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Eradication of microorganisms present in the root canal system during endodontic therapy is one of the critical factors affecting the final outcome of endodontic treatment. However, even adequate technique of the root canal treatment and use of irrigants according to the established protocol does not lead to the complete elimination of microorganisms during endodontic treatment. The presence of Enterococcus (E.) faecalis inside the root canal system may be an important factor contributing to the failure of the treatment. Introducing agitation techniques in irrigation, such as passive ultrasonic irrigation (PUI) and the use of the activating instrument XP-endo Finisher (XPF), contribute to a better debridement and disinfection of the root canal. This study was conducted on 42 root canals experimentally inoculated with E. faecalis and exposed to three irrigation protocols. These have included a standard irrigation protocol using a syringe and needle, passive ultrasonic irrigation, and activation of the irrigant using an XPF instrument. The reduction in microorganisms was evaluated using the quantitative polymerase chain reaction in real-time (RT-PCR) as well as via the method of determining the number of colony forming units on nutrient medium (CFUs). The results of this study showed that the use of supplementary irrigation protocols, PUI, and XPF led to a significant decrease in the number of microorganisms inside the root canal of experimental teeth. These findings indicate a significant positive impact of these procedures on the disinfection of the root canal system. [ABSTRACT FROM AUTHOR]

Objective: To examine the effectiveness of lasers in radiographic periapical healing in endodontic surgery and non-surgical treatment compared to standard or conventional or placebo therapy, a systematic review was designed. Methods: Clinical studies/trials including single or multiple visits endodontic surgical and non-surgical endodontic procedures that involved lasers for periapical healing in comparison with standard or conventional or placebo therapy having at least 6 months of radiographic post-operative follow-up. Participants were adults aged above 12 years, involving intervention in permanent tooth only. Types of study included were Randomized controlled trials only. A systematic review search was conducted in PubMed, EBSCOhost, LILACS, Cochrane Central Register of Controlled Trials (CENTRAL), and Google Scholar, using MeSH words, text words, and Boolean operators. Only Englishlanguage articles published from January 1, 1990 to November 30, 2023 were considered. Only randomized controlled trial was included. A RoB2 tool was utilized to evaluate the Risk of Bias in clinical trials. Results: Out of a total of 676 studies gathered from databases and registers, 7 were eventually included for qualitative analysis. The Risk of Bias 2 tool identifies six studies with an overall low risk and one study with some concerns. Four of the seven trials found no significant difference between the laser and control groups, whereas three showed a significant difference at the 6-month radiography follow-up. Conclusion: We are unable to reach a definite conclusion on whether lasers are effective for periapical healing in endodontic surgery and nonsurgical treatments. More clinical research on the use of lasers in endodontic surgery and non-surgical procedures has to be conducted in future. [ABSTRACT FROM AUTHOR]

Apical lesions are diseases of infectious origin that can cause destruction of the surrounding periapical tissue, including bone tissue and periodontal ligaments, resulting in the loss of the affected teeth. Currently, the microorganisms present in pulp and apical disease are mostly studied as bacteria. However, in recent years, interest has been aroused in the study of viruses that could be present in apical lesions, and how these could affect the progression of disease. In the present study, we conducted a systematic review of the literature to evaluate and synthesize the scientific evidence on the presence of viruses and their possible role in pulpal and apical disease. This systematic review was performed according to the PRISMA reporting guidelines. The search for studies was performed in the PubMed and Web of Science databases. A total of seven studies published in the last 10 years were included. The types of samples used for virus analysis varied from one study to another. In all the included studies, the presence of any of the types of viruses studied was found, either in pulp or apical tissue. Herpesviridae family, Epstein–Barr virus (EBV) and Human cytomegalovirus (HCMV) stood out as the most commonly present in apical lesions. Further studies are required to clarify and understand the pathogenic role of viruses in pulpal and periapical disease. [ABSTRACT FROM AUTHOR]

Background: Root canal retreatment is necessary when initial treatment fails. Nickel-titanium systems help remove filling materials; however, some methods can cause canal content extrusion, resulting in inflammation and delayed healing. This study aimed to examine the impact of different preparation techniques and endodontic file systems on apical debris volume to limit material dispersion to periradicular tissues. Methods: Ninety extracted maxillary incisors were evaluated. Simulated apical root resorption was created by removing the apical 2 mm of the root. The teeth were divided into two groups: one filled with a single cone and the other with cold lateral compaction (CLC). Each group was further divided into three subgroups (n = 15 each): Subgroup 1 used Reciproc R25 for removal and R50 for final preparation; Subgroup 2 used ProTaper Universal Retreatment (PTUR) files D1, D2, and D3 for removal and ProTaper Next X5 for finalization; and Subgroup 3 used VDW.Rotate Retreatment (VDW.RotateR) for removal and VDW.Rotate 50.04 for completion. Debris from retreatment was collected in pre-weighed tubes to determine the amount. The apical extrusion data underwent a two-way analysis of variance. Results: The Reciproc group had a mean extruded debris weight of 0.54 ± 0.24 mg, higher than the PTUR (0.28 ± 0.15 mg) and VDW.RotateR (0.39 ± 0.29 mg) groups (p < 0.05). The single-cone technique (SCT) resulted in a mean debris weight of 0.34 ± 0.23 mg, lower than the CLC technique, which had a mean of 0.46 ± 0.27 mg (p < 0.05). SCT had a shorter retreatment duration (111.12 ± 33.46 s) compared to CLC (176.26 ± 52.26 s) (p < 0.05). Conclusion: The Reciproc file system and the CLC obturation technique resulted in greater apical debris extrusion than the other methods. SCT was quicker than CLC. The Reciproc groups are more susceptible to apex extrusion during retreatment. [ABSTRACT FROM AUTHOR]

Objective: This study evaluated the effect of incorporating 1 wt% egg shell powder (ESP) into Biodentine™ (BD) on its physicomechanical properties. Methods: Chicken eggs were ground and sterilized. Then, one wt% ESP was added to BD powder and mixed with BD liquid. The mixture's pH and solubility were measured on 1, 3, 7, and 28 days. The setting time was determined using a Gillmore needle. Compressive strength was measured using a universal testing machine after 1 and 14 days. Surface chemistry was analyzed via FTIR spectroscopy. The findings were compared by independent samples t-test, the repeated measures ANOVA, and the Bonferroni post-hoc test (a = 0.05). Results: pH levels were comparable between the groups (P > 0.05). BD-ESP had a higher setting time than BD (P < 0.001). BD-ESP solubility was significantly higher than BD on day 1 (P = 0.001) but lower on days 7 (P = 0.006) and 28 (P = 0.001). On day 1, BD had higher compressive strength than BD-ESP (P = 0.027), whereas the compressive strength of both groups was comparable on day 14 (P = 0.099). FTIR analysis revealed an additional IR band associated with the phosphate band in the BD-ESP group, suggesting new apatite formation. Conclusions: Incorporating 1% ESP into BD resulted in lower initial solubility but higher solubility after a week and a month, likely due to increased ion dissolution. ESP incorporation also promoted additional apatite formation but negatively impacted the setting time and initial strength of BD. [ABSTRACT FROM AUTHOR]

