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The reconstruction of alveolar ridge defects can be challenging, especially when the lesion is large, noncontained, and located in the esthetic region. The present report describes the guided bone regeneration (GBR) procedure and prosthetic rehabilitation of a severe perforation defect in the anterior maxilla. Clinical and radiographic evaluations of the lesion indicated an endodonticperiodontal origin, and biopsy results confirmed the absence of malignancy. GBR was performed with the use of cortical mineralized freeze-dried bone allograft (FDBA) combined with recombinant human platelet-derived growth factor-BB (rhPDGF-BB) and a resorbable collagen membrane without the use of tenting or fixation screws. Six months after GBR, CBCT revealed adequate bone fill for the placement of 4.1 × 10-mm or 4.1 × 12-mm dental implants. The implant surgery was fully guided with a two-stage approach. After 10 months of healing, the implants were loaded with a screw-retained porcelain partial denture. The staged GBR approach, using a combination of FDBA, rhPDGF-BB, and a resorbable membrane without the use of tenting or fixation screws, resulted in significant bone fill, successful implant placement, and a functional and esthetic implant-supported prosthesis. [ABSTRACT FROM AUTHOR]

This retrospective study evaluated the clinical outcomes of surgical crown reattachment in the treatment of complicated crown-root fractures in permanent teeth in 35 patients. Treatments were defined as follows: surgical crown reattachment combined with internal fixation with a fiber-reinforced core post, ostectomy, and reattachment of the original crown fragment. Patients were examined to record the periodontal pocket depth (PD), marginal bone loss, tooth migration, and coronal fragment looseness or loss. In most cases, the fracture lines on the palatal aspect were located below the alveolar crest. About 20% to 30% of teeth had periodontal pockets ≥ 3 mm present at least 1 year after surgery. Significant PD differences were observed between the traumatized teeth and adjacent untraumatized teeth at 6 months. The available evidence suggests that surgical crown reattachment is a feasible and effective technique for managing complicated crown-root fractures in permanent teeth. [ABSTRACT FROM AUTHOR]

Tooth autotransplantation is an effective treatment to replace missing teeth. Digital planning can facilitate successful autotransplantation. Guiding templates are highly recommended when performing cases in healed ridges in the posterior area to reduce excessive bone loss and increase the chances of fitting the donor tooth in the new socket. This case report highlights the use of 3D planning tools and fully guided drilling templates for successful tooth autotransplantation in the posterior area. Two tooth autotransplantations were performed in a 51-year-old patient using mandibular third molars to replace hopeless mandibular first and second molars. Root canal treatments were carried out before the surgeries, and different alveoloplasty techniques were used in each recipient area. The prosthetic phase was carried out after 9 months. Both teeth were asymptomatic, functional, and exhibited no signs of resorption or apical radiolucency and showed complete regeneration of the periodontal apparatus at the 2-year follow-up. [ABSTRACT FROM AUTHOR]

Objectives: The prevalence and the economic burden of periodontal disease are high. To save or replace diseased teeth, an objective prognosis assessment using the long-term predictability of the various treatment options should be performed. As dental implants have become a treatment of choice for replacing missing teeth, the number of implant failures and complications has also increased. The objective of this review was to compare the cost-effectiveness of saving and maintaining the teeth vs replacing them with dental implants in patients with severe periodontal disease (with hopeless or questionable teeth). Method and materials: A database search was conducted using Medline (OVID), Embase, Web of Science, and CINAHL electronic sources until July 2023. Two reviewers reviewed the papers in accordance with the specific selection criteria after choosing the abstracts that met the initial selection criterion for full article retrieval. Results: Twelve articles were included, of which nine articles discussed the cost-effectiveness of preserving teeth in severe periodontal disease and three articles discussed the effectiveness of implants that replaced the periodontally compromised teeth. It was found that placing and maintaining implants was more costly than properly treating and maintaining periodontally compromised teeth. Supportive periodontal treatment contributed the most to the cost during the periodontal treatment. Conclusions: Implants are an effective choice to replace missing teeth; however, these are not permanent, present complications, and require strict maintenance. Thus, when deciding whether to maintain a periodontally compromised tooth or to replace it with a dental implant, in terms of cost-effectiveness, implant maintenance cost as well as the cost associated with treating implant complications should be considered. This cost seems to surpass the cost of treatment and maintenance of periodontally compromised teeth. [ABSTRACT FROM AUTHOR]

Objective: This article describes an interdisciplinary treatment that helped a patient with displaced upper anterior teeth. A gingivectomy, root canal therapies, digital smile design, digital wax‐up, and guided tooth preparations were applied. Clinical Considerations: A patient with pathologically migrated teeth asked for treatment without orthodontic involvement due to a primary failed orthodontic treatment history. A smile photo was taken and superimposed with the dentition in a CAD software to accomplish a digital smile design. The jaw movements were recorded with two different methods, a mechanical articulator and an intraoral scanner with Patient‐Specific‐Motion function. The occlusal contacts during protrusive and lateral movements were compared and the digital wax‐up was designed according to the later occlusal data. An aesthetic crown lengthening and pre‐op root canal treatment were carried out in advance accordingly. After guided tooth preparation with a silicone index, the final fixed restorations were manufactured and cemented. A 2‐year follow‐up showed that our prosthesis functions well. Conclusions: This clinical report revealed that an intraoral scanner with Patient‐Specific‐Motion function can effectively record individual dynamic occlusal patterns and these data can be integrated into the CAD/CAM process to enhance the fulfillment of clinical requirements. Clinical Significance: This clinical procedure with a 2‐year follow‐up demonstrated that a prosthodontic‐based interdisciplinary treatment of pathologically migrated teeth using dynamic occlusal recording with an intraoral scanner could achieve satisfactory esthetics in a relatively short treatment period. The Patient Specific Motion module may be used to record a personalized functional movement and the data can be integrated into the design process of the final restorations. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Background: Numerous studies reported that the healing after surgical endodontic retreatment is influenced by multiple factors which include the genetic profile of the patient, epigenetics, and immune responses. The genes which are primarily responsible for the healing potential in different individuals are those which are involved in the regulation of the cytoskeleton and cellular adhesion which subsequently affects bone deposition and healing. Integrins are cell-surface molecules, possess a key role in the cytoskeleton and cellular adhesion. Integrin Subunit Alpha 1 (ITGA1) is one among the integrin family and helps in regulating the Epidermal Growth Factor receptor (EGFR) pathway, consequently affects proliferation and healing. The objectives of the study were to identify mutations in the cytoplasmic domain of Integrin Subunit Alpha 1 (ITGA1), to assess the expression of activated EGFR, EGFRPhospho and TC-PTP in the periapical wound and to correlate these mutations and expression patterns with periapical wound healing. Methods and findings: Thirty-seven patients between ages 18–60 years reported chronic apical periodontitis of single-rooted anterior teeth with periapical radiolucency, equal or greater than 4 mm or periapical lesion in an open apex of single-rooted teeth due to trauma were included in the study from 01st June 2018 till 31st October 2019. Patients with persistent radiolucency after primary root canal treatment and endodontic retreatment were kept on follow-up for 3–4 months surgical endodontic treatment was performed in cases with persistent periapical lesions of 4mm or more in diameter. Periapical lesion sample was collected and used for (1) histo-pathological analysis after Hematoxylin & Eosin staining, (2) total DNA extraction for ITGA1 cytoplasmic domain mutational analysis and immunohistochemistry for EGFR and TCPTP. A positive correlation was observed between the expression levels of EGFRPhospho and the healing of periapical lesions. Moreover, a negative weak correlation was observed between the expression levels of EGFR and TCPTP and the healing of periapical lesions. Out of nine sequences of cytoplasmic domain of ITGA1 which were analyzed, none of them was detected with SNP. Conclusion: Higher expression levels of EGFRPhospho and lower expression levels of EGFR and TCPTP were associated with patients with good healing potential in periapical area. However, immunohistochemistry scores were statistically insignificant to draw any conclusion. [ABSTRACT FROM AUTHOR]

