Papers - Reviews by Dr. Carlos San Martin D.
Biofilms and microbial aggregates are the common mechanisms for the survival of bacteria in natur... more Biofilms and microbial aggregates are the common mechanisms for the survival of bacteria in nature. In other words, the ability to form biofilms has been regarded as a virulence factor. Microbial biofilms play an essential role in several infectious diseases such as pulp and periradicular pathosis. The aim of this article was to review the adaptation mechanisms of biofilms, their roles in pulpal and periapical pathosis, factors influencing biofilm formation, mechanisms of their antimicrobial resistance, models developed to create biofilms, observation techniques of endodontic biofilms, and the effects of root canal irrigants and medicaments as well as lasers on endodontic biofilms. The search was performed from 1982 to December 2010, and was limited to papers in English language. The keywords searched on Medline were "biofilms and endodontics," "biofilms and root canal irrigation," "biofilms and intra-canal medicament," and "biofilms and lasers." The reference section of each article was manually searched to find other suitable sources of information. (Biomed J 2013;36:59-70)
Introduction: The purpose of this study was to identify the 100 top-cited articles published in j... more Introduction: The purpose of this study was to identify the 100 top-cited articles published in journals dedicated to endodontology and analyze their characteristics to describe the quality and evolution of research in the field of endodontology. Methods: The Institute for Scientific Information Web of Knowledge Database and the Journal Citation Report Science Editions were used to retrieve the 100 most cited articles published in journals dedicated to endodontics. The top-cited articles were selected and analyzed with regard to journals, authors, institution, country of origin, publication title and year, number of citations, article type, study design, level of evidence, and field of study. Results: The top 100 articles were cited between 87 and 554 times. These articles appeared in 4 different journals, with more than half in the Journal of Endodontics, followed by the journals Oral Surgery Oral Medicine Oral Pathology Oral Radiology and Endodontology, the International Endodontic Journal, and Endodontics & Dental Traumatology. Forty-eight articles were published between 1990 and 1999. All articles were published in English and primarily originated from the United States (n = 52). The majority of articles were basic science articles (n = 55), followed by clinical research studies (n = 28) and nonsystematic reviews (n = 17). Uncontrolled case series with level IV of evidence and narrative reviews with level V of evidence were the most frequent types of study design. The main topics covered by the top-cited articles were microleakage and endodontic microbiology. Conclusions: This analysis of citation rates reveals useful and interesting information about scientific progress in the field of endodontics. Basic research and observational studies published in highimpact endodontic journals had the highest citation rates. (J Endod 2011;37:1183-1190
Introduction: Anticipation and experience of root canal associated pain is a major source of fear... more Introduction: Anticipation and experience of root canal associated pain is a major source of fear for patients and a very important concern of dentists. Pretreatment, treatment, and posttreatment pain is anticipated, experienced, remembered, and shared by patients. The purpose was to determine the influence of root canal treatment on pain prevalence and severity and estimate the prevalence and severity of pretreatment, treatment, and posttreatment pain in patients receiving root canal treatment. Methods: Defined searching of MEDLINE, Embase, Cochrane, and PsycINFO databases identified 5,517 articles. Systematic review, including title scanning, abstract scanning, full-text review, and quality rating, provided 72 studies for meta-analysis. L'Abbe plots were used to evaluate the influence of root canal treatment on pain prevalence and severity. Pretreatment, treatment, and posttreatment pain prevalence and severity data were analyzed. Results: L'Abbe plots revealed that pain prevalence and severity decreased substantially after treatment. Mean pretreatment, 24hour posttreatment, and 1-week posttreatment pain prevalences with associated standard deviations were 81 (28%), 40 (24%), and 11 (14%), respectively. Pretreatment, 24-hour posttreatment, and 1-week posttreatment pain severities, on a 100-point scale, were 54 (24%), 24 (12%), and 5 (5%), respectively. Supplemental injections were frequently required (60 [24%]). Conclusions: Pretreatment root canal-associated pain prevalence was high but dropped moderately within 1 day and substantially to minimal levels in 7 days. Pretreatment root canal-associated pain severity was moderate, dropped substantially within 1 day of treatment, and continued to drop to minimal levels in 7 days. Supplemental anesthesia was often required. (J Endod 2011;37:429-438)
