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1.	Olsson, Helena, et al. (författare) Dental pulp capping : effect of Emdogain Gel on experimentally exposed human pulps 2005 Ingår i: International Endodontic Journal. - : John Wiley & Sons. - 0143-2885 .- 1365-2591. ; 38:3, s. 186-194 Tidskriftsartikel (refereegranskat)abstract AIM: To investigate the effect of Emdogain Gel (Biora AB, Malmo, Sweden), consisting of a enamel matrix derivative (EMD) in a propylene glycol alginate (PGA) vehicle, on experimentally exposed human pulps and to register postoperative symptoms. METHODOLOGY: Nine pairs of contralateral premolars scheduled for extraction on orthodontic indications were included. Following a superficial pulp amputation performed with a small (016) diamond bur, either EMDgel or a mix of calcium hydroxide and sterile saline was placed at random in contact with the pulp wound. The subjects made records of symptoms and were also interviewed about pain/discomfort by a blinded examiner. After 12 weeks the teeth were extracted, prepared and subjected to light microscopic examination in which the inflammation and newly formed hard tissue in the pulp were analysed. Immunohistochemistry was performed using affinity-purified rabbit anti-EMD polyclonal antibodies. RESULTS: Postoperative symptoms were less frequent in the EMDgel-treated than in the calcium hydroxide-treated teeth, especially during the first six weeks. In the EMDgel-treated teeth, new tissue partly filled the space initially occupied by the gel and hard tissue was formed alongside the exposed dentine surfaces and in patches in the adjacent pulp tissue. EMD was detected in the areas where new hard tissue had been formed. The wound area of the EMDgel-treated teeth exhibited inflammation in the majority of the teeth whereas less inflammation was seen in the calcium hydroxide-treated teeth where the hard tissue was formed as a bridge. CONCLUSIONS: In the EMDgel-treated teeth, postoperative symptoms were less frequent and the amount and pattern of hard tissue formation were markedly different than in the teeth treated with calcium hydroxide. However, the operative procedure and the formulation with EMD in a PGA vehicle do not seem to be effective for the formation of a hard tissue barrier.
2.	Mejare, I. A., et al. (författare) Diagnosis of the condition of the dental pulp: a systematic review 2012 Ingår i: International Endodontic Journal. - : Wiley. - 0143-2885 .- 1365-2591. ; 45:7, s. 597-613 Tidskriftsartikel (refereegranskat)abstract Mejare IA, Axelsson S, Davidson T, Frisk F, Hakeberg M, Kvist T, Norlund A, Petersson A, Portenier I, Sandberg H, Tran ae us S, Bergenholtz G. Diagnosis of the condition of the dental pulp: a systematic review. International Endodontic Journal, 45, 597613, 2012. Abstract The aim of this systematic review was to appraise the diagnostic accuracy of signs/symptoms and tests used to determine the condition of the pulp in teeth affected by deep caries, trauma or other types of injury. Radiographic methods were not included. The electronic literature search included the databases PubMed, EMBASE, The Cochrane Central Register of Controlled Trials and Cochrane Reviews from January 1950 to June 2011. The complete search strategy is given in an Appendix S1 (available online as Supporting Information). In addition, hand searches were made. Two reviewers independently assessed abstracts and full-text articles. An article was read in full text if at least one of the two reviewers considered an abstract to be potentially relevant. Altogether, 155 articles were read in full text. Of these, 18 studies fulfilled pre-specified inclusion criteria. The quality of included articles was assessed using the QUADAS tool. Based on studies of high or moderate quality, the quality of evidence of each diagnostic method/test was rated in four levels according to GRADE. No study reached high quality; two were of moderate quality. The overall evidence was insufficient to assess the value of toothache or abnormal reaction to heat/cold stimulation for determining the pulp condition. The same applies to methods for establishing pulp status, including electric or thermal pulp testing, or methods for measuring pulpal blood circulation. In general, there are major shortcomings in the design, conduct and reporting of studies in this domain of dental research.
3.	Olsson, Helena, et al. (författare) Formation of a hard tissue barrier after pulp cappings in gumans. A systematic review 2006 Ingår i: International Endodontic Journal. - : Wiley. - 0143-2885 .- 1365-2591. ; 39:6, s. 429-442 Forskningsöversikt (övrigt vetenskapligt/konstnärligt)abstract Aim To evaluate the evidence on the formation of a hard tissue barrier after pulp capping in humans. Methodology A PubMed and CENTRAL literature search with specific indexing terms and a hand search were made. The authors assessed the level of evidence of each publication as high, moderate or low. Based on this, the evidence grade of the conclusions was rated as strong, moderately strong, limited or insufficient. Results The initial search process resulted in a total of 171 publications. After reading the abstracts and hand searching the reference lists of the retrieved publications, 107 studies were retrieved in full-text and interpreted. After the interpretation, 21 studies remained and were included in the systematic review and given a level of evidence. No study had a high level of evidence, one study had moderate and 20 studies had a low level of evidence. There was heterogeneity between the studies; therefore, no meta-analysis was performed. The majority of studies on pulp capping using calcium hydroxide based materials reported formation of hard tissue bridging, studies on other pulp capping materials such as bonding agents presented inferior results. The evidence grade was insufficient. Conclusions Insufficient evidence grade does not necessarily imply that there is no effect of a pulp capping procedure or that it should not be used. Rather, the insufficient evidence underpins the need for high-quality studies.
4.	Petersson, Arne, et al. (författare) Radiological diagnosis of periapical bone tissue lesions in endodontics: a systematic review 2012 Ingår i: International Endodontic Journal. - : Wiley. - 0143-2885 .- 1365-2591. ; 45:9, s. 783-801 Tidskriftsartikel (refereegranskat)abstract Petersson A, Axelsson S, Davidson T, Frisk F, Hakeberg M, Kvist T, Norlund A, Mejare I, Portenier I, Sandberg H, Tranaeus S, Bergenholtz G. Radiological diagnosis of periapical bone tissue lesions in endodontics: a systematic review. International Endodontic Journal, 45, 783801, 2012. Abstract This systematic review evaluates the diagnostic accuracy of radiographic methods employed to indicate presence/absence and changes over time of periapical bone lesions. Also investigated were the leads radiographic images may give about the nature of the process and the condition of the pulp in nonendodontically treated teeth. Electronic literature search included the databases PubMed, Embase and CENTRAL from January 1950 to June 2011. All languages were accepted provided there was an abstract in English. The MeSH terms were Cone beam computed tomography (CBCT), Radiography, panoramic, Periapical diseases, Dental pulp diseases, Sensitivity and specificity, receiver operating characteristics (ROC) curve, Cadaver, Endodontics and Radiography dental. Two reviewers independently assessed abstracts and full text articles. An article was read in full text if at least one of the two reviewers considered an abstract to be potentially relevant. Altogether, 181 articles were read in full text. The GRADE approach was used to assess the quality of evidence of each radiographic method based on studies of high or moderate quality. Twenty-six studies fulfilled criteria set for inclusion. None was of high quality; 11 were of moderate quality. There is insufficient evidence that the digital intraoral radiographic technique is diagnostically as accurate as the conventional film technique. The same applies to CBCT. No conclusions can be drawn regarding the accuracy of radiological examination in identifying various forms of periapical bone tissue changes or about the pulpal condition.
5.	af Geijersstam, AR, et al. (författare) Effect of E. faecalis on the release of serine proteases elastase and cathepsin G, and collagenase-2 (MMP-8) by human polymorphonuclear leukocytes (PMNs) 2005 Ingår i: International endodontic journal. - : Wiley. - 0143-2885 .- 1365-2591. ; 38:9, s. 667-677 Tidskriftsartikel (refereegranskat)
6.	Bjorndal, L., et al. (författare) Endodontic malpractice claims in Denmark 1995-2004 2008 Ingår i: International Endodontic Journal. - : Wiley. - 0143-2885 .- 1365-2591. ; 41:12, s. 1059-1065 Tidskriftsartikel (refereegranskat)
7.	Bjørndal, L, et al. (författare) The adoption of new endodontic technology amongst Danish general dental practitioners. 2005 Ingår i: International endodontic journal. - : Wiley. - 0143-2885 .- 1365-2591. ; 38:1, s. 52-8 Tidskriftsartikel (refereegranskat)abstract AIM: To assess the adoption of new endodontic technology in a population of Danish practitioners. METHODOLOGY: Members of the Copenhagen Dental Association (n = 1156) were approached with a questionnaire concerning the frequency of various endodontic procedures. Three options were available: often, occasionally and never. Responses were anonymous. The statistical analyses were performed as studies of association in two- or three-way contingency tables, and with Goodman-Kruskal's gamma-coefficient as the basic tool chosen. RESULTS: Only data from general practitioners (GPs) in private practice were analysed (n = 956). The response rate was 72%. NiTi hand instruments were often used to negotiate canals by 18%, whilst 10% often used NiTi rotary systems. Electronic apex locators were often employed by 15%. Nineteen per cent reported that warm gutta-percha was often used. A majority (53%) often spend two sessions to instrument a molar, and 20% often needed three or more sessions to finish the shaping phase. To complete a treatment of a nonvital case most practitioners reported to use at least three appointments. Only 4% frequently applied rubber dam. CONCLUSIONS: The adoption of new endodontic technology is at an early stage amongst Danish GPs. A new revised remuneration system might influence the rate of adoption, allowing the practitioners to act more rationally and produce a higher frequency of good-quality root fillings. Progress towards high quality endodontics might be hindered by the nonuse of rubber dam.
