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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)., (© 2024 The Author(s). International Endodontic Journal published by John Wiley & Sons Ltd on behalf of British Endodontic Society.)

Objective: 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., Methods: 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., Results: 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., Conclusion: The technical quality of root fillings in single-canal teeth treated by dental students was predominantly satisfactory., (© 2024 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Aim: This single-arm interventional trial aimed to investigate the efficacy of ultrasonic irrigation as a supplementary disinfection approach after chemomechanical procedures using molecular techniques based on ribosomal RNA (rRNA) and rRNA genes (referred to as DNA)., Methodology: Samples were collected from 35 single-rooted teeth with radiographic evidence of apical periodontitis. Samples were taken after gaining root canal access (S1), chemomechanical procedures (CMP, S2), and ultrasonic irrigation (S3). DNA-targeted qPCR using universal primers was used to estimate total bacterial levels, while rRNA-targeted qPCR was used to assess bacterial activity. Ratios between rRNA and DNA levels were calculated to search for active bacteria in the samples (rRNA/ DNA ≥ 1). Wilcoxon matched-pairs signed-rank test was used to compare the differences in DNA levels between samples and DNA and rRNA levels within samples (P <.05)., Results: DNA-based methods revealed a significant decrease in bacterial levels from S1 to S2 and S2 to S3 (both P <.05). Notably, 11 out of 35 (31.4%) root canals did not harbor bacterial DNA after CMP, whereas ultrasonic activation increased DNA-negative samples to 17 (48.6%). However, all DNA-positive samples were also positive for rRNA, with significantly higher rRNA than DNA levels (P <.05), indicating bacterial activity at the sampling time., Conclusions: Ultrasonic irrigation improved the disinfection of root canals after chemomechanical procedures by reducing bacterial levels. However, persisting bacteria remained active in the root canals after CMP and ultrasonic irrigation., (Copyright © 2024. Published by Elsevier Inc.)

Background: Pulpitis 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., Objective: 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?, Methods: 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., Results: 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., Discussion: 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., Conclusion: 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., (© 2024 The Author(s). International Endodontic Journal published by John Wiley & Sons Ltd on behalf of British Endodontic Society.)

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.

Introduction: This study systematically reviewed literature regarding the effect of different concentrations of sodium hypochlorite (NaOCl) used during root canal treatment (RCT) on postendodontic pain (PEP) and rescue analgesia., Methods: Following registration with PROSPERO (CRD42023388916), a search was conducted using PubMed, Scopus, Web of Science, and Embase databases. Randomized controlled trials of patients receiving RCT which assessed PEP at different time intervals were included. Following data extraction and Cochrane risk of bias assessment 2, meta-analyses were performed to evaluate PEP during the first 48 hours along with rescue analgesic intake. The certainty of the evidence was evaluated using the Grading of Recommendations, Assessment, Development, and Evaluation approach., Results: Five randomized controlled trials with 674 patients were included. One study exhibited a low risk of bias, while 4 raised some concerns. Patients treated with low concentrations of NaOCl (≤3%) were significantly less likely to report PEP at 24 hours (OR = 2.32; [95% CI, 1.63-3.31]; P < .05) and 48 hours (OR = 2.49; [95% CI, 1.73-3.59]; P < .05) as compared with high concentrations of NaOCl (≥5%). Furthermore, with low concentrations of NaOCl, significantly lesser moderate-severe PEP was reported at 24 hours (OR = 2.32; [95% CI, 1.47-3.62]; P < .05) and 48 hours (OR = 2.35; [95% CI, 1.32-4.16]; P < .05) and lesser analgesia was needed (OR = 2.43; [95% CI, 1.48-4.00]; P < .05)., Conclusions: While PEP can be influenced by several factors, low certainty evidence suggests that when NaOCl is used as an irrigant during RCT, PEP may be less likely with lower concentrations of NaOCl. Moderate certainty evidence indicates that lesser analgesia may be required with lower concentrations of NaOCl. These results should be cautiously interpreted., (Copyright © 2024 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.)

Primary dental treatments for odontogenic sinusitis (ODS) due to endodontic infections (pulpal necrosis and apical periodontitis ± periapical abscess) include extraction and root canal treatment (RCT). Published evidence is lacking on the success of primary endodontic treatment for purulent ODS, with the majority of RCT-related series reporting on its success at resolving reactive maxillary sinus mucositis. Dental extraction is the most definitive treatment of endodontic disease causing ODS, but compromises the functional dentition and still often fails to resolve the purulent sinusitis. This article highlights key concepts of RCT and dental extraction techniques, as well as their published success at resolving ODS., Competing Interests: Disclosure J.R. Craig: research consultant for Aerin Medical, Inc., (Copyright © 2024. Published by Elsevier Inc.)

Despite significant efforts to eliminate bacterial biofilm within root canals, achieving effective disinfection remains challenging due to the complex anatomy and limitations of disinfectants. In this study, a second near-infrared (NIR-II) semiconducting polymer with aggregation-induced emission (AIE) properties, named PIDT-TBT, is deliberately designed and synthesized. This proposes an AIE luminogen-based sterilization strategy in synergy with a low concentration of sodium hypochlorite (NaClO). Water-dispersible PIDT-TBT nanoparticles (NPs) are prepared, demonstrating good biocompatibility, as well as photothermal and photodynamic properties. Subsequent antibacterial tests show that PIDT-TBT NPs exhibit excellent bactericidal effects against three bacterial strains: Staphylococcus aureus, Streptococcus mutans, and Enterococcus faecalis, upon 808 nm laser irradiation. In synergy with a low concentration of NaClO (0.5%) solution, PIDT-TBT NPs significantly improves the outcome of root canal treatment under 808 nm laser irradiation in a human extracted tooth root canal infection model. Additionally, it is found that PIDT-TBT NPs combine with a low concentration of NaClO solution could safely dissolve dentin debris and further increase the efficiency of root canal preparation by altering the elemental composition of the inner root canal wall., (© 2024 Wiley‐VCH GmbH.)

