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Trial design: This is a randomized, controlled, superiority, double-blinded, parallel-group, two-arms trial with an allocation ratio of 1:1. This study aimed to assess whether the cavity design could affect the clinical performance of the CAD/CAM generated indirect resin composite restoration in endodontically treated teeth (ETT) evaluated using the Modified USPHS criteria after a two-year follow up. Methods: A total of 30 participants who underwent endodontic treatment for MOD cavities in permanent molars were divided randomly into two parallel groups (n = 30 restorations) according to the performed cavity design to group 1 in which there was no cuspal reduction (inlay) and group 2 in which cuspal reduction was performed (overlay). All pulp chambers were filled with bulk fill flowable composite, and the cavities were prepared following the criteria of the cavities for indirect restorations and restored using nano-hybrid composite resin blocks (Brilliant, Coltene, Switzerland). The restorations were evaluated using the modified USPHS criteria at baseline, six months, one-year and two years follow-up visits. For qualitative data, frequencies (n) and percentages (%) were used to display the data, while mean and standard deviation (SD) were used for quantitative data. The normality of the data was evaluated using the Shapiro-Wilk and Kolmogorov-Smirnov tests. For every test, P ≤ 0.05 was used as the significance threshold. Results: Twenty-six individuals completed the follow-up period after receiving the assigned intervention.The inter-group comparison showed that, at the 6- months and 12- months observation points, the overlay design had significantly better marginal adaptation, less incidence of discoloration or tooth/restoration fracture, and similar marginal integrity and caries incidence to the inlay design. After 24- months, the overlay design still had better marginal adaptation, less incidence of discoloration or tooth/restoration fracture and less caries incidence in comparison to the inlay design, while there was no difference in the marginal integrity between either design. Conclusions and clinical relevance: Cuspal reduction in endodontically treated teeth showed better clinical performance than the cusp preservation thus, the former is more reliable. [ABSTRACT FROM AUTHOR]

Background: The aim of this study was to investigate the etiologies of non-surgical root canal treatment (NS-RCT) in a Thai population and examine their association with risk factors. Methods: A cross-sectional observational study was performed to examine the etiologies of NS-RCT and risk factors among Thai-nationality patients treated at a tertiary care dental hospital in Thailand from 2019–2023. Treatment records and radiographs were retrospectively reviewed to identify NS-RCT etiologies, and associated contributing factors were analyzed. Statistical analysis used univariate logistic regression followed by multivariate logistic regression, with a significance level set at P < 0.05. Results: The data from 1500 teeth were analyzed, comprising 59.1% females and 40.9% males, with ages ranging from 7–91 years (mean = 48.56 years). The most prevalent age group was 61–70 years-old. Among the treated teeth, the mandibular first molar was the most frequently involved (13.9%), followed by the maxillary first molar (9.9%) and mandibular second premolar (9.7%). The primary etiologies of NS-RCT were dental caries (53.7%), old and large restorations (7.9%), and attrition (5.9%). Analysis of etiology of NS-RCT due to caries revealed that the most commonly affected sites were the occlusal (32.6%), distal (31.6%), and mesial (17.2%) surfaces. In immature teeth requiring NS-RCT, the predominant etiologies were dens evaginatus (32.1%), dental caries (28.6%), and traumatic injury (21.4%). The association between the etiology of NS-RCT and investigated associated factors were identified. Conclusions: The etiologies of NS-RCT in the selected Thai population were mainly attributed to dental caries, with additional factors being old and large restorations and attrition. Notably, due to the aging society, the elderly population experiences a higher demand for NS-RCT, particularly due to attrition, non-carious cervical lesions, and erosion. In contrast, in immature teeth, the most common etiologies leading to NS-RCT comprise dens evaginatus, dental caries, and traumatic injuries. The distinct etiological patterns observed in different age groups emphasize the importance of specific oral health prevention programs to address individual needs. [ABSTRACT FROM AUTHOR]

Background: This retrospective clinical study was undertaken to comparatively evaluate the number of restorative treatments, endodontic treatments, and tooth extractions performed for patients under general anesthesia due to dental anxiety or special needs between 2015 and 2022 and to examine the pain, bleeding, nausea, and vomiting data of those patients. Methods: In total, 1165 patients underwent dental treatment under general anesthesia in the faculty hospital. Those under the age of 15 and with no endodontic procedure planned (n = 918) were excluded, followed by those with incomplete data (n = 25) and those without endodontic treatment (n = 25). Patients who underwent at least one endodontic treatment were finally included in the study (n = 184). Patients were divided into two groups: healthy and with special needs. Dental treatments were recorded as endodontic, restorative, and teeth extractions. Endodontic treatments were classified according to the tooth type (premolar, molar, and incisors). The composite restorations were classified as anterior, occlusal (O), occluso-distal (OD) or occluso-mesial (OM), and mesio-occluso-distal (MOD) restorations and patients' post-treatment pain, nausea, vomiting, and bleeding were recorded. The data were analyzed statistically. Results: Among the 184 patients included in the study, 70 (38%) were healthy, and 114 (62%) had special needs. Postoperative bleeding was observed more in patients with special needs (χ2 = 4.189, p < 0.05), whereas pain was observed more in healthy patients (U = 2922.00, p < 0.05). While the number of anterior, O, and MOD restorations was higher in patients with special needs, the number of OD or OM restorations was higher in healthy patients (χ2 = 74.877, p < 0.05). Conclusions: Patients with special needs undergo a greater number of restorative treatments compared to control patients, which may be associated with the inadequate oral hygiene care of such patients. However, restorative treatment is mostly indicated for such patients in our faculty hospital, which may indicate that a conservative approach is taken. Additionally, the finding that postoperative bleeding was more severe in this group of patients compared to the control group in this study may emphasize the need to consider more possible complications after general anesthesia in these patients. [ABSTRACT FROM AUTHOR]

Maintaining facial soft tissue contour and inter-implant papilla are challenging for implants in the esthetic zone. To counteract the inevitable hard and soft tissue changes after tooth extraction, the socket shield technique (SST) has been advocated as means to maintain the facial and/ or interproximal osseous and gingival architecture. Because SST is a technique-sensitive procedure, various complications related to SST have been reported. This article presents a unique complication after a socket shield procedure and a novel management of the complication. [ABSTRACT FROM AUTHOR]

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

Background: The rising demand for improved aesthetics has driven the utilization of recently introduced aesthetic materials for creating custom post and core restorations. However, information regarding the fracture resistance of these materials remains unclear, which limits their practical use as custom post and core restorations in clinical applications. Aim of the study: This study aimed to evaluate the fracture resistance of three non-metallic esthetic post and core restorations and their modes of failure. Materials and methods: Thirty-nine single-rooted human maxillary central incisors were endodontically treated. A standardized post space preparation of 9mm length was performed to all teeth to receive custom-made post and core restorations. The prepared teeth were randomly allocated to receive a post and core restoration made of one of the following materials (n=13): glass fiber-reinforced composite (FRC), polyetheretherketone (PEEK) and polymer-infiltrated ceramic-network (PICN). An intraoral scanner was used to scan all teeth including the post spaces. Computer-aided design and computer-aided manufacturing (CAD-CAM) was used to fabricate post and core restorations. Post and core restorations were cemented using self-adhesive resin cement. All specimens were subjected to fracture resistance testing using a universal testing machine. Failure mode analysis was assessed using a stereomicroscope and SEM. The data was statistically analyzed using One-Way ANOVA test followed by multiple pairwise comparisons using Bonferroni adjusted significance level. Results: Custom PEEK post and core restorations displayed the least fracture load values at 286.16 ± 67.09 N. In contrast, FRC exhibited the highest average fracture load at 452.60 ± 105.90 N, closely followed by PICN at 426.76 ± 77.99 N. In terms of failure modes, 46.2% of specimens with PICN were deemed non-restorable, while for PEEK and FRC, these percentages were 58.8% and 61.5%, respectively. Conclusions: Within the limitation of this study, both FRC and PICN demonstrated good performance regarding fracture resistance, surpassing that of PEEK. [ABSTRACT FROM AUTHOR]

