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Objective: The objective of this study was to evaluate the microbiological profile of root canals indicated for endodontic retreatment due to secondary endodontic infections evidenced by the presence of chronic apical periodontitis (G1) or for prosthetic reasons, without clinical and radiographic signs of endodontic reinfection (G2). Methods: Microbiological samples were collected from thirty teeth (N=30) out of which 15 were indicated for retreatment due to the presence of chronic apical periodontitis (G1) and 15 were indicated exclusively for prosthetic reasons (G2). Samples were collected from root canals before (S1), after chemomechanical preparation (S2), and after 30 days of intracanal medication composed of calcium hydroxide and 2% chlorhexidine gel (S3). The molecular analysis was performed using Nested-PCR for the detection of 17 bacterial species. The efficacy of each stage of the retreatment in reducing the microbial load was verified by counting colony-forming units (CFU). The statistical analysis considered a significance level of 5%. Results: The results showed that bacteria were detected in 100% of the cases in S1, in both groups, by Nested PCR. The most frequently found species in S1 in both groups were Enterococcus faecalis, Fusobacterium nucleatum, Porphyromonas gingivalis, Aggregatibacter actinomycetemcomitans, and Parvimonas micra. The microbial load of G1 was higher than G2 in the initial samples (S1). Endodontic retreatment was effective in reducing the microbial load in G1 and G2. Statistically significant associations were found between specific bacteria and clinical signs and symptoms. Conclusion: It was concluded that the microbial community present in the root canal of teeth indicated for endodontic retreatment is mixed and heterogeneous. G1 and G2 differ in the number of species per case and microbial load. Clinical relevance: Endodontic retreatment was effective in reducing the microbial load. Statistically significant associations were found between specific bacteria and clinical signs and symptoms. [ABSTRACT FROM AUTHOR]

Objective: Confocal laser scanning microscopy (CLSM) was used to investigate the penetration of endodontic sealers into the dentinal tubules after retreatment using two different obturation techniques. Materials and methods: Thirty mandibular premolars were prepared up to instrument F3 (ProTaper Universal, Dentsply) and filled with Endofill using the single cone technique. The canals were retreated using Mtwo instruments. Reobturation was performed with the Bio-C sealer mixed with a fluorophore dye (Fluo-3) using either the lateral condensation technique (group LC) or the single cone technique (group SC) (n = 15). Teeth were sectioned 2, 4, and 6 mm from the apex and analyzed with CLSM to assess the penetration of the sealer into the canal perimeter and the maximum depth of penetration of the sealer into the dentinal tubules. Data were analyzed using ANOVA and the Student-t and Holm-Sidak tests. Results: In the apical segment, the penetrated perimeter was significantly higher in the LC group than in the SC group (p < 0.05); no significant difference was found in the middle and cervical segments (p > 0.05). In terms of penetration depth, no significant differences were found for any of the segments studied (p > 0.05). Conclusion: The LC technique promoted a higher percentage of canal circumference penetrated by the sealer than the SC technique in the apical segment after endodontic retreatment. Clinical relevance: CLSM demonstrated that the LC technique promoted a higher percentage of canal perimeter penetrated by the Bio-C sealer than the SC technique in the apical segment of mandibular premolars after retreatment. [ABSTRACT FROM AUTHOR]

Background: The aim of this systematic review and meta-analysis (SRM) was to assess the postoperative pain (PP) after non-surgical endodontic retreatment (NSER) in a one visit compared to multiple visits. The PICO question used was "Does NSER in patients with unsatisfactory endodontic treatment in a one-visit visit have a similar PP to that of NSER in multiple visits?" Materials and methods: This systematic review followed PRISMA and was registered in PROSPERO (CRD42019136700). Searches were performed in the PubMed/MEDLINE, Scopus, and the Cochrane Library databases for articles published until September 2020. The eligible criteria were randomized clinical trials (RCTs). The meta-analysis was based on the Mantel-Haenszel. The PP after the retreatment was analyzed using a dichotomous outcome, measured according to risk ratio (RR) when p < 0.05. The Cochrane scale was used to assess risk of bias, and the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach was used to assess the quality of evidence. Results: Four studies were included. In general analysis without considering intensity, one-visit NSER presented lower PP than the multiple visits only for 1 and 30 days [(RR = 0.67; CI: 0.48 to 0.93; p = 0.02), and (RR = 0.09; CI: 0.01 to 0.66; p = 0.02)], respectively. Regarding sub-analysis considering the intensity, one visit present lower mild PP when compared with multiple visits [(RR = 0.54; CI: 0.30, 0.96; p = 0.04); (RR = 0.33; CI: 0.12, 0.88; p = 0.03); and (RR = 0.12; CI: 0.02, 0.86; p = 0.03)], respectively. However, sub-analysis for moderate and severe PP showed no significant difference, independently of period evaluated (p > 0.05). Regarding the risk of bias analysis, a low risk was observed for most domains, except allocation that was considered unclear, while the certainty of evidence for each analysis was considered low. Conclusion: Within the limitations of study, the one and multiple visit can be considered adequate, because both present a similar occurrence of PP, except for mild pain. However, due to the low number of studies, further well conducted and standardized RCTs are needed to reassess these results. Clinical relevance: Both therapies of endodontic retreatment can be considered in clinical practice. Therefore, the endodontist must consider the patient's individual characteristics and experience to consider the best treatment approach. [ABSTRACT FROM AUTHOR]