The inflamed pulp can develop into pulp necrosis and requires endodontic treatment. The failure of endodontic treatment is mainly caused by Enterococcus faecalis infection. The mechanism is mediated by the ability of E. faecalis, as a gram-positive bacterium, to form a biofilm covering the cell membrane, which is known as microbial surface recognizing adhesive matrix molecules (MSCRAMMs). The aim of this study was to identify MSCRAMMs through the expression of lamininγ, High Mobility Group Box I (HMGB1), and type-1 collagen. All groups were prepared for molar cavitation using a round bur and injected with E. faecalis bacteria with a concentration of 100%. They were observed for 24 hours, 72 hours, and 120 hours after injection. The K group was the control group containing rats that were not received a bacterial injection at 24 hours, 72 hours, and 120 hours. After that, the tooth was decalcified using 10% EDTA at 37 °C, which took up to two months. Macrophages were observed using a light binocular microscope. Significant results (p<0.05) were found in laminin γ and HMGB1 between the control with 24 hours groups, also insignificant results (p>0.05) were found between 24 with 72 hours group and 72 with 120 hours group. All groups within the collagen type-1 group were not significant. Both laminin γ and HMGB1 are good parameters to predict Enterococcus faecalis growth phase and biofilms production with the log phase happening before 24 hours and the stationary phase happening after 24 hours. [ABSTRACT FROM AUTHOR]

Endocarditis is a severe infection affecting the heart's inner layer, the endocardium. Its pathophysiology may involve heart valve damage, bacteria adhesion and biofilm formation, potentially leading to fatal complications. Bacteria from various sources, including from endodontic diseases and its treatments may enter the bloodstream provoking this condition. This systematic review aimed to explore the influence of endodontic factors on endocarditis. Searches across PubMed, Embase, Cochrane Library and manual sources yielded 14 relevant articles from 1562 screened studies. Assessment platforms from JBI Critical Appraisal Tools evaluated studies biases. Findings mainly focused on transient bacteraemia as a key indicator of risk correlating bacterial virulence and counts with endocarditis development. Worryingly, multi-species bacteraemia post-endodontic treatment was noted including the genera Enterococcus, Parvimonas, Streptococcus and Staphylococcus. Conclusive validation of the incidence and association between endodontic patients and endocarditis was limited due to a lack of robust longitudinal investigations, such as randomized controlled trials. This emphasizes the need for further research with well-designed methodologies to provide a full understanding of the causative bacterial population and its pathological mechanisms. A current guideline (2023 European Society of Cardiology) was developed to support healthcare professionals in diagnosing and managing infective endocarditis; this 2023 version is introducing a new diagnostic algorithm to aid in patient classification aiming to improve outcomes for this challenging disease. The study was a priori registered on PROSPERO (CRD42023407736). [ABSTRACT FROM AUTHOR]

Apical periodontitis (AP) is the most prevalent chronic inflammatory disease of the teeth. Bone resorption dynamics in symptomatic and asymptomatic AP are still unrecognized. This study examined different inflammatory markers within gingival crevicular fluid, including matrix metalloproteinases 8 (MMP8), tissue inhibitors of metalloproteinases 1 (TIMP1), receptor activator of nuclear factor κB (RANK), its ligand (RANKL), and osteoprotegerin (OPG), to be used in comparing symptomatic apical periodontitis (SAP) and asymptomatic apical periodontitis (AAP) versus healthy teeth. Subjects with SAP, AAP, and a control group were recruited and GCF samples were collected by Periopaper strips. Clinical and radiographical measures were used for diagnosing AP. Levels of MMP8, TIMP, RANK, RANKL, and OPG were determined by ELISA and their abilities to discriminate between examined sites were evaluated by receiver operator characteristic (ROC) curves. All examined biomarkers were statistically significant higher (p < 0.05) in SAP than AAP and the control group, apart from RANK. Significant positive correlations (p < 0.05) were identified between all SAP and AAP biomarkers except TIMP1 and RANK in AAP teeth. TIMP1 and OPG exhibited the highest ability to distinguish between SAP and AAP with areas under the curve of 0.824 and 0.763 in comparing SAP and the control group, and 0.732 and 0.73 when comparing AAP and the control group, respectively. Additionally, TIMP1 and OPG showed the highest AUC of 0.778 and 0.747 when SAP and AAP were compared, respectively. This study concluded that GCF levels of TIMP1 and OPG can be used to differentiate between SAP, AAP, and healthy teeth. [ABSTRACT FROM AUTHOR]

The use of propolis-based materials within endodontics to promote pulp wound healing or disinfect the root canal system has been a recent focus of scientists and clinicians. This is mainly because of the well-documented antimicrobial, anti-inflammatory, immunomodulatory and wound healing properties of propolis. This scoping review critically appraises the literature on the clinical applications of propolis-based compounds during endodontic therapy of primary and permanent teeth. An electronic literature search was performed in Scopus, PubMed, and Web of Science up to and including October 2023 to identify studies assessing the use of propolis during endodontic therapy of primary and permanent teeth. A combination of relevant Medical Subject Headings (MeSH) terms and keywords was used. Only human clinical studies written in English were included. The identified manuscripts were screened and assessed for inclusion by two independent authors. Eligible manuscripts were then subjected to critical appraisal and data extraction with the information being summarised according to their clinical application. A total of 26 human clinical studies were identified and included in the analysis. Propolis was investigated for use in the primary and permanent dentitions as a direct pulp capping or pulpotomy material as well as in root canal disinfection and root canal filling material of teeth with non-vital pulps. Overall, the included studies reported that the use of propolis was associated with promising outcomes in terms of efficacy to control inflammation, enhance tissue repair, and disinfection of the root canal system. However, a critical appraisal of the studies revealed a range of methodological and reporting deficiencies, resulting in unreliable results and conclusions in terms of the clinical outcomes reported. Although the studies on the use of propolis-based materials in endodontics reported promising clinical outcomes, they had a range of methodological and reporting flaws. Therefore, further well-designed and properly reported controlled clinical studies are essential to derive sound evidence-based conclusions on propolis-based materials. Furthermore, guidelines for quality assurance and safe use of propolis-based materials are necessary to enhance their production for commercial use in endodontics. [ABSTRACT FROM AUTHOR]

This study presents a systematic review with meta-analysis to evaluate the success rates of endodontic retreatments in teeth where separated instruments are located within the roots. The search and selection of studies were conducted across two databases, SCOPUS and PubMed, as well as the Cochrane Library registry, yielding a total of 1620 records. Following the selection process, 11 studies were included in the systematic review. Overall, out of 1133 retreated teeth, there were 172 failures in instrument removal and 55 perforations. The meta-analysis results indicate that failures are more frequent when instruments are located in the apical third, with a failure rate of 21%, compared to an 8.8% failure rate in the middle/coronal third. The anatomy of the root canals, particularly the location of the separated instruments, significantly influences the success rates. [ABSTRACT FROM AUTHOR]

