2016

Question 1

***Bane - “Randomized clinical trial of intraosseous methylprednisolone injection for acute pulpitis pts”

Answer 1

Methylprednisolone injection for acute pulpitis is relieved by a minimally invasive pharmacologic approach more effective than pulpotomy and conserves resources.

Question 2

***Nunes, Ove Peters - “Evaluation of PA lesions and their association with maxillary sinus abnormalities on CBCT”

Answer 2

Maxillary posterior teeth w/ PA lesions had highest frequency of sinus abnormalities. Size of PA lesion not associated with w/ frequency. Close spatial relationship between PA lesions and sinuses related most frequently with sinus abnormalities.

Question 3

Paranjpe - “The effects of Endo Sequence Root Repair material on differentiation of dental pulp cells”

Answer 3

Similar survival and proliferation of dental pulps cells when in contact with ERRM or MTA which means it is suitable as an alternative pulp cap material.

Question 4

Korea - “Prognostic factors for clinical outcomes in autotransplantation of teeth with complete root formation: survival analysis up to 12 years”

Answer 4

Cumulative survival rate at 12 years was 68.2% after autotransplantation.

Question 5

***Ricucci, Siqueira - “Apically extruded sealers: fate and influence on the outcome”

Answer 5

Tx outcome not significantly affected by type of extruded sealer. Significantly better outcome observed for teeth w/ no lesion vs teeth w/ apical periodontitis. Removal of AH+ and Apexit less than other sealers. 79% AP healed vs 100% with no PA.

Question 6

***Brazil - “Micro-CT analysis of root canal morphology of P roots of maxillary first molars’

Answer 6

Oval 61% of the time. Later canals in 25%. 95% of the time the main foramen did not coincide with the root apex. 8% of canals classified as straight. 38% had apical constrictions. Minor dentin thickness at 1mm from foramen was 0.82mm.

Question 7

***China - “An analysis of proximity of maxillary posterior teeth to the maxillary sinus using CBCT”

Answer 7

Mean distances from root tips to border of maxillary sinus floor  increased with increasing age. Under 40yo greater likelihood of the apices being in the sinus.
1st PM 3.6-8.9mm
2nd PM 0.7-5.3mm
1st M MB -0.4-4.6mm
1st M DB -0.3-4.4mm
1st M P -0.4-3.9mm
2nd M MB -0.5-3.4mm
2nd M DB 0.3-3.9mm
2nd M P 1.1-4.6mm
Type in sinus:
1st PM 0-8.13% (v low)
2nd PM 0-25.68%
1st M 0-44.75%
2nd M 0-24.68%

Question 8

***Sebastian - “What is the effect of no endodontic debridement on post-op pain in symptomatic teeth with pulpal necrosis?”

Answer 8

Both groups had decrease in pain and medication use over 5 days. Debridement group had higher success rate than no debridement group. NSSD in groups in regards to breakthrough medication use.

Question 9

***Fowler - “Anesthetic success of IANB and supplemental articaine buccal infiltration for molars and premolars in pts with SIP”

Answer 9

IANB success 28% 1st molar, 25% 2nd molar, 39% premolars with NSSD between them. Supplemental articaine success 42% 1st molar, 48% 2nd molar, and 73% premolars. SSD between molars and premolars. NSSD between molars.

Question 10

France - “Comparative physiochemical analysis of pulp stone and dentin”

Answer 10

Pulpal cells produce unstructured apatitic mineralizations containing abnormally high Zn and Cu levels.

Question 11

***Turkey - “Does parachloroaniline really form after mixing NaOCl and chlorhexidine?”

Answer 11

Study is “cut-off proof” for argument of PCA formation from reaction of CHX and NaOCl. No free PCA was found.

Question 12

***Ricucci, Siqueira - “Complex apical intraradicular infection and extraradicular mineralized biofilms as the cause of wet canals and treatment failure”

Answer 12

Persistent infections showed extraradicular infections from apical areas showing biofilm formation.

Question 13

**Norway - “PA bone healing after apico w./ and w/out retrograde root filling w/ MTA 6 year follow up of randomized controlled trial”

Answer 13

Proportion of healed cases was higher for MTA at 1 and 6 years. 86% MTA and 55% GP at 6 years.

Question 14

***Korea - “Cracked teeth: Distribution, characteristics, and survival after RCT”

Answer 14

2 year survival rate RCT tx teeth approx. 90%. 2nd mandibular molars most common 25%. Most teeth with cracks - no restoration 34.3%, class I 32%. Probing >6mm significant prognostic factor. 74% vs <6mm 96.8%.

Question 15

**Williamson - “Comparison of mechanical and indirect ultrasonic placement technique on MTA aggregate retrofill density in simulated root end surgery”

Answer 15

Indirect ultrasonic placement of MTA retrofill produced fillings significantly more dense than manual condensation alone.

Question 16

**Aggarwal - “Comparative eval of mental incisal nerve block, IANB, and combo on the anesthetic success rate in symptomatic mandibular premolars”

Answer 16

53% MINB, 47% IANB w/ NSSD between them. Combo IANB and MINB significantly improved success rate to 82%.

Question 17

***Setzer - “Late effects if head and neck radiotherapy on pulp vitality assessed by pulse oximetry”

Answer 17

Temporary loss of vitality. Could be be 4-6 years. Short-term changes in micro circulation.

Question 18

**Friedman (Toronto) - “Retention and healing outcomes after intentional replantation”

Answer 18

Cumulative retention rate at 12 years 93% and 77% healed rate after 3 years. healing 1.7X more when replanted within 15 minutes.

