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The Preferred Reporting Items for Diagnostic Accuracy Studies in Endodontics (PRIDASE) 2024 guidelines are based on the Standards for Reporting of Diagnostic Accuracy Studies (STARD) 2015 guidelines and the Clinical and Laboratory Images in Publications (CLIP) principles, with the addition of items specifically related to endodontics. The use of the PRIDASE 2024 guidelines by authors and their application by journals during the peer review process will reduce the possibility of bias and enhance the quality of future diagnostic accuracy studies. The PRIDASE 2024 guidelines consist of a checklist containing 11 domains and 66 individual items. The purpose of the current document is to provide an explanation for each item on the PRIDASE 2024 checklist, along with examples from the literature to help readers understand their importance and offer advice to those developing manuscripts. A link to the PRIDASE 2024 explanation and elaboration document is available on the Preferred Reporting Items for study Designs in Endodontology (PRIDE) website (https://pride‐endodonticguidelines.org/pridase/) and on the International Endodontic Journal website (https://onlinelibrary.wiley.com/page/journal/13652591/homepage/pride‐guidelines.htm). [ABSTRACT FROM AUTHOR]

ABSTRACT Objective Methods Results Conclusion This study assessed the radiographic technical quality of root fillings in single‐canal teeth performed over a decade (June 2013 to June 2023) by undergraduate dental students of the Federal University of Campina Grande.All teeth underwent chemomechanical preparation using Gates‐Glidden drills and hand instrumentation with stainless steel files up to 1 mm short of the root apex. Apical expansion was performed with up to two or three instruments above the initial anatomical apical diameter. The canal was filled in the absence of signs and symptoms of infection using gutta‐percha cones and Sealer 26 or MTA Fillapex. A post‐filling radiograph was routinely taken to assess the quality of root filling and coronal restoration. An experienced researcher trained and calibrated an examiner to evaluate post‐operative periapical radiographs considering root‐filling length, lateral adaptation and taper using ImageJ 1.52q software. Root filling was satisfactory when reaching acceptable classifications for the three parameters. The chi‐squared test compared tooth type, dental arch and pulpal diagnosis at a 5% significance level.The study assessed 124 canals, showing 90 (72.6%) satisfactory root fillings. The sub‐analysis of individual parameters demonstrated that 105 (84.7%) root fillings had acceptable length, 113 (91.1%) adapted well to lateral canal walls, and 109 (87.9%) had proper taper. Most cases occurred in maxillary teeth (n = 99), pulp necrosis was the most frequent pulpal diagnosis (n = 89), and root‐filling quality showed no association with tooth type, dental arch or pulpal diagnosis.The technical quality of root fillings in single‐canal teeth treated by dental students was predominantly satisfactory. [ABSTRACT FROM AUTHOR]

BackgroundObjectiveMethodsResultsDiscussionConclusionPulpitis may be pain free or alternatively characterized by mild to severe pain and associated symptoms. Evidence has recently emerged that patients presenting with carious pulp exposure range of symptoms can be treated effectively with pulpotomy.The current systematic review aimed to answer the following research question: “In patients with deep caries lesions in permanent teeth associated with no symptoms, reversible pulpitis or signs and symptoms indicative of irreversible pulpitis (P), is partial pulpotomy (I) as effective as full pulpotomy (C), in terms of a combination of patient and clinical reported outcomes (O), with “tooth survival” as the most critical outcome?The systematic literature search was conducted in the following electronic databases: OVID, Scopus, PubMed (Including MEDLINE), and Cochrane Central Register of Controlled Trials (CENTRAL) supplemented with Grey literature and hand searching of relevant journals. The English language clinical trials comparing the patient and clinical reported outcomes between partial and full/complete were included. After a structured literature search, two authors independently performed study selection, extracted data and performed a risk of bias assessment; a third reviewer resolved disagreements. As there were only two studies with different exclusion criteria, no meta‐analysis was performed and the quality of evidence was assessed by the GRADE approach.After study selection a total of two randomised clinical trials with a total of 156 teeth were included both for the management of teeth with irreversible pulpitis. There were no studies for asymptomatic teeth or teeth with reversible pulpitis. A “Low” risk of bias was noted for both studies with a high level of overall evidence. A meta‐analysis was not carried out due to differences in inclusion criteria between the studies related principally to caries depth. Both studies reported a high rate of clinical success for pulpotomy with a pooled unadjusted success rate for full pulpotomy of 90% and 83% partial pulpotomy of at 1‐year; however, no significant difference between the treatments was noted in either study. There was significantly reduced postoperative pain reported in the full pulpotomy group over 1‐week compared with the partial pulpotomy in one but not in the other study.Pulpotomy as a definitive treatment modality is as effective in managing teeth exhibiting signs and symptoms indicative of irreversible pulpitis and challenges the established protocols to manage this condition. Although based on only two RCTs with a limited number of patients, no difference was shown in terms of clinical or radiographic outcome or postoperative pain between groups. Further well designed randomised clinical trials of longer duration are required in this area to improve the evidence available.There is no consistent difference in patient‐reported pain between partial and full pulpotomy at day 7 postoperatively and the clinical success rate was similar after 1 year for both treatment modalities. [ABSTRACT FROM AUTHOR]

Aim Methodology Results Conclusions To evaluate M1 and M2 macrophage polarization in radicular cysts and periapical granulomas through an immunohistochemical analysis and the correlation between macrophage polarization and histopathological diagnosis, clinical characteristics and lesion volume using cone‐beam computed tomography.Periapical biopsies diagnosed as radicular cysts (n = 52) and periapical granulomas (n = 51) were analysed by immunohistochemical method. Teeth with periapical lesion with no history of root canal treatment (primary lesion) and lesions persistent to root canal treatment (persistent lesions) were included. Pathological diagnosis, patients' age, gender and clinical characteristics were obtained from treatment records. A cone‐beam computed tomographic periapical volume index (CBCTPAVI) score was assigned to each periapical lesion based on the volume of the lesion. Immuno‐expressions of CD68 and CD163 were quantified. The CD68/CD163 ratio was adopted to represent M1 or M2 macrophage polarization. Mann–Whitney U test was used to determine the different CD68/CD163 ratio between groups of radicular cyst and periapical granuloma. Spearman's correlation test was performed to assess the correlation between the CD68/CD163 ratio and lesion volume and CBCTPAVI score.Radicular cysts and periapical granulomas had CD68/CD163 median of 2.05 (IQR = 1.33) and 1.26 (IQR = 0.81), respectively. A significantly higher CD68/CD163 ratio was observed in radicular cysts (p < .001). In contrast, periapical granulomas had significantly lower median of CD68/CD163 ratio. Larger lesions had a higher median of CD68/CD163 ratio, while smaller lesions had lower median of CD68/CD163 ratio (p = .007, rs = .262). CD68/CD163 ratio was significantly correlated with the CBCTPAVI score in the overall periapical lesions (p = .002, rs = .306). The higher CD68/CD163 ratio in larger lesions indicated a higher degree of M1 polarization compared to smaller lesions. Regarding the pathological diagnosis, there was a significant positive correlation between CBCTPAVI score and CD68/CD163 ratio in periapical granulomas (p < .001, rs = .453), whereas the negative correlation was observed for radicular cysts (p < .001, rs = −.471).Periapical granulomas are characterized by a M2‐dominant macrophage polarization, while radicular cysts have significantly higher M1 macrophages. The higher degree of M1 macrophage polarization was significantly correlated with larger volume and higher CBCTPAVI scores of overall periapical lesion and periapical granuloma. [ABSTRACT FROM AUTHOR]

Background: Determining the correct apical limit for root canal treatment is essential for its success. This study evaluates the accuracy of three electronic apex locators (EALs) in locating the apical constriction (AC) in molar canals. Methods: Forty extracted human mandibular molars were scanned using micro-CT, and endodontic access cavities were created. Teeth were mounted in alginate, and three EALs—Root ZX-mini, Root ZX-II, and Sirona integrated apex locator—were used to measure the canal working length in dry canals and with EDTA gel. Micro-CT scans were performed with files in place, and the distance from the AC was calculated. Measurements within 0.1–0.5 mm were categorized as 'close'. Those extending beyond towards the major foramen were categorized as 'beyond', otherwise they were classified as 'far'. Data analysis was conducted with a level of significance set at 5%. Results: Most readings for all EALs were in the 'close' category, with significant differences between devices (p < 0.0001). Root ZX-mini and Root ZX-II had 74.4% and 72.5% 'close' readings, respectively, versus 51% for Sirona integrated. Accuracy did not differ significantly between dry and EDTA-treated canals (p = 0.306). All EALs demonstrated excellent operator reliability (ICC 0.996–1.00). Conclusions: All EALs accurately determined AC, unaffected by lubricants. However, Root ZX-mini and Root ZX-II outperformed Sirona integrated. All EALs showed consistent reliability. [ABSTRACT FROM AUTHOR]

