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Objective The concept of minimally invasive endodontics recommends less-invasive vital pulp therapy (VPT) modalities over more aggressive traditional endodontic approaches in mature permanent teeth with carious pulp exposure, including irreversible pulpitis (IP) cases. Consequently, VPT needs to be compared with root canal therapy (RCT) in terms of treatment outcomes. This randomized clinical trial compares the results of full pulpotomy using two calcium-silicate cements, i.e., mineral trioxide aggregate (MTA) and calcium-enriched mixture (CEM) cement, with RCT in mature permanent teeth. Materials and methods A total of 157 carious pulp exposure cases in two academic centers with/without established IP were selected/included/randomly appointed to three study arms; (i) RCT (n = 51) as the reference treatment, (ii) pulpotomy with ProRoot MTA (PMTA; n = 55), and (iii) pulpotomy with CEM cement (PCEM; n = 51) as two alternative VPT treatments. Two-year clinical/radiographic results were the outcomes of interest. Data were statistically analyzed through the analysis of variance, chi-square, Fisher exact test, and Kruskal–Wallis. Results At 2-year recall, 147 teeth were examined (6.4% dropout). All molars, except for one, were clinically functional/symptom-free, and there was no statistical difference between the three study arms (p = 0.653). The radiographic success rates in RCT, PMTA, and PCEM arms were 98%, 100%, and 97.9%, respectively, without statistically significant differences (p = 0.544). Conclusion In the management of mature permanent teeth with/without established IP, all experimental groups exhibited equivalent/comparable results. Clinical relevance Simple VPT using MTA/CEM can be suggested/recommended as a viable advantageous alternative to RCT for the management of carious pulp exposures with/without sign/symptoms of IP.

Irrigating solutions play an important role in the eradication of intracanal microbes and debris dissolution during endodontic treatment. Different combinations of solutions and protocols have been advocated, with sodium hypochlorite (NaOCl), ethylenediamine tetra acetic acid (EDTA), and chlorhexidine (CHX) remaining the most widely used ones by many clinicians. Although these solutions provide efficient inorganic dissolution and antimicrobial capacity, their use has also been reported to cause undesired effects on root dentin composition and mechanical and biomechanical properties, such as microhardness, surface roughness, bond strength, and matrix metalloproteinase (MMP) activity. Several corroborating studies attribute these changes in mechanical properties of dentine to the use of irrigating solutions, and there are limited reports on how the solutions affect the expression of MMPs, which may be a correlating link to understanding the role of these enzymes in dentin collagen and changes in the mechanical properties of dentin. Hence, using the basis of several studies from the literature, the objective is to comprehensively review the influence of individual and combined irrigating solutions on root dentine structure and the activity of the MMPs.

The aim of this papper was to systematically verify the literature regarding the action of the irrigating solutions Sodium Hypochlorite and Chlorhexidine on the properties of root dentin.

Introduction: The preparation of root canals is one of the most critical steps of endodontic treatment; anatomical curves in root canals usually consider a confront for the medical practitioner, making a glide path in endodontic treatment became a basic principle to obtain as safe preparation. Objectives: The research aims to assess the effectiveness of the R-Pilot system in creating the glide path with in the simulated S-shaped canal. Material and Methods: A laboratory study to assess the efficiency of three single-file preparation system in preparing 60 transparent resin S-shaped artificial canal, the following preparation systems were used: One Curve, Hyflex EDM, XP Endo Shaper, and manual K-Files and R-Pilot mechanical patency system. Results: No significant difference between the three preparation systems was found in terms of Apical Transportation incidence (P>0.05). Also, there was no difference between the two glide path creation systems used (P>0.05). Evaluating The amount of the removed resin using the two Glide Path systems found a significant difference at all bends between the two groups (P

In the described proof-of-principle experiments, we introduced a novel testing device to investigate how different concurrent torsional loads influence the cyclic fatigue (CF) resistance of a nickel–titanium (NiTi) instrument. The device was designed to test CF resistance of NiTi files with a standardized load on the apical 5mm; a movable cylinder controlled by a lever provided a uniform real-time load. Thirty-three NiTi instruments 25.04 (F360, Komet, Lemgo, Germany) were rotated until fracture at 30° curvature under three different torsional loads (n=11 each); Group A: 2.5Ncm; Group B: 5Ncm; Group C: 10Ncm. anova, multiple comparisons Tamhane tests, regression and Kaplan–Meyer analysis were performed to contrast means. Resistance to cyclic fatigue differed significantly among groups (P=0.0001). Increased torsional loads led to a decrease in time to failure. An inverse correlation (r=−0.721, P=0.001) was observed between time and torsional load, with higher torsional loads correlated to shorter times to fracture.

In-depth knowledge of common and aberrant pulp morphology is essential for appropriate diagnosis and treatment planning prior to commencing root canal treatment. Radicular morphology of mandibular premolars has been extensively studied. Considerable variation in the number of canals and roots found in these teeth has been reported. Aim The purpose of this study is to investigate the root and root canal morphology of mandibular first premolar among Saudi Arabian subpopulation in Aseer using CBCT. Methods Cone-beam computed tomography images of Mandibular first premolar were taken from 166 patients which were referred to Armed Forces Hospitals Southern Region (AFHSR), Khamis Mushayt, Asir region Saudi Arabia. All the images were assessed by two Evaluators (An Endodontist and a Radiologist). Inter-examiner reliability was determined and was assessed by KAPPA value. Results The mandibular first premolar (n = 216) distributed as 120 teeth in female and 96 teeth in male. Out of the 120 teeth examined in female groups one canal was seen in 95 (79.2%) teeth, two canals in 19 (15.8%) teeth and three canals in 6 (5%) teeth where as in the Male group out of 96 teeth, 52 (54.1%) teeth showed one canal, 32 (33.3%) teeth with two canals whereas 12 (12.5%) teeth showed presence of three canals. Chi-Square test for mandibular first premolars demonstrated the chance of second canal in the mandibular first premolar more in male than female and these differences was statistically significant (P ≤ 0.05). Conclusion Endodontic therapy of mandibular premolars is a challenge for clinician because of their frequent morphological and anatomical abnormalities. Proper knowledge about number of root canals and canal configuration is a key to success in Endodontic. There is a great variability in different population regarding the root canal configuration in mandibular pre-molars. However, most studies state the mandibular first premolar has one root canal. Also, the most prevalent type of root canal found was Type I vertucci.

Objective: to evaluate the amount of apical debris extrusion during root canal preparation using continuous and reciprocating systems. Material and Methods: Forty lower incisors were selected and randomly divided into four groups (n=10) for root canal preparation. Two multifile systems with continuous rotation (iRace®and Mtwo®) and two reciprocating single-file systems (Reciproc® and WaveOne®) were used. In the iRace® group, the R1 (15/.06), R2 (25/.04) and R3 (30/.04) instruments were used. In the Mtwo® group, the 10/.04, 15/.05, 20/.06, and 25/.06 instruments were used. In the Reciproc® and WaveOne® groups, the R25 and 25/.04 instruments were used, respectively. Apical debris extrusion was determined by calculating the difference between the pre- and post-instrumentation weight of the Eppendorf tubes. Statistical analysis was performed using the analysis of variance (ANOVA) test with the Bonferroni correction (p0.05). Conclusion: All of the evaluated systems produced apical debris extrusion. The iRace® system produced more apical debris extrusion than the Reciproc® system, and there was no difference observed in this regardbetween the Mtwo®, Reciproc®, and WaveOne® systems. Objetivo: avaliar a quantidade de debris extruidos apicalmente durante o preparo do canal radicular usando sistemas de rotação contínua e reciprocante. Materiais e Métodos: Quarenta incisivos inferiores foram selecionados e randomicamente divididos em quatro grupos (n=10) para o preparo do canal radicular. Dois sistemas de limas múltiplas de rotação contínua (iRace® e Mtwo®) e dois sistemas de limas únicas reciprocantes (Reciproc® e WaveOne®) foram usados. No grupo iRace®, foram utilizados os instrumentos R1 (15/.06), R2 (25/.04) e R3 (30/.04). No grupo Mtwo®, foram utilizados os instrumentos 10/.04, 15/.05, 20/.06, 25/.06. Nos grupos Reciproc® e WaveOne®, foram utilizados os instrumentos R25 e 25.04, respectivamente. A extrusão apical de debris foi calculada pela diferença entre os pesos dos tubos Eppendorf antes e após a instrumentação. A análise estatística foi feita usando o teste de análise de variância (ANOVA) seguida do teste de Bonferroni (p0,05). Conclusão: Todos os sistemas avaliados produziram extrusão apical de debris. O Sistema iRace® produziu mais extrusão apical de debris do que o Sistema Reciproc® e não foi observada diferença entre os sistemas Mtwo®, Reciproc® e WaveOne®.

