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Aim: To compare the effect of low-level laser therapy (LLLT) on postoperative pain after single-visit root canal retreatment on mandibular molars., Methodology: This randomized controlled clinical trial included 36 patients referred to the Department of Endodontics, Islamic Azad University, Tehran, Iran. Healthy patients who required root canal retreatment on symptomatic first or second mandibular molars, with a PAI index score of 2 or 3, preoperative tooth and percussion pain of <56 mm on a 170-mm visual analogue scale (VAS) were included. After local anaesthesia using inferior alveolar nerve block followed by rubber dam isolation and access cavity preparation, the D RaCe retreatment system was used to remove the existing root filling material, and after canal negotiation and gaining patency, working length was determined with an apex locator. Further canal enlargement was carried out with size 35, 0.04 taper, and size 40, 0.04 taper RaCe rotary instruments and then canals were filled using laterally compacted gutta-percha points and AH Plus sealer. The patients were randomly assigned to treatment groups: In the LLLT group, a 980-nm diode laser set at 6.89 W/cm 2 energy density, 0.5 W power, and a tip diameter of 10 mm were activated from the buccal side on the mesial and distal root apices for 15 s. In the sham group, the laser handpiece was placed inside the patient's mouth at the same location, but the laser was not activated. Then patients were instructed to record their postoperative pain levels at 4, 8, 12 and 24 h and 2, 3 and 7 days after treatment on separate VAS scales. For data analysis, the independent sample t and the Mann-Whitney U tests were used. Nominal variables were analysed by using the chi-square test., Results: In the LLLT group, the most intense pain was reported 24 and 48 h post-treatment [mean (SD) = 0.22 (0.54) for both], whereas in the sham group, the most intense pain level was observed 4 h post-treatment [mean (SD) = 0.78 (0.80)]. At the 4-h interval, pain intensity was significantly lower in the LLLT group (p = .016)., Conclusions: Low-level laser therapy reduced postoperative pain after single-visit root canal retreatment of mandibular molars only four hours following the procedure., (© 2021 International Endodontic Journal. Published by John Wiley & Sons Ltd.)

While root canal anatomy in Middle Eastern populations is well‐studied, research on isthmi in mandibular permanent teeth from this region is limited. This retrospective study used cone‐beam computed tomography (CBCT) to examine isthmi prevalence and location, as well as root canal morphologies (per Vertucci's classification) in mandibular permanent teeth from a subpopulation in Ardabil, Iran. The study is aimed at enhancing our understanding of dental anatomical variations in Middle Eastern populations. A total of 3566 teeth from 384 CBCT scans were evaluated in this retrospective study. Mandibular teeth were evaluated on sagittal, coronal, and axial sections regarding the presence of isthmus and root morphology (Vertucci's classification). CBCT scans of 197 males (51.3%) and 187 females (48.7%) were evaluated, with a mean age of 41.1 ± 11.4 years. Isthmi were most prevalent in molar mesial roots, typically located in the middle third for anterior teeth and first premolars and cervical third for posterior teeth. While gender did not play a significant role, the presence of an isthmus in the mesial root of the left second molars was associated with a younger mean patient age (p < 0.05). Root morphology varied across tooth types. Central and lateral incisors predominantly showed Vertucci's Types I and III. Canines and premolars were mostly Type I, with some variation. Molar mesial roots frequently exhibited Types IV and II, while distal roots were predominantly Type I. Statistically significant differences were found between morphology and gender in the first left premolar (Type I more common in women; Type V in men; p < 0.001) and in the right canine (Type I more prevalent in men; Types III and V more prevalent in women; p < 0.001). The results revealed wide variations in root canal morphology and a relatively high prevalence of isthmi in the study population. Our findings suggest a potential difference in tooth anatomy based on sex and a relationship between age and the presence of isthmi. [ABSTRACT FROM AUTHOR]

