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Summary. Endodontic paper points were tested for antibacterial activity after the accidental finding: that bacterial cultures were inhibited by one variety. Of five types tested, two, from the same supplier, were found to exhibit diffusible antibacterial activity against salivary and subgingival plaque micro-organisms. The identity of the agent responsible for this activity has not been determined, but preliminary tests indicate that it is an aldehyde.

Summary. The formaldehyde content in four brands of endodontic paper points was determined with an improved 2,4-dinitrophenylhydrazine (DNPH) method. One brand, earlier shown to exhibit cytotoxic as well as haemolytic activity, contained significantly more formaldehyde than the others.

Aim To investigate the antimicrobial activity of root canal sealers on Enterococcus faecalis, either allowing or avoiding direct contact between sealers and bacteria. Methodology Filter paper discs were immersed in standardized E. faecalis suspensions and exposed to freshly mixed sealers (MCS, AH Plus, Grossman's sealer, Sealapex, Apexit) in teflon wells for 30 min, with or without a filter membrane placed between filter paper discs and sealers (membrane-restricted contact test and direct contact test, respectively). After exposure, the filter paper discs were transferred to vials containing phosphate-buffered saline (PBS) and glass beads, and vigorously vortexed. PBS with resuspended bacterial cells was serially diluted and 25 μL droplets were seeded on TSA plates. The plates were incubated in air at 37 °C for 24 h and colony-forming units were counted. Using α = 0.05 as level for statistical significance, the data obtained were analysed using Student's t-test. Results In the direct contact test, MCS and AH Plus killed the bacteria to a level below the detection limit. They were followed in decreasing order of efficacy by Grossman's sealer, Sealapex and Apexit. In the membrane-restricted contact test, the sealers ranked: MCS, AH Plus, Grossman's sealer, Apexit and Sealapex, in descending order of antibacterial potency. MCS, AH Plus and Grossman's sealer significantly reduced the number of viable bacteria in both tests. Sealapex and Apexit were not statistically different from control. Conclusions MCS, AH Plus and Grossman's sealer were effective in reducing the number of cultivable cells of E. faecalis. Calcium hydroxide-based sealers, Sealapex and Apexit were ineffective in this short-term experiment.

Aim To compare the use of periapical radiographs and digital panoramic images displayed on monitor and glossy paper in the assessment of the periapical status of the teeth using the periapical index (PAI). Methodology A total of 86 subjects were examined. All participants underwent a full-mouth radiographic survey (14 periapical radiographs) and a panoramic radiography. The periapical status, using the PAI score, of all appraised teeth was assessed. Results Periapical radiographs allowed the assessment of the periapical status of 87% of teeth using the PAI. On the contrary, digital radiography had a significantly reduced potential to allow assessment of the periapical status (P

Aims To evaluate the availability, effect of storage, dilution and heating on some commercial sources of sodium hypochlorite (NaOCl). Methodology All pharmacies in a Regional Health Authority were telephone surveyed to establish the proprietary and nonproprietary NaOCl products available, their cost and concentration. Ninety-six freshly produced bottles of a commercially available thin household bleach (J. Sainsbury's) were randomly stored in four different modes (full 1 L bottles in dark at room temperature, half-empty 1 L bottles under the same conditions, full 200 mL bottles under the same conditions, full 200 mL bottles stored at 37 degrees C) up to 6 months. The available chlorine in the bleach solutions was evaluated at specific time intervals (0, 1, 2 weeks, 1, 2, 3, 4, 6 months) using iodometric titration. Four brands of commercially available bleaches (J. Sainsbury's Thin Household Bleach, Tesco's Value Bleach, Tesco's Red Label Bleach, Safeway's Savers Bleach) were diluted (by 1 : 1, 1 : 2 or 1 : 3 dilution factors) and samples taken from each dilution for titration to test predictability. NaOCl solutions (5% w/w) were heated in covered or uncovered beakers up to 60-85 degrees C. Samples were taken from each beaker at time 0 and each h up to 4 h, for titration. Results Of the 116 pharmacies, 33% could supply a proprietary product and 53% a nonproprietary product. In all, 78% were able to supply a NaOCl product. There was no significant difference (P 0.05) between the different modes of storage. When the storage temperature was 37 degrees C, however, there was a significant difference (38% of original; P Conclusions Both proprietary and nonproprietary solutions of NaOCl should be relatively easily obtainable in the UK. Stored under appropriate conditions, commercially available thin bleaches and nonproprietary solutions of NaOCl may be diluted to obtain predictable concentrations. Heating solutions of NaOCl may cause unpredictable changes to the concentration, depending upon conditions.