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. ispartof: ODONTOLOGY vol:111 issue:3 pages:541-553 ispartof: location:Japan status: accepted

Realizou-se um estudo "in vitro" avaliando a capacidade de selamento de 3 cimentos de obturação de canal através de testes de infiltração. 40 incisivos inferiores foram instrumentados pela técnica escalonada e divididos em 4 grupos. Os dentes foram obturados pela técnica da condensação lateral da guta-percha, tendo como variação o cimento de obturação. Fill Canal, Sealer 26, N-Rickert foram testados e comparados com o grupo controle no qual não se utilizou cimento, apenas cones de guta-percha. A penetração linear de corante foi medida após desmineralização e diafanização dos espécimens. Os resultados mostram diferenças estatisticamente diferentes entre os grupos. Os menores níveis de infiltração ocorreram no grupo Fill Canal, seguido pelos grupos N-Rickeft e Sealer 26., It is an "in vitro" study to evaluate the sealing ability of 3 root canal sealers using a dye leakage/clearing method. 40 lower incisors were instrumented by the step-back technique and divided into 4 groups. The teeth were filled with lateral condensation of guta-percha varying the root canal sealer. Fill Canal, Sealer 26, N-Rickert were tested and compared to the control group in which guttapercha cones with no seater were used. Linear dye penetration was measured after demineralizatÎon and clearing. Statistical analysÏs showed significant differences among the groups. The lowest leakage values were found in the Fill Canal group followed by the N-Rickert and the Sealer 26 groups.

Successful non‐surgical orthograde retreatment of a tooth with external root resorption in apical third of root and overfilling material beyond the apical barrier which was diagnosed with the help of cone beam computed tomography (CBCT), was reported. Biodentine was used as the treatment of choice for obturation of resorption area., Overfilling management can be done by performing nonsurgical endodontic procedure. Gutta‐percha of coronal and middle third of root should be removed by mechanical instruments; however, in apical, removal should be done by hand instrument. Biodentine can be considered as the treatment of choice for filling the perforating external root resorption.

Objectives The aim of this study was to compare the volume variation and maintenance of the root canal position when using the ProGlider 16.02 (PG) and the WaveOne Gold Glider 15.02 (WOGG) file systems for glide path preparation. Materials and Methods Twenty-four moderately curved mesiobuccal canals of maxil-lary first molars were selected and randomly divided into two groups: PG and WOGG. The selected teeth were scanned using microtomography before and after root canal preparation to assess centralization and linear transport at 1, 3, 5, and 7 mm from the apical foramen. Statistical Analysis The data were analyzed with the Mann–Whitney U test. The level of significance was 5%. Results There were no significant differences in volume variation or root canal transport (p > 0.05). There was a significant difference in the centralization of the root canal at 3 mm from the foramen (p < 0.05). Conclusions WOGG and PG instruments presented similar results regarding the root canal volume increase and transport. WOGG caused higher decentralization at 3 mm from the apical foramen.

Objective:This study evaluated the radiographic outcome of root canal treatments (RCTs) performed by general dental practitioners (GDPs) with focus on tooth type and quality of root filling. Materials and methods:The target population included all patients receiving root filling by GDPs in City of Helsinki in 2010-2011. Equal numbers of each tooth type (anteriors, premolars, molars) by jaw were included, resulting in 426 teeth. Pre- and post-operative periapical radiographs were assessed to evaluate periapical status and quality of root filling. Statistical evaluation utilized Chi-squared tests, Cohen's kappa and logistic regression modelling. Results:The overall success rate of RCT was 67.4%, being 76.8%, 69.7% and 55.6% (p

Background/Aim: The aim of this study was to compare the apical extrusion during endodontic retreatment using three different endodontic systems. Material and Methods: 120 extracted human teeth were ex vivo endodontically treated and retreatment was performed using three different endodontic systems. Samples were divided into 3 groups, A-retreatment with Hedstroem hand files, B-retreatment with Pro Taper Retreatment files and C-retreatment with Pro Taper Gold files. Apically extruded material was collected in pre-measured Eppendorfs on a laboratory scale (10-5g). The amount of the extruded material was measured after the retreatment. The data were analysed using the the statistical software: STATISTICA 7.1 and SPSS for Windows 20. Results: The statistical analysis of the data revealed significant differences between the three endodontic retreatment systems (P< 0.05). Apical extrusion in the A endodontic system is significantly greater than the rotary (B and C) endodontic systems. Conclusions: In ex vivo conditions the results of this study showed significant statistical difference between three investigated endodontic retreatment systems concerning the amount of apically exuded material. The largest amount of material suppressed periapically was proven for Hedstroem hand instruments.

Journal of The Dental Association of Thailand, 72, 3, 459-466

Instrument separation during root canal therapy is inevitable in endodontics with several unfavorable clinical consequences. Therefore, examining the cyclic flexural fatigue resistance of commonly used rotary endodontic files is crucial. This study aimed to determine the cyclic flexural fatigue resistance of four nickel–titanium (NiTi) rotary files used as a single canal preparation technique: WaveOne, Reciproc, Protaper F2, and Unicone medium instruments. According to the manufacturer’s instructions, each file was rotated freely within a 1.3 mm deep and 1.3 mm wide V-shaped groove in a stainless-steel block with a 40° and 5 mm radius of curvature. Cyclic fatigue resistance was compared between the NiTi files by verifying the time needed to crack. The data were analyzed using one-way analysis of variance (ANOVA) followed by Scheffé post hoc with a significant level set at p < 0.05. Our results demonstrated that the WaveOne instrument had the highest cyclic flexural fatigue resistance among the tested groups (p ≤ 0.05), while Unicone had the lowest cyclic flexural fatigue resistance. This study concluded that WaveOne size 25/0.08 could illustrate a superior cyclic flexural fatigue resistance when instrumenting root canals with the lowest possibility to cause instrument separation.

Aim: To review the reported defect and fracture rates of various NiTi instrumentation systems and identify factors that may influence the chance of NiTi file separation clinically.Data Sources: PubMed, EMBASE, and SCOPUS with controlled vocabulary and keywords in various combinations to identify articles that reported on the defects and/or fracture of NiTi instrument used clinically (Jan 1980 till Aug 2021), with additional search manually by going through the list of references of the initially screened articles. Those satisfying the inclusion and exclusion criteria were entered into the analysis.Study Eligibility Criteria, Participants, and Interventions: All studies from the said databases reporting on NiTi root canal instruments that were deformed or separated during normal clinical use.Study Appraisal and Synthesis Methods: Studies with data available and suitable for meta-analysis were grouped according to the general design of the NiTi instruments for comparison. Safety quotient value was calculated based on the rate of instrument distortion and fracture.Results: Various instrument designs exhibited different incidences of distortion and fracture, hence a different “safety quotient” (ratio of the amount of deformed instruments to that of fractures in use). Heat-treated files showed the highest safety quotient value. All brands of NiTi file demonstrated a statistically significantly lower incidence of fracture, if treated as disposable instruments after clinical use in a patient.Limitations: Inclusion of articles written in English only, and grouping of file systems into general design types in the analysis.Conclusions and Implications of Key Findings: NiTi endodontic files should be scrutinized for defects before being used in the root canal. Disposing the NiTi instruments after clinical use in a patient (so-called “single use”) is recommended for minimizing fracture clinically. Certain instrument designs tend to show discernible deformation before they should fracture in the next use.

Calcium silicate-based cements (CSCs) are widely used in various endodontic treatments to promote wound healing and hard tissue formation. Chitosan-based accelerated Portland cement (APC-CT) is a promising and affordable material for endodontic use. This study investigated the effect of APC-CT on apoptosis, cell attachment, dentinogenic/osteogenic differentiation and mineralization activity of stem cells from human exfoliated deciduous teeth (SHED). APC-CT was prepared with various concentrations of chitosan (CT) solution (0%, 0.625%, 1.25% and 2.5% (w/v)). Cell attachment was determined by direct contact analysis using field emission scanning electron microscopy (FESEM), while the material extracts were used for the analyses of apoptosis by flow cytometry, dentinogenic/osteogenic marker expression by real-time PCR and mineralization activity by Alizarin Red and Von Kossa staining. The cells effectively attached to the surfaces of APC and APC-CT, acquiring flattened elongated and rounded-shape morphology. Treatment of SHED with APC and APC-CT extracts showed no apoptotic effect. APC-CT induced upregulation of DSPP, MEPE, DMP-1, OPN, OCN, OPG and RANKL expression levels in SHED after 14 days, whereas RUNX2, ALP and COL1A1 expression levels were downregulated. Mineralization assays showed a progressive increase in the formation of calcium deposits in cells with material containing higher CT concentration and with incubation time. In conclusion, APC-CT is nontoxic and promotes dentinogenic/osteogenic differentiation and mineralization activity of SHED, indicating its regenerative potential as a promising substitute for the commercially available CSCs to induce dentin/bone regeneration.