Aim Methodology Results Conclusion The objectives of this study were to compare the clinical outcomes of root canal treatment between calcium silicate‐based sealer using the cold hydraulic condensation technique and epoxy resin‐based sealer using warm vertical compaction and to identify the prognostic factors affecting the outcomes of both obturation techniques.Dental records and radiographs of the teeth that received root canal treatment with calcium silicate‐based sealer using the cold hydraulic condensation technique or epoxy resin‐based sealer using warm vertical compaction during 2015–2021 were selected using inclusion and exclusion criteria. The cases were matched between the two groups based on four factors: primary root canal treatment or retreatment, tooth type, periapical lesion and its size and extension of root canal filling. The success rates of root canal treatment between two sealers/obturation techniques were analysed. The incidence and resorption of extruded sealer were evaluated using the McNemar's test. Generalized estimated equations were used to evaluate any prognostic factors.The median recall period of this study was 15 months. A total of 234 teeth, comprising 117 cases in each sealer/obturation group, were included. No significant difference was found in the success rates between the calcium silicate‐based sealer using the cold hydraulic condensation technique group (91.5%) and the epoxy resin‐based sealer using the warm vertical compaction group (94.9%). The incidence of sealer extrusion for the calcium silicate‐based sealer (27.6%) did not significantly differ from that of the epoxy resin‐based sealer (36.2%), with both sealers typically demonstrating no resorption at recalls. No prognostic factors related to the success rate of either technique were detected.The study findings suggest no difference in the success rate between calcium silicate‐based sealer and epoxy resin‐based sealer. The study did not identify any prognostic factors that significantly influenced the outcomes of the endodontic treatments. [ABSTRACT FROM AUTHOR]

Background: Vital pulp therapy (VPT) has recently been reported as an effective approach for preventing and treating carious pulp injury in permanent teeth. Compared with root canal treatment (RCT), which involves complete removal of the pulp tissue, VPT effectively maintains pulp vitality and retains the physiological functions of the pulp. In the research pool, large-scale randomized controlled trials evaluating the treatment outcome of VPT using calcium silicate cements and RCT in cariously exposed permanent teeth are lacking. Here, we present a monocentric clinical protocol to compare the effects of VPT using iRoot BP Plus (Innovative Bioceramix, Vancouver, BC, Canada) as a pulp-capping material with RCT. Methods: The proposed trial is an open-label, single-centre, randomized, controlled, noninferiority trial. In total, 462 patients will be included in this trial according to the following criteria: adult patients (18–50 years old), pulp exposure during the treatment of deep caries in mature permanent teeth, a diagnosis of reversible or partially irreversible pulpitis without apical translucency on X-ray, without periodontitis or systemic disease. Patients with signed informed consent forms will be enrolled and randomly divided into two groups (VPT and RCT) with a balanced treatment allocation (1:1). Clinical evaluations will be conducted at baseline and at 3, 6, 12, and 24 months after treatment, with the potential for extension. The primary outcome measure will be the duration of success. The secondary outcomes will include the success rate at the 1-year follow-up and any adverse reactions. The Kaplan‒Meier method and log-rank test will be used to compare the duration of success of both treatments. For other outcomes, the χ2 test or Fisher's exact test will be used for categorical variables, and the t test or Mann‒Whitney U test will be used for continuous variables to assess the differences between groups. Discussion: The results of this trial will provide a clinical reference for selecting treatments for carious pulp injuries in permanent teeth. Trial registration: ClinicalTrials.gov ChiCTR2100051369. The study has been registered in the Chinese Clinical Trial Registry (ChiCTR) (www.chictr.org.cn). Registered on 21 September 2021 [ABSTRACT FROM AUTHOR]

Background: This clinical study aims to compare postoperative pain after single-visit root canal treatment of teeth with asymptomatic apical periodontitis using epoxy-resin-based AH Plus and calcium silicate-based Endosequence BC sealers with or without sonic activation. Methods: This study included 72 individuals with one first or second mandibular premolar tooth with asymptomatic apical periodontitis. They were randomly divided into four groups according to the root canal sealer (AH Plus or Endosequence BC) and activation protocol (sonic activation or non-activation) (n = 18). The participants were ask to rate their postoperative pain intensity on a NRS scale as none, minimal, moderate, or severe after 24 h, 48 h, 72 h, and 7 days following treatment. Patients were also asked to record the number of prescribed analgesic medication tablets (400 mg of ibuprofen) taken. Statistical analysis were performed using the Mann-Whitney U test, the Friedman test, the Spearman's correlation test, the Chi-square test. Significance level was established at 0.05. Results: There was no statistically significant difference in postoperative pain scores or analgesic intake between AH Plus and Endosequence BC sealers regardless of the activation protocol (p > 0.05). There was no statistically significant difference in postoperative pain scores between the sonic activation and non-activation groups (p > 0.05). A weak positive correlation was detected between Endoactivator sonic activation and sealer extrusion (r = 0.36). Conclusions: AH Plus and EndoSequence BC root canal sealers showed similar results in terms of prevalance and intensity of postoperative pain. Sonic activation and non-activation groups had similar postoperative pain scores. Clinical trial registration: The study was retrospectively registered with ClinicalTrials.gov (NCT06403293). Date of Registration: 07/05/24. [ABSTRACT FROM AUTHOR]

Background: Effective endodontic treatment requires the use of a root canal sealer with optimal properties to ensure a hermetic seal, prevent reinfection, and promote healing. Despite the availability of various sealers, a standardized evaluation system still needs to be improved. Objectives: To develop a Clinical Utility Index (CUI) that systematically evaluates and ranks root canal sealers based on their sealing ability, antimicrobial efficacy, flow rate, and solubility. Methods: The CUI was developed through a structured process involving expert identification, panel discussions, and the establishment of scoring criteria. Five sealers were evaluated (Sealers A, B, C, D, and E). Mean values for the core properties were calculated, and sealers were ranked accordingly. The total CUI for each sealer was computed based on the assigned scores for each property. Results: Sealer B achieved the highest CUI at 95%, demonstrating superior performance across all core properties. Sealer C followed with a CUI of 80%, while Sealer A ranked third with 60%. Sealers D and E showed the lowest performance, with CUIs of 30% and 35%, respectively, highlighting deficiencies in multiple properties. Discussion: The CUI provides a comprehensive evaluation framework for root canal sealers, facilitating informed decision-making by practitioners. Sealer B's high CUI underscores the importance of balancing sealing ability, antimicrobial effect, flow rate, and solubility. The results align with existing literature emphasizing the critical role of these properties in endodontic success. Conclusion: The CUI offers a robust and balanced method for evaluating root canal sealers, aiding in selecting the most suitable sealer based on empirical data. Future research should refine the index and validate its applicability in diverse clinical scenarios to enhance endodontic treatment outcomes. [ABSTRACT FROM AUTHOR]

Objectives: To assess the tooth's fracture resistance when submitted to a selective root canal retreatment compared to the conventional approach. Methods: 33 intact permanent mandibular first molars were selected according to specific criteria. After teeth mounting, the primary root canal treatment was conducted and followed by thermo-mechanical aging procedures to mimic a few clinical conditions. The specimens were randomly divided into three groups (n = 11); a control group in which intact teeth were used and two experimental groups according to the retreatment approach: conventional non-surgical retreatment (Conventional-NSR), and selective non-surgical retreatment (Selective-NSR). Later, the teeth were submitted to a final thermo-mechanical aging procedure and tested regarding their fracture resistance (static fracture test). The maximum load to fracture was recorded as were the types of failure modes (repairable or non-repairable fracture). A proper statistical analysis was conducted, considering a significance level of 5%. Results: The Conventional-NSR group showed a mean failure load of 867.7 ± 108.9 N while the Selective-NSR group had 1106.8 ± 159.8 N (P = 0.012). Both retreatment groups showed significantly lower results when compared to the control group. Additionally, the Conventional-NSR group showed higher proportions of non-repairable fractures (54.5%) when compared to both the Selective-NSR (36.4%) and control (18.2%) groups. Conclusions: Selective root canal retreatment preserved the tooth's fracture resistance compared to the conventional retreatment approach. Clinical trial number: Non-applicable. Conducting the current experiment was limited to obtaining approval from the local Research Ethics Committee at the Faculty of Dentistry, Minia University (Committee No. 105, Registration No. 902, Date: 26/3/2024). [ABSTRACT FROM AUTHOR]