The critically important preoperative and intraoperative factors that affect the success of endodontic microsurgery (EMS) in Japanese patients are not defined. We conducted a retrospective study that analyzed treatment outcomes for 46 teeth in 46 Japanese patients. Treatment was provided between March 2013 and March 2015. All patients were evaluated after one year, the shortest time period over which treatment outcomes after apicoectomy could be evaluated and in which there were complete records for the recruited patient population. Healing was assessed on the basis of clinical symptoms and radiographs. With the use of a binary logistic regression model to quantify success, we estimated the effects of patient age, sex, dental arch, lesion size, lesion type, preoperative root canal treatment, the presence or absence of a post core, and the presence or absence of an isthmus on the surgically prepared dentine surface. The overall success for EMS was 93.5% after one year; failures comprised 6.5%. Successful outcomes were higher ( p = 0.04) for maxillary teeth than for mandibular teeth. Success was higher ( p = 0.019) for patients who received root canal instrumentation prior to EMS. Age, sex, lesion size, lesion type, the presence or absence of a post core, and the presence or absence of a root canal isthmus had no effect ( p > 0.2) on success. We conclude that the percentage of successful outcomes after EMS treatment for Japanese patients presenting with periapical periodontitis is very high after one year and that success is influenced strongly by the dental arch and preoperative root canal instrumentation.

Introduction: This study reported on the outcome of the nonsurgical root canal treatment/retreatment of teeth with large apical periodontitis lesions. The influence of some variables on the prognosis was also evaluated., Methods: The study included 199 teeth with large apical periodontitis lesions from 184 patients, treated/retreated by a single operator. Most teeth were managed in a single visit using NaOCl irrigation. Cases were followed up periodically from >1 to 8 years. Treatment/retreatment outcome was evaluated by clinical and radiographic/tomographic criteria and categorized as healed, healing, or diseased. For statistical analysis, data were dichotomized in such a way that healing cases were considered as success in a loose criterion or failure in a rigid one., Results: Clinical/radiographic analyses revealed that 67% of the initial treatment cases were classified as healed, 22.5% as healing, and 11% as diseased. Treatment success rates were 89% (loose) and 67% (rigid). Variables that influenced the treatment outcome included previous abscess and antibiotic use, very large lesions (≥10 mm), and a sinus tract. The median follow-up time for treatment was 31.5 months. As for retreatment cases, 47% were healed, 32% were healing, and 21% were diseased. Retreatment success rates were 79% (loose) and 47% (rigid), in a median follow-up of 32 months. Cases evaluated by cone-beam computed tomography had lower healed rates., Conclusions: Findings demonstrate that high favorable outcome rates can be achieved by nonsurgical root canal treatment or retreatment of teeth with large apical periodontitis lesions., (Copyright © 2024 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.)

Background: Pulp stones are a type of pulp calcification, the presence of which tends to hinder endodontic treatment. Thus, this retrospective study aimed to analyze the distribution of pulp stones in the population in southwest China and identify the influencing factors., Materials: Cone-beam computed tomography (CBCT) scans of 5066 teeth of 200 patients (91 males and 109 females) aged 16-45 years were evaluated. Pulp stones were marked as either present or absent when distinct radiopaque masses were found in the pulp cavity, then evaluated the occurrence of pulp stones with regard to tooth type, sex, age group, and contact it with tooth status. The Pearson chi-square test and nonparametric test were used for statistical analysis., Results: Pulp stones were detected in 49.0% of patients and 7.4% of teeth, respectively. The incidence in females was 1.9 times higher than in males (OR = 1.9, 95% CI = 1.1-3.3, p = 0.001). Pulp stones were most prevalent in patients 36-45 years of age. Furthermore, in the age range of 16-45 years, the likelihood of finding pulp stones increased 1.1 times per year with age (OR = 1.1, 95% CI = 1.0-1.1, p = 0.032). A higher incidence of pulp stones was observed in the maxilla and molars. Of the 5066 teeth studied, pulp stones were more common in non-intact teeth., Conclusion: Nearly half of the population in southwest China had pulp stones. Pulp stones were found significantly more often in females, maxilla, and non-intact teeth, and their frequency increased with age. For dentists, understanding the distribution of pulp stones is crucial for the proper design of root canal treatment (RCT)., Trial Registration: This study was approved by the Ethics Committee of the Affiliated Hospital of Stomatology, Southwest Medical University (certificate number: 20220818001)., (© 2024. The Author(s).)

The introduction of nickel-titanium rotary instruments revolutionized shaping procedures as they were able to produce a well-tapered preparation while reducing operator fatigue. The major drawback of rotary instruments was the high risk of fracture due to bending and torsional stress. Thus, the creation of a glide path has been advocated and recommended by most rotary instrument manufacturers. The aim of the present review is to summarize existing knowledge on glide path preparation and identify areas where further research is needed. The primary goal is to provide a comprehensive overview of the techniques and instruments used in glide path preparation, highlighting their advantages and limitations. The secondary goal is to explore the effect of glide path creation on the overall success of endodontic treatment, particularly in terms of reducing procedural errors and improving treatment outcomes. An online search on PubMed, ScienceDirect, UCLA, and Scopus databases was conducted, and 116 articles were identified. Eligible articles were divided into nine categories based on what they researched and compared. The categories included centering ability and/or root canal transportation, cyclic fatigue resistance, glide path and shaping time, tortional stress resistance, apical extrusion of debris and/or bacteria, defects in dentine walls, file separation, postoperative pain assessment, and scouting ability and performance. Establishing a glide path reduces root canal transportation, especially with rotary methods. Reciprocating and heat-treated files offer higher fatigue resistance and shorter preparation time. Instruments with shorter pitch lengths have greater torsional strength. Preparation and coronal preflaring reduce apical debris and bacteria. Glide paths do not affect dentine microcracks, file separation, or defects but reduce immediate postoperative pain and improve cutting ability. Randomized trials are needed to assess their impact on treatment outcomes.