The choice of single-versus multiple-visit root canal treatment for infected teeth is in dispute.... more The choice of single-versus multiple-visit root canal treatment for infected teeth is in dispute. The purpose of this systematic review was to compare the healing rate and post-obturation pain of single-versus multiple-visit root canal treatment for teeth with infected root canals. Methods: An exhaustive literature search combined with specified inclusion criteria was performed to identify randomized or quasi-randomized controlled trials (RCTs or quasi-RCTs), comparing root canal treatment in single and multiple appointments (2 or more visits) in patients with infected root canals. Results: Ten RCTs were identified and included in this review. Of these, 6 compared the healing rate and 5 compared the prevalence of post-obturation pain in single-and multiple-visit root canal treatment on teeth with infected root canals. No significant difference was observed in the healing rate between single-versus multiple-visit root canal treatment, as well as the incidence of medium-term post-obturation pain. As to the short-term follow up, the prevalence of postobturation pain was significantly lower in single-visit than in multiple-visit group. Conclusions: On the basis of current studies, the healing rate of single-and multiple-visit root canal treatment is similar for infected teeth. Patients experience less frequency of short-term post-obturation pain after single-visit than those having multiple-visit root canal treatment. (J Endod 2011;37:125-132)
Little is known about the frequency of persistent pain after endodontic procedures even though pa... more Little is known about the frequency of persistent pain after endodontic procedures even though pain is a core patient-oriented outcome. We estimated the frequency of persistent pain, regardless of etiology, after endondontic treatment. Methods: Persistent tooth pain was defined as pain present $6 months after endodontic treatment. Endodontic procedures included in the review were pulpectomy, nonsurgical root canal treatment, surgical root canal treatment, and retreatment. Four databases were searched electronically complemented by hand searching. Two independent reviewers determined eligibility, abstracted data, and assessed study quality. A summary estimate of persistent all-cause tooth pain frequency was established by using a random-effects meta-analysis. Using subgroup analyses, we explored the influence of treatment approach (surgical/nonsurgical), longitudinal study design (prospective/retrospective), follow-up rate, follow-up duration, initial treatment versus retreatment, and quality of reporting (Strengthening the Reporting of Observational Studies in Epidemiology rankings) on the pain frequency estimate. Results: Of 770 articles retrieved and reviewed, 26 met inclusion criteria. A total of 5,777 teeth were enrolled, and 2,996 had follow-up information regarding pain status. We identified 168 teeth with pain and derived a frequency of 5.3% (95% confidence interval, 3.5%-7.2%, p < 0.001) for persistent all-cause tooth pain. High and statistically significant heterogeneity among studies (I 2 = 80%) was present. In subgroup analysis, prospective studies had a higher pain frequency (7.6%) than retrospectives studies did (0.9%). Quality of study reporting was identified as the most influential reason for study heterogeneity. Conclusions: The frequency of all-cause persistent tooth pain after endodontic procedures was estimated to be 5.3%, with higher report quality studies suggesting >7%. (J Endod 2010;36:224-230)
Introduction: Internal root resorption is the progressive destruction of intraradicular dentin an... more Introduction: Internal root resorption is the progressive destruction of intraradicular dentin and dentinal tubules along the middle and apical thirds of the canal walls as a result of clastic activities. Methods: The prevalence, etiology, pathogenesis, histologic manifestations, differential diagnosis with cone beam computed tomography, and treatment perspectives involved in internal root resorption are reviewed. Results: The majority of the documentation that exists in the literature is in the form of case reports, and there are only a limited number of studies that attempted to examine the histologic manifestations and biologic aspects of the disease. This might be due, in part, to the relatively rare occurrence of this type of resorption and the lack of an in vivo model, apart from the previous attempt on the use of diathermy, to predictably reproduce the condition for study. From a histologic perspective, internal root resorption is manifested in one form that is purely destructive, internal (root canal) inflammatory resorption, and another that is accompanied by repair, internal (root canal) replacement resorption that is featured by the deposition of metaplastic bone/cementum-like tissues adjacent to the sites of resorption. Conclusions: From a differential diagnosis perspective, the advent of cone beam computed tomography has considerably enhanced the clinician's capability of diagnosing internal root resorption. Nevertheless, root canal treatment remains the treatment of choice for this pathologic condition