Objectives We assessed the impact of type of tooth on the outcome of root canal treatment (RCT) according to factors potentially weakening the prognosis such as preoperative apical periodontitis (AP) and treatment modality (primary or secondary RCT). Materials and methods We scrutinized patient documents including pre- and postoperative radiographs of 640 permanent teeth receiving non-surgical RCT at Helsinki University Clinic in 2008–2011. Of teeth, 44% were molars, 32% premolars, and 24% anterior teeth. Patients’ mean age was 51.5 years; 51% were male. AP was present in 60.5% of teeth preoperatively. We used the periapical index (PAI) to assess the radiographs and defined radiographically “healthy” and “healing” cases as successful. Statistical evaluation included chi-squared tests, Fisher’s exact tests, t tests, and logistic regression modeling. Results The overall success rate (SR) was 84.1%; 88.3% for primary and 75.5% for secondary RCT (p

Este estudo, por meio de microtomografia computadorizada, avaliou a eficácia de três diferentes instrumentos endodônticos de uso único, quanto ao preparo de canais mesiais curvos de primeiros molares inferiores. Um total de 27 dentes foram distribuídos em três grupos (n = 9), segundo o sistema utilizado na instrumentação: Reciproc® (G1), Reciproc Blue® (G2) e XP-endo Shaper® (G3). Os dentes foram escaneados por micro-CT, antes e após o preparo, para análise da variação do volume e área de superfície, transporte apical e centralização do preparo, e porcentagem de paredes não tocadas. A porcentagem de paredes não tocadas por toda a extensão do canal radicular resultou em uma média semelhante entre os grupos Reciproc e Reciproc Blue (70,75 e 70,24% respectivamente; p > 0,05) e estatisticamente diferentes quando esses grupos foram comparados ao grupo XP-endo Shaper (40,83%), com níveis de significância de p = 0,0298 e p = 0,0315, respectivamente. No terço apical (5 mm), menos paredes foram tocadas pelos grupos Reciproc (53,07%) e Reciproc Blue (59,79%) quando comparados ao grupo XP-endo Shaper (21,06%) (p = 0,0282 e p = 0,0096, respectivamente). Os aumentos de área foram de 40,92% (Reciproc), 41,65% (Reciproc Blue), não havendo diferenças estatisticamente significativas entre os dois grupos (p > 0,05); mas o grupo XP-endo Shaper apresentou, em média, uma área aumentada de 18,74%, demonstrando diferença estatisticamente significativa (p < 0,05) em relação aos grupos Reciproc e Reciproc Blue. No terço apical houve aumento da área de 24,96% no grupo Reciproc, de 40,27% no Reciproc Blue, e de 12,05% no grupo XP-endo Shaper, havendo diferença estatisticamente significativa entre os grupos XP-endo Shaper e Reciproc Blue (p = 0,0089). Houve aumento do volume em toda a extensão do canal de 35,14% para o grupo Reciproc, 35,01% para o Reciproc Blue, e 21,10% para o XP-endo Shaper, sem diferenças estatisticamente significativas (p > 0,05). No terço apical, os aumentos de volumes foram de 23,76%, 33,69% e 29,28% para os grupos Reciproc, Reciproc Blue e XP-endo Shaper, respectivamente, sem diferença estatisticamente significante (p > 0,05). Concluiu-se que os três sistemas produziram aumento de volume semelhantes. Entretanto, o sistema XP-endo Shaper® produziu um menor aumento de área e tocou uma porcentagem maior de paredes do que os sistemas Reciproc® e Reciproc Blue®. This study, using computerized microtomography, evaluated the effectiveness of three different single-use endodontic instruments, regarding the preparation of curved mesial channels of lower first molars. A total of 27 teeth were distributed in three groups (n = 9), according to the system used in the instrumentation: Reciproc® (G1), Reciproc Blue® (G2) and XP-endo Shaper® (G3). The teeth were scanned by micro-CT, before and after preparation, to analyze the variation in volume and surface area, apical transport and centralization of preparation and the percentage of untouched walls. The percentage of untouched walls along the entire root canal resulted in a similar average between the Reciproc and Reciproc Blue groups (70.75 and 70.24% respectively; p > 0.05) and statistically different when these groups were compared to the XP-endo Shaper group (40.83%), with significance levels of p = 0.0298 and p = 0.0315, respectively. In the apical third (5 mm), fewer walls were touched by the Reciproc (53.07%) and Reciproc Blue (59.79%) groups when compared to the XP-endo Shaper group (21.06%) (p = 0.0282 and p = 0.0096, respectively). The increases in area were 40.92% (Reciproc), 41.65% (Reciproc Blue) with no statistically significant differences between the two groups (p > 0.05); but the XP-endo Shaper group showed an average area increased by 18.74%, showing a statistically significant difference (p < 0.05) in relation to the Reciproc and Reciproc Blue groups. In the apical third, there was an increase in the area of 24.96% in the Reciproc group, 40.27% in Reciproc Blue, and 12.05% in the XP-endo Shaper group; with a statistically significant difference between the XP-endo Shaper and Reciproc Blue groups (p = 0.0089). There was an increase in volume over the entire length of the canal of 35.14% for the Reciproc group, 35.01% for the Reciproc Blue, and 21.10% for the XP-endo Shaper, without statistically significant differences (p > 0, 05). In the apical third, the volume increases were 23.76%, 33.69 and 29.28 for the Reciproc, Reciproc Blue and XP-endo Shaper groups, respectively, without statistical significance (p > 0.05). It was concluded that the three systems produced similar volume increase. However, the XP-endo Shaper® system produced a greater area increase and touched a greater percentage of walls than the Reciproc® and Reciproc Blue® systems.

Endodontic microsurgery is a highly predictable treatment option in most cases when conventional endodontic treatment is not feasible. Nevertheless, mandibular molars are still considered by clinicians to be the most difficult type of teeth, with the lowest success rate. In recent years, endodontic microsurgery has been attempted more frequently with the emergence of modern cutting-edge technologies such as dental operating microscopes, various microsurgical instruments, and biocompatible materials, and the success rate is increasing. This review describes the current state of the art in endodontic microsurgical techniques and concepts for mandibular molars. Notably, this review highlights contemporary equipment, technology, and materials.

Systematic review protocol: UPDATE PROSPERO CRD42020169255 Current review status: Review ended

[ES] Existen diferentes fuentes de células madre mesenquimales en la cavidad oral. Éstas se caracterizan por su potencial de autorenovación y propiedades de multidiferenciación y han demostrado ser una opción prometedora en las terapias de regeneración en el campo de la odontología y la medicina general. El objetivo del trabajo es realizar una revisión sistemática relativa a las células madre mesenquimales de origen dental., sus principales fuentes, potencial de diferenciacion y aplicaciones médicas y odontológicas. Dar a conocer un nuevo servicio que pueden proporcionar las clínicas odontológicas a sus pacientes vinculado a la obtención y almacenamiento de sus células madre mesenquimales en una empresa especializada durante un período de tiempo para su posible uso terapéutico futuro. Se dividen en dos partes: una relativa a la revisión sistemática y otra relativa a la obtención, transporte y almacenamiento de las células madre dentales. Para la revisión sistemática realiza una búsqueda manual y electrónica en las bases de datos PubMed, Scielo y Cochrane. Se incluyeron artículos relacionados con células madre de origen dental humanas, escritos en inglés o español y disponibles a texto completo que hubieran sido publicados en los últimos 10 años. Para la realización del protocolo clínico de obtención y almacenamiento de las células madre dentales se contactó con el laboratorio Biobanco Celular S.L. En la revisión sistemática se incluyeron 34 artículos para su análisis. Los resultados obtenidos en el campo de la odontología demuestran que las células madre mesenquimales de origen dental han logrado regenerar el complejo dentino-pulpar, el tejido periodontal y el tejido óseo siendo una alternativa terapéutica en el campo de la endodoncia, la periodoncia y la cirugía. Así mismo han demostrado efectos terapéuticos en numerosos procesos patológicos sistémicos. La conclusión más relevante es que las células madre mesenquimales han demostrado una alta capacidad proliferativa y multipotencial. Se encuentran en varios tejidos de la cavidad oral y son efectivas en tratamientos regenerativos en el campo de la odontología y la medicina general. Los biobancos celulares ofrecen la capacidad de poder criopreservar estas células durante un periodo de tiempo para uso terapéutico futuro.