Aim: Design, produce and assess the viability of a novel nanotechnological antibacterial thermo‐sensible intracanal medicament This involves encapsulating calcium hydroxide (Ca(OH)2) within polylactic‐co‐glycolic acid (PLGA) nanoparticles (NPs) and dispersing them in a thermosensitive gel (Ca(OH)2‐NPs‐gel). In addition, perform in vitro and ex vivo assessments to evaluate tissue irritation and penetration capacity into dentinal tubules in comparison to free Ca(OH)2. Methodology: Reproducibility of Ca(OH)₂‐NPs was confirmed by obtaining the average size of the NPs, their polydispersity index, zeta potential and entrapment efficiency. Moreover, rheological studies of Ca(OH)2‐NPs‐gel were carried out with a rheometer, studying the oscillatory stress sweep, the mean viscosity value, frequency and temperature sweeps. Tolerance was assessed using the membrane of an embryonated chicken egg. In vitro Ca(OH)2 release was studied by direct dialysis in an aqueous media monitoring the amount of Ca(OH)2 released. Six extracted human teeth were used to study the depth of penetration of fluorescently labelled Ca(OH)2‐NPs‐gel into the dentinal tubules and significant differences against free Ca(OH)2 were calculated using one‐way anova. Results: Ca(OH)2‐NPs‐gel demonstrated to be highly reproducible with an average size below 200 nm, a homogeneous NPs population, negative surface charge and high entrapment efficiency. The analysis of the thermosensitive gel allowed us to determine its rheological characteristics, showing that at 10°C gels owned a fluid‐like behaviour meanwhile at 37°C they owned an elastic‐like behaviour. Ca(OH)2‐NPs‐gel showed a prolonged drug release and the depth of penetration inside the dentinal tubules increased in the most apical areas. In addition, it was found that this drug did not produce irritation when applied to tissues such as eggs' chorialantoidonic membrane. Conclusion: Calcium hydroxide‐loaded PLGA NPs dispersed in a thermosensitive gel may constitute a suitable alternative as an intracanal antibacterial medicament. [ABSTRACT FROM AUTHOR]

Dens invaginatus (DI) is one of the developmental dental anomalies that results in an invagination of the enamel organ into the dental papila during odontogenesis. The purpose of this study is to report a case of nonsurgical endodontic treatment of an Oehlers type II DI in a right maxillary lateral incisor with an extensive periapical damage, along with the two-year clinical and tomographic follow-up. A 30-year-old patient was referred for endodontic treatment of tooth #12. On clinical examination, a change in the shape and color of the crown was observed. The tooth responded negative to pulp sensibility, percussion, palpation and mobility tests. After tomographic evaluation, an Oehlers type II DI was visualized, in addition to an extensive periradicular lesion. The diagnosis was asymptomatic apical periodontitis. The treatment was carried out in two sessions, through intense enhancement of the auxiliary chemical substance with passive ultrasonic irrigation, XP-Endo Finisher and the use of hydroxide-based intracanal medication. Appropriate treatment in cases with anatomic variations requires an accurate and early diagnosis based on clinical examination and radiographic images. A two-year follow-up of the present case showed that the correct diagnosis associated with appropriate instrumentation techniques, supplementary disinfection, and adequate three-dimensional sealing of the canal with filling material, resulted in regression of the periradicular lesion and bone repair. [ABSTRACT FROM AUTHOR]

Copyright of Revista de Sanidad Militar is the property of Direccion General de Sanidad Secretaria de la Defensa Nacional and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Key Clinical Message: The main objective of root canal therapy is to locate all the canals, cleaning, and shaping, and obturation to obtain fluid tight seal and to heal the periapical lesion if present. The proper cleaning, shaping, and disinfection of the pulp chambers, as well as the filling of the canals, are critical to the efficacy of treatment with root canals. The success of an endodontically treated tooth is dependent on the accuracy of the diagnosis, disinfection, cleaning and shaping, obturation, and finally, the prosthetic rehabilitation management. Root canal therapy should provide a hermatic as well as fluid impenetrable seal which prevents the progression of periapical infection. There are two ways to treat such lesions: surgical and nonsurgical methods. If the root canal is cleaned, shaped, and sealed properly and adequately without the use of a surgical procedure, these lesions will recover during nonsurgical root canal therapy. This case series focuses primarily on the nonsurgical treatment of an enormous periapical lesion and provides evidence that these lesions respond well without surgery. [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]

Background: Successful endodontic treatment needs accurate determination of working length (WL). Electronic apex locators (EALs) were presented as an alternative to radiographic methods; and since then, they have evolved and gained popularity in the determination of WL. However, there is insufficient evidence on the post-operative pain, adequacy, and accuracy of EALs in determining WL. Objective: The systematic review and meta-analysis aims to gather evidence regarding the effectiveness of EALs for WL determination when compared to different imaging techniques along with postoperative pain associated with WL determination, the number of radiographs taken during the procedure, the time taken, and the adverse effects. Methods: For the review, clinical studies with cross-over and parallel-arm randomized controlled trials (RCTs) were searched in seven electronic databases, followed by cross-referencing of the selected studies and related research synthesis. Risk of bias (RoB) assessment was carried out with Cochrane's RoB tool and a random-effects model was used. The meta-analysis was performed with the RevMan software 5.4.1. Results: Eleven eligible RCTs were incorporated into the review and eight RCTs into the meta-analysis, of which five had high RoB and the remaining six had unclear RoB. Following meta-analysis, no significant difference in postoperative pain was found among the EAL and radiograph groups (SMD 0.00, CI.29 to.28, 354 participants; P value = 0.98). Radiograph group showed better WL accuracy (SMD 0.55, CI.11 to.99, 254 participants; P value = 0.02), while the EAL group had 10% better WL adequacy (RR 1.10, CI 1.03–1.18, 573 participants; P value = 0.006). Conclusion: We found very low-certainty evidence to support the efficacy of different types of EAL compared to radiography for the outcomes tested. We were unable to reach any conclusions about the superiority of any type of EAL. Well-planned RCTs need to be conducted by standardizing the outcomes and outcome measurement methods. [ABSTRACT FROM AUTHOR]

Copyright of Aydin Dental Journal is the property of Aydin Dental Journal and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objectives: The aim was to determine whether premixed calcium silicate-based root canal sealers have better biological properties than AH Plus. Materials and Methods: Searches of studies published up to January 2023 were performed in the PubMed/MEDLINE and EMBASE and via other methods (databases of the International Endodontic Journal, Journal of Endodontics, and gray literature). The inclusion criteria were in vivo animal and in vitro studies that analyzed the response in the dorsal subcutaneous tissue of rats, cell viability, and genotoxicity. Systematic Review Centre for Laboratory Animal Experimentation Risk of Bias (RoB) tool for in vivo studies and modified CONSORT checklist for in vitro were appraised. Meta-analysis was performed using the Stata. Results: Fifty-two studies were included. In the RoB, in vivo studies fulfilled 20%-50% of the items and in vitro 60%-100%. The studies included in the meta-analysis demonstrated better histocompatibility with the premixed calcium silicate-based sealers at 30 days and greater cell viability with these sealers when used in undiluted extracts in experimental period of 72 h and in extracts with 1:2 and 1:4 dilution in 24 and 72 h. In contrast, no difference between materials was found concerning genotoxicity. Conclusion: Premixed calcium silicate-based root canal sealers have better histocompatibility and are less cytotoxic than the epoxy resin-based sealer AH Plus, demonstrating favorable biological behavior. [ABSTRACT FROM AUTHOR]

