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Aim: Endodontic-periodontal disease is difficult to treat. The difficulty is related to establishing which component of the inflammation is of endodontic origin and which is periodontal. It is therefore crucial to reveal the origin of endodontic-periodontal disease before initialising root canal treatment. It is important to realise that if the root canal treatment will lead to a severe periodontal condition, the necessary efforts to save the tooth will be ccomplex and expensive and the outcome will be uncertain. This article describes the cases of two patients diagnosed with endodontic-periodontal lesions. Materials and methods: Two teeth with different types of endodontic-periodontal lesions were treated and followed up. The first was a type II endodontic-periodontal lesion (according to Messing and Stock's classification) and the second was a type IV lesion. In case 1, root canal treatment was carried out over two visits with calcium hydroxide as an intracanal dressing, and in case 2, the appropriate treatment was provided for a type IV lesion. Results: In case 1, complete healing was observed after root canal treatment. In case 2, progressive bone reconstruction was visible around the treated tooth after 1 year of observation. The following year, a decision was made to extract the tooth due to the patient's lack of cooperation with the dental practitioner. Conclusion: It is important to properly diagnose and reveal the origin of endodontic-periodontal disease before initialising root canal treatment, but the patient's cooperation with the dental practitioner is also crucial, and can contribute to successful treatment outcomes. [ABSTRACT FROM AUTHOR]

Background: Root canal obturation is an important step in endodontic treatment, which is performed aiming to three-dimensionally seal the canal and prevent microleakage, reentry, and proliferation of microorganisms in the root canal system. On the other hand, microleakage eventually leads to root canal treatment failure. Sealing ability is an important property of endodontic sealers. This in vitro study aimed to compare the quality of apical seals obtained by three endodontic sealers. Materials and Methods: This in vitro experimental study evaluated 48 extracted single-canal maxillary incisors. Hard- and soft-tissue residues were removed and the teeth were immersed in 5.25% of sodium hypochlorite for disinfection.The teeth were decoronated at the cementoenamel junction with a diamond disc such that 10 mm of root length remained. Canal patency was ensured using a #10 K-file.The canals were then instrumented with ProTaper rotary system.The canals were randomly divided into three experimental groups for the application of Adseal, Proseal, and AH26 sealers, and positive and negative control groups. Sealers were applied in the canals using lateral compaction technique.The external root surfaces were then coated with two layers of nail varnish except for the apical 3 mm. The amount of microleakage was quantified using the dye-penetration technique. The Tukey's test was used to compare the microleakage between the experimental and control groups. The Kruskal-Wallis test was applied to compare the microleakage of experimental groups (P < 0.05). Results: The amount of microleakage in canals filled with Adseal, Proseal, and AH26 sealers with lateral compaction technique was 2.33 ± 0.64, 2.2 ± 0.81, and 2.22 ± 0.71 ^m, respectively. No significant difference was noted among the three sealers regarding microleakage (P = 0.84). However, the amount of microleakage in the sealer groups was significantly lower than that in the control group (P < 0.001). Conclusion: The application of Adseal, Proseal, and AH26 had equal efficacy for the provision of optimal apical seal in filling of root canals with lateral compaction technique. The application of sealers yielded a significantly superior apical seal compared with the control group. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To evaluate the knowledge regarding the prescription of antibiotic for treatment of endodontic disease and errors made by the house officers at Multan Dental College. Since the discovery of antibiotics, they have been in use broadly for the treatment of odontogenic infections. Prescription is a dynamic, customized clinical process, which is set owing to the necessities of patient & the acquaintance of the practitioner. METHODOLOGY: This survey-based study was conducted among 40 house officers working at Multan Dental College. A survey form was designed, about the pattern of antibiotics prescription and the situations for which they were recommended by the House officers. RESULTS: The medication of choice was mostly Amoxicillin + clavulanic acid (52.6%) and Amoxicillin alone (47.3%). The most incidence of antibiotic prescription was reported for acute abscess of periapical area of the tooth (62.8%) and patient having fever with malaise (62%). Chronic apical abscess with sinus tract (58%). Overall, 12% of part takers were used to suggest p antibiotics for root canal treatment. CONCLUSION: We conclude that here is deficiency of information & knowledge for the proper indication, kind, and antibiotics dose. Different educational activity like symposium or lectures should be practiced to teach the practitioner to prescribe antibiotics. Curriculum & syllabus should offer great emphasis on prescribing. [ABSTRACT FROM AUTHOR]

Bioceramics, with excellent bioactivity and biocompatibility, have been widely used in dentistry, particularly in endodontics. Mineral trioxide aggregate (MTA) is the most widely used bioceramic in endodontics. Recently, many new bioceramics have been developed, showing good potential for the treatment of endodontic diseases. This paper reviews the characteristics of bioceramics and their applications in various clinical endodontic situations, including root-end filling, root canal therapy, vital pulp therapy, apexification/regenerative endodontic treatment, perforation repair, and root defect repair. Relevant literature published from 1993 to 2023 was searched by keywords in PubMed and Web of Science. Current evidence supports the predictable outcome of MTA in the treatment of endodontic diseases. Although novel bioceramics such as Biodentine, EndoSequence, and calcium-enriched mixtures have shown promising clinical outcomes, more well-controlled clinical trials are still needed to provide high-level evidence for their application in endodontics. In addition, to better tackle the clinical challenges in endodontics, efforts are needed to improve the bioactivity of bioceramics, particularly to enhance their antimicrobial activity and mechanical properties and reduce their setting time and solubility. [ABSTRACT FROM AUTHOR]