8.	Bjørndal, L, et al. (författare) The annual frequency of root fillings, tooth extractions and pulp-related procedures in Danish adults during 1977-2003. 2004 Ingår i: International endodontic journal. - : Wiley. - 0143-2885 .- 1365-2591. ; 37:11, s. 782-8 Tidskriftsartikel (refereegranskat)abstract AIM: To investigate a hypothesized long-time decrease of endodontic treatment in a population with low caries prevalence. METHODOLOGY: A Danish nationwide database including almost all dental diagnostic, prophylactic and therapeutic procedures performed in Danish adults was available. Data on the annual frequencies of root fillings, extractions, pulpotomies, direct pulp cappings and stepwise excavations between 1977 and 2003 were analysed. Data on pulpal and periapical diagnoses were not available and on patients age and gender only from 1996. RESULTS: Between 1977 and 2003 the annual number of root filled canals increased from 268,223 to 364,867 (36%). The annual number of root filled teeth increased from 160,119 to 191,803 (20%). During the period, the annually registered patients increased by 16%. Calculated per 1000 patients, the number of root fillings showed a statistically significant increase of 17%. In root filled teeth the canal/tooth ratio increased from 1.67 to 1.96. Root fillings were frequently recorded in all age groups with the bulk of treatments performed on patients between 40 and 60 years of age. At a total population level, the rate of root fillings decreased among younger individuals and increased among older. The annual number of tooth extractions was more than halved from 656,624 in 1977 to 346,490 in 2003. Pulpotomies decreased markedly over the period and less than 10 treatments per 1000 patients were noted for pulp capping as well as stepwise excavation procedures. CONCLUSIONS: The present study failed to show a long-time decrease of endodontic treatment in a population with low caries prevalence. On the contrary, an increase of root filled canals was observed between 1977 and 2003, which was probably due to a reduction of the tooth extraction rate and an increased treatment of multi-rooted teeth.
9.	Chávez de Paz, Luis Eduardo, et al. (författare) Response to alkaline stress by root canal bacteria in biofilms 2007 Ingår i: International Endodontic Journal. - : Wiley. - 0143-2885 .- 1365-2591. ; 40:5, s. 344-355 Tidskriftsartikel (refereegranskat)abstract To determine whether bacteria isolated from infected root canals survive alkaline shifts better in biofilms than in planktonic cultures. METHODOLOGY: Clinical isolates of Enterococcus faecalis, Lactobacillus paracasei, Olsenella uli, Streptococcus anginosus, S. gordonii, S. oralis and Fusobacterium nucleatum in biofilm and planktonic cultures were stressed at pH 10.5 for 4 h, and cell viability determined using the fluorescent staining LIVE/DEAD BacLight bacterial viability kit. In addition, proteins released into extracellular culture fluids were identified by Western blotting. RESULTS: Enterococcus faecalis, L. paracasei, O. uli and S. gordonii survived in high numbers in both planktonic cultures and in biofilms after alkaline challenge. S. anginosus, S. oralis and F. nucleatum showed increased viability in biofilms compared with planktonic cultures. Alkaline exposure caused all planktonic cultures to aggregate into clusters and resulted in a greater extrusion of cellular proteins compared with cells in biofilms. Increased levels of DnaK, HPr and fructose-1,6-bisphosphate aldolase were observed in culture fluids, especially amongst streptococci. CONCLUSIONS: In general, bacteria isolated from infected roots canals resisted alkaline stress better in biofilms than in planktonic cultures, however, planktonic cells appeared to use aggregation and the extracellular transport of specific proteins as survival mechanisms.
10.	Chávez de Paz, Luis, 1974, et al. (författare) Gram-positive rods prevailing in teeth with apical periodontitis undergoing root canal treatment. 2004 Ingår i: International endodontic journal. - : Wiley. - 0143-2885 .- 1365-2591. ; 37:9, s. 579-87 Tidskriftsartikel (refereegranskat)abstract AIMS: To identify Gram-positive rods from root canals of teeth with apical periodontitis and to examine their associations with other species. METHODOLOGY: Consecutive root canal samples (RCSs) from 139 teeth undergoing root canal treatment were analyzed prospectively for cultivable microbes. Gram-positive rods in the first RCS submitted after chemo-mechanical preparation were categorised to genus level by selective media and gas-liquid chromatography (GLC), and identified to species level by sodium dodecyl sulphate-polyacrylamide gel electrophoresis (SDS-PAGE). Associations between organisms were measured by odds ratios (OR). RESULTS: In the first samples submitted a total of 158 Gram-positive rods, 115 Gram-positive cocci, 26 Gram-negative rods and 9 Gram-negative cocci, were identified. At genus levels Gram-positive rods were classified into: Lactobacillus spp. (38%), Olsenella spp. (18%), Propionibacterium spp. (13%), Actinomyces spp. (12%), Bifidobacterium spp. (13%) and Eubacterium spp. (6%). The most frequent species were Olsenella uli, Lactobacillus paracasei and Propionibacterium propionicum. In subsequent samples taken during treatment, Gram-positive rods were also identified, although the number of strains was considerably reduced. Positive associations were observed between members of the genus lactobacilli and Gram-positive cocci (OR>2). CONCLUSIONS: Olsenella uli and Lactobacillus spp. predominated over other Gram-positive rods. A possible association exists between Lactobacillus spp. and Gram-positive cocci in root canals of teeth with apical periodontitis receiving treatment.
11.	Chávez de Paz, Luis, 1974, et al. (författare) Response to alkaline stress by root canal bacteria in biofilms. : Viability and mechanisms of response to alkaline stress by selected root canal bacteria. 2007 Ingår i: International endodontic journal. - : Wiley. - 0143-2885 .- 1365-2591. ; 40:5, s. 344-55 Tidskriftsartikel (refereegranskat)abstract AIM: To determine whether bacteria isolated from infected root canals survive alkaline shifts better in biofilms than in planktonic cultures. METHODOLOGY: Clinical isolates of Enterococcus faecalis, Lactobacillus paracasei, Olsenella uli, Streptococcus anginosus, S. gordonii, S. oralis and Fusobacterium nucleatum in biofilm and planktonic cultures were stressed at pH 10.5 for 4 h, and cell viability determined using the fluorescent staining LIVE/DEAD BacLight bacterial viability kit. In addition, proteins released into extracellular culture fluids were identified by Western blotting. RESULTS: Enterococcus faecalis, L. paracasei, O. uli and S. gordonii survived in high numbers in both planktonic cultures and in biofilms after alkaline challenge. S. anginosus, S. oralis and F. nucleatum showed increased viability in biofilms compared with planktonic cultures. Alkaline exposure caused all planktonic cultures to aggregate into clusters and resulted in a greater extrusion of cellular proteins compared with cells in biofilms. Increased levels of DnaK, HPr and fructose-1,6-bisphosphate aldolase were observed in culture fluids, especially amongst streptococci. CONCLUSIONS: In general, bacteria isolated from infected roots canals resisted alkaline stress better in biofilms than in planktonic cultures, however, planktonic cells appeared to use aggregation and the extracellular transport of specific proteins as survival mechanisms.
12.	Diamanti, E., et al. (författare) Endoplasmic reticulum stress and mineralization inhibition mechanism by the resinous monomer HEMA 2013 Ingår i: International Endodontic Journal. - : Wiley-Blackwell. - 0143-2885 .- 1365-2591. ; 46:2, s. 160-168 Tidskriftsartikel (refereegranskat)abstract AIM: To investigate the expression of two endoplasmic reticulum (ER)-resident key chaperone proteins, ERdj5 and BiP, under the influence of resinous monomers and its relationship with the inhibition of mineralization caused by the monomer 2-hydroxyethyl methacrylate (HEMA).METHODOLOGY: The ERdj5 and BiP expression was studied in vitro, in primary human pulp cell cultures after treatment with three different HEMA concentrations at different time periods. Subsequently, the expression of both the odontoblast markers dentine sialoprotein (DSP) and osteonectin (OSN) was studied in human pulp cells under the same conditions.RESULTS: The ERdj5 and BiP expression was upregulated in the pulp cells. DSP and OSN were largely dispersed in the cytoplasm in control cell cultures but accumulated in a perinuclear area after exposure to HEMA. Their expression levels were not affected.CONCLUSIONS: The increased expression of ERdj5 and BiP may reflect activation of ER stress. DSP and OSN accumulation into the cells may lead to their secretion arrest and inhibition of dentine matrix formation. These events may elucidate the mechanism by which HEMA inhibits the mineralization process.
