• A clinical evaluation of the ability of finishing files to supplement the removal of bacteria and endotoxin from primarily infected root canals (Part I- Initial evaluation)

      Kim, Eunice; Martinho, Frederico C. (2020)
      Aim: The aim of this study was to evaluate the ability of XP-endo Finisher (XPF) to supplement the removal of bacteria and endotoxin from primary infected root canals after instrumentation. Methodology: This randomized and blinded controlled trial included eight subjects. Instrumentation was performed using Vortex Blue or XP-endo Shaper, followed by supplemental instrumentation with XPF. All canals were irrigated with 2.5% sodium hypochlorite. Bacterial and endotoxin samples were taken using sterile paper points. Samples were collected before and after instrumentation and after XPF. Results: Bacteria was present in all root canals. After XPF, bacterial mean was reduced from 255 ± 311.82 CFU/mL to 2.5 ± 7.07 CFU/mL (p= .056). Endotoxin was detected in all root canals by the LAL method (KQCL test). After XPF, endotoxin mean was significantly reduced from .85 ± .26 EU/mL to .03 ± .01 EU/mL (p= .00004). Conclusion: The findings of this study showed that the supplemental use of the XP-endo Finisher after root canal instrumentation was effective in significantly reducing endotoxin but not bacteria present in primary endodontic infections.
    • The Association of Statin Intake and Healing of Apical Periodontitis After Root Canal Treatment

      Algofaily, Maha; Tordik, Patricia (2017)
      The aim of this study was to analyze the association between statin intake and apical periodontitis healing after root canal treatment. Patients who self-reported statin use during the treatment and patients who reported never taking statins were included. All who received treatment on a tooth with a periapical radiolucency in the Postgraduate Endodontics Clinic, University of Maryland School of Dentistry (2011-2014) were invited for a two to five-year follow-up examination. Sixty teeth were examined, in 30 patients taking statins and 30 not taking statins (control). Healing was determined using the periapical index. Two calibrated endodontists assessed outcomes blinded to preoperative status. Fisher's Exact Test (FET) showed a significant difference in healing at the two-year or greater follow-up in patients taking statins compared to those who did not (93.0% vs. 70%, FET, p=.02). This study revealed a significant association between statin intake and healing of apical periodontitis after root canal treatment.
    • Development and Implementation of an Audiovisual Informed Consent Delivery System for Non-surgical Root Canal Therapy

      Aguilar, Lauren; Macek, Mark D. (2018)
      The aims of this mixed-methods study were (1) to explore patients' preferences towards informed consent for endodontic procedures, (2) to use focus group feedback to develop short audiovisual presentations, and (3) to determine whether the audiovisual format lead to a different level of understanding than traditional consent. First was a focus group to assess patient expectations and attitudes towards consent for non-surgical root canal therapy (NSRCT). Second was developing two short audiovisual presentations. Finally a clinical trial tested the videos with 50 patients at the University of Maryland School of Dentistry. A questionnaire was used to assess patient preferences, comprehension, and recall of the consent and analyzed. There were no significant differences between groups in terms of recall, comprehension, understanding, or attitudes. Nonetheless, the data collected may be useful to restructure informed consent procedures for NSRCT and set a precedent for innovative consenting procedures.
    • Efficacy of Different File Systems in Removing Gutta-Percha Cones Coated with Nanoparticles and Bioceramic Root Canal Sealer

      Barak, Yaakov; Martinho, Frederico C. (2019)
      INTRODUCTION: The purpose of this study is to compare the ability of the XP-3D (XP) Shaper (Brasseler USA, Savannah, GA), TRUShape 3D (TS) Conforming Files (Dentsply, Tulsa, OK), and Vortex Blue (VB, Dentsply) files to remove gutta-percha and BC Sealer (BCS, Brasseler USA, Savannah, GA) from root canals, and to compare the time necessary for retreatment. MATERIALS AND METHODS: 36 extracted single-rooted mandibular premolars were instrumented, and obturated with gutta-percha and BCS. The teeth were then retreated with either XP, TS, or VB. The teeth were sectioned and analyzed with a digital microscope at 35x and ImageJ software for the percentage of material on the canal walls. RESULTS: All groups removed obturation material to a similar extent. XP was significantly faster than TS or VB. CONCLUSION: There is no significant difference in the ability of XP, TS, or VB in removing obturation material, however, retreatment with XP is significantly faster.
    • Evaluation of Factors Related to Long-term Healing in Endodontic Treatment

