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Copyright of Current Research in Dental Sciences is the property of Ataturk University Coordinatorship of Scientific Journals and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: With the increasing application of guided endodontics to treat complex root canal treatment, the entire process of root canal treatment has become more precise, reducing damage to tooth structure and improving success rates. However, due to the limitations of the operating space, the use of guided endodontic templates in posterior root canal treatment is less common. This study aims to compare the accuracy and reliability of selective laser melting (SLM) and traditional stereolithography etching (SLA) guided endodontic templates for posterior root canals, providing better treatment strategies for posterior root canal treatment. Methods: The teeth were randomly assigned to either SLM or SLA group. Preoperative cone-beam computed tomography (CBCT) and a three-dimensional (3D) scanner were used to establish the 3D root canal system and the accurate occlusal models of the teeth. The virtual access to the canal access was designed using Mimics 19.0 and 3-Matic 11.0. The endodontic access was performed based on either SLM or SLA templates. The accuracy of endodontic preparation was measured in three-dimensions by calculating deviations from planned accesses. The template height and tooth substance loss rates in each group were measured. Results: SLM-guided templates have a low average deviation at the entry point and apical portion of the bur of total posterior teeth (including premolars and molars) and individual molars (P < 0.05). Moreover, there was a significant difference in angular deviations and height of template in total posterior teeth and individual molars (P < 0.05). The mean substance loss rate of the SLA group was slightly greater than that of the SLM group, but the difference was not statistically (P > 0.05). Conclusions: SLM-guided endodontics provides a more predictable and precise location of root canal orifice for the treatment of posterior teeth. [ABSTRACT FROM AUTHOR]

This study explored the antimicrobial effects of ketoprofen, piroxicam, and celecoxib alone or combined with calcium hydroxide (CH) against two strains of Enterococcus faecalis (E. faecalis) and assessed the influence of such combinations on the pH of CH. Minimum inhibitory concentrations (MICs) of the three tested NSAIDs were determined. Tested pastes were placed into wells punched in seeded agar plates and the bacterial inhibition zones were measured. Antibiofilm activity was assessed against 3 weeks of biofilm induced in bovine dentine blocks. The pH of the pastes was measured at four-time intervals. MIC values were 3.12, 25, and 25 mg/ml for ketoprofen, piroxicam, and celecoxib, respectively, and were similar for both bacterial strains except for celecoxib, which showed 8% growth at the highest tested concentration against vancomycin-resistant E. faecalis. Ketoprofen had the largest mean inhibition zone that was comparable to CH. None of the six tested pastes exhibited antibiofilm activity of a significant level in comparison to CH. A noticeable increase in the antibiofilm activity was found when 20% NSAIDs were added to CH while maintaining an alkaline pH. Ketoprofen was found to be the most effective among the tested NSAIDs. Although its effect was comparable to CH, adding ketoprofen at a ratio of 20% resulted in 50% higher antimicrobial action than CH alone. Accordingly, incorporating NSAIDs in inter-appointment dressing has the potential to utilize their anti-inflammatory, local analgesic, and antibacterial actions, which overcome the limitations of CH and improve the outcome of root canal treatment. [ABSTRACT FROM AUTHOR]

Knowledge of tooth anatomy and its variations are essential for the success of endodontic treatment. Dilacerations represent developmental anomalies marked by sudden deviations in a tooth's longitudinal axis. Common causes of treatment failures in such cases are primarily related to procedural errors such as ledging, fractured instruments, canal blockages, zipping, and elbow creations. The current case series presents three such interesting cases of endodontic management of curved root canals in mandibular molars. [ABSTRACT FROM AUTHOR]

Context: Root canal instrumentation is one of the important procedures for successful endodontic therapy. Unexpected fracture of files occurs during root canal instrumentation without any visible signs of deformation compromising the success of root canal treatment. Aims: The aim of the study was to evaluate and compare cyclic fatigue resistance (CFR) of rotary and reciprocating files in simulated canals with 45°, 60°, and 90° angle of curvature. Settings and Design: The study design was an In vitro study. Subjects and Methods: Sixty nickel-titanium files, 30 each of rotary and reciprocating files were selected and divided into four groups (n = 15) of Neoendo Flex, ProTaper Next, WaveOne Gold (WOG), and Reciproc Blue (RPB) files. Each group was further subdivided into three subgroups containing five samples each based on their use in simulated canals with 45°, 60°, and 90° angle of curvature. To simulate root canals with 45°, 60°, and 90° angle of curvature, three artificial canals were designed in a stainless steel metal block. Each file was autoclaved, immersed in 3% sodium hypochlorite (NaOCl), and coated with 17% ethylenediaminetetraacetic acid (EDTA). Each file was tested for CFR using a torque-controlled reduction handpiece by instrumenting in a simulated canal for 10 s until fracture. The cycle of autoclaving, exposure to NaOCl, EDTA, and testing of CFR for 10 s per canal as per groups and subgroups was repeated again and again until the respective file fracture. The time taken to file fracture was recorded using a digital chronometer. The time taken for each file fracture (in minutes) was multiplied by the number of rotations per minute to attain the number of cycles to failure (NCF). Statistical Analysis Used: The obtained results were subjected to statistical analysis using one-way analysis of variance and independent t-test. Results: One-way ANOVA test showed a statistically significant difference between the four groups, P < 0.001. Independent "t"-test between individual subgroups showed a statistically significant difference, as P < 0.05. Conclusions: WOG and RPB reciprocating file systems showed superior CFR, more especially in canals with abrupt 90° angle of curvature compared to both rotary file systems tested. Among rotary file systems tested, Neoendo Flex showed greater CFR than ProTaper Next. [ABSTRACT FROM AUTHOR]