This study evaluates, in vitro, the effects of ozonated water as auxiliary endodontic irrigating and photodynamic therapy on the bond strength of fiberglass posts to root dentin. Sixty bovine incisors were prepared and divided into six groups (n=10):Oxidation only G1 Distilled water G2 5.25% NaOCl G3 10–15mg/L O3. Ox+PDT G4 DW+PDT G5 NaOCl+PDT G6 O3+PDT. Anatomical fiberglass posts were cemented and the roots were sectioned and submitted to the push-out test. Bond strength values were analyzed with two-way ANOVA and Tukey 5%. Failure patterns were analyzed. Sodium hypochlorite and ozonated water without photodynamic therapy showed the highest bond strength, and sodium hypochlorite with photodynamic therapy had the lowest bond strength. The O3+PDT association showed intermediate results. Considering that the main purpose of the O3 is disinfection, it was noted that ozonated water did not interfere on the bond strength of fiberglass posts to root dentin. Photodynamic therapy affected bond strength, mainly when associated with sodium hypochlorite. The ozonated water increases the PDT bond strength results. [ABSTRACT FROM AUTHOR]

Aim: Post‐operative pain may occur after non‐surgical root canal treatment (NSRCT). The root filling technique and choice of sealer may be contributing factors. This randomized controlled clinical trial compared post‐operative pain and analgesics intake after NSRCT using a sealer‐based obturation technique (SBO) with single‐cone gutta‐percha and calcium silicate sealer (CSS) versus a warm‐vertical compaction (WVC) technique with gutta‐percha and a resin‐based sealer (RBS). Methodology: This study was designed as a parallel‐two arm, double‐blind, randomized superiority clinical trial registered at www.clinicaltrials.gov (NCT04753138). Patients referred for NSRCT fulfilling the inclusion criteria participated in this study. Pre‐operative periapical radiographs and CBCT scans were taken and numerical rating scale (NRS) pain scores were recorded. Upon completion of canal instrumentation, participants were randomly allocated to either Group SBO: SBO with CSS or Group WVC: Warm‐vertical compaction with RBS. Post‐operative pain and analgesics intake were recorded at 1, 3 and 7 days after endodontic treatment completion. Non‐parametric Mann–Whitney U and Friedman tests and a generalized estimating equation were used to assess differences in pain scores between the groups, within each treatment group at different time points and for correlations, respectively. Results: The study included 195 participants (212 teeth). One participant declined to submit the NRS form. Therefore, 194 participants (211 teeth) were included in the final analysis (99.5% response rate). No statistically significant differences in post‐operative pain or analgesic intake existed between the two groups at any time point (p >.05). Age, pre‐operative pain, apical diagnosis and post‐operative analgesic intake were significantly related to post‐operative pain (p <.05). Conclusions: Sealer‐based obturation technique with CSS was associated with similar post‐operative pain levels and analgesics intake as WVC with RBS. Regarding post‐operative pain, SBO with CSSs may be a suitable clinical alternative. [ABSTRACT FROM AUTHOR]

Aim: To describe the management of the palato‐mesiobuccal (PMB) canal in maxillary second molars with fused roots using conventional techniques. Summary: Root canal treatment success hinges upon effectively addressing the intricate and variable anatomy of molar teeth. Failure to do so can lead to persistent infections and treatment failure. Recent advancements in imaging technologies have provided unparalleled insights into dental anatomy, especially in molars. Among these discoveries is the PMB canal, a unique anatomical variant recently reported for the first time in Endodontic literature. This canal, found in maxillary second molars with fused roots and originating from the coronal third of the palatal canal while traversing towards the mesiobuccal root presents challenges in clinical management due to its location. This article is the first to showcase the management of the PMB canal using conventional techniques. In the first case, a 38‐year‐old male patient presented with asymptomatic irreversible pulpitis in the maxillary second right molar. Following thorough instrumentation and irrigation, the presence of the PMB canal was discovered during root canal preparation. The canal was managed using rotary instruments and obturated successfully, resulting in a symptom‐free tooth at an 8‐year follow‐up. The second case illustrates a similar scenario in a 23‐year‐old female patient presenting with symptomatic irreversible pulpitis in tooth 17. The PMB canal was identified during treatment and managed using rotary nickel‐titanium instruments, leading to a favourable outcome at a 9‐year follow‐up. Key learning points: In fused roots of maxillary second molars, a PMB canal might be expected.Exploration of the buccal wall of the palatal canal under magnification after shaping procedures can reveal the PMB canal orifice in fused roots.Small tapers are suggested for the enlargement of the PMB canal.Continuous bleeding spots in the palatal canal might indicate a possible PMB canal orifice in vital cases.The use of an apex locator is suggested for the differential diagnosis of the PMB canal orifice from a perforation site. [ABSTRACT FROM AUTHOR]

Aim: To investigate what happens to cross‐sectionally identified root‐filled teeth over a 6‐year period, regardless of the time that elapsed since primary root canal treatment, in a cohort of adult patients regularly attending a Public Dental Service. A secondary aim was to investigate how the cumulative events affecting root‐filled teeth over the same time were associated with variables obtained from a baseline examination. Methodology: Adult patients with ≥1 previously root‐filled tooth and regularly attending the Public Dental Service in Örebro County were enrolled for study participation in 2015. General dental practitioners examined all identified root‐filled teeth in this cohort at baseline using a standardized protocol and were also responsible for further decision‐making and treatments. After six years, information on events of the root‐filled teeth was collected from dental records. The highest rating (most invasive treatment) on a 5‐point ordinal scale was used in the analyses. Regression analyses with stepwise selection were performed for associations between patient‐ and tooth‐related factors and events. Results: A total of 445 patients with 1007 root‐filled teeth were followed the entire observation time. Twenty (2.0%) of the root‐filled teeth had endodontic retreatment and 150 (14.9%) were extracted over six years. Among teeth with periapical radiolucency or pain, the majority did not undergo retreatment or extraction; however, the multivariate analysis demonstrated that retreatment or extraction was associated with baseline recordings of teeth with periapical radiolucency (p <.0001), tenderness to percussion (p <.0001), and poor coronal restoration (p <.0001). Conclusions: This study corroborates the notion that in general dentistry, root‐filled teeth with radiological signs of apical disease often remain untreated over time. Furthermore, it also reveals that root‐filled teeth presenting with mild pain do not necessarily receive any intervention. However, teeth with baseline signs of apical periodontitis, pain, or inadequate coronal restoration were more likely to have received intervention during the six‐year period. [ABSTRACT FROM AUTHOR]

Pain often occurs after root canal treatment due to unavoidable mechanical or chemical damage. The purpose of the present study was to investigate the efficacy of a nickel-titanium (NiTi) device combined with ultrasonic irrigation and multiple antibiotic creams in the treatment of periapical inflammation of deciduous teeth, so as to improve the understanding of root canal treatment and optimize clinical practice. Evaluation of efficacy was conducted using X-rays and the Visual Analog Scale. This treatment significantly reduced pain and also improved patient compliance and treatment outcomes. The findings of the present study may have scientific and clinical significance for optimizing root canal treatment in pediatric dentistry and requires further in-depth research in clinical practice. These outcomes may provide potential new ideas and directions for improving patients' quality of life and the efficacy of clinical treatment and have further impacts on future related research and medical practice. [ABSTRACT FROM AUTHOR]

Objectives: The purpose of this prospective study was to evaluate the incidence and intensity of postoperative pain in oncological patients with infected teeth subjected to nonsurgical root canal treatment or retreatment. Methods: Teeth with apical periodontitis from healthy control patients and oncological patients (n = 70 per group) were root canal treated/retreated and evaluated for the development of postoperative pain. Patients from the two groups were matched for tooth type, gender, clinical manifestation of apical periodontitis, and intervention type. A visual analogue scale (VSA) was used to evaluate the incidence of postoperative pain at 24 h, 72 h, 7d, and 15d after chemomechanical procedures. Data were statistically analyzed for the incidence and intensity of postoperative pain in the two groups. Results: Preoperative pain occurred in 10% of the individuals and in all these cases pain showed a reduction in intensity or was absent after endodontic intervention at 24-h evaluation. The overall incidence of postoperative pain at 24 h was 14% in oncology patients and 30% in controls (p = 0.03). At 72 h, the respective corresponding figures were 4% and 8.5% (p > 0.05). At 7 and 15 days, all patients were asymptomatic, irrespective of the group. Conclusions: No significant differences in postoperative pain were found between control and oncological patients. The low incidence of postoperative pain observed in both groups supports the routine use of nonsurgical root canal treatment/retreatment as valid options in oncological patients. Clinical relevance: Oncological patients had no increased risk of postoperative pain in comparison with control patients. [ABSTRACT FROM AUTHOR]