The mandibular second molar has one unique feature regarding internal anatomy: it tends to have a C-shaped configuration in many cases. In mandibular second molar teeth, it is a variance of racial predilection that is frequently observed. During negotiation, debridement, and obturation, the physician is frequently faced with difficulties due to the complexity inherent in this diversity of canal morphology. This case report describes the management of such canal variation, which requires a thorough knowledge of internal anatomy combined with detailed investigations and the operator's skill in cleaning and shaping the canal for better prognostic outcomes., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Jidewar et al.)

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., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

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., (© 2024 British Endodontic Society. Published by John Wiley & Sons Ltd.)

Guidelines were developed by the Australian Society of Endodontology Inc. with the intent to describe relevant aspects of contemporary evidence-based root canal treatment. The document aims to support clinicians by describing a Standard of Practice in the Australian context. The presented guidelines refer to Competence criteria and Quality standards for the main steps in root canal treatment. While the intent is not to replace individual clinical decision-making, it is envisaged that these periodically reviewable guidelines may help to improve clinical outcomes., (© 2024 The Author(s). Australian Endodontic Journal published by John Wiley & Sons Australia, Ltd on behalf of Australian Society of Endodontology Inc.)

This study assessed canal preparation effects on disinfection and dentin preservation. Thirty mandibular incisors were paired into two experimental groups (n = 10). Following contamination, the initial microbial sample was collected. Instruments 30/0.03 (Group 1) and 30/0.05 (Group 2) were employed and a second sample was obtained. Canals were enlarged using instruments 40/0.03 and 40/0.05, respectively, and a third sample was collected. Final irrigation was performed, and sample S4 obtained. A final scan evaluated volume, surface area, unprepared areas, removed dentin and dentin thickness. Data were analysed using Student t-test, Mann-Whitney, Kruskal-Wallis and Dunn tests. A significant difference was observed between S1 and other time points (p < 0.05). Comparison between groups showed no differences in bacterial loads and in the percentage of microbial reduction (p > 0.05). Group 2 exhibited greater reduction in dentin thickness than group 1 in the mesial aspect of the root (p < 0.05). Instrument 30/0.03 might provide effective disinfection and safety during mandibular incisors canal preparation., (© 2024 Australian Society of Endodontology Inc.)

Introduction: Often there is the need of moving endodontically treated teeth. Orthodontic movement may have no effect on the prognosis of teeth with root canal treatment (RCT). To verify this subject, we evaluated the effect of orthodontic movement on the prognosis of RCT teeth using cone-beam computed tomography (CBCT) and further explored the influence of orthodontic movement on the prognosis of RCT teeth with and without apical periodontitis (AP)., Methods: This retrospective study was conducted by evaluating 169 RCT teeth of 100 patients who had undergone fixed orthodontic treatment. AP was assessed and classified using the CBCT periapical index. Univariate analysis of RCT outcome was performed for the total RCT group, RCT without AP group and RCT with AP group. Multivariate logistic regression was performed for the total RCT group and RCT without AP group, respectively, but not for the RCT with AP group. Variables related to the prognosis of RCT were included, such as age, gender, tooth position, RCT quality, coronal restoration quality, periodontal condition, orthodontic traction distance, and orthodontic rotation angle., Results: The orthodontic traction distance and rotation angle were not significantly correlated to the RCT outcomes, regardless of the presence of AP. Among the total RCT group, teeth with unqualified RCT (odds ratio = 3.42, P = .004) and inadequate coronal restoration (odds ratio = 4.40, P = .031) had a lower success rate. Of the 97 RCT teeth without AP, unqualified RCT was a risk factor for treatment failure (odds ratio = 3.55, P = .041). Of the 72 RCT teeth with AP, the univariate analysis showed that RCT quality were significantly related to the outcome (P = .042)., Conclusions: Orthodontic movement had no effect on the prognosis of RCT teeth regardless of the presence of AP., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)

Bacterial odontogenic sinusitis (ODS) arises from maxillary dental issues or oral procedures, and affects at least the maxillary sinuses, with or without other paranasal sinus involvement. It has been historically underreported, in contrast to more recent findings attributing 25-40% of chronic maxillary sinusitis to dental causes. Endodontic infections represent one of the most common causes of ODS. Endodontic factors like root canal infection and microbial proximity to sinus cavities play pivotal roles. Host immunological responses further shape disease severity and progression. This article aims to explore the complexity of endodontic infections that cause ODS, elucidating anatomical, microbial, and immunological aspects., Competing Interests: Disclosures The authors do not have any conflicts of interest or financial disclosures to declare., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Purpose: This survey aims to assess the understanding, viewpoints, and methods employed by undergraduate dental students in the fourth and fifth grades regarding broken endodontic instruments in root canal procedures., Methods: A survey comprising 27 questions across three sections-demographic information, practical application, and knowledge-approach-awareness inquiries-was developed. It was distributed to 282 students either in person or via a link shared through WhatsApp groups using Google Forms., Results: Out of the total 219 respondents (77.6%), 10.6% experienced instrument breakage once during their clinical internship, while 2.8% encountered it more than once. The majority (86.7%) did not face instrument fracture incidents. Among these occurrences, it was observed that endodontic instruments were most commonly separated in molars, accounting for 51.9%. Nearly half (48.1%) of the students noted instrument breakage during the initial attempt to reach the apical part of the canal, while 55.6% reported breakage during root canal cleaning and shaping., Conclusions: Most dental students opted to leave the separated instrument in the root canal and proceed with filling it. Enhancing students' understanding and awareness of this matter will help prevent potential complications and enable them to handle such situations appropriately when they arise., (© 2024 American Dental Education Association.)