Context: The main objective of endodontic therapy is to achieve a sterile environment and three-dimensional filling of the root canals. Endodontic sealers play an important role in the obturation of the root canal system as they may provide a seal, which prevents the penetration of bacteria. Sealers are meant to entomb residual bacteria, prevent leakage of nutrients, and ideally possess antibacterial properties. Aim: The aim of the study was to evaluate and compare the antimicrobial effectiveness of calcium silicate-based bioceramic root canal sealers against Enterococcus faecalis and Staphylococcus aureus using the agar diffusion method. Materials and Methods: The materials were divided into four groups of nine samples each for both E. faecalis and S. aureus. Group I (control group) - MTA-Fillapex (Angelus), Group II - BioRoot RCS (Septodont), Group III - Bio-C Sealer (Angelus), and Group IV - Dia-Root Bio Sealer (Diadent). To evaluate the antibacterial activity of the samples, the agar diffusion method was utilized. To begin, a bacterial suspension was evenly spread onto sterile Petri dishes using sterile swabs. Four wells of 4 mm diameter were then punched, and the sealers were mixed following the manufacturer's instructions and placed onto the prepared wells. The Petri dishes were then incubated at 37°C for 72 h. After incubation, the zones of inhibition around each well were measured at 24 h, 48 h, and 72 h, and the resulting values were statistically analyzed. Statistical Analysis Used: The data were analyzed using the ANOVA and post hoc Tukey's test. Results: Calcium silicate-based root canal sealers showed significantly better efficacy than the control group. BioRoot RCS (3.44 ± 1.13 mm) showed maximum antibacterial effect against E. faecalis at 24 h, 48 h, and 72 h time intervals. Bio-C Sealer (16.44 ± 1.42 mm) showed maximum antibacterial effect against S. aureus at 24 h, 48 h, and 72 h time intervals. The effectiveness of root canal sealants eventually decreased over a period. Based on analysis using the ANOVA test, a statistically significant difference (P = 0.05) was observed between the mean values of antimicrobial efficacy of sealers against both E. faecalis and S. aureus. Conclusions: The study's findings lead to the conclusion that BioRoot RCS showed a maximum antibacterial effect against E. faecalis and Bio-C Sealer showed maximum antibacterial effect against S. aureus at 24 h, 48 h, and 72 h. [ABSTRACT FROM AUTHOR]

The diverse morphological configurations in teeth present clinical challenges in root canal treatment, complicating instrumentation and irrigation processes, which can lead to treatment failure. Understanding anatomical variations, such as C-shaped canals and radix entomolaris, enhances clinical skills and improves long-term endodontic treatment success rates. Cone-beam computed tomography (CBCT) offers superior diagnostic capabilities over conventional radiography, enabling the pre-operative detection of root configurations and canal numbers, facilitating personalized endodontic treatments. A total of 2173 teeth of a Mexican population, including 1057 first mandibular molars and 1116 s mandibular molars, were studied using only CBCT to identify C-shaped canals and radix configurations of patients who were treated from 2018 to 2023 at the Department of Radiology at the Faculty of Dentistry, Juarez University of the State of Durango, Mexico. C-shaped canals were identified in 160 teeth, with a prevalence of 0.2% in first mandibular molars and 14.1% in second mandibular molars. The highest frequency was in the left second mandibular molar (3.7) at 14.8%. Gender differences were significant, with higher prevalence in females (27.3%) compared to males (13.3%). The most common C-shaped canal configuration was type C2 (39.3%). Radix entomolaris was found in 52 teeth, with a prevalence of 3.4% in first mandibular molars and 1.4% in second mandibular molars. This research on a Mexican population using cone-beam computed tomography (CBCT) highlights significant findings in the prevalence and types of C-shaped canals and radix entomolaris in mandibular molars for this population. The left second mandibular molar (3.7) showed the highest prevalence at 14.8%, followed closely by the right second mandibular molar (4.7) at 13.5%, with a significant difference (p < 0.001). We found a significant difference in the prevalence of C-shaped canals between genders (p = 0.004, OR 1.78). Additionally, radix entomolaris (p < 0.001) was more frequently identified in first mandibular molars to a significant degree. These insights underscore the importance of CBCT in diagnosing complex root anatomies, which can greatly enhance the success rates of endodontic procedures by allowing for more tailored and precise treatments for this population. [ABSTRACT FROM AUTHOR]

Purpose: Nowadays, regenerative endodontics treatment is recommended in the case of loss of vitality of the dental pulp and the presence of a suitable dental structure. One of the primary reasons for failure after regenerative endodontics treatments is the remaining of bacteria in the root canal. Thus, to improve the prognosis of root canal treatment, it is recommended to use different intracanal medicaments including antibiotics and calcium hydroxide as complementary agents. This study aimed to review common intracanal medicaments in the treatment of endodontic regeneration. Materials and Methods: In this review study, the keywords of regenerative endodontics, pulp revascularization, paste antibiotic, intracanal medicament, and calcium hydroxide were searched in the Google, Google Scholar, PubMed, SID, ISI Web of Science, and IranMedex databases from 2018 to 2023. Articles that met the inclusion criteria were included in this study. Results: 39 studies were included in this study. Common intracanal medicaments (triple, double antibiotic pastes, calcium hydroxide, etc.) that are commonly used in regenerative endodontic treatment were used. Both the concentration and duration of exposure to the medicaments affect the viability of stem cells. TAP (Triple Antibiotic Paste) has the highest antibacterial effect against E. faecalis and the highest rate of discoloration. Calcium hydroxide as a medicament will probably have a positive impact on the release of growth factors. Conclusion: It is better to use antibiotic medicaments with a lower concentration at times between 24 hours and 48 hours for dental root canal disinfection so it does not interfere with the viability of stem cells. [ABSTRACT FROM AUTHOR]

Background: Paediatric rotary file systems have recently been developed for primary teeth use. Aim: To study the cleaning efficacies of two paediatric rotary endodontic files, the Prime PedoTM, and the Kedo‐SG BlueTM against the standard H files. Design: This in vitro study included 54 freshly extracted primary molars, which were randomised into three groups (n = 18 each) and were prepared using either Kedo‐SG BlueTM, Prime PedoTM or hand H files after injecting methylene blue dye into the canals. Pre‐ and post‐operative cone beam computerised tomography (CBCT) was performed to assess change in root canal volumes. Methylene blue dye removal from canals was assessed using stereomicroscopy, and canal cleanliness was examined by scanning electron microscopy (SEM). Results: Both Prime PedoTM and Kedo‐SG BlueTM files reduced significantly less dentine when compared with conventional hand filing with Prime PedoTM removing the least amount of dentine. No significant difference was found in median SEM scores among the groups in the cervical, middle and apical thirds of the roots. Stereomicroscopic assessment of root canal cleanliness using dye removal technique shows a statistically significant difference existing between Kedo‐SG BlueTM and hand H files groups. Conclusion: Prime PedoTM removed the least amount of dentine. Kedo‐SG BlueTM performed significantly better than conventional hand filing with H files when the root canal cleanliness was assessed. [ABSTRACT FROM AUTHOR]