Background: Trigeminal nerve injury following endodontic treatment, leading to unpleasant sensations or partial sensory loss in the face or oral mucosa, is uncommon but significant when it occurs. Objective: This study analysed the pharmacological management of trigeminal nerve injuries (TNI) in a university‐based hospital. Methods: We conducted a retrospective analysis of 47 patients who visited the Department of Orofacial Pain and Oral Medicine at Yonsei University Dental Hospital, Seoul, Korea, after TNI following endodontic procedures in primary clinics. Both objective tests and subjective evaluations, assessed the extent and duration of sensory injury during the initial visit. The patient's initial symptoms, presumed cause of TNI, referral delay (time interval between TNI and the first visit to our clinic), and medications were analysed to determine whether these factors affected the outcomes. Results: Most patients with TNI experienced dysesthesia with hypoesthesia (70.2%). The mandibular molars were predominantly affected (72.3%), with the inferior alveolar nerve (IAN), lingual nerve (LN), both IAN and LN, and maxillary nerve compromised in 83.0, 12.8, 2.1, and 2.1% of cases, respectively. Causes of TNI included local anaesthesia (29.8%), overfilling/over‐instrumentation (25.5%), endodontic surgery (17.0%), and unknown factors (27.7%). A shorter referral delay was associated with better outcomes, with an average delay of 8.6 weeks for symptom improvement compared with 44.1 weeks for no change. The medication regimens included steroids, NSAIDs, topical lidocaine, vitamin B complex, Adenosine Triphosphate (ATP), antiepileptics, antidepressants, and opioids administered alone or in combination, with a mean duration of 20.7 weeks. 53.2% of the patients reported improvement in their symptoms, 27.7% experienced no significant change, and 19.1% had unknown outcomes. Conclusions: Swift referral to an orofacial pain specialist is recommended for effective recovery in cases of TNI arising from endodontic treatment. [ABSTRACT FROM AUTHOR]

Aim Methodology Results Conclusion The aim of this study is to investigate the expression of inflammatory biomarkers (TNF‐α, IL‐10, IL‐1β) and the pulpitis‐associated miRNA (miR‐30a‐5p and miR‐128‐3p) in pulp tissue samples from unrestored teeth with a vital normal pulp (NP), teeth with symptomatic irreversible pulpitis (IP) and in unrestored teeth with periodontal disease, unresponsive to periodontal therapy, and a vital pulp (EP).Thirty patients were included in this observational study (10 teeth with NP, 10 teeth with IP, 10 teeth with EP). Dental pulp tissues samples were collected from patients during root canal treatment (RCT). RNA was extracted and qRT‐PCR of target genes (tumour necrosis factor [TNF]‐α, interleukin [IL]‐1β, IL‐10) and miRNAs (has‐miR‐30a‐5p, has‐miR‐128‐3p) performed to assess the expression profile. Fold‐change in expression was calculated using the formula 2−(ΔCt(Exp)−ΔCt(Ctrl)). One‐way anova with post‐hoc Tukey's was used to determine significant differences between groups. The significance level was set at 5% (p < .05). All teeth were also followed up clinically for 1 year and evaluated for a range of endodontic and periodontal‐related outcomes.All investigated genes significantly increased in expression and miRNAs significantly decreased in expression in the IP and EP groups compared with the NP group (p < .05). With regards to TNF‐α and IL‐1β there were no significant differences in expression between the IP and EP groups (p > .05), whereas IL‐10 expression levels were significantly reduced in the EP compared with the IP group (p < .05). Both miR‐30a‐5p and miR‐128‐3p showed significantly reduced expression in both IP and EP lesions, compared with NP (p < .05); however, no significant differences in miRNA expression were observed between IP and EP groups (p > .05). One year after root canal treatment and periodontal maintenance, tooth mobility and probing depth were significantly reduced in the EP group (p < .05).Pulp tissues from teeth with IP and EP presented similar levels of altered inflammatory markers compared with NP. TNF‐α, IL‐10, IL‐1β cytokines and miRNAs (miR‐30a‐5p and miR‐128‐3p) are potential objective biomarkers to indicate pulpal inflammatory status, aiding diagnosis and directing clinical decision‐making. RCT may be beneficial to improve stage III periodontitis unresponsive to non‐surgical periodontal treatment, but further research is required. [ABSTRACT FROM AUTHOR]

Aim Methodology Results Conclusions The pathways to post‐operative pain are complex and encompass factors that extend beyond the treatment protocol employed. This study aimed to identify patient‐related predictors of post‐operative pain following root canal treatment.A total of 154 patients received a single‐visit root canal treatment for asymptomatic necrotic mandibular molars. Before treatment, dental anxiety, dental fear and sense of coherence (SOC) were measured as predictors for each patient using validated questionnaires. Other measured predictors included gender, age, previous negative experiences at the dental offices and prior root canal treatment. Post‐operative pain was assessed using the Numeric Rating Scale at multiple time‐points over 30 days. Structural equation analysis was employed to evaluate the direct and indirect effects of patient‐related predictors on a theoretical model of post‐operative pain. The irrigant solution was also included in the model, as it was the only aspect that varied in the treatment protocol (sodium hypochlorite 2.5% and 8.25%).Dental anxiety (coefficient 0.028; p < .01), dental fear (coefficient 0.007; p = .02) and irrigant solution (coefficient 0.004; p = .03) exerted a direct effect on post‐operative pain. SOC exerted an indirect effect on post‐operative (coefficient 0.006; p = .01) through dental anxiety and dental fear. Moreover, previous negative experiences (coefficient 0.048; p = .04) exerted an indirect effect on post‐operative pain through dental anxiety.Dental anxiety, dental fear, previous negative experiences and SOC are patient‐related predictors of post‐operative pain following root canal treatment. These factors should be taken into consideration in clinical practice, as patients with these characteristics may be at an increased risk of experiencing post‐operative pain. [ABSTRACT FROM AUTHOR]

Aim Methodology Results Conclusions To evaluate the 6‐year outcome of root canal treatment irrigated with 0.5% or 3% sodium hypochlorite (NaOCl).The baseline trial was designed as a quasi‐randomized clinical trial. Patients referred for root canal treatment to an endodontic specialist clinic were recruited to the study (n = 298). The concentration of NaOCl was allocated quasi‐randomized to 271 subjects (0.5% [n = 139], 3% [n = 132]). Bacterial sampling was performed immediately before root canal filling. Samples were cultured and evaluated as growth or no growth. Patients were invited to a clinical and radiological follow‐up >5 years postoperatively. The clinical outcome measurements were tooth survival, cumulative incidence of endodontic retreatments, patients' assessment of pain, clinical findings and radiological signs of apical periodontitis (AP).Tooth survival was 85.6% in the 0.5% NaOCl group and 81.1% in the 3% NaOCl group (p = .45). There was no record of retreatment in 94.4% in the 0.5% NaOCl group and in 92.2% in the 3% NaOCl group (p = .76). The percentage of asymptomatic cases were 87.8% in the 0.5% group and 85.3% in the 3% NaOCl group (p = .81). Absence of clinical signs of AP was seen in 86.6% in the 0.5% NaOCl group and in 83.6% in the 3% NaOCl group (p = .80). Absence of radiological signs of AP was seen in 74.0% in the 0.5% NaOCl group and 64.1% in the 3% NaOCl group (p = .20). Subjects with positive culture before root filling reported subjective pain with a significantly higher frequency as compared to negative‐culture subjects (p = .014).The use of 0.5% or 3% NaOCl for irrigation during root canal treatment resulted in similar clinical outcomes 5–7 years postoperatively. Persisting bacteria immediately before root filling may predict future episodes of subjective pain. [ABSTRACT FROM AUTHOR]

Aim Methodology Results Conclusions Natural bioactive products have been tested as alternative antimicrobial agents. This study evaluated the effect of Punica granatum extract (PGE) on oral multispecies biofilms.Lyophilized extracts from pomegranate peel were prepared, and the punicalagin content was assessed by ultra‐performance liquid chromatography (UPLC). Oral multispecies biofilms from 2 donors were grown on four collagen‐coated hydroxyapatite discs. After incubation for 7 days or 3 weeks, the biofilms were exposed to water (control), 2% CHX, 10% PGE, 20% PGE or 30% PGE for 3 min. The proportions of dead bacteria were assessed by the live/dead staining and confocal microscopy. After the analysis, the best PGE concentration (30%) was combined with CHX. The experimental phases were repeated using water, 2% CHX, 30% PGE and 30% PGE + 2% CHX. Five random areas of the biofilm on each disc were scanned, resulting in 20 scanned areas for each group.Regarding the biofilm volume, no differences were found amongst solutions (p = .111). The PGE solution killed bacteria effectively in 1‐week, 2‐week and 3‐week‐old‐plaque biofilms, ranging from 37 to 55.3%, depending on the PGE concentration. The 30% PGE (a) (p = .0009) had greater antibiofilm effectiveness than 2% CHX (b), which killed bacteria in the 25.2 to 48.7% range. The 10% and 20% PGE had intermediate values (ab), without significant differences from 30% PGE (p = 1.002). Water (c) had the lowest proportion of dead bacteria (p < .00001) in a range of 5 to 6.7% and lower effectiveness in killing bacteria (p < .05). The PGE alone or mixed with 2% CHX had greater anti‐biofilm effectiveness than CHX (p < .05). The old plaque biofilms were more resistant than the 7‐day‐old plaque (p < .05).The 30% PGE (alone or combined with CHX) exhibited a greater antibiofilm effect on oral multispecies biofilms grown on hydroxyapatite discs than 2% CHX. [ABSTRACT FROM AUTHOR]