Objective: This clinical trial aimed to evaluate the effect of nano-silver and nano-calcium hydroxide intracanal medicaments (ICM) during retreatment regarding their antibacterial effect and their effect on post-operative pain and flare-ups. Materials and methods: Sixty-nine patients scheduled for endodontic retreatment were included in this randomized clinical trial and randomly allocated to 3 equal groups (n = 23) according to the type of ICM used. The first microbial sampling (S1) representing the original microbiota was obtained after the removal of the old canal filling. After chemo-mechanical debridement, another sample (S2) was obtained representing the microbial state before ICM application. Patients were randomly allocated to receive either nano-silver (nano-Ag), nano-calcium hydroxide (nano-CH), or calcium hydroxide (CH) as ICM. Patients rated their pain pre-operatively and then after 6, 12, 24, 48, and 72 h. During the second visit (7 days later), the last microbial sample (S3) was obtained after removal of the ICM. Reduction of total bacterial and total E. faecalis counts and the biofilm-forming capability of the existing microbiota were determined. Results: Results showed reduction in total bacterial count, total E. faecalis count and the biofilm-forming,capability of the existing microbiota after chemo-mechanical debridement (S1-S2) and after the application of ICM (S3-S2). However, the reduction after cleaning and shaping was significantly more pronounced (p < 0.001) compared to the effect of ICM application, with no difference between the 3 ICM (p > 0.05). Post-operative pain was significantly reduced at the 48- and 72-h intervals after the application of nano-Ag and nano-CH only (p < 0.001), with no significant difference between these two ICM (p > 0.05). The incidence of flare-ups in all groups was similar (p > 0.05). Conclusions: The antibacterial effect of the nano-Ag and nano-CH was equivalent to that of CH, but they contributed to better pain control. Clinical relevance. Nanoparticles may have a positive impact on post-endodontic pain. [ABSTRACT FROM AUTHOR]

Objectives: The aim of retrospective study was to evaluate the changes to the periapical bone sites after non-surgical endodontic retreatment by using fractal analysis on periapical radiographs. Materials and methods: Thirty patients whose teeth had periapical lesions and underwent primary endodontic treatment were selected for nonsurgical single-visit endodontic retreatment. Two radiographs were taken, the first immediately after retreatment and the second at the 1-year follow-up. An identical region of interest close to the infected root apex was selected from each radiograph. FD was measured using the box-counting method. Periapical status was evaluated using the periapical index (PAI). Treatment outcomes were categorized into healed (PAI < 3), or not healed (PAI ≥ 3) based on radiographic criteria. Results: The mean FD value significantly increased at the 1-year follow-up compared to baseline. No significant sex biases were apparent. According to the PAI, retreatment after 1 year resulted in a 63.3% healed. Conclusion: The extent of periapical trabecular bone evident radiographically increased, as revealed by FD data, 1 year after endodontic retreatment. Clinical relevance The use of fractal analysis as a quantitative method to evaluate changes in periapical trabecular bone (such as healing and inflammation) after endodontic retreatment can be an important marker in determining the prognosis of endodontic retreatment. [ABSTRACT FROM AUTHOR]

Objective: To characterize the microbiota of teeth with endodontic treatment failure by 16S ribosomal RNA genetic sequencing (GS) and PCR at the different phases of the endodontic retreatment and to associate the presence of specific bacteria with clinical and radiographic features in teeth with apical periodontitis. Materials and methods: Twenty infected root canals of single-rooted teeth were selected. Samples were collected with sterile paper points before chemo-mechanical preparation (CMP) (S1), after CMP (S2) and after 30 days of intracanal medication (ICM) (S3). Microbial identification was performed using GS and PCR. Tukey-Kramer post hoc test and post hoc ANOVA were used for intergroup analysis. Paired t test and repeated-measures ANOVA were applied for intragroup analysis, at a significance level of 5%. Results: A total of 89 strains were identified using GS. Sixty-five strains were recovered in S1 and 15 strains in S2, and 9 strains remained in S3. Enterococcus faecalis was the most predominant bacteria. Gram-positive cocci bacteria predominated. Gram-negative species were also detected. Using species-specific PCR primers to detect seven species, the most prevalent ones at all the phases of the endodontic retreatment were E. faecalis and Porphyromonas gingivalis. However, Parvimonas micra and P. gingivalis were associated with previous pain, P. gingivalis was associated with tenderness to percussion and E. faecalis, Fusobacterium nucleatum and P. gingivalis were associated with periapical lesion > 3 mm. Conclusions: In conclusion, the microbiota of persistent infection is polymicrobial with predominance of E. faecalis and P. gingivalis in all phases of the endodontic retreatment, regardless of the method used for microbial identification. Associations were found between specific bacteria and clinical/radiographic features. Clinical relevance: The characterization of the bacteria present at all phases of the endodontic retreatment is important for the monitoring of the effectiveness of the techniques used and to better understand the susceptibility of these species to the disinfection agent used during the procedures. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to evaluate the efficacy of supplementary techniques (ultrasonic tip/XP-endo Finisher R) in removing remaining filling materials (gutta-percha/AHPlus/BCSealer) from oval-shaped root canals during non-surgical endodontic retreatment. Material and methods: Twenty-eight distal roots of human mandibular molars with single and oval-shaped canals were initially shaped with a R40 instrument and filled with gutta-percha points and AH Plus (n = 14) or BC Sealer (n = 14) followed by an initial micro-CT scanning. Initial filling material removal was performed in all 28 samples with an R50 instrument, and all samples submitted to a second micro-CT. Supplementary techniques with ultrasonic tips or XP-endo Finisher R instruments were performed in each sealer group, and all samples submitted to a third micro-CT. The volume of remaining filling material was calculated for the entire canal as well as for the coronal, middle, and apical thirds. Statistical analyses were performed using T, ANOVA 3-way, and Tukey tests. Results: Lower values of remnant filling material were found for BC Sealer (16.06 ± 14.34) compared to AH Plus (28.30 ± 10.54) (P < 0.001), and considering the supplementary technique, lower values of remnant filling material were found for the ultrasonic tip (18.95 ± 11.05) compared to XP-endo Finisher R (25.41 ± 15.81) (P = 0.025). Ultrasonic instruments significantly reduced the percentage of remaining filling material for both AH Plus (P = 0.04) and BC Sealer (P = 0.02) while XP-endo Finisher R was effective for AHPlus only (P = 0.04). The remaining filling material was observed in all samples regardless the filling material or the supplementary technique employed. Conclusions: Supplementary techniques increased filling material removal; however, none of them was able to render root canals completely free from root fillings. Ultrasonic tips should be considered a good option for endodontic retreatment, especially for bioceramic cases. Clinical relevance: Supplementary instrumentation techniques are effective tools to reduce the amount of filling materials during root canal retreatment. [ABSTRACT FROM AUTHOR]