Summary. The Ultrafil heated gutta-percha delivery system was evaluated to determine if (i) the prepackaged gutta-percha used in the system was contaminated and antimicrobial, (ii) the gutta-percha-containing cannules were packaged in a sterile state, and (iii) a combination of alcohol soak and low heat was sufficient to eliminate any contaminating microbes. The results showed that although the gutta-percha did not appear to be contaminated with cultivable bacteria, the cannules were contaminated with micro-organisms that could not be totally eliminated by alcohol soak and low heat. Suggestions for the maintenance of clinical asepsis when using this technique are provided.

The lipopolysaccharides-dentine-infection (LPS-dentine-infection) models and sampling techniques frequently used to evaluate LPS disinfection have limitations. In this study, a LPS-dentine-infection model was devised using fluorescent conjugate LPS. Secondly, a sampling technique using cryogenic grinding for intraradicular LPS analysis was evaluated. Thirdly, the effectiveness of the XP-endo Finisher (XP-EF) was compared with passive ultrasonic irrigation (PUI) in removing LPS from root canal system.Sixty-nine mandibular premolars were submitted to dentine pretreatment and inoculated with fluorescent LPS conjugate (Alexa Fluor® 594). Twenty-three teeth were analysed under confocal laser scanning microscopy (CLSM) to validate this modified LPS-dentine-infection model. Forty-six teeth were randomly divided into two experimental groups: XP-EF (n = 23) and PUI (n = 23). All teeth were instrumented with XP-endo shaper (XPS; FKG Dentaire) and 2.5% NaOCl. The root canals were sampled with paper points before (s1) and after (s2) instrumentation and after supplemental treatment (s3) with XP-EF and PUI. After s3, all roots were cryogenically ground for intraradicular LPS analysis (s4). Limulus amebocyte lysate assay was used for LPS quantification. The Friedman test was used for differences in LPS among four time-points (s1, s2, s3, and s4). Dunn's test was used for pairwise testing of time-points. The significance level was set at 5% (p .05).Fluorescent LPS conjugate was detected in 100% of the samples under CLSM with a penetration depth of approximately 400 μm into dentine. Chemo-mechanical preparation using XPS files significantly reduced LPS levels (p .05). Both the XPS and PUI improved the LPS disinfection (p .05), with no difference between them (p .05). LPS was recovered from all samples after cryogenic grinding. The residual amount of LPS detected using the cryogenically sampling technique at s4 was approximately three times greater than with the paper-point sampling technique at s3.This study established a modified LPS-dentine-infection model using fluorescent conjugate LPS, and validated a LPS sampling technique for using cryopulverization intraradicular LPS analysis. Moreover, both the XP-EF and PUI further improved LPS disinfection from the root canals, and the innovative XP-EF was as effective as PUI.

Aim To report the most common terminology used in titles of scientific papers published in the International Endodontic Journal (IEJ) and Journal of Endodontics (JOE) between 1980 and 2019 and to identify the most-cited papers in these journals. Methodology The Web of Science database was searched to retrieve all the manuscripts published in the IEJ and JOE between 1980 and 2019. The articles were analysed using the VOS viewer software and the terms within the titles extracted. The top-10 terms were categorized according to the number of occurrences and the decade of publication. Maps were created using the text data for each decade of publication. Classic papers were identified when the number of citations was >400. During the same period of time, highly cited studies were identified including the authors, institutions and countries associated with these papers. Results Terms such as canal, molar and periapical lesion were the most commonly used in titles between 1980 and 1999. The terms instruments, expression, case report and cell were the most often terms used between 2000 and 2019. During the last 10 years, an increase in the number of reviews and papers on cone beam computed tomography occurred. The organizations with the largest number of citations in each decade were University of Sao Paulo, University College London, Loma Linda University and United States Army. The country with the largest number of citations and greatest number of top 10 and top 100 manuscripts was the United States. A paper had to be associated with more than 167 citations to be included in the top-100 most-cited list; at least 14 papers met the criteria to be categorized as a citation classic (>400 citations). Conclusion While many diverse areas of endodontics have been explored in the last 40 years within the IEJ and JOE, only a relatively few topics are highly cited and can be considered as classics.

