courtesy of Hussain A, Louca C, Leung A, et al: The influence of varying maxillary incisor shape on perceived smile aesthetics. J Dent 50:12-20, 2016.)
Volume 62
Issue 1
2017
51