Objectives: This randomized clinical trial compared the effectiveness of music and informative videos as distraction tools to reduce the anxiety of patients during root canal treatment and retreatment., Method and Materials: A total of 90 patients were enrolled in the study. The patients were randomly allocated to three groups: Group 1 listened to music during the treatment (n&#61;30), Group 2 watched an informative pre-operative video (n&#61;30) and a control group underwent treatment without a distraction method (n&#61;30). Prior to treatment, the Corah Dental Anxiety Scale (CDAS) and a visual analogue pain scale (VAS) were used to assess anxiety and pre-operative pain. Systolic blood pressure (SBP), diastolic blood pressure (DBP), heart rate (HR) and oxygen saturation (OS) were recorded before the intervention (T1), after the local anesthetic (T2), following pulp extirpation or removal of root fillings (T3), and immediately following rubber dam removal (T4). One-Way ANOVA, followed by post-hoc Bonferroni tests for multiple comparisons, were used to compare mean values of SBP, DBP, HR, and OS among the groups. A P-value of 5% was considered as significant., Results: Listening to music reduced SBP, HR (P <.001) and DBP (P &#61;.003) in patients undergoing root canal treatment and retreatment at T4 compared to the baseline (T1). Music (P <.001) and informative video (P &#61;.003) groups had significantly lower post-operative VAS-pain scores., Conclusion: Listening to music during root canal treatment and retreatment reduced anxiety levels in patients compared to informative pre-operative videos and no distraction technique. Pre-registration: Australian New Zealand Clinical Trials Registry (ACTRN12622000817741).

Background: With the increasing application of guided endodontics to treat complex root canal treatment, the entire process of root canal treatment has become more precise, reducing damage to tooth structure and improving success rates. However, due to the limitations of the operating space, the use of guided endodontic templates in posterior root canal treatment is less common. This study aims to compare the accuracy and reliability of selective laser melting (SLM) and traditional stereolithography etching (SLA) guided endodontic templates for posterior root canals, providing better treatment strategies for posterior root canal treatment., Methods: The teeth were randomly assigned to either SLM or SLA group. Preoperative cone-beam computed tomography (CBCT) and a three-dimensional (3D) scanner were used to establish the 3D root canal system and the accurate occlusal models of the teeth. The virtual access to the canal access was designed using Mimics 19.0 and 3-Matic 11.0. The endodontic access was performed based on either SLM or SLA templates. The accuracy of endodontic preparation was measured in three-dimensions by calculating deviations from planned accesses. The template height and tooth substance loss rates in each group were measured., Results: SLM-guided templates have a low average deviation at the entry point and apical portion of the bur of total posterior teeth (including premolars and molars) and individual molars ( P < 0.05). Moreover, there was a significant difference in angular deviations and height of template in total posterior teeth and individual molars ( P < 0.05). The mean substance loss rate of the SLA group was slightly greater than that of the SLM group, but the difference was not statistically ( P > 0.05)., Conclusions: SLM-guided endodontics provides a more predictable and precise location of root canal orifice for the treatment of posterior teeth., Competing Interests: The authors declare that they have no competing interests., (© 2024 Zhang et al.)

Introduction and Aims: Root canal therapy is a crucial aspect of endodontic treatment aimed at preserving natural dentition. Over the years, advancements in three-dimensional (3D) technology have revolutionized diagnosis and treatment planning. Different 3D technologies are used in dental care, such as cone-beam computed tomography (CBCT), which ensures 3D slice visualization, root canal microanatomy, and dynamic navigation throughout the pulp cavity. By exploring the latest technological progress in this field, we seek to understand how these innovations are enhancing precision, efficiency, and patient outcomes, shedding light on the benefits and potential impact of 3D imaging in improving root canal procedures., Methods: Literature was searched from different databases, including PubMed, ScienceDirect, The Cochrane Library, Scopus, and Google Scholar. Inclusion criteria involved studies on 3D technology in root canal therapy with comparison groups, including RCTs and non-RCTs. Excluded studies lacked 3D imaging advancements, a control group, or were review articles or case studies. Quality assessment utilized QUIN for in vitro studies and ROBINS-I for non-RCTs to evaluate the studies' validity., Results: According to the PRISMA guidelines, among 5015 initial articles, 16 were included. CBCT was the most used 3D imaging technique for root imaging followed by micro-computed tomography (MCT) and limited CBCT (LCBCT) imaging methods. 2D radiographs and 2D histological methods and clearing techniques were the most common comparative modalities. Overall, 3D imaging streamlined dental treatment as clinicians could visualize much clearer and higher-quality images. Different resolutions and voxel sizes were applied to improve imaging quality., Conclusion: Three-dimensional imaging, especially CBCT, improves root canal treatments by providing superior image quality. CBCT outperforms other techniques like MCT and LCBCT, enhancing clarity. Varying resolutions and voxel sizes optimize the effectiveness of 3D imaging in root canal therapy., Clinical Relevance: The advancements in 3D imaging technology, particularly CBCT, have significantly enhanced the diagnosis and treatment planning for root canal therapy. CBCT provides detailed insights into intricate root canal anatomy, improving diagnostic accuracy., Competing Interests: Conflict of interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)

Background: 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., Materials and Methods: 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., Results: 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., Conclusion: 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., (© 2024 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Knowledge of tooth anatomy and its variations are essential for the success of endodontic treatment. Dilacerations represent developmental anomalies marked by sudden deviations in a tooth's longitudinal axis. Common causes of treatment failures in such cases are primarily related to procedural errors such as ledging, fractured instruments, canal blockages, zipping, and elbow creations. The current case series presents three such interesting cases of endodontic management of curved root canals in mandibular molars., Competing Interests: There are no conflicts of interest., (Copyright: © 2024 Journal of Conservative Dentistry and Endodontics.)