This Position Statement represents a consensus of an expert committee convened by the European Society of Endodontology (ESE) on the use of Cone Beam Computed Tomography (CBCT) in Endodontics. This paper is an update of the ESE CBCT position statement which was published in 2014 (European Society of Endodontology 2014, https://doi.org/10.1111/iej.12267). Recent review articles provide more detailed background information and the basis for this position statement. It is intended that this position statement will be updated at least every 4-5 years to keep abreast of relevant research. The aim of this paper is to provide clinicians with evidence-based guidance on the application of CBCT in Endodontics. Since 2014, there has been an increase in the number of clinical studies confirming the positive impact of CBCT on treatment planning, decision-making when reviewing cases and reduced practitioner stress levels.

The aim of this systematic review was to address the question: Do different irrigating protocols have an impact on the dislocation resistance of mineral trioxide aggregate (MTA)-based materials? The review was performed using a well-defined search strategy in three databases (PubMed, Scopus, Web of Science) to include laboratory studies performed between January 1995 and May 2017, in accordance with PRISMA guidelines. Two reviewers analysed the papers, assessed the risk of bias and extracted data on teeth used, sample size, size of root canal preparation, type of MTA-based material, irrigants, canal filling method, storage method and duration, region of roots and the parameters of push-out testing (slice thickness, plunger dimensions and plunger loading direction), the main results and dislocation resistance values (in MPa). From 255 studies, 27 were included for full-text analysis. Eight papers that met the inclusion criteria were included in this review. There was a wide variation in dislocation resistance due to differences in irrigation sequence, time and concentration of irrigants, storage method and duration, and the parameters of push-out bond strength testing. A meta-analysis was not done but qualitative synthesis of the included studies was performed. No definitive conclusion could be drawn to evaluate the effect of irrigation protocols on dislocation resistance of MTA-based materials. Recommendations have been provided for standardized testing methods and reporting of future studies, so as to obtain clinically relevant information and to understand the effects of irrigating protocols on root canal sealers and their interactions with the dentine walls of root canals.

To evaluate the efficacy of different solvent evaporation strategies on bonding of one-step self-etch adhesives to root canal dentine.Two dual-cure resin core systems (Clearfil DC Bond/Clearfil DC Core Automix and Clearfil Tri-S Bond Plus/Clearfil DC Core Plus; Kuraray Noritake Dental, Tokyo, Japan) were equally applied in 24 post spaces from extracted human mandibular premolars. After the adhesive application, specimens were randomly assigned into four water/solvent evaporation strategies as follows (I) insertion of absorbent paper point for 10 s: P, (II) 10 s air-blowing: A, (III) as (II) followed by insertion of absorbent paper point: AP, (IV) as (III) followed by 10 s additional air-blowing: APA. Then, the adhesives were light cured, and resin core materials were placed into the post space, followed by light curing for 60 s. After water storage for 24 h, 0.6 × 0.6 mm-thick beams were prepared to measure the regional μTBS. The mode of failure was also observed. The μTBS values were statistically analysed using three-way anova and Duncan HSD test (α = 0.05).In the coronal region, there were no significant differences in μTBS between each evaporation strategy (P 0.05), except P group. However, in the apical region, APA and AP groups significantly increased in μTBS compared with A and P groups (P 0.05). Only in the APA group of Clearfil Tri-S Bond Plus/Clearfil DC Core Plus, was there no significant difference in μTBS between the coronal and apical regions (P 0.05).The use of paper points with additional air-blowing for removing excessive adhesive and evaporating residual water/solvent would be effective in producing higher bond strength for the tested one-step self-etch adhesives and fewer blister formations in deeper regions of the post space.