Studies investigating the accuracy of diagnostic tests should provide data on how effectively they identify or exclude disease in order to inform clinicians responsible for managing patients. This consensus‐based project was undertaken to develop reporting guidelines for authors submitting manuscripts, which describe studies that have evaluated the accuracy of diagnostic tests in endodontics. These guidelines are known as the Preferred Reporting Items for Diagnostic Accuracy Studies in Endodontics (PRIDASE) 2024 guidelines. A nine‐member steering committee created an initial checklist by integrating and modifying items from the Standards for Reporting of Diagnostic Accuracy (STARD) 2015 checklist and the Clinical and Laboratory Images in Publications (CLIP) principles, as well as adding a number of new items specific to the specialty of endodontics. Thereafter, the steering committee formed the PRIDASE Delphi Group (PDG) and the PRIDASE Online Meeting Group (POMG) in order to collect expert feedback on the preliminary draft checklist. Members of the Delphi group engaged in an online Delphi process to reach consensus on the clarity and suitability of the items in the checklist. The online meeting group then held an in‐depth discussion on the online Delphi‐generated items via the Zoom platform on 20 October 2023. According to the feedback obtained, the steering committee revised the PRIDASE checklist, which was then piloted by several authors when preparing manuscripts describing diagnostic accuracy studies in endodontics. Feedback from this process resulted in the final version of the PRIDASE 2024 checklist, which has 11 sections and 66 items. Authors are encouraged to use the PRIDASE 2024 guidelines when developing manuscripts on diagnostic accuracy in endodontics in order to improve the quality of reporting in this area. Editors of relevant journals will be invited to include these guidelines in their instructions to authors. [ABSTRACT FROM AUTHOR]

Background: Limited evidence is available regarding the superior clinical properties of bioceramic sealers comparted with traditional standard sealers. Objectives: This review aimed to answer the following research questions: 'In healthy patients requiring a root canal treatment (P), what is the efficacy of premixed bioceramic sealers (I) compared with traditional root canal epoxy resin‐based sealers (C) in terms of survival, success rates (PICO1) sealer extrusion and resorption (PICO2) post‐obturation pain (PICO3) (O)?' Methods: Authors independently searched three electronic databases: PubMed (including MEDLINE), Web of Science, Embase and Scopus up to 31 October 2023. This was accompanied by both grey literature and manual search. Detailed selection criteria were applied, namely mature permanent teeth requiring root canal treatment, premixed bioceramic sealer with gutta‐percha as an intervention group, a standard filling technique as control group and full‐text available in English. A random‐effect meta‐analysis was used to synthesize the body of evidence regarding the use of bioceramic sealers in root canal treatment and their impact on post‐obturation pain. Effect sizes were represented as relative risks on a logarithmic scale for binary outcomes and as mean differences for continuous outcomes. Results: A total of 941 articles were identified. Fifteen Comparative clinical studies were finally included. Eleven were randomized clinical trials, and four were prospective clinical trials with control group. The follow‐up of these studies was not greater than 2 years. No publication bias was observed in any study. No significant differences were observed between the two groups in terms of survival and success rates. A small non‐significant lower risk of extrusion was observed for bioceramics. A small, non‐significantly lower post‐operative‐pain within 24‐h was observed when bioceramics were used. Discussion: The majority of current evidence shows inconsistencies in reporting and is of short‐term duration. Robust prospective long‐term trials are needed in this area to better support future recommendations. Conclusion: This systematic review is the first to analyse several clinical outcomes using premixed sealers. Included studies differed in terms of clinical protocol and operator expertise, but reported a similar outcome when comparing bioceramic versus standard sealers. Tooth survival, treatment outcome, post‐operative pain and periapical extrusion were similar and presented no significant differences between the two sealer types. Registration: PROSPERO database (CRD42023449151). [ABSTRACT FROM AUTHOR]

(1) Background: The in vitro study aimed to investigate mechanical characteristics of resin composites and their suitability in direct restauration of endodontically treated teeth (ETT). (2) Methods: 38 endodontically treated premolars with occlusal access cavities were directly restored using the following resin composites and adhesives: Tetric Evo Ceram® + Syntac classic® (n = 10), Venus Diamond® + iBond Total-Etch® (n = 10), Grandio® + Solobond M® (n = 9), Estelite® Sigma Quick + Bond Force® (n = 9). After thermocycling, the elastic modulus, shear-bond-strength, fracture load (Fmax) and fracture mode distribution were evaluated. Statistical analysis: one-way ANOVA, t-test, Kruskal–Wallis test; p < 0.05. (3) Results: Grandio® showed the highest E-modulus (15,857.9 MPa) which was significant to Venus Diamond® (13,058.83 MPa), Tetric Evo Ceram® (8636.0 MPa) and Estelite® Sigma Quick (7004.58 MPa). The highest shear-bond-strength was observed for Solobond M® (17.28 MPa), followed by iBond® (16.61 MPa), Syntac classic® (16.41 MPa) and Bond Force® (8.37 MPa, p < 0.05). The highest fracture load (Fmax) was estimated for ETT restored with Venus Diamond® (1106.83 N), followed by Estelite® Sigma Quick (1030.1 N), Tetric Evo Ceram® (1029 N) and Grandio® (921 N). Fracture-mode distribution did not show any significant differences. (4) Conclusions: The observed resin composites and adhesives show reliable mechanical characteristics and seem to be suitable for direct restoration of endodontically treated teeth. [ABSTRACT FROM AUTHOR]

Background: File fracture during root canal treatment in endodontics is a major concern for clinicians. The strength of the file is strongly dependent on its geometry, material, and working conditions; finite element simulations are used to understand these failure mechanisms. One limitation of the models used for these simulations is the approximate geometric representation typically obtained by rotating and scaling a specific cross-section shape along the file length. Given the influence of file geometry on file strength, a more realistic representation based on the manufacturing method is needed. Methods: A computerized method was developed to generate the file geometry by simulating the flute grinding manufacturing process. This method generates the 3D geometry of the file starting from a blank and reproducing the motions of the file and grinding wheel. Results: The cross-section of the resulting geometry does not involve simple rotation and scaling but changes from the shank to the tip. The tilt angle of the grinding wheel affects the final geometry, thus altering the convexity of the cross-section. Several other parameters, such as the pitch and the radius of the grinding disc tip, impact the final geometry. Conclusions: The proposed computational method allows for the generation of endodontic file geometries that match those produced via the actual flute grinding method. This tool may help researchers and tool designers in the preparation of finite element models to assess the strength of realistic files. [ABSTRACT FROM AUTHOR]

Objectives: To assess the biocompatibility, bioactivity, and immunomodulatory properties of three new calcium silicate cement-based sealers: Ceraseal (CS), Totalfill BC Sealer (TFbc) and WellRoot ST (WR-ST) on human periodontal ligament stem cells (hPDLSCs). Materials and methods: HPDLSCs were isolated from extracted third molars from healthy patients. Eluates (1:1, 1:2, and 1:4 ratio) and sample discs of CS, TFbc and WR-ST after setting were prepared. A series of assays were performed: cell characterization, cell metabolic activity (MTT assay) cell attachment and morphology (SEM assay), cell migration (wound-healing assay), cytoskeleton organization (phaloidin-based assay); IL-6 and IL-8 release (ELISA); differentiation marker expression (RT-qPCR assay), and cell mineralization (Alizarin Red S staining). HPDLSCs cultured in unconditioned (negative control) or osteogenic (positive control) culture media were used as a comparison. Statistical significance was established at p < 0.05. Results: All the tested sealers exhibited similar results in the cytocompatibility assays (cell metabolic activity, migration, attachment, morphology, and cytoskeleton organization) compared with a negative control group. CS and TFbc exhibited an upregulation of at least one osteo/cementogenic marker compared to the negative and positive control groups. CS and TFbc also showed a significantly higher calcified nodule formation than the negative and positive control groups. Both the marker expression and calcified nodule formation were significantly higher in CS-treated cells than TFbc treated cells. WR-ST exhibited similar results to the control group. CS and TFbc-treated cells exhibited a significant downregulation of IL-6 after 72 h of culture compared to the negative control group (p < 0.05). Conclusion: All the tested sealers exhibited an adequate cytocompatibility. CS significantly enhances cell differentiation by upregulating the expression of key genes associated with bone and cementum formation. Additionally, CS was observed to facilitate the mineralization of the extracellular matrix effectively. In contrast, the effects of TFbc and WR-ST on these processes were less pronounced compared to CS. Furthermore, both CS and TFbc exhibited an anti-inflammatory potential, contributing to their potential therapeutic benefits in regenerative endodontics. Clinical relevance: This is the first study to compare the biological properties and immunomodulatory potential of Ceraseal, Totalfill BC Sealer, and WellRoot ST. The results act as supporting evidence for their use in root canal treatment. [ABSTRACT FROM AUTHOR]

This review article describes the methods and clinical recommendations for reinforcing traumatized anterior immature teeth with pulp necrosis treated with mineral trioxide aggregate (MTA) apexification. Traumatic injury can cause pulp necrosis and incomplete root formation in immature teeth. MTA apexification is the treatment of choice for necrotic immature teeth, particularly during the middle or late stages of root development. MTA apexification has a high success rate; however, failures due to cervical or root fractures occasionally occur. The risk of fracture is higher in immature teeth with thin root dentin, particularly those with external root resorption. Furthermore, the loading force from any parafunctional habit also increases fracture risk. Therefore, intra‐radicular reinforcement may be necessary after MTA apexification. In vitro, intraradicular restoration with a resin composite/core build‐up material or a prefabricated fiber post demonstrated better root reinforcement than root canal obturation materials (i.e., gutta‐percha and sealer). However, the root‐reinforcement effect of MTA orthograde filling in the entire root canal remains unclear. In vivo, the survival of fractured teeth with intraradicular restorations (resin composite/core build‐up material or prefabricated fiber posts) is extremely high. Moreover, the survival of teeth with gutta‐percha/sealer obturation or MTA orthograde filling and restoration with resin composite extending into the cervical third of the root canal approximately 1–2 mm below the cemento‐enamel junction is acceptably high. Based on this evidence, the remaining tooth/root structure and loading force should be carefully examined when considering intra‐radicular reinforcement of immature anterior teeth treated with MTA apexification. [ABSTRACT FROM AUTHOR]