Background: Endodontic literature search revealed that no study has been conducted to evaluate the prevalence of apical periodontitis (AP) in root canal treated teeth from an adult Nepalese population of Madhesh Province. Consequently, little is known about the extent and risk factors associated with it. This study aimed to determine AP prevalence in root canal treated teeth from an adult Nepalese subpopulation and to analyze the related risk factors including age, sex, tooth type, type of coronal restoration and quality of root canal treatment and coronal restoration as predictors of AP. Methods: Digital panoramic radiographs were evaluated. Periapical status of 300 root canal-treated teeth was scored by using the periapical index. The quality of root canal treatment and coronal restorations were categorized as adequate or inadequate through radiographic and clinical evaluation. The data were analyzed using univariate and multivariate logistic regression models. Results: Prevalence of AP in the present study was 31.7%. In 45.7% of the treated teeth, quality of root canal treatment was adequate whereas 46% of the cases had adequate coronal restorations. Multivariate logistic regression analysis revealed statistically significant associations and remarkably increased risk for AP in teeth with inadequate root canal treatment (odds ratio [OR] = 7.92; 95% CI: 3.96–15.82; p < 0.001) whereas lower risk for AP was found in females (OR = 0.51; 95% CI: 0.28–0.90; p = 0.021) and in teeth restored with crown (OR = 0.22; 95% CI: 0.09–0.51; p < 0.001) and filling (OR = 0.18; 95% CI: 0.08–0.42; p < 0.001). Quality of coronal restoration, tooth type and age of the patient were not found to be the predictors of AP. Conclusions: Within the limits of this study, a high prevalence of AP and poor overall quality of root canal treatment and coronal restoration was found in the subpopulation studied. Quality of root canal treatment, type of coronal restoration and sex of the patient are significant predictors of possible AP development in root canal treated teeth. Substantial efforts are needed to improve the endodontic treatment standards. [ABSTRACT FROM AUTHOR]

Objective: To investigate factors which influence UK general dental practitioners (GDPs) when restoring posterior root filled teeth. Method: An electronic survey was designed to explore current strategies of treatment of posterior root filled teeth by UK-based GDPs working in primary care. Three vignette cases included in the questionnaire explored a variety of tooth, patient, and financial factors. The survey was distributed by email and social media platforms between December 2018 and February 2019. Results: A total of 528 valid responses were collected. The majority of participants (84.1%) regularly restored posterior root filled teeth with an indirect restoration. Presence of persistent symptoms post root canal treatment (RCT) completion would impact the management of 85% of the surveyed respondents. Referral to a specialist, deferral of provision of the definitive restoration, and fear of litigation were reported by the GDPs as influencing factors. Conclusion: This survey highlights that decision making regarding restoration of root filled teeth is a multifactorial process. Tooth, patient, and financial factors were all shown to influence the restorative management of the posterior root filled teeth. [ABSTRACT FROM AUTHOR]

Background: Coronal seal is one of the essential factors that affects the success of endodontic treatment and reinforces the apical seal. The intra-orifice barrier is an efficient alternative approach to decrease coronal leakage in endodontically treated teeth and various materials have been used for this purpose. This study aimed to compare the coronal sealing of flowable composite, resin-modified glass ionomer (RMGI), and mineral trioxide aggregate (MTA) in endodontically treated teeth. Materials and Methods: In this in vitro study, 35 single-canal canine teeth were divided into five groups, including flowable composite, RMGI, MTA, positive control, and negative control groups. The teeth were filled with restorative materials according to the factory's instructions. Afterward, the samples were immersed in 2% methylene blue dye solution for 1 week at 37°C and 100% humidity condition. Finally, the teeth were sectioned longitudinally and dye penetration was measured using a stereomicroscope with x10. Data were analyzed with Kolmogorov-Smirnov and Kruskal-Wallis tests (α= 0.05). Results: The positive control group showed the highest amount of dye penetration compared to other groups (12.34 ± 0.46). Dye penetration in the MTA group was significantly lower (4.25 ± 0.31) compared to the RMGI group (5.94 ± 0.24) (P = 0.02). Moreover, while the dye penetration in the MTA group was lower than in the flowable composite group (5.65 ± 0.26), the difference was not statistically significant (P = 0.12). Conclusion: MTA reduces the coronal leakage and provides an acceptable coronal seal in endodontically treated teeth, especially compared to RMGI, and therefore, using MTA as an intra-orifice barrier increases the endodontic treatment success rate. [ABSTRACT FROM AUTHOR]

Objective: To introduce the "Peripheral Build‐Up technique – PBUt" as a foundation restoration strategy for structurally compromised teeth (SCT). Clinical Considerations: Several strategies have been proposed over time (cervical marginal relocation, doughnut, and preformed ring techniques) to enable the management of restorative procedures in challenging situations such as the presence of deep subgingival defects. The PBUt is a versatile, completely additive direct technique that share some strategical concepts with these techniques to approach critical clinical situations while supplying a wider field of application thanks to distinct operative expedients. The clamp insertion modality, the extension of the proximal wall and the matrix customization/stabilization strategies adopted in PBUt endorse the possibility to manage the most apical and peripheral border of the residual tooth structure when located up to >1.5 mm above the bone crest. The periodontal response has to be then monitored over time. Moreover, thanks to the peripheral and apically‐extended addictive approach, it allows a massive preservation of residual sound tooth structure and improves the resistance and retentive physical/geometrical features of the abutment tooth. The PBUt operative workflow is herein explained. Clinical Significance: The Peripheral‐Build‐Up technique (PBUt) advocates some innovative clinical restorative steps for the management of SCT with coronal and deep subgingival defects. [ABSTRACT FROM AUTHOR]

This article aims to determine the knowledge, attitude, and practice regarding Deep Dentinal Caries Removal before Root Canal Treatment (RCT) and Restoration among practicing dental surgeons. A descriptive cross-sectional study was executed amongst dental surgeons practicing with undergraduate and post-graduate degrees. A Google questionnaire form was developed and distributed, and 111 authentic entries were short-listed. Data obtained from the study were recorded in Microsoft Excel 2007 version, and SPSS version 18.0 was used for statistical analysis. Most dental surgeons who participated in the study practiced for over 15-20 years. Among them, 60% believe in removing dentinal caries before RCT; 83.8% believe in completely removing caries before any restoration, of which only 32.4% use caries-disclosing agents to detect caries. 77.5 % of dentists often encounter cases of RCT failure with incomplete caries removal, and 51.8% believe RCT failure could be due to incomplete caries removal; hence, 83.8% of dentists would recommend complete caries removal to their fellow dentists before RCT. Unnecessary planning of operative tooth intervention makes it go through a lifetime of restorative care through the re-restoration cycle, with additional economic costs with each appointment and an increased chance of premature tooth loss. Diagnostic aids combining visual and tactile examinations, radiographs, and disclosing agents are reliable diagnostic techniques for deciding on any operative intervention for infected dentine. If caries are excavated before any endodontic treatment, a considerable amount of chair time is reduced during crown preparation, and the longevity of the prosthesis is increased. [ABSTRACT FROM AUTHOR]

This article describes the management of a patient who experienced an unexpected and unattractive 'greening' of an anterior tooth following a course of bleaching. It examines the reasons for this phenomenon and describes a method for disguising the discolouration in a minimally invasive manner that can be carried out in general practice. [ABSTRACT FROM AUTHOR]

