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The aim of this study was to assess whether calcium silicate root fillings prevent bacterial penetration and to determine how bacteria penetrate roots. Extracted single-rooted, single-canal human teeth were decoronated, prepared and filled with ProRootMTA or Biodentine (n = 12 each). Positive and negative (n = 2 each) controls were not filled. A two-chamber model was used with Streptococcus gordonii. The lower compartment was evaluated for turbidity over 150 days. Roots were split and examined for bacteria via SEM. The chi-squared test was used for comparisons (α = 0.05). Experimental groups had bacteria in their coronal thirds. Tubules contained bacteria in 90.9% and 91.7% of areas examined in the Biodentine and ProRootMTA groups, respectively, with no significant difference (p = 0.914). Experimental and negative roots had no turbidity with no significant difference between Biodentine and ProRootMTA (p = 1.000). Positive controls had turbidity. Bacteria penetrate roots via dentine tubules of root-filled teeth. Biodentine was comparable to ProRoot MTA., (© 2024 The Authors. Australian Endodontic Journal published by John Wiley & Sons Australia, Ltd on behalf of Australian Society of Endodontology Inc.)

The Guidelines for Prevention of Traumatic Dental Injuries were reviewed and approved by the Board of Directors of the International Association of Dental Traumatology (IADT) and the Academy for Sports Dentistry (ASD)., (© 2024 The Authors. Dental Traumatology published by John Wiley & Sons Ltd.)

The Guidelines for Prevention of Traumatic Dental Injuries were reviewed and approved by the Board of Directors of the International Association of Dental Traumatology (IADT) and the Academy for Sports Dentistry (ASD)., (© 2024 The Authors. Dental Traumatology published by John Wiley & Sons Ltd.)

The Guidelines for Prevention of Traumatic Dental Injuries were reviewed and approved by the Board of Directors of the International Association of Dental Traumatology (IADT) and the Academy for Sports Dentistry (ASD)., (© 2024 The Authors. Dental Traumatology published by John Wiley & Sons Ltd.)

The Guidelines for Prevention of Traumatic Dental Injuries were reviewed and approved by the Board of Directors of the International Association of Dental Traumatology (IADT) and the Academy for Sports Dentistry (ASD)., (© 2024 The Authors. Dental Traumatology published by John Wiley & Sons Ltd.)

The Guidelines for Prevention of Traumatic Dental Injuries were reviewed and approved by the Board of Directors of the International Association of Dental Traumatology (IADT) and the Academy for Sports Dentistry (ASD)., (© 2024 The Authors. Dental Traumatology published by John Wiley & Sons Ltd.)

The Guidelines for Prevention of Traumatic Dental Injuries were reviewed and approved by the Board of Directors of the International Association of Dental Traumatology (IADT) and the Academy for Sports Dentistry (ASD)., (© 2024 The Authors. Dental Traumatology published by John Wiley & Sons Ltd.)

The Guidelines for Prevention of Traumatic Dental Injuries were reviewed and approved by the Board of Directors of the International Association of Dental Traumatology (IADT) and the Academy for Sports Dentistry (ASD)., (© 2024 The Authors. Dental Traumatology published by John Wiley & Sons Ltd.)

Currently no standard, universally accepted, and clinically useful classification of pulp, root canal and peri-radicular conditions is used within the dental profession. Most published classifications are either too simple and miss many of the conditions reported to occur within the pulp, root canal and peri-radicular tissues, or they are too complex for use in clinical settings. Furthermore, many classifications have used inappropriate terminology that has either not been defined or has been poorly defined. The lack of standardisation leads to confusion amongst practitioners and potential uncertainty regarding treatment. It also limits the ability to communicate effectively, to teach appropriately, and to compare data and research findings throughout the world. When developing a classification of tissue conditions or diseases, it is essential that the classification is developed appropriately and meets the recommended criteria for effective clinical, educational and research use. It is also extremely important that correct and well-defined terminology is used since "words do matter". Popular terminology based on symptoms should be avoided as these have been proven to lead to inappropriate treatment decisions. This review discusses how classifications should be developed for pulp, root canal and peri-radicular conditions. It also discusses the deficiencies of some popular classifications and outlines the classifications that truly address the recommended criteria and reflect the physiological and pathological changes in the pulp, root canal and peri-radicular tissues. Hence, it is recommended that these latter classifications be adopted as the internationally-accepted classifications for future clinical use, as well as for educational, research and communication purposes., Competing Interests: None.

The primary aim was to compare cases seen by public endodontic clinicians (endodontists and endodontic registrars) to that of private endodontists. This was done by comparing item numbers charged over a 3-year period from 1 January 2016 to 1 January 2019 from both sectors. The secondary aim was to compare item numbers charged by endodontic registrars during their training as recorded by their submitted logbooks to that of private endodontists. In both comparisons, private endodontists recorded higher numbers of many item numbers including consultations, routine root canal treatment, removal of posts and broken instruments. Endodontic registrar logbooks also recorded fewer numbers compared to private endodontists, however, the frequency of more invasive procedures such as surgery and hemisection were similar., (© 2023 The Authors. Australian Endodontic Journal published by John Wiley & Sons Australia, Ltd on behalf of Australian Society of Endodontology Inc.)

The aim was to compare referral patterns and treatment provided by specialist Endodontists and Endodontic Registrars. A retrospective review was conducted of the clinical records of the first 25 patients seen by seven private endodontic clinicians and the equivalent number (175) of patients seen by five public sector endodontic clinicians from 1 January 2017. The average age and range of medical co-morbidities of patients in the public sector were statistically greater. Referred patients and referrers mainly worked in metropolitan Perth. The most frequent reasons for referral in both public and private sectors were to assess and manage non-painful endodontic pathosis, to manage pain, and to manage calcified canals. There was a wide range of cases referred to both sectors but with similar patterns suggesting that the training of specialists adequately prepares them for private practice. The results also indicate that Endodontists must be proficient in all aspects of the speciality., (© 2023 The Authors. Australian Endodontic Journal published by John Wiley & Sons Australia, Ltd on behalf of Australian Society of Endodontology Inc.)