Introduction: Although long-term functional survival rates can be high for initial endodontically... more Introduction: Although long-term functional survival rates can be high for initial endodontically treated permanent teeth, they are generally more susceptible to fracture than teeth with vital pulps. Tooth extraction is often the consequence of an unfavorable prognosis after coronal and root fractures, but their occurrence in endodontically treated teeth might be reduced by identifying the risks for fracture associated with various operative procedures. Methods: This article presents an overview of the risk factors for potential tooth fractures in endodontically treated teeth on the basis of literature retrieved from PubMed and selected journal searches. Results: Postendodontic tooth fractures might occur because of the loss of tooth structure and induced stresses caused by endodontic and restorative procedures such as access cavity preparation, instrumentation and irrigation of the root canal, obturation of the instrumented root canal, post-space preparation, post selection, and coronal restoration and from inappropriate selection of tooth abutments for prostheses. Conclusions: Potential tooth fractures might be reduced by practitioners being aware during dental treatments of controllable and noncontrollable risks. (J Endod 2010;36:609-617) A lthough the long-term functional survival of initial endodontically treated perma-
Ahmad IA. Rubber dam usage for endodontic treatment: a review.
Un correcto tratamiento endodóntico está basado por una secuencia de factores que se relacionan e... more Un correcto tratamiento endodóntico está basado por una secuencia de factores que se relacionan entre sí y que culminan con una adecuada rehabilitación de la pieza dentaria con la finalidad de restituir su función. Desde el punto de vista del paciente, un tratamiento endodóntico exitoso consiste en la ausencia de síntomas y que la pieza dental tratada permanezca estética y funcional en su boca, sin embargo, la literatura endodóntica propone evaluar el éxito del tratamiento mediante parámetros sintomáticos, radiográficos e histológicos. Es importante considerar que existe una relación directa entre la condición física del paciente, la capacidad del profesional y los criterios de funcionalidad requeridos. El conocimiento profundo y el constante estudio de los avances de la endodoncia son factores esenciales durante el ejercicio profesional. El presente estudio propone una revisión de consideraciones asociadas y relacionadas al éxito del tratamiento endodóntico.
Introduction: The purpose of this systematic review was to compare the clinical and radiographic ... more Introduction: The purpose of this systematic review was to compare the clinical and radiographic outcomes of nonsurgical retreatment with those of endodontic surgery to determine which modality offers more favorable outcomes. Methods: The study began with targeted electronic searches of MEDLINE, PubMed, and Cochrane databases, followed with exhaustive hand searching and citation mining for all articles reporting clinical and/or radiographic outcomes for at least a mean follow-up of 2 years for these procedures. Pooled and weighted success rates were determined from a meta-analysis of the data abstracted from the articles. Results: A significantly higher success rate was found for endodontic surgery at 2-4 years (77.8%) compared with nonsurgical retreatment for the same follow-up period (70.9%; P < .05). At 4-6 years, however, this relationship was reversed, with nonsurgical retreatment showing a higher success rate of 83.0% compared with 71.8% for endodontic surgery (P < .05). Insufficient numbers of articles were available to make comparisons after 6 years of follow-up period. Endodontic surgery studies showed a statistically significant decrease in success with each increasing follow-up interval (P < .05). The weighted success for 2-4 years was 77.8%, which declined at 4-6 years to 71.8% and further declined at 6+ years to 62.9% (P < .05). Conversely, the nonsurgical retreatment success rates demonstrated a statistically significant increase in weighted success from 2-4 years (70.9%) to 4-6 years (83.0%; P < .05). Conclusions: On the basis of these results it appears that endodontic surgery offers more favorable initial success, but nonsurgical retreatment offers a more favorable long-term outcome. (J Endod 2009;35:930-937)