Objective: The objective of this randomized clinical trial was to compare the effect of different NiTi shaping systems on postoperative pain after single-appointment nonsurgical endodontic retreatment. Method and materials: Between September 2016 and December 2016, 99 patients with asymptomatic root canal-treated teeth requiring nonsurgical endodontic retreatment were randomly divided into three groups (n = 33 per group). After removing previous root canal filling, instrumentation was performed using One Shape, Revo-S, and Wave One systems in groups 1, 2, and 3, respectively. Postoperative pain intensity was assessed at 6, 12, 18, 24, 48, and 72 hours, 7 days, and 1 month after the retreatment. Data were analyzed using one-way ANOVA and Mann-Whitney U and Kruskal-Wallis tests (alpha = .01). Results: Up to 72 hours, postoperative pain was significantly less in group 1 than in groups 2 and 3 (P < .01). From 72 hours to 7 days, postoperative pain was significantly less in groups 1 and 2 (P > .05), compared to group 3 (P < .01). At 1 month, postoperative pain was not significantly different among all three groups (P > .05). Postoperative pain was the highest with WaveOne group. Conclusions: Since One Shape and Revo-S are both based on the rotational approach and WaveOne on reciprocal approach, less incidence of postoperative pain intensity with One Shape and Revo-S in singleappointment nonsurgical endodontic retreatment could be associated with the motion type during root canal shaping. [ABSTRACT FROM AUTHOR]

Objectives: The aim of the present double-blind, randomized, controlled clinical trial was to evaluate the effect of ketorolac buccal infiltration of on postendodontic pain of patients with symptomatic irreversible pulpitis in mandibular first/second molars. Method and materials: Sixty patients meeting the inclusion criteria were evaluated. After receiving a standard inferior alveolar nerve block (IANB) followed by a buccal infiltration injection with lidocaine, half of the participants randomly received a supplemental buccal infiltration of 30 mg/mL ketorolac tromethamine and the other half received a buccal infiltration of normal saline adjacent to the periapical region of the tooth being treated. Afterwards, all participants received a single-visit root canal treatment. Pre- and postoperative (immediately after treatment, and at 2, 4, 6, and 24 hours) pain levels were evaluated via Heft-Parker visual analog scale (HP-VAS). Analgesic consumption was also recorded. The data were statistically analyzed using repeated-measures ANOVA and Friedman tests. The significance level was set at P < .05. Results: There was a significant difference in postoperative pain between the two groups in overall evaluations and in each time interval (P < .001 and P = .043 respectively). Of those patients receiving ketorolac, 60% (18/30) did not require any analgesic consumption up to 24 hours postoperatively, whereas this number was 43% (13/30) for the placebo group. Conclusion: Ketorolac buccal infiltration could reduce the postoperative pain experienced by patients requiring endodontic treatment diagnosed with symptomatic irreversible pulpitis. [ABSTRACT FROM AUTHOR]

A critical narrative review focusing on studies providing insight about the potential and actual effect of lavage (irrigants and irrigation techniques) on clinical, biological, chemical and mechanical outcomes of root canal treatment, including microbial load reduction, periapical healing, postoperative pain, tooth survival and dentine changes. [ABSTRACT FROM AUTHOR]

Irrigant delivery by a syringe and needle is still widely used during root canal treatment. It seems to perform similarly to other irrigation methods in the main root canal, provided that the needle is inserted close to working length, the canal is adequately enlarged and the irrigant is delivered at a sufficient flow rate. However, additional delivery and activation methods are needed to clean and disinfect areas beyond the main root canal. Neither the entrapment of air bubbles in the apical part of the root canal ('apical vapor lock') nor the surface tension of irrigants are limiting irrigant penetration during syringe irrigation. [ABSTRACT FROM AUTHOR]

The main goal of chemomechanical preparation is to remove microorganisms, pulp tissue remnants and dentine debris from the root canal system. Irrigation plays a major role in the cleaning and disinfection of the root canal. A large number of chemical compounds have been suggested over the years for use as irrigants during root canal treatment. At the moment there is no single irrigant that can satisfy all of these requirements, so a combination of irrigants is frequently used during treatment while seeking a balance between efficacy and safety. However, the need to use more than one solution also brings additional challenges because they may interact with each other inside the root canal. The aim of this article is to provide a critical review of the current evidence on the properties of the root canal irrigants, focusing particularly on those that are most widely used. [ABSTRACT FROM AUTHOR]

An undesirable injury of adjacent teeth is one of many accidents that may occur during implant placement. Limited surgical access in a noncooperative patient can induce apical root transection. When endodontic pathosis is identified, root canal treatment is often initiated to prevent implant microbial contamination. This case report demonstrates the successful resolution of implant endodontitis by endodontic intervention without any surgical treatment in a patient presenting a moderate mental disorder. [ABSTRACT FROM AUTHOR]

Background: Numerous publications have reported on migraines misdiagnosed as endodontic pathologies. However, reports on the effect that concurrent migraine and endodontic pathology can have on each other and how their respective treatments can also affect each other are limited. Clinical Presentation: Two cases are reported that presented with both migraine and periapical pathology. Patient 1 underwent root canal treatment, which partially alleviated both the migraine and odontalgia. Subsequent treatment with sumatriptan provided additional relief. Patient 2 underwent sumatriptan treatment, with no effect. Subsequent root canal treatment provided significant relief. Patients in both cases have shown continued improvement. Conclusion: Further research is necessary, but the two cases presented suggest that endodontic pathology and migraine symptoms may be associated and endodontic therapy may have an effect on migraine pain. [ABSTRACT FROM AUTHOR]

Background: Endodontic ledge (EL) formation is the most common complication of endodontic treatment. Although various etiological factors have been identified, canal curvature is the most significant variable correlated with EL formation. The aim of this micro-computed tomographic (micro-CT) study was to evaluate EL position in the mesial canals of the lower molars in relation to the degree of canal curvature. Methods: Forty intact mandibular first molars with independent mesial canals with 20°–40° primary mesio-distal curvature, 10°–30° buccal-lingual canal curvature and 4 < r ≤ 8 mm main curvature radius were selected. Working length was measured with a K-File #10 and a high resolution pre-operative micro-CT analysis was performed. Ledges were created at the point of maximum canal curvature using stainless steel K-Files #30–35, alternating irrigation with 5% NaOCl and 10% EDTA. A post-operative high-resolution micro-CT analysis was then completed. Pre- and post-operative images were analyzed. The angle (α) formed between the vector passing through the geometric center of the EL and the center of the original canal lumen and the line joining the centers of the mesio-buccal and mesio-lingual canal orifices was calculated, and a descriptive statistical analysis was achieved. The α angle values were analyzed in relation to canal curvature using Kruskal-Wallis and post hoc Dunn's tests. The level of significance was set at P < 0.05. Results: The α angles appeared inversely proportional to canal curvatures in the buccal-lingual and mesio-distal projections. The mean α angle was 36.4° (standard deviation 10.64; 95% confidence interval 34.1–40.9). Conclusion: Within the limitations of this study, endodontic ledges develop in the opposite direction to the three-dimensional canal curvature and their position is influenced by the degree of curvature. Clinically, the α angle values may be related to the recommended direction to manage endodontic ledges. [ABSTRACT FROM AUTHOR]