Background: Vital pulp therapy (VPT) is recommended as an alternative treatment to root canal therapy (RCT) for management of teeth with carious pulp exposure. This randomized clinical trial aimed to compare the outcomes and postoperative pain, and to evaluate the time and cost after full pulpotomy (FP) and RCT in mature molar teeth with irreversible pulpitis (IP). Methods: A total of 160 mature molar teeth with IP were randomly divided into two treatment groups. The FP group (test group) was treated with FP using iRoot BP Plus by an endodontist, the RCT group (control group) was treated with RCT using iRoot SP as sealer by the same endodontist. Pain was recorded preoperatively and daily until day 7 postoperatively. The treatment time and cost were recorded. Clinical and radiographic assessments were collected, and pulp sensibility tests were done by electric pulp test (EPT) at 3-, 6-, 12- month postoperatively. Data were analyzed through chi-square test, Mann-Whitney U test, Fisher exact and independent t test. Results: FP and RCT had comparable success rates (Clinical, 97.3% vs. 98.6%; radiographic, 93.3% vs. 94.6%) (P > 0.05). Pain levels decreased over time from day 1 to day 7 postoperative in both groups, and the FP group had larger reductions in pain intensity than RCT at day 1 (P < 0.05). In the FP group, there were 5, 3 and 3 unresponsive teeth with EPT at 3-, 6- and 12- month follow-ups, respectively. The treatment time and cost in the FP group were significantly lower than in the RCT group (P < 0.05). Conclusions: FP could be an appropriate alternative treatment for management of mature teeth with IP in short follow-up. Trial registration: The trial was registered in Chinese Clinical Trial Registry (ChiCTR2200063380 at 05/09/2022). [ABSTRACT FROM AUTHOR]

Background: Dentigerous cysts (DCs) are among the most frequently odontogenic cysts in young and middle-aged individuals. Marsupialization and enucleation are the main treatment options in clinical practice. However, there are few reports on preserving molars severely involved by the cyst. Case presentation: A 35-year-old male patient with a large odontogenic cyst that was successfully treated using a multidisciplinary approach. The patient's chief complaint was discomfort during mastication in the lower left molar region for a month. Clinical examination revealed that teeth 36 and 37 were intact without pain upon percussion, while tooth 38 was unerupted. The radiology examination illustrated a typical well-defined oval radiolucent lesion surrounding the crown of unerupted tooth 38, extending to the distal root of tooth 37. The treatment was divided into two parts: removal of the cyst and the impacted third molar, followed by filling with collagen bone particles; and preserving the tooth 37 via hemisection, root canal treatment and crown restoration. Pathological examination indicated a dentigerous cyst. After 18 months of treatment, the bone defect completely recovered and tooth 37 functioned well following the hemisection. Conclusions: Hemisection effectively preserves the cyst-associated molars and maintains oral function. This article underscores the significance of collaboration among various departments in the treatment of odontogenic cysts, ultimately aiming to achieve minimally invasive and functional surgery. [ABSTRACT FROM AUTHOR]

Background: Different types of dental laser can be used instead of the traditional hand and rotary files in root canal treatment with highly acceptable performance. Laser devices emit an intense and focused light energy, which interacts with biologic tissues, for pulp removal, shaping and cleaning the dentinal walls to be finally sealed with gutta-percha. Various laser devices with different wavelengths such as CO2, Er:YAG, Nd: YAG and Diode present the best laser–tissue interaction. Lasers in root canal treatment show more advantages than traditional treatment. Laser is more accurate than conventional root canal treatment that allow minimal removal of healthy dentinal tissue. Lasers have anti-bacterial effect by reduction of more than 99.7% bacterial counts for root canal sterilization. Laser provides less bleeding, inflammation, pain, discomfort and infection than conventional procedures. Laser treatment of root canals results in a good sealing of gutta-percha to root canal walls to prevent infections. Conclusions: Laser application is comfortable to the patients by removing the disturbing sounds of drills and decreasing the need for local anesthesia. It decreases the need for suturing in endodontic surgery due to better hemostasis, thus getting clean and well-sealed surgical wounds. [ABSTRACT FROM AUTHOR]

Background: In clinical practice, the buccal approach is typically the primary choice for endodontic microsurgery. Owing to the thickness of the buccal bone plate, the distance between the buccal bone plate and palatal lesion location, and soft tissue traction, the palatal approach may be more suitable for microsurgery for apical periodontitis of the palatal roots of the maxillary molars. However, the length of the palatal root, location of the greater palatine artery (GPA) and foramen (GPF), and surgical field of observation make palatal surgery challenging. Case presentation: With the aid of Cone-beam computed tomography imaging, the palatal approach was successfully applied in nine cases of endodontic microsurgery of the palatal root of a maxillary molar with a periapical lesion in Hangzhou Stomatology Hospital from January to December 2022. Conclusions: Complete healing was assessed based on clinical symptoms and radiographic images at the 3- and 24-month follow-up visits in all nine cases. Several tips have been proposed including surgical positioning, incision design, palate flap modification, bone removal, and root-end resection. [ABSTRACT FROM AUTHOR]

Background: This study evaluates the fracture strength and patterns of feldspathic porcelain restorations made using CAD/CAM technology for lower first molars with extensive crown destruction. The restorations include post-core and full-contour crown, composite resin core and full-contour crown, and endocrown. This research provides insights into effective restorative options to address tooth fracture risk, supporting minimally invasive procedures and CAD/CAM integration in dental practices. Methods: This study utilized 80 permanent mandibular first molars, which were divided into four groups: Group I (Post-Core-Full-contour crown), Group II (Core- Full-contour crown), Group III (Endocrown), and Group IV (Control). Root canal treatment was performed on all samples except for the control group. Following access cavity preparation, restorations for each tooth were fabricated using the CAD/CAM system and cemented with resin cement. The specimens were embedded in acrylic blocks. After undergoing thermomechanical aging, the samples were subjected to fracture resistance testing using a universal testing machine, which applied force until fracture occurred. The fracture patterns were subsequently analyzed, and the data were statistically evaluated using the Kruskal-Wallis and Chi-Square tests (p < 0.05). Results: A significant difference in fracture values under axial forces was observed (p < 0.05). The control group had the highest fracture strength (1830 ± 277 N), while the Core- full-contour crown group showed the lowest (1532 ± 371 N). Failure types varied significantly among the groups (χ2 = 26.886, df = 9, p = 0.001). The most common failure type was Type-2 (33.75%), characterized by restorable fractures, while Type-3 fractures, unrestorable, were the least common (12.5%). Conclusions: The findings underscore the significance of technological advancements in CAD/CAM for effectively restoring endodontically treated teeth with extensive crown damage. This study contributes valuable insights, emphasizing the clinical relevance of selecting appropriate restorative options to mitigate the risk of tooth fracture associated with coronal restoration failures. [ABSTRACT FROM AUTHOR]

Background: There is insufficient data on orofacial pain related to the COVID‐19 outbreak in Thailand. Objective: To investigate the incidence, diagnosis and management of orofacial pain among new patients over the last 6 years, before and during the COVID‐19 outbreak. Methods: Medical records from new patients who first visited Chulalongkorn Dental Hospital between 2017 and 2022 were retrospectively investigated. The sample size was determined, and proportional stratified random sampling was employed to distribute the sample number proportionally across each year. The hospital number of each patient was randomised using online software as a sampling strategy. A data collection form was developed and used to gather information from the digital data system. Results: At the first visit, 770 out of 1359 patients (56.7/100 people, 95% CI: 54.0–59.3) reported orofacial pain defined as acute, chronic and unclassified pain. The most common chief complaints based on the AAOP classification were odontogenic pain (90.00%) and temporomandibular disorders (6.10%). The top three provisional modified ICD‐10‐TM diagnoses among these patients were pulp diseases (21.95%), impacted teeth (20.65%) and dental caries (9.09%). 81.87% of dental students' provisional diagnoses matched the final diagnoses given by dental specialists. Only 63.38% of orofacial pain patients were completely managed during the COVID‐19 pandemic with common procedures being surgical removal, extraction and root canal therapy. Conclusion: Half of Thai dental patients seeking tertiary care at a university dental hospital reported orofacial pain, which was not impacted by the COVID‐19 pandemic. In contrast, dysfunction‐related problems in the orofacial area significantly increased during the pandemic. [ABSTRACT FROM AUTHOR]

