To Örebro University

BACKGROUND: An overwhelming majority of root-filled teeth are asymptomatic, despite commonly exhibiting radiological signs of apical periodontitis (AP). When symptoms prevail, several sources are conceivable. This case-control study investigates underlying causes of pain from root-filled teeth.

OBJECTIVES: The aims were to (i) compare painful root-filled teeth with root-filled teeth without pain matched on sex, age, jaw and tooth type, and (ii) explore patient- and tooth-related factors that may explain the pain.

METHODS: Adult participants (≥ 20 years) with root-filled teeth were investigated through anamnestic, clinical and radiographic examinations. Analyses compared painful to pain-free teeth statistically, and possible origins of pain were indicated. Clinical data and periapical radiographs were used to identify the presence of AP.

RESULTS: Tenderness to percussion and apical palpation, probing depth ≥ 6 mm, swelling and apical radiolucency (p = 0.002-0.040) were more common with painful teeth, while density and length of root filling, unfilled canals, fracture of root and positive screening for TMD (3Q/TMD) did not differ between groups (p = 0.074-0.63). Among the 55 symptomatic teeth, AP was identified in 48 with varying diagnostic certainty. Indication of temporomandibular disorder (TMD) was present in 15 teeth, and marginal periodontitis (MP) in eight teeth. For six teeth, none of the three conditions could be identified.

CONCLUSIONS: Tenderness to percussion and apical palpation, swelling, pocket depth ≥ 6 mm, and apical radiolucency were more common with painful teeth. The pain was most frequently associated with AP, but pain due to TMD and MP may occur. For 10% of the root-filled teeth, no findings could explain the symptoms.

To compare pain characteristics, impact of pain and characteristics of patients with painful root-filled teeth with and without signs of inflammatory dental disease. This cross-sectional study was performed in the Public Dental Health services, Region orebro County, Sweden. Adult patients with >= 1 root-filled tooth identified at their regular check -up were included and assigned to one of two groups; those with >= 1 sign of inflammatory dental disease (DD+) and those without any such sign (DD-). Patients/teeth were compared regarding pain characteristics (intensity, frequency, duration, quality and provoking factors), impact of pain (medication intake, impact on life) and patient characteristics as background factors (general health, other bodily and orofacial pain). Statistics included descriptive data (frequency tables) and group comparisons (Chi-square, Fisher's Exact and Mann-Whitney U-tests). The DD+ group included 27 participants (30 teeth) and the DD- group 22 participants (23 teeth). On average, pain intensity was mild, the frequency most often recurrent, and the impact was low. Average pain duration since onset exceeded 2 years in both groups. The only observed between-group differences were average pain intensity; 3.1 (0-10 Numerical Rating Scale (NRS)) in DD- group compared to 1.6 for DD+ (p = 0.030), and tenderness to apical palpation; only reported in the DD+ group. The similarities in clinical presentation between the two groups underscore the difficulties in correctly distinguishing between pain of odontogenic and non-odontogenic origin in root-filled teeth with a standard clinical investigation. Additional diagnostic methods need to be investigated for their ability to differentiate between tooth pain or discomfort of different origins.

BACKGROUND: In conjunction with post placement in root-filled teeth with periapical healthy conditions, root canal retreatment may be performed to improve the seal of the root canal. Whether root canal retreatment for technical reasons (retreatments in teeth without apical periodontitis (AP)) results in lower frequency of AP is unknown.

OBJECTIVE: To examine whether there is a difference in frequency of AP between roots with root canals retreated for technical reasons, and roots with root canals not retreated before post placement, with a minimum follow-up of 5 years. Also, to examine changes in root filling quality following root canal retreatment for technical reasons.

METHODS: This retrospective study included radiographs of 441 root-filled roots without periapical radiolucencies at baseline, scheduled for post and core treatment. Follow-up data for a minimum of 5 years were available for 305 roots (loss to follow-up 30.8%), 46 of which were retreated for technical reasons. Two calibrated observers assessed root filling sealing quality and length, respectively, and periapical status according to the Periapical Index. The main outcome of the study, AP, was used as the dependent variable and all analyses were performed at root level.

RESULTS: The overall frequency of AP at follow-up was 13.8%. The difference in frequency of AP between retreated (4.3%) and nonretreated (15.4%) root canals was not statistically significant, p = .061. Analyses including only roots with preoperatively inadequate root filling quality showed a statistically significant difference (p = .017) between the two treatment groups (2.4% vs. 22.9%).

CONCLUSIONS: Root canal retreatment for technical reasons before post and core placement significantly reduces the frequency of AP in roots with inadequate root filling quality.