The objective of a root canal therapy is to remove the necrotic or disease pulp and seal the apex of the tooth root to preserve the tooth. Vital pulp therapy has been an accepted practice for preserving the vitality of the pulp in complicated fractures of mature and immature teeth and in the treatment of malocclusion. In this 4-h lab, we will demonstrate the most common methods used to treat endodontic disease in small animal veterinary patients including standard and surgical root canal therapy (apicoectomy) and vital pulp therapy. Root Canal Therapy Instruments Denise S. Rollings, CVT, VTS (Dentistry) The purpose of endodontic therapy is to maintain and salvage a tooth. [Extracted from the article]

Objective: To compare the effect on human gingival cell proliferation (HGC) exposed to an epoxy resin-based sealer at different temperatures. Materials and methods: Human gingival fibroblasts (HGFs) were established from explants of healthy gingival tissue, exposed to heat-treated sealer (150°C) and at room temperature (14°C). Cellular responses were recorded using flow cytometry at different times of assessment - 12 h, 24 h, 48 h and 72 h. Results: Cells exposed to room temperature sealer showed an increase proliferation at 12 h and 24 h. However, at both experimental temperatures there was not a significant difference in cellular response at 72 h, but there was a decrease proliferation compared to the control group. At both experimental conditions there was a significant increase in the rate of cell death, compared with the control group at 72 h. Conclusions: In vitro experimental assay showed a cytotoxic effect on HGFs after being exposed to resin epoxy sealer at 72 h. Clinical Significance: Elevated temperature changes in root canal sealers during warm vertical compaction techniques should not impact periapical cellular responses adversely, if any sealer is inadvertently expressed beyond the confines of the root canal system. Conflict of interest statement: All the authors have contributed significantly on this work research and in writing this article; and all are in agreement with the manuscript in form and content. The authors deny any conflicts of interest related to this study. [ABSTRACT FROM AUTHOR]

Objectives: Despite the variety of root canal sealers on the market, an ideal root canal sealer has not been developed. A new epoxy resin sealer, BJM Root Canal Sealer, contains a quaternary amine macromolecule, Biosafe, which provides anti-biofilm features. The aim of the present study was to perform an in vitro evaluation and comparison of the physical properties of this novel endodontic epoxy resin-based sealer (BJM Root Canal Sealer) with those of AH Plus and MM-Seal. Materials and methods: Flow, working time and solubility were evaluated based on the ISO 6876/2012 standards. Dimensional change was assessed based on the ISO 6876/2001 standards. The physical properties were analysed using one-way analysis of variance (ANOVA). Results: The tested sealer flows were consistent with the ISO 6876/2012 recommendations. The dimensional changes of the tested sealers were inconsistent with the ISO 6876/2001 recommendations. The AH Plus sealer exhibited a lower flow than the other sealers (P < 0.05). The MM-Seal sample featured the lowest working time and highest dimensional change compared with the other sealers (P < 0.05). Solubility tests showed that AH Plus and BJM Root Canal Sealer have solubilities within the limit allowed by the ISO 6876/2012 recommendations (3% mass fraction). Conclusions: BJM Root Canal Sealer presented physicochemical properties that were similar to the AH Plus sealer. The physicochemical properties of BJM Root Canal Sealer conformed to the ISO 6876/2012 recommendations, except for the dimensional change, which did not fulfil the ISO 6876/2001 recommendations, as seen in all tested sealers. [ABSTRACT FROM AUTHOR]

Objective: To compare the effect of glide path established by size 20/0.02 taper hand K-file and size 20/0.04 taper rotary file, on the amount of debris extruded apically during root canal instrumentation by rotary ProTaper Universal (S1-F2) and reciprocating WaveOne (Primary) file systems. Materials and methods: Eighty mandibular molars with curved mesial roots and two separate canals were selected and randomly divided into two groups (n = 40) for glide path preparation using either size 20/0.02 taper hand K-files and size 20/0.04 taper rotary files. These groups were further divided into two (n = 20) for root canal instrumentation by ProTaper Universal and WaveOne files; Group 1: 20/0.02 + ProTaper, Group 2: 20/0.02 + WaveOne, Group 3: 20/0.04 + ProTaper, and Group 4: 20/0.04 + WaveOne. The debris extruded during instrumentation was collected in pre-weighed Eppendorf tubes and stored in an incubator at 70°C for 5 days. Tubes containing the dry, extruded debris were then weighed. One-way analysis of variance was applied to the weights obtained followed by Tukey's post hoc test for multiple comparison. Results: All the groups resulted in debris extrusion. Establishing a glide path with size 20/0.04 taper rotary files, resulted in less debris extrusion, compared to a glide path prepared by size 20/0.02 taper hand K-files (P < 0.001). Conclusion: Creating a glide path with size 20/0.04 rotary file, reduced the debris extrusion in curved root canals during instrumentation by ProTaper Universal and WaveOne. [ABSTRACT FROM AUTHOR]