The objective of this study was to assess the root apical closure ages of first permanent molars retrospectively among a group of western Turkish children aged between 5 and 15 years using cone-beam computed tomography (CBCT). CBCT images of 202 patients were examined. The patients were divided into 7 groups according to age: ≤8 years, 8–8.99 years, 9–9.99 years, 10–10.99 years, 11–11.99 years, 12–12.99 years, and ≥13 years. Teeth with at least one open apex were considered as 'teeth with open apex' and teeth with all closed apices were considered as 'teeth with closed apex'. The data was evaluated by Pearson Chi-square test and Fisher's exact test. P value of <0.05 was considered statistically significant. Apical closure rate of the maxillary first molars was 4.1%, 32.2%, 55.4%, 76.2%, and 90.6% at 8–8.99 years, 9–9.99 years, 10–10.99 years, 11–11.99 years, and 12–12.99 years, respectively. Apical closure rate of the mandibular first molars was 4.4%, 41.2%, 70.7%, 80.0%, and 92.2% at 8–8.99 years, 9–9.99 years, 10–10.99 years, 11–11.99 years, and 12–12.99 years, respectively. At 12–12.99 years, females had a significantly higher rate of closed root apices of mandibular first molars than males (P < 0.05). At 9–9.99 and 12–12.99 years, females had a significantly higher rate of closed root apices of maxillary molars than males (P < 0.05). CBCT is a useful tool for the evaluation of root development. The results of present study can provide valuable aids for clinicians during root canal treatment of permanent first molars. [ABSTRACT FROM AUTHOR]

The effectiveness of root canal treatments with different file systems in primary teeth is important in terms of clinical practice and the use of file systems that work with different principles in primary tooth pulpectomy is becoming widespread. The amount of remaining dentin in the coronal region of the root is important in terms of the prognosis of the tooth and the long-term success of the treatment in teeth that have undergone root canal treatment. The aim of this study was to evaluate the remaining dentin volume in the coronal part of the root after the use of rotary, reciprocating, and conventional hand files in primary tooth pulpectomy. A total of 30 primary molars were divided into three groups. In each group, the preparations were made with three different file types: WaveOne Gold, which works with reciprocating motion; TruNatomy, which works with rotational motion; and conventional hand files. The three-dimensional images were evaluated for remaining dentin volume in the 2-mm coronal part of the root. Group means were compared using one-way analysis of variance, and post hoc analyses were performed with the Tukey test. There was no statistically significant difference between the groups in terms of preoperative and postoperative dentin volume (P > 0.05). The mean difference after preparation was observed the most in the WaveOne Gold group and the least in the TruNatomy group. When the mean percentage differences were evaluated, it was observed that statistically significantly more dentin volume was preserved after the preparation with TruNatomy than with WaveOne Gold (P = 0.021). In primary tooth pulpectomy, file systems working with rotational motion can be preferred over file systems working with reciprocating motion in preserving the amount of dentin in the 2-mm coronal part of the root. [ABSTRACT FROM AUTHOR]

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. 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. 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. Findings demonstrate that high favorable outcome rates can be achieved by nonsurgical root canal treatment or retreatment of teeth with large apical periodontitis lesions. [ABSTRACT FROM AUTHOR]

To assess the effect of combinations of two different endodontic sealers used in initial and endodontic retreatment on the bond strength of the secondary obturation and the penetrability of the sealers. Forty-eight mandibular premolars were used, receiving standardized endodontic access and biomechanical preparation. Twenty-four teeth received AH Plus sealer (AHP) in primary obturation and the others received Bio-C Sealer (BCS). Retreatment protocol was performed with an R50 instrument. The samples were further subdivided into four groups (n = 12) based on the combination of primary/secondary obturation sealers: AHP/AHP; AHP/BCS; BCS/AHP; and BCS/BCS. Four samples from each subgroup received the addition of fluorophores to the sealer for penetrability analysis using laser scanning confocal fluorescence microscopy. The root portion on the 8 push-out samples was sectioned into 6 slices of 1.0 mm. Bond strength (BS) was assessed using a universal testing machine until displacement of the filling mass. Failure pattern was evaluated under a stereomicroscope (20× magnification). BS data were analyzed using two-way analysis of variance followed by Tukey's test (P <.05), and the association between the failure pattern and BS value was assessed using the chi-square test (P <.05). Penetrability was qualitatively evaluated. The highest BS values were observed in the AHP/AHP (4.54 ± 1.5 MPa) and BCS/AHP (5.00 ± 1.0 MPa) groups (P <.05), with a higher percentage of adhesive failures to the filling material for all groups. Laser scanning confocal fluorescence microscopy images indicated greater penetrability of AHP compared to BCS, both in initial treatment and retreatment. AHP sealer exhibited higher BS and greater penetrability compared to BCS sealer. [ABSTRACT FROM AUTHOR]

This narrative review considers the common clinical dilemma of choosing from non-surgical root canal re-treatment (NSRCreT), surgical root canal re-treatment or dental extraction. While orthograde root canal treatment is generally successful, cases with unresolved symptoms or persistent infection prompt the need for orthograde root canal re-treatment or surgical intervention. The latter involves microsurgery, reserved for suitable cases. Deciding on the appropriate treatment requires a holistic understanding of the patient, the existing dentition and specific tooth factors. This article discusses insights into decision-making, fostering optimal endodontic care and successful treatment outcomes. CPD/Clinical Relevance: Knowledge of current recommendations regarding non-surgical root canal re-treatment, extraction or referral for apical surgery is useful knowledge. [ABSTRACT FROM AUTHOR]

Purpose: Endodontic success mainly depends on the complete root canal system debridement, both mechanically and chemically. The maxillary first molar possesses one of the most complex root canal anatomy. The purpose of this study was to map the maxillary first molar's root canal anatomy and its variations. Cone Beam Computed Tomography (CBCT) was used to determine the prevalence of the Second Mesiobuccal Canal (MB2) and its possible relation to the gender of the patient in the Iraqi population. Materials and Methods: Images from documented archives of CBCT scans for 415 patients who had maxillofacial diagnosis or root canal treatment were used in this study. Totally 656 maxillary first molars (336 females and 320 males) were included. The root canal configuration, frequency of MB2, and its two-sided symmetry were observed. The (chi-square test) was used to calculate the gender correlation. The P-value of less than 0.05 (p < 0.05) was considered significant. Results: In 61.1% of the cases, the MB2 canal was discovered with high bilateral symmetry (73.6%). Genders did not show any statistically significant differences. Conclusion: The existence of MB2 canal in the maxillary first molars is high and approximately more than half of the cases. No relation was found between the existence of the MB2 canal and the gender of the patient. CBCT is a clinically efficient method for the diagnosis and improvement of root canal therapy. [ABSTRACT FROM AUTHOR]

This study aimed to evaluate and compare the quality of matching single-cone obturation using three different single-file systems—WaveOne® Gold (Dentsply Sirona, Bensheim, Germany), Reciproc® blue (VDW GmbH, Munich, Germany), and Procodile® (Komet Medical, Gebr. Brasseler GmbH & Co. KG, Lemgo, Germany). The evaluation focused on the percentage of gutta-percha-filled areas (PGFAs), sealer-filled areas (PSFAs), and unfilled areas (PUAs) across three different sections of curved and straight root canals. Sixty extracted human teeth were categorized into six groups. Based on radiographically determined root canal curvature, thirty curved and thirty straight root canals were prepared using the single-file systems according to the manufacturers' instructions and obturated with matching gutta-percha cones using AH-Plus sealer. A total of 180 sections were evaluated digitally under the microscope and the results were statistically analyzed. The mean gutta-percha percentages for Reciproc® blue, Procodile®, and WaveOne® Gold were 83%, 82%, and 80%, respectively. No significant (p > 0.05) and relevant (ηp2 < 0.10) differences were found in the proportion of form-fitting gutta-percha cones between the systems in all sections. Similarly, canal anatomy showed no significant influence (p > 0.05). Ex vivo, all three systems showed comparable filling quality in all sections of curved and straight canals. Therefore, it can be concluded that all three file systems, in combination with their corresponding gutta-percha points, might be reliable methods for root canal obturation. Reciproc® Blue, Procodile®, and WaveOne® Gold consistently achieved comparable obturation results across various root configurations and levels of the root canal. [ABSTRACT FROM AUTHOR]