Background/aim: The extent of education regarding dental trauma within dental schools around the world is believed to be very diverse, but also largely unknown. The aim of this study was to analyze and depict the current curriculum regarding dental trauma education among all Canadian dental schools, in an effort to refine and consolidate the education system., Methods: A survey was conducted over a scheduled meeting with dental trauma Instructors from all 10 dental schools in Canada. Questions were categorized into three sections investigating the dental trauma curriculum, the examinations/assessments of students, and the clinical exposure provided to students during the course of their dental studies. Data were first analyzed individually, and then common findings were grouped together., Results: A total of 17 instructors were interviewed. In 9 out of the 10 universities, dental trauma education remains fragmented with an overall mean of only 4 ± 5.2 h allocated to teaching dental trauma throughout the dental courses. Only one single university reported testing students following the completion of their dental trauma course, and only one university conducted a final examination dedicated separately to dental trauma only. All instructors reported a lack of ample exposure to trauma cases during clinical rotations., Conclusions: Many deficiencies exist in teaching dental trauma among Canadian universities. Due to low clinical exposure, students might be under-prepared to clinically manage trauma cases. Also, the lack of unification in the curriculum creates confusion among students. Additional clinical exposure along with unification within, and between, dental schools could result in a more coherent and a better presented dental trauma curriculum., (© 2023 The Authors. Dental Traumatology published by John Wiley & Sons Ltd.)

Reporting guidelines assist basic scientists, translational healthcare researchers and clinicians to publish manuscripts of the highest standard by improving the accuracy, transparency and completeness of the publications they submit to journals. This paper provides an overview of reporting guidelines relevant for the specialty of dental traumatology and discusses their application, significance and potential impact. The Preferred Reporting Items for study Designs in Endodontology (PRIDE) suite of reporting guidelines includes a range of study designs that can be used within the broad field of Endodontics but they are also applicable to dental traumatology and other dental disciplines (Preferred Reporting Items for Case reports in Endodontics [PRICE] 2020, Preferred Reporting Items for RAndomized Trials in Endodontics [PRIRATE] 2020; Preferred Reporting Items for Animal Studies in Endodontology [PRIASE] 2021; Preferred Reporting Items for Laboratory studies in Endodontology [PRILE] 2021 and Preferred Reporting items for OBservational studies in Endodontics [PROBE] 2023). The PRIDE guidelines were developed by an extensive network of globally renowned academics, researchers and expert clinicians working within dentistry using an accepted and validated consensus methodology. The aim of the PRIDE guidelines is to improve the overall quality of manuscripts describing case reports, randomized trials, animal research, laboratory studies and observational studies. Although attention to reporting guidelines adds a degree of complexity when writing reports, such guidelines provide a template for authors to develop standardized manuscripts of the highest quality, which will allow colleagues, readers and the wider public to have confidence that their findings are valid and robust. They also provide evidence to editors that manuscripts submitted to journals comply with the highest global standards of reporting within their respective discipline. Endorsement of the PRIDE guidelines by editors will lead to improvements in the reporting quality of manuscripts submitted to their journals., (© 2023 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Aim: To review variables and management techniques that may affect anaesthesia failure during root canal treatment and methods of overcoming anaesthesia failure., Methodology: The PubMed and Cochran databases were searched for evidence-based investigations regarding pain during needle insertion, pain on injection, efficacy of the anaesthetic solutions and anaesthesia techniques, and premedication., Results: Variables such as pain on injection, premedication with various types of drugs, volume of anaesthetic solutions, supplemental anaesthetic techniques, and additives to the anaesthetic solutions may influence pain perception during root canal treatment. Differences between teeth with healthy pulps versus those with irreversible pulpitis should be considered when the effects of variables are interpreted. However, there are several concerns regarding the methodology of investigations that have evaluated anaesthesia success rates., Conclusion: Several variables may influence anaesthesia success rates. There are conditions that may help to predict a patient's pain during endodontic procedures. These conditions could be overcome either by employing methods such as premedication with a non-steroidal anti-inflammatory drug prior to the treatment visit or by using supplementary techniques before or during the treatment. However, investigators need to be more careful when reporting details of their studies to reduce concerns regarding their study bias., (© 2022 British Endodontic Society. Published by John Wiley & Sons Ltd.)

Aim: The aim of this study was to assess and compare the pain during infiltration by a modified two-stage local anesthetic infiltration technique under topical anesthesia (TA)., Materials and Methods: In this cross-over double-blind study, 30 volunteers participated, where two groups were given single-stage infiltration and the other two had two-stage infiltrations. Depending upon the infiltration technique (one- or two-stage) and the use of TA, the patients were randomly divided into four groups. Local anesthesia (LA) was administered by infiltration into the mucobuccal fold of the maxillary central incisor, and the pain perceived during the infiltration in each group was recorded. The volunteers were recalled after 24 hours to assess the tenderness at the injection site. The volunteers were recalled 2 weeks after infiltration for the subsequent groups to assess the pain for this cross-over study., Results: A statistically significant difference was observed in the pain perceived when TA was used and when the infiltration was done in two stages. Regarding the pain at the site of injection after 24 hours, no significant difference was observed among the volunteers., Conclusion: Topical anesthesia was effective in reducing the pain of injection when compared to placebo. The pain of injection is further reduced with a two-stage infiltration technique after TA application., Clinical Significance: Topical anesthesia can be used routinely before infiltration, and LA infiltration injections are less painful if administered in two stages.

Background/aim: Traumatic dental injuries are the result of impact injuries to the teeth and/or soft and hard tissues within and around the vicinity of the oral cavity and pose a very serious public health dilemma. The aim of this study was to appraise the level of knowledge of dentists in Australia regarding the management of traumatic dental injuries based on the International Association of Dental Traumatology (IADT) guidelines., Methodology: A link to an electronic questionnaire investigating personal and professional information and twelve questions about dental trauma was distributed by email using the Qualtrics Survey Software to ensure anonymity of the respondents, to members of the Australian Dental Association. The respondents were grouped according to demographic characteristics and practice profiles. Data were evaluated by the Student's T test or one-way ANOVA with post hoc testing using Fisher's least significant difference, with the α level set at 5%., Results: A total of 180 complete responses were obtained. The overall mean number of correct answers was 7.55 ± 1.91 from a maximum possible score of twelve. Gender, year of primary dental qualification, dentist identity (general dentist or specialist), area of main practice or region worked by the practitioner did not significantly affect the mean scores. However, increased knowledge of the IADT guidelines was significantly associated with the number of trauma cases treated and the dentists' self-reported knowledge., Conclusions: The overall knowledge of Australian dentists regarding the management of traumatic dental injuries based on the IADT guidelines was generally good but it was also deficient in some areas., (© 2022 The Authors. Dental Traumatology published by John Wiley & Sons Ltd.)