Background: Eccentric instruments have been proposed as more effective and less time‐consuming for endodontic instrumentation. Aim: To compare biomechanical outcomes of different instrumentation systems and time undertaken for instrumentation in resin prototypes. Design: Sixty standardized prototypes of mandibular second primary molars were instrumented according to the following systems: K‐files, ProTaper Next (PTN), XP‐endo Shaper (XPS), XP‐endo Finisher (XPF), XP–Clean (XPC), and Sequence Baby File (SBF; n = 10/each). Irrigation was performed with saline with simultaneous aspiration, and time spent was recorded. The prototypes were micro‐CT‐scanned before and after the instrumentation, and image sets were reconstructed and registered. Non‐instrumented areas, accumulated debris, removed root material volume, and canal transportation were quantified. Data were analyzed through ANOVA, the Kruskal–Wallis test, and the Wilcoxon signed‐rank test (α = 5%). Results: K‐files and SBF resulted in more instrumentation time (p <.05). SBF, XPC and PTN removed less root dentine (p <.05), but PTN left more untouched areas (p <.05). Accumulated debris were lower for XPC and SBF (p <.05). Canal transportation was similar among the groups. Conclusion: Rotary systems reduced instrumentation time, whereas SBF and XPC resulted in more conservative instrumentation, with less debris accumulation and non‐instrumented areas. A dedicated paediatric endodontic system (SBF) outperformed eccentric instruments in terms of effectiveness. [ABSTRACT FROM AUTHOR]

Background: Octenidine dihydrochloride (OCT) has been used as a canal irrigation agent. However, no research has been done on its use as a primary root canal paste mixed with calcium hydroxide in primary teeth. Purpose: This study aims to determine the in vitro antibacterial effect of an experimental canal sealer prepared using OCT and calcium hydroxide (CaOH) on primary root canal pathogens and compare them to zinc oxide eugenol (ZOE) and iodoform paste (IP). Methods: Staphylococcus aureus (S. aureus), Streprococcus mutans (S. mutans) and Enteroccus faecalis (E. faecalis) were used as microorganisms to determine their antibacterial effect. A disc diffusion test was applied to the strains of impregnated discs with canal sealer. The number of bacteria was standardized and incubated into the Mueller–Hinton growth medium. At the end of the incubation period, the inhibition zones around the discs were measured in millimeters and recorded. Results: When the diameters of the inhibition zones were compared, the experimental canal paste obtained by mixing OCT and CaOH at a ratio of 2:1 was found to have the highest antibacterial effect against S. aureus, S. mutans and E. faecalis, and the primary tooth canal paste containing iodoform, which is used routinely in clinical practice, had the lowest antibacterial effect. Conclusion: As a result of this study, the antibacterial effect of experimental canal sealer containing OCT–CaOH on S. mutans, S. aureus and E. faecalis was found to be considerably higher than the root canal sealer containing eugenol and iodoform.

Background and purpose: To achieve a successful root canal treatment, it is necessary to have a sealer with ideal characteristics that seal the permanent filling of the tooth canal. Over time, various sealers with different compositions have been introduced to increase the obturation quality of tooth root canals, and many studies are still ongoing to find the ideal sealer. This study aims to evaluate the obturation quality of Endoseal MTA sealer based on the void and spreader track in the root canal using intraoral digital radiography (PSP) and compare it with Adseal and MTA Fillapex. Materials and methods: This laboratory study was conducted on 36 central maxillary single-canal permanent human teeth with the same shape and in the pre-clinic of the dental school of Mazandaran University of Medical Sciences. Root canal preparation was done with the Denco rotary system up to size F3 according to the manufacturer's instructions. During preparation, sodium hypochlorite 5.25% was used for washing, and finally EDTA 17% and sodium chlorite 5.25% were used to remove the smear layer. The teeth were dried with a paper cone. The samples were randomly divided into 3 groups and were filled with gutta-percha and sealers; MTA Fillapex, Endoseal MTA, and Adseal by lateral compaction method using Master Cone 35 and cone 20. After the sealers were set completely for 24 hours, PSP imaging was done with a parallel technique, buccolingually and mesiodistally, from the root canal of the teeth, and the presence of void and gaps in the form of spreader track in the three apical, middle and coronal regions, was evaluated with 3 independent observers. The data were evaluated with chi-square or Fisher's exact test, and items less than 0.05 were considered significant. Results: In the current study, the obturation quality of MTA Fillapex, Endoseal MTA, and Adseal sealers was investigated on 36 teeth based on void and gap in the form of spreader track. These evaluations were done according to the direction and location of the sealers. In these evaluations, Adseal sealer had the lowest and MTA Fillapex had the most prevalence of spreader track prevalence, although these differences were not significant based on the chi-square test and there was no significant difference between the prevalence of Spreader track among the three sealers. The void was observed only in the Endoseal group in coronal (mean: 0.5) and apical (mean: 0.7) areas. The results of the Chi-square test showed that there was no significant relationship between the prevalence of void with coronal, middle, and apical sites in Endoseal (P

Abstract Background Pulp stones are a type of pulp calcification, the presence of which tends to hinder endodontic treatment. Thus, this retrospective study aimed to analyze the distribution of pulp stones in the population in southwest China and identify the influencing factors. Materials Cone-beam computed tomography (CBCT) scans of 5066 teeth of 200 patients (91 males and 109 females) aged 16–45 years were evaluated. Pulp stones were marked as either present or absent when distinct radiopaque masses were found in the pulp cavity, then evaluated the occurrence of pulp stones with regard to tooth type, sex, age group, and contact it with tooth status. The Pearson chi-square test and nonparametric test were used for statistical analysis. Results Pulp stones were detected in 49.0% of patients and 7.4% of teeth, respectively. The incidence in females was 1.9 times higher than in males (OR = 1.9, 95% CI = 1.1–3.3, p = 0.001). Pulp stones were most prevalent in patients 36–45 years of age. Furthermore, in the age range of 16–45 years, the likelihood of finding pulp stones increased 1.1 times per year with age (OR = 1.1, 95% CI = 1.0–1.1, p = 0.032). A higher incidence of pulp stones was observed in the maxilla and molars. Of the 5066 teeth studied, pulp stones were more common in non-intact teeth. Conclusion Nearly half of the population in southwest China had pulp stones. Pulp stones were found significantly more often in females, maxilla, and non-intact teeth, and their frequency increased with age. For dentists, understanding the distribution of pulp stones is crucial for the proper design of root canal treatment (RCT). Trial registration This study was approved by the Ethics Committee of the Affiliated Hospital of Stomatology, Southwest Medical University (certificate number: 20220818001).