Objectives: The aim of this clinical study was to evaluate and compare the incidence and intensity of postoperative pain following removal of gutta-percha from root canals using rotary and reciprocating instruments.Materials and methods: One hundred and sixty patients scheduled for a non-surgical endodontic retreatment were included for evaluation. Preoperative pain was recorded with using a questionnaire with a 10-cm visual analogical scale (VAS). Endodontic filling material was removed with Reciproc (VDW, Munich, Germany) or ProFile (Dentsply Tulsa Dental Specialties, Tulsa, OK) instruments. Patients then recorded their postoperative pain in a VAS pain scale at 4, 8, 16, 24, 48, and 72 h post-treatment. Results were analyzed using the Mann-Whitney U, Kruskal-Wallis, and Chi-square tests. Multivariate logistic and a multiple regression analysis were used to detect the effect of confounding factors.Results: Results showed a direct relation between the intensity of pre-operative pain and that of postoperative pain (P < .05). No significant differences were observed between the two groups regarding postoperative pain (P > .05) as a qualitative variable. As numerical values, statistically significant differences were found regarding sex and the system used (P < .05).Conclusions: The method for pain evaluation was determinant in postoperative pain findings. Endodontic retreatment preparation with Reciproc results in lower values of postoperative pain compared with ProFile. Women are more susceptible to postoperative pain than are men.Clinical relevance: One of the most significant contributions of this research is the importance given to the method used for pain evaluation. The present study analyzed postoperative pain resulting from the use of reciprocating or continuous rotary instruments during removal of gutta-percha in retreatment procedures. [ABSTRACT FROM AUTHOR]

Objectives: This study aimed to compare WaveOne Gold with ProTaper and RaCe systems regarding remaining filling material, apical transportation (AT), and working time (WT) after (i) filling removal and (ii) shaping of curved canals.Methods: Thirty mesiobuccal canals of maxillary molars were prepared and filled. After 30 days, they were randomly assigned into three groups (n = 10), according to the instruments used for filling removal and shaping, respectively: WOG—WaveOne Gold Primary and Medium; PTG—ProTaper Retreatment and ProTaper Next; RCG—D-RaCe and RaCe. Micro-CT analysis assessed the residual filling material and AT. WT was recorded. Data were statistically analyzed (α = .05).Results: There was no significant difference between groups in the amount of filling material at any evaluated moment (P > .05). All groups presented low AT values. The WT was similar in all groups in filling removal (P > .05), and in shaping step WOG was faster than PTG and RCG (P < .05).Conclusions: Neither system could completely remove the filling material. The instruments evaluated were safe and the reciprocating system was faster than the rotary systems in shaping the canals.Clinical relevance: This study provided consistent information on filling material removal capacity of WaveOne Gold. Considering that all tested systems were safe, WaveOne Gold may be an alternative with cost-effectiveness and shorter learning curve for endodontic retreatment. [ABSTRACT FROM AUTHOR]

Introduction: This clinical study was conducted to compare the effectiveness of single-file reciprocating systems and rotary systems in removing endotoxins and cultivable bacteria in endodontic retreatment. Methods: Thirty endodontically treated teeth with post-treatment apical periodontitis were selected. The specimens were divided into three groups according to the system used: WaveOne ( n = 10), Reciproc instrument ( n = 10), and ProTaper Universal Retreatment system ( n = 10). Samples were collected before and after chemomechanical preparation. The irrigation was performed by using 2.5 % sodium hypochlorite. A chromogenic limulus amebocyte lysate assay test was used to quantify endotoxins. Culture techniques were used to determine bacterial colony-forming unit counts. Results: At baseline, endotoxins and cultivable bacteria were recovered from 100 % of the root canal samples in a median value of 5.84 EU/mL and 4.98 × 10 CFU/mL, respectively. After CMP, no differences were found in the median percentage values of endotoxin reduction achieved with reciprocating systems-WaveOne [94.11 %] and Reciproc [93.29 %] and with rotary systems-ProTaper [94.98 %] ( P > 0.05). Both single-file reciprocating systems [WaveOne (98.27 %) and Reciproc (99.54 %)] and rotary system [ProTaper (98.73 %)] were effective in reducing bacterial load ( P > 0.05). Moreover, no differences were found among the systems tested. Conclusions: The Reciproc and WaveOne reciprocating systems were as effective as the ProTaper system for removal of endotoxins and bacteria in endodontic retreatment. Clinical relevance: All systems tested were effective to remove cultivable bacteria and endotoxin in endodontic retreatment. As no differences among systems were observed, it is possible to suggest that clinicians should choose the preferred technique to perform endodontic. [ABSTRACT FROM AUTHOR]