13.	Eckerbom, M, et al. (författare) A 20-year follow-up study of endodontic variables and apical status in a Swedish population 2007 Ingår i: International Endodontic Journal. - : Wiley-Blackwell. - 0143-2885 .- 1365-2591. ; 40:12, s. 940-948 Tidskriftsartikel (refereegranskat)abstract AIM: To re-examine a population after 20 years and evaluate changes in prevalence of endodontic treatment and apical periodontitis, as well as the technical quality of root fillings.METHODOLOGY: One hundred and fifteen out of an original 200 patients living in the northern part of Sweden were re-examined with a full mouth radiographic survey after 20 years. Frequencies of root canal treated teeth, apical periodontitis and quality parameters of root fillings were registered.RESULTS: The frequency of root canal treated teeth increased significantly (P < 0.05) from 13.9% at the first investigation to 17.7% after 20 years. There was also a statistically significant increase (P < 0.05) in teeth with apical periodontitis from 3.3% to 6.8%. Apical periodontitis both in connection with root canal treated teeth and teeth without endodontic treatment, had increased during the follow-up period. Even though the quality of the root fillings had improved, there was no corresponding improvement of the apical status in teeth with root fillings.CONCLUSIONS: There is still a great need for endodontic treatment in the Swedish population, and no improvement in apical health was found during this 20-year follow up.
14.	Fransson, Helena, et al. (författare) Dentine sialoprotein and Collagen I expression after experimental pulp capping in humans using Emdogain(R) Gel 2011 Ingår i: International Endodontic Journal. - : John Wiley & Sons. - 0143-2885 .- 1365-2591. ; 44:3, s. 259-267 Tidskriftsartikel (refereegranskat)abstract Aim To characterize the hard tissue formed in human teeth experimentally pulp capped either with calcium hydroxide or with Emdogain®Gel (Biora AB, Malmö, Sweden) – , a derivative of enamel matrix (EMD), using two markers for dentine; dentine sialoprotein (DSP) and type 1 collagen (Col I). Formation of hard tissue following pulp capping in these teeth has previously been observed and reported. Methodology Affinity-purified rabbit anti-Col I and anti-DSP polyclonal antibodies were used to stain histological sections from 9 pairs of contra-lateral premolars, that had been experimentally pulp amputated and randomly capped with EMDgel or calcium hydroxide. The teeth were extracted 12 weeks after being pulp capped. Results In the calcium hydroxide treated teeth DSP was seen in the new hard tissue which formed a bridge. DSP was also seen in the newly formed hard tissue in the EMDgel treated teeth. Proliferated pulp tissue partly filled the space initially occupied by EMDgel and DSP-stained hard tissue was observed alongside exposed dentine surfaces as well as in isolated masses within the proliferated pulp tissue, although the new hard tissue did not cover the pulp exposure. DSP staining was also seen in the cells lining the hard tissue in both groups. Col I staining was seen in the newly formed hard tissue in both groups. Conclusions The new hard tissue formed after pulp capping with EMDgel or calcium hydroxide contained DSP and Col I, considered to be markers for dentine.
15.	Frisk, Fredrik, 1971, et al. (författare) A 24-year follow-up of root filled teeth and periapical health amongst middle aged and elderly women in Göteborg, Sweden. 2005 Ingår i: International endodontic journal. - : Wiley. - 0143-2885 .- 1365-2591. ; 38:4, s. 246-54 Tidskriftsartikel (refereegranskat)abstract AIM: To describe the endodontic status amongst middle-aged and elderly women longitudinally and cross-sectionally over 24 years. METHODOLOGY: A random sample of 1462 women 38, 46, 50, 54 and 60 years old, living in Göteborg, Sweden, were sampled in 1968 for medical and dental examinations with a participation rate of 90.1%. The same women were re-examined in 1980 and 1992 together with new 38- and 50-year-old women. The dental examination consisted of questionnaires, clinical and panoramic radiological survey (OPG). The number of teeth, number of root filled teeth (RF) and number of teeth with periapical radiolucencies (PA) were registered. The RF and PA ratios were calculated. Cross-sectional data were analysed by means of anova and longitudinal data by a general linear model for repeated measures. Sample prevalences were compared and statistical inferences were made with the chi-squared test. In all analysis, the confidence interval (CI) regarded mean difference between groups (95% CI). RESULTS: The RF and PA ratio decreased over time as well as the frequency of edentulous subjects. Cross-sectional analysis revealed a minor increase in frequency of RF and PA and loss of teeth with age. Longitudinally, loss of teeth was evident in all cohorts. In addition, there was a trend of lower number of teeth with PA, and the RF ratio increased with age. CONCLUSIONS: The prevalence of periapical disease did not increase with age, probably as a result of root canal treatment and extractions. Data showed that the prevalence of RF teeth and teeth with PA decreased for comparable age cohorts during the 24-year follow-up.
16.	Frisk, Fredrik, 1971, et al. (författare) Technical quality of root fillings and periapical status in root filled teeth in Jönköping, Sweden. 2008 Ingår i: International endodontic journal. - : Wiley. - 1365-2591 .- 0143-2885. ; 41:11, s. 958-68 Tidskriftsartikel (refereegranskat)abstract AIM: To study changes in technical quality of root fillings and periapical status in root filled teeth in random samples of 20 to 70 year-olds between 1973 and 2003. METHODOLOGY: Data from dentate subjects aged 20-70 years from examinations conducted in 1973 (n = 498), 1983 (n = 530), 1993 (n = 547) and 2003 (n = 491) were used for the analysis. Length of root fillings were measured on radiographs to the nearest 0.1 mm. Adequate seal was defined as a root filling without lateral and/or apical voids. Periapical status was assessed according to the periapical index. All observations were made by one calibrated observer registered from full mouth radiographic examinations. Teeth with root fillings ending within the canal without lateral or apical voids were considered adequate. The association between root filling quality and periapical status was analysed by means of the Chi-squared test and a multilevel logistic regression analysis. RESULTS: Adequately root filled teeth had a significantly lower frequency of apical periodontitis than inadequately root filled teeth (11.8% vs. 22.8%). The frequency of technically adequate root fillings increased statistically significant from 1973 (23.7%) to 2003 (36.4%) without a concomitant improvement of the periapical status in root filled teeth over time (24.5% vs. 24.6%). CONCLUSIONS: This study reports on an improving technical quality of root fillings over time, without a concomitant improvement of the periapical status in root filled teeth. A larger proportion of treated molars over time may be of importance for the result.
17.	Jonasson, P., et al. (författare) A preliminary study on the technical feasibility and outcome of retrograde root canal treatment 2008 Ingår i: International Endodontic Journal. - : Wiley. - 0143-2885 .- 1365-2591. ; 41:9, s. 807-813 Tidskriftsartikel (refereegranskat)
18.	Koch, Margaretha, et al. (författare) A cost-minimization analysis of root canal treatment before and after education in nickel-titanium rotary technique in general practice 2012 Ingår i: International Endodontic Journal. - : Wiley. - 0143-2885 .- 1365-2591. ; 45:7, s. 633-641 Tidskriftsartikel (refereegranskat)abstract AIM:To compare root canal treatments performed before and after education in a nickel-titanium rotary technique (NiTiR) with respect to costs for instrumentation and number of instrumentation sessions in a County Public Dental Service in Sweden.METHODOLOGY: Following education, 77% of the general dental practitioners adopted completely the NiTiR. The randomly selected sample comprised 850 root canal treatments: 425 performed after the education, mainly using the NiTiR-technique (group A) and 425 performed before, using mainly stainless steel hand instrumentation (SSI) (group B). The number of instrumentation sessions in root canal treatments in group A and B was calculated. A CMA was undertaken on the assumption that treatment outcome was identical in group A and B. Direct costs associated with SSI and NiTiR were estimated and compared. Investment costs required for implementation of NiTiR were calculated, but not included in the CMA.RESULTS:Instrumentation sessions were counted in 418 (98%) root canal treatments performed in group A and 419 (99%) in group B. The number of instrumentation sessions in group A was significantly lower; 2.38, compared with 2.82 in group B (P < 0.001). Thus, on average, for every second root canal treatment performed after the education, one instrumentation session was saved. Root canal treatments in teeth with one canal, and three or more canals, were completed in significantly fewer instrumentation sessions after the education (P < 0.001). Direct costs of instrumentation sessions were SEK 2587 (USD 411) for group A and SEK 2851 (USD 453) for group B, for teeth with one canal, and SEK 2946 (USD 468) for group A and SEK 3510 (USD 558) for group B, for teeth with three or more canals (year 2011). Root canal treatments of teeth with two canals showed no significant difference with respect to number of instrumentation sessions and costs.CONCLUSIONS:Significantly fewer instrumentation sessions were required in group A, and root canal instrumentation therefore costs less than in group B. On the assumption that treatment outcome is identical in group A and B, root canal instrumentation performed after the education was more cost-effective.
