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(1) The objective of the study is to conduct a comprehensive systematic review of in vitro studies in order to assess the depth to which E. faecalis bacteria penetrate human dentinal tubules after the use of various irrigation solutions. (2) Methods: A literature search of the MEDLINE, Scopus, Cochrane CENTRAL, and Embase databases was conducted, as well as a backward and forward citation search. Two independent reviewers then selected suitable studies based on inclusion and exclusion criteria. Data were extracted and the risk of bias and methodology of the studies were evaluated. (3) Results: Out of a total of 504 papers evaluated following the removal of duplicates, 7 studies met the inclusion criteria and were included in the systematic review. The heterogeneity of the studies made it impossible to perform a meta-analysis. The majority of the studies reported that sodium hypochlorite (NaOCl) and chlorhexidine digluconate (CHX) can affect the penetration depth of E. faecalis suspensions. The studies included in this review possess a moderate to high risk of bias and thus represent moderate evidence that the antimicrobial activity of NaOCl and CHX affects the intra-tubular penetration of bacteria. (4) Conclusions: The evidence indicates that irrigants may affect the bacteria inside human dentinal tubules. Standardized high-quality methods are needed to evaluate bacterial penetration in in vitro studies.

Introduction: The integration of clinical inspection and diagnostic imaging forms the basis for endodontic diagnosis, decision making, treatment planning, and outcome assessments. In recent years, CBCT imaging has become a common diagnostic tool in endodontics. CBCT should only be used to ensure that the benefits to the patient exceed the risks. As such, our aim in this study was to evaluate the high level diagnostic efficacy studies and their risk of bias. Methods: A systematic search of the literature was conducted to identify studies evaluating the use of CBCT imaging in endodontics. The following databases were searched: Medline (PubMed), Scopus, and Cochrane Central. The identified studies were subjected to rigorous inclusion criteria. Studies considered as having a high efficacy level were then subjected to a risk of bias assessment using the Cochrane Handbook for Systematic Reviews of Diagnostic Test Accuracy. Results: Initially, 1568 articles were identified for possible inclusion in the review. Following title and abstract assessment, duplicate removal, and a full-text evaluation, 22 studies were included. Of those studies, 2 had a low risk of bias and 20 had a high risk of bias. Six studies investigated non-surgical treatment, eight investigated surgical treatment, two investigated both non-surgical and surgical treatment, and six studies investigated diagnostic thinking or decision making. Conclusion: The evidence for the influence of CBCT on decision making and treatment outcomes in endodontics is predominantly based on studies with a high risk of bias.

Introduction: Vertical root fracture (VRF) is a root-canal treatment complication and is a major reason for extraction of the root-canal-treated teeth. The diagnosis of VRF can be complicated because of absence of specific signs, symptoms, and radiographic features. A combination that includes the presence of deep pocket and a sinus tract in root-canal-treated tooth was proposed as a pathognomonic for VRF. The purpose of this study was to systematically search and evaluate the literature regarding the correlation between the clinical signs considered pathognomonic for the diagnosis of VRF, with the actual reference standard by means of systematic review of the literature. Methods: A systematic search of the literature was performed to identify studies evaluating the clinical signs considered pathognomonic for the diagnosis of VRF. The following databases were searched: Medline (PubMed), Scopus, and Cochrane Central. The identified studies were subjected to strict inclusion and exclusion criteria. Results: Initially, 1141 possible relevant articles were identified. After title and abstract screening, 40 articles were subjected to a full-text evaluation, 3 articles met the inclusion criteria and contained data regarding the prevalence of the pathognomonic combination in VRF’s-confirmed teeth. The presence of deep pocket and a sinus tract in endodontically treated teeth was found in 28% of the cases. Conclusion: To date, the current scientific knowledge regarding the correlation between the clinical symptoms considered pathognomonic for VRF diagnosis in the root-canal-treated tooth and the actual reference standard is quite low.

This study aimed to determine the bactericidal efficacy of sequential use of NaOCl pH 12 followed by acidified NaOCl pH 6.5, and compare it to that of either of these NaOCl solutions alone. E. faecalis biofilm was grown on standardized dentine specimens for four weeks. The specimens were randomly divided into four groups: (A) 4 min exposure to 0.9% saline solution (control); (B) 4 min exposure to 4% NaOCl pH 12; (C) 4 min exposure to 4% NaOCl pH 6.5; and (D) 2 min exposure to 4% NaOCl pH 12 followed by 2 min exposure to 4% NaOCl pH 6.5. The bactericidal activity was evaluated after the 4 min of contact time using confocal laser scanning microscopy. The volume ratio of red fluorescence to green and red fluorescence indicated the proportion of dead cells in the biofilm. The percent of dead cells in the saline solution group was significantly lower than those in the other groups. There was no significant difference between NaOCl pH 12 compared to NaOCl pH 6.5. The sequential use of NaOCl pH 12 followed by pH 6.5 significantly increased the percent of dead cells compared to both the samples exposed to either NaOCl pH 12 or pH 6.5. These results show that sequential irrigation protocol had a stronger bactericidal effect than the commonly used NaOCl pH 12.