(1) Background: Microorganisms originating from the microflora of the oral cavity are the main cause of the inflammatory diseases of the dental pulp and periapical periodontium, as well as the failure of endodontic treatment. The subsequent root canal treatment is not able to remove all the pathogens, and a small number of viable bacteria remain in the dentine tubules, which must be sealed by endodontic sealers. These sealers should have at least a bacteriostatic effect to prevent the remaining bacteria from reproducing. The aim of this study is to compare the short-term antibacterial activity of three endodontic sealers based on poly-epoxy resin, zinc oxide-eugenol and calcium silicate with a calcium hydroxide-based sealer. Calcium hydroxide is used as temporary intracanal medicament and, thus, should show significant antibacterial activity. (2) Methods: A total of 25 bovine dentine samples infected with Enterococcus faecalis were used in this study. After the sealer placement and a 24 h incubation period, the root canal walls were scraped, and the suspension of dentine fillings was used for a semi-quantitative evaluation of microbial growth. (3) Results: The poly-epoxide resin-based sealer ADSeal™ showed significant antibacterial properties. (4) Conclusions: The highest antibacterial activity was shown in poly-epoxide resin-based sealer group, followed by the zinc oxide-eugenol-based sealer and calcium silicate-based sealer.

The aim of this study to evaluate the biofilm formation of sulfate-reducing bacteria from two microbial species, Desulfovibrio desulfuricans (oral and environmental strain) and Desulfovibrio fairfieldensis, in root canals with fractured endodontic files in vitro and the biocorrosive changes that these strains are capable of promoting on the metal surface of endodontic files. Fourteen teeth were included with fractured # 90 Kerr files and inoculants of Desulfovibrio desulfuricans strains and Desulfovibrio fairfieldensis in a modified Postgate E culture medium. The inoculated teeth were evaluated at 28, 41, 51 and 477 days. The biofilm was evaluated through scanning electron microscopy (SEM) and confocal laser scanning microscope with the fluorophore the Live / Dead® kit. For the 477 day, chemical pickling followed, with subsequent evaluation of the metallic surface of endodontic files in the SEM. In the biofilm analyzes of 28, 51 and 477 days, a mixed biofilm was observed, with a predominance of living cells and areas of corrosion along the entire metallic surface of the file for the last time, contrasting the metallic surface of the control groups. The SRB showed cellular activity both on the metal surface of the file and on the dentin surface of the root canal at the deepest levels of the root canal, apical and medium, promoting biocorrosion along the metal surface of endodontic files. El objetivo de este estudio es evaluar la formación de biopelículas de bacterias reductoras de sulfato de dos especies microbianas, Desulfovibrio desulfuricans (cepa oral y ambiental) y Desulfovibrio fairfieldensis, en conductos radiculares con limas endodónticas fracturadas in vitro y los cambios biocorrosivos que estas cepas son capaces de la promoción en la superficie metálica de las limas endodónticas. Se incluyeron catorce dientes con limas Kerr # 90 fracturadas e inoculantes de cepas de Desulfovibrio desulfuricans y Desulfovibrio fairfieldensis en un medio de cultivo Postgate E modificado. Los dientes inoculados se evaluaron a los 28, 41, 51 y 477 días. La biopelícula se evaluó mediante microscopía electrónica de barrido (SEM) y microscopio de barrido láser confocal con el kit de fluoróforo Live / Dead®. Para el día 477, siguió el decapado químico, con la evaluación posterior de la superficie metálica de las limas endodónticas en el SEM. En el biofilm analizado de 28, 51 y 477 días se observó un biofilm mixto, con predominio de células vivas y áreas de corrosión a lo largo de toda la superficie metálica de la lima por última vez, contrastando la superficie metálica de los grupos control. El SRB mostró actividad celular tanto en la superficie metálica de la lima como en la superficie dentinaria del conducto radicular en los niveles más profundos del conducto radicular, apical y medio, promoviendo la biocorrosión a lo largo de la superficie metálica de las limas endodónticas. O objetivo deste estudo foi avaliar a formação de biofilme de bactérias redutoras de sulfato de duas espécies microbianas, Desulfovibrio desulfuricans (cepa oral e ambiental) e Desulfovibrio fairfieldensis, em canais radiculares com limas endodônticas fraturadas in vitro e as alterações biocorrosivas que essas cepas são capazes de promover na superfície metálica de limas endodônticas. Quatorze dentes foram incluídos com limas Kerr # 90 fraturadas e inoculantes com cepas Desulfovibrio desulfuricans e Desulfovibrio fairfieldensis em meio de cultura Postgate E modificado. Os dentes inoculados foram avaliados aos 28, 41, 51 e 477 dias. O biofilme foi avaliado por meio de microscopia eletrônica de varredura (MEV) e microscopia confocal de varredura a laser com o fluoróforo kit Live / Dead®. Após 477 dias, seguiu-se a decapagem química, com posterior avaliação da superfície metálica das limas endodônticas no MEV. Nas análises do biofilme de 28, 51 e 477 dias, observou-se um biofilme misto, com predomínio de células vivas e áreas de corrosão ao longo de toda a superfície metálica da lima pela última vez, contrastando com a superfície metálica dos grupos controle. As BRS apresentaram atividade celular tanto na superfície metálica da lima quanto na superfície dentinária do canal radicular nos níveis mais profundos do canal radicular, apical e médio, promovendo biocorrosão ao longo da superfície metálica das limas endodônticas.

Introduction: The aim of the study was to investigate (a) whether patients' mouth opening influenced their discomfort during maxillary buccal infiltration (MBI) anesthesia and (b) whether dentists preferred their patients' mouth opened during MBI or closed. Materials and Methods: The protocol of this study was registered in ClinicalTrials.gov (NCT03921190). In this parallel equivalence randomized clinical trial, 120 American Society of Anesthesiologists I or II adult patients with a maxillary posterior tooth diagnosed with irreversible pulpitis and normal apical tissues and scheduled for root canal treatment were included and randomly divided into two groups using a coin toss; Group A (n = 56) received MBI with an open mouth, while Group B (n = 64) were injected using a closed-mouth technique. Patients with psychological disorders, soft-tissue abnormalities, tenderness to palpation, or percussion, and those who used analgesics 12 h before the appointment were excluded. Patients rated their discomfort during needle penetration, cheek retraction, and their overall discomfort using a standard 100 mm visual analog scale (VAS). Furthermore, 50 practicing dentists assessed (on a standard 100 mm VAS) the visibility of the injection site and ease of cheek retraction during MBI using either technique and chose their preferred technique. Data were analyzed using the Student's t, independent sample t, and the Chi-square tests. Results: The mean discomfort experienced in Groups A and B were 32.4 and 31.6 upon needle penetration (P = 0.84), 28.9 and 18.9 upon cheek retraction (P < 0.001) and 32.6 and 25.0 throughout the injection procedure (P < 0.001), respectively. Out of 48 dentists who returned the completed forms, 38 dentists reported that they preferred the closed-mouth technique for MBI (P < 0.001). Conclusions: The closed-mouth technique of MBI anesthesia results in less patient discomfort and improved visibility.

Made available in DSpace on 2019-10-06T16:13:03Z (GMT). No. of bitstreams: 0 Previous issue date: 2018-09-01. Added 1 bitstream(s) on 2021-07-15T15:05:16Z : No. of bitstreams: 1 S0103-64402018000500452.pdf: 625631 bytes, checksum: 6bc6334552098e76a5012831fa232f4c (MD5) This study evaluated physicochemical properties, cytotoxicity and bioactivity of MTA Angelus (MTA), calcium silicate-based cement (CSC) and CSC with 30% Ytterbium oxide (CSC/Yb 2 O 3 ). Setting time was evaluated using Gilmore needles. Compressive strength was evaluated in a mechanical machine. Radiopacity was evaluated using radiographs of materials and an aluminum scale. Solubility was evaluated after immersion in water. Cell viability was evaluated by means of MTT assay and neutral red staining, and the mineralization activity by using alkaline phosphatase activity and Alizarin Red staining. The data were submitted to ANOVA, Tukey and Bonferroni tests (5% significance). The bioactive potential was evaluated by scanning electron microscopy. The materials presented similar setting time. MTA showed the lowest compressive strength. MTA and CSC/Yb 2 O 3 presented similar radiopacity. CSC/Yb 2 O 3 showed low solubility. Saos-2 cell viability tests showed no cytotoxic effect, except to 1:1 dilution in NR assay which had lower cell viability when compared to the control. ALP at 1 and 7 days was similar to the control. MTA and CSC had greater ALP activity at 3 days when compared to control. All the materials present higher mineralized nodules when compared with the control. SEM analysis showed structures suggesting the presence of calcium phosphate on the surface of materials demonstrating bioactivity. Ytterbium oxide proved to be a properly radiopacifying agent for calcium silicate-based cement since it did not affected the physicochemical and biological properties besides preserving the bioactive potential of this material. Department of Restorative Dentistry Araraquara Dental School UNESP – Univ Estadual Paulista Department of Clinical Dentistry School of Dentistry UFBA – Universidade Federal da Bahia Department of Restorative Dentistry Araraquara Dental School UNESP – Univ Estadual Paulista