Aim To compare the antimicrobial activities of Activ Point (Roeko, Langenau, Germany), Calcium Hydroxide Plus Point (Roeko, Langenau, Germany), calcium hydroxide, 1% chlorhexidine gel and bioactive glass (S53P4) against Enterococcus faecalis and Streptococcus mutans. Methodology One hundred and twenty extracted single-rooted human teeth were used. After removing the crowns, root canals were prepared by using the Protaper rotary system. Following autoclave sterilization, root canals were incubated at 37 °C with E. faecalis ATCC 29212 and S. mutans RSHM 676 for 1 week. The specimens, which were divided into five treatment groups for each microorganism according to the intracanal medicament used, were tested in 10 experimental runs. In each experimental run, 10 roots were included as treatment, one root as positive control and one root as sterility control. Sterile paper points were utilized to take samples from root canals after the incubation of teeth in thioglycollate medium at 37 °C for 1 week. Samples taken from teeth by sterile paper points were inoculated onto sheep blood agar, and following an overnight incubation, the colonies grown on sheep blood agar were counted and interpreted as colony-forming units. Results were tested statistically by using Kruskal–Wallis and Conover's nonparametric multiple comparison tests. Results CHX gel (P

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.

The purpose of this study was to compare the antibacterial effects of Allium sativum (garlic extract), calcium hydroxide (Ca [OH]This prospective double-blind, controlled, parallel, superiority, randomized clinical trial was carried out on 66 permanent, necrotic incisors associated with asymptomatic apical periodontitis in 66 male patients. Patients were randomly divided into three groups (n = 22) according to the intracanal medications used. After access preparation, four microbiological samples (S) were taken using sterile absorbent paper points as follows: S1: before canal instrumentation and S2: after cleaning and shaping. The third sample (S3) and fourth sample (S4) were taken after the placement of the tested intracanal medications into their corresponding canals for 7 and 14 days, respectively. Total DNA was extracted from microbiological samples and relative quantitative real-time PCRs were done to quantify the relative gene expression fold change (FC) for Enterococcus faecalis and Streptococcus species. At significance level p ≤ .05, the data were statistically analysed in SPSS software using Kruskal-Wallis and Freidman's tests, followed by Dunn-Bonferroni post hoc test for pairwise comparisons.Both bacterial mean FC decreased significantly after mechanical instrumentation (S1 to S2) in all groups. However, no statistically significant differences were found after intracanal medicament placement (from S2 to S3 and from S3 to S4) except in the garlic group. Garlic significantly reduced Enterococcus faecalis FC in S3 and S4 when compared to Ca (OH)Within the study limitations, garlic intracanal medicament has a comparable anti-Streptococcus efficiency to Ca (OH)

Violich DR, Chandler NP. The smear layer in endodontics – a review. International Endodontic Journal, 43, 2–15, 2010. Root canal instrumentation produces a layer of organic and inorganic material called the smear layer that may also contain bacteria and their by-products. It can prevent the penetration of intracanal medicaments into dentinal tubules and influence the adaptation of filling materials to canal walls. This article provides an overview of the smear layer, focusing on its relevance to endodontics. The PubMed database was used initially; the reference list for smear layer featured 1277 articles, and for both smear layer dentine and smear layer root canal revealed 1455 publications. Smear layer endodontics disclosed 408 papers. A forward search was undertaken on selected articles and using some author names. Potentially relevant material was also sought in contemporary endodontic texts, whilst older books revealed historic information and primary research not found electronically, such that this paper does not represent a ‘classical’ review. Data obtained suggests that smear layer removal should enhance canal disinfection. Current methods of smear removal include chemical, ultrasonic and laser techniques ‐ none of which are totally effective throughout the length of all canals or are universally accepted. If smear is to be removed, the method of choice seems to be the alternate use of ethylenediaminetetraacetic acid and sodium hypochlorite solutions. Conflict remains regarding the removal of the smear layer before filling root canals, with investigations required to determine the role of the smear layer in the outcomes of root canal treatment.