The Cochrane Collaboration promotes evidence-based healthcare decision making globally through sy... more The Cochrane Collaboration promotes evidence-based healthcare decision making globally through systematic reviews of the effects of healthcare intervention. The purpose of this systematic review was to investigate whether the effectiveness and frequency of short-term and long-term complications are different when endodontic procedure is completed in one or multiple visits. Randomized and quasi-randomized controlled trials enrolling patients undergoing endodontic treatment were identified by searching biomedical databases and handsearching relevant journals. The following outcomes were considered: tooth extraction as a result of endodontic problems and radiologic failure after 1 year, postoperative discomfort, swelling, analgesic use, or sinus track. Twelve studies were included in the review. No detectable difference was found in the effectiveness of root canal treatment in terms of radiologic success between single and multiple visits. Neither single-visit root canal treatment nor multiple-visit root canal treatment can prevent 100% of short-term and long-term complications. Patients undergoing a single visit might experience a slightly higher frequency of swelling and refer significantly more analgesic use. (J Endod 2008; 34:1041-1047
Tooth discoloration varies in etiology, appearance, localization, severity, and adhesion to tooth... more Tooth discoloration varies in etiology, appearance, localization, severity, and adhesion to tooth structure. It can be defined as being extrinsic or intrinsic on the basis of localization and etiology. In this review of the literature, various causes of tooth discoloration, different bleaching materials, and their applications to endodontically treated teeth have been described. In the walking bleach technique the root filling should be completed first, and a cervical seal must be established. The bleaching agent should be changed every 3-7 days. The thermocatalytic technique involves placement of a bleaching agent in the pulp chamber followed by heat application. At the end of each visit the bleaching agent is left in the tooth so that it can function as a walking bleach until the next visit. External bleaching of endodontically treated teeth with an in-office technique requires a high concentration gel. It might be a supplement to the walking bleach technique, if the results are not satisfactory after 3-4 visits. These treatments require a bonded temporary filling or a bonded resin composite to seal the access cavity. There is a deficiency of evidence-based science in the literature that addresses the prognosis of bleached nonvital teeth. Therefore, it is important to always be aware of the possible complications and risks that are associated with the different bleaching techniques. (J Endod 2008; 34:394 -407)
Apical periodontitis is an infectious disease caused by microorganisms colonizing the root canal ... more Apical periodontitis is an infectious disease caused by microorganisms colonizing the root canal system. For an optimal outcome of the endodontic treatment to be achieved, bacterial populations within the root canal should be ideally eliminated or at least significantly reduced to levels that are compatible with periradicular tissue healing. If bacteria persist after chemomechanical preparation supplemented or not with an intracanal medication, there is an increased risk of adverse outcome of the endodontic treatment. Therefore, bacterial presence in the root canal at the time of filling has been shown to be a risk factor for posttreatment apical periodontitis. About 100 species/phylotypes have already been detected in postinstrumentation and/or postmedication samples, and gram-positive bacteria are the most dominant. However, it remains to be determined by longitudinal studies if any species/phylotypes persisting after treatment procedures can influence outcome. This review article discusses diverse aspects of bacterial persistence after treatment, including the microbiology, bacterial strategies to persist, the requisites for persisting bacteria to affect the outcome, and future directions of research in this field. (J Endod 2008;34:1291-1301
Current concepts suggest that persisting infections subsequent to endodontic therapy are caused b... more Current concepts suggest that persisting infections subsequent to endodontic therapy are caused by one or two bacterial species that are "too robust" to be eliminated by conventional treatment measures. As a consequence, numerous studies are exploring the characteristics of these "most" resistant organisms to define an effective treatment strategy to eradicate them from root canals. By taking an ecological perspective, the main objective of this review is to present evidence that the nature of persisting endodontic infections depends not on the robustness of the organisms in the infected site, but on their capability of adapting their physiology to the new environmental conditions set by the treatment. Changes in the environment, such as an increase in pH by calcium hydroxide or the effect of antimicrobials, are capable of triggering genetic cascades that modify the physiological characteristics of bacterial cells. Surface adherence by bacteria to form biofilms is a good example of bacterial adaptation and one that is pertinent to endodontic infections. Increasing information is now available on the existence of polymicrobial biofilm communities on root canal walls, coupled with new data showing that the adaptive mechanisms of bacteria in these biofilms are significantly augmented for increased survival. This ecological view on the persisting infection problem in endodontics suggests that the action of individual species in persisting endodontic infections is secondary when compared to the adaptive changes of a polymicrobial biofilm community undergoing physiological and genetic changes in response to changes in the root canal environment. (J Endod 2007; 33:652-662)