Aim: This prospective clinical study analyzed the 24-month outcome of conventional apical surgery retro-filled with calcium-silicate cement versus apical surgery with simultaneous orthograde retreatment by means of clinical and radiographic criteria. Materials and methods: This study included 83 teeth affected by persistent periapical lesions in 68 patients. Mean age was 52 years (median = 51 years; range 19–81 years). Twenty-eight cases were treated with apical surgery, 16 cases with apical surgery with simultaneous orthograde retreatment and 39 cases with orthograde retreatment in previously treated teeth established as control group. Periapical index score (PAI) was used as radiographic criteria. Teeth were examined at 6 months, 1 and 2 years and classified as healed (without any symptoms and PAI ≤ 2), healing (without any symptoms and PAI = 3) or diseased (with symptoms or PAI ≥ 4 and not functional) on the basis of radiographic and clinical criteria. At 24 months evaluation, healed and healing were considered as success and diseased and fracture as failure. Multilevel GLM model and an ordered logistic regression as statistical analysis was made with level of significance set at p

Postoperative pain after root canal treatment can be reduced by applying recent advances in endodontic techniques and equipment. This systematic review includes current knowledge about pain after nonsurgical root canal treatment, including predictors, related factors, effects of recent advances, and management. A literature search was performed using the PubMed, ScienceDirect, and Cochrane Library databases for articles published between 1990 and 2016. Search keywords included postoperative pain, nonsurgical treatment, single visit, recent advances in endodontics, and management of postoperative pain with endodontic treatment. Only original research studies were included; editorials, reviews, brief notes, conference proceedings, and letters to the editor were excluded. The initial search yielded 4941 articles, which were assessed and filtered using the selection criteria. Sixty-five studies met the inclusion criteria and were included in the review. The findings showed that pain after nonsurgical root canal treatment occurred in 3-69.3% of patients. Microorganisms were identified as the primary contributors to postoperative pain, and there was no significant difference in postoperative pain between single- and multiple-visit treatments. Postoperative pain after root canal treatment ranges from mild to moderate and occurs even after optimally performed procedures. Furthermore, adequate management of postoperative pain is often considered an indicator of clinical excellence. Application of recently developed endodontic techniques and devices will reduce postoperative pain. Furthermore, a flexible, severity-based drug administration plan can be used to control and manage pain after root canal treatment. Application of the current research findings will reduce pain following root canal treatment and improve patient outcomes.من الممكن إنقاص آلام ما بعد الجراحة لمعالجة القناة الجذرية من خلال تطبيق التطورات الحديثة في التقنيات والمعدات لعلاج الجذور. إن هذه المقالة المرجعية تقدم المعرفة الحالية حول الألم لمعالجة القناة الجذرية غير الجراحية بما في ذلك توقع الحدوث، والعوامل المرتبطة، وتأثيرات التطورات الحديثة، والعلاج. روجعت الأدبيات الطبية بين عامي ١٩٩٠م-٢٠١٦م باستخدام قواعد البحث PubMed, Cochrane, ScienceDirect. اشتملت الكلمات المفتاحية للبحث ألم ما بعد الجراحة، والعلاج غير الجراحي، وزيارة واحدة، والتطورات الحديثة في علاج الجذور، وعلاج ألم ما بعد جراحة الجذور. كما اشتملت المراجعة على الأبحاث الأصيلة فقط بينما تم استبعاد المقالات الافتتاحية، والمراجعات، والملاحظات المختصرة، ومحاضر المؤتمرات، والرسائل إلى المحرر. وأسفر البحث الأولي عن ٤٩٤١ مقالة، تم تقييمها وتصفيتها وفقا لمعايير الاختيار. وتوافقت ٦٥ مقالة مع معايير الاختيار، وتم تضمينها في هذه المقالة المرجعية. أظهرت النتائج حدوث ألم ما بعد معالجة القناة الجذرية غير الجراحية لدى ٣- ٣.٦٩٪ من المرضى. وتم تحديد الكائنات الحية الدقيقة كمسببات أساسية لألم ما بعد العلاج، ولم يكن هناك فرق في ألم ما بعد الجراحة بين زيارة واحدة وعدة زيارات علاجية. تراوح ألم ما بعد الجراحة لعلاج القناة الجذرية من خفيف إلى معتدل، وحدث حتى عند تنفيذ الإجراءات على النحو الأمثل. وبالإضافة إلى ذلك، يعتبر علاج ألم ما بعد الجراحة غالبا مؤشرا على التميز السريري. قلل تطبيق التقنيات والأجهزة الحديثة في علاج الجذور من ألم ما بعد الجراحة. بالإضافة إلى ذلك، يمكن أن يستعمل وصف الأدوية بشكل مرن بحسب حدة الألم للسيطرة على ألم ما بعد علاج القناة الجذرية. إن تطبيق نتائج هذا البحث سوف يقلل من ألم ما بعد علاج القناة الجذرية ويحسن نتائج المرضى.

Background and aims. The sterilization of the entire root canal system represents the main goal of every endodontist, given the fact that the control of the microbial flora is the key point of every root canal treatment. The diversity of microorganisms found inside the root canal and also the resistance of some bacterial species to intracanal medications led to a continuous development of new endodontic products. The present study focuses on the comparison of the antibacterial and antifungal properties of different endodontic products, two commercially available, one experimental plant based extract, and two control substances. Methods. The disc diffusion assay was used to determine the antibacterial and antifungal properties of chlorhexidine, calcium hydroxide, a mix extract between Arctium lappa root powder and Aloe barbadensis Miller gel, Amoxicillin with clavulanic acid and Fluconazole (as control substances). Two of the most common microorganisms found in endodontic infections were chosen: Enterococcus faecalis (ATCC 29212) and Candida albicans ATCC(10231). Results. All tested substances showed inhibition zones around the discs, for Enterococcus faecalis and Candida albicans , including the experimental mix extract of Arctium lappa root powder with Aloe vera gel. Conclusion. The experimental mix extract of Arctium lappa root powder and Aloe vera gel is able to inhibit very resistant microorganisms, like Enterococcus faecalis and Candida albicans.

Objective To quantify the persistence of residues after endodontic retreatment related to the root canal obturation technique (lateral compaction or single cone) previously performed and the solvent used (xylol or Endosolv-R) in the cervical and root apical segment using digital radiograph. Materials and methods Forty root canals were prepared using the F2 instrument and filled with gutta-percha and AH Plus, 20 canals using #25 point by lateral compaction and the other 20 using F2 point by single cone. The root canals were transversely sectioned, and two segments (cervical and apical) were obtained. Radiographs were taken from the segment in buccolingual and mesiodistal direction, as well as the area that was originally filled with the root canal obturation was measured using ImageJ. After the specimens were set on special devices, the obturations were removed using the rotary system and divided into four groups (n = 10): G1 — lateral compaction and xylol; G2 — lateral compaction and Endosolv-R; G3 — single cone and xylol; and G4 — single cone and Endosolv-R. A new radiograph was taken and the area occupied by residues was measured. The persistence of residues was obtained from the obturation remaining in the root canal in percentage. The data were analyzed using Kruskal—Wallis test (p = 0.05). Results There was no difference among the examined groups, regardless of the radicular segment or the radiograph direction (p > 0.05). Conclusion The endodontic retreatment using xylol or Endosolv-R in the obturations previously performed by lateral compaction or single cone technique presented similar persistence of residues in the root canal, regardless of the radicular segment. How to cite this article Aranda-Garcia AJ, Kuga MC, Vázquez-Garcia FA, Tonetto MR, Bandeca MC, Lima SNL, Freitas J, Borges AH, Jordão-Basso KCF, do Carmo Monteiro JC. Persistence of Residues after Endodontic Retreatment related to the Obturation Technique and to the Solvent. World J Dent 2017;8(1):41-44.