Aim To review and discuss the aetiology, prevalence and classification of this dental anomaly together with the morphology of an invagination and the most appropriate nomenclature. Summary This review considers the different possible nomenclatures and concludes that dens invaginatus is the most appropriate description. The paper highlights the different reported prevalence figures and concludes that the problem is probably one of the most common of the dental developmental abnormalities with maxillary lateral incisors most commonly affected. The paper suggests that the classification system described by Oehlers (1957a) is probably the most clinically relevant and that the morphological features associated with this problem may increase the risk of pulpal pathology developing and complicate any possible endodontic treatment. Key learning points • The aetiology of dens invaginatus is still unknown, although there is some evidence that it may be genetic in origin. • The problem is probably more prevalent than most clinicians are aware of and this is because of the diagnostic difficulties associated with the anomaly. • The nature of the problem may increase the risk of pulp disease and complicate any root canal treatment.

Canal filling materials and techniques have been one of the most studied topics in Endodontics. A simple search using the mesh term "root canal filling" in PubMed revealed more than 11 000 articles, an impressive number that is much higher than "root canal disinfection" (5544 articles) or even the popular "root canal preparation" (8527 articles). The overriding importance attributed to root filling procedures is not merely intuitive. It derived from the appealing relevance given by the appearance of the white lines in common radiographs grounded on retrospective clinical data that had identified the quality of a root filling as one of the major causes of treatment failure (lack of healing). Since the publication of the Washington study, impressive efforts have been made for the release of new materials and techniques, as well as, for the development of a plethora of laboratory methods to assess the quality of root filling procedures. This narrative review aims to address and discuss the most relevant laboratory methods to assess the root canal filling. As filling quality improvements have not translated into higher success rates, as reported in longitudinal clinical studies, more than to deliver a simple methodology-based review, this paper aims to present an in-depth critical view on the assessment of laboratory methods used to study the filling materials and techniques. Recent data indicate that the long-term dimensional stability/degradation over time of endodontic sealers plays a central role in the treatment outcome. In this context, laboratory methods should be developed focusing on predicting, at least to some degree, the long-term clinical behaviour of root canal fillings, rather than simply ranking different materials or techniques.

As a range of materials used in endodontics may cause tooth discolouration, exploration of factors responsible for the darkening of the tooth crown or root is warranted. This narrative review paper discusses the range of technical factors that apply in laboratory studies that assess endodontic discolouration. As an example of how these factors operate, particular examples relating to discolouration caused by endodontic medicaments containing tetracycline antibiotics are used. Following the PRILE 2021 guideline approach, a summary of key variables to be addressed in the methodology for laboratory studies is presented, to inform future work.

Aim The aim of this study was to determine the influence of vehicles on the antimicrobial efficiency of calcium hydroxide. Methodology A total of 588 size 50 sterile absorbent paper points, were immersed in various microbial suspensions for 3 min. The points were then placed on Petri dishes and covered with intracanal dressings containing calcium hydroxide: Ca(OH)2 + saline; Ca(OH)2+ camphorated paramonochlorophenol; Ca(OH)2 + 1% chlorhexidine solution; Ca(OH)2 + 3% sodium lauryl sulphate; Ca(OH)2 + Otosporin®. After 1 min, 48 and 72 h and 7 days, 147 absorbent paper cones were removed from contact with the intracanal dressings and individually transported and immersed in 5 mL of Letheen Broth, followed by incubation at 37 °C for 48 h. Microbial growth was evaluated by turbidity of the culture medium. A 0.1-mL inoculum obtained from the Letheen Broth was transferred to 5 mL of BHI, and incubated at 37 °C for 48 h. Bacterial growth was again evaluated by turbidity of the culture medium. Positive BHI tubes were selected and inocula were spread on the surface of BHI agar and incubated at 37 °C for 48 h. Gram staining of the BHI growth and from colonies growing on BHI agar was carried out. Results An antimicrobial effect occurred after 48 h on the cultures of S. mutans, E. faecalis, S. aureus, P. aeruginosa, B. subtilis, C. albicans and a mixed culture, irrespective of the intracanal dressing. Conclusions Under the conditions of this study, the various vehicles associated with calcium hydroxide pastes did not influence the time required for microbial inactivation.

