LPB inrylic leh se EEnnddooddoonnttiiccss r E Contents n RReevviieeww d 1 Evidence-Based Dentistry o d 2 Microbiology o n 3 Pulpal and Periapical Anatomy and Physiology SECOND EDITION t i 4 Pulpal and Periapical Pathology c s 5 M edicine and Pharmacology Brooke Blicher, | Rebekah Lucier Pryles, | Jarshen Lin, dmd dmd dds R 6 Diagnosis e 7 D iagnosis of Non-Endodontic Disease Entities v i e 8 T reatment of Pulpal and Periapical Disease w 9 Traumatic Dental Injuries 10 Cracked and Fractured Teeth 11 Resorptive Dental Diseases S E 12 Prognosis C O N 13 Complications D E D I T I O N ISBN 978-0-86715-831-1 90000> 9 780867158311 Endodontics Review, Second Edition Dedication This book is dedicated to Drs Daniel Green and Robert Amato, great mentors and educators who inspired our pursuit of excellence and love of evidence-based endodontics. May you all find your Drs Green and Amato. 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Editor: Zach Kocanda Design: Sue Zubek Production: Angelina Schmelter Printed in Croatia EEnnddooddoonnttiiccss RReevviieeww SECOND EDITION Brooke Blicher, Rebekah Lucier Pryles, dmd dmd Private Practice Limited to Endodontics Private Practice Limited to Endodontics White River Junction, Vermont White River Junction, Vermont Clinical Instructor, Department of Restorative Assistant Clinical Professor Dentistry and Biomaterials Sciences Department of Endodontics Harvard School of Dental Medicine Tufts University School of Dental Medicine Assistant Clinical Professor Clinical Instructor, Department of Restorative Department of Endodontics Dentistry and Biomaterials Sciences Tufts University School of Dental Medicine Harvard School of Dental Medicine Boston, Massachusetts Boston, Massachusetts Instructor in Surgery Geisel School of Medicine at Dartmouth Jarshen Lin, dds Hanover, New Hampshire Director of Predoctoral Endodontics Department of Restorative Dentistry and Biomaterials Sciences Harvard School of Dental Medicine Clinical Associate, Department of Surgery Division of Dentistry Massachusetts General Hospital Boston, Massachusetts Contents Preface vi 1 E vidence-Based Dentistry 1 2 M icrobiology 11 3 Pulpal and Periapical Anatomy and Physiology 29 4 Pulpal and Periapical Pathology 52 5 M edicine and Pharmacology 77 6 Diagnosis 105 7 D iagnosis of Non-Endodontic Disease Entities 132 8 T reatment of Pulpal and Periapical Disease 150 9 Traumatic Dental Injuries 226 10 Cracked and Fractured Teeth 257 11 Resorptive Dental Diseases 271 12 Prognosis 288 13 Complications 308 Index 333 Preface We are pleased to offer the second edition of what became known as “The Orange Book” in certain circles to those seeking a literature-based discussion of endodontics. Whether this book will supplement your predoctoral or postdoctoral endodontics curriculum or guide self-study in general dental or specialty practice, we are proud to share the evidence-based why behind the diagnosis and delivery of endodontic care. Evidence-based endodontics evolves as the literature changes. As new literature is published, including updated position statements and guidelines, practitioners must adapt their clinical practice. Many important updates have occurred in the field of endodontics research and clinical practice since the first edition was published in 2016. These updates have been incorporated into this second edition. That said, as the literature continues to advance, we encourage readers to stay abreast of changes to ensure delivery of the most up-to-date, evidence-based clinical care. This text provides the foundation to pursue this necessary continued self-study. vi 1 Evidence-Based Dentistry The practice of evidence-based dentistry requires that providers make treatment decisions based on a comprehensive and constantly evolving evaluation of the bodies of research and literature in their field. Practi- tioners must sift through the available resources with a discerning eye. They must be able to justify their decisions and recommendations based on the highest-quality evidence available. Research published in peer- reviewed journals is considered to be unbiased and therefore most useful. Although textbooks and lectures are effective means of disseminating information, quality versions of these resources will refer back to primary resources in peer-reviewed journals. Consequently, it is imperative that providers familiarize themselves with the primary references cited in all examples. This chapter covers study design, measures of statistical significance and validity, and epidemiology. For a more in-depth review of research design and biostatistics, please refer to Hulley et al’s Designing Clinical Research and Glaser’s High-Yield Biostatistics, Epidemiology, and Public Health. 1 1 Evidence-Based Dentistry Study Design Beyond citing peer-reviewed journals as the ideal reference source, certain study designs are generally considered more scientifically sound. The Oxford Centre for Evidence-Based Medicine (OCEBM) outlines a hierarchy of levels of evidence by study design, illustrated in Fig 1-1. Systematic review Randomized controlled trial Cohort Case control Case series Expert opinion Fig 1-1 OCEBM hierarchy of levels of evidence by study design. Systematic reviews, including meta-analyses, are considered the highest level of evidence, and their quality improves based on the compiled levels of evidence of the studies reviewed. Systematic reviews involve a comprehensive search and review of all of the literature on a topic, whereas a meta-analysis delves deeper by doing statistical analyses to make direct comparisons between studies. Depending on the variability of the statistics reported in the literature available on a topic, a meta-analysis may not be achievable. Further algorithm-based criteria exist for rating the quality of evidence compiled in a systematic review or meta-analysis. The strength of recommendation taxon- omy (SORT) grading system evaluates and categorizes systematic reviews and evidence-based clinical guidelines based on the quality, quantity, and consistency of the evidence included (Newman et al). Similarly, the Grading of Recommendation, Assessment, Development, and Evaluation (GRADE) system aims to summarize evidence addressing a question for use in producing systematic reviews and guidelines (Guyatt et al). Whether or not one of the above algorithms is included in a systematic review, it behooves the reader to take into account the quality of literature reviewed. The Cochrane Collaborative produces systematic reviews that can be considered the gold standard for evidence-based medicine. The reviews are constantly updated with post-publication peer review and a strong conflict of interest policy. They may contain meta-analysis when homogenous data is available for comparison among the studies reviewed. Efforts are made by the Cochrane authors to focus on randomized controlled trials when possible to reduce effects of known and unknown confounders 2