Aim : To compare and evaluate the sealing ability of four different commercially available sealers to provide seal against the dye penetration test using a stereomicroscope-an in-vitro study. Material/Method : 80 extracted single rooted mandibular premolar with single canal were used in this study. The samples were divided in 4 groups (20 in each) based on sealer. Group I (Diaproseal), Group II (apexit Plus), Group III (MTA Fillapex) and Group IV (Bio-C). The samples were analyzed using a stereomicroscope and data analysis was done with one-way Anova And post hoc Tukey's test. Result : The mean dye penetration score was 1.2400 ± 0.778 mm for Group I. 2.6000 ± 0.897 mm for Group II, 4.2000 ± 0.923 mm for Group III and 4.225 ± 2.055 mm for Group IV. One-way Anova analysis shows that intergroup comparison was statistically significant between the four groups. The post hoc Tukey's test reveals that the difference was statistically non-significant between group III and group IV. Conclusion : It was concluded that between the four groups the Group I (Diaproseal) showed the least dye penetration followed by Group II (Apexit Pus), Group III (MTA Fillapex) and then Group IV (Bio-C), where there was no significant difference between the Group III (MTA Fillapex) and Group IV (Bio-C). [ABSTRACT FROM AUTHOR]

Objective The aim of this article was to evaluate the influence of mesial root canal preparation of mandibular molars with the reciprocal systems (RCP) and self-adjusting file (SAF) in the incidence of voids spaces in endodontic obturation performed by modified continuous wave compaction (MCWC) technique, through images obtained in micro-computed tomography (micro-CT). Materials and Methods Mesial roots of 15 mandibular molars, with two independent root canals, were divided into three groups (n = 5/roots), according to the endodontic instrumentation strategy (RCP, SAF, and twisted file [TWF]). After the root canals (n = 10, for each instrumentation system) were filled with MCWC, images of each specimen were obtained by micro-CT followed by three-dimensional reconstruction. The percentage of voids was obtained (in mm 3) in relation of the total volume, cervical–middle, and apical thirds. Statistical Analysis The data obtained were submitted to statistical analysis by Kruskal–Wallis and Dunn tests (p < 0.05). Results With respect to the total volume of root canal, TWF demonstrated a lower percentage in comparison to SAF (p < 0.05). No significant difference was obtained between TWF and RCP or RCP and SAF (p > 0.05). In the apical third, RCP showed a smaller percentage of voids when compared with SAF (p < 0.05); however, TWF demonstrated similarity with RCP and SAF (p > 0.05). The middle–cervical third exhibited no statistically difference between TWF and RCP or RCP and SAF (p > 0.05), whereas TWF was lower than SAF (p < 0.05). Conclusion Root canal preparation of mesial root of mandibular molars with TWF provides a lower incidence of voids in the endodontic filling performed by MCWC. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to compare efficacy in removing filling material remaining in oval and curved canals using different complementary cleaning methods. Material and methods: Sixty single-rooted tooth with oval shaped canal with curvature were prepared up to size 25 and .08 taper, filled and subsequently retreated. The teeth were then scanned in micro-CT and divided into 6 groups (n = 10) according to the complementary cleaning method: CUI with Irrisafe, CUI with NiTiSonic, PUI with Irrisafe, PUI with NiTiSonic, Eddy and XP-endo Finisher R. After, the teeth were newly scanned in micro-CT. The volume of the filling material remaining before and after the application of the complementary methods was calculated and then calculated the percentage of material removed total and in the apical region. Data were submitted to the Kruskal-Wallis, Dunn and Wilcoxcon tests with a significance level of 5%. Results: No suplementary cleaning method completely removed the remaining of filling material, however, all significantly reduced the volume, both in the apical region and in the total root canal (p<0.05). There was no significant difference among the groups tested, regardless of the region analyzed (p>0.05). Conclusion: No method was effective in completely removing the remaining filling material. All complementary cleaning methods significantly reduce the volume of material, with no difference among them. [ABSTRACT FROM AUTHOR]

Numerous failures in root canal treatment (RCT), attributed to the persistence of adverse microbiota, prompted researchers to develop a biomaterial with effective antibacterial and antifungal properties. In our systematic review, emphasis was placed on examining the antimicrobial properties of gutta-percha, the most used material for root canal obturation. The review aimed to determine whether gutta-percha demonstrated adequate antibacterial and antifungal features. Additionally, it sought to identify specific substances added to gutta-percha's composition that could enhance the success rate of root canal obturation. On October 30, 2023, electronic searches were systematically performed in the PubMed, Web of Science (WoS), and Scopus databases using the specified keywords: ((antibacterial) OR (antimicrobial)) AND ((gutta-percha) OR guttapercha)). A thorough evaluation commenced, with an initial pool of 330 studies, from which 174 duplicates were methodically identified and removed. The ultimate dataset for qualitative synthesis consisted of 26 studies. The results of the compared studies did not unequivocally indicate whether the use of gutta-percha alone exhibits antibacterial or antifungal effects. Among the six studies demonstrating results supporting gutta-percha's antimicrobial activity, five showed activity against Enterococcus faecalis. Conversely, six studies concluded that gutta-percha lacks any discernible antimicrobial features. One study even suggested that gutta-percha might promote the progression of bacterial development. However, eight out of nine studies demonstrated an increase in gutta-percha's antimicrobial properties after the addition of chlorhexidine. Furthermore, calcium hydroxide and iodoform also improved gutta-percha's properties, showing promising results. Unfortunately, none of the materials added to gutta-percha displayed comprehensive improvement in its antimicrobial efficacy, including activity against Enterococcus faecalis. The review demonstrated the benefit of enhancing gutta-percha with chlorhexidine, calcium hydroxide, and iodoform. Nevertheless, achieving the inactivation of Enterococcus faecalis posed a challenge. [ABSTRACT FROM AUTHOR]

Objectives: In order to test the resistance of rotary instruments to cyclic fatigue fracture and its importance in root canal preparationthe purpose of this study was to see how different tapers (4% and 6%) affected the cyclic fatigue resistance of the Edge File X7 and 2Shape endodontic systems at 45° and 60° canal curvature. Methods: Eighty NiTi files from two different systems (N= 40 each) were used; Group 1: Edge File X7, Group 2: 2Shape. each group was subdivided into four subgroups (N= 10 for each subgroup). The files were evaluated for cyclic fatigue resistance using a modified custom-made static model with 45°and 60° angles having a radius of 3mm and a diameter of 1.5 mm. Each file was rotated in a continuous rotation motion at 300 rpm with 1.2 N.cm torque for TS1, 300 rpm with 2.5 N.cm torque for TS2, and Edge file X7 was used at 300 rpm and 3 N.cm. Until it fractured. The time it took to separate the files was noted. Each file's number of cycles to failure was computed. A Kolmogorov-Smirnova normality test was done for all groups, and a two-way ANOVA was used to statistically examine the data. Results: The ranking of the groups from the highest to the lowest NCF was as follows: EdgeFile 4% 45 degrees (6594.00), EdgeFile 6% 45 degrees (6317.90), EdgeFile 4% 60 degrees (5682.00), EdgeFile 6% 60 degrees (2142.00), 2Shape 4% 45 degrees (2517.00), 2Shape 4% 60 degrees (535.90), 2Shape 6% 45 degrees (474.50), and 2Shape 6% 60 degrees (213.00). Conclusions: Edge File X7 showed better results than the 2Shape system. EdgeFile X7 4% at 45 degrees showed the highest NCF. The 2Shape system 6% at 60 degree that showed lowest NCF. As the canal curvature increased the NCF decreased. Taper 4% is better than taper 6%. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to assess canal morphology of maxillary first molars by analyzing cone beam computed tomography (CBCT) images. Methods: A total of 324 maxillary first molars were collected from the Turkish population and scanned using the in vitro CBCT method. The number of roots and canals, root canal configuration, canal shape, the presence of a C-shaped canal, apical delta, and lateral canal, as well as the distance between radiographic and anatomic apices were examined. Results: The majority of the samples (97.9%) had 3 separate roots; while the remaining teeth had two or four roots (1.5% and 0.6% respectively). CBCT results showed 2, 3, 4, and 5 root canals in 0.3%, 47.9%, 50.3% and 1.5% of the teeth, respectively. All distobuccal (DB) and palatal (P) roots had one canal. The mesiobuccal (MB) roots frequently showed a second mesiobuccal canal (MB2). The most common canal morphology in the MB roots was type I (33.1%), followed by type II and type III (29.0% and 9.8%, respectively). The P and DB roots commonly showed a type I canal configuration. C-shaped canals were rare. The mean distances between radiographic and anatomic apices in MB, DB, and P roots were 0.77 ± 0.45, 1.68 ± 0.9 and 0.91 ± 0.46 mm, respectively. Conclusions: The MB roots of maxillary first molars showed greater variations in their canal anatomy than other roots. These anatomical differences, potentially attributable to ethnic variations, should be considered when performing surgical or nonsurgical root canal treatments on maxillary molars. [ABSTRACT FROM AUTHOR]

