Objective: To evaluate tooth/implant survival and function time, as well as costs of root canal treatment versus extraction and replacement through implant therapy in the management of endodontic disease.

Methods: This retrospective register-based cohort study used data from the Swedish Dental Health Register. Adults (≥20 yrs) diagnosed with endodontic disease (2015-2016) and provided with either root canal therapy (ENDO) or extraction and implant-supported replacement (IMPLANT) were followed until 2023. Survival was assessed in propensity score-matched groups (ENDO: 10, 654; IMPLANT: 5, 327 individuals) using Kaplan-Meier and Cox regression analyses. Function time was expressed through restricted mean survival time (RMST), truncated at 7 yrs. Cumulative costs (3% annual discount applied) were estimated using mixed-effects regression models, and incremental cost-effectiveness ratios (ICERs) were calculated as cost per additional yr in function.

Results: 9-yr survival was 83.4% for ENDO and 97.9% for IMPLANT. RMST was 5.8 yrs for ENDO and 6.6 yrs for IMPLANT and respective mean cumulative costs were USD 1, 243 and USD 2, 667. With the exception of mandibular anterior sites, IMPLANT showed longer mean function times. The overall ICER was USD 1, 874 per yr gained, ranging from USD 1, 352 (maxillary molar sites) to USD 4, 836 (maxillary anterior sites).

Conclusions: Overall, survival and function time of implants replacing endodontically diseased teeth was greater than that of teeth following root canal treatment. Cumulative costs were higher for implant therapy. At mandibular anterior sites, however, root canal treatment resulted in higher survival and function time, at lower costs.Clinical significanceWhile implant-based tooth replacement provided greater survival and function time than root canal treatment in general, benefits came at considerably higher cumulative costs. Site-specific differences were also evident as root canal treatment at anterior sites in the mandible resulted in both higher survival and lower treatment costs.

AIM: To evaluate the outcome of pulpectomy, root canal treatment (RCT) and orthograde retreatment in permanent teeth performed by undergraduate dental students and to assess the influence of various variables.

METHODOLOGY: Electronic dental health records at the Department of Odontology, University of Copenhagen, Denmark were analysed covering pulpectomy, RCT and orthograde retreatment performed by dental students 2012-2022 and follow-ups until 2025. Patient-, tooth- and treatment-related variables and follow-up periods were monitored. Effective treatment outcome was defined as absence of pain, no or reduced periapical radiolucency. Chi-square was used for comparisons and uni- and multi-variable logistic regression analyses to assess outcome-related factors. Odds ratio (OR) estimates were presented with 95% confidence interval (CI).

RESULTS: One thousand four hundred and sixty-six teeth in 1304 individuals were included. Median follow-up was 14.5 months (interquartile range: 7.6-31.7 months). The overall proportion of effective treatment outcome was 89% (92% for pulpectomy, 87% for RCT and 81% for orthograde retreatment). Using RCT as the reference, pulpectomy was associated with lower odds of non-effective outcome (OR: 0.61/CI: 0.42-0.88). In multivariable analysis, non-smoking, younger age, premolar teeth and longer follow-up periods had lower odds of non-effective treatment (p < 0.05). Indirect compared to direct restoration was associated with lower odds of non-effective treatment (OR: 0.29/CI: 0.18-0.47), p < 0.001.

CONCLUSIONS: Non-surgical endodontic treatments performed by undergraduate dental students showed a high rate of effective treatment outcome. Pulpectomy showed better outcome compared with RCT and orthograde retreatment. Smoking, older age, non-premolar teeth, shorter follow-up periods and direct restorations were associated with higher odds of non-effective treatment. Awareness of these factors may help improve the predictability of endodontic treatment in an undergraduate clinical setting. Taking the retrospective design and study limitations into account, the results should be interpreted with caution.

BackgroundThe European Federation of Periodontology (EFP) has developed Clinical Practice Guidelines (CPGs) for the treatment of periodontitis and for the management of peri-implant diseases. In accordance with the 2018 Classification, acute periodontal conditions are characterised by rapid-onset pain or discomfort, tissue destruction and infection. Therefore, the development of a CPG to guide patients and clinicians in their management is justified.AimTo develop an S2k-level CPG for the management of acute periodontal conditions, necrotising periodontal diseases, periodontal abscesses and acute manifestations of endodontic-periodontal lesions.MethodsThis S2k-level CPG was developed by the EFP, following methodological guidance from the Association of Scientific Medical Societies in Germany and the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) process. A rigorous and transparent process included synthesis of relevant research in two commissioned systematic reviews, evaluation of the quality and strength of evidence, formulation of specific recommendations and a structured consensus process involving leading experts and a broad base of stakeholders. Recommendations were based on the best available evidence, combined with structured expert consensus, particularly in areas where direct evidence remains scarce.ResultsThe S2k-level CPG for the management of acute periodontal conditions presents a structured approach, grouping the recommendations in three successive steps: (1) confirming diagnosis, following the case definitions of the 2018 classification; (2) initial treatment, to control the acute condition including pain and active tissue destruction; and (3) subsequent treatments, to manage the pre-existing conditions and prevent the risk of disease recurrence and/or control the potential sequelae.ConclusionThe present S2k-level CPG informs clinical practice, health systems, policymakers and, indirectly, the public on the available and most effective interventions in the management of acute periodontal conditions.