Tooth resorption is either a physiological or a pathological process resulting in loss of dentin and/or cementum. It may also be associated with bone loss. Currently there is no universal classification for the different types of tooth resorption. This lack of a universal classification leads to both confusion amongst practitioners and poor understanding of the resorptive processes occurring in teeth which can result in incorrect/inappropriate diagnoses and mis-management. When developing a classification of diseases and/or conditions that occur within the body, several criteria should be followed to ensure a useful classification. The classification should not only include pathological conditions but also physiological conditions. Since tooth resorption can be either pathological or physiological, a classification of tooth resorption should include both of these categories. Any classification of diseases should be possible to use clinically, meaningful, useful, clear and universal. It should enable easy storage, retrieval and analysis of health information for evidenced-based decision-making. It should also be possible to share and compare data and information between different institutions, settings and countries. A classification of tooth resorption should be developed by combining anatomical, physiological and pathological approaches. For some types of resorption, the aetiological approach should also be incorporated. A classification of tooth resorption that uses simple, relevant and appropriate terminology based on the nature and location of the resorptive process occurring in teeth is proposed. There are two broad categories of internal and external tooth resorption which are sub-divided into three types of internal tooth resorption (surface, inflammatory, replacement) and eight types of external tooth resorption (surface, inflammatory, replacement, invasive, pressure, orthodontic, physiological, idiopathic). The clinician's understanding, diagnosis and management of tooth resorption can be facilitated by using this simple classification which should ideally be used universally by the entire dental profession to ensure clarity and to avoid confusion., (© 2022 The Authors. Dental Traumatology published by John Wiley & Sons Ltd.)

Endodontic emergencies are common in both general dental practices and specialist Endodontic practices. The aim of this review is to provide an overview of endodontic emergencies. Endodontic emergencies can be a result of many different conditions of the pulp, root canal and periradicular tissues. They may occur before endodontic treatment has been started, between appointments when treatment is being performed over multiple visits, or after endodontic treatment has been completed. In the latter situation, the emergency may be very soon after the treatment or it may occur many years later, in which case it is usually a new disease process as a result of the root canal system becoming infected. An emergency can be a stressful situation for both the patient and the dentist (or endodontist) as it is usually an unexpected event. It is incumbent on dental professionals to provide timely assistance to patients who have an emergency, and it is also important to allow sufficient time to manage the situation comprehensively. Management of endodontic emergencies should follow the principles of the 3D's-Diagnosis, Definitive dental treatment and Drugs-and in that sequence. An accurate diagnosis, the first "D", is essential so the appropriate treatment can be provided. Diagnosis requires a thorough understanding of the various conditions that can cause the emergency and this can be helped by having a comprehensive classification of the various conditions. The diagnosis should also direct the clinician to the appropriate Definitive dental treatment, the second "D". Root canal treatment will not always be required as some cases can be managed conservatively. Other cases may require root canal re-treatment. The specific details of how the treatment are done can also vary, according to the diagnosis. The final "D" is Drugs-the use of drugs should also be dependent on the diagnosis and the dental treatment. Drugs should only be an adjunct following the treatment. The clinician must also differentiate between inflammation and infection in order to provide the appropriate treatment and to prescribe the appropriate medication for effective pain relief and resolution of other symptoms or signs such as swelling., (© 2021 International Endodontic Journal. Published by John Wiley & Sons Ltd.)

High-quality systematic reviews in the field of Dentistry provide the most definitive overarching evidence for clinicians, guideline developers and healthcare policy makers to judge the foreseeable risks, anticipated benefits, and potential harms of dental treatment. In the process of carrying out a systematic review, it is essential that authors appraise the methodological quality of the primary studies they include, because studies which follow poor methodology will have a potentially serious negative impact on the overall strength of the evidence and the recommendations that can be drawn. In Endodontology, systematic reviews of laboratory studies have used quality assessment criteria developed subjectively by the individual authors as there are no comprehensive, well-structured, and universally accepted criteria that can be applied objectively and universally to individual studies included in reviews. Unfortunately, these subjective criteria are likely to be inaccurately defined, unreliably applied, inadequately analysed, unreasonably biased, defective, and non-repeatable. The aim of the present paper is to outline the process to be followed in the development of comprehensive methodological quality assessment criteria to be used when evaluating laboratory studies, that is research not conducted in vivo on humans or animals, included in systematic reviews within Endodontology. The development of new methodological quality assessment criteria for appraising the laboratory-based studies included in systematic reviews within Endodontology will follow a three-stage process. First, a steering committee will be formed by the project leaders to develop a preliminary list of assessment criteria by modifying and adapting those already available, but with the addition of several new items relevant for Endodontology. The initial draft assessment criteria will be reviewed and refined by a Delphi Group (n = 40) for their relevance and inclusion using a nine-point Likert scale. Second, the agreed items will then be discussed in an online or face-to-face meeting by a group of experts (n = 10) to further refine the assessment criteria. Third, based on the feedback received from the online/face-to-face meeting, the steering committee will revise the quality assessment criteria and subsequently a group of authors will be selected to pilot the new system. Based on the feedback collected, the criteria may be revised further before being approved by the steering committee. The assessment criteria will be published in relevant journals, presented at national and international congresses/meetings, and will be freely available on a dedicated website. The steering committee will update the assessment criteria periodically based on feedback received from end-users., (© 2022 International Endodontic Journal. Published by John Wiley & Sons Ltd.)