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This study examined the association between a dental implant and changes in adjacent teeth over time. Electronic health records of 1818 patients who received a dental implant were retrospectively evaluated over 14 years (2005–2019) in a university setting. The status of the adjacent tooth and vertical and horizontal distance from the implant platform to adjacent teeth were determined using digital intraoral radiographs taken at baseline and the last follow-up visit (1–14 years, median 4 years). In total, 1085 dental implants were evaluated. There were 234 instances of a change in the adjacent tooth. Decay was observed in 83 (7.6%) of adjacent teeth; the mean time to development was 4 years (range 1–14 years). Approximately 9% of adjacent teeth received direct restorations, 4.8% received indirect restorations, 1% received endodontic root canal treatment, and 5.6% were extracted. The mean horizontal distance between the implant platform and the adjacent teeth was 3.56 mm; the mean vertical distance from the contact point to the alveolar crest on the tooth side was 6.2 mm at the first time of the reported decay on X ray. These distances did not significantly influence the occurrence of caries. The prevalence of interproximal contact loss was higher on the mesial of the implant crown at 63% compared with 20% on the distal side. This large retrospective analysis identified that teeth adjacent to a dental implant were at risk of decay and changes in their condition. In addition, the implant-to-tooth distance and inadequate emergence profile may contribute as caries risk factors in addition to hygiene and a high sugar level diet. These findings appear essential for clinicians when making treatment decisions and discussing outcomes with patients. [ABSTRACT FROM AUTHOR]

Introduction: Endodontic treatment errors (EEs) can lead to complications and require additional follow- up care. This study aimed to investigate the prevalence of root canal treatment errors among dental students, identifying error types based on radiographic criteria, tooth type, location, and technical errors. Materials & Methods: A cross-sectional study analyzed data from 201 patients who underwent root canal treatment at Ilam University of Medical Sciences between 2021 and 2022. Inclusion criteria were confirmed root disease diagnosis, adherence to standard treatment protocol, availability of radiographs, and complete patient files. The protocol included rubber dam isolation, radiographic length determination, manual file canal preparation, irrigation, obturation with the lateral compression method, and temporary restoration. Two endodontists evaluated filling length, density, convergence, and technical errors such as floor perforation, broken instruments, transportation, ledge formation, and access cavity gouging. Results: The study included 89 male (44.3%) and 112 female (55.7%) dental students with a mean age of 25.36 years. Among the 201 patients (28.9% male, 71.1% female; mean age 35.24 years), 71.6% had fillings of appropriate length, 12.14% short, and 15.9% long. Appropriate density was observed in 67.6%, and convergence in 86.1%. Technical errors included ledge formation (8.5%), floor perforation (1%), access cavity gouging (1.5%), and broken instruments (0.5%). A significant relationship was found between density and tooth type (p<0.002) and convergence and tooth type (p < 0.009). Conclusion: Proper filling, convergence, and density were more frequent in anterior teeth. Maxillary teeth had higher rates of proper filling compared to mandibular teeth. The overall rate of treatment errors was low, likely due to professor supervision. [ABSTRACT FROM AUTHOR]

This randomized clinical trial compared postoperative pain between a minimally invasive (MP) and conventional root canal treatment protocol (CP). A total of 170 mature permanent teeth (either with vital or necrotic pulp), were randomly assigned into two groups. In the CP group, ProTaper Gold (Dentsply Sirona, Ballaigues, Switzerland) and a continuous wave of condensation technique were used, whereas, in the MP group, TruNatomy (Dentsply Sirona), ultrasonic-assisted irrigation (UI), calcium hydroxide, and a sealer-based obturation technique were used. Patients recorded preoperative and postoperative pain using a 0–10 numerical rating scale (NRS) at 4 h, 1, 2, 3, 4, 5, 6, and 7 days after instrumentation and 1 day after canal obturation, respectively. There were no significant differences in pain intensity at any time points assessed between the two groups (p > 0.05). The occurrence of moderate/intense pain after instrumentation was significantly associated with preoperative periapical index (PAI) (p = 0.017) and NRS scores (p < 0.001). Preoperative pulp status (p = 0.009) and NRS score (p = 0.006) were identified as significant factors in the occurrence of moderate/intense pain after obturation. Instrumentation unequivocally reduced pain severity for both groups. The post-endodontic pain associated with the use of MP, combined with UI, Ca(OH)2, and calcium-silicate cement, did not differ from that of CP. Preoperative pain score, PAI, and preoperative pulp status were determined to be prognostic factors for postoperative pain. [ABSTRACT FROM AUTHOR]

The mandibular premolars can pose a significant challenge in root canal treatment due to their complex canal system. This study investigated the prevalence of multiple roots and complex canal morphology of mandibular premolars in a selected Egyptian sub-population using cone beam computed tomography (CBCT). 283 CBCT scans (131 males, 152 females, age 18–70) included 1132 mandibular premolars (566 first, and 566 second premolars) were viewed for incidences ofvariation in root numbers and canal configuration according to Vertucci's classification. CBCT images were assessed by two endodontists, data were statistically analyzed using Fisher exact and Chi-square tests. The majority of first premolars (85.7%) exhibited a single root, whereas 14.7% had 2 roots with a significantly higher frequency in males (19.8%) than in females (9.5%) (P <.05). The most prevalent type was type I (57.8%), followed by type V (21.7%), while types II and VII made up only 1%. Types V and III were more prevalent among females, while males had a higher prevalence of types I and IV. In 2.5% of cases, mandibular second premolars were found to have 2 roots, with a higher incidence in males (P <.05). Type I canals were significantly more prevalent (90.8%) than other types, followed by type V (5.3%) (P <.05). A statistically significant gender correlation was found regarding root number and canal configuration. It is not uncommon to find mandibular first premolars with two roots in the southern Egyptian population, particularly in males. These observations may be valuable for dentists who treat Southern Egyptians, in Egypt and other countries. [ABSTRACT FROM AUTHOR]

Background Aim Methodology Results Conclusion Few studies focus upon patient‐reported outcomes in endodontics.To determine whether full pulpotomy offers a less painful, improved health‐related quality of life (HRQoL) compared with root canal treatment (RCT) in cases of irreversible pulpitis (IP) in the 7 days after the treatment.One hundred sixty‐eight participants presenting with symptoms of IP were randomized to either pulpotomy (n = 86) or RCT (n = 82). Two participants were excluded, 61 participants underwent full pulpotomy with Biodentine (35.7%), 80 had RCT (46.8%), and 25 were randomized to have pulpotomy which progressed to RCT (PRCT) due to uncontrollable bleeding (14.6%). Clinical and radiographic assessments, using CBCT and periapical radiographs, were carried out preoperatively, for the evaluation of the results only CBCT images were used. Pain (VAS) and HRQoL (EQ 5D) assessments were carried out at baseline and Days 1, 3, 5 and 7 post‐baseline. Analysis included descriptive and continuous variables, chi‐squared, Fisher's exact, and two‐sample t‐tests.In pulpotomy and RCT groups, VAS pain decreased significantly over the first week (p < .001). The magnitude of reduction was similar in RCT and pulpotomy (p = .804), RCT and PRCT (p = .179), pulpotomy vs. PRCT (p = .144) and in the comparison of combined RCT /PRCT groups (ORCT) with Pulpotomy (0.729). However, the overall level of VAS pain was significantly higher in the PRCT group than in the Pulpotomy (p = .045) and RCT group (p = .049). Using CBCT, significantly more radiolucencies were found in the PRCT group than in the pulpotomy group and overall teeth presenting with CBCT radiolucencies had significantly higher pain scores (p = .015), particularly at Days 1, 3 and 5. There were significant differences in many OHRQoL domains (Questions 1, 6, 11 and 12) between RCT and PRCT groups with higher frequencies of the impact of oral health problems at Day 0 and Day 7 in the PRCT group.In the treatment of IP, pulpotomy is as effective as RCT in reducing post‐operative pain, and improving QoL and HRQoL, teeth displaying uncontrollable bleeding and periapical radiolucencies detected using CBCT are associated with more intense postoperative pain and lower QoL. [ABSTRACT FROM AUTHOR]