Aim: To prospectively investigate the incidence of symptoms and changes in the size of the apical bone destruction in symptom-free root-filled teeth with persistent apical periodontitis (AP) over 1 year without treatment.

Methodology: Patients referred to two specialist endodontic clinics in Västra Götaland, Sweden, with asymptomatic periapicalbone destructions (summing to ≤ 10 mm in diameter, when measured in two dimensions) on intraoral radiographs were invited.After informed consent, participants underwent cone-beam computed tomography (CBCT). Patients with bone destructionsbeyond cortical boundaries were excluded. A 1-year follow-up included recording subjective symptoms, clinical findings andestimating bone destruction size.

Results: Of 187 eligible patients, 171 (91.4%) participated. After CBCT, four were excluded, and 10 were lost to follow-up. Among 157 patients, three developed symptomatic AP and were treated, and one tooth was lost due to fracture. Of the 153 patients with complete follow-up, eight (5.2%) reported mild pain or discomfort but did not seek care. Lesion size changes were small(M = 0.059 mm), with the mean increasing from 7.25 mm (SD 2.11) to 7.31 mm (SD 2.33), which was not statistically significant.

Conclusion: The findings align with previous studies, suggesting that patients with symptom-free root-filled teeth with apicalperiodontitis rarely experience exacerbation or significant increase in size of bone destruction in the short term. Longer follow-upis needed to identify potential risk factors.

Objective: The aim of this cross-sectional study was to assess the root canal filling quality and the frequency of apical periodontitis (AP) in root-canal-filled teeth in a randomly selected adult non-patient population in Sweden.

Materials and Methods: In 2023, 295 root-canal-filled teeth were identified in 126 adults in across-sectional study in Jönköping, Sweden. Periapical radiographs were assessed by two calibrated observers. The periapical status was scored according to the periapical index (PAI) and then dichotomized as either healthy (PAI 1-2) or diseased (PAI 3-5). The root canal filling quality was deemed as adequate/inadequate. An adequate root canal filling was considered to end 0.5-2 mm from the radiographic apex and to have no radiolucent voids.

Results: Adequate root canal fillings were seen in 89 (30.2%) of the teeth. AP was present in 94 (31.9%) of the teeth, and of these, 72 (76.6%) had an inadequate root canal filling. Of the 122 root-canal-filled molars, 101 (82.8%) had inadequate root canal filling and 57 (46.7%) had AP.

Conclusion: A large proportion of root-canal-filled teeth have inadequate root canal filling quality and AP, especially in molars. Both contributing factors and strategies for improvement require further study.

Aim: Endodontic infections can spread, leading to life-threatening systemic infections. However, the available literature is limited concerning factors associated with a higher risk. This study aimed to characterize patients hospitalized with a severe endodontic infection spread and explore the course of endodontic infection and treatment prior to hospitalization. Methodology: This retrospective cohort study included patients hospitalized with a severe odontogenic infection (SOI) of endodontic origin at the Department of Oral & Maxillofacial Surgery, Copenhagen University Hospital, between the 1st of November 2012 and the 31st of December 2019. Hospital records (demographic, anamnestic, and radiographic data) and dental records (preoperative, intraoperative, and radiographic data) were analyzed with descriptive statistics, chi-square test of homogeneity, Fisher's exact test, independent sample t-test, Welch's ANOVA, and, if indicated, post hoc test (level of statistical significance: p < 0.05). Results: Out of 384 patient cases hospitalized with SOI, 229 (59.6%) were considered to have endodontic aetiology. Among these, apical periodontitis (AP) was related to root-filled (RF) teeth in 44 cases (19.2%), teeth with ongoing endodontic treatment in 44 cases (19.2%), endodontically untreated teeth in 121 cases (52.8%), and unknown endodontic treatment status in 20 cases (8.7%). Men were more often hospitalized with endodontically untreated teeth (56.2%) compared to RF teeth (34.1%) (p = 0.023). Patients hospitalized with endodontically untreated teeth had a higher mean age (46.5 [±20.1] years), more diseases (48.7%), and consumed more medications (53.7%) compared to those with ongoing endodontic treatment (38.9 [±13.5] years, 19.5% and 27.3%, respectively) (p = 0.025, p = 0.005, and p = 0.011, respectively). In total, 85% of the root fillings were assessed as insufficient regarding length and seal. From dental records, it was documented that 34% received systemic antibiotics (ABs) for their AP without initiating operative endodontic treatment. Conclusions: Endodontic infections, especially from endodontically untreated teeth, were the most frequent cause of SOIs leading to hospitalization. The quality of root fillings was generally insufficient, and numerous patients were prescribed systemic ABs prior to hospitalization without concomitant operative endodontic treatment. This indicates the importance of well-performed operative dental treatments to decrease the risk of severe infection spread.