      Orgel, Adam William; Fouad, Ashraf F. (2012)
      Introduction: This study sought to determine the effects of residual root canal bacteria and treatment factors on endodontic treatment outcomes up to 6 years post-operatively using traditional radiography (PA radiographs) and limited cone beam computed tomography (CBCT). Methods: Root canal samples were obtained from 50 patients with pulp necrosis and a periapical lesion, following two-visit treatment using contemporary chemomechanical preparation techniques. PCR, with broad range 16S rDNA bacterial primers, was performed followed by cloning and sequencing on pre-obturation specimens. Periapical and CBCT radiographs were taken at 10 months to 6 years post-treatment. Images were scored by two blinded, calibrated endodontists using the conventional periapical index (PAI) and a CBCT index. Statistical analysis was performed using bivariate and multivariate regression analysis for treatment factors. Kaplan-Meier survival analysis and Pearson's regression analysis was used for year-over-year changes. Results: 41 patients were included in the final data analysis. Recall decreased from 98% at 10-17 months to 51% at 33+ months. The percentage of patients healed at 10-17 months, 18-32 months and 33+ months and overall was 65%, 63%, and 66% respectively. Factors influencing outcomes were presence of bacteria at time of obturation (56% when present, 81% absent), primary versus persistent disease (71% vs. 39%), tooth type (85% anterior,23% molar), obturation to the radiographic apex (100% to the apex, 56% not to the apex), and larger master apical file sizes (73%MAF>45 vs. 36% MAF<45).. Short-term outcomes had a strong positive relationship with final outcome (Pearson's, r2=0.56, p=<0.01). Conclusions: Bacterial DNA presence at the time of obturation adversely affects short-term and intermediate-term endodontic treatment outcomes, but this effect is not found in the long-term. Various patient factors such as tooth type and treatment factors such as master apical file size influence outcomes. Short-term treatment outcomes are good predictors of long-term outcomes.
    • In Vivo Evaluation of Contemporary Endodontic Antimicrobial Procedures

      Bellingham, Peter John; Fouad, Ashraf F. (2011)
      Introduction: Clinical assessment of the efficacy of novel root canal disinfection protocols is an important focus in endodontic research. The purpose of this randomized, masked study was to: (1) Determine and compare the incidence of bacterial DNA and growth after final rinse with MTAD or 5.25% NaOCl by conventional syringe irrigation and ultrasonic irrigation, and (2) Determine and compare colony forming units and incidence of bacterial DNA and growth before and after ProUltra PiezoFlow ultrasonic irrigation. Methods:Canals in 20 teeth (single-rooted) were prepared using 5.25% NaOCl and 17% EDTA, then rinsed with MTAD or 5.25% in random sequence by conventional syringe and ultrasonically-activated irrigation, medicated for 7 days with Ca(OH)2, and filled. Root canal samples were obtained before (A) preparation, after final rinse conventional syringe needle irrigation (B), and after final rinse ultrasonically-activated irrigation (C). Samples were evaluated for incidence of bacterial DNA using PCR amplification of the bacterial 16S rRNA gene.Incidence of bacterial DNA. Additionally, incidence of bacterial growth and colony counts was determined after 10 days of anaerobic incubation. Results: Incidence of bacterial DNA and bacterial growth did not differ significantly between final rinse MTAD and 5.25% NaOCl groups, both after conventional syringe and ultrasonically-activated irrigation. Incidence of bacterial growth was significantly less after ultrasonically-activated irrigation, and a trend was observed towards reduction in colony count. Conclusion: The results of this randomized, masked study did not show a significant short-term antimicrobial advantage of final rinse MTAD over 5.25% NaOCl. Ultrasonically-activated irrigation demonstrated a significant reduction in the incidence of bacterial growth and a trend towards reduction in colony counts. Bacterial presence before obturation can adversely affect the outcome of treatment. The results of this study could provide direction for new irrigation techniques to improve outcomes for the endodontic treatment of teeth.
    • An in vivo Investigation of Dentin-Pulp Regeneration