Purpose: To examine the effect of CHX pre-treatment on long-term bond strength of fiber posts luted with self-adhesive resin cements. Materials and Methods: Seventy-two single-rooted teeth were selected for root canal treatment and post space preparation. The tested self-adhesive cement/post combinations were (N = 36): 1. RelyX Fiber-Posts luted with RelyX Unicem; 2. Rebilda Posts luted with Bifix SE Cement. For both self-adhesive cements, half of the specimens (experimental groups) were luted after the application of a solution of 2% CHX, while no CHX application was performed for the remaining specimens (control groups). Luted specimens were cut and used for push-out bond strength evaluation immediately, and after storage in artificial saliva for 6 months or 1 year. Additional specimens were processed for quantitative interfacial nanoleakage analysis. Results: ANOVA showed that the variable times of storage had a significant influence on the results (p < 0.05), while no influence of the luting procedure (cements with or without CHX) on the final outcome (p > 0.05) was found. Tukey’s pairwise post-hoc test showed that the radicular bond strength decreased with time of storage. In particular, a significant difference was found between T0 and T1y, but not between T0 and T6m. In contrast, in terms of pre-treatment, no significant reduction in push-out bond strength was observed, irrespective of the aging time. Conclusion: CHX pretreatment did not prevent bond strength degradation of fiber posts luted with self-adhesive cements. [ABSTRACT FROM AUTHOR]

Root canal treatment of immature teeth is considered a great challenge for both the dentist and the patient. The thinness of the root canals walls and the lack of an apical barrier leads to unpredictable treatment results. Revascularization is a novel promising treatment option in the field of regenerative endodontics for management of immature necrotic permanent teeth. This case presents a successful treatment of an 8-year-old patient with a partially necrotic, immature permanent mandibular right first molar pulp by revascularization. The revascularization procedure was performed in two appointments using nitrous oxide sedation to reduce the child's anxiety during treatment. Following root canal disinfection with NaOCl, a triple antibiotic paste (ciprofloxacin, metronidazole, and minocycline) was applied into the canal. One week later, induction of bleeding, application of MTA, and tooth restoration using a stainless steel crown were performed. At the subsequent follow-up appointments (3, 9, and 16 months) the tooth was asymptomatic. After 2 years a radiographic assessment revealed complete periapical healing and apical closure, as well as increase in root length and dentin thickness. Conclusion: This case supports the evidence of revascularization as a biological treatment option for the management of necrotic young permanent teeth. [ABSTRACT FROM AUTHOR]

Objective: Reducing the pain after root canal therapy is a key aspect in endodontic practice. The present systematic review aimed to identify the factors that influence postobturation pain (POP) in patients receiving single-visit nonsurgical root canal treatment. Data Sources: A literature search was performed manually and in Pubmed (Medline) database to identify relevant articles. A data extraction form was constructed and data were collected from the identified articles. Results: In total, 24 articles were identified for the systematic review, and factors associated with POP were tabulated. Conclusion: Specific preoperative factors (old age, sex, molar teeth, mandibular teeth, presence of preoperative pain, and absence of periapical radiolucency) and procedures (administration of prophylactic drug, bupivicaine anesthetic agent, radiograph or apex locator working length determination methods, instrumentation, irrigating system, laser, cold lateral compaction obturation technique, reducing the occlusion, and postoperative drugs) were associated with POP. [ABSTRACT FROM AUTHOR]

Treatment of a maxillary second premolar with an associated cystic lesion through conventional endodontic therapy combined with decompression and cyst enucleation is reported. Although cystic lesions frequently heal simply with endodontic therapy, refractory large lesions after nonsurgical endodontic treatment may require additional diagnosis and treatment. In this case, conventional root canal treatment resulted in incomplete healing and required further surgery. Following cyst enucleation with biopsy of the lesion and apical surgery on the tooth, the cause of the refractory lesion was found to be associated with foreign latex material in the periapical tissue, which was speculated to have originated from exposure to a dental glove. At the 1-year follow-up visit, the lesion exhibited continued resolution. [ABSTRACT FROM AUTHOR]

Aim: The aim of this in-vitro study was to comparatively evaluate the ease of retreatment in canals, obturated through GuttaFlow 2, GuttaCore, and conventional Lateral compaction technique using ProTaper Universal Retreatment (PTUR) Files. Materials and Methods: Sixty single-rooted mandibular premolars were selected and the canals were instrumented with ProTaper Universal rotary files up to size #F3. Samples were randomly divided into three experimental groups of 20 teeth each and obturated using three different obturating systems (GROUP I-Lateral compaction technique, GROUP II-GuttaFlow 2, GROUP III-GuttaCore). All the groups underwent cone-beam computed tomography (CBCT) analysis following which retrieval of the previous root canal filling was done using the PTUR files. Post retreatment CBCT images were used to assess the amount of remaining obturating material at varying depths (3 mm, 6 mm, and 12 mm) for all three groups. Statistical analysis was performed using repeated measures analysis of variance and ANOVA. Results: Irrespective of the obturating system used, filling material could not be removed completely from the root canal walls. Significantly more amount of obturating material was observed in the apical third than the middle third and coronal third of the root canal space (P < 0.05). When comparing the groups, the maximum percentage of remaining obturating material was seen in Group III (GuttaCore) followed by Group I (lateral compaction), with the least being observed in Group II (GuttaFlow2). Conclusion: The GuttaCore technique utilizing carrier-based gutta-percha had the maximum amount of remaining obturating material after retreatment when compared to the GuttaFlow2 and Lateral Compaction techniques. [ABSTRACT FROM AUTHOR]

Background: The endodontic treatment of calcified root canals in molars is a challenging and time-consuming procedure. Even with the aid of a surgical microscope, the risk of root perforation is high, especially in the furcation area. The purpose of this study is to report the Computer-Aided-Design and Manufacturing (CAD–CAM) workflow, the innovative strategies for the template ideation, and the guided endodontic treatment of a mandibular molar with dystrophic calcification in the mesial root canals. Case presentation: A 58-year-old female patient, ASA I, was referred to endodontic treatment in the right first mandibular molar for prosthetic reasons. The mesiobuccal and mesiolingual canals appeared obliterated in the radiographic images. The absence of dental crown, tooth inclination, and the limited mouth opening of the region contributed to a poor visual reference of the tooth in the dental arch and the direction of the remaining lumens of the canals. Despite using surgical microscopy, the conventional technique led to the deviation of the mesiobuccal canal towards the furcation area. The obliteration of both mesial root canals was confirmed using the Cone Beam Computer Tomography. The clinical history associated with the tomography diagnosis was compatible with dystrophic calcifications in the pulp canals. The patient was submitted to an intra-oral scanning as well. The Digital Imaging and Communications in Medicine data (DICOM) were segmented. The Standard Tessellation Language (STL) files were processed following the CAD–CAM workflow, aiming to create two different endodontic templates with a new open design concept. The templates with open design allowed direct visualization of the operative field, irrigation, and dentin debris removal. The strategy of the guidance sleeves niche as half-cylinders allowed the drill insertion in a limited mouth opening region. Conclusions: The digital planning and guided access permitted to overcome the case limitations and then re-establish the glide path following the original anatomy of the root canals. The guided endodontic represents a personalized technique that provides security, reduced risks of root perforation, and a significant decrease of the working time to access obliterated root canals even in the mesial root canal of mandibular molars, a region of limited mouth opening. [ABSTRACT FROM AUTHOR]