Objectives: Vertical root fractures (VRFs) are a common cause of tooth loss. Little evidence exists though, relating the incidence of VRFs to the type of endodontic retreatment. This retrospective study aimed at evaluating the impact of conventional versus surgical endodontics on root canal-filled teeth with VRFs. Materials and methods: Over a period of 13 years, 200 endodontically retreated teeth from 192 patients with VRFs were extracted and further examined. VRFs were assessed in relation to age, gender, tooth group, clinical signs, extension on the root surface, patency, as well as type of endodontic retreatment and restoration. Statistical analysis was conducted using a Cox PH Model, Chi-squared, Wilcoxon rank-sum, and Log rank tests at a significance level of 5 %. Results: The majority of teeth with VRFs (62.31 %) had undergone the combination of conventional root canal retreatment and apical surgery. Women (64.06 %) presented VRFs more frequently than men (35.94 %) at the mean age of 51.1 and 55.1 years, respectively. Maxillary first (17.5 %) and second (16.5 %) premolars, restored by a resin-based material without a post (56.28 %) were more susceptible to VRFs. Apically initiated (84.1 %) VRFs could be diagnosed more easily on radiographs. Conclusions: The type of endodontic treatment strongly correlated with VRFs. The prevalence of VRFs in teeth having undergone both conventional and surgical endodontic retreatment could be attributed, among others, to additive dentin damage related to the aforementioned endodontic procedures. Clinical relevance: The possible involvement of endodontic retreatment in the multifactorial etiology of VRFs needs to be taken into consideration in clinical practice. [ABSTRACT FROM AUTHOR]

Subcutaneous emphysema is rarely encountered in endodontic practice and consequently there is a dearth of information in the dental literature about this complication. The following report presents an interesting case of periorbital emphysema encountered during endodontic therapy. Attention is drawn to the presentation and management of this mostly preventable complication. [ABSTRACT FROM AUTHOR]

Objective: To assess apical root canal transportation using Mtwo or Reciproc during retreatment of severely curved canals, using a multi-analytical approach. Methods: Forty mesial canals from mandibular molars (Vertucci type IV) were evaluated before and after endodontic retreatment to compare apical transportation with Mtwo retreatment or Reciproc. The systems were used on the same root but alternating the mesial canals. The analyses were performed by micro-computed tomography. Four evaluations were performed: (a) longitudinal transportation, (b) horizontal transportation, (c) variation in the angle of curvature of the canal, and (d) canal-root width ratio. Horizontal transportation and canal-root width ratio were evaluated in 1-, 3-, and 5-mm levels. Results: Longitudinal transportation occurred in all samples, with a mean of 0.13 mm for Mtwo and 0.17 mm for Reciproc. Horizontal transportation increased as distant from the apex was the evaluated level, in mean. However, the transport was not observed in all samples. The mean angle of curvature was 4.16 for Mtwo and 3.03 for Reciproc. Canal-root width decreased as distant from the apex was the evaluated level. No significant differences were observed considering all tested variables, independently of the retreatment system or evaluated level (p > 0.05). Conclusion: Mtwo retreatment and Reciproc presented similar apical transportation (horizontal or vertical). Clinical relevance: Both Mtwo retreatment and Reciproc systems could be considered safe regarding apical transportation. [ABSTRACT FROM AUTHOR]

Objectives: To compare the efficacy of fiber post removal using conventional (CONV) versus guided endodontics (GE) in terms of dentin loss, residual resin material, procedural errors, and working time in vitro. Material and methods: Ninety human central incisors were root-filled and scanned by micro-computed tomography (CT), then restored with fiber posts and composite. Twenty-four sets of teeth with up to four human maxillary central incisors were fabricated and divided into three groups: conventional post removal by a general dentist (CG) or endodontology specialist (CS) and guided endodontics (GE) by a general dentist, yielding 30 teeth per operator and group. After treatment, the prepared access cavities were volumetrically assessed by micro-CT. Statistical significance was evaluated by one-way analysis of variance followed by post hoc comparisons with Tukey's HSD test and Pearson's chi-squared test for independence. Results: Both CONV and GE resulted in dentin loss and residual resin material. CS resulted in more dentin loss and less residual resin material than CG and GE (p <.05). All groups had some deviations from the original root canal but no perforations. The shortest working time was observed in the GE group. Conclusions: Compared to the conventional freehand technique, GE resulted in significantly less radicular dentin loss, a few deviations but no perforations. Clinical relevance: Guided endodontics can improve the speed and safety of fiber post removal without root perforation. [ABSTRACT FROM AUTHOR]