Purpose: The study's objective was to evaluate the efficiency of various irrigation activation methods for removing gutta-percha and sealer using Micro-CT and SEM after retreatment with rotary files. Methods: Twenty-one permanent single-rooted teeth that were extracted and had a single canal were decoronated to a length of 16 mm. AH Plus sealer was used for obturating the root canals. Following obturation, Micro-CT scanning was carried out (S1). Another Micro-CT scan was performed following the elimination of the original filling material using ProTaper Universal retreatment files (S2). Next, each of the 21 samples was divided into three groups (n = 7): Group 1: XP-Endo Finisher (XPF); Group 2: Passive Ultrasonic Irrigation (PUI); Group 3: SWEEPS. Subsequent irrigation activation technique by one of each system was followed by the final Micro-CT scanning (S3). After calculating the remnant volume of the filling material, a single specimen was examined under a scanning electron microscope for every group. Statistical evaluation was accomplished utilizing the Kruskal-Wallis and Shapiro-Wilk tests. Results: After analyzing the samples, S1 and S2 scanning results revealed no statistically significant differences among the three groups (p > 0.05). Furthermore, no significant difference in the final volume of residual filling material (S3) between the three groups was found statistically. Conclusion: In summary, XPF, PUI, and SWEEPS techniques are equally efficient at removing remnant filling materials after conventional retreatments. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the effect of storage time on the dislocation resistance of core material to root canal sealer in standardized artificial root canals. Methods: A single root canal with a round shape was selected using cone-beam computed tomography imaging, and root canal treatment was performed. The root was scanned with micro-computed tomography, and the data were exported as a stereolithography file. Forty artificial roots were manufactured using 3D printing technology. The artificial root canals were obturated using a single cone technique. The roots were divided into two groups according to the storage time of filled roots: 7 days and 30 days (n = 20), and stored at 37°C and 100% humidity. After each storage period, 2-mm sections were taken from the middle part of the roots. The sections were tested on a universal testing machine. The dislocation resistances (MPa) were calculated, and the data were analyzed using the Shapiro-Wilk test and independent samples t-test (α = .05). Results: The dislocation resistance of the filling material was significantly higher in the 30-day storage time group compared to the 7-day group (p < .05). Conclusion: The storage time of the root fillings affected the dislocation resistance in the standardized experimental setup with artificial roots. [ABSTRACT FROM AUTHOR]

Over the past few decades, endodontic treatment has benefited from the development of new techniques and using newer instruments. The use of ultrasonics in endodontics gives better predictability and outcome of endodontic root treatment. The purpose of this study is to review the literature regarding the use of ultrasound in certain phases of endodontic treatment of root canals, and critically evaluate the benefits and possible unwanted consequences on the outcome of endodontic treatment. In preparing this paper, research from relevant databases was done (MEDLINE, PubMed, ScienceDirect), using the following keywords: ultrasonics in endodontics, ultrasonic irrigation, ultrasonic files, ultrasonic cavity preparation, root canal and obturation by ultrasonic condensation, ultrasonic retreatment, ultrasonic rootend preparation in apical surgery. The results of the review revealed that the ultrasound: has been proven to provide better visualization, and better access, and considerably shortens the duration of endodontic treatment. During ultrasound work we will have better irrigation compared to traditional irrigation with a syringe, ultrasound removes more organic tissue, planktonic bacteria, and dentin particles in the root canal. The ultrasonic method of placing the sealer in the root canal is more thorough than placing the sealer with manual instruments, and ultrasonically condensed gutta-percha is more homogeneous and has fewer cavities than gutta-percha condensed by classical lateral condensation. The audit of root canal filling is facilitated by ultrasound, and also instrumentation is more successful in removing broken instruments and intracanal extensions. The ultrasound device has the potential to become routinely incorporated into almost every step of endodontic treatment and retreatment. The evolution of dentistry is strongly correlated to the development of science and technology. [ABSTRACT FROM AUTHOR]

With the ever-increasing understanding of tooth anatomy, there is a renewed focus on the pulp chamber as an important component of the root canal system. For example, the pulp chamber is of critical relevance during diagnostic procedures such as pulp sensibility tests, deep caries removal, vital pulp treatments, access cavity preparation, tooth whitening, tooth restoration as well as methods for examining the floor of the pulp chamber to aid the detection of root canal orifices or the presence of perforations and cracks. The more recent concept of minimal invasive endodontics has also created a need to understand better the anatomy of the pulp chamber. The purpose of this article is to discuss the research methods used to study pulp chamber anatomy and the significance of the pulp chamber in endodontic research and clinical practice. In addition, directions for future research are emphasised. [ABSTRACT FROM AUTHOR]

Introduction and Objective. When filling root canals with gutta-percha points (GP), good adaptation of the point to the apical diameter must be achieved through the use of a point corresponding to the size of the master apical file (MAF). GP points with a greater taper, designed to fit into root canals shaped with files with a greater taper, are currently in common use. The study was performed to evaluate the ISO compliance of GP greater taper points (4% and 6%). Materials and Method. Two boxes of GP in sizes 20, 30 and 40 (Dentsply Maillefer, Switzerland) with a taper of 4% (GP 4% group) and 6% (GP 6% group) were used. The percentage of GPs conforming to the ISO size and those not conforming to the ISO size was determined by assessing the fit of the GP apex diameter (D0) with an endodontic gauge (Dentsply Maillefer, Switzerland). Data were analysed using the chi2 test with a significance level of 0.05. Results. Overall, 58.9% of the GP points assessed were in accordance with the ISO size. Depending on the size (20, 30, 40 according to ISO), compliance was 75%, 52.5% and 44.4% in the group GP 4%, and 87.5%, 32.5% and 60% in the group GP 6%, respectively. The results were statistically significant in the GP 4% (p<0.0001) and GP 6% (p<0.05) groups. In both groups, standardisation of greater taper GP was most accurate at size 20. There were no statistically significant differences between the number of GP points with correct diameter between groups GP 4% and GP 6%. Conclusions. The study demonstrated the presence of differences between the ISO size and the actual size of the greater taper GP points. Therefore, the calibration of greater taper GP points before root canal filling should be a routine procedure. [ABSTRACT FROM AUTHOR]

Aim: To evaluate the effects of root canal treatment (RCT) and post-crown restoration on stress distribution in teeth with periapical bone defects using finite element analysis. Methodology: Finite element models of mandibular second premolars and those with periapical bone defects (spherical defects with diameters of 5, 10, 15, and 20 mm) were created using digital model design software. The corresponding RCT and post-crown restoration models were constructed based on the different sizes of periapical bone defect models. The von Mises stress and tooth displacement distributions were comprehensively analyzed in each model. Results: Overall analysis of the models: RCT significantly increased the maximum von Mises stresses in teeth with periapical bone defects, while post-crown restoration greatly reduced the maximum von Mises stresses. RCT and post-crown restoration slightly reduced tooth displacement in the affected tooth. Internal analysis of tooth: RCT dramatically increased the maximum von Mises stress in all regions of the tooth, with the most pronounced increase in the coronal surface region. The post-crown restoration balances the internal stresses of the tooth and is most effective in periapical bone defect − 20-mm model. RCT and post-crown restoration slightly reduced the tooth displacement in all regions of the affected tooth. Conclusions: Root canal treatment seemed not to improve the biomechanical state of teeth with periapical bone defects. In contrast, post-crown restoration might effectively balance the stress concentrations caused by periapical bone defects, particularly extensive ones. [ABSTRACT FROM AUTHOR]

Pulpotomy is increasingly being recognized as a treatment option for the management of permanent teeth with extremely deep caries. These teeth can present with or without symptoms of pulpitis. Traditionally, irreversible pulpitis has been managed with pulp extirpation and root canal treatment. Contemporary research has shown that pulpotomy may be suitable to manage permanent teeth diagnosed with irreversible pulpitis. This article discusses the options and decision-making process of how to restore posterior permanent teeth that have undergone a pulpotomy. In addition, the article highlights diagnostic and material considerations relating to the role of pulpotomy in managing deep caries. CPD/Clinical Relevance: Clinicians should be aware of the use of pulpotomy in management of extremely deep caries or partial irreversible pulpitis in permanent teeth. [ABSTRACT FROM AUTHOR]

Purpose This in vitro study aimed to assess the performance of ProTaper Universal Retreatment (PTUR), Reciproc Blue (RB), and XP-endo Shaper (XPS) system in the removal of bioceramic root canal filling. Materials and Methods Forty-five human single-rooted mandibular premolars were prepared up to 30/.04 and filled with Endosequence BC sealer and BC points before being assigned into three groups (n=15). The root canal fillings were removed until reaching pre-determined working length (WL) with PTUR in group 1, RB in group 2, and XPS in group 3. During the removal of the filling material, apically extruded debris was collected in pre-weighed Eppendorf tubes, and operation time was recorded with a digital chronometer. Reaching the WL and maintaining apical patency were evaluated separately. The data were statistically analyzed using Kruskal Wallis and Mann Whitney U tests. Results The mean amount of extruded debris was highest in the PTUR group, although all instruments caused apical extrusion of debris. The mean time for reaching WL was longest for RB and shortest for XPS, with significant differences among the groups (p<0.05). Although the difference was not significant (p=0.799), in the PTUR group the WL was reached in 93.3% of the samples, which was higher than other groups (86.7%). Conclusion All tested systems caused a certain amount of debris extrusion. XPS was associated with less extrusion while regaining more rapid access to the periapical area than PTUR and RB. [ABSTRACT FROM AUTHOR]