This study evaluate the maxillary anterior teeth anatomy by micro-computed tomography (µCT), about relevant characteristic for endodontic treatment planning. Fifty maxillary central incisors (MCI), lateral incisors (MLI) and maxillary canines (MC) were scanned using a µCT device. Two and three-dimensional parameters at 1 to 5mm distance to the apical foramen, external anatomic characteristics of the teeth and qualitative analysis of the internal anatomy was performed. The roundness and form factor values revealed a circular canal in the apical third in the MCI and MC, whereas MLI showed flattening in the apical third. The linear regression test indicated a progressive increase in the major/minor diameters in the five mm assessed (p < 0.001). The 3D analysis revealed the greatest volume and surface area in MC. The SMI showed a cylindrical geometry of root canals. All teeth presented Vertucci's type I root canal configuration. A mild curvature was prevalent in the MCI (45%) and a moderate one in the MLI (50%) and MC (50%). Palatal shoulder volume was smaller in the MLI (11.46 ± 3.09) than in the MCI (14.15 ± 3.85) and MC (13.95 ± 2.55). The most common exit of main apical foramen was in a central (22%), distolingual (30%) and mesiobuccal position (28%) for MCI, MLI and MC, respectively. Radicular grooves were observed in 2% of MCI and 4% of MLI. Two and three-dimensional data obtained by µCT allowed to observe morphological characteristics of internal/external anatomy of the maxillary anterior teeth. These characteristics may affect the endodontic treatment planning. [ABSTRACT FROM AUTHOR]

Endodontic implant pathology (EIP) refers to cases in which endodontic infections cause infections in adjacent implants, and vice versa. This case report demonstrates the successful resolution of two types of EIPs, implant endodontitis and endodontic implantitis, by endodontic intervention with surgical treatment. In case 1, the patient complained of tooth discomfort after implant placement in the adjacent tooth. The tooth was sensitive to percussion and showed slight mobility with a negative reaction to an electric pulp test. The symptoms persisted despite conventional root canal treatment, and surgical treatment of the symptomatic tooth and implant lesion was performed. In case 2, the patient suffered from repeated infection around a newly installed implant. The adjacent devitalized tooth exhibited a periapical lesion that was contiguous with the implant. Conventional root canal treatment and retreatment did not successfully resolve the symptoms. Surgical root canal therapy was then performed with regenerative biomaterials as needed. Neither case showed radiographic or clinical evidence of failure after 4 and 5 years of follow-up, respectively, after the surgery and the adjacent implants were successfully osseointegrated. Endodontic intervention combined with surgical treatment resolved both types of EIPs and led to tooth preservation and successful osseointegration of adjacent implants. [ABSTRACT FROM AUTHOR]

Invasive cervical resorption is a pathologic process leading to progressive and usually destructive loss of tooth structure. The pathogenic mechanism is not completely understood and the diagnosis may be challenging. The aim of this article is to present an unusual case of bilateral presence of invasive cervical resorption lesions in maxillary central incisors and to discuss the treatment procedures using a novel repair material. The management of the present case was carried out in three phases. The first stage of the treatment aimed at curetting the active tissue from the resorption cavity and restoring the defect with the novel calcium silicate-based cement (Biodentine, Septodont). In the maxillary left central incisor it was not possible to remove the resorptive tissue without exposing the pulp, and therefore root canal treatment was performed. At the second phase, a full-thickness flap was raised in order to expose and repair the defect that was extending subgingivally. At the third phase teeth were restored with composite resin. The patient was kept under review and after a follow-up period of 2 years neither signs of periradicular lesion nor recurrence of resorption were observed. The teeth were asymptomatic, and restorations appeared to be in excellent condition. In conclusion, Biodentine seems to be a promising material for the treatment of invasive cervical resorption lesions. [ABSTRACT FROM AUTHOR]

The aim of the present report is to describe the unusual finding of mineral trioxide aggregate's (MTA) disappearance from the root-end cavity, several years after successful periapical surgery and complete wound healing. A 32-year-old male patient was referred by a general practitioner for root canal treatment of the right maxillary central and lateral incisors with a sinus track and a large periapical radiolucent lesion. After completion of the root canal treatment, endodontic surgery was performed since symptoms persisted. The retrograde cavity of the lateral incisor was sealed with MTA and the patient was monitored in the subsequent years, in order to evaluate the surgical outcome. Recall examination after 4 months revealed absence of signs and symptoms and reduction of the radiolucent lesion, indicating normal healing. After 2 years, the follow-up radiographic examination revealed further healing of the periapical lesion, with the MTA apical retrograde filling remaining in its place but with signs of disintegration. However, follow-up radiographic examination after 7 years revealed that the former radiolucent area is diminished and the root apex is completely covered by normal periodontal ligament and alveolar bone, whilst the retrograde filling is not visible at all, possibly due to disintegration. Long-term follow-up of apicoectomy cases is mandatory and further research is deemed necessary for the long-term evaluation of MTA, when in contact with periapical and periodontal tissues. [ABSTRACT FROM AUTHOR]