      Verma, Prashant; Fouad, Ashraf F. (2014)
      Tissue regeneration requires an interaction of stem cells and growth factors in a bioactive scaffold. This study utilized the ferret canine as an in situ animal model to investigate a clinically applicable tissue engineering approach for dentin-pulp regeneration. Specifically, we aimed to determine the efficacy of delivering stem cells within a bioactive scaffold directly into the root canal space, in the presence of growth factors released from dentin, compared with traditional procedures in dentin-pulp regeneration. Periapical lesions were induced in 24 canine teeth of 6 ferrets. Dental pulp stem cells were isolated, characterized, encapsulated in a hydrogel scaffold, and injected in half the experimental teeth. The other half were treated using the conventional protocol with a blood clot scaffold. After an evaluation period of 3 months, the animals were sacrificed and block sections were processed for radiographic analysis. Results showed that there was no statistically significant difference between groups. Some teeth in both groups showed control of the infectious process with increase in root wall thickness, root length and apical closure, while others did not. There was a significant association between the presence or absence of a periapical lesion at the 3-month evaluation and whether the tooth showed continued root maturation. Pre-operative infection may have played a critical role in the treatment outcome.
    • Nanogel-Based Scaffold in Endodontics

      Kheirieh, Sanam; Tordik, Patricia (2016)
      Aim: The purpose of this study was to evaluate a degradable nanogel-based scaffold with antibacterial content. Methods: This nanogel design consisted of the cross-linker, polyethyleneglycol (PEG 4600) with 3-dimensional network. This polymer degrades over time (~30 days), delivering a controlled release of antibiotic. Amoxicillin was added to the scaffold with 25 wt% (n=26). Nanogel-scaffold only and amoxicillin only were used as controls. Agar diffusion test against E. faecalis was performed at eight time intervals (days 1, 3, 5, 7, 10, 14, 21, 30). One-Way ANOVA was used to compare the antibacterial properties of experimental groups at the eight different times. Results: The antibacterial properties for experimental plates, at the different times, were not significantly different (F=.624, p=.74). Based on the profile, the scaffold-only group showed a smaller inhibition zone compared to the two other groups. The antibacterial profiles for the experimental group and the antibiotic-only group were similar. Conclusion: This particular scaffold presented antibacterial properties. Findings suggest that nanogel-modified scaffolds may have potential use for drug-delivery in endodontics.
    • Observational Study Evaluating Pain in Endodontic Patients Diagnosed with Depression – A Pilot Study

      Mannan, Saurabh; Greenspan, Joel D. (2019)
      TITLE: Observational Study Evaluating Pain in Endodontic Patients Diagnosed with Depression – A Pilot Study Saurabh Mannan, Master of Science 2019 Thesis Directed By: Joel Greenspan, PhD AIM: To evaluate the role of depression in endodontic post-procedural pain METHODOLOGY: This prospective observational study enrolled 42 patients that explored the correlation between patient’s level of depression and pain perception following non-surgical root canal treatment (NSRCT). The Hospital Anxiety and Depression Scale (HADS) assessed the patient’s level of anxiety/depression pre-and postoperatively. The patient used a visual analog scale (VAS) to record their pain intensity and feelings of unpleasantness with their dental experience immediately following their NSRCT. Pain diaries recorded pain intensity post-operatively at the 2nd, 4th, and 7th day. A cohort of endodontic patients who were not diagnosed with depression served as controls. RESULT: A total of 41 patients were included, 30 non-depressed patients and 11 patients diagnosed with depression by their physicians. Two patients did not return the pain dairy. Therefore, data from 29 non-depressed patients and ten depressed patients were available for analysis. This study showed that the diagnosis of depression was significantly associated with both higher immediate post-operative pain and immediate sensations of unpleasantness. Furthermore, HADS ≥ 8 was found to be a significant predictor of greater post-operative pain at day two. CONCLUSIONS: Within the limitations of this study, either a diagnosis of depression or signs of anxiety or depression are a positive predictor of greater post-operative pain.
    • The Relationship Between Diabetic Control and Periapical Lesion Resolution