Background: Large cavity designs and access cavities impair endodontically treated tooth fracture resistance. As the tooth's strength is known to reduce significantly after the root canal treatment, occlusal loading as a result of functions such as chewing, biting and certain parafunctional tendencies makes the endodontically treated tooth vulnerable to fracture. Hence, after endodontic treatment, it is vital to give adequate and appropriate restorative material to avoid tooth fractures. Accordingly, the choice of such restorative material should be dictated by the property of fracture resistance. Objective: The goal of this study was to conduct a systematic review and critical analysis of available data from in vitro studies examining the fracture resistance of endodontically treated posterior teeth restored with fiber-reinforced composites. Methodology: The Preferred Reporting Items for Systematic Review and Meta-Analysis (PRIS-MA) Statement was used to guide the reporting of this systematic review A comprehensive literature search was performed using MEDLINE (via PubMed), Scopus, ScienceDirect, Google Scholar, and LILACS. A manual search of the reference lists of the articles was also performed. The databases provided a total of 796 studies from the electronic systematic search. The databases provided a total of 796 studies from the electronic systematic search. Two reviewers scrutinized the papers for eligibility based on inclusion/exclusion criteria and extracted data. The studies were assessed for their potential risk of bias. Based on modified JBI & CRIS (checklist for reporting in vitro studies) guidelines, along with the methodology and treatment objective, we have formulated 13 parameters specifically to assess the risk of bias. A total of 18 studies met the inclusion criteria and were included for qualitative analysis. Considering the high heterogeneity of the studies included, a meta-analysis could not be performed. Results: The majority of the included studies had a moderate or high risk of bias. When compared to traditional hybrid composites, fiber-reinforced composites showed increased fracture resistance of endodontically treated teeth in the majority of investigations. On the other hand, limited evidence was found for the bulk fill composites. Moreover, moderate evidence was found for the fracture resistance of inlays and fiber posts with fiber-reinforced composites for core build-up in endodontically treated teeth. No evidence could be found comparing the fracture resistance of endo crowns and fiber-reinforced composites in endodontically treated teeth. Conclusion: According to the research, using fiber-reinforced composites instead of conventional hybrid composites improves the fracture resistance of endodontically treated teeth. However, there was a high risk of bias in the research considered. No judgments could be reached about the superiority of one material over another based-on comparisons between other core restorations. [ABSTRACT FROM AUTHOR]

However, when bone dehiscence is present at the time of implant placement, different bone regenerative techniques, such as guided bone regeneration (GBR), need to be used to allow the correct placement of a dental implant. "Biological complications" refer to disturbances in the function of the implant, characterized by biological processes that affect the supporting tissues, including peri-implant diseases [[62]]. A rise in requests for esthetic dental treatments has led to the introduction of new materials, treatments and procedures able to provide non-invasive, long lasting and predictable treatment options [[1], [3]]. The adhesive reattachment of a fragment, combined with vital pulp-therapy procedures, represents the first-choice treatment option in cases of both simple and complicated crown fractures [[4], [16]]. Microbial plaque accumulation is considered to be the most important factor in the pathogenesis of peri-implant diseases, similarly to periodontitis, and the presence of micro-gaps at the implant-abutment interface has been implicated in several studies as the source of bacterial penetration [[66]]. [Extracted from the article]

Background: Due to tooth structure loss from caries, trauma, fracture, prior restorations, and endodontic therapy, all of which lower the tooth’s fracture resistance, restoring teeth that have had endodontic therapy presents a number of challenges. To evaluate the attitude and practice of dentists and specialists in Southern Saudi Arabia regarding the restoration of endodontically treated teeth. Materials and Methods: A cross‑sectional questionnaire‑based study was carried out in Southern Saudi Arabia with a sample of general dentists as well as dental specialists. The questionnaire consisted of 12 items (questions), of which the first few inquired about participants’ demographic data such as age, years of practice, and the rest of the questions were intended to ask regarding their choice and use of restorative options of endodontically treated teeth. Data hence obtained were subjected to statistical analysis using SPSS version 20. Results: A majority of the study dentists (33.8%) prefer tooth‑colored crowns to use for endodontically treated anterior teeth when more than 50% of the tooth structure is remaining. Nearly 29.7% believed to use of prefabricated post and tooth‑colored crowns for endodontically treated anterior teeth when <50% of the tooth structure is remaining. Most of the study participants (75.7%) preferred composite core material and (64.9%) placed the “post” after waiting for 1 week. It was observed that the majority of the specialists used prefabricated post and tooth‑colored crown (29.3%) as a restorative material for endodontically treated anterior teeth when <50% of tooth structure was remaining. A statistically significant difference (P = 0.011*) was found between the responses of specialists and general dentists for their preferred restorative material post root canal treatment (RCT). Conclusion: The survey revealed a clear predisposition among respondents to tapered prefabricated metallic posts. This result demonstrates a consensus among dentists, indicating a preferred option for postdesign in their clinical practice. Different views were expressed by general dentists and specialists for the questions related to restoration options, depending on their choices. [ABSTRACT FROM AUTHOR]

The world today is literate enough about the basics of oral health conditions and available treatment options. Due to the availability of many resources on different platforms the urge to retain natural teeth rather than have extractions has increased. Dental catastrophes are sometimes unavoidable in everyday dental practice. The prime motive should be patient benefit while the general dental practitioner (GDP) identifies the risks associated with the case, availability of equipment and enhanced operator skill when deciding to the referral of the patient to a specialist. Most failed root canal treatment cases have one or more associated endodontic errors. This case report presents stepwise management of such a case of iatrogenic perforation that occurred during the initial endodontic management. It emphasizes the significance of evidence-based treatment planning, role of magnification, selection of the appropriate armamentarium for performing root canal treatment, use of bioactive materials that collectively demonstrate peri-apical healing following the repair of endodontic mishaps. It also emphasizes on the importance of recall in such cases where adequate healing can be tracked over a period. CPD/Clinical Relevance: Knowledge of management of iatrogenic perforations is useful information for clinicians. [ABSTRACT FROM AUTHOR]

The science of endodontology and the practice of endodontics have changed immeasurably in the last 50 years. Improved understanding of the aetiology of peri-radicular diseases, in particular the central role of micro-organisms, has driven a more biological approach to treatment. Advances in technology have brought to market sophisticated armamentaria that have facilitated and enhanced clinical delivery. The development of biomaterials and the refinement of clinical techniques have contributed to improved outcomes for both non-surgical and surgical endodontic treatments. The present article summarizes the changes in this field in the past 50 years, and updates the reader on contemporary clinical endodontic practice. CPD/Clinical Relevance: An awareness of historical developments in the field of endodontics provides useful context and an increased understanding of current practices [ABSTRACT FROM AUTHOR]

Introduction: This study aimed to investigate the most important stage of endodontic surgery by examining failed cases and analyzing the cause of failure during each stage of the procedure. Materials and Methods: We searched the clinical database of the Department of Conservative Dentistry, Dankook University, for patients with a history of endodontic microsurgery (EMS) performed between March 2017 and February 2021. Among the 428 patients who underwent EMS, those with a history of endodontic surgery were included. All surgical procedures were performed using a microscope, and the previously resected root surface or the root surface to be resected was inspected during surgery. The patients were followed up at 6 and 12 months and every year thereafter. Results: A total of 68 cases were included for analysis. The most common cause of failure was incomplete root-end filling (24 cases, 35.3%), and mineral trioxide aggregate (MTA) was used in 17 cases. This was followed by no root-end management after root-end resection (33.8%), incorrect root-end preparation (19.1%), inspection error (7.4%), cracks (2.9%), and incomplete root-end resection (1.5%). After resurgery, 41 were followed up for more than 1 year (recall rate, 60.3%), and the success rate was 85.4% (35 out of 41 cases). Conclusions: Root-end filling was shown to be the most important stage in determining the outcome, even when using the biocompatible material, MTA. [ABSTRACT FROM AUTHOR]