Aim: In uncertain clinical situations, such as assessing the risk of exacerbation of apical periodontitis in root-filled teeth, un-dergraduate students can benefit from being trained to reflect. This study aimed to explore how students specifically reflectedon clinical experiences in relation to uncertainty when assessing a case involving a root-filled tooth with apical periodontitis.

Methodology: Short reflections were written by 52 dental students at Malmö University in 2021. All students were asked toreflect on the risk for exacerbation of apical periodontitis in a case with a root-filled tooth with a diffuse widening of the perio-dontal ligament space. The reflections were written according to prompts developed to stimulate reflection. For each student, thereflections were analysed by a qualitative method, Systematic Text Condensation (STC).

Results: The analysis of the qualitative data resulted in the formulation of two themes about experience and lack of experience:Theme 1 ‘The meaning of clinical experience’ and Theme 2 ‘Differences and similarities’. The themes were subdivided into ninesubgroups and described the relationship between experience and certainty.

Conclusions: The students believed that certainty comes with experience even when there is a lack of scientific evidence

European Society of Endodontology har udarbejdet retningslinjer for behandling af pulpitis, som vi i denne artikel beskriver og vurderer fra et skandinavisk perspektiv. 

Introduction: Epidemiological studies indicate that root filled teeth exhibit higher rates of apical periodontitis and extraction compared to non-root filled teeth, underscoring the importance of vital pulp treatment (VPT) when feasible in teeth with pulpitis. The European Society of Endodontology has established guidelines for treatment of pulpitis, which this article evaluates from a Scandinavian perspective.

Review of available scientific literature: The guidelines are based on three systematic reviews on pulpitis management. For teeth with pulpitis without spontaneous pain, evidence is insufficient to favour direct pulp capping over pulpotomy or selective/stepwise caries removal. In teeth with pulp exposure due to caries, direct pulp capping and pulpotomy show comparable short-term outcomes. For teeth diagnosed with pulpitis, with or without spontaneous pain, pulpotomy and root canal treatment demonstrate similar short-term effectiveness. Root canal treatment is suggested to be performed on teeth as soon as the diagnosis necrosis is confirmed to prevent apical periodontitis.

Discussion: VPT offers advantages, though concerns persist regarding long-term pulp survival and undetected disease progression. ESE’s guidelines are in line with the Scandinavian’s, though evidence is weak concerning balancing short-term benefits against long-term outcomes, emphasizing the need for careful clinical judgment and further research.

Keywords: dental caries, dental pulp capping, dental pulp exposure, pulpectomy, pulpotomy

AIM: A successful outcome of root canal treatment is defined by the Strindberg Concept (SC) as the absence of symptoms and no periapical radiolucency. Hence, other outcomes are deemed unacceptable and should render retreatment, or extraction. However, empirical as well as experimental studies within the area of endodontic decision-making have repeatedly challenged the position of the SC among clinicians. A fundamentally different clinical approach is a conservative concept (CC), which is to prescribe treatment only if new or persistent symptoms (exacerbations) occur in order to keep the patient asymptomatic. The aim in this study is to compare the expected costs of SC versus CC, depending on varying risk of exacerbation and outcome of the interventions.

Methodology: Decision trees were constructed with the main branches representing treatment strategies SC or CC. Estimated costs for both treatment strategies were calculated using the 2025 Swedish Dental and Pharmaceutical Agency's reference pricelist. Outcomes of ortho- and retrograde retreatment were based on data in recently published high-quality reviews. A one-way sensitivity analysis varying the likelihood of exacerbation was performed.

Results: Preliminary results To strictly adhere to the SC in the Swedish population would render a cost of approximately €2.50 billion. Setting the probability of exacerbation to 10%, it would be at least 11 times as expensive to pursue the SC strategy compared to the CC. The sensitivity analyses revealed that it is not cost-effective to choose the SC in favour of the CC strategy unless the probability of exacerbation exceeds 80-90%. '

Conclusions (mandatory): Within the limitations and assumptions of this study, strictly adhering to the SC in the Swedish population is an expensive strategy that risks blocking other urgent dental care.

Acknowledgements (optional): Funding source: Uppsala County Council, Sweden