19.	Koch, M, et al. (författare) Effect of educational intervention on adoption of new endodontic technology by general dental practitioners : a questionnaire survey 2009 Ingår i: International Endodontic Journal. - : Wiley. - 0143-2885 .- 1365-2591. ; 42:4, s. 313-321 Tidskriftsartikel (refereegranskat)abstract To survey the clinical endodontic protocols of general dental practitioners (GDPs) in public dental clinics and to assess the effect of an educational intervention on the adoption of a nickel-titanium (Ni-Ti) rotary system. General dental practitioners in a Swedish Intervention County (IC), underwent an educational programme in endodontics. A follow-up questionnaire was posted to 98 GDPs in the IC and to 97 GDPs in a Control County (CC), where no specific training had been provided. The questionnaire concerned demographics, clinical endodontic protocols and instrumentation techniques. The response rate to the questionnaire was 87%. More than 90% of all GDPs reported they always or generally used rubber dam, determined working length, used the canal irrigant 0.5% buffered NaOCl and calcium hydroxide as an interappointment dressing. Two of three GDPs reported, they generally or always informed the patient of the prognosis. Every second GDP reported routines for postoperative recall and follow-up. The Ni-Ti rotary technique was reported to be completely adopted by 77% of the GDPs in the IC, significantly higher than in the CC (6%), P < 0.001. In the IC 79% of the GDPs reported they completed instrumentation in one treatment session, compared with only 32% in the CC, P < 0.001. The 'single-cone' mode of canal filling was reported to be significantly more frequent amongst GDPs in the IC, P < 0.001. General dental practitioners in both counties reported using contemporary clinical endodontic protocols. GDPs who had undergone an educational programme in Ni-Ti rotary instrumentation reported they had successfully integrated the technique into daily clinical practice.
20.	Laustsen, M H, et al. (författare) A temporary filling material may cause cusp deflection, infractions and fractures in endodontically treated teeth. 2005 Ingår i: International endodontic journal. - : Wiley. - 0143-2885 .- 1365-2591. ; 38:9, s. 653-7 Tidskriftsartikel (refereegranskat)abstract AIM: To test the hypothesis that Coltosol F might cause infractions and cusp fracture in root-filled teeth because of material expansion. METHODOLOGY: Thirty-two extracted human molar teeth were root filled and prepared with mesial-occlusal-distal (MOD) cavities with or without undercuts. The specimens were filled proximally with glass-ionomer cement and then occlusally with either Coltosol F or zinc oxide eugenol (ZOE). The tooth specimens were kept in water at 37 degrees C for a period of 20 days, and every second day the intercusp distance (ICD) of each specimen was measured in a travelling microscope, and the number of infraction lines as well as fractures were noted. RESULTS: The number of infraction lines increased in teeth filled with Coltosol F. Between day 8 and 16, seven of 16 teeth filled with Coltosol F showed fracture and exhibited a mean increase in ICD of 316 +/- 156 microm. Teeth filled with ZOE did not show an increase in number of infraction lines or in ICD, and none showed fracture. CONCLUSIONS: The hygroscopic expansion of Coltosol F in a cavity may lead to cusp deflection, infraction development and fracture. Masticatory forces will in vivo aggravate this unfavourable condition. The material is not recommended for temporary filling in root-filled teeth except for a few days.
21.	Laustsen, M.H., et al. (författare) Root canal treatment in Denmark is most often carried out in carious vital molar teeth and retreatments are rare 2006 Ingår i: INTERNATIONAL ENDODONTIC JOURNAL. - : Wiley. - 0143-2885 .- 1365-2591. ; 39:10, s. 785-790 Tidskriftsartikel (refereegranskat)
22.	Molander, Anders, 1951, et al. (författare) Improved quality of root fillings provided by general dental practitioners educated in nickel-titanium rotary instrumentation. 2007 Ingår i: International endodontic journal. - : Wiley. - 0143-2885 .- 1365-2591. ; 40:4, s. 254-60 Tidskriftsartikel (refereegranskat)abstract AIM: To test the hypothesis that an increased utilization of nickel-titanium rotary instrumentation (NTRI) by general dental practitioners will lead to an increased frequency of good quality root fillings. A second aim was to determine whether the educational format would exert influence on the quality. METHODOLOGY: Dentists were assigned at random to three intervention groups: a 4-h lecture (L-group, n = 40); a 4-h lecture plus a full day hands-on course (LH-group, n = 40); or a control group receiving no instruction (n = 68). The control group received education later on in the study. Radiographs of two root filled molar teeth per dentist were selected at random before the start of the education program and after a 6-month clinical learning period. Using length, seal and shape of root-fillings a 5-level variable was created. RESULTS: The rate of good quality root fillings increased after the introduction of NTRI. Calculated over all types of roots the frequency of excellent (score 1) root fillings increased from 31% to 51% (P = 0.006) in the L-group and from 27% to 47% (P = 0.016) in the LH-group. The frequency of low quality root-fillings (score 5) dropped in the L-group from 22% to 16% (P = 0.29) and in the LH-group from 13% to 9% (P = 0.48). No statistically significant difference was seen among the controls. CONCLUSIONS: When NTRI technology replaced manual stainless steel techniques the rate of good quality root fillings increased. A significant drop in the rate of low quality root fillings was not found.
23.	Nakamura, Y, et al. (författare) The induction of reparative dentine by enamel proteins 2002 Ingår i: International endodontic journal. - : Wiley. - 0143-2885 .- 1365-2591. ; 35:5, s. 407-417 Tidskriftsartikel (refereegranskat)
24.	Pigg, Maria, et al. (författare) Diagnostic yield of conventional radiographic and cone-beem computed tomographic images in patients with atypical odontalgia 2011 Ingår i: International Endodontic Journal. - : John Wiley & Sons. - 0143-2885 .- 1365-2591. ; 12:44, s. 1092-1101 Tidskriftsartikel (refereegranskat)abstract Abstract AIM: To investigate whether the additional diagnostic yield of a cone-beam computed tomography (CBCT) examination over conventional radiographs in patients primarily suspected of having atypical odontalgia (AO) improves differentiation between AO and symptomatic apical periodontitis (SAP) in patients with severe chronic intraoral pain. METHODOLOGY: In this clinical study, 25 patients (mean age 54 ± 11 years, range 34-72) participated; 20 were diagnosed with AO and 5 with SAP. All patients were recruited from the clinics of the Faculty of Odontology, Malmö University. AO inclusion criteria were chronic pain (>6 months) in a region where a tooth had been endodontically or surgically treated, with no pathological cause detectable in clinical or radiologic examinations. SAP inclusion criteria were recurrent pain from a tooth diagnosed with apical periodontitis in clinical and radiographic examinations. Assessments comprised a self-report questionnaire on pain characteristics, a comprehensive clinical examination and a radiographic examination including panoramic and intraoral radiographs and CBCT images. The main outcome measure was periapical bone destruction. RESULTS: Sixty per cent of patients with AO had no periapical bone destructions detectable with any radiographic method. Overall, CBCT rendered 17% more periapical bone destructions than conventional radiography. Average pain intensity in patients with AO was 5.6 (± 1.8) on a 0-10 numerical rating scale, and average pain duration was 4.3 (± 5.2) years. CONCLUSION: Cone-beam computed tomography improves identification of patients without periapical bone destruction, which may facilitate differentiation between AO and SAP.
25.	Reit, C, et al. (författare) Surgical endodontic retreatment 1986 Ingår i: International Endodontic Journal. - : Wiley. - 0143-2885 .- 1365-2591. ; 19:3, s. 107-112 Tidskriftsartikel (refereegranskat)abstract In teeth with periapical lesions and defective root canal seals non-surgical retretment is usually preferred. Sometimes, howeve, such treatment may not be feasible and periapical surgery must be performed. The present study investigated a technique of retrograde root canal treatment as an alternative to the more conventional types of surgical procedure. The material consisted of 35 teeth whose root canals contained posts. In 77 percent of the cases it was possible to instrument and obturate the root canal up to the post. Following treatment the periapical tissues, as evaluated clinically and radiographically, showed evidence of having healed in 71 per cent of cases.