Needle syringe irrigation is frequently used in root canal therapy, and the flow pattern during irrigation can be efficiently manipulated by means of passive flow control technique, resulting in expected irrigation performance improvement. Therefore, novel needles with composite flow control structures are numerically investigated and optimized in this study. Based on the 30G needle, six single/double side‐vented needles with dimple and protrusion are proposed. Two flow rates in line with clinical applications, 5.3 and 8.6 m/s, are used in the analysis. Three performance parameters are investigated. The safety of the irrigation system is evaluated by the root canal apical pressure, whereas the irrigant extension and the flushing efficiency are evaluated by the extending depth and the effective cleaning area, respectively. The results demonstrate that the shear stress of the double‐side‐vented needle is higher while the irrigant extension is enhanced with a dimple structure. The performance of the double‐side‐vented needle with a dimple is superior to that of other designs, with up to 33% improvement in extending depth and a 22% increase in effective cleaning area over the prototype. New needles do not raise risk of irrigant extrusion. Furthermore, the effect of dimple depth and outlet angle are investigated. The needle with a dimple of 0.04 mm depth shows the highest extending depth within the confines of the investigation. The effective cleaning area is significantly influenced by the needle outlets, and the effective cleaning area expands with an increase in needle outlet angle, while the extending depth gradually declines. [ABSTRACT FROM AUTHOR]

Objective: To explore the effect of disposable endodontic treatment combined with crown repair and its effect on chewing function. Methods: 80 patients with cryptic cleft dental pulp disease admitted to our hospital from January 2018 to January 2023 were selected and divided into observation group and Matched group, with 40 patients in each group. The Matched group patients underwent crown restoration after multiple root canal treatments, while the observation group patients underwent crown restoration after a single root canal treatment. After 3 months of treatment, the clinical efficacy of the two groups of patients was compared, and record all patients treatment success rates. The chewing function, pain level, inflammatory factors in gingival crevicular fluid, and expression levels of alkaline phosphatase (ALP) were compared between the two groups of patients before and after 3 months of treatment. Finally, their plaque index (PLI) was compared, Changes in periodontal health indicators related to bleeding index (BI) and probing depth of gingival sulcus (PD). Results: The total effective rate and treatment success rate of the observation group were higher than those of the matched group (P<0.05); Post-treatment, the chewing function score of the two groups of patients increased, and the observation group was higher than the matched group. The pain level score decreased, and the observation group was lower than the matched group (P<0.05); Post-treatment, the levels of PD, BI, and PLI in both groups of patients decreased, and the observation group was lower than the matched group (P<0.05); Post-treatment, the two patients had lower levels of IL-6, CRP, TNF-α, and ALP, while the observation group was lower than the matched group(P<0.05). Conclusion: The combination of one-time root canal therapy and crown restoration has a significant therapeutic effect on cracked pulp disease, and can improve the long-term success rate of treatment, enhance chewing function, alleviate periodontal pain, reduce periodontal inflammation, alleviate disease severity, and improve periodontal health. [ABSTRACT FROM AUTHOR]

Background Materials and Methods Results Conclusion The aim of this study was to calculate the stress distribution of fiberglass post associated with resin composite crown restoration and fiberglass posts with zirconia restorations in mature and immature endodontically treated central maxillary incisor under various loading conditions.The study created six different study models in a virtual environment: healthy mature maxillary central teeth, intact immature maxillary central teeth, mature maxillary central teeth with fiberglass post associated with resin composite crown restoration, immature maxillary central teeth with fiberglass post associated with resin composite crown restoration, mature maxillary central teeth with fiberglass posts and zirconia restoration, and immature maxillary central teeth with fiberglass posts and zirconia restoration. Loading conditions simulating mastication, trauma, and bruxism were applied to each of the models at different angles and amounts. The von Mises and the maximum and minimum principal stress values in tooth structures (dentin) and support structures (bone, PDL) and materials were observed using finite element stress analysis.The highest stress values in the tissue and the restoration structure were observed for masticating force and crowns rehabilitated with zirconia restorations. None of the compared loading conditions and restorations showed destructive stress values on periodontal ligament or bone.The mature and immature endodontically treated central maxillary incisors can be better rehabilitated using fiberglass post associated with resin composite crown restoration and may be preferred to zirconia restorations in order to reduce the stresses on the surrounding tissues and teeth. However, further clinical studies are needed to fully explore this topic. [ABSTRACT FROM AUTHOR]

Introduction: Perforation is a pathological connection between the root canal system and the external surface of the tooth that can occur unintentionally during pulp chamber preparation. The consequence of this complication is inflammation and destruction of the periodontal tissues. Therefore, it is essential to seal the perforation to avoid tooth loss. Among different bioactive materials, mineral trioxide aggregate (MTA) and Biodentine (BD) ensure a favorable prognosis in therapeutic dental procedures due to their healing properties. Materials and methods: The present case series report describes successful treatments of different sizes, locations, and immediate and mediated perforations. Results: Clinical and radiographic follow-up showed asymptomatic teeth without discomfort, swelling, fistula, or radiolucency in the furcal area. Conclusion: Mineral trioxide aggregate and BD can be successfully used as a biocompatible material for the repair of furcal and root canal perforations. [ABSTRACT FROM AUTHOR]

Three-dimensional obturation of the root canal system is the primary goal of endodontic treatment. Endodontic sealers should fill any irregularities in the root canal system and penetrate as deeply as possible into the dentinal tubules. They should also ensure that the gutta-percha points adhere well to the dentinal walls of the root canal without leaving voids at their margins. The purpose of this study was to evaluate contemporary imaging techniques used for in vitro testing of selected specimens consisting of tooth scrapings after endodontic treatment with gutta-percha and selected endodontic sealers: AH Plus-Dentsply Sirona, Well Root ST-Vericon, Korea, and AH Bioceramics Sealer-Dentsply Sirona. The following imaging techniques were used in the evaluation: scanning electron microscopy (SEM), confocal laser scanning microscopy (CLSM), micro-computed tomography (micro-CT), surgical microscopy, and light microscopy. A comparison of the imaging methods (SEM, CLSM, micro-CT, surgical microscopy, light microscopy) showed significant differences in their suitability for assessing the penetration depth of endodontic sealers into dentinal tubules in vitro. Based on the analysis of the imaging methods, it was concluded that confocal microscopy and SEM were the most objective and accurate methods for visually assessing the quality of root canal filling in vitro. However, the high cost of specimen preparation and the limited availability of specialized equipment are factors that limit their use in clinical settings. [ABSTRACT FROM AUTHOR]

Aim: To compare the effect of different sodium hypochlorite (NaOCl) agitation techniques on an ex vivo oral multispecies biofilm during passive disinfection of simulated immature roots. Methodology: Extracted human teeth were prepared to simulate immature roots. They were infected with a dental plaque‐derived multispecies biofilm and cultured for 14 days. The roots were randomly designated into four groups: (1) negative control (PBS), (2) 1.5% NaOCl (CNI), (3) CNI + Ultrasonic activation (UA), (4) CNI + EasyClean agitation (ECA), (5) CNI + XP‐endo finisher agitation (XPF), and (6) positive control (6% NaOCl). Biofilm samples were collected from the root canals and used to determine the number of viable cells (colony‐forming units), scanning electron microscopy, and 16S rRNA gene sequencing. The mean colony‐forming units per mL (CFU/mL) were analysed using One‐way anova. 16S rRNA sequencing data were analysed for alpha (observed OTUs, Shannon index, and Chao1) and beta diversity (Bray‐Curtis dissimilarities). The LEfSe analysis was used to determine the effect of treatment procedures on the abundance of root canal microbiota. The significance was set at.05. Results: PBS and CNI samples had significantly higher CFU/mL counts than UA, ECA, XPF, and 6% NaOCl samples (p <.05). The pre‐treatment, PBS, and CNI groups had significantly greater alpha diversity than the UA, ECA, XPF, and 6% NaOCl groups (p <.05). NaOCl agitation groups and the 6% NaOCl group achieved a more pronounced reduction in bacteria from the genera Fusobacterium, Actinomyces, Porphyromonas, and Capnocytophaga. Conclusions: The effectiveness of passive disinfection protocols was enhanced by NaOCl agitation techniques, suggesting that this supplementary method can improve the outcome of revitalization procedures. [ABSTRACT FROM AUTHOR]

Endodontic therapy includes various procedures such as vital pulp therapy, root canal treatment and retreatment, surgical endodontic treatment and regenerative endodontic procedures. Disinfection and tissue repair are crucial for the success of these therapies, necessitating the development of therapeutics that can effectively target microbiota, eliminate biofilms, modulate inflammation and promote tissue repair. However, no current endodontic agents can achieve these goals. Antimicrobial peptides (AMPs), which are sequences of amino acids, have gained attention due to their unique advantages, including reduced susceptibility to drug resistance, broad‐spectrum antibacterial properties and the ability to modulate the immune response of the organism effectively. This review systematically discusses the structure, mechanisms of action, novel designs and limitations of AMPs. Additionally, it highlights the efforts made by researchers to overcome peptide shortcomings and emphasizes the potential applications of AMPs in endodontic treatments. [ABSTRACT FROM AUTHOR]