Aim: The aim of the study was to assess the tolerance to the new root canal irrigation fluid RISA after root canal treatment (RCT) by evaluating the subject's postoperative well‐being, postoperative pain (PP) and treatment outcome. Methodology: A single‐arm prospective study with 16 subjects (17 teeth) diagnosed with asymptomatic apical periodontitis. Endodontic treatment in one session performed using RISA for root canal irrigation. Well‐being was assessed on the same day and after 24 h by telephone. For pain intensity, a visual analogue scale was used at 0–5 days. Clinical and radiographic evaluations were performed at ≥12 months. Well‐being, occurrence of PP and outcome were qualitatively reported. Friedman test for paired samples and Spearman correlation coefficient were used. Significance was set at p <.05. Results: At the same day and after 24 h, 14/16 subjects felt 'good'. 9/16 presented intra‐ or extra‐oral swelling. The frequency of PP ≥36 (weak) was 82.4%. On the same day, 1 and 2 days postoperatively, there was more pain compared with preoperative pain p <.05. At Day 3, PP equalled preoperative pain (p >.05). 62.5% of subjects needed analgesics Day 0–2. The recall rate was 94.1%, and resolution of apical periodontitis was observed in 87.5%. Conclusions: The well‐being of subjects was good, and the overall PP intensity was low. However, postoperative intra‐ and extra‐oral swelling occurred often. At the recall visit, the effectiveness of the RCT with RISA appeared high (87.5%). The encouraging outcome results plus the fact that RISA has a broader action range than NaOCl in vitro, justify further work on the RISA solution. To reduce postoperative swelling, it is advised to further investigate the optimal way of application of RISA in the laboratory before clinical application is recommended. [ABSTRACT FROM AUTHOR]

The aim of the study was to evaluate the influence of resin cement material types on tooth with endocrown and onlay restorations. The first molar was scanned using Micro‐CT and underwent a modelling process to obtain the 3D model for computational simulation. Eight models were simulated in the current study with two loading conditions (720N vertical load and 200N oblique load), two types of restoration (onlay and endocrown restorations), and two resin cement variants (dual‐cure resin cement and light‐cure resin cement). The tooth with onlay restoration showed a significant stress reduction (up to 70%) when using light‐cure resin cement compared to dual‐cure resin cement. In contrast, types of cement did not affect stress distribution in the tooth with endocrown restoration. The current study found that dual‐cure resin cement was preferable in Endocrown and Onlay restorations, due to dual‐cure resin cement provided better bond strength compared to light‐cure resin cement. [ABSTRACT FROM AUTHOR]

The purpose of this study was to assess the effect of a calcium silicate‐based sealers (CeraSeal) and an epoxy resin‐based sealer (AH Plus) on cytotoxicity and cell migration of stem cell from the human apical papilla (hSCAPs) by using the Alamar Blue, Annexin V‐FICT and wound healing assays. In Alamar Blue assay, hSCAPs exposed to undiluted CeraSeal extract had significantly higher cell viability compared with that observed when cells were treated with AH Plus in all experimental period (p < 0.001). The flow cytometry analysis confirmed the comparison on viable cells and indicated that AH Plus increased apoptosis compared to CeraSeal and the control groups (p < 0.001). Additionally, AH Plus exhibited significantly lower level of cell migration than CeraSeal and the control for up to 48 h observation (p < 0.01). In summary, calcium silicate‐based sealer (CeraSeal) is less cytotoxic and more biocompatible than epoxy resin‐based sealer (AH Plus). [ABSTRACT FROM AUTHOR]

Objective: To assess the effect of different irrigating solutions (Normal saline, 5.25% NaOCl and 90% Ethanol) on apical sealing ability of resin based root canal sealer filled with single cone obturation technique in extracted teeth. Methods: From March 2022 to September 2022, the case control research was carried out at the Department of Operative Dentistry, Karachi Medical and Dental College in Karachi. Sample size of 30 single root teeth were decoronated and roots were divided into Group A and B. Group B is subdivided into two cases according to the type of irrigating solution used. Group A irrigation solutions include 5ml of Normal saline solution, while group B include 5ml of 5.25% Sodium Hypochlorite and 5ml of 90% Ethanol solution. Teeth were prepared, obturated, placed in 2% methylene blue dye and extent of dye penetration was done under a digital stereomicroscope and maximum leakage was measured by using software. Data was analyzed on SPSS version 26.0. Results: All solutions were normally distributed. While comparing both groups, Ethanol has the lowest mean value of dye penetration i.e. 1.07±0.63 which means that this irrigating solution has least micro leakage and provides effective seal of resin sealer to the root canal wall filled by using single cone obturating technique. Case group irrigation solutions has significant p-value i.e. 0.000 which indicates absolute absence of micro leakage. Upon Comparison of mean value of Sodium Hypochlorite and Ethanol, Ethanol is more efficient irrigation solution as it has shown lesser dye penetration as compared to Sodium Hypochlorite. Conclusion: It has been concluded that among all the solutions, Ethanol has proved to be the most effective irrigation solution followed by Sodium Hypochlorite, showed least dye penetration and hence least micro leakage. [ABSTRACT FROM AUTHOR]