26.	Reit, Claes, 1946, et al. (författare) The effect of educational intervention on the adoption of nickel-titanium rotary instrumentation in a Public Dental Service. 2007 Ingår i: International endodontic journal. - : Wiley. - 0143-2885 .- 1365-2591. ; 40:4, s. 268-74 Tidskriftsartikel (refereegranskat)abstract AIM: To study the influence of two educational programmes on the adoption of nickel-titanium rotary instrumentation (NTRI) amongst general dental practitioners in a short-term as well as a long-term perspective. METHODOLOGY: All dentists employed in the Gothenburg Dental service (n = 148) were enrolled in the study. The clinics in the organization were randomly assigned to one of two educational programmes. In the first programme a 4-h lecture on root canal instrumentation was given. In the second programme the lecture course was supplemented by a 6-h hands-on training session. The short-term effect was measured by a questionnaire distributed 6 months after completed education. The long-term effect was evaluated 4 years later. RESULTS: The overall utilization rate of NTRI increased from 4% to 73%. However, lectures in combination with hands-on training resulted in a better short-term acceptance rate (94%) than if teaching was given only in lecture-format (53%) (P = 0.000). As a consequence, all staff were offered hands-on training. The long-term adoption rate was 88%. Reasons for accepting the new technology usually were found within the 'relative advantage' category. Common reasons for dentists not to adopt NTRI were that they could not get started or that they found no advantage over the old technology. CONCLUSIONS: The short-term adoption of a new technology might be influenced by the design of an introductory educational programme. For clinical procedures, such as root canal instrumentation, the inclusion of hands-on training sessions seems to be important to reach a high acceptance rate.
27.	Ali, IAA, et al. (författare) The influence of substrate surface conditioning and biofilm age on the composition of Enterococcus faecalis biofilms 2020 Ingår i: International endodontic journal. - : Wiley. - 1365-2591 .- 0143-2885. ; 53:1, s. 53-61 Tidskriftsartikel (refereegranskat)
28.	Antunes, T. B. M., et al. (författare) Heating stability, physical and chemical analysis of calcium silicate‐based endodontic sealers 2021 Ingår i: International Endodontic Journal. - : John Wiley & Sons. - 0143-2885 .- 1365-2591. ; 54:7, s. 1175-1188 Tidskriftsartikel (refereegranskat)abstract Aim: To evaluate possible modifications in root canal sealers subjected to a variety of heating conditions using vibrational spectroscopy and analysis of physical and chemical properties.Methodology: EndoSequence BC Sealer HiFlow, Bio-C Sealer, BioRoot RCS and AH Plus were analysed chemically using Raman spectroscopy (25–220 °C) and Fourier-transform infrared spectroscopy (FT-IR) (37–100 °C ). For FT-IR, the materials were tested individually and mixed with root dentine powder. Scanning electron microscopy (SEM) and coupled energy dispersive spectroscopy (EDS) were used to evaluate surface and chemical elements. ISO 6876-2012 and ASTM-C266-07 specifications were followed to evaluate flow, setting time (moist and dry), solubility and radiopacity. Also, pH analysis at 37 and 100 °C was performed. Shapiro–Wilk and Mixed ANOVA (within and between the effects of the subjects), Levene, and a post hoc analyses with Bonferroni correction were performed (P < 0.05).Results: Vibrational spectroscopy revealed peaks of tricalcium silicate, dicalcium silicate and zirconium dioxide. Chemical changes in the Raman spectra during heating were discrete, as the inorganic content predominated the signalling for all root canal sealers. FT-IR analysis exhibited spectral changes in water absorption for EndoSequence BC Sealer HiFlow and Bio-C Sealer, probably related to dehydration. For BioRoot RCS and AH Plus, no significant chemical changes were observed. Bio-C Sealer exhibited a band of polyethylene glycol only after heating to 100 °C, probably related to its thermal decomposition. SEM/EDS analysis corroborated the composition results observed in vibrational spectroscopy for all materials. Heating to 100 °C significantly changed the flowability of all calcium silicate-based sealers with a wide variation in setting times at both temperatures, along with solubility levels above ISO standards. For all tested sealers, radiopacity fulfilled the requirements, and pH exhibited alkaline values.Conclusions: The tested calcium silicate-based sealers were affected by heating. Calcium silicate-based root canal sealers had high solubility which is a concern for their clinical use. AH Plus was the only root canal sealer that was stable after heating.
29.	Bergenholtz, Gunnar, 1939, et al. (författare) Call for improved research efforts on clinical procedures in endodontics 2013 Ingår i: International Endodontic Journal. - : Wiley. - 0143-2885 .- 1365-2591. ; 46:8, s. 697-699 Tidskriftsartikel (refereegranskat)
30.	Brundin, Malin, 1972-, et al. (författare) Preservation of Fusobacterium nucleatum and Peptostreptococcus anaerobius DNA after loss of cell viability 2015 Ingår i: International Endodontic Journal. - : Wiley-Blackwell. - 0143-2885 .- 1365-2591. ; 48:1, s. 37-45 Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)abstract Aim: To investigate whether DNA from two obligate anaerobes, Fusobacterium nucleatum and Peptostreptococcus anaerobius, is recoverable after loss of cell viability induced by air exposure. Methodology: Harvested cultures of F. nucleatum and P. anaerobius were killed by exposure to air and stored in phosphate-buffered saline. Dead cells were incubated aerobically for up to 6 months. Every month, the presence of detectable DNA in the cell pellet and supernatant was assessed by conventional and quantitative PCR. Cell staining techniques were used to characterize the cell wall permeability of air-killed cells. Scanning electron microscopy was used to examine viable, freshly killed and stored cells. Results: With conventional PCR, amplifiable DNA was detectable over 6 months in all samples. Quantitative PCR showed a progressive fall in DNA concentration in nonviable cell pellets and a concomitant rise in DNA concentration in the supernatant. DNA staining showed that some air-killed cells retained an intact cell wall. After storage, SEM of both air-killed species revealed shrivelling of the cells, but some cells of P. anaerobius retained their initial form. Conclusion: Amplifiable DNA from F. nucleatum and P. anaerobius was detectable 6 months after loss of viability. Air-killed anaerobes initially retained their cell form, but cells gradually shriveled over time. The morphological changes were more pronounced with the gram-negative F. nucleatum than the gram-positive P. anaerobius. Over 6 months, there was a gradual increase in cell wall permeability with progressive leakage of DNA. Bacterial DNA was recoverable long after loss of cell viability.
31.	Chavez de Paz, Luis E., et al. (författare) Strains of Enterococcus faecalis differ in their ability to coexist in biofilms with other root canal bacteria 2015 Ingår i: International Endodontic Journal. - : Wiley. - 0143-2885 .- 1365-2591. ; 48:10, s. 916-925 Tidskriftsartikel (refereegranskat)abstract AimTo investigate the relationship between protease production and the ability of Enterococcus faecalis strains to coexist in biofilms with other bacteria commonly recovered from infected root canals. MethodologyBiofilms with bacteria in mono-, dual- and four-species communities were developed in flow chambers. The organisms used were Lactobacillus salivarius, Streptococcus gordonii and Actinomyces naeslundii and E.faecalis strains, GUL1 and OG1RF. Biovolume and species distribution were examined using 16S rRNA fluorescence insitu hybridization in combination with confocal microscopy and image analysis. The full proteome of the E.faecalis strains was studied using two-dimensional gel electrophoresis. Spots of interest were identified using tandem mass spectroscopy and quantified using Delta 2D software. ResultsAll bacteria formed biofilms and an anova analysis revealed that the biofilm biomass increased significantly (P0.01) between 6 and 24h. L.salivarius, S.gordonii and A.naeslundii formed mutualistic biofilm communities, and this pattern was unchanged when E.faecalis GUL1 was included in the consortium. However, with OG1RF, L.salivarius and S.gordonii were outcompeted in a 24-h biofilm. Proteomic analysis revealed that OG1RF secreted higher levels of proteases, GelE (P=0.02) and SprE (P=0.002) and a previously unidentified serine protease (P=0.05), than GUL1. ConclusionsDifferent strains of E.faecalis can interact synergistically or antagonistically with a consortium of root canal bacteria. A possible mechanism underlying this, as well as potential differences in virulence, is production of different levels of proteases, which can cause detachment of neighbouring bacteria and tissue damage.
32.	Dahlström, Lisbeth, 1962, et al. (författare) “It′s good enough”: Swedish general dental practitioners on reasons for accepting sub-standard root filling quality 2018 Ingår i: International Endodontic Journal. - : Wiley. - 0143-2885 .- 1365-2591. ; 51:S3 Tidskriftsartikel (refereegranskat)abstract Aim The concept of “good enough” is central and necessary in the assessment of root filling quality. The aim was to explore the concept by analysing reasons and arguments for the acceptance or rejection of substandard root filling quality as reported by GDPs in Sweden. Methodology The study was designed as a qualitative and exploratory study based on seven videotaped focus group interviews analysed by means of qualitative content analysis. Thirty-three general dental practitioners (GDPs) employed in the Public Dental Health Service in Gothenburg, Sweden, participated (4-6 GDPs/interview). In all nine predetermined questions were followed. Before each focus group, the participants received radiographs of 37 root fillings and were asked to assess the root filling quality. The three cases representing the most divergent assessments served as a basis for the discussion. The cases were presented without clinical information, the dentists would relate to the cases as being just root filled by themselves. Results The radiographs did not provide a sufficient basis for decisions on whether or not to accept the root filling. The present study emphasised that dentists did not primarily look for these arguments in the technical details of the root filling per se but instead they considered selected features of the contextual situation. The GDPs constantly introduced relevant “ad hoc considerations” in order to account for the decisions they made. These contextual considerations were related to aspects of pulpal and periapical disease, risks (e.g. technical complications) or to consumed resources (personal and/or economic). Conclusions It was obvious that the concept of “good enough” does not exist as a general formula ready to be applied in particular situations. Instead, it is necessarily and irremediably tied to contextual properties that emerge from case to case.