Aim: To investigate what happens to cross-sectionally identified root-filled teeth over a 6-year period, regardless of the time that elapsed since primary root canal treatment, in a cohort of adult patients regularly attending a Public Dental Service. A secondary aim was to investigate how the cumulative events affecting root-filled teeth over the same time were associated with variables obtained from a baseline examination.

Methodology: Adult patients with >= 1 previously root-filled tooth and regularly attending the Public Dental Service in & Ouml;rebro County were enrolled for study participation in 2015. General dental practitioners examined all identified root-filled teeth in this cohort at baseline using a standardized protocol and were also responsible for further decision-making and treatments. After six years, information on events of the root-filled teeth was collected from dental records. The highest rating (most invasive treatment) on a 5-point ordinal scale was used in the analyses. Regression analyses with stepwise selection were performed for associations between patient- and tooth-related factors and events.

Results: A total of 445 patients with 1007 root-filled teeth were followed the entire observation time. Twenty (2.0%) of the root-filled teeth had endodontic retreatment and 150 (14.9%) were extracted over six years. Among teeth with periapical radiolucency or pain, the majority did not undergo retreatment or extraction; however, the multivariate analysis demonstrated that retreatment or extraction was associated with baseline recordings of teeth with periapical radiolucency (p < .0001), tenderness to percussion (p < .0001), and poor coronal restoration (p < .0001).

Conclusions: This study corroborates the notion that in general dentistry, root-filled teeth with radiological signs of apical disease often remain untreated over time. Furthermore, it also reveals that root-filled teeth presenting with mild pain do not necessarily receive any intervention. However, teeth with baseline signs of apical periodontitis, pain, or inadequate coronal restoration were more likely to have received intervention during the six-year period.

BACKGROUND: It is not clear to what extent chewing is improved by unilateral oral rehabilitation with implant-supported fixed partial prostheses (ISFPPs).

AIM: This study aimed to investigate whether patients treated with unilateral ISFPPs in the maxilla use their prostheses during mastication to the same extent as they used their contralateral natural teeth. A further aim was to investigate whether there is a correlation between preferred chewing side and laterality.

MATERIAL AND METHODS: Chewing side preference was assessed in 15 participants treated with unilateral ISFPPs in the maxilla. The first, second, third, fifth, and tenth chewing cycles were assessed, and the test was repeated ten times. All participants also answered a questionnaire about their chewing side preference.

RESULTS: Most of the participants presented bilateral chewing, but two (13%) chewed only on the ISFPP. There was no statistically significant association between the objectively assessed chewing side and dental status (natural teeth or ISFPPs) during any of the recorded chewing cycles (p >.1). There were statistically significant correlations between both the subjectively reported usually preferred chewing side and the subjective chewing side preference during the test, and the objectively assessed chewing side for the first three chewing cycles (p <.01). No correlation was found between handedness and the objectively assessed chewing side.

CONCLUSION: In the present study, most participants chewed bilaterally, and chewing was performed both on the ISFPP and on the natural teeth. No correlation was found between the preferred chewing side, objectively or subjectively determined, and laterality.

Objective: This study examined the frequency of unplanned follow-up visits to the Public Dental Service in€Orebro due to postoperative discomfort/complications after mandibular third molar surgery and associated factors.

Materials and methods: Data were retrieved from the dental records of 465 patients who underwent mandibular third molar surgery in 2017. The collected data covered patient age and gender, health status, diagnosis, surgeon, and planned and unplanned follow-up visits.

Results: Twenty-eight percent of patients had unplanned visits after mandibular third molar surgery, while 68% of patients without a planned follow-up visit had an unscheduled visit. None of the patients with a planned visit had an unplanned visit. Female patients and patients who had bone removed during surgery had significantly more unplanned follow-up visits due to post-extraction discomfort (p¼.047 and .01, respectively). Patients diagnosed with caries made fewer unplanned follow-up visits (p<.012).

Conclusions: The frequency of unplanned follow-up visits after third molar surgery was relatively high, though no patient with a planned follow-up visit made an unplanned visit. Scheduling follow-upvisits could significantly reduce the number of unplanned follow-up visits.

STATEMENT OF PROBLEM: To minimize technical complications, implant-supported fixed dental prostheses must fit well. The fit of complete-arch veneered zirconia frameworks has not been fully evaluated.

PURPOSE: The purpose of this in vitro study was to evaluate the fit of screw-retained zirconia implant-supported complete-arch maxillary frameworks for fixed dental prostheses before and after porcelain veneering.