Introduction: Untreated canals represent the primary cause of treatment failure in molars and the second leading cause in other dental groups. This study determined the prevalence of untreated canals and their relationship with periapical periodontitis using cone-beam computed tomography (CBCT) images. Materials and Methods: 385 CBCT images with at least one treated canal were selected from the oral and maxillofacial radiology center. The number of roots and canals, presence, and size of periapical pathology, and presence of untreated canals were recorded. The study used descriptive statistics and Chi-square, Fisher's exact, and odds ratio tests to analyze data. Results: Of the 2053 teeth examined, 14.9% had at least one untreated canal. Untreated canals in teeth increase the chance of having a periapical lesion, raising the prevalence by 11 times. Of these, 91.8% had both untreated canals and periapical lesions. This was more than teeth without untreated canals (35.8%). Most untreated canals were in maxillary molars (65.3%), and mandibular molars (12.54%). There was a statistically significant relationship (P<0.001) between the number of roots, canals, expansion, destruction, and jaw type with the prevalence of untreated canals. The maxillary first molar (68.66%) and second mesiobuccal (MB2) canal (63.27%) had the highest percentages of untreated canals. Conclusions: The MB2 had the highest prevalence of untreated canals. The presence of untreated canals significantly increased the risk of expansion and/or destruction. Therefore, identifying these conditions can also be useful in diagnosing untreated canals. Dentists should assess the anatomy of the tooth and the structure of the root canal to minimize the possibility of an untreated canal. CBCT can assist in this process. [ABSTRACT FROM AUTHOR]

Background: In this study, the effects of pure AH Plus sealer and its combination with triple antibiotic paste at different concentrations on Enterococcus faecalis bacteria have been investigated. Materials and Methods: This in vitro study was accomplished by the means of a triple antibiotic paste combination (minocycline, metronidazole, and ciprofloxacin) at different concentrations (0%, 1%,5%, 10%, and 25%) with AH Plus sealer on E. faecalis bacteria. Sealers were set in an incubator for 1 h, 1 day, 3 days, and 7 days, and then 10 µL of bacteria solution was placed on all samples except the negative control group. After drying for 1 h, 250 µL brain-heart infusion broth culture medium was added, and it was cultured in solid media. Direct contact test technique was performed, and the obtained data were analyzed by 1-way ANOVA, 2-way ANOVA, 3-way ANOVA, and post hoc test least significant difference. It should be noted that the data were evaluated at the significance level of P < 0.05. Results: The average of colony-forming unit (CFU)/mL illustrated that there were no significant differences between fresh antibiotic-sealer combination, 1-day set, and 3-day set (P = 0.525), while in sealer with 7-day set, the average of CFU/mL was notably lower than other sets (P < 0.001). The outcomes revealed a considerable variation by passing time and the number of CFU/mL was remarkably reduced (P < 0.05).The data suggested that, by increasing the concentration, the average of CFU/mL was decreased, whereas the average of CFU/mL did not have significant differences in all concentrations of the antibiotic-sealer combination compared to pure sealer (P < 0.05). Conclusion: The concentration of 1% triple antibiotic in combination with root canal sealer may become a crucial factor for inhibiting the growth of remaining bacteria. [ABSTRACT FROM AUTHOR]

Introduction: Root-end preparation and restoration with an endodontic material are required when nonsurgical endodontic retreatment has failed or is impossible. The present clinical study reports the treatment outcomes of periradicular surgery using calciumenriched mixture (CEM) cement. Materials and Methods: A prospective outcome study of periradicular surgery using CEM was conducted on 14 permanent teeth with persistent apical periodontitis. Using a standardized surgical protocol, 2-3 mm of the root apex was resected; approximately 3 mm deep root-end cavities were ultrasonically prepared and filled with CEM cement. All patients were available for recall. Results: Clinical and radiographic examination revealed complete healing of periradicular lesions, i.e. regeneration of periodontal ligament and lamina dura in 13 teeth (93% success) during a mean time of 18 months; moreover, the teeth were functional and asymptomatic. Conclusion: Favorable treatment outcomes in this prospective clinical study suggested that CEM cement may be a suitable root-end filling biomaterial. [ABSTRACT FROM AUTHOR]

Background: General anesthesia in dentistry has been widely utilized in cases of uncontrollable fear/anxiety and uncooperative patients, patients of young age, and those allergic to local anesthesia and with other existing systemic diseases. These people usually require re-treatment owing to their weak immunity. Our study investigates the frequency and the prevalence of re-treatment in patients and candidates for dental procedure under general anesthesia in Isfahan during 1393-1396. Materials and Methods: The present cross-sectional study randomly chose 162 patients who were candidates for dental procedures. Patients who came in for re-treatment twice or more during this period were identified and their records were requested from the archives. Demographic data, reason for using general anesthesia, underlying disease, physical condition, and mental condition were all gathered through a questionnaire. The causative etiology of re-treatment was identified by examining the patients' medical records including restorations, denervation, tooth extraction, filling, and pulpotomy. Statistical analysis was performed using the SPSS software (version 25) and tests such as Kolmogorov-Smirnov Z-test, Spearman, and Chi-square test. P < 0.05 was considered statistically significant. Results: The findings of the present study showed that 92.25% of patients needed dental re-treatment during their second visit. The most needed treatment was in the second repair session and the least was related to prosthetics. It was also noted that 42.15% of patients needed dental treatment at the third visit and the highest need for treatment was in the third prosthesis session and the lowest reason was related to tooth restoration and extraction. Conclusion: The most needed treatment was in the second session of endodontic treatment, and in the third session, tooth extraction was one of the required treatments, which indicates the progression of dental problems in the interval between treatments. [ABSTRACT FROM AUTHOR]