In the last two decades, the activation of root canal irrigants with pulsed lasers as an adjunct in root canal treatment has become increasingly popular. This narrative review explains the physical basics and the working mechanism of laser‐activated irrigation (LAI), explores the parameters influencing LAI efficacy, considers historical evolutions in the field and summarizes laboratory and clinical evidence with emphasis on the antimicrobial action of LAI. Cavitation is the driving force behind LAI, with growing and imploding vapour bubbles around the laser tip causing various secondary phenomena in the irrigant, leading to intense liquid dynamics throughout the underlying root canal. High‐speed imaging research has shown that laser wavelength, pulse energy, pulse length and fibre tip geometry are parameters that influence this cavitation process. Nevertheless, this has not resulted in standardized settings for LAI. Consequently, there is significant variability in studies assessing LAI efficacy, complicating the synthesis of results. Laboratory studies in extracted teeth suggest that, with regard to canal disinfection, LAI is superior to conventional irrigation and there is a trend of higher antimicrobial efficacy of LAI compared to ultrasonic activation. Clinical evidence is limited to trials demonstrating similar postoperative pain levels after LAI versus no activation or ultrasonic activation. Clinical evidence concerning the effect of LAI on healing of apical periodontitis as yet is scarce. [ABSTRACT FROM AUTHOR]

Calcium Hydroxide-based endodontic sealer loaded with antimicrobial agents have been commonly employed in conventional root canal treatment. These sealers are not effective against E. faecalis due to the persistent nature of this bacterium and its ability to evade the antibacterial action of calcium hydroxide. Therefore, endodontic sealer containing Carbon nanodots stabilized silver nanoparticles (CD-AgNPs) was proposed to combat E. faecalis. The therapeutic effect of CD-AgNPs was investigated and a new cytocompatible Calcium Hydroxide-based endodontic sealer enriched with CD-AgNPs was synthesized that exhibited a steady release of Ag+ ions and lower water solubility at 24 hours, and enhanced antibacterial potential against E. faecalis. CD-AgNPs was synthesized and characterized morphologically and compositionally by Scanning Electron Microscopy, Fourier Transform Infrared Spectroscopy (FTIR), and UV-Vis Spectroscopy, followed by optimization via minimum inhibitory concentration (MIC) determination against E. faecalis by broth microdilution technique and Cytotoxicity analysis against NIH3T3 cell lines via Alamar Blue assay. Calcium hydroxide in distilled water was taken as control (C), Calcium hydroxide with to CD-AgNPs (5mg/ml and 10mg/ml) yielded novel endodontic sealers (E1 and E2). Morphological and chemical analysis of the novel sealers were done by SEM and FTIR; followed by in vitro assessment for antibacterial potential against E. faecalis via agar disc diffusion method, release of Ag+ ions for 21 days by Atomic Absorption Spectrophotometry and water solubility by weight change for 21 days. CD-AgNPs were 15–20 nm spherical-shaped particles in uniformly distributed clusters and revealed presence of constituent elements in nano-assembly. FTIR spectra revealed absorption peaks that correspond to various functional groups. UV-Vis absorption spectra showed prominent peaks that correspond to Carbon nanodots and Silver nanoparticles. CD-AgNPs exhibited MIC value of 5mg/ml and cytocompatibility of 84.47% with NIH3T3 cell lines. Novel endodontic sealer cut-discs revealed irregular, hexagonal particles (100–120 nm) with aggregation and rough structure with the presence of constituent elements. FTIR spectra of novel endodontic sealers revealed absorption peaks that correspond to various functional groups. Novel endodontic sealers exhibited enhanced antibacterial potential where E-2 showed greatest inhibition zone against E. faecalis (6.3±2 mm), a steady but highest release of Ag+ ions was exhibited by E-1 (0.043±0.0001 mg/mL) and showed water solubility of <3% at 24 hours where E-2 showed minimal weight loss at all time intervals. Novel endodontic sealers were cytocompatible and showed enhanced antibacterial potential against E. faecalis, however, E2 outperformed in this study in all aspects. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to compare the healing of periapical bone between type II diabetes patients and healthy patients after root canal treatment. Subjects and Methods: This study included 26 diabetic patients and the control group with healthy patients matching the diabetic group in age and sex. The study included only teeth with satisfactory coronal restoration. The periapical index system was used to evaluate the periapical status of treated teeth at follow‐ups after 6 and 12 months. Results: Analysis of the results revealed a significantly higher healing rate in the control group compared to the diabetic group only at the 6‐month follow‐up (66.6 vs. 33.3%; Χ2 = 4.857; p = 0.0275). Analysis of the full‐scale PAI index disclosed significantly higher PAI values in the diabetic subjects at 6‐ and 12‐month follow‐up. The regression analysis showed that the risk of apical periodontitis persistence increased significantly with female gender (OR = 3.92; 95% CI = 1.04–14.79; p = 0.043), diabetes mellitus (OR = 4.27; 95% CI: 1.18–15.50; p = 0.027) and higher household income (OR = 5.39; 95% CI = 1.33–21.89; p = 0.018). Conclusion: Root canal treatment remains an effective means of conservative treatment in diabetic patients. While the healing is not compromised, regular follow‐ups are necessary to monitor the healing process. [ABSTRACT FROM AUTHOR]

Dentin pulp has a complex function as a major unit in maintaining the vitality of teeth. In this sense, the Wnt/β-Catenin pathway has a vital part in tooth development, maintenance, repair, and regeneration by controlling physiological activities such as growth, differentiation, and migration. This pathway consists of a network of proteins, such as Wnt signaling molecules, which interact with receptors of targeted cells and play a role in development and adult tissue homeostasis. The Wnt signals are specific spatiotemporally, suggesting its intricate mechanism in development, regulation, repair, and regeneration by the formation of tertiary dentin. This review provides an overview of the recent advances in the Wnt/β-Catenin signaling pathway in dentin and pulp regeneration, how different proteins, molecules, and ligands influence this pathway, either upregulating or silencing it, and how it may be used in the future for clinical dentistry, in vital pulp therapy as an effective treatment for dental caries, as an alternative approach for root canal therapy, and to provide a path for therapeutic and regenerative dentistry. [ABSTRACT FROM AUTHOR]

Introduction: Understanding the intricate root canal system of mandibular incisors is crucial for successful root canal therapy. Variations in canal anatomy pose challenges in diagnosis and treatment planning, emphasising the need for comprehensive evaluation methods. Aim: To evaluate and assess the root canal configuration of permanent mandibular incisors based on Vertucci’s classification using periapical radiographs and correlating the same with the gold standard decalcification and dye-penetration technique. Materials and Methods: The current in-vitro study was carried out from December 2018 to March 2019 in the Department of Conservative Dentistry and Endodontics, Dr. R. Ahmed Dental College and Hospital, Kolkata, West Bengal, India. It analysed the root canal morphology of mandibular central and lateral incisors using radiographic examination and decalcificationdye penetration evaluation. Data from 50 central and 50 lateral incisors (100 mandibular incisors) were procured and were assessed and subsequently analysed statistically using International Business Machines (IBM) Statistical Package for the Social Sciences (SPSS) Statistics for Windows, Version 27.0 (Armonk, NY: IBM Corp). The study outcome included assessing the various canal types and configurations, types of canals (straight/curved), and the position of the apical foramen (labial/ lingual) by both techniques. The existence of agreement was also tested using statistical analysis by the kappa (κ) coefficient between the two techniques with an alpha level of 5%. Results: The radiological findings of mandibular central incisors revealed a predominant presence of Type-I canals, constituting 66 (66%) cases, according to Vertucci’s classification. Decalcificationdye penetration evaluation of central incisors showed a similar trend, with Type-I canals exhibiting a significantly higher percentage 35 (70%) compared to other canal types (p<0.001). Lateral incisors exhibited similar trends in both radiological findings and decalcification-dye penetration. Type-I canals were significantly more prevalent 29 (58%) compared to other types (p<0.001). Evaluation with the decalcification-dye penetration technique further supported this, with Type-I canals showing a higher percentage 27 (54%) compared to other types (p<0.001). A moderate amount of agreement was detected between the two modalities concerning canal configuration (κ=0.46, p=0.049) and position of the apical foramen (κ=0.43, p<0.001), while an almost perfect agreement was present on canal curvature (κ=0.85, p<0.001). Conclusion: These results collectively suggest a similarity in the radiological characteristics and decalcification-dye penetration patterns between central and lateral incisors. [ABSTRACT FROM AUTHOR]

Key Clinical Message: This paper illustrated successful endodontic non‐surgical (re)treatments of molars and premolar with different taurodontic classifications and accompanied anomalies like C‐shape and extra root canals in otherwise healthy patients. Magnification with illumination besides active irrigation with NaOCl were the most helpful items in managing these cases. [ABSTRACT FROM AUTHOR]