Science and commerce advance together and the stem cell field is no exception. With the promise of cures for conditions as diverse as cancer, autism, neural degeneration, organ replacement and addiction, long-term preservation of dental stem cells is a growth market. The discovery nearly twenty years ago, of viable, multipotent, stem cells in dental pulp from both baby and adult teeth initiated, and drives, this market.The dental stem cell preservation services, “tooth banks”, focus on the collection of a child’s baby teeth, as they are shed naturally, and storage of the stem cells from within the pulp for therapeutic use in later years should the child require them. This review focuses on the procedures related to these stem cell storage services and may serve as an introduction for many to the practice of “tooth banking”.

Antibiotic resistance is one of our most serious global health threats. The adverse effects of overusing and misusing antibiotics are highly publicized in the health professional literature. Antibiotic abuse occurs during routine endodontic treatment and there are deficiencies in knowledge regarding prescribing antibiotic and appropriate prophylactic antibiotic use. Multidisciplinary coordination and cooperation among dentists, pharmacists, and patients is needed to curb antibiotic abuse. As endodontists, we can become part of the solution to the antibiotic resistance crisis and deal with it conclusively. This review article discusses antibiotic resistance resulting from antibiotic abuse during endodontic treatment, various factors contributing to it, and measures required for stopping antibiotic abuse in endodontic treatment. A web-based research on MedLine was performed with terms Review Articles published in the last 10 year's dental journals in English for literature researching, extracting, and synthesizing data. Relevant articles were shortlisted. Important cross-reference articles were also reviewed.

Objectives To compare the success, survival and costs of selective versus stepwise carious tissue removal (SE/SW) in permanent teeth with deep (>2/3 dentine depth) carious lesions. Design Randomised controlled, unicentre, clustered two-arm superiority trial. Setting Outpatient clinic of a private university in Cairo, Egypt. Participants One hundred and fifteen participants (n=132 teeth), aged 18–47 years, from Cairo, Egypt, were enrolled. Premolars/molars with occlusal/occlusal-proximal deep lesions (radiographically >2/3 dentine), sensible pulps, without spontaneous pain, were included. Interventions Peripheral carious tissue removal to hard dentine was performed. Pulpo-proximally, soft dentine was left. A glass ionomer (GI) restoration was placed. After 3–4 months, teeth were randomly allocated to SE (n=66), with reduction of the GI into a base and no further tissue removal, followed by a composite resin restoration, or SW (n=66), with full removal of the GI, additional excavation until firm dentine pulpo-proximally, followed by a GI-based composite restoration. Mean follow-up was 1 year. Primary and secondary outcome measures Primary outcome was success (absence of endodontic/restorative complications). Secondary outcomes were tooth survival and initial and total treatment costs. Results Zero/five pulp exposures occurred during SE/SW, and seven/five SE/SW teeth required endodontic therapy. Success after 12 months was 89.4% for SE and 84.9% for SW. The estimated mean time free of complications was 23 and 18 months for SE and SW, respectively, without significant differences between SE and SW (p>0.05/Cox). Initial treatment costs were significantly higher for SW (mean (SD): 507.5 (123.4) Egyptian pounds (EGP)) than SE (mean (SD): 456.6 (98.3) EGP), while total costs showed no significant difference (p>0.05). Conclusion Within the limitations of this interim analysis, and considering the depth of these lesions (>2/3 dentine), SE and SW showed similar risk of failure and overall costs after 1 year. Trial registration number PACTR201603001396248.

Einleitung: Für den langfristigen Erfolg einer endodontischen Behandlung ist die mechanische Erweiterung und die suffiziente Desinfektion des Kanalsystems von entscheidender Bedeutung. Eine größtmögliche Entfernung der Mikroorganismen ist das Ziel. Konventionelle Therapieprotokolle können diese Anforderung aufgrund der Komplexität des Wurzelkanalsystems nicht immer erfüllen. Gegenwärtig wird nach Behandlungsstrategien gesucht, die eine zuverlässige Desinfektion des Wurzelkanals sicherstellen. Zielsetzung: Ziel dieser In-vitro-Studie war die bakterienreduzierende Wirksamkeit verschiedener Spülprotokolle, der photodynamischen Therapie (PDT) sowie der kombinierten Anwendung von chemomechanischer Aufbereitung und adjuvanter PDT auf einen Multispeziesbiofilm zu untersuchen. Material und Methode: 160 extrahierte, humane Zähne wurden standardisiert aufbereitet und sterilisiert. Es folgte eine Inokulation der Proben mit den Spezies Enterococcus faecalis (E. faecalis), Streptococcus oralis (S. oralis) und Prevotella intermedia (P. intermedia). Der Nachweis für die Ausbildung eines Multispeziesbiofilmes entlang der Kanalwand wurde durch eine Fluoreszenz-in-situ-Hybridisierung (FISH) erbracht. Zu Beginn der Versuchsdurchführung wurde in jedem Wurzelkanal die planktonische Bakterienkonzentration bestimmt. Anschließend erfolgte die endodontische Therapie mit der Aufbereitung des Wurzelkanals um drei weitere ISO-Größen. Die Proben wurden auf vier Hauptgruppen (HG) aufgeteilt. Die HG 1 erfuhr keine chemomechanische Aufbereitung, sie diente als Kontrollgruppe. In der HG 2 wurde intermittierend mit Natriumchloridlösung (NaCl) 0,9 % gespült. HG 3 und HG 4 erfuhren eine Aufbereitung mit Natriumhypochloritspülung (NaOCl) 1 %. In der HG 4 erfolgte eine Abschlussspülung mit Chlorhexidindigluconatlösung (CHX) 2 %. Die Hälfte der Proben in jeder HG erhielt eine adjuvante PDT. Nach der Behandlung wurden in jedem Wurzelkanal die planktonische sowie die dentinadhärente Bakterienkonzentration bestimmt. Die Probenentnahmen erfolgten zu zwei Zeitpunkten: direkt nach der Therapie (T1) oder nach fünf Tagen erneuter Inkubation (T2). Ergebnisse: Für die planktonischen Bakterien wurde ein signifikant höherer Reduktionsfaktor (LRF) der koloniebildenden Einheiten pro Milliliter (KBE/ml) zu beiden Zeitpunkten T1 (HG 3: 6,3 ± 1,3; HG 4: 6,3 ± 0,7) und T2 (HG 4: 2,4 ± 2,4) durch die Spülung mit desinfizierenden Lösungen nachgewiesen (p < 0,0001; ANOVA). Ein signifikanter Einfluss der PDT zeigte sich nur zum Zeitpunkt T2. Die Kombination aus chemomechanischer Aufbereitung mit NaOCl und CHX und anschließender PDT erzielte sowohl gegenüber der Kontrollgruppe (p < 0,0001; Tukey-HSD) als auch gegenüber der alleinigen chemomechanischen Aufbereitung (p = 0,001; T-Test) eine signifikant höhere Bakterienreduktion. In 85,6 % aller Wurzelkanäle stimmten die kategorialen Ergebnisse der Bakterienkonzentration im Dentin mit denen der planktonischen Bakterien überein. Schlussfolgerung: Eine zuverlässige Bakterienreduktion wurde durch die Spülung mit desinfizierenden Lösungen erzielt. Die PDT konnte nur unter bestimmten Voraussetzungen als therapieergänzende Maßnahme die Bakterienreduktion steigern., Introduction: For the long-term success of endodontic treatment chemomechanical debridement is of great importance. Conventional root canal therapy does not always achieve complete disinfection of the root canal system. Todays research focuses on additional treatment strategies for eradication of microorganisms in the root canal system. Aim: The objective of this study was to compare the antibacterial effect of conventional endodontic treatment with various irrigation protocols and photodynamic therapy (PDT) and the combination of both strategies on the removal of a multispecies biofilm in human root canals in vitro. Methodology: A total of 160 extracted human single-rooted teeth were divided into four groups (n = 40). In group G1 (control group) preparation was performed up to size 60. In group G2 to G4 root canals were enlarged up to size 40. All root canals were inoculated with the bacterial species Streptococcus oralis (S. oralis), Prevotella intermedia (P. intermedia) and Enterococcus faecalis (E. faecalis) for four days. The presence of a multispecies biofilm covering the dentinal wall was verified by Fluorescence-in-situ-Hybridization (FISH). In all specimen samples of planktonic bacteria were taken at baseline. In G2 to G4 root canals were enlarged up to size 60 using the following irrigation solutions: 0.9% sodium chloride (NaCl) (G2), 1% sodium hypochlorite (NaOCl) (G3), 1% sodium hypochlorite (NaOCl) and a final rinse with 2% chlorhexidine (CHX) (G4). Half of the root canals of each group received an adjunctive PDT. After treatment planktonic and dentine-adherent bacterial concentration were evaluated by counts of colony-forming units (CFUs) immediately after treatment (T1) or after five days of further incubation (T2). Results: Irrigation protocol using antibacterial solutions reduced the concentration of planktonic bacteria at T1 and T2 significantly (p < 0.0001; ANOVA). Adjunctive PDT significantly reduced bacterial levels only at T2 (p < 0.0001; ANOVA). PDT after irrigation using NaOCl and CHX was significantly more effective in reducing CFU compared to both, control group (p < 0.0001; Tukey-HSD) and chemomechanical debridement alone (p = 0.001, T-Test). For both planktonic and dentine-adherent bacteria the same categories of CFU counts were registered in 85.6 % of all samples at T1 and T2. Conclusion: An irrigation protocol including disinfectant solutions reduced bacterial counts reliable. After five days of further incubation in combination with an irrigation protocol including NaOCl and CHX adjunctive PDT achieved a higher bacterial reduction in root canals than irrigation alone.