Objectives: This ex vivo study aimed to evaluate the influence of different filling techniques on the filling removal from oval root canals filled with bioceramic sealer. Methods: Thirty-six mandibular incisors with single oval canals were filled with bioceramic sealer following the techniques (n = 12): single-cone, modified McSpadden, or continuous wave of condensation, and scanned by micro-computed tomography (micro-CT). The filling was removed using the Clearsonic ultrasound tip and Reciproc system up to the R40 instrument, and the working time was recorded. The teeth were scanned again by micro-CT. Percentage of remnant volume (mm³) of the filling material, dentin thickness, and root canal transportation were measured. The data was analyzed using parametric and non-parametric tests with a significance level of 5%. Results: It took more time to remove the filling material using the continuous wave of condensation technique (p < 0.05), followed by the modified McSpadden and single-cone techniques. There was no difference (p > 0.05) when comparing the percentage of remaining filling material among the three groups, nor did it among the segments of each tooth. There was also no difference in the analysis of dentin thickness and transportation when comparing the groups (p > 0.05). Conclusions: The filling technique did not influence the amount of remaining filling material, dentin thickness, and transportation. The working time was longer with thermoplastic filling techniques. Clinical relevance: Endodontic retreatment in teeth filled with bioceramic sealers increases with their use. Several techniques are used to fill the root canals, thus, it is important to know whether the filling technique influences the non-surgical endodontic retreatment. [ABSTRACT FROM AUTHOR]

Scarce evidence when considering endodontic retreatment. [ABSTRACT FROM AUTHOR]

The article focuses on the outcome of endodontic retreatment. In an Italian endodontic clinic, 452 consecutive retreatments in 451 patients of mean age 41 years were followed up for 2 years, with 26 drop-outs. Teeth were classified as those where root canal morphology was respected by the previous root treatment and those where it was altered.

Objective: The persistence of pathogenic microorganisms in root canals is the most common reason for the failure of root canal treatment and the necessity of a root filling treatment, which results in an uncertain prognosis due to technical complexity and the variety of highly adaptable microorganisms. This study evaluated the effect of passive ultrasonic irrigation (PUI) on the outcome of the microbial analysis of root canal-treated teeth with persistent or recurrent apical inflammation in vivo. Materials and methods: Sample collection was performed after root filling removal (sample S1, control group) and after PUI with NaCl (sample S2) using sterile paper points. In total, 19 samples were obtained. Quantification was performed by means of serial dilution of the samples. Subcultivated pure cultures were identified using MALDI-TOF MS complemented by the Vitek-2-System or PCR, followed by sequencing of the 16S rRNA gene. The results of the samples (S1 and S2) were evaluated regarding their bacterial count and composition. Results: The total count of bacteria and the number of aerobic/facultative anaerobic microorganisms significantly increased in the S2-samples after application of PUI. The number of obligate anaerobic microorganisms showed an increase after PUI, although it was not significant. We detected 12 different aerobic/facultative anaerobic microorganisms before PUI, and in 21 cases after PUI. Two different obligate anaerobic microorganisms were found in S1 samples compared to nine different species in S2 samples. Conclusions: PUI is a powerful method for detaching bacteria in infected root canals and enables a more precise analysis of the etiology of persistent endodontic infections. Clinical relevance: This study indicates that PUI exerts a positive cleansing effect and adds to the accessibility of microorganisms during the application of bactericidal rinsing solution in root canal treatments. [ABSTRACT FROM AUTHOR]

Objective: To assess physico-chemical properties of BioRoot RCS (powder-to-liquid formulation) and BioRoot Flow (pre-mixed formulation) after exposure to citric acid (CA) and EDTA. Methods: BioRoot RCS and BioRoot Flow specimens (5 × 2 mm) were incubated for 28 days at 37 °C before being treated with test solution (distilled water, 17% EDTA, 10% CA, 20% CA or 40% CA). Changes in mass, ion release (inductively coupled plasma optical emission spectroscopy), phase composition (X-ray diffraction and Raman spectroscopy), surface morphology (scanning electron microscopy and energy dispersive spectroscopy) were evaluated. The Shapiro–Wilk, Levene and one-way ANOVA, followed by Tukey’s test, were used for statistical analysis (p < 0.05). Results: The greatest mass loss, ion release and surface morphological changes (pores and cracks) of BioRoot RCS and BioRoot Flow occurred in 10% and 20% CA. No significant differences were identified between BioRoot RCS and BioRoot Flow in distilled water and EDTA (p > 0.05), whereas BioRoot Flow was significantly more soluble than BioRoot RCS in all CA solutions (p < 0.001). The main phase identified for both materials was zirconium oxide, which remained unaffected by the solutions. Conclusions: Within the limitations of the study, 10% and 20% CA were more effective than distilled water, 17% EDTA and 40% CA in terms of dissolving BioRoot RCS and BioRoot Flow. The BioRoot Flow was significantly more soluble in all CA solutions than BioRoot RCS. Clinical significance: 10% and 20% CA solutions may have a potential to be used as a solvent for hydraulic calcium silicate sealers during endodontic retreatment. [ABSTRACT FROM AUTHOR]

Subcutaneous emphysema is rarely encountered in endodontic practice and consequently there is a dearth of information in the dental literature about this complication. The following report presents an interesting case of periorbital emphysema encountered during endodontic therapy. Attention is drawn to the presentation and management of this mostly preventable complication. [ABSTRACT FROM AUTHOR]