As a range of materials used in endodontics may cause tooth discolouration, exploration of factors responsible for the darkening of the tooth crown or root is warranted. This narrative review paper discusses the range of technical factors that apply in laboratory studies that assess endodontic discolouration. As an example of how these factors operate, particular examples relating to discolouration caused by endodontic medicaments containing tetracycline antibiotics are used. Following the PRILE 2021 guideline approach, a summary of key variables to be addressed in the methodology for laboratory studies is presented, to inform future work., (© 2022 International Endodontic Journal. Published by John Wiley & Sons Ltd.)

Introduction: The aim was to compare the compressive strength of dentin after irrigation with different concentrations of sodium hypochlorite (NaOCl)., Methods: A total of 259 extracted human tooth roots with no root caries or previous endodontic treatment were collected. They were sorted by size and length, and assigned to 7 groups (n = 37): negative control (no instrumentation, no irrigant), positive control (saline irrigant), 1%, 2.5%, 4%, 5.25%, and 10% NaOCl. A total of 13 mL NaOCl or saline (in 1-mL increments) was used per canal while being instrumented to #35 files (approximately 13 minutes). EDTAC (15%) was then used to remove the smear layer (2 minutes), followed by NaOCl as a final rinse. The roots were sectioned into 2-mm-thick disks and subjected to compression testing., Results: There was a significant difference between the negative control group and all instrumented groups (P < .05). The positive control group was significantly different from the 5.25% group (P < .05) and had a low P value when compared with the 2.5% group and the other higher concentrations (P ≅ .1). When the NaOCl groups were compared with each other, there was a significant difference between 1% NaOCl and all higher concentrations (P < .05), but no significant difference when 2.5% NaOCl was compared with higher concentrations., Conclusion: A concentration of 1% NaOCl had the least effect on the compressive strength of dentin and this was significantly different from all higher concentrations tested. Therefore, the use of concentrations of NaOCl above 1% should be reconsidered., (Copyright © 2021 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.)

Introduction: This study aimed to determine the success rate of the combination of buccal infiltration (BI) and inferior alveolar nerve block (IANB) injections in irreversible pulpitis in mandibular molars after premedication with ibuprofen., Materials and Methods: From 132 patients participated in the study, 120 patients were included. One hour before root canal treatment, patients with mandibular molars with symptomatic irreversible pulpitis received either a 600 mg ibuprofen capsule or a placebo. All patients received 2% lidocaine with 1:80000 epinephrine and 4% articaine with 1:100000 epinephrine for IANB and BI, respectively. Patients' pain was evaluated using the Heft-Parker visual analog scale during the preparation of access cavity, exposure of pulp, and instrumentation of root canal. The success of anesthesia was defined as the absence of pain or mild pain. The Chi-square and t -test were employed for data analysis., Results: The difference between patient age and gender in the two groups was not significant ( P >0.05). The anesthesia success rate was 85% in the premedicated and 70% in the placebo group, with statistically significant results ( P =0.049)., Conclusion: Based on this triple-blinded randomized clinical study, mandibular molars with irreversible pulpitis were not thoroughly anesthetized by a combination of IANB+BI after premedication with ibuprofen (600 mg), even though anesthesia success was improved significantly by ibuprofen premedication ., Competing Interests: ‘None declared’.

These revised guidelines for contemporary endodontic education in Australia and New Zealand (version 2021) propose the minimum criteria for the training of dentistry students. The document contains a definition of endodontics and a description of the scope of endodontics. It proposes a general outline for education programmes in endodontics as part of general dental practice., (© 2021 Australian Society of Endodontology Inc.)

Introduction: An accurate diagnosis is required for the appropriate management of endodontic conditions. It is unknown whether the specific descriptive terminology used in diagnosis influences treatment decision making. The aim of this study was to determine whether treatment choices made by dentists are influenced by the diagnostic terminology used., Methods: One hundred ninety-four dentists in Australia were recruited through the Australian Dental Association to complete an online survey regarding 14 endodontic cases. Respondents selected treatment options based on a given diagnosis and radiograph. Data were analyzed using SPSS software (Version 26; IBM Corp, Armonk, NY) and the exact McNemar test to determine if there was a difference between treatment choices for matched diagnoses with different terminology., Results: More dentists chose to manage irreversible pulpitis operatively when the descriptive term chronic was used compared with asymptomatic (93.3% vs 59.8%, χ 1 2 = 57.69, P < .005). This trend was repeated when using chronic or asymptomatic to describe apical periodontitis (96.9% vs 89.7%, exact P = .004) and apical abscesses (99.0% vs 83.5%, χ 1 2 = 104.125, P < .005). The differences between acute and symptomatic were less dramatic but still presented significant differences in treatment choices for an apical abscess described as "primary acute" or "secondary acute" compared with "symptomatic" (82.0% and 96.4% vs 93.3%, P < .05)., Conclusions: Descriptive terminology, specifically the terms acute and chronic as opposed to symptomatic and asymptomatic, used in the diagnosis of endodontic conditions did influence whether clinicians chose operative management or nonoperative management. Further research is warranted to determine the extent of this influence among dentists., (Copyright © 2020 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.)

Introduction: The aim of this study was to compare a reduction in working length and area of canal enlargement resulting from instrumentation with Hedström (Kerr Dental, Orange, CA), K (Kerr Dental), ProTaper Next (Dentsply Sirona, York, PA), and TF Adaptive (Kerr Dental) files. The effect of the canal curvature on the working length and area of canal enlargement was also assessed., Methods: A total of 80 plastic canal models were used, 40 with a canal curvature of 10° and another 40 with a canal curvature of 30°. Instrumentation of 10 models with a 10° canal curvature and 10 models with a 30° canal curvature was performed using each of the file systems up to size 25. Working length measurements were taken before and after instrumentation with each file type and size. Twenty composite images were made from superimposition of pre- and postpreparation photographs, and the difference in area was calculated using ImageJ software (National Institutes of Health, Bethesda, MD)., Results: ProTaper Next rotary files and TF Adaptive files produced the smallest reduction in the working length and the least canal enlargement followed by Hedström files and K files, respectively. The degree of canal curvature increased the working length reduction by a significant amount when K files and ProTaper Next rotary files were used, and the degree of curvature increased canal enlargement by a significant amount when K files were used., Conclusions: Nickel-titanium rotary files produced more favorable results than stainless steel hand files in terms of maintaining a consistent working length and producing minimal canal enlargement. Hedström files performed significantly better than K files in terms of working length reduction and canal enlargement., (Copyright © 2019 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.)