Background: This investigation compared the extent of external apical root resorption (EARR) in root-filled teeth (RFT) and their contralateral vital pulp teeth (VPT) counterparts during orthodontic treatment (OT) with clear aligner (CA) treatment or fixed appliance (FA) treatment. Methods: Sixty-six patients with similar baseline American Board of Orthodontics (ABO) discrepancy index scores were divided into two groups: 37 patients (21 females, 16 males; mean age 17.45 ± 2.67 years) in the FA group, and 29 patients (18 females, 11 males; mean age 18.33 ± 1.96 years) in the CA group. Digital panoramic radiographs captured pre- and post-OT were used to measure tooth lengths and root surface measurements in mandibular molars. EARR in both RFT and contralateral VPT was evaluated pre- and post-OT. Statistical analysis employed paired t-tests, independent t-tests, and analysis of covariance (ANCOVA) (p <.05). Results: All teeth exhibited varying degrees of EARR following OT. FA treatment resulted in significantly longer treatment duration (p <.05) and greater EARR compared to CA treatment (p <.05). Moreover, statistically significant differences in EARR were observed within both groups between RFT and VPT (p <.05). Conclusions: Comparison of pre- and post-OT radiographs revealed different degrees of EARR in all teeth. CA treatment resulted in less frequent and less severe EARR compared to FA treatment. RFT demonstrated greater resistance to EARR than VPT in both treatment groups. [ABSTRACT FROM AUTHOR]

Background: Complicated crown-root fractures are a type of tooth fracture that involves the enamel, dentin, and cementum and accompanied by pulp exposure. The treatment of a complicated crown-root fracture is always challenging due to the difficulties in achieving a hermetic seal and a stable restoration with a fracture level close to the crestale bone level. This study aimed to evaluate and compare the efficacy of single-visit and multi-visit approaches for fragment reattachment in complicated crown-root fractures of anterior teeth. Methods: Two cohort consist of 10 adolescent patients in each group at both genders, who suffered from permanent anterior tooth complicated crown-root fracture were included. Fragment reattachment with root canal treatment was performed with either single or multiple-visit approach. Single visit fragment attachement combined with root cannel therapy was conducted in single-visit approach group immediately after injury. Fragment attachment, root cananel therapy and post resoration were performed during three times ' clinical visit in multi-visit approach group. Results: All the patients in both groups achieved satisfactory aesthetic results one year after fragment reattachment. Patients who underwent a multi-visit approach had a significantly shorter operative duration, less intra-operative pain and fatigue, slightly better periodontal health at an early stage, and a decreased incidence of temporomandibular joint disorders compared to those who underwent a single-visit approach. However, multiple visits approach may increase the risk of fragment detachment postoperatively. Conclusion: Fragment reattachment a reliable but temporary technique for adolescent patients who have suffered from complicated crown-root fractures. Multi-visit approach showed similar effecacy to single-visit approach but with slightly less complications. The choose of these two merhos should depend on the specific patient situation and patient compliance. Trial registration: This prospective cohort study was retrospectively registered in Chinese Clinical Trial Registry (ChiCTR2300076811) on 19/10/2023. [ABSTRACT FROM AUTHOR]

ABSTRACT Introduction Materials and Methods Results Discussion Conclusion Access cavity preparation is a crucial step in root canal treatment but is one of the most complex procedures in the curriculum to learn, with students often reporting spatial orientation difficulties during drilling. The present study aimed to evaluate the influence of spatial abilities on the preparation of endodontic access cavities among third‐year dental students.Students from Lyon dental faculty participated voluntarily. The mental rotation test (MRT) evaluated spatial ability. Students prepared access cavities on 3D‐printed mandibular molars, subsequently scanned and assessed against eight evaluation points, including morphology, canal access, floor preservation and convergence angle. Principal component analysis (PCA) assessed dataset variations.A total of 43 volunteers participated. PCA revealed two principal components accounting for 80.8% of variations: the first PC primarily consisted of MRT score (64.3%) and morphology (14.1%); the second comprised operative time (46.1%) and morphology (18.0%). There were significant differences in morphology based on MRT scores, but no correlation was found between other parameters.Lower MRT scores were associated with larger cavity preparations, raising questions about potential curriculum adaptations to enhance spatial reasoning. The operative time was not correlated with higher MRT scores but did contribute to variations in cavity morphology.Spatial abilities have a substantial impact on the quality of endodontic access cavity preparations; further studies should evaluate if the incorporation of 3D atlas exercises could be beneficial. [ABSTRACT FROM AUTHOR]

This review aims to comprehensively explore calcium-enriched mixture (CEM) cement as a crucial biomaterial in dentistry/endodontics. With its growing clinical relevance, there is a need to evaluate its composition, chemical/physical/biological properties, clinical applications, and future perspectives to provide clinicians/researchers with a detailed understanding of its potential in endodontic procedures. Through systematic analysis of available evidence, we assess the advantages/limitations of CEM cement, offering valuable insights for informed decision-making in dental/endodontic practice. Our findings highlight the commendable chemical/physical properties of CEM cement, including handling characteristics, alkalinity, color stability, bioactivity, biocompatibility, sealing ability, and antimicrobial properties. Importantly, CEM cement has shown the potential in promoting regenerative processes, such as dentinogenesis and cementogenesis. It has demonstrated successful outcomes in various clinical applications, including vital pulp therapy techniques, endodontic surgery, open apices management, root resorption/perforation repair, and as an orifice/root canal obturation material. The efficacy and reliability of CEM cement in diverse clinical scenarios underscore its effectiveness in endodontic practice. However, we emphasize the need for well-designed clinical trials with long-term follow-up to further substantiate the full potential of CEM cement. This review serves as a robust reference for researchers/practitioners, offering an in-depth exploration of CEM cement and its multifaceted roles in contemporary dentistry/endodontics. [ABSTRACT FROM AUTHOR]

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

Background Objectives Method Results Conclusions Registration Postoperative endodontic pain (PEP) is crucial in clinical practice. Recently, the effects of various laser adjuvant therapies in endodontic treatments have been widely evaluated. However, as a virtually side‐effect‐free treatment, its effect on postoperative pain management during endodontic treatment remains controversial.This review aimed to compare the efficacy of laser adjuvant therapy for pain management after endodontic treatment.The Cochrane Library, PubMed, Embase, Scopus and Web of Science databases were systematically searched for articles published until 12 February 2023. The risk of bias in the included studies was evaluated based on the Cochrane risk‐of‐bias assessment tool. Data on continuous outcomes of visual analogue scale pain scores are expressed as standard mean difference (SMD) and dichotomous outcomes of pain prevalence as relative risk (RR).We included 22 studies, of which 15 enrolled 892 patients with visual analogue scale pain scores and 7 enrolled 422 patients with pain prevalence. Of the 22 studies, seven studies had a low risk of bias, 10 had a moderate risk of bias and 5 had a high risk of bias. For pain level, the pooled outcomes indicated reduced pain scores in all laser adjuvant therapy, including low‐level laser therapy (SMD = −0.86 [95% CI: −1.16, −0.55] in 24 h and SMD = −0.64 [95% CI: −0.84, −0.43] in 48 h), diode laser therapy (SMD = −0.27 [95% CI: −0.50, −0.04] in 48 h) and photodynamic therapy (SMD = −1.12 [95% CI: −2.18, −0.05] in 24 h). For postoperative pain incidence, a significant correlation was observed with reduced pain incidence rates in the photodynamic therapy group (pooled RR = 0.47 [95% CI: 0.31, 0.72]) but not in the low‐level laser therapy group (RR = 0.89 [95% CI: 0.30, 2.70] at 12 h and RR = 0.57 [95% CI: 0.09, 3.72] at 24 h).High‐quality evidence suggests that laser adjuvant therapies such as low‐level laser therapy, diode laser therapy and photodynamic therapy have a positive impact on reducing postoperative endodontic pain intensity. However, the differences in PEP management effects between laser therapies are unknown, and no significant differences were observed among the subgroups.CRD 42023402872 (PROSPERO). [ABSTRACT FROM AUTHOR]