The use of regenrative endodontics is restoring the health status of the root canals of retreated mature teeth is a novel approach. Therefore, the current trial aimed to compare the effectiveness of regenerative endodontic procedures (REPs) to non-surgical root canal retreatment (NS-RCR) in reducing periapical radiolucency over one year for the retreatment of mature incisors with periapical periodontitis. The secondary purpose was to assess clinical success and regain pulp sensibility. A parallel randomized controlled trial, 66 mature incisors with periapical radiolucencies were randomly divided into two equal groups and retreated with either REPs or NS-RCR. At baseline and after 6 and 12 months, teeth were assessed clinically and radiographically using a periapical index (PAI). The Mann–Whitney test was used to analyze nonparametric PAI scores. The Electric pulp test readings were analyzed using the repeated measure analysis of variance (ANOVA). Over the follow-up intervals, there was no significant intergroup difference in the PAI medians, the majority of the teeth displayed a reduction in periapical radiolucency. At the end of the follow-up period, the clinical successes for the REP and NS-RCR groups were 93.9% and 97%, respectively (p = 0.555). Positive pulp sensibility was recorded in 54.54% of cases in the REPs after 12 months. Both approaches showed a comparable diminishing of periapical radiolucencies and equivalent clinical results. A conventional, non-surgical endodontic retreatment may not always be necessary. [ABSTRACT FROM AUTHOR]

Objectives: This randomized clinical trial aimed to compare the effect of intracanal medicaments on the incidence of postoperative pain and flare-up with posttreatment apical periodontitis (PTAP) of retreatment cases. Materials and methods: One hundred twenty patients diagnosed with PTAP with single-rooted teeth with single-canal without spontaneous pain or swellings were included and randomly divided into three groups according to the intracanal medicament used. Intracanal medicaments were placed into the root canals following the removal of previous root canal fillings and re-instrumentation. Calcium hydroxide (Ca (OH)2), chlorhexidine gel (CHX), calcium hydroxide and chlorhexidine gel combinations were used as intracanal medicaments. Postoperative pain scores were recorded at 6 and 12 h and 1, 2, 3, 4, 5, 6, and 7 days using a visual analog scale (VAS). Sensitivity on percussion, spontaneous pain, swelling, antibiotic and analgesic requirements of the patients were evaluated during clinical examinations performed postoperatively after 2 and 7 days. Results: There were no statistically significant differences between groups in terms of VAS scores following the intracanal medicament application (p > 0.05). However, compared to the patients of 20–34 and 50–65 age groups, greater VAS scores were observed in patients of 35–49 age groups at 12 h, and 3, 4, 7 days (p < 0.05). Flare-up was observed in only one patient in the CHX gel group, and no flare-up was observed in other groups. Conclusions: Similar postoperative pain incidence in all experimental groups indicates that all three medicaments are clinically acceptable in inter-appointment management of retreatment cases in terms of post-endodontic pain and flare-up. Clinical relevance: In this randomized clinical trial, three different intracanal medicaments were utilized in nonsurgical endodontic retreatment and their effect on postoperative pain and flare-up incidence was examined. Thus, this study will be a significant contribution in the decision-making during clinical practice; since there are a limited number of prospective clinical trials in the literature about the severity of pain following retreatment procedures including intracanal medicament use. [ABSTRACT FROM AUTHOR]

Objectives: This study aimed to evaluate dentinal tubule penetration and the retreatability of EndoSequence BC Sealer HiFlow (HiFlow), iRoot SP, and AH Plus when using the single-cone (SC) or continuous wave condensation (CWC) technique. Materials and methods: Sixty-five single-rooted teeth were instrumented and randomly divided into 5 groups: group 1, AH Plus/CWC; group 2, iRoot SP/CWC; group 3, iRoot SP/SC; group 4, HiFlow/CWC; and group 5, HiFlow/SC. The ability to re-establish patency during endodontic retreatment was recorded, as was the time taken to reach the working length. Dentinal tubule penetration and remaining debris after retreatment were evaluated by confocal microscopy and scanning electron microscopy. Data were analyzed by Kruskal-Wallis test and Dunn's multiple comparisons test (α = 0.05). Results: The HiFlow/CWC and iRoot SP/CWC groups required more time to reach the working length than groups that underwent the SC technique regardless of the sealer used (P <.05). The HiFlow/CWC group showed a significantly higher percentage of sealer penetration area than that of the iRoot SP/SC at 4 mm from the apex (P <.05) and penetrated deeper into dentinal tubules than iRoot SP/SC at both 8-mm and 12-mm levels (P <.05). Moreover, the HiFlow/CWC and HiFlow/SC groups demonstrated less remaining sealer along the canal wall than AH Plus/CWC group at 4-mm level (P <.05). Conclusions: HiFlow/CWC technique showed better performance in dentinal tubule penetration than that of iRoot SP/SC. Both HiFlow and iRoot SP combined with CWC technique groups required more retreatment time than the other groups. Furthermore, using HiFlow with either the CWC or SC technique left less remaining sealer at 4-mm level than using AH Plus with the CWC technique during retreatment. Clinical relevance: With favorable performance in dentinal tubule penetration and retreatability in endodontic retreatment, the combined use of EndoSequence BC Sealer HiFlow with the recommended continuous wave condensation technique may be a worthwhile choice in root canal treatment. [ABSTRACT FROM AUTHOR]

Aim: The objective of this study was to evaluate the presence of microorganisms in the root canals (RC) of teeth submitted to endodontic retreatment due to prosthetic reasons and without evidence of apical periodontitis. Material and methods: Twenty teeth referred to endodontic retreatment due to prosthetic reasons and without evidence of apical periodontitis were included in this study. Gutta-percha (GP) was collected from each third of the RC. After GP removal, microbial samples were also collected from the full extension of RC using paper points and files. The samples were cultivated in Fastidious Anaerobe Agar and the colony-forming units (CFU/mL) were counted. They were also semi-quantitatively analyzed by checkerboard DNA–DNA hybridization using 40 DNA bacterial probes. Results: Microorganisms were found in all samples. The coronal third of GP was more contaminated than the apical third (p ≤ 0.05). There was prevalence of Enterococcus hirae and Enterococcus faecalis in all RC thirds and also in the samples collected from the full extension of RCs. Conclusion: Microorganisms were found in all cases referred to endodontic retreatment due to prosthetic reasons and without evidence of apical periodontitis. Enterococcus was the genus most frequently detected. Clinical significance: An endodontic retreatment should be considered before replacing a prosthesis. [ABSTRACT FROM AUTHOR]