Background Objectives Methods Results Conclusions Registration Analysis of the survival of root‐filled posterior teeth and the associated prognostic tooth‐related factors will enable clinicians to predict the outcome of root canal treatment.To investigate (i) the survival of root‐filled posterior teeth and (ii) the tooth‐related factors that may affect their survival.Randomized controlled trials, comparative studies and observational studies assessing survival rates of root‐filled posterior teeth with a minimum 4‐year follow‐up period were identified through an electronic search of the following databases up to January 2023: The Cochrane Central Register of Controlled Trials, Medline via PubMed, the Cochrane Database of Systematic Reviews, Embase, Web of Science and NIHR centre for reviews and dissemination. Two reviewers (SP and ML) independently selected the final studies based on pre‐defined inclusion criteria. The Newcastle Ottawa Scale and the Cochrane Risk of Bias Tool for Randomized Trials were used to assess the risk of bias. Pooled weighted survival rates were analysed using a random effects meta‐analysis model using DerSimonean and Laird methods. Descriptive analysis of studies describing any prognostic tooth‐related factors was conducted.Of the 72 studies identified, data from 20 studies were included in the survival meta‐analysis, and data from 13 of these studies were included in the descriptive analysis of tooth‐related factors; 12 studies were retrospective, 7 were prospective, and one was a randomized control trial. The pooled survival rates at 4–7 years and 8–20 years of root‐filled posterior teeth regardless of tooth type was 91% (95% CI, 0.85; 0.95) and 87% (95% CI, 0.77; 0.93), respectively. The prognostic tooth‐related factors mentioned in the included studies were (i) remaining coronal tooth structure, (ii) ferrule, (iii) crown‐to‐root ratio (iv) tooth type and location (v) periodontal disease (vi) proximal contacts and (vii) cracks.The meta‐analysis suggests that root canal treatment has a high medium to long term survival outcome. The narrative summary identified 7 factors that affect tooth survival. However, there is a paucity of evidence, and more research is needed in this area.PROSPERO Registration: CRD42021227213. [ABSTRACT FROM AUTHOR]

BACKGROUND: For placement of intraradicular posts the intracanal filling material has to be removed. If drills are employed for this purpose, extra widening of the canal, incomplete cracks or root perforation are probable when inappropriate size of drill is used. OBJECTIVE: This in vitro study assessed the efficacy of radiographs taken after completion of root canal therapy in selecting the appropriate-sized Peeso reamer for post space preparation. METHODS: Canals of 53 extracted maxillary and mandibular teeth of different types were cleaned and shaped. Then with acrylic resin 3-dimensional model of the intracanal space of each tooth was fabricated. Next, all canals were filled with gutta-percha and teeth were radiographed buccolingually. Based on these radiographs two observers selected a Peeso reamer that best matched each canal's diameter. The diameter of the selected Peeso reamer was compared to the diameter of the corresponding resin model of each canal by two independent observers and the difference was measured. The data were analyzed by paired sample t -test using SPSS version 22. RESULTS: The diameter of the selected Peeso reamers ranged from 0.21 mm smaller to 0.12 mm larger than the diameter of intracanal spaces. The difference between reamer and resin model was less than 0.1 mm in 75% of the cases. CONCLUSION: The result of this study suggests that post-operation endodontic radiographs are reliable means for selecting a size of Peeso reamer that does not encroach on dentinal wall during removal of intracanal filling material and post space preparation. [ABSTRACT FROM AUTHOR]

For successful root canal treatment, adequate chemomechanical instrumentation to eliminate microorganisms and pulp tissue is crucial. This study aims to assess the organic tissue dissolving activity of various irrigation solutions on bovine tooth pulp tissue. 40 extracted bovine mandibular anterior teeth (n = 10) were used for the study. Bovine pulp pieces (25 ± 5 mg) were placed in 1.5 ml Eppendorf tubes. Each tooth pulp sample was then covered with 1.5 ml of different irrigation solutions, dividing them into four groups: Group 1 with freshly prepared 5% Boric acid, Group 2 with 5% NaOCl, Group 3 with Irritrol, and Group 4 with Saline. Samples were left at room temperature for 30 min, then dried and reweighed. The efficacy of tissue dissolution ranked from highest to lowest was found to be NaOCl, Boric Acid, Irritrol, and saline (p < 0.05). It was observed that the decrease in the NaOCl group was greater than the decrease in the Irritrol and saline groups, and the decrease in the Boric acid group was significantly greater than the decrease in the saline group (p < 0.05). It also emphasizes the need for future studies to further investigate the effects of Irritrol and Boric Acid on tissue dissolution. [ABSTRACT FROM AUTHOR]

Background/Aim Materials and Methods Results Conclusions To evaluate the long‐term survival of immature traumatized incisors with pulp necrosis and apical periodontitis after endodontic treatment with two apexification techniques (calcium hydroxide apexification and MTA‐apical plug) and to identify major factors affecting the survival of these teeth.Records of 2400 children and adolescents were screened for presence of traumatic dental injuries to immature incisors where endodontic treatment with the two apexification techniques was performed during January 2003 and December 2022, compared to a control group of mature teeth treated with conventional endodontic techniques. The studied variables were age; sex; apexification technique, presence of luxation and hard tissue injuries; preoperative root development stage (RDS), preoperative and postoperative periapical index (PAI), the time‐point for tooth loss, and overall survival time in years. Kaplan–Meier estimates were used to graphically present the survival functions and Cox proportional hazard model to calculate hazard ratios (HR, 95% CI).The median survival time was 10 years for calcium hydroxide apexification, 16.1 for MTA‐apexification, for luxation injuries other than intrusions and avulsions 15.5 years, for intrusions 12.5 years and for avulsions 6.8 years. The variables with significant negative impact on tooth survival were calcium hydroxide apexification, avulsion and postoperative PAI 3–5. No significant relationships were found for the variables MTA apexification, concussion; subluxation; lateral luxation; extrusion, intrusion, hard tissue injuries, preoperative RDS and PAI scores and postoperative PAI 1–2. After adjustment, the risk for premature tooth loss was 13.5 times higher in calcium hydroxide apexification, approximately 2 to 4 times higher in PAI 3–5, and 5.6 times higher in avulsions.Calcium hydroxide apexification, avulsion, and postoperative PAI 3–5 were identified as prognostic variables with significant negative impact on the risk for premature tooth loss. [ABSTRACT FROM AUTHOR]

Aim and background: Periapical lesions, which occur due to the infection and necrosis of dental pulp, are a significant dental pathology that poses risks to oral and systemic health. These lesions often require interventions such as root canal treatment or periapical surgery. Recent research has focused on the effectiveness of biocompatible materials, including mineral trioxide aggregate, bioceramics, and leukocyte-platelet-rich fibrin (L'PRF), in improving healing outcomes. This report presents the application of leukocyte-platelet-rich fibrin (L'PRF) derived from the patient's autologous blood to enhance bone healing. Case description: A 61-year-old woman with well-controlled hypertension and good oral hygiene visited the dental clinic due to a painless swelling near her upper left central incisor. After examination, it was determined that she had a periapical granuloma. The patient underwent successful root canal retreatment and apical surgery, during which leukocyte-platelet-rich fibrin was applied. After 30 months, she experienced significant improvement with no symptoms and substantial bone regeneration. Conclusion: Clinical evidence and this case study indicate that leukocyte-platelet-rich fibrin (L'PRF) may enhance healing post periapical surgery. Further research, including more extensive and longer-term randomized trials, must confirm L'PRF's effectiveness and refine treatment protocols. Clinical significance: L'PRF enhances bone healing post periapical surgery. Clinicians should consider integrating L'PRF in periapical surgeries, ensure diligent follow-up, and inform patients of its long-term advantages. Further randomized trials are needed to refine L'PRF clinical guidelines. [ABSTRACT FROM AUTHOR]

This systematic review and meta‐analysis aimed to determine whether apical patency increases postoperative pain after endodontic therapy. This study explored the degree and incidence of postoperative pain during root canal therapy, as well as the number of required analgesic doses. We searched PubMed, Scopus, Embase, Web of Science, Cochrane Library, and gray literature from the date of database inception until May 2023. RevMan 5.4 software was used for data analysis. Twelve studies were considered eligible for meta‐analysis. The mean pain scores on days 1 (mean difference [MD] = ‐1.69) and 2 (MD = ‐0.85) differed significantly between the apical patency and non‐patency groups. The odds for pain after 24 h were significantly lower (OR 0.59) in the apical patency group than in the non‐patency group. Furthermore, the mean number of required analgesic doses was not significantly different between the two groups. In conclusion, apical patency significantly alleviated postoperative pain (low‐quality evidence) and reduced the incidence of pain (moderate evidence). However, high‐quality randomized controlled trials are required to validate these findings. [ABSTRACT FROM AUTHOR]