Dental dilacerations are abrupt deviations of the longitudinal axis of the crown or root portion of the tooth, caused by traumatic axial displacement of previously formed hard tissue in relation to the developing soft tissue. Case presentation: A 13-year-old boy in good general health was referred for root canal treatment of the maxillary left central incisor, for which abnormal crown morphology impeded orthodontic treatment. He presented bilateral crown dilaceration at both maxillary central incisors. Treatment involved a CAD/CAM milled veneer of the maxillary left central incisor and semidirect warm composite veneer of the maxillary right central incisor. Follow-up and monitoring of the restoration was performed through .stl file analysis. Discussion: Crown dilaceration severity assessment is crucial for deciding the best treatment plan for each case. In this patient, additive restorative protocols, CBCT, and 3D digital model analysis were the most useful aids by providing key multidisciplinary information. Conclusion: A multidisciplinary treatment workflow with a minimally invasive approach aided by digital tools such as CBCT and CAD/CAM technologies is useful to achieve successful and predictable outcomes in crown dilaceration cases. [ABSTRACT FROM AUTHOR]

Background/purpose: The effectiveness of root canal treatments with different file systems in primary teeth is important in terms of clinical practice and the use of file systems that work with different principles in primary tooth pulpectomy is becoming widespread. The amount of remaining dentin in the coronal region of the root is important in terms of the prognosis of the tooth and the long-term success of the treatment in teeth that have undergone root canal treatment. The aim of this study was to evaluate the remaining dentin volume in the coronal part of the root after the use of rotary, reciprocating, and conventional hand files in primary tooth pulpectomy. Materials and methods: A total of 30 primary molars were divided into three groups. In each group, the preparations were made with three different file types: WaveOne Gold, which works with reciprocating motion; TruNatomy, which works with rotational motion; and conventional hand files. The three-dimensional images were evaluated for remaining dentin volume in the 2-mm coronal part of the root. Group means were compared using one-way analysis of variance, and post hoc analyses were performed with the Tukey test. Results: There was no statistically significant difference between the groups in terms of preoperative and postoperative dentin volume (P > 0.05). The mean difference after preparation was observed the most in the WaveOne Gold group and the least in the TruNatomy group. When the mean percentage differences were evaluated, it was observed that statistically significantly more dentin volume was preserved after the preparation with TruNatomy than with WaveOne Gold (P = 0.021). Conclusion: In primary tooth pulpectomy, file systems working with rotational motion can be preferred over file systems working with reciprocating motion in preserving the amount of dentin in the 2-mm coronal part of the root.

The effects of Easydo Activator (EA), a new sonic irrigation system, on sealer penetration at the root apex were compared to needle irrigation (NI) and passive ultrasonic irrigation (PUI) in this study. Forty-two single-rooted teeth were prepared and randomly divided into three groups (n = 14): group 1: NI; group 2: PUI; and group 3: EA. A solution of 3% sodium hypochlorite (NaOCl) was used for irrigation. Nine teeth in each group were filled with AH Plus sealer mixed with CY5 fluorescent dye and a single gutta-percha cone. The sealer penetration area, maximum penetration depth and percentage of sealer penetration at 5 mm and 1 mm from the apex were analyzed by confocal laser scanning microscopy (CLSM). The remaining 5 teeth in each group were subjected to test smear layer scores by scanning electron microscopy (SEM). The CLSM evaluation showed that increases in the area, depth and percentage of sealer penetration were detected at 1 and 5 mm from the root apex in the PUI group compared with the NI group, and greater increases were observed in the EA group (P < 0.05). The SEM experiment showed that the lowest scores for the smear layer and debris removal were achieved by the EA group when compared with the PUI and NI groups (P < 0.05). In conclusion, EA was superior to PUI and NI regarding sealer penetration at the root apex during endodontic treatment, and it could provide a new technical idea for clinical root canal therapy. [ABSTRACT FROM AUTHOR]

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

Lesion formation after soft tissue gingival grafting is a rare but challenging clinical scenario to manage. This report presents a unique case of cyst formation after connective tissue grafting. All previously reported cases are confined to the mandibular labial lateral-canine space, whereas the present case is the first found in the maxilla. These cysts manifest clinically 9 months to 1.5 years after grafting and may communicate with the surface, as evidenced by sinus tract or cystic discharge. Because of the unique nature of these lesions with respect to clinical history, appearance, symptoms, and location, the differential diagnosis should be limited. The treatment recommendation is complete surgical excision, which should eliminate the risk of recurrence. In this report, a novel case is presented, and the literature is reviewed to discuss etiology and provide treatment recommendatio [ABSTRACT FROM AUTHOR]