Introduction: The choice between the two modes of treatment, endodontic treatment and single tooth implants are very different depending on the dentist, design, definition of successful outcomes, evaluation methods, and sample size. The aim of this study was to compare the clinical and radiographic results of single tooth implants versus endodontic treatment with post and crown restoration in patients referred to the School of Dentistry of Islamic Azad University of Isfahan. Materials & Methods: In this cross-sectional analytical study in the academic year 2021, 90 (46 females and during three different time intervals post treatment (under 3 years, 3 to 5 years and Over 5 years) were examined clinically and radiographically (periapical). Outcome of treatment was classified based on clinical and radiographic findings into three categories: successful, surviving and unsuccessful. Data were analyzed using Chisquared test (α = 0.05). Results: In this study, 60% of women and 40% of men had endodontic treatment and 42.2% of women and 57.8% of men had single tooth implants. There was no significant difference between the treatment outcomes in the studied groups (p value > 0.521). There was no statistically significant relationship between gender and type of treatment as well as gender and treatment satisfaction (p value > 0.05). Conclusion: Considering the preservation of natural teeth, if possible, root canal treatment is the main treatment of choice, otherwise a single-tooth implant can be a good alternative to missing or extracted teeth in terms of successful outcomes. [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 ×10. 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]

Introduction: A successful endodontic treatment depends on a comprehensive knowledge of the morphology of canal and its variations, an appropriate access cavity, proper cleaning and shaping and adequate root canal filling. The present study was carried out to evaluate the root canal morphology of permanent maxillary first molars in an Iranian population. Methods and Materials: In this in vitro study, 80 extracted permanent maxillary first molars from a population in Rafsanjan, Iran were collected. Root canal morphology was evaluated by clearing technique under stereomicroscope under 40× magnification. A combination of Vertucci’s and Sert and Bayirli’s classifications were used to determine the root canal types. Data were analyzed by SPSS 18 software using descriptive statistics. Results: All palatal roots and almost all distobuccal roots had type I configuration. Ten different types of root canal system were found in mesiobuccal roots, among which type I was the most common (38.75%), followed by type II, IV, V, VI, IX, XV, XVI=XIX and VII, respectively. Conclusion: The mesiobuccal roots of permanent maxillary first molar had the most complex root configuration. [ABSTRACT FROM AUTHOR]

Case selection and treatment plan are important aspects of endodontic treatment. Dentists should organize the treatment plan based on their knowledge, abilities, skills and more importantly the patients' preference and dentition. Indubitably, the treatment plan for each patient is exclusive and “tailor-made” and cannot be used for all patients. Dentists' self-estimation of their abilities opens up treatment options; however, in difficult or complicated cases it is advisable to refer to a specialist. Currently, one of the most challenging aspects in dentistry is the choice between extraction and placement of implant (EPI) instead of a complicated root canal treatment (RCT). Overemphasis on one treatment plan while neglecting other options, not only mislead the dentist but also impose unnecessary charges to the patients. This mini-review compares RCT to EPI from various aspects to help practitioners in routine decision making. [ABSTRACT FROM AUTHOR]

Background: The aim of the present study was to investigate the quality of root canal obturation performed by 6th year undergraduate dental students at the Dental School, University of Mashhad, Iran. Materials and Methods: A random 200 sample records of patients who received endodontic treatment at the Dental School, University of Mashhad between 2009 and 2010 was investigated. The quality of root canal filling was determined in relation to the adequate density and length of root fi lling. Statistical analysis of the data was carried out using statistical package for the social sciences (SPSS 12.0, SPSS Inc., Chicago, IL, USA) with Chi-square test. P < 0.05 was considered as significant. Results: About 38% of teeth fulfilled the criteria of an acceptable root canal filling. Adequate length and density of root filling was found in 73% and 66% of teeth respectively. There was significant difference between maxillary and mandibular teeth according to the quality (P = 0.009), length (P = 0.039) and density (P = 0.005) of root filling. The frequency of root canals with an “acceptable” filling was significantly greater in the anterior teeth than in molars. Conclusion: The technical quality of root canal treatment performed by undergraduate dental students was found to be less than ideal. Thus, the training course of the students at the preclinic and clinic has to be revised. [ABSTRACT FROM AUTHOR]