The final success of root canal treatment depends on the correct diagnosis of the endodontic disease and the knowledge of pulp chamber and root canal anatomy. The anatomy of the roots is always complex because of its variability; there are secondary canals, apical deltas, anastomoses, isthmuses and apical curvatures. The root canal treatment becomes more and more difficult when clinicians have to treat teeth with anatomical anomalies. This article reports two infrequent cases of mandibular anterior teeth with root anomalies. The first one is a mandibular incisor with three root canals treated in one visit through an endodontic laserassisted treatment to enhance the decontamination of root canals. The second one is a clinical case of a mandibular canine with two roots and two canals treated with conventional root canal treatment and subsequently rehabilitated with a fibre post and complete metal-ceramic crown. The aim of this article is to point out the importance of the correct study of the root anatomy before root canal treatment, based on accurate radiographic evaluation. [ABSTRACT FROM AUTHOR]

Introduction: The purpose was to study the influence of Erbium,Chromium:Yttrium Scandium Gallium Garnet (Er,Cr:YSGG) laser at short pulse duration on smear layer removal from apical root third. Materials and Methods: Twenty-four single-rooted mandibular premolars were used. The roots length was cut to 14 mm and instrumented using the Protaper Gold system to size 40/0.06. The samples were divided into four groups (n=6) as follows: (A) conventional irrigation with 5 mL of 17% Ethylenediaminetetraacetic acid ( EDTA), (B) passive ultrasonic irrigation with 5mL of 17% EDTA, (C) Er,Cr:YSGG induced photoacoustic streaming (PIPS) with 5 mL of 17% EDTA and (D)Er,Cr: YSGG induced PIPS with 5 mL of 5.25% sodium hypochlorite (NaOCl). After final irrigation with normal saline and drying, the roots were painted with nail varnish externally, and 2%methylene blue dye was injected into the canal. The tooth split horizontally at the fourth millimetres. The picture was taken by a professional Digital SLR camera. The dye penetration was measured using analytical software (measure picture CAD-KAS Kessler Germany). Dunnett's test was used to compare control group against experimental groups. Results: After the statistical test, the highest mean percentage was presented in the laser group with 17% EDTA (Group C=85.9804) followed by the laser group with 5.25% NaOCl (Group D=69.7817) and ultrasonic group (Group B=34.5453) respectively and the lowest mean percentage was in the control group (Group A=20.7969). Conclusion: Based on this in vitro study, PIPS technique using Er,Cr:YSGG pulse laser (0.5 W,5 Hz, air and water off) at short pulse duration and 17% EDTA proved effectively in smear layer removal, while the PIPS proved an acceptable results when the laser is used alone activated by NaOCI. [ABSTRACT FROM AUTHOR]

This report demonstrates that root canal treatment of dens invaginatus in a maxillary lateral incisor with a sinus tract and large periradicular lesion can be successfully managed over a long period of time. The aim of this article is to show that contemporary technology, including a dental microscope and modern materials like mineral trioxide aggregate, are essential to secure a high survival of teeth, which have a difficult anatomy. The complex morphology of the root canal system and the invagination requires accurate intracoronal inspection, in order to find all delicate parts that need to be instrumented, disinfected and obturated. An 11-year-old girl with a type III dens invaginatus was referred to the Department of Operative Dentistry. A multiple-visit endodontic procedure was necessary to find, instrument and seal both the root canal and the invagination successfully. The presented case was treated by means of conventional non-surgical root canal treatment and apical placement of ProRoot MTA (Dentsply DeTrey, Konstanz, Germany). At 10-year follow-up the tooth was asymptomatic (no response to percussion or palpation) and complete periapical bone healing was observed radiographically. In the meantime the tooth was restored with a ceramic crown. [ABSTRACT FROM AUTHOR]

Vital pulp therapy after traumatic dental injuries with pulp involvement plays a key role in the treatment of dental injuries, especially in those sustained by young patients. Unlike conventional root canal therapy, maintaining pulp vitality enables the roots of immature teeth to continue growing. Provided that the indication is correct, vital pulp therapy methods have a high success rate, particularly in partial pulpotomy, which has a prognosis of over 90%. [ABSTRACT FROM AUTHOR]

A case study of a 42-year-old-male patient reported to the Department of Dentistry with the chief complaint of pain in the upper left posterior teeth, and Biomechanical preparation was initiated with the Prosper system using manufacturer guidelines along with intermittent irrigation.

Numerous case reports emphasise the importance of thorough knowledge of the anatomic morphology in the maxillary molars for the success of root canal treatment. The aim of this paper was to present a case of a maxillary second molar with four roots (two palatal roots) and four distinct canals requiring root canal therapy. Root canal treatment was performed using nickel-titanium rotary files. In addition, the role of cone beam computed tomography as an objective tool for confirmatory diagnosis and successful treatment is demonstrated. Properly prepared access cavity and cone beam computed tomography (CBCT) scanning revealed unusual root morphology and led to a favourable outcome for root canal treatment. A thorough knowledge of possible variations in internal anatomy of human teeth is important for successful root canal treatment. [ABSTRACT FROM AUTHOR]

Objective: Sodium hypochlorite (NaOCl) is an important tool in root canal disinfection although it is well known that the shelf-life of NaOCl is limited. In this study, NaOCl solutions that were collected from dental practices and were intended for endodontic irrigation were investigated to see whether they contained the expected concentration of free available chlorine. Method and Materials: NaOCl solutions were collected from dental practices. The concentration of available chlorine per sample was determined with iodometric titration and the pH was measured. Each participating dentist completed a questionnaire that requested data on a range of issues relating to the assumed concentration of NaOCl and handling of the sample. Results: Eighty-four samples with questionnaires were received. NaOCl was purchased from supermarkets and drugstores (36%), dental suppliers (48%), or pharmacies (16%). The median expected concentration was 2% (n = 36). On average, 27% less available chlorine was measured than the dentist assumed was in the sample (P < .001). Fifteen percent of samples contained less than 1% available chlorine, which is needed for tissue dissolution and disinfection. The average pH was 11.5. Conclusion: The greatest differences in concentrations were found in NaOCl sourced from supermarkets or drugstores. Future studies should elucidate the cause of this discrepancy. Clinical relevance: In the meantime it is recommended to purchase NaOCl from professional suppliers, because this group showed the most reliable content of free available chlorine. [ABSTRACT FROM AUTHOR]