Purpose: With success rates comparable to that of root canal treatment, vital pulp therapy (VPT) has gained clinical interest and has been used in the management of young permanent teeth with inflamed pulps. The aim of the present study was to retrospectively evaluate the radiographic success of VPT in young first permanent molars 24 months post-treatment and correlate findings with tooth and treatment-related characteristics. Materials and Methods: Dental records of all patients with first permanent molars which received VPT in the Department of Paediatric Dentistry (National and Kapodistrian University of Athens) were retrieved. Demographic characteristics and data regarding the treatment performed were recorded. Patients' radiographs were evaluated at 6, 12 and 24 months post-treatment by two qualified paediatric dentists blinded regarding the treatment performed. Radiographic success, reasons for failure and continuation of root development were evaluated. Differences were tested using the x² and Student's t-test, and possible correlations were determined by calculating the odds ratio. Results: Overall radiographic success rate at 24 months was 77%, ranging between 50% for direct pulp capping and 92% for full pulpotomy. Differences were not statistically significant. Continuation of root development was recorded in almost 1/3 of the teeth and completion in almost 1/5. No statistically significant association was recorded between the outcome and any tooth and treatment-related variables. Conclusion: VPT seems to be a reliable option in the long term for the treatment of deep carious lesions in young permanent molars. [ABSTRACT FROM AUTHOR]

Objective: Dens in dente is a developmental dental malformation with various anatomical traits that make treatment difficult. The importance of a timely and correct diagnosis in determining the most effective treatment approach cannot be overstated. Using three-dimensional (3D) imaging techniques has improved the diagnosis of teeth with complex anatomies, such as dens in dente. This systematic review aimed to determine the different techniques for endodontic management of teeth with Dens in dente having periapical lesions. Materials and Methods: Case reports and case series were identified in databases - PubMed-MEDLINE, Google Scholar, Research Gate, EBSCO-Host, Scopus, and Cochrane Library based on title, abstract, and full text published in the English language between January 1, 2016 and April 30, 2023. Patients who have periapical lesions and dens in dente in their permanent teeth and reporting on the results of nonsurgical or surgical intervention in terms of healing were eligible for this review, while editorial reviews, review papers, abstracts, letters to the editor, and animal studies are all excluded. Case studies on deciduous teeth, dens in dente retreatment, or dens associated with other developmental disorders are also excluded. Three authors evaluated the quality of the included studies. The quality of the included case reports and case series was evaluated using the Joanna Briggs Institute’s Critical Appraisal Checklist for Case Reports and Case Series. Results and Discussion: A total of 28 articles were suitable for inclusion, with 24 case reports and 4 case series. According to the available evidence, the condition is linked to an increased prevalence of pulp disease. Any necessary endodontic treatment may be difficult due to the aberrant anatomy. Early identification and preventive intervention rescued the teeth from further dental diseases. Conclusion: Nevertheless, thorough diagnoses and treatment planning are essential. Maintaining the vitality of the pulp or conserving the tooth using the least invasive way is the guiding principle when choosing a treatment modality. A surgical approach is only needed if the conservative approach fails. In the current systematic review, all cases showed reduction in the size of the periapical lesion or complete periapical healing.

Abstract For successful root canal treatment, adequate chemomechanical instrumentation to eliminate microorganisms and pulp tissue is crucial. This study aims to assess the organic tissue dissolving activity of various irrigation solutions on bovine tooth pulp tissue. 40 extracted bovine mandibular anterior teeth (n = 10) were used for the study. Bovine pulp pieces (25 ± 5 mg) were placed in 1.5 ml Eppendorf tubes. Each tooth pulp sample was then covered with 1.5 ml of different irrigation solutions, dividing them into four groups: Group 1 with freshly prepared 5% Boric acid, Group 2 with 5% NaOCl, Group 3 with Irritrol, and Group 4 with Saline. Samples were left at room temperature for 30 min, then dried and reweighed. The efficacy of tissue dissolution ranked from highest to lowest was found to be NaOCl, Boric Acid, Irritrol, and saline (p

Introduction: Root canal treatment (RCT) is a common dental procedure performed by general dentists and endodontists. It is prone to complications, such as the wrong tooth treatment. The objective is to study the prevalence of wrong tooth RCT (WTRCT) among dental health-care practitioners in Saudi Arabia in addition to the causative factors leading to the treatment of the wrong tooth. Materials and Methods: A cross-sectional study was conducted among dentists (n = 393) in Saudi Arabia between May and November 2022. Respondent characteristics, WTRCT incident details, and procedures followed before RCT were collected from the survey. Minitab was used for the data analysis. Descriptive statistics, binary logistic regression, and t-test were used. A P < 0.05 was set for statistical significance. Results: The number of respondent dentists was 390. The prevalence of dentists performing WTRCT accounted for 6.9% (n = 27). Misdiagnosis 14.67% was the leading cause of WTRCT, followed by the simultaneous placement of a rubber dam with a clamp and miscommunication 13.33%. WTRCT is more likely to occur in dentists who have more than 10 years of clinical experience since graduation (P = 0.004). Endodontists were about six times more likely to have this error occur (P = 0.001). Conclusions: The prevalence of WTRCT among dentists in Saudi Arabia is 6.9%, with the majority being general dentists and endodontists. Posterior teeth are found to be the most involved site. It is important to spread awareness among dentists about WTRCT and to be more cautious while performing treatment on multirooted teeth.

Background and aims: Apical patency (AP), a technique in endodontics, involves keeping a small opening in the apical foramen during root canal instrumentation. However, there has been a debate about its effect on postoperative pain. To clarify this issue, this systematic review aimed to study the literature and determine the impact of AP on postoperative pain after endodontic procedures. Methods: A systematic search was conducted across multiple databases, including PubMed/MEDLINE, Scopus, Web of Science, and Cochrane Library, up to November 2, 2023. Studies on the relationship between AP and postoperative pain in endodontic treatments were included in this research. Relevant articles were independently screened, and data were extracted based on our study aims. Results: Eleven randomized controlled trial studies met the inclusion criteria. The findings indicated that among the included studies, six demonstrated no differences between the AP and non-AP (NAP) groups in terms of postoperative pain scores. In addition, four studies reported a decrease in operative pain in the AP group compared to the NAP group, and only one study showed that AP increases postoperative pain. However, conflicting evidence was observed in a subset of studies; there were no significant differences between the AP and NAP groups in terms of the postoperative pain scores. Conclusion: Compared with NAP, AP does not intensify the postoperative pain in teeth with vital and necrotic pulp.