Background: Infected dentinal tubules are a possible source of bacteria that are responsible for the failure of root canal treatment. Therefore, disinfection of dentinal tubules by increasing the penetration of the irrigation solution is important for success in retreatment cases. This study utilized confocal laser scanning microscopy (CLSM) to assess and compare the impact of XPR, ultrasonic irrigation (UI) and sonic activation (SA) on NaOCl penetration into dentinal tubules following endodontic retreatment. Methods: A total of forty mandibular premolars were enrolled in this investigation. Following root canal preparation up to ProTaper X3 file (30/0.07), root canals were obturated with gutta-percha and bioceramic root canal sealer with single cone technique. The root canal filling materials were removed using ProTaper nickel-titanium rotary retreatment files until the working length was reached. The retreatment procedure was finalized using the ProTaper Next X4 (40/0.06). The teeth were divided into four groups based on the irrigation activation technique: control (conventional needle irrigation), SA, UI and XPR. During the final irrigation procedure, Rhodamine B dye was introduced to 5% NaOCl for visualization via CLSM. Subsequent to image acquisition, the maximum penetration, penetration percentage, and penetration area were calculated. Data were statistically analyzed using the Kruskal-Wallis, Friedman, and Bonferroni Dunn multiple comparison tests through R software (p < 0.05). Results: In the middle third, UI yielded a significantly higher penetration percentage than the control group (p < 0.05). The UI and XPR groups showed increased penetration percentages in the coronal and middle thirds compared with the apical third (P < 0.05). Maximum penetration was notably reduced in the apical third than in comparison with the coronal and middle thirds in all groups (p < 0.05). In the control, SA and XP groups, the penetration area was ranked in descending order as coronal, middle and apical (p < 0.05). Conversely, in the ultrasonic group, the penetration area was significantly lower in the apical third than in the middle and coronal thirds (p < 0.05). Conclusions: UI enhanced the penetration percentage in the middle third of the root compared with that in the control group. XPR and SA showed no significant effect on NaOCl penetration following retreatment. [ABSTRACT FROM AUTHOR]

Background: Apexification is a procedure that promotes apical closure by forming mineralized tissue in the apex region of a nonvital young permanent tooth. Calcium silicate-based cement like Mineral trioxide aggregate (MTA) and Biodentine are commonly employed as apical barriers to facilitate this process. Microleakage, defined as the leakage along the junction between the canal wall and filling material, is a crucial aspect to assess in MTA and Biodentine applications as apical barriers, as it directly impacts the prevention of bacterial seepage and maintenance of structural integrity. The current study aims to assess the microleakage of MTA and Biodentine when used as apical barriers in simulated young permanent teeth. Methods: From a total of 128 extracted teeth, 114 were selected for the study and randomly allocated into three groups: G1 (MTA), G2 (Biodentine), and G3 (Control), with 38 teeth per group. After excluding 5 teeth from each group due to issues such as canal calcification, breakage during sectioning, and procedural errors, 33 teeth were analyzed to ensure equal distribution. To simulate young permanent teeth, samples were instrumented using a person-reamer with a diameter of 1.7 mm. A 4 mm thick apical plug of MTA and Biodentine was placed in G1 and G2, respectively, while G3 was the control group. Apical microleakage in all experimental groups was assessed using a dye penetration method. Specimens were longitudinally sectioned and examined under a stereomicroscope with graded eyepiece. Results: The Kruskal-Wallis test revealed variations in mean apical microleakage among the groups: G1 recorded 0.67, G2–0.16, and G3–1.62, with G2 showing the lowest value and G3 group exhibiting the highest. Conclusions: Biodentine was found to excel in its ability to create a secure seal and function effectively as an apical barrier in simulated young permanent teeth. These results underscore its potential as a highly efficient material for dental applications, particularly in scenarios requiring reliable sealing and barrier formation in the root canal system of developing permanent teeth. [ABSTRACT FROM AUTHOR]

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

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

Background: This study aimed to compare the marginal adaptation of a single customized gutta percha cone with calcium silicate-based sealer versus mineral trioxide aggregate (MTA) and Biodentine apical plugs in simulated immature permanent teeth. Methods: Thirty-nine extracted human maxillary anterior teeth were selected, prepared to simulate immature permanent teeth with an apical diameter 1.1 mm, placed in moist foam and divided into three groups. Group 1: Obturation with a single customized gutta percha cone and calcium silicate sealer. Group 2: MTA apical plug. Group 3: Biodentine apical plug. After incubation, teeth were horizontally sectioned at 1 mm and 3 mm from the apex and marginal adaptation was evaluated using scanning electron microscope (SEM). Results: Biodentine showed the least mean gap size at both 1 and 3 mm from the apex with no statistically significant differences compared to MTA (p > 0.05). The single customized cone with calcium silicate based sealer showed the greatest mean gap size at both 1 and 3 mm from the apex with a statistically significant difference compared to the other groups (p < 0.001). Conclusion: Biodentine and MTA apical plugs provide a significantly better marginal adaptation to the dentinal walls than a single customized gutta percha cone with calcium silicate based sealer in simulated immature permanent teeth. [ABSTRACT FROM AUTHOR]

Background: The use of cone beam computed tomography (CBCT) for dentomaxillofacial diagnostics in pediatric dentistry is expanding and concerns have been raised about the radiation risks associated with this imaging modality, especially for children. Dentomaxillofacial paediatric imaging: an investigation towards low-dose radiation induced risks (DIMITRA) is a multidisciplinary project focused on optimizing CBCT exposure for children and adolescents. This study aims to clarify the indications behind CBCT scans in children aligned with DIMITRA's recommendations. Methods: For each CBCT examination, data were collected on patient age at the time of the CBCT examination, gender, reason for request, referring department, CBCT-requested region, and the field of view (FOV) dimension of imaging. The CBCT indications were categorized under six headings according to an adaptation of the DIMITRA project recommendations: impacted teeth, dentoalveolar trauma, orofacial clefts, dental anomalies, bone pathology, syndromes. Indications not categorized in DIMITRA were recorded below the heading "other". Results: The most common indication was the "other" category (34.8%), which included implant, temporomandibular joint dysfunction, orofacial anomalies, foreign object and root canal morphology. The least common indication was "orofacial cleft" (1.9%) and no requests were made for cases related to syndromes. Detection of supernumerary tooth in dental anomalies (68.6%) was the most common CBCT indication, while dentigerous cysts (37.6%) were among the most common CBCT indication in bone pathologies and orofacial anomalies (68.1%) in the other category. The most common size was External Center (15 × 15 cm) (27%) and the least common size was Both Arches/small (8 × 8 cm) (0.4%) when the CBCT FOV was analysed. Conclusions: Although the option of a smaller FOV size was available, the larger FOV size that included the both jaws were most frequently used. When justifying CBCT requests, patient-specific radiation dose risks should be considered and specific guidelines should be followed. [ABSTRACT FROM AUTHOR]