In root canal treatment, regardless of instrumentation technique, the presence of smear layer covering contaminated dentin walls is always a concern. Therefore, irrigation plays an important role in reducing the bacterial load, and to improve the effectiveness of irrigation, different irrigation techniques and equipment have emerged that allow improving the prognosis of endodontic treatment. Literature review research was carried out, which investigated the current equipment that could help obtain better removal of the smear layer from the root canal during endodontic treatment. To do this, an electronic search was carried out in Wiley, Research 4 Life, Elsevier and Springer using a combination of the terms "smear layer", "irrigation techniques", and "agitation in endodontics". Resulting in a total of 63 articles, without language restriction, with certain inclusion criteria, making evident the lack of clinical studies that evaluate the smear layer in certain activation equipment. Among the equipment were: EndoActivator (EA), Vibringe (VB), EndoVac (EV), EDDY (ED), Sonic MM 1500 MicroMega, RinsEndo System (RE), EasyClean (EC), GentleWave (GW) Canal CleanMax (CCM), EQ-S and EndoUltra (EU). And when analyzing the effectiveness of each device in relation to smear layer, no device has been shown to completely eliminate the smear layer from the apical region of the root canal system, regardless of the chemomechanical preparation technique performed, the success It depends a lot on the irrigation protocol carried out, as well as an adequate pre-endodontic restoration that will improve the prognosis of the treatment, according to the researched literature. [ABSTRACT FROM AUTHOR]

Recent evidence suggests that an ever-growing number of pediatric patients require invasive treatments such as root canal therapy (RCT) in their permanent dentition, albeit with little information about risk factors such as prior invasive treatments of pulpotomy or pulpectomy in their primary dentition. Therefore, the primary objectives of this study were to determine the number of pediatric patients who have had any type of invasive treatment in their primary teeth, to assess their association with any subsequent invasive treatment (root canal therapy, extractions) in their permanent dentition, and to assess these trends over time. This retrospective study utilized summary data from a clinical pediatric patient pool (ages 0–17) over the period of 2013–2022. This analysis revealed that pediatric patients requiring pulpotomies and pulpectomies in primary dentition declined between 2013 (n = 417, n = 156) and 2022 (n = 250, n = 12), while root canal therapy (RCT) in permanent dentition increased six-fold from n = 54 to n = 330. In addition, few (7.8%) patients with RCT had a previous history of pulpotomy or pulpectomy, which suggests that invasive treatments performed in primary dentition have no direct association with the subsequent need for invasive treatments in permanent dentition, although more research is needed to determine the explanations for these observations. [ABSTRACT FROM AUTHOR]

Tooth decay, also known as caries, is a significant medical problem that harms teeth. Treatment is based on the removal of the carious material and then filling the cavity left in the tooth, most commonly with amalgam or composite resin. The consequences of filling failure include repeating the filling or performing another treatment such as a root canal or extraction. Dental amalgam contains mercury, and there is a global effort to reduce its use. However, no consensus has been reached regarding whether amalgam or composite resin materials are more durable, and which is the best restorative material, when using randomized clinical trials. To determine which material is superior, we performed a retrospective cohort study using a large database where the members of 58 dental clinics with 440 dental units were treated. The number of failures of the amalgam compared to composite resin restorations between 2014 and 2021 were compared. Our data included information from over 650,000 patients. Between 2014–2021, 260,905 patients were treated. In total, 19,692 out of the first 113,281 amalgam restorations failed (17.49%), whereas significantly fewer composite restorations failed (11.98%) with 65,943 out of 555,671. This study indicates that composite is superior to amalgam and therefore it is reasonable to cease using mercury-containing amalgam. [ABSTRACT FROM AUTHOR]

Background: Pediatric rotary file systems were developed to solve manual file limitations. With many systems available, it may be tricky to select the most appropriate one. Aim: to assess & compare Kedo-S Square, Fanta-AF™-Baby rotary files with manual K-file concerning removed dentin amount, canal transportation, centric ability & root canal taper using CBCT in primary anterior teeth. Design: Extracted Seventy-five upper primary anterior teeth with intact 2/3 root length were collected and divided into three groups based on root canal instrumentation, group-I: prepared using K-file, group-II: prepared using Kedo-S Square, and group-III: prepared using Fanta AF™ Baby file. The teeth were imaged with CBCT before & following canal instrumentation. Then, the removed dentin amount was calculated at each root-canal level. The Kruskal-Wallis test was utilized to statistically analyze study data. Result: The difference among the three groups was highly statistically significant at cervical & apical thirds concerning dentin thickness changes on both mesial & distal sides following canal preparation with the least removed dentin in the Kedo-S Square group(P < 0.0001). Regarding transportation & centering ability, a non-significant difference between the three groups was found. 80% of the Fanta AF™ Baby group had good-tapered preparation compared to the Kedo-S Square (72%) and K-file (40%) groups(P < 0.05). Conclusion: Kedo-S Square was preferable to Fanta-AFTM-Baby & manual K-files in primary root canal preparation. [ABSTRACT FROM AUTHOR]

The primary aim of this literature review is to delineate the key inflammatory cytokines involved in the pathophysiology of pulp inflammation. By elucidating the roles of these cytokines, a deeper comprehension of the distinct stages of inflamed pulp can be attained, thereby facilitating more accurate diagnostic strategies in endodontics. The PRISMA statement and Cochrane handbook were used for the search strategy. The keywords were created based on the review question using the PICO framework. The relevant studies were meticulously assessed according to predefined inclusion and exclusion criteria for this systematic review. A rigorous quality checklist was implemented to evaluate each included study, ensuring scrutiny for both quality and risk-of-bias assessments. The initial pilot search conducted on PubMed, Scopus, Cochrane, and WoS databases yielded 9 pertinent articles. Within these articles, multiple cytokines were identified and discussed as potential candidates for use in endodontic diagnosis, notably including IL-8, IL-6, TNF-α, and IL-2. These cytokines have been highlighted due to their significant roles in the inflammatory processes associated with pulp pathology. The identification of specific inflammatory cytokines holds promise for enhancing endodontic diagnostic procedures and exploring diverse treatment modalities. However, the current body of research in this area remains limited. Further comprehensive studies are warranted to fully elucidate the potential of cytokines in refining diagnostic techniques in endodontics. [ABSTRACT FROM AUTHOR]

Introduction: The root canal obturating material provides a three-dimensional fluid-impervious seal. Root canal sealers play a major role in providing a seal between the core material and the tooth for the long-term success of endodontic treatment. Aim: To evaluate the intratubular penetration and Bond Strength (BS) and push-out BS of AH Plus, GuttaFlow 2, and GuttaFlow Bioseal sealers. Materials and Methods: The in-vitro study was conducted in the Department of Conservative Dentistry and Endodontics at Ranjeet Deshmukh Dental College and Research Centre, Nagpur, Maharashtra, India, from October 2019 to April 2021. A total of 75 human mandibular first premolars were decoronated at the Cemento-enamel Junction (CEJ) with a standardised length of 16 mm. The root canal was prepared using the crown-down technique with HyFlex Electrical Discharge Machining (EDM) rotary files and divided into three groups: Group-I: AH Plus, Group-II: GuttaFlow 2, and Group-III: GuttaFlow Bioseal. 0.1% Rhodamine B dye was added to the sealer and obturated using the single cone technique. These samples were transversely sectioned into beams at the middle third of the root. A confocal laser scanning microscope was used to evaluate the depth of sealer penetration in the dentinal tubule, and a Universal Testing Machine was utilised to measure the push-out BS (MPa). The recorded data were subjected to statistical analysis {one-way Analysis of Variance (ANOVA) test, Tukey's post-hoc test, and Pearson's correlation coefficient}. Results: The results obtained indicated that there was a significant difference in the depth of penetration and push-out BS of AH Plus and GuttaFlow 2 sealers (p <0.0001). However, there was no significant difference found between AH Plus and GuttaFlow Bioseal sealers (p=0.206). In addition, there was no significant difference in the correlation between intratubular penetration and push-out BS of the sealers (negative correlation). Conclusion: Considering the results, the GuttaFlow Bioseal sealer was found to have comparable clinical performance with AH Plus sealer; hence, it can be used as an acceptable root canal sealer. [ABSTRACT FROM AUTHOR]

Endodontic retreatment is a procedure to remove root canal filling material from the tooth, followed by cleaning, shaping, and obturation of the canals. Treatment outcomes may be influenced by incomplete removal of filling materials. The present literature review aimed to identify the techniques and materials used to remove Bioceramic Sealers (BCS) from the root canal system using Micro-Computed Tomography (Micro-CT) and Scanning Electron Microscopy (SEM). A search of the PubMed, Web of Science, Scopus, Science Direct, and Google Scholar databases using applicable keywords such as "BCS" and "calcium silicate-based sealer" and "retreatment" and "retreatability" and "micro-CT" and "SEM" identified studies on techniques and materials used to remove BCSs from the root canal system, as assessed by micro-CT and SEM. A total of 46 studies were included in the review. Of these, 32 studies used Nickel-titanium (NiTi) rotary instruments, 11 used reciprocating systems, and three compared continuous nickel-titanium rotary and reciprocating systems with rotary systems and reciprocation in removing filling materials. Apical patency and Working Length (WL) could be achieved in a canal obturated with gutta-percha and a BCS. The review revealed that removing filling materials using various instrumentation protocols can be successful but incomplete. Both rotary and reciprocating systems can efficiently remove root-filling material. Using supplemental techniques can improve the cleanliness of the root canal during retreatment. Solvents require less time to reach the WL and achieve patency; however, they leave a larger amount of residual root canal-filling material than non solvents. Additionally, the formation of dentinal microcracks remains controversial during the non surgical retreatment of canals filled using BCSs. [ABSTRACT FROM AUTHOR]