Untreated canals are a primary cause of persistent apical periodontitis, and the inability to identify and adequately treat canals has been considered a major cause of failure of root canal therapy in maxillary molars. The purpose of this retrospective study was to use cone beam computed tomography (CBCT) to quantify the number of missed canals in maxillary first and second molars needing endodontic retreatment after treatment by general dentists. A total of 401 CBCT scans of maxillary first and second molars were examined. A total of 214 scan sets (53.37% [95% CI, 48.48%-58.25%]) showed evidence of an untreated canal, with the highest rate (49.38%; n = 198) observed in the second mesiobuccal canal. Imaging revealed that multiple canals were missed in some patients, for a total of 225 missed canals. The examinations showed untreated first mesiobuccal canals in 2.99% of CBCT scan sets (n = 12), untreated distobuccal canals in 2.99% of CBCT scan sets (n = 12), and untreated palatal canals in 0.75% of CBCT scan sets (n = 3). Preoperative CBCT imaging should be considered prior to initial root canal treatment of maxillary molars. When the risks and limitations of CBCT are taken into consideration, the additional information it provides can improve diagnostic accuracy, increase confidence in decision-making, and positively impact treatment planning., Competing Interests: No conflicts of interest reported.

Background: 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., Objectives: To investigate (i) the survival of root-filled posterior teeth and (ii) the tooth-related factors that may affect their survival., Methods: 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., Results: 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., Conclusions: 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., Registration: PROSPERO Registration: CRD42021227213., (© 2024 The Author(s). International Endodontic Journal published by John Wiley & Sons Ltd on behalf of British Endodontic Society.)

Objectives: The aim of this study was to observe the radiographic healing of periapical lesions after root canal treatment via volumetric measurements based on cone-beam computed tomography (CBCT) over 4 years., Methods: In total, 162 single-root teeth from patients with chronic periapical periodontitis who underwent primary root canal treatment were included in this retrospective study. Follow-up visits were scheduled at 1, 2, and 4 years after treatment. The volume of radiolucency at pretreatment and follow-up were measured, and the radiographic outcomes were classified into 4 categories: absence, reduction, uncertain or enlargement. Reduction or enlargement was considered when the volumetric change in radiolucency was 20 % or more., Results: During the 4-year follow-up period, 128 teeth were reviewed at least once, including 3 extracted teeth. Of the remaining 125 teeth, the volume of radiolucency was reduced in 116 teeth (90.6 %), uncertain in 5, and enlarged in 4 teeth during 1 to 4 years after treatment. Among the 43 teeth with reduced radiolucency at 1 year after treatment, 42 (97.7 %) had continuing reduced lesions at 4 years. In the 2 teeth with enlarged radiolucency at 1 year, the volume of radiolucency doubled at 4 years. Cox regression analysis revealed that the preoperative radiolucency size was a risk factor for persistent periapical radiolucency., Conclusions: The efficacy of root canal treatment for apical periodontitis was predictable. When the radiolucency changed by 20 % or more in volume on CBCT scans at 1 year after treatment, reversal of the radiographic healing tendency was rare., Clinical Significance: The volumetric changes in radiolucency on CBCT could reflect trends in the healing process and may foster early clinical decision-making., Competing Interests: Declaration of competing interest The authors declare that they have no conflict of interest., (Copyright © 2024. Published by Elsevier Ltd.)

Background: The aim of this study was to determine the effect of root canal filling using different obturation materials combined with apicoectomy in upper central incisors under loading with 1 N and 100 N. The effect of incomplete root formation was also investigated., Methods: Based on a CBCT-scan, a model of an upper central incisor was created. The model was altered to simulate different clinical situations: root canal treatment, apicoectomy at two different lengths and with different obturation protocols, and immature root formation after trauma. In each model the tooth was loaded with 1 and 100 N, and peak Von Mises stress of bone and tooth, elastic strain of the periodontal ligament, as well as rotation and displacement of the tooth were measured., Results: Periapical surgery increases stress in dentin and the surrounding bone. Different obturation materials only produce minor differences in a coronally intact tooth., Conclusions: Interincisal angle or loading direction strongly affects all measured values and needs to be considered when planning periapical surgery or comparing finite element analysis. Immature roots show the highest stress values in this study, reaching half the yield strength of dentine., Competing Interests: Declaration of Competing Interest Authors state no conflict of interest., (Copyright © 2024 The Authors. Published by Elsevier GmbH.. All rights reserved.)

This retrospective cohort study compared the effect of primary root canal treatment (RCT) with root canal retreatment (Re-RCT) on patient-reported outcomes in Kuala Lumpur, Malaysia. Forty randomly selected adults participated (RCT n = 20; Re-RCT n = 20). The impact their dentition had on the Oral Health Impact Profile-14 (OHIP-14) was assessed by calculating the prevalence of oral health impact, and the severity score. Focus group discussions using a semi-structured guide were arranged through an online meeting platform. Qualitative content analysis identified common themes, and relevant quotes gathered. The impact on OHIP-14 was limited for both RCT and Re-RCT groups with no significant differences in the prevalence of oral health impact. Significant differences were found for functional limitation (RCT higher) and psychological discomfort (Re-RCT higher). Common themes from the discussions include the importance of retaining teeth, the significance of effective communication between clinicians and patients and that the respondents were satisfied with the treatment., (© 2024 The Author(s). Australian Endodontic Journal published by John Wiley & Sons Australia, Ltd on behalf of Australian Society of Endodontology Inc.)