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

Background and Purpose: Diabetes Mellitus is a group of complex, multi-system metabolic disorders that alter many functions of the immune system and are associated with delayed recovery and a reduced immune response. Apical periodontitis is the inflammation and destruction of the periodontium in the apical region of the root, originating from the pulp, and as a result, an inflammatory response creates a radiolucent area at the root apex. In this study, we aimed to investigate the relationship between the presence of pulp and periapical lesions and controlled type 2 diabetes in the radiographic images of patients. Materials and Methods: In this cross-sectional study, 45 patients were included in the case group (patients with controlled diabetes) and 45 in the control group (healthy individuals). Periapical and endodontic status was evaluated based on examinations using panoramic and periapical images. In the dental examinations (excluding third molars), the following were recorded for each patient: the number of teeth in the mouth, the number and location of teeth without root canal treatment with a periapical lesion, the number and location of teeth with root canal treatment, and the number and location of teeth with root canal treatment with a periapical lesion. The periodontal condition was assessed using the periapical index (PAI), with scores greater than 3 considered indicative of periapical pathology. For inferential analysis, chi-square tests and independent t-tests were used. Results: Among the 90 participants, 53 were women and 37 were men. The average age of the participants was 43.6 years,and the average age was higher in the diabetic group. In total, 52.2% of patients had periapical lesions and 63.3% had pulpal lesions, with these two lesions being significantly more common in diabetic individuals(P<0.05). Among all patients, there was a significant relationship between gender and periapical lesions (P=0.022), with women having a higher prevalence of these lesions. In non-diabetic individuals, unlike diabetic individuals, the relationship between gender and periapical lesions was significant, with women having more lesions(P=0.03). Across all patients, there was a significant relationship between age and periapical lesions (P=0.001), with the average age being higher in patients with periapical lesions. In diabetic individuals, unlike non-diabetic individuals, no significant relationship was observed between these two variables (P=0.828). Conclusion: The study results demonstrated a significant relationship between the prevalence of pulp and periapical lesions and factors such as sex, age, and type 2 diabetes. The findings revealed that the prevalence of pulp and periapical lesions is higher in patients with type 2 diabetes compared to those without diabetes. The likelihood of developing these lesions increases with age and is generally higher in women. Additionally, no correlation was found between the prevalence of pulp and periapical lesions in men without type 2 diabetes and increasing age in individuals with type 2 diabetes. [ABSTRACT FROM AUTHOR]

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

Purpose: Endodontic inflammation typically results from root canal infections and sensitizations to filling materials after root canal treatment (RCT), potentially leading to systemic inflammation and disease. We therefore aimed to characterize the inflammatory alterations after RCT as well as the inflammatory molecule levels following tooth extraction or renewed RCT. Patients and Methods: All (a total of 2585) walk-in patients with or without RCT history were included in this retrospective study. During the 3-year observation period, blood levels of RANTES/CCL5 (regulated on activation, normal T-cell expressed and secreted/chemotactic cytokine ligand 5), C-reactive protein (CRP), tumor necrosis factor-α (TNF-α), interferon-γ (IFN-γ), and interleukin-10 (IL-10) were measured before and after tooth extraction or renewed RCT. Control patients did not undergo any dental treatment. Results: A total 49.38% of patients had a history of at least one RCT. In RCT patients, RANTES/CCL5 values were significantly reduced by both tooth extraction (p=0.03) and renewed dental RCT (p=0.038), while a non-significant increase was observed in untreated patients. TNF-α levels were reduced by tooth extraction (p=0.014) but not by renewed RCT and no intervention. CRP levels were not significantly changed by either treatment. Tooth extraction significantly lowered IFN-γ levels (p=0.003), while in control patients, IFN-γ levels did not change. IL-10 levels were non-significantly reduced by tooth extraction (p=0.061). In a subcohort of RCT patients, the lymphocyte transformation test revealed an allergic reaction to at least one of the root filling materials in 39.46% of patients, with raw gutta percha (56%) and eugenol (19%) being frequent triggers. Conclusion: Here, we demonstrate the involvement of root-treated teeth in inflammatory processes, as tooth extraction and renewed RCT could significantly reduce individual cytokine levels. Our data support the use of biomarkers for in vivo monitoring of treatment success. [ABSTRACT FROM AUTHOR]

The objective of this study was to investigate the effects of different oral root canal filling materials on the expression of inflammatory factors and protease related molecules in gingival crevicular fluid (GCF). A total of 90 patients with posterior tooth defects who underwent root canal therapy in our hospital were selected. They were divided into an observation group (group A) and a control group (group B) based on different root canal filling materials, with 45 teeth in each group. The group A patients were repaired with fiber post, composite resin combined with zirconia ceramic crown, while the group B patients were repaired with metal post core combined with metal ceramic crown. The clinical effect, periodontal index, restoration success rate, mastication efficiency, periodontal index, restoration effect, and the levels of GCF and Alkaline phosphatase (ALP) before and after restoration were compared between the two groups. The clinical efficacy of the group A was better than that of the group B patients. The success rate of repair and chewing efficiency in the group A were higher than those in the group B. The completeness rate, color matching rate, edge fit rate, edge coloring qualification rate, and gingival qualification rate of the group A patients were higher than those of the group B patients. After repair, the levels of GCF and ALP in both groups of patients were higher than before repair, and the group B was raised than the group A. The PLI, GI, and SBI indices of the group A patients were reduced than those of the group B patients. The application of fiber post, composite resin combined with zirconia porcelain crown restoration in patients with posterior tooth defects after root canal treatment can improve the success rate, chewing efficiency, and restoration effect, with little impact on changes in GCF and ALP levels in the body. [ABSTRACT FROM AUTHOR]

Background • Acute pulpitis poses a significant clinical challenge. Traditional root canal treatment has been a standard approach, and the incorporation of adjunctive therapies, such as eugenol cement, presents a potential avenue for enhanced efficacy and reduced complications. Objective • This study aimed to assess the clinical efficacy of root canal treatment combined with eugenol cement for acute pulpitis and its impact on inflammatory factor levels. Design • The study employed a parallel, randomized, controlled, experimental design. Setting • The research was conducted at Suzhou Ninth People’s Hospital. Participants • A total of 92 patients diagnosed with acute pulpitis and seeking treatment at our hospital between August 2020 and November 2021 were included in the study. Interventions • Participants were randomly assigned to two groups with 46 patients in each group: the control group receiving traditional root canal treatment and the experimental group receiving root canal treatment combined with eugenol cement. Primary Outcome Measures • The primary outcomes assessed included (1) treatment efficiency, (2) masticatory function, (3) complications, and levels of inflammatory factors. Results • In the study, root canal treatment combined with eugenol cement showed superior efficacy (95.7% vs. 76.1%, P < .05) compared to root canal treatment alone. After one month, both groups exhibited reduced bleeding and gingival indices, with a more significant reduction in the experimental group (P < .05). The combined treatment significantly improved masticatory efficiency and occlusal strength (P < .05). The experimental group had a lower complication rate (6.5% vs. 26.1%, P < .05) and reduced inflammatory markers (IL-6, IL-8, TNF-α, LTB4) compared to the control group (P < .05). Conclusions • Root canal treatment plus eugenol cement enhances masticatory function, reduces complications and inflammatory response in patients with acute pulpitis, alleviates dental pain and looseness, and mitigates inflammatory responses with fewer adverse effects. [ABSTRACT FROM AUTHOR]

The design of the access cavity is an important factor in endodontic treatment for the further evolution of the tooth. The objective of this study was to highlight the most favorable access cavity design (TrussAC, UltraAC, TradAC, CariesAC, ConsAC, RestoAC) based on the stress distribution on virtual models of mandibular molars. To achieve the objectives of the study, four series of virtual models of six molars were made. The first two series of external virtual models were obtained based on the three-dimensional scanning of the molars before the access cavity preparation and after their restoration, to obtain the density of the restorative materials. Internal morphology was added to the next two series of virtual models and after that, materials were added, specific for root canal obturation and coronal restoration. The simulations were performed for two coronary restoration materials, bulk fill composite and amalgam. The results showed, based on the stress maps, that the highest values were recorded for CariesAC and the lowest values for UltraAC. Comparing the two restorative materials, the lowest level of stress, strains, and displacements was highlighted in the case of UltraAC, TradAC, and ConsAC cavities for amalgam. The results obtained in this study should guide doctors towards a conservative attitude with the preservation of as much hard tissue as possible and the differentiated use of restorative materials according to the amount of tissue lost when preparing the access cavity. [ABSTRACT FROM AUTHOR]