Objective: The aim of this prospective clinical study was to assess the effect of different instruments and root canal filling techniques on post-operative pain in single visit of endodontic retreatment. Methods: Forty five patients (18-65 yrs old) who needed non-surgical endodontic retreatment in mandibular premolar or molar teeth without any symptoms were included in this study. The teeth were randomly assigned into 3 groups of 15 teeth, according to the instrumentation and filling techniques: hand files with lateral compaction (group 1), Reciproc with lateral compaction (group 2), Reciproc with continuous wave compaction technique (group 3). Retreatments were performed in a single visit and post operative pain was assesed at 4 intervals; 24, 48,72 hours and 7 days. All data were analyzed using One way Anova, Chi-square and Fisher's Exact test and the significance level was set to (p=0.05). Results: No statistically significant difference was found among the groups in relation to post-operative pain (p>0.05). Although the intensity of post-operative pain was decreased over the time in all groups, significant difference was found only in Reciproc groups (p<0.05). However, no pain was found in any patient at the end of 7 day. Also, statistically significant difference was found between pain intense and periapical index in 24 and 72 hours (p<0.05). Conclusion: In the present study, the intensity of post-operative pain was not found to be related to instrumentation or filling techniques in retreatment cases. The intensity of pain could be related to periapical index of the tooth. [ABSTRACT FROM AUTHOR]

Introduction: The exposure to amalgam restorations has been reported to bring about altered immunity followed by inflammation and infection. Aims: This study aimed at identifying whether patients who received restorative or endodontic treatments, or tooth extraction, would have altered odds of developing oral lichen planus (OLP). Material and methods: In this population‐based nested case–control study, 421 cases of OLP and 1,684 controls were included after propensity score matching. Logistic regression was used to estimate the adjusted odds ratio (aOR) of OLP in individuals who had received amalgam and composite resin restorations, root canal therapy, and tooth extraction over a follow‐up duration of five years. Results: There were no significantly different odds of OLP for those who underwent either amalgam (aOR = 0.948, 95% CI = 0.853–1.053, p = 0.3170) or resin restorations (aOR = 1.007, 95% CI = 0.978–1.037, p = 0.6557) in both anterior and posterior teeth in an observational period of five years after restorations. Root canal therapy was associated with significantly lower odds of OLP, with each additional root canal therapy attenuating the risk of OLP at an aOR of 0.771 (95% CI = 0.680–0.874, p = 0.0001) for both anterior (aOR = 0.786, 95% CI = 0.626–0.986, p = 0.0372) and posterior teeth (aOR = 0.762, 95% CI = 0.650–0.893, p = 0.0008). Likewise, each tooth extraction reduced the risk of OLP, with an aOR of 0.846 (95% CI = 0.772–0.927, p = 0.0003), especially for anterior teeth (aOR = 0.733, 95% CI = 0.595–0.904, p = 0.0037). Conclusions: We reported no significant association between dental restorations and consequent OLP, and significantly lower odds of OLP following both root canal therapy and tooth extraction. [ABSTRACT FROM AUTHOR]

Background and Aims: Success in endodontic treatment is directly related to proper diagnosis and neutralization of microorganisms using mechanical and chemical methods and full canal obturation. Given that technical errors can affect the success of treatment and cone beame CT can detect these errors perfectly, the aim of this study was to determine the frequency of technical errors in root canal treatment using CBCT Materials and Methods: In this descriptive-analytical study, 1067 endodontically treated roots in CBCT stereotypes were investigated. Fine-grained diagnostic radiographies were investigated in coronal, sagittal and axial planes. Filling length errors (tip to tip obturation, underfilling, overfilling, voide), errors during preparation (perforations, transport, broken instruments, missed canal and vertical root fracture) were recorded. The data were analyzed by Chi-square and Fisher's exact test Results: Moreover, the highest technical errors occurred were transport (23.8%), overfilling (21.2%), underfilling (21.1%) and voide (17.8%) and the lowest technical error occurred was zipping (0.3%). The highest technical errors occurred in the anterior regions including single canal teeth (18.7%) and single canal premolar (11.4%) and the lowest technical errors were found in the buccal and lingual canal of double canal canines (4 %). The frequency of radiographic lesions (p = 0.005) and the expansion of PDL (p <0.001) were significantly different between different dental areas; however, the frequency of resorption was not significantly different between different dental areas (p = 0.11). Conclusion: The highest observed error was in the anterior area of a canal and the lowest error rate determined by the CBCT was related to the two canal canine (buccal) and two canal canine (lingual). transport, short-term filling, and void were the most endodontic errors and the lowest ones were related to zipping cousing with broken file and post perforation in the root canal treatment. [ABSTRACT FROM AUTHOR]

This study aimed to evaluate the effect of general anesthesia (GA) on the 1-year outcome of Root Canal Treatment (RCT) performed in pediatric patients and to compare it to the outcome of RCT in pediatric patients without GA. Patients admitted for RCT in permanent dentition in a public hospital, dated 2015 to 2020, age 8–15 with a minimum of one year follow-up period, were included in the study. The sample consisted of 326 teeth from 269 patients treated by a single operator, with a recall rate of 81%. Overall, 124 teeth were treated under GA and 142 teeth were without GA. The mean follow-up time was 31.5 months. Data underwent statistical analysis and the significance threshold was set for p < 0.05. Of the total cases, 90% showed favorable outcomes. A significantly higher favorable outcome was seen in the GA group than in the non-GA group (98% and 85%, respectively, p < 0.001). The outcome was significantly affected by the type and quality of the coronal restoration, degree of root development, and lesion size (p < 0.05). According to the current study, in uncooperative pediatric patients, a more favorable outcome of root canal treatment can be obtained under GA than LA if the procedure is carried out with immediate restoration. [ABSTRACT FROM AUTHOR]

The present case report demonstrates the nonsurgical endodontic treatment intervention of a large through‑and‑through periapical lesion in the anterior maxillary region of an 18‑year‑old female with a chief complaint of regular swelling and drainage of pus from the buccal and palatal areas of the maxillary anterior region of gingiva with no history of pain. The treatment includes thorough chemomechanical debridement, followed by complete endodontic therapy. The root canal was filled with calcium hydroxide for 2 weeks, followed by a bioceramic apical plug and obturation. Clinical and radiographic re‑evaluations up to 2 years showed a total cure of periapical lesion. This case report shows that the conservative nonsurgical approach leads to the complete healing of large periapical lesions. [ABSTRACT FROM AUTHOR]

Aims: To evaluate the complexity of root canal treatments accepted for treatment by postgraduate training grades at Cardiff University Dental Hospital (CUDH) using the English Commissioning Standard for Restorative Dentistry (ECS) in comparison with the American Association of Endodontists case complexity form (AAE) and the Restorative Index of Treatment Need (RIOTN). Methodology: Two hundred case records were evaluated using the AAE, RIOTN and ECS scoring systems. Each case received a score from minimal to high complexity (1–3). Examiners were calibrated and inter‐examiner reliability calculated using the percentage agreement. Frequency of scores were then compared. Results: Most cases were at level 3 and assessment varied amongst the criteria used (AAE: 99.5%, RIOTN: 65.5% and ECS: 55.5%). The AAE factor 'endodontic treatment history' was largely responsible for differing scores when compared with the RIOTN (78%) and ECS (64%). The RIOTN factor regarding post treatment disease ('endodontic retreatment') was responsible for increased complexity compared with ECS in most cases (74%). The ECS factor 'quality of root filling' was the most common reason (85%) for an increase in complexity compared with RIOTN. Conclusions: Within the limitations of this service evaluation, it was possible to conclude that a high proportion of cases treated by training grades at CUDH were of a high complexity level (level 3) using the three guidelines (ECS, AAE and RIOTN). These cases were appropriate for postgraduate training under various levels of supervision and substantiated by the findings reported here. The factors responsible for a large part of difference in allocation of scores amongst the systems were 'endodontic treatment history', 'root canal retreatment' and 'quality of root filling'. [ABSTRACT FROM AUTHOR]