Objectives: The purpose of this study was to evaluate and compare the clinical and radiographic outcomes of nonsurgical endodontic retreatment and endodontic microsurgery by a meta-analysis. Materials and methods: Electronic databases including PubMed, Embase, Medline, and The Cochrane Library were searched, and the references of related articles were manually searched to identify all the clinical studies that evaluated the clinical and radiographic outcomes after retreatment or microsurgery. The first and second screening processes were conducted by three reviewers independently. The final studies were selected after strict application of the inclusion and exclusion criteria. The random effects meta-analysis model with the DerSimonian-Laird pooling method was performed. The weighted pooled success rates and 95 % confidence interval estimates of the outcome were calculated. Additionally, the effects of the follow-up period and study quality were investigated by a subgroup analysis. Results: Endodontic microsurgery and nonsurgical retreatment have stable outcomes presenting 92 and 80 % of overall pooled success rates, respectively. The microsurgery group had a significantly higher success rate than the retreatment group. When the data were organized and analyzed according to their follow-up periods, a significantly higher success rate was found for the microsurgery group in the short-term follow-up (less than 4 years), whereas no significant difference was observed in the long-term follow-up (more than 4 years). Conclusions: Endodontic microsurgery was confirmed as a reliable treatment option with favorable initial healing and a predictable outcome. Clinical relevance: Clinicians may consider the microsurgery as an effective way of retreatment as well as nonsurgical retreatment depending on the clinical situations. [ABSTRACT FROM AUTHOR]

Objectives: The aim of this study was to compare the efficiency of sonic, ultrasonic, and hydrodynamic devices in the removal of a root canal sealer from the surface and from simulated irregularities of root canals. Materials and methods: Fifty-three root canals with two standardized grooves in the apical and coronal parts of longitudinally split roots were covered with AH Plus root canal sealer. Compared were the effects of (control) syringe irrigation, (1) CanalBrush, (2) passive ultrasonic irrigation, (3) EndoActivator, and (4) RinsEndo on the removal of the sealer. The specimens were divided into four groups ( N = 12) and one control group ( N = 5) via randomization. The amount of remaining sealer in the root canal irregularities was evaluated under a microscope using a 4-grade scoring system, whereas the remaining sealer on the root canal surface was evaluated with a 7-grade scoring system. Results: Passive ultrasonic irrigation is more effective than the other tested irrigation systems or syringe irrigation in removing sealer from root canal walls ( p < 0.01). None of the techniques had a significant effect on cleaning the lateral grooves. Conclusions: Within the limitations of this study protocol ultrasonic irrigation shows a superior effect on sealer removal from the root canal surface during endodontic retreatment. Cleaning of lateral grooves seems not to be possible with one of the techniques investigated. Clinical relevance: Incomplete removal of root canal sealer during re-treatment may cause treatment failure. Passive ultrasonic irrigation seems to be the most effective system to remove sealer from a root canal. [ABSTRACT FROM AUTHOR]

Endodontic treatment failure is usually characterised by the presence of post-treatment apical periodontitis, which may be persistent, emergent or recurrent. The major aetiology of post-treatment disease is persistent intraradicular infection, but in some cases a secondary intraradicular infection due to coronal leakage or an extraradicular infection may be the cause of failure. Understanding the causes of endodontic treatment failure is of paramount importance for the proper management of this condition. Teeth with post-treatment apical periodontitis can be managed by either nonsurgical endodontic retreatment or periradicular surgery, both of which have very high chances of restoring the health of the periradicular tissues and maintaining the tooth function in the oral cavity. This review article focuses on the aetiological factors of post-treatment apical periodontitis and discusses the indications and basics of the procedures for optimal clinical management of this condition. [ABSTRACT FROM AUTHOR]

Non-surgical endodontic retreatment is the treatment of choice for endodontically treated teeth with recurrent or residual disease in the majority of cases. In some cases, surgical endodontic treatment is indicated. Successful micro-surgical endodontic treatment depends on the accuracy of diagnosis, appropriate case selection, the quality of the surgical skills, and the application of the most appropriate haemostatic agents and biomaterials. This article describes the armamentarium and technical procedures involved in performing micro-surgical endodontics to a high standard. [ABSTRACT FROM AUTHOR]

Diagnosis and treatment planning are key factors in achieving successful outcomes after placing and restoring implants placed immediately after tooth extraction. The efficacy of immediate implant placement has been established and shown to be predictable if reasonable guidelines are followed. Some or all of the following suggestions, depending on individual circumstances, should be considered when evaluating a patient for dental implants: thorough medical and dental histories, clinical photographs, study casts, periapical and panogram radiographs as well as a linear tomography or computerised tomography of the proposed implant sites. Reasons for tooth extraction include but are not limited to: insufficient crown to root ratios, remaining root length, periodontal attachment levels, periodontal health of teeth adjacent to the proposed implant sites, unrestorable caries, root fractures with large endodontic posts, root resorption, teeth with deep furcation invasions being considered as abutments for fixed partial dentures and questionable teeth in need of endodontic retreatment. [ABSTRACT FROM AUTHOR]