Objective: Management of a skin dimpling due to a chronic periapical lesion may pose challenges. This case report presents a multidisciplinary approach to resolving a persistent cutaneous scar of endodontic origin and also offers a flowchart for the management of similar cases. Case report: A 34-year-old female referred to the Endodontics Department of Mashhad Dental School at Mashhad University of Medical Sciences, complained of a skin dimpling on her face with a history of pus discharge. Diagnostic workup and radiographic examination revealed that the right mandibular first molar had a failing root canal treatment and a defective restoration. The respective tooth underwent endodontic retreatment. Due to palpation of a cord-like tract at the apical region of the tooth, surgical removal of the mentioned structure was planned using a mucoperiosteal flap. After flap elevation, the cord was cut at the base of attachment to the bone, which resulted in immediate correction of facial contour. Finally, the tooth was permanently restored. At the 6-month follow-up visit, the periapical lesion was healing, and the face had a normal contour. Conclusions: Considering the significance of surgical intervention in cases with a cord-like sinus tract and consequent skin dimpling, a flowchart for a step-by-step decision-making process is offered to better restore the normal facial contour. [ABSTRACT FROM AUTHOR]

Introduction: An ideal sealer produces a hermetic closure, does not cause tooth discoloration, is bacteriostatic, insoluble in tissue fluids and biocompatible, and has good adhesion and a long setting time. Until now, no sealer material has met all these criteria. This study analyzed the differences in sealer adaptation between epoxy resin calcium silicate-based sealers in the middle third of the root canal wall. Materials and Methods: Thirty-two mandibular premolar teeth were prepared and divided into two groups (n = 16 each) according to the type of sealer used for obturation, Group 1 teeth were obturated with an epoxy resin-based sealer, and Group 2 teeth were obturated with a calcium silicate-based sealer. The teeth were cut vertically and prepared for scanning electron microscopy analysis. Sealer adaptation was scored and then analyzed statistically by a Chi-square test. Results: The adaptation scores were poor for 0 (0%) teeth, good for 13 (81.25%), and very good for 3 (18.75%) for the epoxy resin-based sealer and poor for 3 (18.75%) teeth, good for 5 (31.25%), and very good for 8 (50%) for the calcium silicate-based sealer. No statistically significant difference was detected between the adaptation of epoxy resin-based and calcium silicate-based sealers (P > 0.05). Overall, the particles appeared larger for epoxy resin than for calcium silicate. Discussion and Conclusion: No statistical difference was detected for sealer adaptation between epoxy resin-based and calcium silicate-based sealers in the middle third of the root canal wall. [ABSTRACT FROM AUTHOR]

Objective: The aim of the study was to assess the awareness of patients visiting the dental Outpatient Department of JSS Dental College Hospital regarding coronavirus symptoms and their willingness to get dental treatment done during this period. Materials and Methods: Five hundred and twenty-five patients in the age group of 25--65 years who reported to the department of conservative dentistry and endodontics during 6 months were assessed for coronavirus symptoms using a questionnaire of descriptive statistics and analysis. Results: Patients were willing to undergo treatment during the pandemic (97%). Conclusion: Irrespective of the coronavirus, patients seem to be keen to get either their restorative or endodontic treatment done, which shows that the patients are not completely aware of the spread of COVID-19 infection and awareness programs have to be conducted to educate people. [ABSTRACT FROM AUTHOR]

The aim of this study was to assess the prevalence and proportions of antimicrobial‐resistant species in patients with endodontic infections. A systematic scoping review of scientific evidence was accomplished involving different databases. Nine investigations were selected including 651 patients. Enterococcus faecalis was resistant to tetracycline (30%–70%), clindamycin (100%), erythromycin (10%–20%), ampicillin (9%) and azithromycin (60%). On the contrary, Prevotella spp., Fusobacterium spp., Peptostreptococcus spp. and Streptococcus spp. were resistant to penicillin, tetracycline, doxycycline, ciprofloxacin, amoxicillin, erythromycin, metronidazole and clindamycin in different proportions. Fusobacterium nucleatum showed high resistance to amoxicillin, amoxicillin plus clavulanate and erythromycin. Prevotella oralis presented a predisposition to augment its resistance to clindamycin over time. Tanerella forsythia exhibited resistance to ciprofloxacin and rifampicin. Lactococcus lactis presented robust resistance to cephalosporins, metronidazole, penicillin, amoxicillin and amoxicillin–clavulanic acid. It was observed high levels of resistance to antimicrobials that have been utilised in the local and systemic treatment of oral cavity infections. [ABSTRACT FROM AUTHOR]

Objective: The objective of the study was to evaluate incidence of C-shaped canals in mandibular second molars using Cone Beam Computed Tomography. Study Design: Cross Sectional, Descriptive study. Place and Duration: This study was undertaken in Department of Radiology, Rehman College of Dentistry, Peshawar, from 15th June 2022 till 15th December 2022. Methodology: Cone Beam Computed Tomography scans of 60 patients of both genders between 18 and 60 years of age were studied for the presence of C-shaped canals in mandibular 2nd molars. Results were analyzed with the help of SPSS version 21. Chi-square was applied for comparison of male and female groups. Results: Cone Beam Computed Tomography scans of 60 patients of both genders between 18 and 60 years of age were studied for the presence of C-shaped canals in mandibular 2nd molars. Results were analyzed with the help of SPSS (version 21). Chi-square was applied for comparison of male and female groups (p > 0.05). Conclusion: Incidence of C-shaped canal is high in patients with mandibular 2nd molars. Endodontists need to be vigilant for the existence of C-shaped canals and proper imaging of these canals is essential for successful endodontic treatment. [ABSTRACT FROM AUTHOR]

The purpose of this study was to perform an integrative review on the effects of cranberry and grape seed extracts concerning the disinfection of root canals maintaining the strength of the remnant tooth tissues' structure. A bibliographical search was carried out on the PubMed electronic platform using the following key terms: cranberry, grape seed, vaccinium macrocarpon, proanthocyanidin, antibacterial, antimicrobial, decontamination, disinfection, bacteria removal, bacteria eradication, bacteria elimination, endodontic, root canal, faecalis, and strength. The inclusion criteria involved articles published in the English language, until March, 2022, reporting the antibacterial effect of grape seed and cranberry extracts. Of 185 studies identified, 13 studies were selected for the present review. The grape seed extract (GSE), composed of proanthocyanidins, showed an antioxidant activity against the main bacteria found in endodontic secondary infection. The percentage of bacteria removal was recorded at around 96.97% by using GSE. Studies on cranberry extracts, which are composed of proanthocyanidins, revealed antimicrobial effects against bacteria related to periodontitis and dental caries. Additionally, GSE or cranberry allowed the dentin collagen cross-linking that preserved the 3D collagen network leading to the maintenance of the strength of the remnant tooth structure. However, the contaminated smear layer could not be removed by using only GSE or cranberry. Cranberry extracts and GSE revealed a significant antimicrobial activity in endodontic disinfection without changing the mechanical properties of the remnant dentin tissues. Furthermore, those components can be associated with traditional compounds to enhance their antimicrobial effects and eliminate the smear layer. [ABSTRACT FROM AUTHOR]