Minimum intervention and retention of every part of the tooth structure is an imperative objective in contemporary endodontic practice. Nevertheless, elective (intentional) root canal treatment (RCT) of sound teeth with normal pulps may be necessary. This article aims to define the criteria for considering RCT as an elective treatment, to discuss the indications of this approach and the prevalence among different countries, and to outline special precautions that should be considered when commencing elective RCT. In addition, other elective pulp treatment procedures are highlighted. [ABSTRACT FROM AUTHOR]

The success rate of endodontic treatment is lower than expected, and is both time-consuming and expensive. Thus, techniques to enable a clinician to avoid it deserve more attention. Indirect pulp treatment (IPT) is a simple and effective treatment to preserve pulp vitality in teeth with deep carious lesions. Scientific data supports this treatment as means to preserving a healthy, vital pulp. [ABSTRACT FROM AUTHOR]

Background: Restoration of teeth after endodontic treatment is an urgent problem. There is a large selection of materials and structures for dental restoration after endodontic treatment. Aim: This work aimed to determine the strength characteristics of endocrowns made of hybrid ceramics, depending on various conditions. Methods: The study involved 40 samples of removed teeth (mandibular molars). Mechanical and medical treatment of root canals was previously carried out in the teeth, after which the root canals were sealed with a sealer and guttapercha. The defect in the crown part of the tooth was repaired with a hybrid ceramic endocrown. Endocrowns were made by milling. The endorocrowns were cemented according to the standard cementation protocol for ceramic restorations. All tooth samples were divided into 2 groups of 20 teeth each group. Group 1 was placed in the thermostat for 24 hours at a temperature of +37±1°C, and group 2 was subjected to thermal cycling. After that, the samples of the studied groups were subjected to uniaxial compression until the moment of destruction. The measurements of the maximum load (kN), maximum stress (MPa), and % of deformation at the moment of failure were carried out. All the results obtained were statistically processed. Results and Discussion: According to the results of the study, the samples of group 1 showed higher values of strength and elasticity than samples of group 2. Conclusions: Thus thermocycling, which simulates the natural oral environment negatively affects the durability of the hybrid ceramic. However, the obtained values make it possible to use it for the restoration of teeth after endodontic treatment. [ABSTRACT FROM AUTHOR]

The types of pulpal disease found in multirooted teeth may vary from one root canal to the next. Current endodontic treatment strategies allow for options such as regenerative endodontics, vital pulp therapy, or conventional root canal treatment depending on the disease status of the pulp in a specific root canal. A combination of procedures was used in the 3 teeth in this case series based on the assumed pulpal status in each canal. The follow-up ranged from 24–27 months, and in each case the healing response was satisfactory. This report illustrates the use of a combination of treatment procedures that can provide specific treatment benefits in various clinical situations. [ABSTRACT FROM AUTHOR]

The success of root canal therapy implies a thorough knowledge of the internal as well as the external dental anatomy, in addition to its variations. An aberrant morphology of the root canals can be observed in any tooth, even in a maxillary lateral incisor. This case report looks at the root canal treatment of a maxillary lateral incisor fused with a supernumerary tooth, which shows large periapical radiolucency. This treatment was successfully carried out with the aid of computed tomography (CT) and an operative microscope. [ABSTRACT FROM AUTHOR]

Aim: The most common anatomy for the maxillary first molar is the presence of four root canals. However, other configurations regarding the number of root canals have been reported. The purpose of this paper is to present two cases with five root canals diagnosed during an endodontic retreatment. Materials and methods: Diagnosis was made and the endodontic retreatment was purposed and performed. A dental operating microscope was used for better understanding of this anatomy and especially looking for possible undetected canals along the developmental lines and grooves. Results: Both cases had undergone previous root canal treatments, which had failed. Both teeth had an anatomic configuration with five root canals with previously undetected MB2 and DB2, with both mesial and distal roots presenting a Vertucci Type II root canal configuration. The recall radiographs showed periapical healing. Conclusions: Although it is an uncommon configuration, the presence of both MB2 and DB2 may be present. The failure to identify the correct anatomy and locate all root canals may lead to treatment failure. The discovery of these missed canals in the endodontic retreatment of the presented cases might have been one of the reasons for retreatment success. [ABSTRACT FROM AUTHOR]

In 2011 the Reciproc System was introduced to the market by VDW (Munich, Germany) as a single file reciprocating system. It is claimed that root canals can be completely prepared with only one Reciproc instrument. This case series describes the treatment of four teeth needing root canal treatment by using the Reciproc System. The illustrated cases show that root canal treatment as well as endodontic retreatment can be safely carried out with Reciproc instruments. [ABSTRACT FROM AUTHOR]

Aim: The presence of three root canals in the mesiobuccal root is an uncommon configuration in the maxillary first molar. The purpose of this paper is to present two cases that were diagnosed during an endodontic treatment. Materials and methods: Root canal therapy was performed with the aid of a dental operating microscope for better understanding of the complex anatomy. Careful analysis was given in the retreatment case, particularly looking for undetected canals that might have been a cause for endodontic failure. Results: The identification of two undetected root canals in a previously root canal therapy failure might be one of the reasons for the success of a reported case. The correct identification of an uncommon root canal configuration led to favourable results. Conclusions: The identification of unexpected anatomic configurations is mandatory. The failure to do so may lead to the failure of an endodontic therapy. [ABSTRACT FROM AUTHOR]

Internal root resorption (IRR) is characterized by progressive loss of tooth substance initiating at the root canal wall as a result of clastic activity. The use of periodontal surgery and mineral trioxide aggregate is a good approach to repair lesions with periodontal communication (perforating IRR). This case describes the treatment and follow-up of a maxillary central incisor with perforating IRR in a 56-year-old male patient where root canal treatment, periodontal surgery, and white mineral trioxide aggregate were employed to achieve complete repair and to restore function. Clinical findings and periapical radiographs indicated success after a 5-year follow-up. [ABSTRACT FROM AUTHOR]