Question 19

***McClanahan - “Mandibular canal location: CBCT examination”

Answer 19

Respective locations of mandibular canal (Buccal, Inferior, Lingual): 2nd molar 57%B, 40%I, 3%L. 1st molar 18%B, 55%I, 27%L. 2nd PM 33%B, 55%I, 11%L. Buccal bone thickness greatest at M roots of 2nd molar, thinnest over 2 PMs. Anterior loop present in about 10% of pts. Average depth below bone 13.4mm, more on L than R, and bilateral 50% of the time.

Question 20

***Kim - “The influence of an isthmus on outcomes of surgically treated molars”

Answer 20

72/106 had isthmus (68%) 34/106 no isthmus (32%). Isthmus survival 61% at 4 years. No isthmus survival 87.4% at 4 years. Isthmus = 6.01X higher failure rate compared to no isthmus.

Question 21

***Tsesis - “Comparison of CBCT vs PA in detection of separated instruments retained in the apical third of root canal-filled teeth”

Answer 21

PA performed better than CBCT for detection of retained separated instrument in apical third. PA sensitivity 71.25%, specificity 93.75%. CBCT sensitivity 71.3%, specificity 41.25%.

Question 22

***India - “Diagnosis of vertical root fracture in restored endodontically treated teeth: a time-dependent retrospective cohort study”

Answer 22

Mandibular molars 34%, maxillary premolars 22.8%, most frequently affected teeth. Post op time to diagnosis of VRF was 4.35 years. Posterior teeth, females, >40 yo more likely to have a VRF within 5 years.

Question 23

***Siqueira - “Bacteremia after endodontic procedures in pts with heart disease: culture and molecular analyses”

Answer 23

No detectable bacteremia evident by culture after tx of infected root canals. No difference noted between prophylaxis and no prophylaxis in molecular analysis of bacterial DNA and streptococcus.

Question 24

***Taschieri - “Does the papilla preservation flap technique induce soft tissue modifications over time in endodontic surgery procedures?”

Answer 24

About 0.1mm difference with NSSD b/w papilla base vs intrasulcular incision.

Question 25

***Johnson, Paranjpe - “Disinfection efficacy of current regenerative endodontic protocols in simulated necrotic immature permanent teeth”

Answer 25

Current recommended CaOH and TAP/DAP concentrations not capable of completely eliminating bacteria from simulated necrotic immature permanent teeth. Balance between stem cell toxicity and bacterial elimination needs to be re-evaluated.

Question 26

***Glenn - “Does liposomal bupivicaine (Exparel) significantly reduce postoperative pain/numbness in symptomatic teeth with a diagnosis of necrosis?”

Answer 26

Liposomal bupivicaine did not significantly increase post-op success in pts with symptomatic necrotic teeth compared to 4.0mL infiltration with regular bupivicaine, although there was a small decrease in pain and use of escape meds vs regular bupiviaine.

Question 27

**Italy - “Influences of 432 Hz music on the perception of anxiety during endodontic treatment”

Answer 27

Effective at reducing vital values and subjective perception of anxiety during endodontic therapy.

Question 28

***Fouad - “Association between systemic diseases and apical periodontitis”

Answer 28

Moderate risk of correlation between some systemic diseases and apical periodontitis.

Question 29

***Webster - “How effective is supplemental intraseptal anesthesia in patients with SIP?”

Answer 29

Intraseptal injection was successful in 29% of pts when the IANB failed. Still not enough success and would require additional supplemental.

Question 30

***Abbott - “the effect of maxillary first molar root length on the success rate of buccal infiltration anesthesia”

Answer 30

Maxillary first molar with irreversible pulpitis with longer roots may have more anesthetic failures after single buccal infiltration injection with 2% lidocaine 1:80k epi.

Question 31

**Tawil - “Periapical microsurgery: Can ultrasonic root end preparation clinically create or propagate dentinal defects?”

Answer 31

Ultrasonic root-end preps are safe. Pre-existing defects can be propagated by ultrasonic root end prep but no effect on prognosis.

Question 32

**Brazil - “Association between odontogenic conditions and maxillary sinus disease: A study using CBCT”

Answer 32

Generalized mucosal thickening 65.2% (most common), localized mucosal thickening 24.8%, maxillary sinusitis 6.4%, retention cysts 3.6%. Localized mucosal thickening was associated with PA lesions (3.09 odds ratio) and close relationship of teeth and the sinus floor (2.77 odds ratio).

Question 33

Spain - “Hemostatic agents in PA surgery: A randomized study of gauze impregnated in epinephrine vs aluminum chloride”

Answer 33

24/48 epi, 37/51 AlCl. AlCl is better than epi impregnated gauze.

Question 34

Montagnese - “8 year retrospective study of the critical time lapse between root canal completion and crown placement: Its influence on the survival of endodontically treated teeth”

Answer 34

Teeth that received crown >4 months after RCT are 3X more likely to be extracted than teeth crowned <4 months after RCT.

Question 35

Tawil - “Periapical microsurgery: the effects of locally injected dexamethasone on pain, swelling, bruising, and wound healing”

Answer 35

Minimal impact noted for dexamethasone (only reported less swelling at 24 hours) for anything over the 7 day period.

Question 36

*Diogenes - “Influence of age and apical diameter on the success of endodontic regeneration procedures”

Answer 36

Can be done in pts 9-18, but younger were better. >1mm apical diameter showed greater increase in root length etc. Still successful even on 0.5mm apical diameter.

Question 37

**Bultema - “Pain reduction in intreated symptomatic irreversible pulpitis using liposomal bupivicaine (Exparel)”

Answer 37

Gave soft tissue numbness for 1-3 days, but did not relieve pain to manageable levels in untreated pts with SIP.