      Fein, Joshua Evan; Fouad, Ashraf F. (2012)
      The association between oral and systemic disease continues to be elucidated, expanding from periodontal disease and cardiovascular disease risk to include endodontic infection and diabetes. The purpose of this study was to determine whether diabetic control, as measured by hemoglobin A1c, has a direct relationship with the size of periapical lesions as measured through cone beam CT imaging at the time of follow-up examination. 100 patients who received appropriate root canal treatment (as determined radiographically) two to four years prior in the Postgraduate Endodontics Clinic were recruited through phone calls and a mailed letter. All had periapical lesions at the time of initial diagnosis. Following informed consent, standard recall examination and periapical radiographs were completed. Then, blood was drawn for hemoglobin A1c (HbA1c) analysis and CBCT images were exposed. Measurement of the largest diameter in any direction of the lesion was determined by two experienced endodontists who were masked to the diabetic status or HbA1c levels of the patients. Statistical analysis was completed with Pearson correlation, as well as ANOVA and multiple regression analysis. 29 patients consented to participate. Two patients were excluded, as the treated teeth had been previously extracted. A significant positive correlation was found between the HbA1c and lesion size (r = 0.375, p = 0.027). Blood glucose level, as measured by Hemoglobin A1c, demonstrated a direct association with periapical lesion size at the time of recall.
    • The Relationship between Short Term Healing of Periapical Lesions and Glycemic Control

      Tawady, Tontesh Shivakumar; Tordik, Patricia (2016)
      Aim: This study aimed to examine the relationship between HbA1c level and short-term healing of periapical lesions. Methods: Patients were recruited for the study (n=21). After RCT, the final radiograph was taken, and the patient's blood was drawn for HbA1c analysis. The patients returned in six months for a recall examination. The Periapical Index (PAI) scoring system was used to compare the difference in the periapical status from the initial appointment and at the recall appointment. Results: Out of 21 recruited patients, eight patients returned for recall. To investigate the rate of healing and how it related to the patients' Hba1c levels, Pearson's r was done with the HbA1c of the recall patients (N=8) and the level of healing (difference in PAI). This correlation was r= -.474. Conclusion: There was a negative correlation between HbA1c level and the level of healing of periapical lesion, this correlation was not statistically significant.
    • The Relationship Between Short Term Healing of Periapical Lesions and Glycemic Control: A Pilot Study

      Zhou, Zuwu; Chand, Priya; Tordik, Patricia (2019)
      The aim of this study was to evaluate the relationship between HbA1c level and short-term healing of periapical lesions after non-surgical root canal treatment (NSRCT). After NSRCT, digital periapical radiographs were taken and blood samples were drawn for HbA1c analysis. To assess short-term healing (PAI difference), subjects returned after six months for a radiograph and blood draw. A calibration exercise established the reliability of the PAI scoring process. Thirty-eight subjects returned for the recall. The relationship between HbA1c level and also the co-variables, with healing was explained using Spearman’s rho and logistic regression. There was a significant correlation between healing and HbA1c level (rs = -.52, p ≤.0001), age (rs = -.44, p ≤.003), recall days (rs =.29, p ≤.036), and cardiovascular status (rs = -.34, p ≤.018). A final logistic regression showed a significant relationship between HbA1c level and short-term healing of periapical lesions (R = .62, p≤ .05).