We report the surgical endodontic treatment of a maxillary first premolar with a lateral lesion that originated from an accessory canal. Although lesions originating from accessory canals frequently heal with simple conventional endodontic therapy, some lesions may need additional and different treatment. In the present case, conventional root canal retreatment led to incomplete healing with the need for further treatment (i.e., surgery). Surgical endodontic management with a fast-setting calcium silicate cement was performed on the accessory canal using a dental operating microscope. At the patient's 9-month recall visit, the lesion was resolved upon radiography.

Цель исследования – дать оценку инструментальной обработки корневых каналов системой ручных инструментов ProTaper Universal. Объектом исследования были 72 экстрагированных зуба: 44 однокорневых и 28 многокорневых. Все зубы были разделены на две группы: в первой обработка корневого канала проводилась по классической методике инструментами из нержавеющей стали фирмы Kerr, во второй – системой инструментов ProTaper Universal согласно рекомендациям производителя. Оценку осуществляли при помощи рентгенографии и микроскопии продольных срезов. Для этого образцы подвергались специальной обработке и исследованию в проходящем свете посредством прямого микроскопа Axio Scope. A1 Carl Zeiss. В ходе исследования установлено 50% несоответствий ко всем предъявляемым требованиям в целом у образцов 1 группы и 30% у 2 группы. Также во 2 группе отмечалось лучшее состояние структуры дентина. При работе с ручными никель-титановыми инструментами значительно сокращались временные затраты, количество используемых файлов ограничивалось тремя на каждый образец. В то же время работа с файлами из нержавеющей стали занимала больше времени, была трудоемкой. Использование современных ручных никель-титановых инструментов повышает качество инструментальной обработки корневых каналов с различной анатомией, уменьшает временные затраты и, главное, риск возникновения осложнений. Это является показателем для использования системы ProTaper Universal в ежедневной практике врача-стоматолога., The purpose of the study is to evaluate the instrumental root canal treatment with the ProTaper Universal hand tools system. The object of the study were 72 extracted teeth: 44 single-rooted and 28 multirooted. All teeth were divided into two groups: in the first treatment of the root canal was carried out according to the classical technique with Kerr stainless steel tools, in the second with the ProTaper Universal tool system according to the manufacturer's recommendations. The evaluation was carried out by means of radiography and microscopy of longitudinal sections. For this the examples were subjected to special treatment and examination in transmitted light by means of a direct microscope Axio Scope.A1 Carl Zeiss. In the course of the study, 50% of the inconsistencies in all requirements for the whole of the samples of group 1 and 30% of group 2 were found. Also in the second group was noted the best condition of the dentine structure. During working with manual nickel-titanium instruments, time costs were significantly reduced, the number of used files was limited to three for each sample. At the same time, working with files from stainless steel took more time, was laborious. The use of modern hand-held nickel-titanium tools improves the quality of instrumental processing of root canals with various anatomy, reduces time costs and, most importantly, the risk of complications. This is the reason for using the ProTaper Universal system in the daily practice of a dentist.

Introduction : Patients treated with orthodontics show short root due to apical root resorption. Aim: The aim of the study was to compare the external apical root resorption (EARR) of endodontically treated teeth before and after orthodontic movements using clear aligner therapy. Materials and Methods: The study group comprised 22 class I adult healthy patients with a mean age of (28 ± 8.2) years treated with clear aligner therapy. Thirty-four endodontically treated teeth (maxillary incisors and molars) were measured for the extent of the EARR in panoramic radiographs at the beginning and at the end of clear aligner therapy. Root resorption was measured using an electrical digital caliper (Mitutoyo Manufacturing Co. Ltd., Tokyo, Japan) on the dental panoramic radiographs from the mesial cusps of the first molar tooth to the apex of the root, and from the incisal edge to the apex of the root for the central incisors. Results and Discussion: All the endodontically treated teeth demonstrated reduction in pretreatment root length. Less than one percent of EARR was found in 4 teeth, and 1%–4.9% of the EARR was observed in 23 teeth. Six teeth showed EARR of 5–7.9 while only one tooth EARR in the range of 8–10. A pretreatment versus posttreatment comparison of median root lengths of #16, #26, #36, and #46 showed a statistically significant difference (P < 0.05). The mean differences of root lengths after clear aligner therapy among different teeth showed no significant difference (P = 0.981). Conclusion: All the endodontically treated teeth showed minimal external root resorption after orthodontic treatment with a clear aligner.

Aims and Objectives: The present study was undertaken for evaluating various hand instrumentation techniques with different instruments in the formation of smear layer. Materials and Methods: One hundred and seventy-five extracted mandibular molars were collected and were cut at cementoenamel junction. Afterward, the distal roots were separated. Working length was determined, and roots were divided into five equal groups with 35 roots in each group as follows: Group A: K-type files with conventional step-back technique, Group B: Canal Master U instrument with clockwise–counterclockwise rotation, Group C: Flex-R® files with clockwise–counterclockwise rotation, Group D: FlexoFiles® with conventional step-back technique, and Group E: Nickel titanium files with conventional step-back technique. Biomechanical preparation was done according to their respective groups. The teeth in various groups were scanned under scanning electron microscope and scoring was done. All the results were analyzed by SPSS software version 17.0. Results: Scanning electron microscopic results indicated that apparently there seems to be a significant difference in the scoring of the smear layer between each group at all the three levels, but the difference was statistically nonsignificant. Microleakage was present in all the samples. Nonsignificant results were obtained while comparing the microleakage in between different the groups. However, microleakage was highest in Group D. Conclusion: The amount of smear layer is maximum at the apical third and lesser in the middle third followed by the coronal third in all the groups. All the samples showed microleakage to a varying extent.

The study aimed to explore the profile of articles published on pulp revascularization by a bibliometric analysis. Material and methods: A search was conducted on the PubMed database and studies were independently categorized according to: (i) year of publication; (ii) country where the study was conducted; (iii) study design; (iv) main topic addressed; (v) main conclusion of the article; and (vi) clinical application/other results. Findings were reported descriptively. There was not restriction regarding to initial date and the established final date was December 2014. Results: 133 studies were found; but only 86 articles were included. The most of them was published recently (23.2% in 2014) and were conducted in 24 different countries. The most frequent study design was case report (37.2%), followed by narrative reviews (16.2%). The main topic addressed was the radiographic outcomes (38.3%) and tissue engineering (19.7%). Some of the articles point the clinical application of their results. Conclusion: Most of the publications highlight that the disinfection of the root canal (and the stimulation of residual stem cells) would induce formation of new hard tissue on the dentin wall and continue root development in length, improving the tooth survival. The number of publications on pulp revascularization has increased recently, but the majority of articles published are studies with low levels of evidence.

Objectives: Obliteration of the root canal system due to accelerated dentinogenesis and dystrophic calcification can challenge the achievement of root canal treatment goals. This paper describes the application of 3D digital mapping technology for predictable navigation of obliterated canal systems during root canal treatment to avoid iatrogenic damage of the root.Methods: Digital endodontic treatment planning for anterior teeth with severely obliterated root canal systems was accomplished with the aid of computer software, based on cone beam computer tomography (CBCT) scans and intra-oral scans of the dentition. On the basis of these scans, endodontic guides were created for the planned treatment through digital designing and rapid prototyping fabrication.Results: The custom-made guides allowed for an uncomplicated and predictable canal location and management.Conclusion: The method of digital designing and rapid prototyping of endodontic guides allows for reliable and predictable location of root canals of teeth with calcifically metamorphosed root canal systems.Clinical significance: The endodontic directional guide facilitates difficult endodontic treatments at little additional cost. (C) 2016 Published by Elsevier Ltd.