The ability to assess an area of interest in 3 dimensions might benefit both novice and experienc... more The ability to assess an area of interest in 3 dimensions might benefit both novice and experienced clinicians alike. High-resolution limited cone-beam volumetric tomography (CBVT) has been designed for dental applications. As opposed to sliced-image data of conventional computed tomography (CT) imaging, CBVT captures a cylindrical volume of data in one acquisition and thus offers distinct advantages over conventional medical CT. These advantages include increased accuracy, higher resolution, scan-time reduction, and dose reduction. Specific endodontic applications of CBVT are being identified as the technology becomes more prevalent. CBVT has great potential to become a valuable tool in the modern endodontic practice. The objectives of this article are to briefly review cone-beam technology and its advantages over medical CT and conventional radiography, to illustrate current and future clinical applications of cone-beam technology in endodontic practice, and to discuss medicolegal considerations pertaining to the acquisition and interpretation of 3-dimensional data. (J Endod 2007;33:1121-1132
Failure to grasp the rationale behind cleaning and shaping concepts can increase the occurrence o... more Failure to grasp the rationale behind cleaning and shaping concepts can increase the occurrence of needless complications, such as ledges. A ledge is created when the working length can no longer be negotiated and the original pathway of the canal has been lost. Extension of the access cavity to provide unobstructed access to the root canals, precurving and not forcing instruments, using NiTi files, using passive step-back and balanced force techniques, and instrumenting the canal to its full length will all help to prevent ledge formation. Initial negotiation and bypassing the ledge can be achieved using a small file with a distinct curve at the tip, whereas a slight rotation motion of the file combined with a ЉpickingЉ motion can often help advance the instrument. A review of the literature and a discussion of the options for prevention, recognition and managing the ledge are presented. (J Endod 2007; 33:1155-1162
During the past few decades endodontic treatment has benefited from the development of new techni... more During the past few decades endodontic treatment has benefited from the development of new techniques and equipment, which have improved outcome and predictability. Important attributes such as the operating microscope and ultrasonics (US) have found indispensable applications in a number of dental procedures in periodontology, to a much lesser extent in restorative dentistry, while being very prominently used in endodontics. US in endodontics has enhanced the quality of treatment and represents an important adjunct in the treatment of difficult cases. Since its introduction, US has become increasingly more useful in applications such as gaining access to canal openings, cleaning and shaping, obturation of root canals, removal of intracanal materials and obstructions, and endodontic surgery. This comprehensive review of the literature aims at presenting the numerous uses of US in clinical endodontics and emphasizes the broad applications in a modern-day endodontic practice. (J Endod 2007;33: 81-95)
Nickel-titanium rotary instruments are important adjuncts in endodontic therapy. This review atte... more Nickel-titanium rotary instruments are important adjuncts in endodontic therapy. This review attempts to identify factors that influence shaping outcomes with these files, such as preoperative root-canal anatomy and instrument tip design. Other, less significant factors include operator experience, rotational speed, and specific instrument sequence. Implications of various working length definitions and desired apical widths are correlated with clinical results.
The restoration of endodontically treated teeth is a topic that is extensively studied and yet re... more The restoration of endodontically treated teeth is a topic that is extensively studied and yet remains controversial from many perspectives. This article reviews the major pertinent literature on this topic, with an emphasis on major decision-making elements in post placement and restoration of endodontically treated teeth. Recommendations are made for treatment planning, materials, and clinical practices from restorative and endodontic perspectives. FIG 3. The mesial roots in mandibular molars tend to be thin mesiodistally and the canals often are curved. They are a poor choice for post placement.
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Papers - Reviews by Dr. Carlos San Martin D.