Objective: The aim of this randomized controlled clinical trial was to investigate the antimicrobial efficacy of traditional positive pressure (PP) irrigation compared with apical negative pressure (ANP) in tapered as well as non-tapered root canal preparation techniques.Method and Materials: Patients referred for treatment of mandibular permanent molars with necrotic pulps and apical periodontitis were considered for this study. A total of 32 eligible teeth were evaluated based on strict inclusion and exclusion criteria and randomly assigned as follows: Group 1: LightSpeed LSX 0.02 preparation and A NP irrigation (n = 8). Group 2: LightSpeed LSX 0.02 preparation and PP irrigation (n = 8). Group 3: ProTaper preparation and A NP irrigation (n = 8). Group 4: ProTaper preparation and PP irrigation (n = 8). A ll teeth were sampled immediately upon access (S1), after completion of the chemo- mechanical preparation (S2), and one week later after intracanal medication (S3). All samples were microbiologically processed immediately and plated in duplicates on aerobic plates, anaerobic plates, and chocolate plates and colonies statistically analyzed. Results: No statistically significant differences were found between groups at S1. When comparing colony-forming unit (CFU) levels at S1 and S2 within groups, the reduction was statistically significant in all groups. While no significant difference was found in the proportion of teeth that culture positive at either S2 or S3 by shaping groups, a significant difference was noted when comparing PP irrigation and A NP groups. The percentage of samples in the PP irrigation group with a negative culture at both time points was 67%, compared to 100% among the A NP group. Conclusion: Within the limitations of the present study, taper and apical size failed to demonstrate a difference in microbiological reduction of cultivable bacteria. On the other hand, A NP revealed a significant difference when compared to PP irrigation. [ABSTRACT FROM AUTHOR]

Introduction: The mesiobuccal root of maxillary molar has generated more research and clinical investigation than any other root. Maxillary molar is the tooth with the largest volume and most complex root and root canal anatomy, also possibly the most treated and least understood posterior tooth. To identify and locate all root canal spaces along with thorough chemomechanical preparation and to achieve a fluid-impervious seal with an inert obturating material in all the portal of exits are the key requisites for successful endodontic therapy. Post treatment disease can be attributed to the presence of any undetected, unfilled anatomical spaces in the root canal system which can act as a nidus for infection leading to treatment failure. Case Report: This case report describes endodontic treatment of maxillary first molar with two mesiobuccal canals. It also highlights the need for good anatomical knowledge of root canal morphology and its variations in order to achieve successful results. Discussion: The incidence of MB2 canal in maxillary first molar is 86.36%, absent in 12.1% and untraceable in 1.5%. This case report on maxillary first molar in which MB2 in mesiobuccal root was located using visual, tactile and magnifying devices followed by endodontic treatment. Conclusion: It is generally accepted that a major cause for failure of root canal therapy is an inability to recognize the presence of, and to adequately treat, all of the canals in the root canal system. Therefore, it is worthwhile to put the time and effort into properly locating and treating these canals in an attempt to increase the prognosis of endodontic therapy in maxillary molars. [ABSTRACT FROM AUTHOR]

Endodontic disease, a biofilm infection of the root canal space, is a significant cause of dental morbidity worldwide. Endodontic treatment, or root canal treatment, as it is commonly known is founded on the ability to eradicate microbial biofilm infection and prevent re-infection of the highly complex root canal space. Despite many "advances" in clinical endodontics we have seen little improvement in outcomes. The aim of this critical review paper is to provide a contemporary view of endodontic microbiology and biofilm polymicrobiality, provide an understanding of the host response, and how together these impact upon clinical treatment. Ultimately, it is intended to provide insight into novel opportunities and strategies for the future diagnostics, treatment, and prevention of endodontic disease. [ABSTRACT FROM AUTHOR]

Aim of the study: Deep carious lesions may cause irreversible pulpitis and the current endodontic treatment typically removes the whole dental pulp tissue, which finally reduces lifespan of the teeth. Nowadays, the most frequent treatment is based on removing the infected tissue and filling the root canal with inert synthetic materials. Tissue engineering approaches are important alternatives to the current treatment, because they can potentially maintain the biological function of the tooth instead of sacrificing it. Materials and Methods: In this study, we propose a tissue engineering approach based on a hand-held in situ bioprinting strategy. Our approach enabled bioprinting of cell-loaded collagen-based bioinks with suitable rheological, structural and biological properties, which allowed for vasculogenesis in the root canal. Results: The rheological properties of the bioprintable bioink were measured by oscillatory amplitude sweep testing and were corroborated by macroscopic evaluation after in vitro culture, in which printed bioinks maintained their original form without contraction. Moreover, we showed evidence for successful vasculogenesis in bioprintable bioinks with comparable quality and quantity to control fibrin and collagen non-bioprintable hydrogels. Conclusions: We conclude that hand-held bioprinting holds potential for in situ treatment of dental diseases with successful evidence for vascular tube formation, as an asset for maintenance of the biological function of the tooth. [ABSTRACT FROM AUTHOR]

Objective: to discuss the diagnosis and therapeutic management in cases of endodontic urgency in teeth with symptomatic irreversible pulpitis. Material and Methods: a bibliographic review of studies published in the last 5 years (2015-2020) was carried out by searching the databases: PubMED, BVS (Virtual Health Library) and Scielo (Scientific Electronic Library). For the research, the following descriptors were used: Irreversible Pulpitis, Treatment, Pain and Endodontics. Results: The diagnosis is a fundamental step in the treatment of urgencies and emergencies of endodontic origin, as it is from the correct diagnosis that the correct treatment will be instituted, reestablishing the patient's comfort. When the professional has enough time to remove the pulp tissue and prepare the root canal, this is the treatment of choice for cases of symptomatic irreversible pulpitis, which can be performed in a single session or in multiple sessions. When the professional does not have enough time to carry out the conventional endodontic treatment, the treatment option is to perform only emergency care to remove the patient from the present acute pain condition, and at a future time to carry out the complete endodontic treatment. Conclusion: Endodontic emergencies are always present in dental offices, professionals must always be prepared to carry out a correct diagnosis and treatment for each case, thus bringing comfort to the patient. [ABSTRACT FROM AUTHOR]