Restorative Dentistry and Endodontics

The Korean Academy of Conservative Dentistry (대한치과보존학회)
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Incidence of interappointment emergencies in multiple-visit root canal treatments performed with or without intracanal medicament by undergraduate students

  • Annemarie Baaij (Department of Endodontology, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam) ;
  • Corine Mirjam Visscher (Department of Orofacial Pain and Dysfunction, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam) ;
  • Manon Jansen (Department of Endodontology, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam) ;
  • Ahmet Rifat Ozok (Department of Endodontology, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam)
  • Received : 2023.03.06
  • Accepted : 2023.05.07
  • Published : 2023.08.31
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Abstract

Objectives: This retrospective cohort study examined the incidence of interappointment emergencies during multiple-visit molar root canal treatments conducted by undergraduate students. Treatments performed without the use of intracanal medicament were compared to treatments that incorporated calcium hydroxide as an intracanal medicament. Materials and Methods: Interappointment emergencies, defined as instances of pain or swelling that required the patient to make an unscheduled follow-up visit, were recorded for up to 2 months after the intervention. To avoid the influence of obturation on the observed incidence of emergency visits, only unscheduled visits occurring between the start and end of the root canal treatment were included. Results: Of the 719 patients included in this study, 77 (10.7%) were recorded as experiencing interappointment emergencies. Of these emergencies, 62% occurred within 2 weeks following the most recent intervention. In the group of patients who did not receive intracanal medicament, the incidence of interappointment emergencies was 11.9% (46 of 385 patients). In comparison, this rate was 9.3% (31 of 334 patients) among those who received calcium hydroxide as an intracanal medicament (odds ratio, 1.33; 95% confidence interval, 0.82-2.15; p = 0.249). Conclusions: Interappointment emergencies may arise at any point during root canal treatment, but they most commonly occur within the first 2 weeks following intervention. The omission of intracanal medicament in multiple-visit molar root canal treatments, performed by undergraduate students, did not significantly increase the incidence of these emergencies.

Keywords

Acknowledgement

We extend our gratitude to Ms H. H. Alferink for extracting the patient records from the axiUm dental software, Ms L. N. Ali for collecting data for this study, and Prof. M. Væth for his considerable assistance regarding the statistics and visualization aspects of this research.