Nada Othman Bamashmous,1 Wala Dhafar,2 Jihan Turkistani,3 Manal Ibrahim Almalik,4 Rzan Zaatari,5 Ahlam Bahkali,3 Heba Jafar Sabbagh1 1Pediatric Dentistry Department, Faculty of Dentistry, King Abdulaziz University, Jeddah, Saudi Arabia; 2University Dental Hospital, King Abdulaziz University, Jeddah, Saudi Arabia; 3Department of Dental Services, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Jeddah, Saudi Arabia; 4Dental Department, King Fahad Armed Forces Hospital, Jeddah, Saudi Arabia; 5Alarak Almutamayzah Medical Company, Jeddah, Saudi ArabiaCorrespondence: Heba Jafar Sabbagh, Pediatric Dentistry Department, King Abdulaziz University, Faculty of Dentistry, PO Box 80200, Jeddah, 21589, Saudi Arabia, Tel +966505668481, Email hsabbagh@kau.edu.saAim: This study aimed to assess the Oral Health-Related Quality of Life (OHRQoL) of pediatric patients (9– 18 years old) who underwent root canal treatment (RCT) on first permanent molars (FPMs).Methods: A cross-sectional study was conducted at three healthcare centers in Jeddah, Saudi Arabia. Participants (n = 482) completed the validated OHIP5-Ar questionnaire to assess OHRQoL. Responses were classified as “optimal” (no problems) or “less than optimal” (any reported problems). Logistic regression analyzed the relationship between OHRQoL and sociodemographic factors.Results: There were 66.8% children reported optimal OHRQoL after RCT. Logistic regression showed no significant association between optimal OHRQoL and gender, family income, or location of treated tooth. However, although not statistically significant. Treating only one FPM with RCT (compared to multiple teeth) and lower family income (compared to higher income) were more likely to have decreased or increased odds of optimal OHRQoL (AOR = 0.684 or 1.424; respectively).Conclusion: RCT on FPMs can be a successful treatment option for pediatric patients, offering optimal oral health-related quality of life.Keywords: oral health-related quality of life, root canal treatment, first permanent molars, children

Objective To investigate the clinical characteristics, diagnosis and treatment of severe combined periodontal-endodontic lesions in a double-rooted maxillary lateral incisor with a palatal radicular groove and to provide a reference for clinical diagnosis and treatment. Methods A patient with a double-rooted left maxillary lateral incisor with a palatal radicular groove and severe combined periodontal-endodontic lesions underwent complete root canal therapy and intentional replantation, and a retrospective analysis of the management of this type of patient was performed based on the literature. Results The 3-year follow-up examination revealed no discomfort, good healing of the upper left lateral incisor, no pathological loosening, and a palatal gingival sulcus was found at a depth of approximately 1 mm. Review of the literature showed that the prognosis of the affected tooth and the choice of treatment plan were correlated with the length and depth of extension of the lingual groove toward the root, the periodontal condition and the pulpal status of the affected tooth. For minor PRGs or for affected teeth with no loss of pulpal viability, flap surgery and odontoplasty can be used to avoid endodontic treatment or retreatment. For deep or long lingual grooves that result in significant loss of periodontal tissue, endodontic treatment, odontoplasty, or closure of the grooves and guided tissue regeneration are needed. In the case of PRGs with double root formation, the affected tooth can be preserved via root canal therapy, removal of the small root and filling with apical restorative material, and intentional replantation. Conclusion In cases of severe combined periodontal-endodontic lesions due to palatal radicular grooves occurring in double-rooted maxillary lateral incisors, clinical presentation and imaging can prevent missed diagnoses, and appropriate treatment should be based on the length and depth of lingual grooves extending toward the roots, periodontal conditions, and pulpal status of the affected teeth.

Abstract Background Successful endodontic treatment needs accurate determination of working length (WL). Electronic apex locators (EALs) were presented as an alternative to radiographic methods; and since then, they have evolved and gained popularity in the determination of WL. However, there is insufficient evidence on the post-operative pain, adequacy, and accuracy of EALs in determining WL. Objective The systematic review and meta-analysis aims to gather evidence regarding the effectiveness of EALs for WL determination when compared to different imaging techniques along with postoperative pain associated with WL determination, the number of radiographs taken during the procedure, the time taken, and the adverse effects. Methods For the review, clinical studies with cross-over and parallel-arm randomized controlled trials (RCTs) were searched in seven electronic databases, followed by cross-referencing of the selected studies and related research synthesis. Risk of bias (RoB) assessment was carried out with Cochrane's RoB tool and a random-effects model was used. The meta-analysis was performed with the RevMan software 5.4.1. Results Eleven eligible RCTs were incorporated into the review and eight RCTs into the meta-analysis, of which five had high RoB and the remaining six had unclear RoB. Following meta-analysis, no significant difference in postoperative pain was found among the EAL and radiograph groups (SMD 0.00, CI .29 to .28, 354 participants; P value = 0.98). Radiograph group showed better WL accuracy (SMD 0.55, CI .11 to .99, 254 participants; P value = 0.02), while the EAL group had 10% better WL adequacy (RR 1.10, CI 1.03–1.18, 573 participants; P value = 0.006). Conclusion We found very low-certainty evidence to support the efficacy of different types of EAL compared to radiography for the outcomes tested. We were unable to reach any conclusions about the superiority of any type of EAL. Well-planned RCTs need to be conducted by standardizing the outcomes and outcome measurement methods.

BackgroundNewer concept of root canal therapy is single-visit one rather than conventional multivisit therapy. Major complaint of patients after root canal therapy is mild or severe pain. AimThis study aims to assess the prevalence of postoperative discomfort after root canal treatment conducted in both single and multiple visits. Materials and MethodsAn experiment using a randomized controlled trial design was conducted, including a total of 80 participants. These individuals were then separated into two groups, with each group consisting of 40 participants. Group A had single-visit root canal therapy, whereas Group B received multivisit root canal treatment. The incidence of pain after therapy was evaluated and compared at four time points: 6 hours, 12 hours, 24 hours, and 48 hours after obturation. ResultsThe level of pain experienced by patients in Group B was notably greater in comparison with individuals in Group A. Nevertheless, there was no statistically significant difference in the level of pain reported by the patients 48 hours after treatment in either of the groups. ConclusionThere is no significant difference in the occurrence of discomfort after endodontic treatment conducted in either a single visit or many visits, as seen during a 48-hour period after obturation.