Objective: To compare the effects of lava ultimate high toughness ceramic inlay and sonicfill acoustic resin in the repair of large-area tooth defects after root canal treatment. Methods: 124 patients with large-area tooth defects after root canal treatment treated in our hospital from January 2019 to January 2022 were selected as the research objects. They were divided into group A (62 cases) and group B (62 cases) according to the method of tooth restoration. Group A was repaired with lava ultimate high toughness porcelain inlay, and group B was repaired with sonicfill acoustic resin. The clinical efficacy, gingival index (GI) and plaque index (PLI), complications and patient satisfaction were compared between the two groups at 6 months and 1 year. Results: (1) There was no difference between group A and group B in the classification of edge tightness, shape, color, fracture and secondary caries of abutment teeth in the modified USPHS standard at 6 months and 1 year after restoration (P>0.05); (2) The GI and PLI of group A and group B at 6 months and 12 months after repair were significantly lower than those before repair (P<0.05), but there was no difference between the two groups at different times (P>0.05); (3) The total satisfaction of repair in group A was higher than that in group B (P<0.05); (4) The total incidence of complications in group A and group B were 3.23% and 4.84% respectively. There was no difference between the two groups (P>0.05). Conclusion: Lava ultimate superior tough porcelain high inlay and sonicfill acoustic resin have the same effect on the treatment of large-area tooth defects after root canal treatment. They can effectively ensure the appearance recovery, tightness and occlusion of tooth defects, which is conducive to periodontal health, but the high inlay satisfaction is high. [ABSTRACT FROM AUTHOR]

Introduction: Quality of root canal treatment is considered as an important prognostic factor for endodontic therapy success. The aim of this study is to evaluate radiographic errors during the root canal treatment by 5th and 6th year undergraduate students of Islamic Azad university of Isfahan (Khorasgan) from 2015 to 2018. Materials & Methods: In this study records of 860 cases of endodontic treatment of patients referred to the General Endodontics Department and the Comprehensive Treatment Department of Isfahan Azad University (Khorasgan) during 2015-2018 including 1903 root canals that had received root canal treatment were examined. Periapical radiography was used to evaluate errors during access cavity preparation, canal preparation, and canal filling by two endodontic specialists and it was recorded in pre-prepared forms. In the access cavity preparation: furcation perforation, low access cavity expansion, high access cavity expansion were evaluated. During the canal preparation phase, errors such as missing of canal, ledge, transport, perforation types and broken instruments were investigated. Length and density of root filing were the criteria evaluated at the canal filling stage. The analysis was performed at both descriptive and inferential levels. Statistical analysis was performed by Chi-Square test and exact Fisher's test. Results: Frequency of acceptable root canal treatment (without errors) was 37.5%. Lower first molars showed the highest error rate (40.7%). Furcation perforation was reported with 9.4% highest error of access cavity preparation. The highest error rate was reported transport (7.8%) in the preparation phase. Inadequate density (gap) of 36.9% and under filling of 31.1% had the highest error in filling stage. Conclusion: According to the results of this study, it can be stated that general endodontics department needs careful planning to increase the quality of root canal treatments performed by students. [ABSTRACT FROM AUTHOR]

Objectives: The aim of the present study was to evaluate the efficacy of R-Endo and D-RaCe Retreatment instruments with and without using passive ultrasonic irrigation on the removal of root canal filling material, and the time required for its removal. Materials and methods: Sixty mandibular premolars with single canals were decoronated; the root canals prepared using the Revo-S rotary system and obturated with gutta-percha size (25/.06), using lateral compaction technique. Roots were divided into four equal groups (n = 15) according to the retreatment rotary system and the final irrigation technique used in the removal of root canal filling material into: R-Endo retreatment system with conventional irrigation (R-Endo/C), R-Endo retreatment system with passive ultrasonic irrigation (R-Endo/PUI), D-RaCe retreatment system with conventional irrigation (D-RaCe/C) and D-RaCe retreatment system with passive ultrasonic irrigation (D-RaCe/PUI). Roots were split into two halves longitudinally and the canal walls photographed using a digital camera connected to a stereomicroscope. The remaining filling material in each root canal third was evaluated using Image-J software. Data were analysed using the Mann-Whitney U test for the rotary system comparisons and irrigation techniques, while Friedman's test was used to compare between the different root canal levels. Results: There was a statistically significant difference in the total area percentage of the remaining filling material among the four groups (P < 0.05). The D-RaCe/PUI group showed the least amount of the remaining root canal filling material, followed by R-Endo/PUI, then D-RaCe/C, while the R-Endo/C showed the highest amount. Conclusion: D-RaCe/PUI group was the fastest and the most efficient technique in the removal of the root canal filling material. Conflict of interest: The authors declare that they have no conflict of interest. [ABSTRACT FROM AUTHOR]

Objective: The goal was to investigate the clinical value of two-dimensional radiographs and different radiographic measurement techniques before instrument removal with a microsonic technique. The aim was to find an easy-to-use technique for predicting the success of removal and case evaluation. Additionally the quality of root canal filling after instrument removal was assessed. Method and Materials: This retrospective study analyzed patients' records and preoperative and postoperative periapical radiographs made using the paralleling technique. On preoperative radiographs, canal access angle and Schneider and Weine angle of root canal curvature were measured and compared. The Sch'fer method was used for measuring the radius of curvature. In cases of successful removal taper, homogeneity and length of obturation were evaluated on postoperative radiographs. Results: A total of 123 cases of instrument removal were investigated. In total, 97 fragments (78.9%) were removed successfully. Statistical analysis was performed with Pearson's chi-square and Fisher's exact test (α < .05). The site of fragment relative to canal curvature, canal access angle, and Schneider angle significantly influenced the success of removal. The highest chance of removal failure was associated with > 20 degrees of canal access angle and > 40 degrees of Schneider angle. Only 26.3% of obturations met all technical standards. Altered taper could be identified in 64.2% and was always associated with ledge formation. Conclusion: Microsonic removal is a successful method to retrieve separated instruments. The use of only one radiographic measurement technique is not sufficient to precisely evaluate root canal anatomy, case difficulty, and chance of successful removal before instrument removal on a periapical radiograph. Postoperative root canal fillings are mainly substandard. [ABSTRACT FROM AUTHOR]

Purpose: The objective of this systematic review was to assess the impact of endodontic post insertion on the clinical performance of endodontically treated teeth (ETT). Materials and Methods: A specific PICO question was developed and a Medline search was performed in January 2017 using relevant terms in order to identify studies comparing the success/survival of dental restorations using endodontic posts or no posts. Additionally, the electronic databases "Opengrey", "BBO", "LILAC" and "IBECS" were assessed and a hand search of cross references from original articles and reviews was performed. The methodological quality of the included studies was assessed independently by three referees using (1) the critical appraisal skills program (CASP) and (2) Cochrane checklist (version 5.1.0). Results: A total of 14 studies were included, among them 11 randomized controlled trials (RCT), two prospective clinical trials, and one retrospective clinical trial. The overall quality of the studies was good according to the CASP. However, the Cochrane rating showed that in seven studies, the risk of bias was high in > 40% of the items, indicating a relevant level of methodological flaws. Three studies showed a low risk of bias in > 80% of the items. The majority (10 out of 14) of the clinical studies included failed to show a positive effect of post placement. A post effect is possible when no cavity wall is present. Conclusion: There is no unequivocal clinical evidence to support or reject the use of posts even for no-wall cavities, either for direct or indirect restorations. [ABSTRACT FROM AUTHOR]

Aim: The aim of the study was to investigate the influence of cavity cleaning and conditioning on marginal integrity of directly placed post‐endodontic composite class‐I‐restorations in vitro. Methodology: A total of 168 fully intact teeth without caries or fillings received pre‐endodontic composite restorations (class‐II) after their extraction. Occlusal endodontic access‐cavities were prepared, and root canals were instrumented and filled with gutta‐percha and an epoxy resin‐based sealer. Prior to post‐endodontic class‐I‐restoration, access cavities were completely contaminated with sealer, cleaned with alcohol and pre‐treated as follows: cleaner only (alcohol), glycine‐polishing, Al2O3 sandblasting, carbide bur (immediate as well as delayed restoration). A positive control (not contaminated with sealer and adhesive used) and negative control (cleaner used but no adhesive) were established. Half of the teeth from each group were subjected to thermocycling and mechanical loading (TCML). Marginal integrity of post‐endodontic restoration was evaluated in oro‐vestibular or mesio‐distal sections after AgNO3 dye penetration (DP) by standardized photomacroscopic imaging and expressed in per cent of margin length along all segments and separately for enamel, dentine and composite, respectively. Results were analysed non‐parametrically (α =.05). Results: No restorations or teeth fractured or debonded completely. Without TCML, the median DP of all segments was significantly higher for the negative control compared with all other groups in oro‐vestibular cutting direction (53%; p =.002) and in mesio‐distal cutting direction (51%; p ≤.041). The other groups without TCML revealed 16%–24% DP (oro‐vestibular) and 12%–24% DP (mesio‐distal). With TCML, the median DP in oro‐vestibular cutting direction for all segments ranged between 48% and 62% for all groups, a significant difference was only observed between glycine‐polishing and carbide bur (p =.041). In mesio‐distal cutting direction, the median DP in negative control was 69% with TCML and significantly higher compared with all other groups (p =.002). For all other groups, the median DP of all segments ranged between 28% and 40% with TCML without significant differences. Error rates method (k = 7) revealed a significant influence of TCML in general on penetration of all segments in both oro‐vestibular and mesio‐distal cutting directions. Conclusion: Additional access cavity pre‐treatment after alcohol cleaning did not improve the marginal integrity of post‐endodontic composite restorations. Thorough cleaning of the access cavity with alcohol seems to assure an acceptable marginal integrity to the tooth and restorative composite. [ABSTRACT FROM AUTHOR]