References

  1. Alves VO. Endodontic flare-ups: a prospective study. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2010;110:e68-e72. https://doi.org/10.1016/j.tripleo.2010.05.014
  2. Azim AA, Azim KA, Abbott PV. Prevalence of inter-appointment endodontic flare-ups and host-related factors. Clin Oral Investig 2017;21:889-894. https://doi.org/10.1007/s00784-016-1839-7
  3. Duane B, Harford S, Ramasubbu D, Stancliffe R, Pasdeki-Clewer E, Lomax R, Steinbach I. Environmentally sustainable dentistry: a brief introduction to sustainable concepts within the dental practice. Br Dent J 2019;226:292-295. https://doi.org/10.1038/s41415-019-0010-7
  4. Walton RE. Interappointment flare-ups: incidence, related factors, prevention, and management. Endod Topics 2002;3:67-76. https://doi.org/10.1034/j.1601-1546.2002.30107.x
  5. Walton R, Fouad A. Endodontic interappointment flare-ups: a prospective study of incidence and related factors. J Endod 1992;18:172-177. https://doi.org/10.1016/S0099-2399(06)81413-5
  6. Bystrom A, Claesson R, Sundqvist G. The antibacterial effect of camphorated paramonochlorophenol, camphorated phenol and calcium hydroxide in the treatment of infected root canals. Endod Dent Traumatol 1985;1:170-175. https://doi.org/10.1111/j.1600-9657.1985.tb00652.x
  7. Vera J, Siqueira JF Jr, Ricucci D, Loghin S, Fernandez N, Flores B, Cruz AG. One- versus two-visit endodontic treatment of teeth with apical periodontitis: a histobacteriologic study. J Endod 2012;38:1040-1052. https://doi.org/10.1016/j.joen.2012.04.010
  8. Cvek M, Hollender L, Nord CE. Treatment of non-vital permanent incisors with calcium hydroxide. VI. A clinical, microbiological and radiological evaluation of treatment in one sitting of teeth with mature or immature root. Odontol Revy 1976;27:93-108. 
  9. Trope M, Delano EO, Orstavik D. Endodontic treatment of teeth with apical periodontitis: single vs. multivisit treatment. J Endod 1999;25:345-350. https://doi.org/10.1016/S0099-2399(06)81169-6
  10. Sathorn C, Parashos P, Messer HH. Effectiveness of single- versus multiple-visit endodontic treatment of teeth with apical periodontitis: a systematic review and meta-analysis. Int Endod J 2005;38:347-355. https://doi.org/10.1111/j.1365-2591.2005.00955.x
  11. Waltimo T, Trope M, Haapasalo M, Orstavik D. Clinical efficacy of treatment procedures in endodontic infection control and one year follow-up of periapical healing. J Endod 2005;31:863-866. https://doi.org/10.1097/01.don.0000164856.27920.85
  12. Siqueira JF Jr, Lopes HP. Mechanisms of antimicrobial activity of calcium hydroxide: a critical review. Int Endod J 1999;32:361-369. https://doi.org/10.1046/j.1365-2591.1999.00275.x
  13. Chavez de Paz LE, Bergenholtz G, Dahlen G, Svensater G. Response to alkaline stress by root canal bacteria in biofilms. Int Endod J 2007;40:344-355. https://doi.org/10.1111/j.1365-2591.2006.01226.x
  14. van der Waal SV, Connert T, Crielaard W, de Soet JJ. In mixed biofilms Enterococcus faecalis benefits from a calcium hydroxide challenge and culturing. Int Endod J 2016;49:865-873. https://doi.org/10.1111/iej.12542
  15. van der Waal SV, van der Sluis LW, Ozok AR, Exterkate RA, van Marle J, Wesselink PR, de Soet JJ. The effects of hyperosmosis or high pH on a dual-species biofilm of Enterococcus faecalis and Pseudomonas aeruginosa: an in vitro study. Int Endod J 2011;44:1110-1117. https://doi.org/10.1111/j.1365-2591.2011.01929.x
  16. Swedish Council on Health Technology Assessment. Methods of diagnosis and treatment in endodontics. Stockholm: Swedish Council on Health Technology Assessment (SBU); 2010. SBU Report No: 203. 
  17. Pabel AK, Hulsmann M. Comparison of different techniques for removal of calcium hydroxide from straight root canals: an in vitro study. Odontology 2017;105:453-459. https://doi.org/10.1007/s10266-017-0293-6
  18. Bottcher DE, Hirai VH, Da Silva Neto UX, Grecca FS. Effect of calcium hydroxide dressing on the long-term sealing ability of two different endodontic sealers: an in vitro study. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2010;110:386-389.  https://doi.org/10.1016/j.tripleo.2010.05.007
  19. Mohammadi Z, Dummer PM. Properties and applications of calcium hydroxide in endodontics and dental traumatology. Int Endod J 2011;44:697-730. https://doi.org/10.1111/j.1365-2591.2011.01886.x
  20. Ahlgren FKEK, Johannessen AC, Hellem S. Displaced calcium hydroxide paste causing inferior alveolar nerve paraesthesia: report of a case. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2003;96:734-737. https://doi.org/10.1016/j.tripleo.2003.08.018
  21. Sharma S, Hackett R, Webb R, Macpherson D, Wilson A. Severe tissue necrosis following intra-arterial injection of endodontic calcium hydroxide: a case series. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2008;105:666-669. https://doi.org/10.1016/j.tripleo.2007.11.026
  22. Tavares LG, Lima SMF, Lima MG, Arruda MP, Menegazzi TC, Rezende TMB. Undergraduate dentistry students' perception of difficulties regarding endodontic treatment. Aust Endod J 2019;45:98-105. https://doi.org/10.1111/aej.12290
  23. Krishnan U, Huang HJ, Moule A, Lalloo R. An assessment of endodontic treatment completion rate in a university-based student clinic and the factors associated with incomplete treatment. Aust Endod J 2019;45:305-310. https://doi.org/10.1111/aej.12317
  24. Walton RE, Holton IF Jr, Michelich R. Calcium hydroxide as an intracanal medication: effect on posttreatment pain. J Endod 2003;29:627-629. https://doi.org/10.1097/00004770-200310000-00003
  25. Genet JM, Hart AA, Wesselink PR, Thoden van Velzen SK. Preoperative and operative factors associated with pain after the first endodontic visit. Int Endod J 1987;20:53-64. https://doi.org/10.1111/j.1365-2591.1987.tb00590.x
  26. Al-Herz W, Bousfiha A, Casanova JL, Chatila T, Conley ME, Cunningham-Rundles C, Etzioni A, Franco JL, Gaspar HB, Holland SM, Klein C, Nonoyama S, Ochs HD, Oksenhendler E, Picard C, Puck JM, Sullivan K, Tang ML. Primary immunodeficiency diseases: an update on the classification from the international union of immunological societies expert committee for primary immunodeficiency. Front Immunol 2014;5:162.
  27. Iqbal M, Kurtz E, Kohli M. Incidence and factors related to flare-ups in a graduate endodontic programme. Int Endod J 2009;42:99-104. https://doi.org/10.1111/j.1365-2591.2008.01461.x
  28. Checkoway H, Pearce N, Kriebel D. Selecting appropriate study designs to address specific research questions in occupational epidemiology. Occup Environ Med 2007;64:633-638. https://doi.org/10.1136/oem.2006.029967
  29. Torabinejad M, Kettering JD, McGraw JC, Cummings RR, Dwyer TG, Tobias TS. Factors associated with endodontic interappointment emergencies of teeth with necrotic pulps. J Endod 1988;14:261-266. https://doi.org/10.1016/S0099-2399(88)80181-X
  30. American association of endodontists: AAE glossary of endodontic terms. Available from: https://www.aae.org/specialty/clinical-resources/glossary-endodontic-terms/ (updated March 2020; cited December 9, 2021).