Objective: The purpose of this study was to retrospectively assess the prevalence and efficacy of endodontic treatments in Turkish subpopulations, as well as the relationship between the type of coronal restorations, procedural errors, and their association with the periapical status of treated teeth. Methods: Cone beam computed tomography (CBCT) images of 500 patients were analyzed. A total of 10500 teeth were evaluated and 1185 of those had received root canal therapy. Periapical condition, coronal restoration, and root canal quality of these teeth were evaluated. Periapical status was evaluated by two observers regarding to CBCT periapical index scoring system. The chi-square test was used to evaluate all data for statistical analysis. Results: Healthy periapical status was seen in 44.9% of endodontically treated teeth. Teeth with procedural errors (broken instrument, untreated canal, perforation, ledge formation, short or overfilled canals, inadequate filling) showed more periapical pathosis than teeth with good endodontic treatment (p

Abstract Background Molar root canal treatment (RCT) is challenging and requires training and specific skills. Rotary instrumentation (RI) reduces the time needed for instrumentation but may increase the risk of certain procedural errors. The aims of this study were to evaluate the quality of molar RCTs provided by undergraduate students, to compare the prevalence of procedural errors following manual and RI, and to assess the students’ self-perceived confidence to perform molar RCT without supervision and their preference for either manual or RI. Methods Molar RCTs performed by the final year students were evaluated radiographically according to predefined criteria (Appendix 1). The procedural errors, treatment details, and the students’ self-perceived confidence to perform molar RCT and their preference for either manual or RI were recorded. Descriptive statistics were performed, and the Chi-squared test was used to detect any statistically significant differences. Results 60.4% of RCTs were insufficient. RI resulted in more sufficient treatments compared with MI (49% vs. 30.3% respectively. X2: 7.39, p = 0.007), required fewer visits to complete (2.9 vs. 4.6 respectively. X2: 67.23, p

Abstract Objectives This prospective randomized multicenter clinical trial (PRMCT) investigated postoperative pain after single-visit root canal treatments in teeth affected by pulp necrosis (PN), and asymptomatic apical periodontitis (AAP) (with apical radiolucent areas) or normal periradicular tissues (without apical radiolucent areas) comparing different instruments' kinematics and apical instrumentation limits. Methods Before chemomechanical preparation, 240 patients/teeth were randomly distributed into four groups (n = 60) according to the instruments' kinematics (rotary or reciprocating) and apical instrumentation limits (with or without intentional foraminal enlargement [IFE]). After that, specimens were submitted to the same irrigation and obturation techniques, and the patients were referred to undergo the definitive restorations. No medication was prescribed, but the patients were instructed to take either paracetamol (750 mg every 6 h for three days) or ibuprofen (600 mg every 6 h for three days) in pain cases. Postoperative pain incidence and levels were assessed at 24-, 48-, and 72 h following treatment completion according to a verbal rating scale (VRS) following a score. The Kolmogorov–Smirnov test was applied to assess the normality of the data. Mann–Whitney U, Chi-square, Friedman's ANOVA, and Friedman's multiple 2 to 2 comparison tests were employed to identify potential significant statistical differences among the variables in the study groups (P

Pulp therapy aims to maintain the health and integrity of teeth and their supporting tissue and preserve the vitality of the tooth pulp affected by dentinal caries or severe traumatic injury. Thus, the best clinical practice provides pulpal health or pathosis diagnosis and various therapeutic interventions evidenced in both the deciduous and permanent dentition for endodontic treatment. The pulp health status determines the type of pulpal therapy used. Vital pulp therapies for primary teeth include protective liners, pulp capping, and pulpotomy for reversible pulpitis; for permanent teeth, pulpotomy can be considered for irreversible pulpitis.For reversible or irreversible pulpitis, invasive management of decayed teeth has traditionally been performed. However, at present, coronal pulpotomy-like vital pulp therapy has led to successful treatment outcomes that are less invasive. Compared to root canal treatments, coronal pulpotomy is cost-effective, less time-consuming, and less technically demanding.The success of a pulpotomy depends on the clinician’s experience, appropriate clinical techniques, and materials used. This narrative review provides insights into the systematic analysis of pulpotomy failure, causes and signs of failure, and alternative endodontic interventions.

Background: Gutta-percha (GP) combined with an endodontic sealer is still the core material most widely used for tridimensional obturation. The sealer acts as a bonding agent between the GP and the root dentinal walls. However, one of the main drawbacks of GP core material is the lack of adhesiveness to the sealer. ZnO thin films have many remarkable features due to their considerable bond strength, good optical quality, and excellent piezoelectric, antibacterial, and antifungal properties, offering many potential applications in various fields. This study aimed to explore the influence of GP surface's functionalization with a nanostructured ZnO thin film on its adhesiveness to endodontic sealers. Methods: Conventional GP samples were divided randomly into three groups: (a) Untreated GP (control); (b) GP treated with argon plasma (PT); (c) Functionalized GP (PT followed by ZnO thin film deposition). GP's surface functionalization encompassed a multi-step process. First, a low-pressure argon PT was applied to modify the GP surface, followed by a ZnO thin film deposition via magnetron sputtering. The surface morphology was assessed using SEM and water contact angle analysis. Further comprehensive testing included tensile bond strength assessment evaluating Endoresin and AH Plus Bioceramic sealers' adhesion to GP. ANOVA procedures were used for data statistical analysis. Results: The ZnO thin film reproduced the underlying surface topography produced by PT. ZnO thin film deposition decreased the water contact angle compared to the control (p < 0.001). Endoresin showed a statistically higher mean bond strength value than AH Plus Bioceramic (p < 0.001). There was a statistically significant difference between the control and the ZnO-functionalized GP (p = 0.006), with the latter presenting the highest mean bond strength value. Conclusions: The deposition of a nanostructured ZnO thin film on GP surface induced a shift towards hydrophilicity and an increased GP's adhesion to Endoresin and AH Bioceramic sealers. [ABSTRACT FROM AUTHOR]