Introduction: Root canal fillings using Gutta-percha and root canal sealers are considered the gold standard in endodontics. Bondable root canal sealers help in strengthening the root by penetrating into the dentin. Aim: The aim was to compare and evaluate the fracture resistance of root dentin following the application of AH Plus sealer, MTA Fillapex sealer, and BioRoot RCS sealer. Materials and Methods: Decoronation was performed on 70 extracted single-rooted premolars at the cementoenamel junction. The samples were divided into three experimental and two control groups. Fourteen samples served as the negative control (Group 4), which were left unprepared. The remaining 56 samples were prepared with Pro Taper rotary files up to F3. The roots were obturated using cold lateral compaction using Gutta-percha and AH Plus sealer (Group 1), MTA Fillapex (Group 2), and BioRoot RCS (Group 3). Group 5 served as the positive control group. A universal testing machine was used to compress the samples until fracture occurred. One-way analysis of variance with post hoc Tu key's test was used to analyze the data. Results and Discussion: The highest resistance to fracture was shown by Group 4 (negative control), followed by Group 1 (AH Plus), Group 3 (BioRoot RCS), Group 2 (MTA Fillapex), and the least by Group 5 (positive control). There was a statistically significant difference between all the groups (P = 0.00) except between AH Plus and BioRoot RCS (P > 0.05). Conclusion: Samples in all the groups fractured when vertical force was applied. The maximum resistance to fracture was shown by the roots which were neither instrumented nor obturated. AH plus sealer showed the highest resistance to fracture among the three experimental groups, followed by BioRoot RCS and MTA Fillapex. [ABSTRACT FROM AUTHOR]

Background: Previously published epidemiological outcome studies of nonsurgical root canal therapy (NSRCT) in the United States utilize data only from a single, private dental insurer for adult populations. Aim: This study aimed to investigate the outcomes of initial NSRCT, performed on permanent teeth, in a publicly insured paediatric population. Design: New York State Medicaid administrative claims were used to follow 77 741 endodontic procedures in 51 545 patients aged 6–18, from the time of initial NSRCT until the occurrence of an untoward event (retreatment, apicoectomy, and extraction). The initial treatment and untoward events were identified by Current Dental Terminology codes. The Kaplan–Meier survival estimates were calculated at 1, 3, and 5 years. Hazard ratios for time to permanent restoration and restoration type were calculated using the Cox proportional hazards model. Results: The median follow‐up time was 44 months [range: 12–158 months]. Procedural, NSRCT, survival was 98% at 1 year, 93% at 3 years, and 88% at 5 years. Extraction was the most common untoward event. Teeth permanently restored with cuspal coverage had the most favorable treatment outcomes. Conclusions: Overall, 89% of teeth were retained and remained functional over a minimum follow‐up time of 5 years. These results elucidate the expected outcomes of NSRCT in permanent teeth for paediatric patients with public‐payer dental benefits. [ABSTRACT FROM AUTHOR]

Aim: The aim of the study was to evaluate the clinical and radiographic outcome of single‐visit root canal retreatment and compare the results with conventional two‐visit root canal retreatment as control group. Methodology: One hundred root canal‐treated, single‐rooted asymptomatic teeth with periapical lesion were retreated by one operator. Fifty of the teeth were randomly assigned to the single‐visit group and the others were treated in two visits. In both groups, root canal filling material was removed, and re‐instrumentation of the root canal was performed using step‐back technique with hand files using 2.5% NaOCl and 5% EDTA as irrigants. In the single‐visit group, 5 ml 2% chlorhexidine (CHX) were applied as the final irrigation and in the two‐visit group, calcium hydroxide paste was placed into the root canal as an interappointment dressing. All root canal obturations were performed with lateral compaction. All patients were followed up for 24 months. The success was determined depending on both healed and healing cases. The chi‐square or Fisher's exact test was used to analyse the differences between the groups for success rates and the factors affecting the outcome. Results: The recall rate was 89 (89%). At 24 months, 39 teeth (88.6%) were considered as healed, three teeth (6.8%) as healing, and two teeth (4.5%) were identified as failed in the single‐visit group, while in the two‐visit group 39 teeth (86.7%) had healed, two teeth (4.4%) were scored as healing, and four teeth (8.9%) as failed. There was no statistically significant difference in the success rates between the two groups (p >.05). Size of the lesion and the preoperative length of root canal filling had a statistically significant impact on the outcome (p <.05). Conclusion: No statistically significant difference was observed in terms of healing in 24‐month follow‐up of retreatments completed in single visit or two visits in asymptomatic teeth with periapical lesions. The size of the periapical lesion and initial apical level of root canal filling have affected the outcome of root canal retreatment. [ABSTRACT FROM AUTHOR]

Traumatic dental injuries (TDIs) are of great concern when it comes to a child. Crown-root fracture is the most complicated type as both crown and root are affected by trauma. Complicated crown-root fracture seldom occurs in deciduous dentition. It is a tragic experience and requires immediate attention and quick functional and esthetic repair. Appropriate and early diagnosis leads to successful treatment, for which knowledge on types of TDIs, classification, and management is necessary. Complete restoration of teeth affected with trauma will restore function and esthetics and preserve occlusal harmony. The objective of the present case report is to discuss the appropriate diagnosis and conservative treatment of this unusual and rare case of complicated crown-root fracture in a 4-year-old child using tooth fragment reattachment. This case will focus on the options to restore the uncommon trauma and normalize the function and esthetics of the patient, which will lead to improvement of speech, increase in self-confidence and protection of successors, and describe the treatment and aspects concerning follow-up of the patient. [ABSTRACT FROM AUTHOR]

Background: Single visit endodontics has been shown to be an effective treatment modality when compared with multiple visit therapy and it does not deviate from achieving the objectives of proper biomechanical preparation, debridement, shaping, disinfection and 3 dimensional obturation of root canal system and is more beneficial to the patient and dentist provided there is careful case selection and strict follow of standard endodontic protocols. Symptomatic teeth can also be managed by single visit after controlling the abscess infection with antibiotic, provided the root canal is dry without any discharge. Purpose: This study aims to perform single visit root canals on teeth with irreversible pulpitis and restoration with post core and crown. Case: A 48-years-old female comes with dental complaints of upper left rear spontaneous pain at night. The tooth has had cavities since about two years ago and has never been previously treated. The patient said had not any systematic health disorder. There is a spontaneous pain that the patient feels. Case Management: From the examination that has been carried out, a clinical diagnosis of tooth 25 were symptomatic pulpitis irreversible with normal apical tissue. The restoration endodontic treatment plan was a single visit endodontic and the restoration is post core and crown. Conclusion: Symptomatic pulpitis irreversible with normal apical tissue treatment can be carried out single visit root canal treatment. Restoration of post endodontic treatment in this case need fiber post and core using composite and finally restoration using crown that made of zirconia. Zirconia has a higher level of material resistance than lithium disilicate. This is what makes zirconia the choice, especially for posterior teeth. [ABSTRACT FROM AUTHOR]