Background: Root fractures are not a common injury, but a thorough understanding of their etiology, healing responses, diagnosis, management, and prognosis is essential., Review: The prognosis is largely related to the patient's age; degree of displacement, if any, of the coronal fragment; and the location and orientation of the fracture. The more apical the fracture is located, the better the prognosis. Teeth with root fractures located supracrestally may have the worst prognosis, but their management and outcome depend on many factors, with the most influential factor being the ability to restore the tooth because the coronal fragment usually needs to be removed. In contrast, root fractures located in the apical and middle thirds and those subcrestally in the coronal third of the root have a good prognosis and usually require little, if any, treatment apart from immediate repositioning (if the coronal fragment has been displaced) and stabilization. Monitoring of root-fractured teeth over time is essential to determine the healing response and to assess whether the pulp survives or not. In some cases, the pulp in the coronal fragment may necrose and become infected, thus requiring root canal treatment, but this should only be done to the fracture line. Pulp necrosis and infection typically occur within the first 3-4 months if it is a direct result of the trauma. However, pulp necrosis and infection can also occur many years later, in which case it is likely to be a result of bacterial penetration via cracks or breakdown of restorations., Conclusion: Overall, root fractures should be managed conservatively unless they are located supracrestally., (Copyright © 2019 John Wiley & Sons A/S and American Association of Endodontists. Published by Elsevier Inc. All rights reserved.)

Introduction: The aim of this work was to assess and compare changes in pulp blood flow (PBF) and pulp sensibility (PS) after surgically assisted rapid maxillary expansion (SARME) and rapid orthopedic maxillary expansion (OME)., Methods: Ten patients requiring SARME and 10 requiring OME had the pulp status of their maxillary incisors and canines assessed with the use of laser Doppler flowmetry, electric pulp testing (EPT), and CO 2 snow. The SARME group was assessed at T1-S (before surgery), T2-S (after surgery, before expansion), T3-S (after surgery, at completion of expansion), and T4-S (3 months after surgery). The OME group was assessed at T1-O (before expansion), T2-O (after rapid expansion), and T3-O (3 months after expansion commencement). Relationships between PBF/PS and the procedures, assessment times, and tooth types were evaluated., Results: In the SARME group, surgery did not cause significant (P ≥0.05) reduction in PBF, maxillary expansion did cause significant (P ≤0.05) reduction in PBF, pretreatment PBF was reestablished by T4-S, and nonresponses to both EPT and CO 2 peaked at T2-S. In the OME group, rapid expansion caused significant (P ≤0.05) reduction in PBF, pretreatment PBF was reestablished by T3-O, and all teeth responded to at least 1 of EPT or CO 2 at each assessment time., Conclusions and Clinical Implications: Within the study's limitations, it can be concluded that both SARME and OME induce reduction but not elimination of PBF to maxillary anterior teeth and therefore do not cause loss of pulp vitality; surgery for SARME does not significantly reduce PBF to maxillary anterior teeth, rather it is the process of maxillary expansion that significantly reduces PBF in SARME patients; and caution when using CO 2 and EPT tests alone to assess pulp status after SARME is warranted because the capacity for CO 2 or EPT to provide negative sensibility responses despite the presence of PBF was observed., (Copyright © 2019 American Association of Orthodontists. All rights reserved.)

Tetracyclines are a unique class of antibiotics which also have additional effects including anti-inflammatory, anti-resorptive and substantive within the root canal. There has been a long-held view that tetracycline medicaments discolour teeth and should be avoided. The evidence base around this topic was explored, including a review of the methodology used in laboratory studies. A search of PubMed, Medline and Scopus databases was conducted to identify studies of demeclocycline and doxycycline medicaments used in root canal therapy. An analysis of the methodology used in these studies was performed to determine if these replicate current clinical practice. The related literature on mechanisms of tetracycline stability and the effects of light, oxidation, moisture and chemical interactions was examined. Studies investigating the effects of Ledermix paste on segments of bovine dentine and avulsed or reimplanted teeth as well as combinations with other antibiotics were excluded from this review. Even though demeclocycline medicament pastes were introduced in 1962, the first laboratory studies of discolouration were not done until 2000. All later studies followed a similar approach, which included exposure to sodium hypochlorite for up to 30 minutes and storage in moist conditions with 100% humidity. Staining during dark storage and enhanced staining on exposure to light were reported, indicating multiple pathways of degradation of demeclocycline and its reaction products. Light, moisture and oxidation are the key factors which drive discolouration from demeclocycline. Clinical issues from tooth staining can be prevented by removal of medicament pastes from the access cavity, and placement of a sound interim restoration. Use of a doxycycline paste obviates concerns of staining. Laboratory assessments of the potential for staining should replicate in vivo conditions., Competing Interests: Disclosures Conflict of interest: The authors declare no direct conflicts of interest. Paul Abbott declares that he has acted on occasions as a Consultant to OzDent Pty Ltd., the manufacturers of Calmix, and the Australian suppliers of Ledermix paste. Basil Athanassiadis and Laurence Walsh have a licensing agreement with Ozdent Pty Ltd., the manufacturers of Calmix. OzDent Pty Ltd., had no role in the design of the study, in the collection, analyses, in the writing of the manuscript, or in the decision to publish the results., (Copyright: © 2018 European Endodontic Journal.)

Objectives: The aims of this study were to report the prevalence of inter-appointment flare-ups following adequate root canal disinfection and to investigate the host factors contributing to its occurrence., Materials and Methods: One thousand five hundred patient records were reviewed and the prevalence of flare-up was recorded. Patients' root canal space status (vital, non-vital or retreatment), medical condition and demographics (age, gender, tooth type and position) were recorded from their dental records. Statistical analyses were performed to determine the impact of the recorded factors on flare-up occurrence., Results: Nine hundred fifty-one patient records met the inclusion criteria. The prevalence of flare-up was 2.3 %. There was a correlation between the canal space status and patient's age with flare-up development (P < 0.05). There was no association between flare-up occurrence and tooth type, location, gender or medical condition (P > 0.5)., Conclusion: The root canal space status was the primary factor affecting flare-up occurrence. Patients >50 years had the highest risk in developing flare-ups., Clinical Relevance: This article provides evidence that patients suffering from inflamed pulp will not develop flare-up if adequate cleaning and shaping of the root canal space was performed. It also shows that patients above the age of 50 are a high-risk group that is prone to flare-up development.