33.	Dahlström, Lisbeth, 1962, et al. (författare) "Working in the dark”: Swedish general dental practitioners on the complexity of root-canal treatment 2017 Ingår i: International Endodontic Journal. - : Wiley. - 0143-2885 .- 1365-2591. ; 50:7 Tidskriftsartikel (refereegranskat)abstract Aim: To explore elements of reasoning and understanding that might obstruct the performance of good-quality root canal treatment (RCT) and make general dental practitioners (GDPs) produce and accept root fillings of inferior quality. Methodology: The study was designed as a qualitative and explorative study based on seven videotaped focus group interviews analysed by means of qualitative content analysis. Nine predetermined questions were followed. Thirty-three GDPs (4–6 dentists/interview), employed in the Public Dental Health Service in Gothenburg, Sweden, participated. Results: Feelings such as anxiety, frustration, stress or exhaustion were associated with RCT. In general, RCT was regarded as complex, mysterious and embedded in uncertainty. A feeling of loss of control was frequently described in relation to all procedural steps from negotiating the canal to prognostic deliberations. Reasons could include challenging canals, complicated instruments and the fact that treatment had to be performed in a concealed space without visible insight. Several dentists questioned the requirements for correctly performing RCT, and some indicated that striving towards optimal technical root filling quality should not be expected in each case in general practice. Most of the GDPs were unable to complete a case within the remuneration system, and they therefore either spent more time than the set fee allowed for or accepted a suboptimal root filling when the time limit was reached. Conclusions: High levels of stress and frustration in relation to RCT were reported by the GDPs. RCT was regarded as complex and was often performed with an overall sense of lack of control.
34.	Dawson, Victoria, et al. (författare) Coronal restoration of the root filled tooth - a qualitative analysis of the dentists' decision-making process 2021 Ingår i: International Endodontic Journal. - : Wiley. - 0143-2885 .- 1365-2591. ; 54:4, s. 490-500 Tidskriftsartikel (refereegranskat)abstract Aim To describe the decision-making process of the general dental practitioner (GDP) underlying the choice of coronal restoration of a root filled tooth. Methodology GDPs were strategically selected with respect to gender, age, undergraduate dental school, service affiliation and duration of professional experience. Semistructured in-depth interviews were conducted, focusing on the informant's personal experience of the process which leads to a decision as to how to restore a root filled tooth. The informants were invited to describe in their own words the latest two cases involving decisions of direct or full crown restorations respectively. The interviews were digitally recorded and transcribed verbatim. Interviews from 14 informants, aged 27-64 (mean age 46 years), were included and analysed according to Qualitative Content Analysis. Results A theme (latent content) was identified: Clinical factors were considered important but were overruled by context and patient opinions, if in conflict. Three main categories, including seven subcategories (manifest content), were identified. The categories were clinical factors, contextual factors and patient's views. Clinical factors underlying the GDPs' decision included the current dental status and the estimated longevity of the intended restoration. In certain cases, contextual factors were also of importance, either supporting the GDPs' decision or modifying it. However, the patient's views played a decisive role in the final choice of coronal restoration, leading to either mutual acceptance or a compromise, taking into account the patient's economic status and opinions. Conclusions With respect to coronal restoration of a root filled tooth, the GDPs' decision-making process was based not only on clinical factors, but also on decisive contextual factors and consideration of the patients' views.
35.	Dawson, Victoria, et al. (författare) Endodontic complications in teeth with vital pulps restored with composite resins : a systematic review 2015 Ingår i: International Endodontic Journal. - : John Wiley & Sons. - 0143-2885 .- 1365-2591. ; 48:7, s. 627-638 Forskningsöversikt (refereegranskat)abstract Composite resin is used extensively for restoration of teeth with vital pulps. Although cell culture studies have disclosed harmful effects on pulpal cells, any untoward clinical effects, manifest as adverse pulpal responses, have yet to be determined. This study comprises a systematic review, designed to address the question of whether the risk of endodontic complications is greater with composite resin restorations than with other restorative materials, such as amalgam. The study methodology involved (i) formulation of the research question, (ii) construction and conduct of an extensive literature search with (iii) interpretation and assessment of the retrieved literature. A search of the medical database PubMed was complemented with a search of the Controlled Trials Register (CENTRAL). The initial search yielded 1043 publications, the abstracts of which were read independently by the authors. After additional searches, 10 studies were included in the review. In all the included studies, the level of evidence was assessed as low. No conclusions could therefore be drawn. The included studies reported few, if any, endodontic complications. Little or no differences emerged between teeth restored with composite resins and those restored with amalgam. To determine whether composite resin restorations of teeth with vital pulps are associated with an increased risk for development of endodontic complications such as apical periodontitis, further evidence is needed, from well-constructed studies with a large number of participants.
36.	Duncan, H F, et al. (författare) European Society of Endodontology position statement : Management of deep caries and the exposed pulp 2019 Ingår i: International Endodontic Journal. - : John Wiley & Sons. - 0143-2885 .- 1365-2591. ; 52:7, s. 923-934 Tidskriftsartikel (refereegranskat)abstract This position statement on the management of deep caries and the exposed pulp represents the consensus of an expert committee, convened by the European Society of Endodontology (ESE). Preserving the pulp in a healthy state with sustained vitality, preventing apical periodontitis and developing minimally invasive biologically based therapies are key themes within contemporary clinical endodontics. The aim of this statement is to summarise current best evidence on the diagnosis and classification of deep caries and caries-induced pulpal disease, as well as indicating appropriate clinical management strategies for avoiding and treating pulp exposure in permanent teeth with deep or extremely deep caries. In presenting these findings, areas of controversy, low-quality evidence and uncertainties are highlighted, prior to recommendations for each area of interest. A recently published review article provides more detailed information, and was the basis for this position statement (Bjørndal et al. 2019, International Endodontic Journal). The intention of this position statement is to provide the practitioner with relevant clinical guidance in this rapidly developing area. An update will be provided within 5 years as further evidence emerges. This article is protected by copyright. All rights reserved.
37.	Figdor, David, et al. (författare) [Obituary] Göran Sundqvist (1937-2020) 2020 Ingår i: International Endodontic Journal. - : John Wiley & Sons. - 0143-2885 .- 1365-2591. ; 53:5, s. 726-727 Tidskriftsartikel (refereegranskat)
38.	Fransson, Helena, et al. (författare) Effects of bacterial products on the activity of odontoblast-like cells and their formation of type 1 collagen 2014 Ingår i: International Endodontic Journal. - : John Wiley & Sons. - 0143-2885 .- 1365-2591. ; 47:4, s. 397-404 Tidskriftsartikel (refereegranskat)abstract AIM: To study how products released from different bacteria in a deep carious lesion affect the metabolic activity of odontoblast-like cells and their ability to produce the major organic component of dentine, collagen 1. METHODOLOGY: MDPC-23 cells were exposed to supernatants from biofilm cultures of strains isolated from the deepest part of a carious lesion as well as from a clinical isolate of Enterococcus faecalis. Lipoteichoic acid (LTA) and lipopolysaccharide (LPS) were used for comparison. Cell activity was assessed using an methyl-thiazolyl-diphenyl tetrazolium bromide (MTT) assay, and collagen 1 levels were determined by ELISA. RESULTS:The lesion microflora was dominated by Lactobacillus spp. Neither extracellular products from the isolates nor LPS affected the activity of the MDPC-23 cells, whereas extracellular products from E. faecalis and LTA significantly reduced total cell activity (P < 0.01). Enterococcus faecalis had an inhibitory effect upon collagen 1 production by the cells, whereas no such effect or even a slight stimulatory effect was seen for the isolates from the deep carious lesion. CONCLUSIONS: These studies indicate that culture supernatants from E. faecalis reduced the metabolic activity of odontoblast-like cells as shown using the MTT assay. No effect was seen for supernatants from biofilms of bacteria recovered from a deep carious lesion. Different bacteria varied in their effects upon collagen 1 production suggesting that the nature of the bacterial species in a carious lesion may have a direct influence upon the ability of the odontoblasts to produce tertiary dentine.