The morphological variations in roots and root canals vary greatly in multi-rooted teeth making it a challenge for accurate diagnosis and effective endodontic therapy. In addition to using technology appropriately, this article highlights how important it is to have a complete understanding of root canal morphology. With the assistance of cone-beam computed tomography (CBCT) images and a dental operating microscope (DOM), successful endodontic treatment was performed on a single-rooted maxillary first molar with Vertucci's type II canal configuration. CBCT and DOM proved to be valuable tools for the effective diagnosis and management of this atypical morphology., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Bajaj et al.)

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., (© 2024. The Author(s).)

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., Abstract: 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., Competing Interests: All authors disclose that there is no actual or potential conflict of interest including any financial, personal or other relationships with other people or organizations., (© 2024 The Author(s). Clinical Case Reports published by John Wiley & Sons Ltd.)

Background/aim: 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., Materials and Methods: 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)., Results: 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., Conclusions: 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., (© 2024 The Author(s). Dental Traumatology published by John Wiley & Sons Ltd.)

Introduction: Large-scale clinical studies on the incidence of middle mesial canals (MMCs) in nonsurgical root canal treatment (RCT) and retreatment of mandibular molars are lacking. The primary aim of this observational study was to determine the incidence of MMCs in mandibular first and second molars that received RCT or nonsurgical retreatment (NSRetx). The secondary aim was to determine factors associated with incidence of MMCs., Methods: Included were 3018 mandibular molars that received RCT (n = 1624) or NSRetx (n = 1394) by 3 endodontists in a private practice. Demographic and procedural data were collected. Bivariate and multivariable (Poisson regression model) analyses were performed., Results: Incidence of MMCs was 8.8% (n = 267). Although the bivariate analysis showed that NSRetx was significantly associated with incidence of MMCs, this association did not reach the threshold for statistical significance after controlling for all covariates (P = .07). Multivariable analysis on the entire cohort showed that incidence of MMCs was significantly associated with younger age (risk ratio [RR] = 1.62; 95% confidence interval [CI], 1.28-2.06), male gender (RR = 1.48; 95% CI, 1.18-1.85), preoperative cone-beam computed tomography (CBCT) (RR = 1.48; 95% CI, 1.17-1.89), and first molar (RR = 2.30; 95% CI:1.74-3.05). Subgroup multivariable analyses revealed that incidence of MMCs was associated with male gender only in the RCT group (RR = 2.26; 95% CI, 1.55-3.30) but not in the NSRetx group (RR = 1.11; 95% CI, 0.82, 1.50); and with preoperative CBCT only in the NSRetx group (RR = 1.78; 95% CI, 1.28, 2.50) but not in the RCT group (RR = 1.10; 95% CI, 0.71, 1.69). Associations with younger age and first molar remained unchanged., Conclusions: Overall incidence of MMCs was 8.8%. Incidence of MMCs was significantly higher in younger patients and in mandibular first molars but was not associated with the type of treatment., (Copyright © 2024 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.)

Dental anatomy exhibits considerable variation with the presence of additional canals being a common occurrence. The upper second molar typically presents with three canals and three roots; however, variations such as the existence of an extra canal or a root can pose challenges during endodontic treatment. Maxillary molar is characterized by an additional canal located within the palatal root, often exhibiting complex configurations and variations in morphology. Access refinement is critical to gaining adequate visibility and facilitating instrumentation. Meticulous exploration of the pulp chamber floor and careful examination of radiographs from different angles are essential for accurate diagnosis. Careful negotiation and cleaning of the extra canal with appropriate files and irrigants are essential to remove pulp tissue and debris effectively. Furthermore, obturation of the canal space with biocompatible materials is crucial to ensure a three-dimensional seal and prevent bacterial ingress. Clinically, the inability to detect and treat the extra palatal canal can lead to persistent infection, incomplete debridement, and compromised treatment outcomes. This case report delves into the significance of this anatomical variation, diagnostic modalities, and effective management strategies., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Manik et al.)

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-AF TM -Baby & manual K-files in primary root canal preparation., (© 2024. The Author(s).)

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.

Root canal treatment of vital, non-infected teeth can often be completed in a single visit, negating the necessity for dressing and provisionalization. Conversely, cases involving infected canals typically demand multiple visits, during which antibacterial medicaments are applied, making effective provisionalization crucial for varying durations. The key components of a successful root canal treatment include adequate canal shape to promote efficient obturation, thorough chemical and mechanical debridement, and complete removal of pulp tissue remnants and bacteria. The primary cause of pain following the initiation of endodontic treatments is often attributed to inadequate debridement or incomplete removal of the pulp tissue, closely followed by insufficient temporary restorations. This review aims to comprehensively overview provisionalization materials used during and immediately after endodontic procedures., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2024, Rathod et al.)

Aim: This study aimed to assess the Oral Health-Related Quality of Life (OHRQoL) of pediatric patients (9-18 years old) who underwent root canal treatment (RCT) on first permanent molars (FPMs)., Methods: A cross-sectional study was conducted at three healthcare centers in Jeddah, Saudi Arabia. Participants (n = 482) completed the validated OHIP5-Ar questionnaire to assess OHRQoL. Responses were classified as "optimal" (no problems) or "less than optimal" (any reported problems). Logistic regression analyzed the relationship between OHRQoL and sociodemographic factors., Results: There were 66.8% children reported optimal OHRQoL after RCT. Logistic regression showed no significant association between optimal OHRQoL and gender, family income, or location of treated tooth. However, although not statistically significant. Treating only one FPM with RCT (compared to multiple teeth) and lower family income (compared to higher income) were more likely to have decreased or increased odds of optimal OHRQoL (AOR = 0.684 or 1.424; respectively)., Conclusion: RCT on FPMs can be a successful treatment option for pediatric patients, offering optimal oral health-related quality of life., Competing Interests: The authors declare no conflicts of interest in this work., (© 2024 Bamashmous et al.)