Copyright of International Arab Journal of Dentistry is the property of Saint Joseph University, Faculty of Dental Medicine and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: Herbal medications are an effective alternative in dental endodontic treatment due to their antimicrobial, anti-inflammatory, and biocompatibility properties and thus they are more biocompatible and less cytotoxic. The antibacterial, antifungal, and antiviral properties of garlic (Allium sativum L.) support broad-spectrum activity against gram-positive and gram-negative organisms and effectiveness against multidrug-resistant organisms that are essential as endodontic materials. Purpose: The purpose of this literature review is to analyze how the antimicrobial efficacy of garlic (Allium sativum L.) extract can be used as a root canal irrigant in endodontic treatment. Review: The development of pulp and periapical disease involves high-intensity bacterial activity that proliferates and produces toxic side products such as organic acids. When crushed or minced, garlic releases allicin compounds through the enzymatic action of alliinase (cysteine sulfoxide lyase) on alliin. Allicin, organosulfur compounds, and antioxidant compounds in garlic extract can exert antimicrobial role by inhibiting the synthesis of pathogenic microorganisms, fighting the resulting infection, and working synergistically with other antimicrobial agents to increase the effectiveness of treatment against antibioticresistant bacterial infections. In comparison to other antimicrobial agents, a number of studies have shown that there is no significant difference between garlic extract and sodium hypochlorite (NaOCl) in exerting bactericidal effects against pathogenic bacteria. Other studies have also shown that garlic extract has good dentin penetration properties as well as ideal flow and wetting capabilities. Conclusion: Garlic (Allium sativum L.) extract has good antimicrobial efficacy, dentin penetration, as well as ideal properties of root canal irrigation in endodontic treatment. [ABSTRACT FROM AUTHOR]

Cone Beam Computed Tomography (CBCT) allows three-dimensional evaluation of external root morphology and internal canal configuration of teeth thus allowing accurate diagnosis of rare complexities in the root canal system. This case study presented root canal re-treatment of a maxillary first molar #16 of a 29 years old female patient, wherein, thorough radiographic examination revealed single root morphology in all the teeth. CBCT analysis confirmed the root form and root canal configuration. Endodontic retreatment of the #16 was performed. The maxillary first molars had double fused roots with C-shaped canal configuration while maxillary second and third molars had O-shaped canals with single roots bilaterally. The mandibular first molars had two completely fused roots with C-shaped canal configuration. While the mandibular second and third molars also had C-shaped canal configuration with single roots. The canal configuration of maxillary and mandibular molars was classified according to Martin's and Fan's classification respectively. This unique finding of single and double fused roots with C-shaped canal configuration in the posterior teeth in a single patient has rarely been reported in literature. [ABSTRACT FROM AUTHOR]

Objective: To answer the question: "Does the pharmacological management of dental anxiety influence pain occurrence during root canal treatment?". Methods: Searches on MEDLINE/PubMed, Cochrane Library, Web of Science, Scopus, EMBASE and Open Grey were conducted until September 02, 2022. Only randomised clinical trials were included. The Cochrane risk of bias tool for randomized trials (RoB 2) was used. The overall quality of evidence was assessed through the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) tool. Results: Initial screening resulted in 811 studies. Three hundred seventy-three were excluded for being duplicates. Of 438 eligible papers, ten studies met the inclusion criteria and were selected for full-text reading. Four studies were included in the final analysis. Three studies had a low risk of bias, and one was a high risk. GRADE demonstrated a low quality of evidence. Conclusion: There is insufficient evidence to determine whether the pharmacological control of anxiety can influence intraoperative pain occurrence. [ABSTRACT FROM AUTHOR]

To investigate the quality of root canal fillings and frequency of apical periodontitis (AP) in root canal filled teeth in a Swedish population. This study used data from a cross-sectional survey conducted in 2013. The root canal filling quality and periapical status were assessed in 491 root canal filled teeth in 196 individuals aged 20–70 years, randomly selected from the population of Jönköping, Sweden. All root canal filled teeth were examined with periapical radiographs. Three calibrated observers recorded length and density in root canal fillings as well as periapical status according to the Periapical Index. A root filling ending within 0.5–2 mm from the radiographic apex without lateral or apical voids was considered adequate. Data were analyzed in a generalized estimating equation (GEE) model with AP as dependent variable and gender, age, number of teeth, number of root filled teeth, tooth type, and root filling quality as independent variables. Teeth with technically inadequate root fillings were associated with AP in a simple GEE-analysis. In the multiple GEE-model, the association between technical quality and apical peridontitis was nonsignificant when controlling for tooth type and gender. The quality of root canal fillings is poor and the prevalence of AP in root canal filled teeth is high, particularly in molar teeth, in a Swedish population. [ABSTRACT FROM AUTHOR]

This study compared the original (ProTaper Next and Reciproc) endodontic systems with their replica‐like brands (X File and Only One File) in terms of standardisation, design, phase‐transformation behaviour, composition and mechanical behaviour. X File showed greater taper values than ProTaper Next, while Only One File had the greatest tip diameter. Both replica‐like files had an active tip and greater dimensions than their reports. There were also significant differences between the original and replica‐like systems in terms of their phase‐transformation behaviour and the precision of the measurement lines. Only One File showed significantly lower cyclic fatigue and torsional resistance than Reciproc (p < 0.05). There were no significant differences in the cyclic fatigue, torsional resistance and composition of NiTi between X File and ProTaper Next (p > 0.05). Although replica systems show mechanical properties that can be acceptable, they are not consistent in terms of standardisation and design. [ABSTRACT FROM AUTHOR]

Shaping ability evaluation of taper./01 instruments in large root canals, by microcomputed tomography (micro‐CT) and scanning electron microscopy (SEM). Maxillary central incisors with large diameter root canals were divided into two groups (n = 10): XP‐Endo Shaper (FKG‐Dentaire, Switzerland) and manual instrumentation (FKG‐Dentaire). Two‐ and three‐dimensional parameters from cervical to apical root thirds were evaluated by micro‐CT. Apical stop was evaluated by SEM images. Data were analysed by ANOVA and Tukey tests (α = 5%). XP‐Endo Shaper allowed a regular biomechanical preparation with less dentinal wear compared with manual instrumentation, which showed excessive wear of the thin root canal walls (p < 0.05). Roundness and SMI showed similarity between both protocols (p > 0.05). XP‐Endo Shaper SEM showed a regular and well‐defined shape of the apical foramen suggesting the formation of the apical stop. Reduced diameter and taper instruments promoted a conservative wear and a well‐defined apical stop formation in large root canals. [ABSTRACT FROM AUTHOR]

The so-called endodontic-periodontic lesion or relationship has been a clinical concept that has mystified the dental profession for decades as it relates to accurate, precise diagnoses. It is a typical chicken-before-the-egg type of dilemma imbued with unknowns as to the etiology, interrelationships, and correct procedural management. Attempts have been made over the last 100 years to classify this relationship, with all efforts falling short of ideal in various respects. This article will attempt to provide historical relevance, scientific validity, and some clinical perspectives to this dilemma, including reflections that are encountered daily in contemporary dental practice. [ABSTRACT FROM AUTHOR]

In addition to pathogenic teeth associated with cysts, the roots of adjacent teeth are often included in the cystic cavity. Whether these teeth require elective endodontic treatment followed by cystic enucleation remains unclear. In the case presented herein, we aimed to preserve the pulp of the teeth included in the cystic lesion. Unfortunately, the sensibility of the included teeth was negative after endodontic surgery, including cystic enucleation. However, the sensibility recovered after 1 year and was maintained throughout a 4.5-year follow-up. Therefore, we suggest that elective endodontic treatment of the included teeth should be avoided, and further research should be conducted regarding this issue. [ABSTRACT FROM AUTHOR]