Peterson J, Gutmann JL. The outcome of endodontic resurgery: a systematic review. International Endodontic Journal , 34 , 169‐175, 2001. Aim The aim of this paper is to establish an outcome standard for the assessment of healing radiographically after resurgery of persistent periradicular lesions by systematically reviewing the results from published studies. Methodology The systematic review process requires the definition of predetermined criteria delineating the inclusion parameters of studies reviewed. Of 42 papers that were reviewed, eight qualified for inclusion. A weighted-average was calculated from the results taken from the eight eligible, peer-reviewed studies, published between 1970 and 1997. Results Three hundred and thirty patients out of 2375 (14%) from the included studies underwent resurgery for failure of healing as determined radiographically. Of this population, 35.7% healed successfully after resurgery, 26.3% healed with uncertain results and 38% did not heal at the one-year follow-up. Conclusions Although there is nearly equal distribution of results between all categories, a 35.7% rate of healing as assessed radiographically is essentially equivalent to the 38% failure rate. This paper will allow an evaluation of current research results to establish an outcome standard and enable techniques and filling materials to be evaluated and compared. Furthermore, the outcome standard can assist in defining demographic and aetiological factors that contribute to the potential outcome of resurgery cases.

CLINICAL TECHNIQUE: Since the introduction of nickel-titanium in endodontics, several canal preparation techniques involving the use of rotary instruments have become popular. Such engine-driven rotary instruments rotate between 150 and 2000 r.p.m. and may be high or low torque orientated. This paper describes one such engine-driven system called the ProFile technique. The instruments are of a different specification to that used for conventional endodontic files and reamers. This paper describes a technique employed by the Division of Endodontology, Zurich Dental School, in a step-by-step procedure using primarily photographs of radiographs. The intention is to give any interested clinician a better idea of the technique using radiographs taken from both the buccolingual (clinical) perspective and the mesiodistal projection. Basically, the technique involves preparing the coronal portion of the root canal using Gates-Glidden burs and the ProFile instruments. Only when any constricting coronal parts of the canals have been removed is the working length established using conventional files. Finally, the apical part of the canal is prepared using only the ProFile instruments. Three clinical cases are also briefly described, in order to illustrate the potential of the technique in cases treated generally by clinicians.

Aim This study determined the frequency of Porphyromonas endodontalis, Porphyromonas gingivalis, Prevotella intermedia and Prevotella nigrescens in 20 closed periapical lesions associated with symptomatic and asymptomatic refractory endodontic disease.Methodology To deliniate possible oral sources of P. endodontalis, the presence of the organism was assessed in selected subgingival sites and saliva in the same study patients. Periapical samples were obtained by paper points during surgical endodontic procedures using methods designed to minimize contamination by non-endodontic microorganisms. Subgingival plaque samples were obtained by paper points from three periodontal pockets and from the pocket of the tooth associated with the closed periapical lesion. Unstimulated saliva was collected from the surface of the soft palate. Bacterial identification was performed using a species-specific polymerase chain reaction (PCR) detection method.Results P. Endodontalis was not identified in any periapical lesion, even though subgingival samples from eight patients (40 %) revealed the P, endodontalis-specific amplicon. P. gingivalis occurred in one periapical lesion that was associated with moderate pain. P. nigrescens, P. Endodontalis and P. intermedia were not detected in any periapical lesion studied.Conclusions Black-pigmented anaerobic rods appear to be infrequent inhabitants of the closed periapical lesion.

The introduction of microinstruments for root-end cavity preparation has clearly improved the surgical technique in periradicular surgery with apicectomy. The new generation of sonic and ultrasonic root-end preparation devices, usually termed 'retrotips', has simplified the preparation of a sufficiently deep cavity that follows the original path of the root canal. The present paper describes the use of a new set of diamond-surfaced retrotips driven by a sonic handpiece. For clinical evaluation a prospective study was carried out, with assessment of pre-, intra- and postoperative data in 50 teeth (43 patients). This paper analyses: (i) the applicability of the new retrotips; (ii) the quality of the root-end filling assessed radiographically; (iii) the immediate postoperative course. Access with the retrotips to the resected root-end was found to be excellent in 80% of the treated teeth. The postoperative radiographs showed a root-end filling of at least 3 mm in 70% of the resected teeth. Healing was uneventful in all cases and most patients presented without any symptoms after 5 days and 10 days. The long-term treatment outcome will be reported in a future paper.