Single Visit RCT With or Without MTAD: Enriching Discussion

Root canal treatment With or Without MTAD

In a rigorous clinical trial led by Dr. Berkcan Yildiz, the outcomes of single-visit root canal treatments in 100 patients with apical periodontitis were scrutinized over a 2-year period.

  • Research paper title: Outcome of single-visit root canal treatment with or without MTAD: A randomized controlled clinical trial
  • First Author: Berkcan Yildiz
  • Date of publishing: 28 September 2023
  • Link

The participants were randomly assigned to receive root canal treatment either with BioPure MTAD solution or without (control group). Initial and follow-up periapical radiographs were meticulously examined, focusing on the fractal dimension (FD) of the periapical lesion’s trabecular patterns around the root apex and utilizing the periapical index (PAI) for classification of periapical status as “healed” or “unhealed.”

Intriguingly, 28 patients did not complete the 24-month follow-up, leaving 72 patients for analysis. The results indicated a statistically significant decrease in PAI scores and a notable increase in FD values in both groups, suggesting that root canal treatments, whether with or without BioPure MTAD, contributed significantly to periapical healing in single-visit procedures.

In conclusion, Yildiz’s study underscores the effectiveness of root canal treatments in promoting periapical healing, irrespective of the use of BioPure MTAD irrigation. The statistical analysis revealed a substantial reduction in PAI scores and a simultaneous increase in FD values over the 2-year period, indicating improved radiographic outcomes in the trabecular bone surrounding the root apex.

The findings emphasize the reliability of single-visit root canal procedures in fostering positive long-term effects on periapical health.

Methodology appraisal

StrengthsAreas for Improvement
Meticulous patient selection criteriaExplanation of the rationale for the choice of BioPure MTAD
Adherence to ethical guidelines and approvalMore information on patient compliance during follow-up
Randomized clinical trial designDetailed discussion on potential biases introduced by blinding
Single-blinded approach for minimizing biasClarification on patient non-compliance reasons during follow-up
Detailed description of root canal procedure
Adherence to PRIRATE guidelines for transparency

The methodology of the study conducted by Berkcan Yildiz on the outcome of root canal treatment with or without BioPure MTAD solution demonstrates several strengths, but there are areas where improvements could be considered.

One notable strength is the meticulous patient selection process, ensuring homogeneity in the study population. The inclusion and exclusion criteria are well-defined, focusing on single-rooted teeth with apical periodontitis, and considering factors such as age, medical history, and previous treatments.

The study’s adherence to ethical guidelines, approval from the Ethics Committee, and registration on with a unique identifier contribute to the credibility of the research.

The randomized clinical trial design with a single-blinded approach adds robustness to the study, minimizing bias. The use of randomization blocks and an independent biostatistician for allocation enhances the reliability of group assignments.

The study’s adherence to the PRIRATE guidelines for randomized trials is a commendable practice that ensures transparency and replicability. Moreover, the detailed description of the root canal procedure, including the assessment of pulp sensibility, local anesthesia, and instrumentation, adds clarity to the methodology.

However, there are areas for potential improvement.

The study could benefit from a more detailed explanation of the rationale behind the choice of BioPure MTAD solution and the control group.

Additionally, while the patient follow-up schedule is well-defined, providing more information on patient compliance during the follow-up period and addressing the reasons for non-compliance would enhance the study’s completeness.

Furthermore, a detailed discussion on any potential biases introduced by the single-blinded approach and the steps taken to mitigate them would strengthen the methodological transparency.

Actionable insights to consider

Based on the conclusion and the aim of the study, here are actionable insights that you can consider incorporating into your practice:

Consideration of Single-Visit Root Canal Treatments

The study emphasizes the effectiveness of single-visit root canal treatments in promoting periapical healing. Dentists may consider incorporating or optimizing single-visit procedures in appropriate cases to enhance patient outcomes.

Evaluation of Periapical Healing

Dentists can adopt a proactive approach by evaluating periapical healing using reliable indicators such as the periapical index (PAI) and fractal analysis. Regular radiographic assessments can provide valuable insights into the success of root canal treatments over time.

Selection of Irrigation Solutions

While the study found no significant difference between BioPure MTAD and the control group, dentists may consider the choice of irrigation solutions based on individual patient needs and treatment outcomes. Regular review of emerging irrigation solutions and their efficacy may be beneficial.

Patient Informed Consent and Communication

The study highlights the importance of informing patients about the nature of the study and obtaining consent. Dentists should prioritize clear communication with patients, explaining the chosen treatment protocols and expected outcomes.

Periodic Radiographic Assessments

Regular follow-up appointments, as suggested by the study at 6, 12, 18, and 24 months, can aid in monitoring the long-term success of root canal treatments. Dentists may consider incorporating a structured follow-up schedule to assess radiographic changes and ensure continued periapical health.

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