Copyright of Revista de Odontopediatría Latinoamericana is the property of Asociacion Latinoamericana de Odontopediatria and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objective: To develop an in vitro model for real-time monitoring of endodontic biofilm growth and evaluate the ex vivo effect of antibiotics on biofilm growth. Material and Methods: Root canal samples were taken from 40 patients and inoculated into 96-well plates in a system that measures biofilm growth through electrical impedance. Biofilm bacterial composition at the genus and species level was analyzed by Illumina sequencing. ANCOM-BC corrected data were used to compare bacterial composition after antibiotic treatment through compositional analysis, and to compare microbiological with clinical data. Results: The stationary phase was reached at 8 hours. The biofilm formed had a similar bacterial composition to the inoculum, and Enterococcus faecalis was virtually absent from the samples. The bacterial composition and the effect of antibiotics were sample-dependent. Metronidazole was the antibiotic that most inhibited biofilm formation and azithromycin the one that inhibited it in the highest percentage of cases. The antibiotic effect could not be related to the biofilm original bacterial composition. Conclusions: The impedance system allowed real-time monitoring of endodontic biofilm formation, and we propose it as a model for ex vivo evaluation of the whole biofilm susceptibility to antimicrobials, as opposed to evaluating antibiotic sensitivity of specific bacterial isolates. [ABSTRACT FROM AUTHOR]

Microbial biofilms play a dominant role in the failure of endodontic therapies. Bacterial adhesion is the first step in the establishment of biofilms, activating the host immune response leading to tissue damage. Biosurfactants are microbe‐derived tensioactive molecules with latent anti‐adhesive and anti‐microbial activity. This study reports the extraction and characterization of a biosurfactant from Lactobacillus (L.) plantarum (Lp‐BS) and investigates its anti‐microbial and anti‐adhesive properties compared to rhamnolipid, a commercially available biosurfactant. Lp‐BS, extracted from L. plantarum during the growth phase, was characterized as a glycoprotein, able to reduce surface tension and emulsify non‐polar liquids. Proteomic analysis of Lp‐BS identified three bacterial adhesin‐like proteins, suggesting roles in hindering bacterial adhesion. Lp‐BS did not show significant anti‐microbial activity against endodontic pathogens from the Streptococcus (Strep.) anginosus group or Enterococcus (Ent.) faecalis at 50 mg/ml. However, anti‐adhesive activity on abiotic surfaces was observed against both Strep. anginosus and Strep. intermedius. Rhamnolipid exhibited strong anti‐microbial activity, with minimum inhibitory concentrations of 0.097 mg/ml against Strep. anginosus, and 0.048 mg/ml against Strep. constellatus and Strep. intermedius, in addition to a marked anti‐adhesive activity. These findings offer preliminary evidence for the potential application of biosurfactants as an anti‐microbial and/or anti‐adhesive pharmacotherapy in endodontics. [ABSTRACT FROM AUTHOR]

Copyright of Brazilian Journal of Surgery & Clinical Research is the property of Master Editora and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

This study aimed to evaluate the effect of direct pulp capping on the expression of erythropoietin (Epo) and Epo‐receptor (Epor) genes in relation to the expression of inflammatory and osteogenic genes in rat pulp. Dental pulps of the first maxillary molars of Wistar Albino rats were exposed and capped with either calcium hydroxide or mineral trioxide aggregate, or were left untreated. After 4 wk, animals were euthanized, and maxillae were prepared for histological and real‐time polymerase chain reaction analysis. Histological scores of pulp inflammation and mineralization, and relative expressions of Epo, Epor, inflammatory cytokines, and pulp osteogenic genes were evaluated. The capped pulps showed higher expressions of Epo, while the untreated pulps had the highest expression of Epor. Both calcium hydroxide and mineral trioxide aggregate downregulated the expression of tumor necrosis factor alpha compared to untreated controls, and upregulated transforming growth factor beta compared to healthy controls. Alkaline phosphatase expression was significantly higher in experimental groups. Relative expression of Epo negatively correlated with pulp inflammation, and positively correlated with pulp mineralization. Pulp exposure promoted expression of Epor and pro‐inflammatory cytokines, while pulp capping promoted expression of Epo, alkaline phosphatase, and downregulated Epor and pro‐inflammatory cytokines. [ABSTRACT FROM AUTHOR]

Background: Ultraviolet (UV) irradiation can modulate host immune responses and this approach is a novel application for treating endodontic infections and inflammation in root canals. Methods: A dataset of UV-induced molecules was compiled from a literature search. A subset of this dataset was used to calculate expression log2 ratios of endodontic tissue molecules from HEPM cells and gingival fibroblasts after 255, 405, and 255/405 nm UV irradiation. Both datasets were analyzed using ingenuity pathway analysis (IPA, Qiagen, Germantown, MD, USA). Statistical significance was calculated using Fisher's exact test and z-scores were calculated for IPA comparison analysis. Results: The dataset of 32 UV-induced molecules contained 9 antimicrobial peptides, 10 cytokines, 6 growth factors, 3 enzymes, 2 transmembrane receptors, and 2 transcription regulators. These molecules were in the IPA canonical pathway annotations for the wound healing signaling pathway (9/32, p = 3.22 × 10−11) and communication between immune cells (6/32, p = 8.74 × 10−11). In the IPA disease and function annotations, the 32 molecules were associated with an antimicrobial response, cell-to-cell signaling and interaction, cellular movement, hematological system development and function, immune cell trafficking, and inflammatory response. In IPA comparison analysis of the 13 molecules, the predicted activation or inhibition of pathways depended upon the cell type exposed, the wavelength of the UV irradiation used, and the time after exposure. Conclusions: UV irradiation activates and inhibits cellular pathways and immune functions. These results suggested that UV irradiation can activate innate and adaptive immune responses, which may supplement endodontic procedures to reduce infection, inflammation, and pain and assist tissues to heal. [ABSTRACT FROM AUTHOR]

Infection control is a term used to describe the precautions, policies, and procedures undertaken in a healthcare setting in order to minimize the risk of spreading an infection. It helps prevent the transmission of disease-producing agents such as bacteria, viruses, and fungi from one patient to another, from the dental practitioner and dental staff to patients, and from patients to dental practitioner or other dental staff. Among the many aspects of infection control, sterilization and disinfection of instruments and associated appliances play a crucial role for any infection control regimen to be successful in a health-care setting. Sterilization and disinfection of instruments can be described in general as decontamination procedures for treating instruments, enabling their safe usage. Failure to adhere to recommended sterilization guidelines and protocols can lead to serious cross-infection causing a disease which could be far more incapacitating than what the patient was originally suffering from. It also increases the chances of persistence of the infection. In either case, treatment outcomes are drastically reduced, rendering the entire treatment unfruitful. Sterilization and disinfection of instruments are of particular significance in the field of endodontics due to the intrinsic nature of the various procedures involved as part of the field and the type of instruments that are used. Routine decontamination procedures are usually not effective due to the complex, intricate, and minute design of various endodontic instruments. In addition, it is very important to take into account the effect of various sterilization protocols on the material of the instrument. This review article aims to describe the various sterilization and disinfection procedures for endodontic instruments in a concise manner, taking into consideration the potential effects that the sterilization/disinfection procedure might have on the instrument to be sterilized. Hopefully, it will make it easier for clinicians to choose the most suited/appropriate sterilization and disinfection procedure for any given endodontic instrument. [ABSTRACT FROM AUTHOR]