The aim of this study was to evaluate the sealing ability in orthogradely filled, apicoectomised and retrogradely filled maxillary premolars with two canals and two separate apical foramina. The root canals of 51 extracted maxillary premolars of type IV were uniformly shaped and filled by means of lateral condensation and subsequently randomly divided into three groups of 17 teeth each. The teeth of groups II and III received an apicoectomy. In group III an additional retrograde seal (Ketac Fil) was applied. Group I served as control. All specimens were immersed in a methylene blue solution for 24 h. The teeth were cross-sectioned and the maximal dye-penetration was measured. The significantly least dye-penetration was observed in group II (apicoectomy only), followed by group I and group III. The differences among all groups were statistically significant (p<0.05). Most of the retrograde restorations in group III revealed circular colouration around the retrograde fillings extending to the gutta percha. Although the teeth of group II revealed the least dye-penetration, an apicoectomy cannot be favoured against an endodontic retreatment in maxillary premolars of type IV. The application of retrograde fillings using Ketac Fil must be considered critically. [ABSTRACT FROM AUTHOR]

Aims This study was designed to determine the effect of reflection and discussion of a group of dentists with differing backgrounds and qualifications in the management of failed endodontic treatment.Materials and methods During the Dental Pan-Society plenary session (16-17 November 2007) delegates (n = 393) were asked a series of questions on the management of a case with failed endodontic treatment of four maxillary incisors restored with linked crowns in a patient with a high smile line. The case had been previously posted on the conference website in addition to being presented on the day of the forum. Responses of delegates to predetermined questions and options on the management of the case were recorded using closed-circuit devices for each individual delegate. The questions were repeated after the case was opened up for discussion by the delegates in conjunction with a panel of leading experts. The discussion topics included the factors affecting the outcome of secondary root canal treatment, post-extraction changes and the options for prosthetic replacement including the provision of implants in the aesthetic zone.Results The initial response of the majority (58%) of delegates favoured extraction and prosthetic rehabilitation over endodontic retreatment of the affected teeth. Following the discussion this figure reduced to 50%. In respect to those individuals who were specialists, extraction was again the preferred option before the discussion for periodontists (74%), prosthodontists (64%) and restorative dentists (65%). This was in contrast to endodontists who preferred endodontic retreatment, with only 30% identifying extraction as the treatment of choice. Following the discussion, the number of periodontists and endodontists who favoured extraction reduced by 3% and 5% respectively, whereas the number of prosthodontists and restorative dentistry specialists who preferred extraction increased by 2% and 4% respectively.Conclusion Reflection and discussion can make individuals reconsider their initial treatment decisions. These personal skills may become more significant when planning treatment for complex restorative cases. [ABSTRACT FROM AUTHOR]

Aims This study was designed to determine the effect of reflection and discussion of a group of dentists with differing backgrounds and qualifications in the management of failed endodontic treatment.Materials and methods During the Dental Pan-Society plenary session (16-17 November 2007) delegates (n = 393) were asked a series of questions on the management of a case with failed endodontic treatment of four maxillary incisors restored with linked crowns in a patient with a high smile line. The case had been previously posted on the conference website in addition to being presented on the day of the forum. Responses of delegates to predetermined questions and options on the management of the case were recorded using closed-circuit devices for each individual delegate. The questions were repeated after the case was opened up for discussion by the delegates in conjunction with a panel of leading experts. The discussion topics included the factors affecting the outcome of secondary root canal treatment, post-extraction changes and the options for prosthetic replacement including the provision of implants in the aesthetic zone.Results The initial response of the majority (58%) of delegates favoured extraction and prosthetic rehabilitation over endodontic retreatment of the affected teeth. Following the discussion this figure reduced to 50%. In respect to those individuals who were specialists, extraction was again the preferred option before the discussion for periodontists (74%), prosthodontists (64%) and restorative dentists (65%). This was in contrast to endodontists who preferred endodontic retreatment, with only 30% identifying extraction as the treatment of choice. Following the discussion, the number of periodontists and endodontists who favoured extraction reduced by 3% and 5% respectively, whereas the number of prosthodontists and restorative dentistry specialists who preferred extraction increased by 2% and 4% respectively. Conclusion Reflection and discussion can make individuals reconsider their initial treatment decisions. These personal skills may become more significant when planning treatment for complex restorative cases. [ABSTRACT FROM AUTHOR]

This study evaluated the incidence of postoperative pain after intracanal dressings with either 0.12% chlorhexidine digluconate gel (CHX) or a calcium hydroxide/camphorated paramonochlorophenol/glycerin paste (CH/CPMC). Overall, 138 asymptomatic teeth had their canals instrumented under irrigation with 2.5% NaOCl and then dressed with either CH/CPMC or CHX. The incidence of different intensity levels of postoperative pain was registered for the period between appointments. Data revealed that 84% of the total number of cases treated with either medicament showed absence of any level of pain. No case medicated with CH/CPMC and four cases (5.8%) medicated with CHX were categorized as flare-ups. There were no statistically significant differences between all possible comparisons involving the two medicaments in treatment/retreatment cases and teeth with/without apical periodontitis lesions. The low incidence of postoperative pain after the use of both medications, coupled to their antimicrobial effectiveness, gives support to using one or the other in routine treatment/retreatment. [ABSTRACT FROM AUTHOR]