The resistance of nickel-titanium endodontic instruments against cyclic fatigue failure remains a significant concern in clinical settings. This study aimed to assess the cyclic fatigue strength of five nickel-titanium rotary systems, while correlating the results with the instruments' geometric and metallurgical characteristics. A total of 250 new instruments (sizes S1/A1, S2/A2, F1/B1, F2/B2, F3/B3) from ProTaper Gold, ProTaper Universal, Premium Taper Gold, Go-Taper Flex, and U-Files systems underwent mechanical testing. Prior to experimental procedures, all instruments were meticulously inspected to identify irregularities that could affect the investigation. Using a stereomicroscope, design characteristics such as the number of spirals, length, spirals per millimeter, and average helical angle of the active blade were determined. The surface finishing characteristics of the instruments were examined using a scanning electron microscope. Differential scanning calorimetry was employed to establish the instruments' phase transformation temperatures, while energy-dispersive X-ray spectroscopy was utilized to analyze the elemental composition of the alloy. The instruments were subjected to cyclic fatigue testing within a stainless steel non-tapered artificial canal featuring a 6 mm radius and 86 degrees of curvature. Appropriate statistical tests were applied to compare groups, considering a significance level of 0.05. The assessed design characteristics varied depending on the instrument type. The least irregular surface finishing was observed in U-Files and Premium Taper Gold files, while the most irregular surface was noted in Go-Taper Flex. All instruments exhibited near-equiatomic proportions of nickel and titanium elements, whereas ProTaper Universal and U-Files instruments demonstrated lower phase transformation temperatures compared to their counterparts. Larger-sized instruments, as well as ProTaper Universal and U-Files, tended to display lower cyclic fatigue strength results. Overall, the design, metallurgical, and cyclic fatigue outcomes varied among instruments and systems. Understanding these outcomes may assist clinicians in making more informed decisions regarding instrument selection.

Introduction: Tooth fracture is one of the most common traumatic maxillofacial injuries in dogs and cats. For fractures with pulp exposure occurring in functionally important teeth, the literature indicates that root canal treatment (RCT) is an effective therapy option that may be the remedy of choice before extraction. The most commonly reported fractures in the United States involve canine teeth; however, fractures of the maxillary fourth premolars are more common in Korea, where there are many small-and medium-sized dogs. RCT mechanically and chemically removes pulp tissue and bacteria (cleaning and shaping) from the infected root canal, and obturates the root canal with filling material to restore tooth functionality without inflammation. Various techniques, instruments, and materials used in humans have been modified for application in veterinary dentistry., Methods: This study analyzed the results of RCT of the maxillary fourth premolar in 120 small-and medium-sized dogs (weighing less than 25 kg) using three different sealers (silicone-based sealer, bioceramic sealer, and calcium hydroxide-based sealer) through a simple application of the single-cone technique., Results: The overall success rate of RCT in maxillary fourth premolars was 90.83%, with 8.33% no evidence of failure (NEF) and 0.83% failure., Discussion: There were no significant differences between the three different sealers. Furthermore, preexisting periapical lesion (PAL) was reconfirmed as a factor in reducing the success rate of RCT. In addition, the working length and master apical file of each root were analyzed in our study as a novel reference for endodontic veterinarians., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Kwon, Yoo, Kang, Jang and Kim.)

The fracture of nickel-titanium (Ni-Ti) instruments during root canal instrumentation leads to compromised outcomes in endodontic treatments. Despite the significant impact of instrument facture during a root canal treatment, there is still no universally accepted method to address this complication. Several previous studies have shown the ability of a Neodymium: Yttrium-Aluminum-Perovskite (Nd: YAP) laser to cut endodontic files. This study aims to determine safe irradiation conditions for a clinical procedure involving the use of a Neodymium: Yttrium-Aluminum-Perovskite (Nd: YAP) laser for removing fractured nickel-titanium files in root canals. A total of 54 extracted permanent human teeth ( n = 54) were used. This study involved nine distinct groups, each employing different irradiation conditions. Groups 1 s, 3 s, 5 s, 10 s, and 15 s simply consist of irradiation for 1, 3, 5, 10, and 15 s, respectively. After identifying the longest and safest duration time, four additional groups were proposed (labeled A, B, C, and D). Group A was composed of three series of irradiations of 5 s each separated by a rest time of 30 s (L5s + 30 s RT). Group B consisted of three series of irradiations of 5 s each separated by a rest time of 60 s (L5s + 60 s RT). Group C consisted of two series of irradiations of 5 s each separated by a rest time of 30 s (L5s + 30 s RT), and group D consisted of two series of irradiations of 5 s each separated by a rest time of 5 s (L5s + 5 s RT). In all groups, during the rest time, continuous irrigation with 2.5 mL of sodium hypochlorite (3% NaOCl) was carried out. The variation in temperature during irradiation was registered with a thermocouple during irradiation with different protocols. The mean and standard deviation of the temperature increase was noted. The calculation of the temperature was made as the Δ of the highest recorded temperature at the root surface minus (-) that recorded at baseline (37°). Additionally, scanning electron microscopy (SEM) was used after irradiation in all groups in order to assess the morphological changes in the root dentinal walls. The Nd: YAP laser irradiation parameters were a power of 3W, an energy of 300 mJ per pulse, a fiber diameter of 200 µm, a pulsed mode of irradiation with a frequency of 10 Hz, a pulse duration of 150 µs, and an energy density of 955.41 J/cm 2 . Our results show that the safest protocol for bypassing and/or removing broken instruments involves three series of irradiation of 5 s each with a rest time of 30 s between each series. Furthermore, our results suggest that continuous irradiation for 10 s or more may be harmful for periodontal tissue., Competing Interests: The authors declare no conflicts of interest.