39.	Fransson, Helena, et al. (författare) Efficacy of lasers as an adjunct to chemo-mechanical disinfection of infected root canals : a systematic review 2013 Ingår i: International Endodontic Journal. - : Wiley-Blackwell. - 0143-2885 .- 1365-2591. ; 46:4, s. 296-307 Tidskriftsartikel (refereegranskat)abstract The aim was to evaluate the efficacy of various types of lasers used as an adjunct to chemo-mechanical disinfection of infected root canals with the outcome measures 'normal periapical condition' or 'reduction of microbial load'. PubMed, CENTRAL and ISI Web of Knowledge literature searches with specific indexing terms and a subsequent hand search were made with stated limits and criteria. Relevant publications were retrieved, followed by interpretation. The quality of each included publication was assessed as high, moderate or low. The initial search process yielded 234 publications. All abstracts of these publications were read, and the reference lists of relevant publications were hand-searched. Ten articles were read in full text and interpreted according to a data extraction form. Five were included in the systematic review and were assessed. A meta-analysis was impossible to perform because the included studies were heterogeneous with regard to study design, treatment and outcome measures. Positive effects were reported; however, no concluding evidence grade could be made because each included study was judged to have low quality, primarily due to lack of a power analysis, blinding and reproducibility. The evidence grade for whether lasers can be recommended as an adjunct to chemo-mechanical disinfection of infected root canals was insufficient. This does not necessarily imply that laser should not be used as an adjunct to root canal treatment but instead underscores the need for future high-quality studies.
40.	Fransson, Helena, et al. (författare) Formation of a hard tissue barrier after experimental pulp capping or partial pulpotomy in humans : an updated systematic review 2016 Ingår i: International Endodontic Journal. - : John Wiley & Sons. - 0143-2885 .- 1365-2591. ; 49, s. 533-542 Forskningsöversikt (refereegranskat)abstract The aim was to update a systematic review of pulp capping and partial pulpotomy by Olsson et al. (2006), by evaluating new evidence on formation of a hard tissue barrier after pulp capping and partial pulpotomy of experimental exposures in humans. PubMed (01-01-2005 to 01-03-2014) and CENTRAL were searched using specific keywords. Hand searches were made and the level of evidence for each included article was evaluated by the authors. The evidence of the conclusions was graded as strong, moderately strong, limited or insufficient. The initial search in PubMed yielded 215 abstracts. Hand searches of reference lists yielded no additional original scientific articles. After a selection process and interpretation, 22 articles were included and rated for level of evidence: no article was rated as high and seven as moderate. Overall the methodological quality of studies has improved since the previous systematic review was published in 2006. The conclusions are that there is limited scientific evidence that application of calcium hydroxide or mineral trioxide aggregate to an exposed pulp frequently results in formation of a hard tissue barrier, whereas adhesives or enamel matrix derivatives do not. There is insufficient scientific evidence that mineral trioxide aggregate promotes hard tissue formation more frequently than calcium hydroxide.
41.	Fransson, Helena, et al. (författare) Tooth survival after endodontic treatment 2023 Ingår i: International Endodontic Journal. - : John Wiley & Sons. - 0143-2885 .- 1365-2591. ; 56:S2, s. 140-153 Forskningsöversikt (refereegranskat)abstract There are several measures that are, or could be, in use in relation to estimating the outcome of endodontic treatments. It is important to reflect on when and why a certain outcome measure is used; when caring for an individual patient it is obvious that the goal always should be a tooth in a healthy state, that is striving to remove any infection and aim for the tooth to have healthy periapical tissues. For patients in general and for society, it is also interesting to know if endodontic treatments will lead to retention of teeth in a functioning state. From epidemiological studies, with high prevalence of root filled teeth with periapical radiolucencies, it is implied that dentists and/or patients accept the retention of a root filled tooth with persistent apical periodontitis. However, we do not know if or how this affects the health of the individual. In conjunction with an endodontic treatment the prognosis is considered and since the prognostic factors seem to be somewhat different depending on whether one is considering for example the outcome ´healthy periapical tissues´ or ´tooth survival´ they are equally important to know. Factors affecting the outcome ´healthy periapical tissues´ probably has to do with removal of infection and reconstituting the barrier to prevent leakage whilst ´tooth survival´ is more likely associated with factors outside of the classical endodontic field such as restorability and avoidance of further destruction of tooth substance. This narrative review will focus on tooth survival after endodontic treatment and root canal treatment will be the focus. As a crude estimation, there is to be an annual loss of 2% of teeth which have received a root canal treatment. Of the pre-, peri- and postoperative factors that have been studied in conjunction with root canal treatments the restoration of the tooth is the factor that has been most extensively studied. Many studies imply that root filled teeth restored with indirect restorations have a better survival than teeth restored with direct restorations, it is not possible to determine whether this indeed is a prognostic factor.
42.	Jakovljevic, Aleksandar, et al. (författare) Effectiveness of vital pulp treatment in managing nontraumatic pulpitis associated with no or nonspontaneous pain : A systematic review 2023 Ingår i: International Endodontic Journal. - : John Wiley & Sons. - 0143-2885 .- 1365-2591. ; 56:S3, s. 340-354 Tidskriftsartikel (refereegranskat)abstract BACKGROUND: The exposed pulp has been the topic of numerous studies, but well-designed and well-executed comparative trials on the outcome and treatment of these teeth have been limited.OBJECTIVES: This study was conducted to answer the following questions: in patients with nontraumatic pulpitis associated with no or nonspontaneous pain in permanent teeth, (i) is direct pulp capping or pulpotomy (partial/full) as effective as selective or stepwise caries removal [Population/participants, Intervention(s), Comparator(s)/control, Outcome(s) (PICO) 1], (ii) is pulpotomy (partial/full) as effective as direct pulp capping (PICO 2) and (iii) is pulpotomy (partial/full) as effective as a pulpectomy (PICO 3), in terms of a combination of patient and clinical reported outcomes, with 'tooth survival' as the most critical outcome?METHODS: A literature search was conducted using Clarivate Analytics' Web of Science, Scopus, PubMed and Cochrane Central Register of Controlled Trials from inception to November 3rd 2021. Grey literature and contents of the major subject journals were examined. Eligibility criteria followed the PICO questions. Two independent reviewers performed study selection, data extraction and appraisal; disagreements were resolved by a third reviewer. The risk of bias was assessed by the revised Cochrane risk-of-bias tool for randomized trials.RESULTS: Three randomized clinical trials (RCTs) were included in the review. No study fulfilled the criteria to answer PICO 1. There were no significant differences in the reported outcomes between investigated treatments in all included RCTs. None of the included studies reported the most critical outcome 'tooth survival'. A high loss of patients during the follow-up period was observed.DISCUSSION: Although a few studies fulfilled strict eligible criteria, the results of this systematic review clearly highlight a paucity of available evidence. At the present time, clinical decisions cannot be substantiated by direct comparative trials.CONCLUSIONS: Based on limited evidence, this systematic review discovered no significant differences in effectiveness between compared vital pulp treatments in managing nontraumatic pulpitis associated with no or nonspontaneous pain. Further high-quality RCTs are necessary to investigate the effectiveness of direct pulp capping or pulpotomy (partial/full) compared to selective or stepwise caries removal.REGISTRATION: PROSPERO database (CRD42021259742).
43.	Jonasson, Peter, et al. (författare) Retrograde root canal treatment: A prospective case series. 2017 Ingår i: International endodontic journal. - : Wiley. - 1365-2591 .- 0143-2885. ; 50:6, s. 515-521 Tidskriftsartikel (refereegranskat)abstract Root canal treatment of teeth with necrotic pulps and apical periodontitis may be complicated by limited access to the root canals due to restorations and dystrophic calcifications. The objective of this study was to evaluate retrograde root canal as a primary treatment using a surgical approach as an alternative to conventional orthograde treatment.Patients with apical periodontitis in the anterior region of the maxilla were consecutively recruited to the study over a period of 4 years. Fifty-Seven patients met the inclusion criteria and received retrograde root canal treatment. A clinical and radiographic evaluation was made after one and two years postoperatively.Clinical and radiographically evaluation after 2 years revealed a successful outcome (as defined in this study) in 90% of the cases.Retrograde root canal as a primary treatment was a reliable alternative to treat apical periodontitis on single- and two-rooted teeth with limited orthograde access to the root canals in the maxilla. This article is protected by copyright. All rights reserved.