Backgrounds: Intentional replantation (IR) is a reliable and predictable treatment option for cases with failed non-surgical root canal treatment. The success of IR is found to be 52-95%. The current case is of 35years old female who presented with severe pain and swelling in lower right first mandibular molar with previously initiated non-surgical root canal treatment that resulted in instrument separation in mesio-buccal canal. Periapical radiograph showed rarefactions at furcation area, mesial and distal root apices. It was decided to complete the non-surgical root canal treatment followed by intentional replantation and retrograde filling with MTA. The tooth was found to be asymptomatic after two years follow up and periapical radiographs depicted complete healing. Intentional replantation with careful case selection is a successful, easy and reliable treatment option for hopeless cases. Atraumatic extraction, minimum extra-alveolar time and aseptic techniques during the procedure are the key factors for success of the procedure. [ABSTRACT FROM AUTHOR]

Connective tissues in lateral canals mostly remain vital even after pulp necrosis of the main canals. However, lateral canals may become necrotic following the pulp necrosis of the main root canal or after root canal therapy. This case report presents a maxillary central incisor with a necrotic lateral canal and a sinus tract that initially showed healing following the primary endodontic treatment but showed infection after fiber-post placement and permanent restoration with composite resin. Tracing the sinus tract did not reveal the reason for the infection; however, cone beam computed tomography (CBCT) confirmed a lateral radiolucency of the maxillary right central incisor as the only reason for the return of the infection. A conservative re-treatment approach was performed, replacing the fiber post with gutta-percha and root canal sealer. Successful outcome was achieved with a conservative approach; however, it took some time for the sinus tract to heal. In the case of lateral canal infection, sealing the main root canal space could heal the lesion even without lateral canal negotiation. If the main root canal seal is disturbed, re-cleaning and obturating the main root canal could be successful. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the fracture resistance and failure characteristics of simulated thin wall endodontically treated teeth without ferrules restored with various techniques. Materials and methods: Forty‐eight human mandibular single‐root canal premolars were decoronated and endodontically treated. The 1 mm thick remaining root canal dentin was prepared. The roots were randomly divided into four groups of 12 roots according to the following post and core reconstruction techniques: direct resin composite post and core (CP), multiple fiber posts and resin composite core (FP), CAD/CAM anatomical post and core (AP), and metal cast post and core (MP). Full metal crowns were cemented to the cores. All specimens were subjected to thermocycling for 5000 cycles and submitted to axial compression until failure at a 45°angle using a universal testing machine. The failures were classified into one of the followings: post and/or core fractures, root fractures, and root fractures combined with post and/or core fractures. Results: Average failure loads of groups CP, FP, AP, and MP were 360.0, 655.2, 402.7, and 856.1 N, respectively. MP provided the highest failure load, which was significantly higher than those of the other groups (p < 0.05). FP was second, being inferior to MP with a significance level of p = 0.039. CP exhibited the least failure load, and it was not significantly different from the AP group (p > 0.05). Root fractures were the major failure mode for most of the specimens except the CP group, in which composite fractures at the cervical level were commonly observed. Conclusion: Metal cast post and core provided the highest fracture resistance for reconstruction of a thin wall in endodontically treated teeth without ferrules, followed by multiple fiber posts and resin composite core. The milled anatomical post and core and a direct resin composite post and core provided significantly lower fracture resistance. Clinical significance: Metal cast posts and core and multiple fiber posts with resin composite core techniques were effective for restoring severely compromised endodontically treated teeth. [ABSTRACT FROM AUTHOR]

This report describes a regenerative endodontic procedure of an immature permanent incisor with internal root resorption (IRR) and 4-years follow-up. A healthy 8-year-old man was referred for treatment of tooth #9 after a traumatic intrusion. The periapical radiograph showed an IRR and an open apex with periradicular lesion. A diagnosis of pulp necrosis and chronic apical abscess was achieved. In the first appointment, under local anesthesia and rubber dam isolation, an access cavity was designed and the root canal was chemically cleaned under irrigation with 10 mL 1.5% sodium hypochlorite (NaOCl). The root canal was then dried and calcium hydroxide paste was placed. During the second appointment, the root canal was irrigated with 5 mL of 17% ethylenediaminetetraacetic acid (EDTA) for 5 minutes and dried. The blood clot was established in a time of 3 minutes after the bleeding from the periapical tissue was trigged. White mineral trioxide aggregate (MTA) was placed up to the amelocemental junction and the final restoration of the access cavity was carried out. During periodic clinical and radiographic follow-up, the patient remained symptom free, the periapical region was completely healed, inhibition of the root resorption process achieved, and formation of the new periodontal ligament as well as tooth widening development observed, meeting functional expectations after 48 months. The regenerative endodontic procedures are an available option to treat IRR in severely immature teeth. The available literature on the regenerative endodontic procedures applied to IRR treatment is limited, and more research is needed in this field. [ABSTRACT FROM AUTHOR]

Vertical root fracture (VRF) is a common reason for the extraction of root filled teeth. The accurate diagnosis of VRF may be challenging due to the absence of clinical signs, whilst conventional radiographic assessment is often inconclusive. However, an understanding of the aetiology of VRFs, and more importantly, the key predisposing factors, is crucial in identifying teeth that may be susceptible. Thorough clinical examination with magnification and co‐axial lighting is essential in identifying VRFs, and although CBCT is unable to reliably detect VRFs per se, the pattern of bone loss typically associated with VRF can be fully appreciated, and therefore, increases the probability of correct diagnosis and management. The prevalence of VRFs in root filled teeth is significantly greater than in teeth with vital pulps, demonstrating that the combination of loss of structural integrity, presence of pre‐existing fractures and biochemical effects of loss of vitality is highly relevant. Careful assessment of the occlusal scheme, presence of deflective contacts and identification of parafunctional habits are imperative in both preventing and managing VRFs. Furthermore, anatomical factors such as root canal morphology may predispose certain teeth to VRF. The influence of access cavity design and root canal instrumentation protocols should be considered although the impact of these on the fracture resistance of root filled teeth is not clearly validated. The post‐endodontic restoration of root filled teeth should be expedient and considerate to the residual tooth structure. Posts should be placed 'passively' and excessive 'post‐space' preparation should be avoided. This narrative review aims to present the aetiology, potential predisposing factors, histopathology, diagnosis and management of VRF and present perspectives for future research. Currently, there are limited options other than extraction for the management of VRF, although root resection may be considered in multi‐rooted teeth. Innovative techniques to 'repair' VRFs using both orthograde and surgical approaches require further research and validation. The prevention of VRFs is critical; identifying susceptible teeth, utilizing conservative endodontic procedures, together with expedient and appropriate post‐endodontic restorative procedures is paramount to reducing the incidence of terminal VRFs. [ABSTRACT FROM AUTHOR]

In the last decades, the move of medicine towards minimally invasive treatments is notorious and scientifically grounded. As dentistry naturally follows in its footsteps, minimal access preparation have also becume a trend topic in the endodontic field. This procedure aims to maximize preservation of dentine tissue backed up by the idea that this is an effective way to reduce the incidence of post‐treatment tooth fracture. However, with the assessment of the body of evidence on this topic, it is possible to observe some key points (a) the demand for nomenclature standardization, (b) the requirement of specific tools such as ultra‐flexible instruments, visual magnification, superior illumination, and three‐dimensional imaging technology, (c) minimally invasive treatment does not seem to affect orifice location and mechanical preparation when using adequate armamentarium, but it (d) may impair adequate canal cleaning, disinfection and filling procedures, and also (e) it displays contradictory results regarding the ability to increase the tooth strengthen compared to the traditional access cavity. In spite of that, it is undeniable that methodological flaws of some benchtop studies using extracted teeth may be responsible for the conflicting data, thus triggering the need for more sophisticated devices/facilities and specifically designed research in an attempt to make clear the role of the access size/design on long‐term teeth survival. Moreover, it is inevitable that a clinical approach such as minimal endodontic access cavities that demands complex tools and skilled and experienced operators bring to the fore doubts on its educational impact mainly when confronted with the conflicting scientific output, ultimately provoking a cost‐benefit analysis of its implementation as a routine technique. In addition, this review discusses the ongoing scientific and clinical status of minimally invasive access cavities aiming to input an in‐depth and unbiased view over the rationale behind them, uncovering not only the related conceptual and scientific flaws but also outlining future directions for research and clinical practices. The conclusions attempt to skip from passionate disputes highlighting the current body of evidence as weak and incomplete to guide decision making, demanding the development of a close‐to‐in situ laboratory model or a large and well‐controlled clinical trial to solve this matter. [ABSTRACT FROM AUTHOR]