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By Dr. Eshwar Arasu

The Journal of Endodontics is an invaluable resource for both contemporary and historical research in endodontics. In this issue of The Paper Point, I selected an article from each of the past three months to provide synopses.

  1. September 2019: Poorya Jalali, Mehrnaz Tehmasbi, Robert A. Augsburger, N. Karang Khalilkhani, Kian Daghighi. “Dynamics of Bone Loss in Cases with Acute or Chronic Apical Abscess

This study assessed forty-eight limited field of view CBCT scans of cases with either acute apical (AAA) or chronic apical abscesses (CAA). The CBCT studies—taken pre-operatively between 2016 and 2018—were culled from an endodontic private practice database and evaluated under standardized conditions by an endodontist and an oral and maxillofacial radiologist. The variables compared between the types of abscesses included volume/pattern of the periradicular lesions and presence/location of fenestration through bony cortices. The authors concluded that all of the sampled CAA cases demonstrated cortical fenestration compared to 47% of AAA cases—a statistically significant difference. The CAA cases tended to exhibit larger cortical disruptions and median lesion volumes (233 mm3) relative to those of AAA cases (109 mm3). Despite intact cortical bone in cases of AAA, the authors posit that inflammation may still be transmitted through blood vessels and lymphatics resulting in swelling and fascial space involvement.

  1. October 2019: Venkateshbabu Nagendrababu, Hany Mohamed Aly Ahmed, Shaju Jacob Pulikkotil, Sajesh K. Veettil, M Phram, Lalli Dharmarajan, Frank C. Setzer. “Anesthetic Efficacy of Gow-Gates, Vazirani-Akinosi, and Mental Incisive Nerve Blocks for Treatment of Symptomatic Irreversible Pulpitis: A Systematic Review and Meta-analysis with Trial Sequential Analysis

In this systematic review and meta-analysis, five randomized clinical trials were included to compare the anesthetic success rates of GG, VA, and MI nerve blocks with inferior alveolar nerve blocks (IANB) in mandibular premolars and molars diagnosed with irreversible pulpitis. Anesthetic technique efficacy was assessed via access cavity preparation and/or instrumentation rather than pre-treatment testing, which was deemed unreliable in 42% of patients who experienced intra-operative pain despite negative pre-treatment responses. The authors conclude that GG, VA, and MI nerve blocks may be suitable techniques as alternatives to an IANB for these mandibular teeth with pulpitis. Anesthetic type and volume were analyzed and shown not to be significant confounders when comparing a GG nerve block with an IANB. The authors conclude that supplemental anesthesia in combination with nerve blocks is likely to lead to higher anesthetic success rates among teeth with irreversible pulpitis.

  1. November 2019: Thomas von Arx, Simone F.M. Janner, Stefan Hanni, Michael M. Bornstein. “Radiographic Assessment of Bone Healing Using Cone-beam Computed Tomographic Scans 1 and 5 Years after Apical Surgery

The authors of this prospective clinical study evaluated radiographic healing one and five years after apical surgery, using post-treatment CBCT scans. Three independent observers were calibrated to assess post-surgical CBCT images and categorize periapical healing as “full, partially, or not healed” with respect to the resection plane, cortical plate, apical area, and overall bone healing. CBCT images of 41 teeth from as many patients comprised the study sample. The authors concluded that higher rates of fully healed cases were noted for all parameters at the five year time point relative to those at one year post-surgically. The authors also note that periapical healing tends to be incomplete after just one year post-surgically and that re-establishment of the cortical bony plate exhibited the greatest lag time.

Eshwar Arasu, D.M.D., M.S.D., is AAE’s Resident and New Practitioner Committee chair.