JOE Review: December 2018-February 2019

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 have delved into an article from each of the past three months to provide synopses.

1. December 2018: Mahmoud Torabinejad, Arin Alexander, Seyed Aliakbar Vahdati, Anupama Grandhi, David Baylink, Shahrokh Shabahang. “Effect of Residual Dental Pulp Tissue on Regeneration of Dentin-pulp Complex: An In Vivo Investigation”

This in vivo study assessed three pulp revascularization protocols in a sample of young ferret cuspids. The seven teeth comprising the positive control group underwent complete extirpation of the dental pulp. In the two experimental groups, pulpal tissue was amputated either 1-2 mm or 2-4 mm short of the apex. MTA was placed at the level of the CEJ atop the blood clots that formed in each tooth. After histologic evaluation three months later, the authors concluded that complete removal of the pulpal contents consistently resulted in bone formation within the root canal. In contrast, the authors noted regeneration of normal neurovascular tissue and hard tissue bridges toward the MTA barrier in most of those teeth in which residual apical pulp tissue was maintained. The study concludes that regeneration of the pulp-dentin complex in immature teeth is possible with preservation of 1-4 mm of the apical pulp.

2. January 2019: Frank C. Setzer, Haochang Shou, Pacharee Kulwattanaporn, Meetu Kohli, Bekir Karabucak. “Outcome of Crown and Root Resection: A Systematic Review and Meta-analysis of the Literature”

Published in the first issue of the year, this systematic review and meta-analysis pooled outcomes studies for crown resection (CR) and root resection (RR) procedures. Here, CR was defined to include hemisection, trisection, and premolarization. Root resection was defined to include amputations and resections that spare the crown. The primary search inquiry focused on expected probability of survival among teeth in patients undergoing surgical therapy by either CR or RR. Only studies with at least 12 months of follow-up data were sought. Thirty-four articles were included in the final analysis from which 19 studies emerged for data extraction. The model deployed in this meta-analysis suggested a mean survival rate of 81.9% for CR, 87.2% for RR, and an overall rate of 81.9% for both procedures. However, no statistically significant difference was noted between CR and RR or between maxillary and mandibular molars. The authors conclude that CR and RR are viable procedures with good outcome rates.

3. February 2019: Seyed Aliakbar Vahdati, Mahmoud Torabinejad, Robert Handysides, Jamie Lozada. “A Retrospective Comparison of Outcome In Patients Who Received Both Nonsurgical Root Canal Treatment and Single-tooth Implants”

In this month’s issue, the authors of this study investigated the survival outcome of nonsurgical root canal therapy (NSRCT) and single-tooth implants (STIs) in patients who have received at least one of each treatment. Under the inclusion criteria of a minimum five-year recall for treatment, 170 patients were evaluated. Chief among the study’s conclusions is that NSRCT and STIs are both successful treatment modalities with a 95% survival rate and a mean 7.5-year follow-up. While pre- and post-operative factors did not appear to bear a significant effect on treatment outcomes, STIs required significantly higher numbers of adjunct treatments, appointments, and prescribed medications than did NSRCT. STIs also demanded more elapsed time before placement of the final restoration and general treatment costs.

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