MATERIAL AND METHODS: Ten stone casts simulating an edentulous maxilla and provided with 6 abutment analogs were produced. For each stone cast, 1 zirconia framework was fabricated by computer-aided design and computer-aided manufacturing. The fit was analyzed by using a coordinate measuring machine in 3 dimensions (x, y, and z axes) using best fit by virtual matching of center point coordinates before and after porcelain veneering. Also, the horizontal distances between implant position pairs P1-P6, P2-P5, and P3-P4 were measured. Furthermore, an optical microscope was used to evaluate vertical fit at the terminal abutments after porcelain veneering.

RESULTS: Before the porcelain veneering procedure, the frameworks had a mean horizontal misfit of 27.7 μm in the x-axis and 12.0 μm in the y-axis. In the vertical dimension (z-axis), the mean misfit was 2.4 μm and the mean 3D misfit value was 32.3 μm before veneering. Porcelain veneering increased the mean misfit by 0.2 μm in the horizontal plane (x and y axes), 0.4 μm in the vertical plane, and 0.4 μm in 3D; the difference before and after veneering was not statistically significant (P>.05). The mean ±standard deviation vertical misfit at the terminal abutments was 9.2 ±2.9 μm, optically recorded after porcelain veneering. The measured horizontal distances between implant position pairs P1-P6, P2-P5, and P3-P4 increased to 0.9 μm, 2.0 μm, and 1.9 μm, respectively, after porcelain veneering. The difference for the implant position pair P2-P5 was statistically significant (P<.05).

CONCLUSIONS: Screw-retained zirconia implant-supported complete-arch maxillary frameworks for fixed dental prostheses have a fit well within the range of 30 μm in the horizontal plane and 10 μm in the vertical plane. The porcelain veneering procedure did not affect the fit of the frameworks.

Aim: To (i) investigate the frequency and characteristics of pain and discomfort associated with root filled teeth in adult patients regularly attending the Public Dental Service in orebro County, Sweden; (ii) assess the association between symptoms and clinical and radiographic findings; and (iii) explore the impact of pain and discomfort from root filled teeth on daily life.

Methodology: Patient records of adult patients (>= 20 years) scheduled for routine check-ups in April 2015 were screened to identify individuals with root filled teeth; all patients with >= 1 root filled tooth were asked to participate. The examination comprised of clinical and radiographic examinations and questionnaires on general health, on pain symptoms from root filled teeth and on the impact of pain on daily activities. In a general estimating equation (GEE), examination findings and patient-related factors were independently analysed in relation to the outcome 'presence of pain'.

Results: In total, 550 patients with 1256 root filled teeth participated. Fifty-three patients (9.6%) experienced pain or discomfort from 62 (4.9%) root filled teeth. Lower age, percussion tenderness and apical tenderness were significantly associated with pain (P > 0.001 to P = 0.044). The average pain intensity was 2.1 on a (0-10) Numeric Rating Scale, and average duration was 28.4 months. The impact on daily life was low.

Conclusions: On average, pain associated with root filled teeth was of mild intensity, >2 years of duration and had low impact on daily life. Although the significantly associated clinical findings may indicate apical periodontitis as the most probable explanation in some teeth, the origin of pain from root filled teeth remains partly unexplained.

Purpose: The purpose of this study was to evaluate the fit of additively manufactured cobalt-chromium and titanium and CNC-milled titanium frameworks before and after ceramic veneering.

Materials and Methods: Ten stone casts simulating an edentulous maxilla provided with six abutment analogs were produced. For each stone cast, one additively manufactured cobalt-chromium framework (AM CoCr) and one titanium framework (AM Ti) were fabricated. The fit was analyzed with a coordinate measuring machine in three dimensions (x, y, and z axes) using best-fit virtual matching of center point coordinates, before and after ceramic veneering. CNC-milled titanium frameworks (CNC Ti) and earlier results from CNC-milled cobalt-chromium frameworks (CNC CoCr) were used for comparison.

Results: All frameworks presented minor misfit before and after veneering in the horizontal plane (x- and y-axes) between 2.9 and 13.5 mu m and in the vertical plane (z-axis) between 1.6 and 5.4 mu m. Ceramic veneering affected the fit of all groups of frameworks. Both AM Ti and AM CoCr presented significantly smaller distortion in the vertical plane compared with the CNC-milled frameworks.

Conclusion: Implant-supported frameworks can be produced in either Ti or CoCr using either CNC milling or additive manufacturing with a fit well within the range of 20 mu m in the horizontal plane and 10 mu m in the vertical plane. The fit of frameworks of both materials and production techniques are affected by the ceramic veneering procedure to a small extent.