44.	Kebke, S., et al. (författare) Tooth survival following root canal treatment by general dental practitioners in a Swedish county - a 10-year follow-up study of a historical cohort 2021 Ingår i: International Endodontic Journal. - : Wiley. - 0143-2885 .- 1365-2591. ; 54:1, s. 5-14 Tidskriftsartikel (refereegranskat)abstract Aim To evaluate the 10-year survival rate of root filled teeth treated by general dental practitioners (GDPs), and to identify possible prognostic factors. Methodology In 2006, 3676 individuals had at least one tooth root filled by a GDP within the Norrbotten Public Dental Service, Sweden. Over the next 10 years, 331 individuals died and were excluded. A random sample of 302 of the remaining individuals was included in the study, of whom 280 (n = 280 teeth) were included in the analysis. Dental records were reviewed retrospectively by a calibrated researcher to collect predetermined data regarding individual, pre-operative, intra-operative and post-operative factors. The outcome measure was tooth extraction over time, and cases with no events were censored, regardless of apical status or symptoms, until last known date of tooth survival. In case of missing data, individuals were recalled for a control visit. Kaplan-Meier survival tables and Cox regression models were used for analysis.P The cumulative 10-year survival was 81.7% (standard error: 2.6%), and the mean incidence of tooth extraction during the 10 years was 1.8% per year. The univariate analysis identified three possible prognostic factors (P < 0.05) that were associated with extraction: molars, two or more emergency inter-appointment visits during the treatment, and root canal treatments consisting of five or more separate sessions. A multivariate regression analysis revealed no significant relationships for the variables gender, tooth type, number of contacts, any emergency visits during endodontic treatment, number of sessions to complete endodontic treatment, pulp diagnosis, or type of permanent restoration and extraction. Conclusions The mean incidence of tooth loss over the first 10 years after completion of root canal treatment performed by a GDP was approximately 2% per year. No prognostic factors could be identified.
45.	Koch, M., et al. (författare) Effect of education intervention on the quality and long-term outcomes of root canal treatment in general practice 2015 Ingår i: International Endodontic Journal. - : Wiley-Blackwell. - 0143-2885 .- 1365-2591. ; 48:7, s. 680-689 Tidskriftsartikel (refereegranskat)abstract Aim: To compare the technical quality and long-term outcomes of root canal treatment by general practitioners of a Swedish Public Dental Service, before and after an endodontic education including Ni-Ti rotary technique (NiTiR).Methodology: A random sample was compiled, comprising one root filled tooth from each of 830 patients, treated by 69 general practitioners participating in the education: 414 teeth root filled in 2002, pre-education, using primarily stainless steel instrumentation and filling by lateral compaction, and 416 teeth root filled post-education (2005), using mainly NiTiR and single-cone obturation. Follow-up radiographs taken in 2009 were evaluated alongside immediate post-filling radiographs from 2002 to 2005. The density and length of the root fillings were registered. Periapical status was assessed by the Periapical Index (PAI), using two definitions of disease: apical periodontitis (AP) (PAI 3 + 4 + 5) and definite AP (PAI 4 + 5). Tooth survival was registered. Root fillings pre- and post-education were compared using chi-square and Fisher's exact tests. Crude extraction rates per 100 years were calculated for comparison of tooth survival. Explanatory variables (type of tooth, root filling quality, periapical status, marginal bone loss, type and quality of coronal restoration) in relation to the dependent variable (AP at follow-up) were analysed by multivariable logistic regression.Results: Follow-up data were available for 229 (55%) of teeth treated pre-and 288 (69%) treated post-education: both tooth survival (P < 0.001) and root filling quality were significantly higher (P < 0.001) in the latter. However, there was no corresponding improvement in periapical status. Both preand post-education, root fillings with definite AP on completion of treatment had significantly higher odds of AP or definite AP at follow-up. For teeth treated post-education, inadequate root filling quality was significantly associated with AP at follow-up.Conclusions: Despite a higher tooth survival rate and a significant improvement in technical quality of root fillings after the education, there was no corresponding improvement in periapical status.
46.	Konstantinidi, E, et al. (författare) Apical negative pressure irrigation versus syringe irrigation: a systematic review of cleaning and disinfection of the root canal system 2017 Ingår i: International endodontic journal. - : Wiley. - 1365-2591 .- 0143-2885. ; 50:11, s. 1034-1054 Tidskriftsartikel (refereegranskat)
47.	Kvist, Thomas, 1959, et al. (författare) Clinical decision making of post-treatment disease 2023 Ingår i: International Endodontic Journal. - : Wiley. - 0143-2885 .- 1365-2591. ; 56:Suppl 2, s. 154-168 Forskningsöversikt (refereegranskat)abstract Root-filled teeth presenting with signs of post-treatment disease is a common finding in virtually every dental practice. There is both empirical and experimental evidence that, as long as the condition is asymptomatic, it is often left untreated. Professional judgements and decision making in endodontics as in any medical discipline are based on qualified estimations of the probability and the value of relevant outcomes. In this paper we describe various aspects of clinical decision making in general, from a descriptive as well as a normative point of view, but with a particular focus on the condition of the root-filled tooth with post-treatment disease. We review how attention to various types of uncertainties are relevant for the decision-making process. Additionally, we discuss the nature of value judgements and different concepts of health and disease which are important for understanding the complexity of the clinical decision-making process. We also refer to a set of principal rules that can guide the clinician's decision making in every-day practice in front of a case with endodontic post-treatment disease. Finally, we provide some aspects on the sometime cumbersome decision whether to go for a non-surgical or surgical method, whenever a decision on retreatment has been made.
48.	Landt, Kristoffer, et al. (författare) Demographic factors in Swedish adults undergoing root filling and subsequent extraction of a maxillary first molar: a comparative study 2018 Ingår i: International Endodontic Journal. - : Wiley. - 0143-2885 .- 1365-2591. ; 51:9, s. 975-980 Tidskriftsartikel (refereegranskat)abstract AimTo study the demographics of Swedish adults who had received a root filling, followed by extraction during the following 5-6years in comparison with subjects who had undergone a corresponding root filling with an uneventful outcome. MethodologyThe root filled maxillary first molar was chosen as the comparison model. The Swedish Social Insurance Agency provided data on all teeth reported as root filled in Sweden during 2009. A comparison group, equally large as the study group, was constructed by randomly selecting subjects with root filled maxillary first molars, which had not subsequently been extracted, that is, an uneventful outcome. Demographic data on the subjects were obtained from Statistics Sweden: country of birth, disposable income, educational level, age, civil status and gender. Chi-square, t-tests and logistic regression were used for statistical analyses. ResultsIn the year 2009, 36139 maxillary first molar teeth were reported to have been root filled, 4362 (12.1%) of which were then recorded as extracted during the following 5-6year period. Only minor intergroup differences were noted: 86.5% of the studygroup were Swedish-born, compared with 84.4% of the comparison group (P=0.007). Women comprised 53.2% of the study group and 50.5% (P=0.01) of the comparison group. There was an association between extractions and gender as well as age; men had a lower odds ratio (OR) for extraction OR, 0.87; confidence interval (CI), 0.80-0.95. For every additional year, the chance for extraction was higher OR, 1.01; CI, 1.01-1.01. No other significant differences were detected. ConclusionsThere was only little or no demographic differences between the study group, comprising Swedish adults who had undergone root filling of one of their maxillary first molars in 2009 and subsequent extraction during the following 5-6years, and the comparison group, with uneventful outcomes after a corresponding root filling.
49.	Liljestrand, JM, et al. (författare) Association between dental factors and mortality 2021 Ingår i: International endodontic journal. - : Wiley. - 1365-2591 .- 0143-2885. ; 54:5, s. 672-681 Tidskriftsartikel (refereegranskat)
50.	Markvart, M., et al. (författare) Frequency of additional treatments in relation to the number of root filled canals in molar teeth in the Swedish adult population 2021 Ingår i: International Endodontic Journal. - : Wiley. - 0143-2885 .- 1365-2591. ; 54:6, s. 826-833 Tidskriftsartikel (refereegranskat)abstract Aim To investigate the 5-year frequency of additional treatments in relation to the number of reported root filled canals in molar teeth in Sweden. Methodology The cohort included first and second molars in adult individuals who were registered with a root filling performed in 2009. Treatment codes corresponding to root fillings of teeth with from one up to four root filled canals were identified in the Swedish Social Insurance Agency database. The studied additional treatments were extraction, non-surgical root canal retreatment and endodontic surgery during the subsequent 5 years, identified by corresponding codes for these treatments registered on these specific teeth. Differences in the frequency of additional treatments based on the number of root filled canals were analysed using chi-square test and considered statistically significant at P In 2009, root fillings on a first or second molar tooth were registered in 100 720 individuals. The study included 32 901 maxillary first molars (6.4% with four root filled canals), 12 763 maxillary second molars (3.3% with four root filled canals), 37 703 mandibular first molars (19.2% with four root filled canals) and 17 353 mandibular second molars (3.7% with four root filled canals). The total frequency of additional treatments was 14.3% (n = 14 425) during the 5-year observational period. Additional treatments were more frequent in teeth with 1-3 root filled canals compared to teeth with four root filled canals for maxillary first molars (15.2% vs. 12.7%, P = 0.002), maxillary second molars (13.8% vs. 9.1%, P = 0.007) and mandibular first molars (14.0% vs. 10.7%, P < 0.001) but not mandibular second molars (15.6% vs. 13.7%, P = 0.200). Conclusions Over 5 years, 85.7% of the included teeth were not registered with any additional treatments. Maxillary first and second molars and mandibular first molar teeth had a greater frequency of additional treatments when <= 3 root canals were filled compared to four canals.

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