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., (© 2024. The Author(s).)

There is currently a lack of research on the application of newly developed irrigation techniques in root canal treatment of primary teeth. This study aimed to evaluate the effects of various irrigation activation techniques on two key parameters: apical debris extrusion (ADE) and dentinal tubule penetration depth (DTPD) of the root canal filling material. A total of 96 primary mandibular second molars were randomly divided into 4 groups: Group 1-Conventional Needle Irrigation (CNI), Group 2-XP-Endo Finisher (XPF), Group 3-EndoActivator (EA), and Group 4-Passive Ultrasonic Irrigation (PUI). In all groups, the One Reci single-file system was used for root canal preparation. For ADE measurement, each group was rinsed with distilled water. For DTPD assessment, sodium hypochlorite (NaOCl) was applied. ADE quantification was performed by collecting debris in pre-weighed Eppendorf tubes. A combination of fluorescent dye and root canal filling material (DiaPex Plus) was used for root canal filling. In order to examine DTPD, horizontal cross-sections of the coronal and apical regions of the teeth were taken with a thickness of 1 mm. The maximum and mean DTPD was examined by confocal laser scanning microscopy. Data were analyzed using the Kruskal-Wallis, One-way ANOVA, and Mann-Whitney U tests ( p = 0.05). As a result, PUI had the highest mean ADE and CNI had the lowest mean ADE, while CNI had the highest mean DTPD in both the coronal and apical regions, whereas PUI had the lowest mean DTPD in the coronal region, and EA had the lowest mean DTPD in the apical region. There were no statistically significant differences in DTPD and ADE among the four groups. Comparing intragroup maximum DTPD across all groups, it was significantly higher in the coronal region than in the apical region ( p < 0.05). ADE and DTPD of root canal filling materials in primary teeth did not differ significantly among CNI, XPF, EA and PUI irrigation activation techniques., Competing Interests: The authors declare no conflict of interest., (©2024 The Author(s). Published by MRE Press.)

Aim: To investigate the prevalence of apical periodontitis (AP) and the technical standard of root canal treatment in a Belgian population, assess the association of different variables with periapical status, and compare the results to a similar study conducted 22 years previously., Methodology: In this cross-sectional study, 614 panoramic radiographs of first-time adult attendees at the Dental School of the University Hospital of Ghent were examined. Recorded patient-level parameters included gender, age, number of teeth, number of root filled teeth, presence of any AP lesion, and number of implants. The following tooth-level data were collected: tooth presence, coronal status, quality of coronal restoration, post presence, type of root-filling material, length and density of root filling, root-end filling material, presence of AP, and adjacent implant. Multivariable multilevel binary logistic regression was used to explore the association between patient and tooth characteristics and AP prevalence. Risk differences and confidence intervals were calculated to compare the present with the previous study., Results: The prevalence of AP at patient and tooth level was 46.9% and 5.6%, respectively. Fifty-one per cent of the 614 patients had at least one root filled tooth, and 5.9% of the 14 655 teeth studied were root filled. AP was found in 45% of root filled teeth. Fifty-four per cent of the root-filled teeth were rated as inadequate. Multivariable multilevel logistic regression revealed that more teeth, more implants, fewer root-filled teeth, adequate density, adequate coronal restoration, and no caries reduced the likelihood of AP. There were no statistically significant differences between the two studies regarding the prevalence of root-filled teeth or AP and the technical quality of root canal treatment., Conclusions: The prevalence of AP and the technical quality of root canal treatment in Belgium have not substantially changed over the last 22 years, despite the technological advancements and continuing education in the field., (© 2024 British Endodontic Society. Published by John Wiley & Sons Ltd.)

Background: There is an increased tendency towards adopting minimally invasive interventions in dentistry, supported by advancement in materials and techniques. However, the decision-making process in choosing conservative or invasive treatments is influenced by several factors, particularly in permanent teeth with irreversible pulpitis., Objectives: The objective of the study was to systematically review the literature regarding factors that influence decision-making for vital pulp therapy (VPT) as definitive treatment option in permanent mature teeth diagnosed with irreversible pulpitis., Methods: Two independent reviewers searched five electronic databases (PubMed, Embase, Web of Science, Scopus and Cochrane Library). Grey literature was searched through Google Scholar and contact with experts. Defined search keys were applied, and all peer-reviewed literature published with no language nor publication date limits were included. The All studies investigating the factors influencing treatment decision-making in mature permanent teeth with irreversible pulpitis were included. The quality of included studies was assessed by two independent reviewers using the Joanna Briggs Institute quality assessment tool., Results: Six articles were included in the review. All included studies used questionnaires to characterize clinician preferences and attitudes in choosing treatment options for mature permanent teeth with irreversible pulpitis. The available evidence suggests that dentist-related factors have a significant influence on the chosen treatment in teeth with irreversible pulpitis, with speciality training and years of experience influencing the choice of VPT over other treatment options. COVID-19 reportedly swayed the dentists' decision to favour VPT. Only one article studied the influence of patient-related factors, such as age and presence of spontaneous pain on decision-making. Of note, a history of cardiovascular disease moved dentists towards prescribing VPT., Discussion: Collectively, the included studies demonstrated an overriding influence of dentist-related factors on choosing among treatment options for painful teeth diagnosed with irreversible pulpitis. Patient-related factors were acknowledged but there are also potential factors such as socio-economic constraints that were not included in the component studies., Conclusion: In teeth with irreversible pulpitis clinicians educational background influence the decision towards a specific treatment option. Further data, preferably derived from clinical records, is necessary in future investigations to explore the effect of other important factors related to both dentists and patients., Registration: PROSPERO database (CRD42022339653)., (© 2024 The Authors. International Endodontic Journal published by John Wiley & Sons Ltd on behalf of British Endodontic Society.)