Introduction: Several variables may influence anesthesia success in maxillary molars. This investigation was conducted to evaluate the effect of root length on the success rate of infiltration injections of 2% lidocaine with 1:80,000 epinephrine., Methods: One hundred maxillary first molars with irreversible pulpitis were treated. After the administration of a buccal infiltration injection of 2% lidocaine with 1:80,000 epinephrine, the patients' pain during dentin cutting, pulp exposure, and root canal instrumentation were evaluated using the Heft-Parker visual analog scale. No or mild pain was considered as success. Data were analyzed by the point-biserial correlation test and receiver operating characteristic curve analysis., Results: Overall, 61% of the teeth had successful anesthesia after the administration of a single buccal infiltration injection of anesthetic solution. The point-biserial correlation test showed that the teeth that had palatal and distobuccal roots with longer root lengths showed significantly higher anesthesia failure (P < .05). However, receiver operating characteristic curve analysis did not show a clinically useful cutoff point of root length corresponding with anesthesia failure., Conclusions: Maxillary first molars having irreversible pulpitis with longer roots may have more anesthesia failures after a single buccal infiltration injection with 2% lidocaine and 1:80000 epinephrine., (Copyright © 2016 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.)

Introduction: The purpose of this prospective, randomized, double-blind, placebo-controlled study was to determine whether ketorolac buccal infiltrations (BIs) helped to improve the success of inferior alveolar nerve blocks (IANBs) in patients with acute irreversible pulpitis (AIP)., Methods: Forty adult volunteers with AIP in a mandibular molar were included in this study. Patients were instructed to evaluate their pain by using a Heft-Parker visual analog scale. They were randomly divided into 2 groups (n = 20). All patients received standard IANB injection and after that a BI of 4% articaine with 1:100,000 epinephrine. After 5 minutes, 20 patients received a BI of 30 mg/mL ketorolac, and the other received a BI of normal saline (control group). Endodontic access cavity preparation (ACP) was initiated 15 minutes after the IANB when the patient reported lip numbness and had 2 electric pulp tests with no responses. The patient's pain during caries and dentin removal, ACP, and canal length measurements (CLM) was recorded by using Heft-Parker visual analog scale. Successful anesthesia was defined as no or mild pain during any of these steps, without the need for additional injection. Data were statistically analyzed by using Mann-Whitney U and χ(2) tests., Results: Successful anesthesia after an IANB plus BI of articaine was obtained in 15% of patients in the control group at the end of CLM. Adding BI of ketorolac significantly increased the success rate to 40% (P < .05). Patient's pain during ACP and CLM was significantly lower in the ketorolac group (P < .05)., Conclusions: Ketorolac BI can increase the success rate of anesthesia after IANB and BI with articaine in patients with AIP., (Copyright © 2016 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.)

This paper seeks to provide the reader with an overview of the endodontic curriculum in Fiji from 2009 to 2013. It also intends to inform readers of the changes in endodontic teaching, the learning methods utilised, curriculum development, the transition from block teaching to partial block teaching combined with longitudinal teaching, and the future plans for the endodontic module., (© 2015 Australian Society of Endodontology.)

Introduction: Achieving anesthesia in mandibular molar teeth with irreversible pulpitis is very difficult. The aim of this study was to compare the efficacy of 1.8 mL and 3.6 mL articaine for an inferior alveolar nerve block (IANB) when treating molars with symptomatic irreversible pulpitis., Methods: In a randomized, double-blind clinical trial, 82 first mandibular molar teeth with symptomatic irreversible pulpitis randomly received conventional IANB injection either with 1 (1.8 mL) or 2 cartridges (3.6 mL) of 4% articaine with 1:100,000 epinephrine. The patients recorded their pain before and during access cavity preparation as well as during root canal instrumentation using a Heft-Parker visual analog scale. No or mild pain was considered as successful anesthesia. Data were analyzed by t and chi-square tests., Results: Eighty patients were eligible to participate in this study, which showed that 3.6 mL articaine provided a significantly higher success rate (77.5%) of IANBs compared with 1.8 mL of the same anesthetic solution (27.5%) although neither group had 100% successful anesthesia (P < .001)., Conclusions: Increasing the volume of articaine provided a significantly higher success rate of IANBs in mandibular first molar teeth with symptomatic irreversible pulpitis, but it did not result in 100% anesthetic success., (Copyright © 2015 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.)

Trauma to the mouth involves not only the teeth but also the dental pulp, the periodontal ligament, bone, gingiva and other associated structures. There are many different types of injuries with varying severity in each case and often more than one injury to a tooth at the same time. Hence, there are many different potential responses of the pulp, peri-radicular and soft tissues following trauma. The responses of the different tissues are inter-related and dependent on each other, which results in many potential consequences of trauma to the teeth. It is imperative that dentists have a thorough understanding of the possible tissue responses so appropriate treatment can be provided to minimise the consequences of trauma. The five main strategies to reduce these consequences are to: 1) perform a thorough examination and accurate diagnosis to identify all injuries and to assess the likely healing responses; 2) reposition and stabilise the teeth and bones to provide optimum conditions for healing; 3) carefully manage soft tissues to help healing; 4) commence root canal treatment immediately in specific situations to prevent external inflammatory resorption; and 5) follow-up and review all traumatised teeth to identify and manage any adverse consequences as soon as they occur in order to minimise their effects on the patient.

