ENDO, 01/2018

Intracoronal and intracanal diagnosis (ICD) are important aspects of the endodontic diagnostic process. The intracoronal diagnosis of the pulp cavity is completed before embarking on the root canal treatment itself, while the intracanal diagnosis of the root canal systems continues throughout the instrumentation of the root canal. During this diagnostic process, the endodontist records and documents the findings using optical magnification and coaxial light. The ICD serves to verify the preliminary diagnosis and facilitates the early detection of potential complications as well as an early identification of non-salvageable teeth. Therefore, this diagnostic step is recommended both before and during root canal treatment. Keywords: dental operating microscope, diagnostics, endodontic access cavity, loupe, prognosis

This case report deals with the endodontic management of a mandibular second premolar with a category 3 C-shaped root canal configuration, aided with cone beam computed tomography (CBCT) for the proper diagnosis and clinical management planning of the case. It also discusses use of a rotary file system such as XP-Endo that respects the root canal anatomy and the possible role of calcium hydroxide in the healing of a large apical lesion - all of this proven by periodic evaluations with radiographs and post-treatment CBCT. Keywords: C-shaped root, C-shaped root canal, cone beam computed tomography, dental anomalies, mandibular premolar root canal

Objective: To determine the prevalence of cone beam computed tomography (CBCT) use, including training and knowledge, among endodontic practitioners in the UK. Methodology: A questionnaire was designed and sent out electronically to specialists in endodontics (SiE) on the General Dental Council (UK) specialist register and also distributed to delegates at a British Endodontic Society Spring Scientific meeting, which included non-specialists in practices limited to endodontics (PLE). Results: The response rate was 24% (n = 94); 41% of the respondents were SiE and 59% PLE. Most of the respondents worked in practice (67%) while the remainder worked in a hospital (20.4%) or university (12.6%) setting. CBCT was used by 26% of all respondents and 22% owned their scanner. Practitioners who used CBCT, but did not own a scanner, referred their patients to a dental imaging centre (40.9%), a dental hospital (30%), or another dental practice (29.1%), when a scan was needed. The three most common reasons for CBCT use were to detect root resorption (25.2%), for case assessment prior to endodontic surgery (18.7%) and to determine root anatomy (18.3%). The CBCT scans were mainly interpreted by the practitioners themselves (44%), by a dental and maxillofacial radiologist (36.4%) or by another practitioner with CBCT training (14%). A medical radiologist (5.6%) was rarely involved in interpretation of CBCT scans. The majority of the clinicians had CBCT referrer training (50%), but only a small percentage had CBCT operator training (12.5%), while the rest had no CBCT training (37.5%). Conclusions: CBCT use is popular in the UK with SiE and PLE. The majority of respondents using CBCT had referrer training, but only a small percentage had operator training. Keywords: cone beam computed tomography, CBCT, endodontics, UK

Objective: To describe a case of breast carcinoma metastasis combined with pulpitis-like pain complaints in a mandibular molar. Although metastasis from distant sites to the mandible is unusual, it should be considered in the differential diagnosis of patients referred for endodontic treatment. Summary: A 54-year-old female with carcinoma of the breast was referred to the endodontic department for root canal treatment of tooth 47. After endodontic treatment, her pain disappeared, but periodontal problems persisted. Because hypoesthesia of the lip and chin, in combination with periodontal complaints, were noticed during follow-up appointments, a more aggressive process was suspected. Additional investigations with cone beam computed tomography (CBCT) and magnetic resonance imaging (MRI) revealed a metastasis in the mandibular molar area. Metastatic carcinomas may rarely mimic pulpal or periapical pathology. Failure to diagnose them may result in serious consequences for the patient. Patients with a history of malignancy and suffering from oral pain that is not completely resolved after therapy should undergo specific diagnostic tests to exclude a neoplastic aetiology for their symptoms. Interpretation: Follow-up of endodontic treatments is necessary to see if symptoms dissolve and to consider if the diagnosis should be modified. Endodontists are well qualified to detect oral metastases. Metastases from distant sites to the oral cavity are uncommon, but should be considered in the differential diagnosis. Keywords: endodontic diagnosis, endodontic-periodontal relations, metastasis Conflict-of-interest statement: The authors declare there are no conflicts of interest in this study.

Aim: Presentation and discussion of orthodontic-endodontic treatment of a maxillary central incisor diagnosed with infected dens invaginatus (Oehlers' type III) and associated apical periodontitis utilising ultrasonic and hand instruments and the surgical operating microscope as an auxiliary tool for both diagnosis and treatment planning. Materials and methods: This case report describes the diagnosis and conservative treatment of a unilateral case of a maxillary central incisor with an infected type III dens invaginatus and an associated periradicular lesion followed of an orthodontic movement. Results: At the 1-year follow-up examination, clinical and radiographic findings showed that a diligent nonsurgical root canal treatment resulted in satisfactory periradicular healing. Conclusions: The present report demonstrates successful nonsurgical treatment of tooth with a challenging anatomy using contemporary techniques and materials. Keywords: cryotherapy, dens in dente, dens invaginatus, pathology, tooth morphology

Objective: Cell phones can release electromagnetic interference (EMI) and their usage is commonly forbidden in many hospitals to prevent potential interference with medical devices. The purpose of this clinical study was to assess the impact of three smartphones on electronic apex locator (EAL) working length (WL) determination. Materials and methods: Forty teeth (30 anterior; 10 posterior) with 60 canals were chosen for the study. The effect of three brands of smartphones, when present or absent and in proximity, on an EAL was investigated. The WL of teeth determined using an EAL, in the presence or absence of a Smartphone were compared with the digital radiography. The collected data were analysed using one-way ANOVA; the statistical significance was set at 0.05. Results: Ten canals showed a disparity in the WL determination in the presence of smartphones. There was a significant difference (P = 0.039 and P = 0.001) in the WL by the three methods in anterior and posterior teeth respectively. Conclusions: From this study, it can be concluded that smartphones can affect the WL determination when using an EAL. Smartphones should not be placed in close proximity to an EAL during use. Keywords: digital radiography, electronic apex locator, smartphones, working length