There is a growing realization that endodontic infections are often polymicrobial, and may contain Candida spp. Despite this understanding, the development of new endodontic irrigants and models of pathogenesis remains limited to mono-species biofilm models and is bacterially focused. The purpose of this study was to develop and optimize an interkingdom biofilm model of endodontic infection and use this to test suitable anti-biofilm actives. Biofilms containing Streptococcus gordonii, Fusobacterium nucleatum, Porphyromonas gingivalis, and Candida albicans were established from ontological analysis. Biofilms were optimized in different media and atmospheric conditions, prior to quantification and imaging, and subsequently treated with chlorhexidine, EDTA, and chitosan. These studies demonstrated that either media supplemented with serum were equally optimal for biofilm growth, which were dominated by S. gordonii, followed by C. albicans. Assessment of antimicrobial activity showed significant effectiveness of each antimicrobial, irrespective of serum. Chitosan was most effective (3 log reduction), and preferentially targeted C. albicans in both biofilm treatment and inhibition models. Chitosan was similarly effective at preventing biofilm growth on a dentine substrate. This study has shown that a reproducible and robust complex interkingdom model, which when tested with the antifungal chitosan, supports the notion of C. albicans as a key structural component.

The perio-endo lesions confront the clinician as far as diagnosis and prognosis of the affected teeth is concerned. Hemisection is the treatment choice for perio-endo lesions to preserve the remaining part of the molar having sound periodontium. It is a resection of periodontally involved root along with the associated crown portion. Prognosis and treatment of perio-endo lesions depend on the severity of bone loss, root trunk length, degree of root separation, curvature of root, ability to eradicate the osseous defect, and restorative and oral hygiene procedures. In this case report, root canal treatment and hemisection were successfully performed to treat advanced perio-endo lesions. By this way, natural tooth and surrounding structures were preserved and thereby cost was lesser than the other treatment alternatives.

This systematic review aimed to analyze the efficacy of corticosteroid premedication compared to placebo or no treatment to reduce postoperative pain in endodontic patients. Randomized controlled trials (RCTs) assessing corticosteroids via oral, intramuscular, subperiosteal, intraligamentary or intracanal route compared to passive or active placebo, or no treatment were included. Four databases were searched: PubMed, Web of Science, Cochrane Library and Embase up to 2/21/2018. Risk of bias was assessed with Cochrane Risk of bias tool. Fourteen RCTs with 1,462 generally healthy adults in need of endodontic treatment were included. 50% of the studies were at unclear risk and 50% at high risk of bias. Meta-analysis showed Visual Analog Scale (VAS) pain at 4–6 hours after Inferior Alveolar Nerve Block (IANB) was significantly lower by 21 points (0–100 scale) in the corticosteroid group compared to the control group (95% CI −35 to −7; P = 0.003), however this difference was not statistically significant after 24 hours (P = 0.116). The route of administration was oral and intraligament injection. Patients who received corticosteroids prior to IANB were 70.7% more likely to have none or mild pain 4–8 hours after treatment (P = 0.001) and 13.5% more likely 24 hours after IANB (P = 0.013) than patients in the control group. In conclusion, corticosteroid administration (oral or intraligamental) may clinically reduce the level of postoperative pain at 4–8 hours after IANB, however the quality of the evidence was low/moderate due to risk of bias and heterogeneity. Further studies are recommended.

Objectives: The aim of this study is to determine the success rate of the endodontically treated teeth in patients attending the Polyclinic, Kulliyyah of Dentistry, International Islamic University Malaysia (IIUM), from 2012 to 2015. Materials and Methods: A retrospective study involved endodontically treated teeth of patients attending the Polyclinic, Kulliyyah of Dentistry, IIUM, from 2012 to 2015. Clinical and radiographic data were recorded and classified as successful or failed, and further analyzed by Fisher's exact test to measure the correlation between the variables using SPSS software version 16.0. Kappa test was used to measure the overall relationship between clinical and radiographic findings. Results: A total of sixty teeth were evaluated clinically and radiographically, the overall success rate was 85% (n = 51). Correlation between the variables showed nonsignificant (P > 0.05) in the success rate among age, gender, and race, upper and lower arches and between anterior and posterior teeth at the time of treatment. At postendodontic fixed restorations, the variables showed statistically significant relationship with the success rate (P < 0.05). Conclusions: Patients with no signs and symptoms and with no radiographical changes at the the time of clinical examination, showed the highest percentage of success rate (85%) of postendodontic fixed restorations. Age, gender, and race have no significant relations with the success rate of endodontically treated teeth.

Aim To investigate the impact of systemic health and tooth-based factors on the outcome of root canal treatment (RCT). Methodology The target population consisted of all patients receiving RCT at the Helsinki University Clinic in 2008-2011. The inclusion criteria were diagnosable pre- and postoperative (minimum 6 months after root filling) radiographs and adequate patient records of RCT available. Teeth extracted for nonendodontic reasons were excluded. Patient documents including digital radiographs of 640 permanent teeth in 504 patients were scrutinized. The radiographs were assessed by two examiners under standardized conditions. The Periapical Index was used to define radiographically 'healthy' and 'healing' cases as successful. Data included systemic health, technical quality of root fillings, type of restoration and level of alveolar bone loss. Statistical evaluation of differences between groups included chi-squared tests and Fisher's exact tests. Logistic regression modelling utilizing robust standard errors to allow for clustering within patients was applied to analyse factors related to the outcome of RCT. Results The mean age of patients was 51.5 years (standard deviation (SD) 15.0; range 10-83), and 49% were female. In 41 cases (6%), the patient had diabetes mellitus (DM), in 132 (21%) cardiovascular disease and in 284 (44%) no systemic disease. The follow-up period was 6-71 months (mean 22.7). In the primary analyses, the success rate of RCT was 73.2% in DM patients and 85.6% in patients with no systemic disease (P = 0.043); other systemic diseases had no impact on success. In the multifactorial analysis, the impact of DM became nonsignificant and RCTs were more likely to succeed in the absence of apical periodontitis (AP; odds ratio (OR) = 4.4; P

As the dental pulp could not be directly inspected before endodontic treatment, indirect evaluation of the pulp status via (para)/clinical tests should be performed which need careful inspection. This report presents a root-treated right maxillary first molar with recurrent abscess formation and a radiolucent periradicular lesion surrounding the distobuccal root of the right maxillary second molar. The patient underwent surgical retreatment, employing CEM root-end filling, which resulted in no relief from sign/symptoms. In the cone-beam computed tomography (CBCT), the relationship of the lesion with the mesio-buccal root of the second maxillary molar was detected. Despite the latest tooth showed positive responses to pulp sensibility tests, endodontic therapy was planned for it. During treatment, it became clear that the mesiobuccal canal pulp was necrotic, although vital pulp tissues were present in two other root canals. Following treatment, full recovery from all discomforts was obtained and the lesion healed after 18 months. This case showed that a more complicated evaluation such as CBCT should be used for diagnosis of perpetuated lesions. Furthermore, it might be probable that root canals of vital teeth become necrotic due to involvement in the adjacent apical lesion, a phenomenon known as anachoresis.

Introduction: The aim of this study was to compare root preparation of deciduous teeth with WaveOne Large (WO) and ProTaper F4 (PT) instruments with or without passive ultrasonic irrigation (PUI). Methods and Materials: Forty-eight deciduous teeth were scanned before and after root preparation and divided in four groups (n=12): WO+EDTA (WO); WO+EDTA with PUI (WOPUI); PTF+EDTA (PT); and PT+EDTA with PUI (PTPUI). Root canal enlargement by micro-computed tomography and root canal cleaning by scanning electron microscopy (SEM) were analyzed. Data were submitted to two-way ANOVA and Tukey’s tests to analyze the root canal volume variation, and Kruskal-Wallis followed by Friedman and Wilcoxon tests were used to evaluate the cleaning efficacy. The level of significance was set at 0.05. Results: No significant difference occurred in total volume between groups (P>0.05). On analysis by thirds of the root canal, there was a difference in volume between WO (cervical) compared to WO and PT (apical), and PTPUI (middle and apical) (P

Introduction: The objective of this study was to evaluate the physical properties, cytotoxicity and sealing ability of HealApex _a new premixed calcium-silicate-phosphate-based biosealer_ in comparison with AH-26. Methods and Materials: Setting time, working time, film thickness, flow and radiopacity evaluation were performed according to ISO 6876 specification. L929 fibroblasts were incubated with the extracts of sealers and cytotoxicity was then evaluated using MTT assay. Thirty intact extracted human premolars were instrumented using step-back technique. The specimens were obturated with gutta-percha and experimental sealers employing lateral condensation technique. Sealing ability of sealers was investigated for up to one month using fluid filtration method. Data were statistically analyzed by t-test and ANOVA. Results: Physical properties of both sealers conformed to ISO specification. AH-26 exhibited significantly higher flow, higher radiopacity and lower film thickness; whereas HealApex showed lower setting time (P