Introduction: Pain management is very important in endodontic practice. The aim of this study was to compare the effect on pain relief of on-demand versus regular prescription of ibuprofen after single-visit root canal treatment in teeth with irreversible pulpitis., Methods: Sixty mandibular and maxillary molar teeth with irreversible pulpitis without spontaneous pain had single-visit root canal treatment. After this treatment, patients were randomly allocated to 2 groups of 30 patients each. Patients in group 1 received a single dose of 400 mg ibuprofen and a rescue bag of the same medication to use if they felt pain and needed further medication. Patients in group 2 received the same medication as group 1 patients after treatment, and they were also provided with a prescription to use 400 mg ibuprofen every 6 hours for at least 24 hours. The patients were asked to rate their pain on a visual analog scale for up to 48 hours after treatment. The data were analyzed with Mann-Whiney, chi-square, Fisher exact, and McNemar tests., Results: Two patients were excluded because they did not return their pain record forms. Data analysis of the remaining 58 patients showed no significant difference in pain felt by the patients in groups 1 and 2 at either 24 or 48 hours after treatment (P = .849 and P = .732, respectively). Patients in group 2 used significantly more medication compared with patients in group 1 (P = .04)., Conclusions: In patients who had irreversible pulpitis with no moderate to severe spontaneous pain, prescribing ibuprofen on a regular basis after root canal treatment had no significant effect on pain relief compared with an on-demand regimen up to 48 hours after treatment., (Copyright © 2014 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.)

Aim: To investigate the pattern of routine endodontic practices among Nigerian dentists., Materials and Methods: This study was a questionnaire-based survey of samples of dentists in the Nigerian cities of Enugu and Benin. The self-administered questionnaire contained 25 close-ended questions with multiple choice options. The data collected included demographic details of respondents, root canal preparation techniques, irrigants and intracanal medicaments used, the number of appointments, method of working length determination, root filling techniques, cements used, and the scope of treatment performed., Results: Most respondents used sodium hypochlorite as the irrigant, the step back technique for canal preparation, and lateral condensation with a zinc oxide-eugenol-based sealer for obturation. Most respondents did root canal treatment on all types of teeth and used radiographs to determine the working length 70% of the time. Most respondents followed up their patients for less than 12 months and most treated teeth with periapical areas larger than 10 mm by root canal therapy combined with apical surgery., Conclusion: Most Nigerian dentists use step back technique for canal preparation and lateral condensation for obturation., Clinical Significance: Endodontic practice by Nigerian dentists differs from some established practice quality guidelines in many other countries, particularly in nonperfusion of modern techniques into practice, popularity of antibiotic use for endodontic emergencies and a high rate of perforations.

Introduction: This study was performed to investigate the effect of topical anesthesia on pain during needle penetration and infiltration injection as well as the effect of pain during injection on success rate of anesthesia in maxillary central incisors., Methods: In a crossover double-blind study, 25 volunteers randomly received either topical anesthesia or placebo before infiltration injection with prilocaine for their maxillary central incisors in 2 separate appointments. The pain after needle penetration and during injection was separately recorded. An electric pulp tester was used to evaluate the success of the anesthetic injection. Data were analyzed by McNemar, Wilcoxon, and χ(2) tests., Results: Overall for 50 injections, 72% of the teeth had successful anesthesia. No significant difference was found between placebo and topical anesthetic groups for the pain of needle penetration as well as pain during injection (P > .05). The volunteers who reported moderate-to-severe pain during injection showed no significant difference in the success rate of anesthesia compared with those with no or mild pain during injections (P > .05)., Conclusions: Use of topical anesthesia had no significant effect on pain during either needle penetration or injection. Pain during injection had no significant effect on the success of anesthesia., (Copyright © 2012 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.)

Introduction: Pain control after root canal treatment is of great importance in endodontic practice. The aim of the present study was to investigate the effect of a long-acting anesthetic (bupivacaine) on postoperative pain and the use of analgesics after root canal treatment., Methods: In a randomized double-blinded clinical trial, 60 patients (30 per group) having first or second mandibular molars with irreversible pulpitis randomly received either 0.5% bupivacaine with 1:200,000 epinephrine or 2% lidocaine with 1:80,000 epinephrine as the anesthetic solutions for inferior alveolar nerve blocks. After single-visit root canal treatment, each patient recorded their pain score on a visual analogue scale at 6, 12, 24, 36, 48, and 72 hours after treatment. Data were analyzed by Mann-Whitney, χ(2), Cochrane Q, and t tests as well as Pearson correlation analysis., Results: The results indicate that patients who received bupivacaine had significantly lower pain scores at 6 and 12 hours after root canal treatment compared with the patients who received lidocaine (P < .05). The use of analgesics in the bupivacaine patients was significantly lower than in the lidocaine group (P < .05)., Conclusions: Patients who received bupivacaine as the anesthetic agent for single-visit endodontic treatment of irreversible pulpitis in mandibular molars had significantly less early postoperative pain and used fewer analgesics than those who had lidocaine as the anesthetic., (Copyright © 2012 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.)

Introduction: The aim of this study was to compare the clinical accuracy, reliability, and repeatability of laser Doppler flowmetry (LDF), an electric pulp test (EPT), and various thermal pulp sensibility tests., Methods: Pulp tests were done on 121 teeth in 20 subjects by using LDF, EPT, and thermal pulp testing (CO(2), Endo Frost [EF], Ice) during 2 or 3 test sessions with at least 1-week intervals. The order of testing was reversed on the second visit. A laser Doppler flowmeter was used to measure mean pulp blood flow (Flux) calibrated against a brownian motion medium and zeroed against a static reflector. The laser source was 780 nm, with 0.5-mm fiber separation in the probe, 3.1 kHz as the primary bandwidth for filter set to 0.1-second time output constant. Customized polyvinylsiloxane splints were fabricated for each participant, and a minimum of 90-second recording time was used for each tooth. Raw data were analyzed by using repeated measure analysis of variance, pairwise comparisons, and interclass correlations (ICC)., Results: The accuracy of EPT, CO(2), and LDF tests was 97.7%, 97.0%, and 96.3%, respectively, without significant differences (P > .3). Accuracy of EF and Ice was 90.7% and 84.8%, respectively. EPT (P = .015) and CO(2) (P = .022) were significantly more accurate than EF. LDF was more accurate than EF, but this was not statistically significant (P = .063). Ice was significantly less accurate than EPT (P = .004), CO(2) (P = .005), LDF (P = .006), and EF (P = .019). With the exception of Ice (effect of visit: F(2,38) = 5.67, mean squared error = 0.01, P = .007, η(2)(p) = 0.23), all tests were reliable. Ice (ICC = 0.677) and LDF (ICC = 0.654) were the most repeatable of the tests, whereas EPT (ICC = 0.434) and CO(2) (ICC = 0.432) were less repeatable., Conclusions: CO(2), EPT, and LDF were reliable and the most accurate tests, but CO(2) and EPT were less repeatable yet less time-consuming than LDF. EF was reliable but not as accurate as EPT and CO(2) and less repeatable than Ice and LDF. Ice was the most repeatable but the least accurate and least reliable test., (Copyright © 2011 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.)

