Title Influence of Infection At The Time of Root Filling on The Outcome of Endodontic Treatment of Teeth with Apical Periodontitis
Clinical Question Is the overall prognosis for success different for root canal therapy in patients who have bacteria present at the time of obturation compared to those who do not?
Clinical Bottom Line Patients who have active disease at the time of root canal filling (obturation) are less likely to have a successful outcome compared to those patients who have a negative culture at time of obturation. (See Comments on the CAT below)
Best Evidence  
PubMed ID Author / Year Patient Group Study type
(level of evidence)
9477818Sjogren 199755 single rooted teeth, 22 root canals had a (+) culture at of obtur, while 33 had (-) cultureCohort
Key results94% success was noted in cases with a negative culture compared to 68% with a positive culture at the time of obturation.
Evidence Search Pubmed search: Endodontics, one-visit, bacteria, success rate
Comments on
The Evidence
One other article was found with the evidence search but it was on dogs, therefore it was not included.
Applicability Teeth with apical periodontitis must have special consideration prior to obturation completion.
Specialty (Endodontics) (General Dentistry)
Keywords Endodontics, bacteria, one-visit, success rate
ID# 286
Date of submission 11/11/2009
E-mail PachecoMA@uthscsa.edu
Author Marc Pacheco, DDS
Co-author(s)
Co-author(s) e-mail
Faculty mentor
Faculty mentor e-mail
   
Basic Science Rationale
(Mechanisms that may account for and/or explain the clinical question, i.e. is the answer to the clinical question consistent with basic biological, physical and/or behavioral science principles, laws and research?)
None available
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Comments and Evidence-Based Updates on the CAT
(FOR PRACTICING DENTISTS', FACULTY, RESIDENTS and/or STUDENTS COMMENTS ON PUBLISHED CATs)
by Brent Winward (San Antonio, TX) on 07/07/2012
A study done in 2005 (PubMed ID 16306819) confirms the results found in this CAT. The study evaluated the efficacy of treatment procedures on limiting bacterial growth prior to obturation. At a one year follow-up there was a significant difference on healing of periapical lesions between the positive/negative culture groups.
by Diane Banks (San Antonio, TX) on 04/03/2012
I conducted research through PubMed on this topic and was able to find another article more current than the one stated that supports the clinical bottom line. PubMed ID 16911098. This experimental study was done in 2006 on 175 root canals of monkeys. This study is more recent and a greater amount of teeth were used.
by Olivia Gassmann (San Antonio, TX) on 03/31/2015
Critically Appraised Topic #2880 discusses a similar question. Consistent with this study, immediately placed implants are determined to be a successful treatment option when compared to conventionally placed implants. However, immediately placed implants are associated with greater variability of outcomes regarding midfacial mucosal recession 1-3 years post-placement. This is supported by a Systematic Review of Randomized Control Trials and numerous studies that measured objective esthetic indices in 594 total patients, determining that a median of 26% of sites had greater than 1 mm of midfacial mucosal recession 1-3 years after immediate implant placement.
by Thomas Oates (San Antonio, TX) on 10/06/2015
Similar to Polyzos, Schwendicke 2015 (PMID 26035835) also demonstrated an effect of study design on LBW outcomes, with higher quality studies (lower risk of bias) not identifying a treatment effect, in contrast to lower quality studies.
by John P. Hatch, PhD (San Antonio, Texas) on 10/06/2015
A more recent meta-analysis (Rosa 2012; PMID 23090163) supports the conclusion of this CAT that the risks of adverse pregnancy outcomes are not reduced by SRP. Two recent analyses of the same data (Kim 2012, PMID 22376207; Schwendicke 2015, PMID 26035835) used subgroups analysis and reported a possible benefit only for women at high risk of adverse pregnancy outcomes. Results based on subgroups analysis should be noted cautiously.