Introduction: Achieving pulp anesthesia with irreversible pulpitis is difficult. This study evaluated whether nonsteroidal anti-inflammatory drugs assist local anesthesia., Methods: In a randomized double-blinded clinical trial, 150 patients (50 per group) with irreversible pulpitis were given placebo, 600 mg ibuprofen, or 75 mg indomethacin 1 hour before local anesthesia. Each patient recorded their pain score on a visual analog scale before taking the medication, 15 minutes after anesthesia in response to a cold test, during access cavity preparation and during root canal instrumentation. No or mild pain at any stage was considered a success. Data were analyzed by the chi-square and analysis of variance tests., Results: Overall success rates for placebo, ibuprofen, and indomethacin were 32%, 78%, and 62%, respectively (p < 0.001). Ibuprofen and indomethacin were significantly better than placebo (p < 0.01). There was no difference between ibuprofen and indomethacin (p = 0.24)., Conclusions: Premedication with ibuprofen and indomethacin significantly increased the success rates of inferior alveolar nerve block anesthesia for teeth with irreversible pulpitis., (Copyright 2010 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.)

Objective: The aim of this study was to assess the efficacy of inferior alveolar nerve (IAN) block combined with buccal infiltration for mandibular molars with irreversible pulpitis., Methodology: Eighty-four patients were randomly assigned to 3 groups of 28 patients each. Lidocaine 2% with 1:80,000 epinephrine was used for all injections. Group I patients received an IAN block with 1.8 mL of anesthetic. Group II patients received an IAN block using 3.6 mL. Group III patients received 1.8 mL as an IAN block and 1.8 mL as a buccal infiltration. A visual analogue scale was used to rate pain before anesthesia and discomfort experienced before and during access cavity preparation. Data were analyzed by chi-square, ANOVA, Kruskal-Wallis, and Mann-Whitney tests., Results: The success rates for groups I to III were 14.8%, 39.3%, and 65.4%, respectively. Group III had significantly better anesthesia compared with group I (P < .05)., Conclusion: Combining an IAN block and a buccal infiltration injection provided more effective anesthesia in mandibular molars with irreversible pulpitis. However, some cases may still require further anesthesia to prevent pain during endodontic treatment., (Copyright 2010 Mosby, Inc. All rights reserved.)

Introduction: Consensus Conference Subcommittee 2 was charged with the identification and definition of all diagnostic terms for pulpal health and disease states by using a systematic review of the literature., Methods: Eight databases were searched, and numerous widely recognized endodontic texts were consulted. For each reference the level of evidence was determined, and the findings were summarized by members of the subcommittee. Highest levels of evidence were always included when available. Areas of inquiry included quantification of pulpal pain, the designation of conditions that can be identified in the dental pulp, diagnostic terms that can best represent pulpal health and disease, and metrics used to arrive at such designations., Results and Conclusions: On the basis of the findings of this inquiry, specific diagnostic terms for pulpal health and disease are suggested. In addition, numerous areas for further study were identified.

Introduction: The purpose of this study was to investigate the association between dye and bacterial penetration through interim restorations used during endodontic treatment., Methods: Sixty-four extracted human teeth were used, with 2 teeth each as positive and negative controls. Endodontic access with a mesio-occluso-distal cavity was prepared. Palatal cusps of maxillary molars and buccal cusps of mandibular molars were removed. Cotton was placed over the canals and covered with Cavit. Thirty teeth were restored with Ketac Silver (KS) and 30 with KS reinforced with a stainless steel band (KSSB). Samples were submersed in India ink mixed with brain heart infusion broth containing Streptococcus gordonii. After 3 months of simulated chewing, structural integrity and dye and bacterial penetration were assessed., Results: Positive controls had both dye and bacterial penetration. Negative controls had no dye or bacterial penetration. All KS restorations debonded, whereas 18 KSSB restorations (60%) debonded. KS restorations were 1.67 times more likely to debond than KSSB restorations (Fisher exact test). KS was 1.3 times more likely to have dye penetration than KSSB (Fisher exact test) and 3 times more likely to have bacterial penetration, although not statistically significant (chi(2) test). Overall, 88.3% of specimens had dye penetration, and 20% had bacterial penetration. This 68.3% difference indicated no association between dye and bacterial penetration (exact McNemar test)., Conclusions: Stainless steel bands helped maintain structural integrity of KS restorations under masticatory function. Bands helped prevent dye penetration but not bacterial penetration. There was no association between dye and bacterial penetration.

Aim: The aims of this study were to determine the attitudes of endodontists toward the risk of root fracture when removing posts and to determine which methods they commonly used to remove posts from root-filled teeth., Methodology: A survey was sent to all 74 members of the Australian and New Zealand Academy of Endodontists. The survey was divided into three parts to gather information concerning root canal retreatment performed in specialist endodontic practice, attitudes about the risk of root fracture when removing posts and the methods used to remove different post systems., Results: Responses were received from 62 (84%) of the Academy members. When a post was present in a tooth that required root canal retreatment, 66% of the endodontists preferred to remove the post, whilst 27% considered either post removal or periapical surgery. Forty-five per cent reported that a root fracture had occurred during post removal, but this represented less than 0.002% of the estimated number of posts removed by all respondents. Ultrasonic vibration was the most common method used to remove posts, although post removal devices were used more often in anterior teeth; the Eggler post remover was the most commonly used device., Conclusions: Most endodontists preferred to remove posts rather than perform periapical surgery. Few root fractures were reported. Ultrasonic vibration was the most common method used to remove posts from all tooth types, with the Eggler post remover used most commonly for posts in anterior teeth.