For successful root canal treatment, adequate chemomechanical instrumentation to eliminate microorganisms and pulp tissue is crucial. This study aims to assess the organic tissue dissolving activity of various irrigation solutions on bovine tooth pulp tissue. 40 extracted bovine mandibular anterior teeth (n = 10) were used for the study. Bovine pulp pieces (25 ± 5 mg) were placed in 1.5 ml Eppendorf tubes. Each tooth pulp sample was then covered with 1.5 ml of different irrigation solutions, dividing them into four groups: Group 1 with freshly prepared 5% Boric acid, Group 2 with 5% NaOCl, Group 3 with Irritrol, and Group 4 with Saline. Samples were left at room temperature for 30 min, then dried and reweighed. The efficacy of tissue dissolution ranked from highest to lowest was found to be NaOCl, Boric Acid, Irritrol, and saline (p < 0.05). It was observed that the decrease in the NaOCl group was greater than the decrease in the Irritrol and saline groups, and the decrease in the Boric acid group was significantly greater than the decrease in the saline group (p < 0.05). It also emphasizes the need for future studies to further investigate the effects of Irritrol and Boric Acid on tissue dissolution. [ABSTRACT FROM AUTHOR]

Objective: This systematic review aims to comparatively analyse the amount of dentin removal by free hand and static guided endodontics with dynamic navigation system (DNS) in endodontic access cavity preparation. Methods: The systematic review was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines. Based on the structured PICO framework of "Comparative evaluation of dynamic navigation system (I) to freehand (C) and static guided endodontics (C) in endodontic access cavity preparation on the preservation of tooth structure (O) when assessed on permanent human teeth (P)", the keywords were formulated and the articles were retrieved from three databases namely PubMed, Scopus and Embase, based on the keywords from the time of inception of DNS till June 2023. The risk of bias assessment was done using a modified Joanne Briggs Institute checklist, which evaluated domains such as randomisation, sample size, image acquisition using CBCT, angulation, accuracy and time taken. As the data was heterogenous, a quantitative meta-analysis was not performed. Results: Initially, 174 articles were retrieved from the three databases, 30 duplicates were removed, after title check 108 articles were excluded and following abstract check only 10 articles qualified for full text analysis. On reviewing the 10 full text articles, 5 articles were excluded and the remaining 5 articles were subjected to the risk of bias analysis which showed that 2 articles displayed low risk of bias and three articles showed high risk of bias. The RoB analysis revealed that only 2 studies evaluated the preservation of dentin in terms of accuracy, angulation and time taken proving the increased precision with minimal loss of tooth structure using DNS. In both the studies, DNS proved to be superior to free hand technique in terms of precision, accuracy and efficiency in locating the canals during access cavity preparation with maximal preservation of tooth structure. Conclusion: With the minimal literature evidences, the present systematic review highlights maximal preservation of dentin using DNS. However, further invitro and invivo studies comparing the free hand, static guided endodontics to DNS must be carried out for its translation into clinical practice. Clinical Significance: Dynamic navigation system provides maximal preservation of dentin during access cavity preparation. [ABSTRACT FROM AUTHOR]

Background/Aim Materials and Methods Results Conclusions To evaluate the long‐term survival of immature traumatized incisors with pulp necrosis and apical periodontitis after endodontic treatment with two apexification techniques (calcium hydroxide apexification and MTA‐apical plug) and to identify major factors affecting the survival of these teeth.Records of 2400 children and adolescents were screened for presence of traumatic dental injuries to immature incisors where endodontic treatment with the two apexification techniques was performed during January 2003 and December 2022, compared to a control group of mature teeth treated with conventional endodontic techniques. The studied variables were age; sex; apexification technique, presence of luxation and hard tissue injuries; preoperative root development stage (RDS), preoperative and postoperative periapical index (PAI), the time‐point for tooth loss, and overall survival time in years. Kaplan–Meier estimates were used to graphically present the survival functions and Cox proportional hazard model to calculate hazard ratios (HR, 95% CI).The median survival time was 10 years for calcium hydroxide apexification, 16.1 for MTA‐apexification, for luxation injuries other than intrusions and avulsions 15.5 years, for intrusions 12.5 years and for avulsions 6.8 years. The variables with significant negative impact on tooth survival were calcium hydroxide apexification, avulsion and postoperative PAI 3–5. No significant relationships were found for the variables MTA apexification, concussion; subluxation; lateral luxation; extrusion, intrusion, hard tissue injuries, preoperative RDS and PAI scores and postoperative PAI 1–2. After adjustment, the risk for premature tooth loss was 13.5 times higher in calcium hydroxide apexification, approximately 2 to 4 times higher in PAI 3–5, and 5.6 times higher in avulsions.Calcium hydroxide apexification, avulsion, and postoperative PAI 3–5 were identified as prognostic variables with significant negative impact on the risk for premature tooth loss. [ABSTRACT FROM AUTHOR]

Aim and background: Periapical lesions, which occur due to the infection and necrosis of dental pulp, are a significant dental pathology that poses risks to oral and systemic health. These lesions often require interventions such as root canal treatment or periapical surgery. Recent research has focused on the effectiveness of biocompatible materials, including mineral trioxide aggregate, bioceramics, and leukocyte-platelet-rich fibrin (L'PRF), in improving healing outcomes. This report presents the application of leukocyte-platelet-rich fibrin (L'PRF) derived from the patient's autologous blood to enhance bone healing. Case description: A 61-year-old woman with well-controlled hypertension and good oral hygiene visited the dental clinic due to a painless swelling near her upper left central incisor. After examination, it was determined that she had a periapical granuloma. The patient underwent successful root canal retreatment and apical surgery, during which leukocyte-platelet-rich fibrin was applied. After 30 months, she experienced significant improvement with no symptoms and substantial bone regeneration. Conclusion: Clinical evidence and this case study indicate that leukocyte-platelet-rich fibrin (L'PRF) may enhance healing post periapical surgery. Further research, including more extensive and longer-term randomized trials, must confirm L'PRF's effectiveness and refine treatment protocols. Clinical significance: L'PRF enhances bone healing post periapical surgery. Clinicians should consider integrating L'PRF in periapical surgeries, ensure diligent follow-up, and inform patients of its long-term advantages. Further randomized trials are needed to refine L'PRF clinical guidelines. [ABSTRACT FROM AUTHOR]

This systematic review and meta‐analysis aimed to determine whether apical patency increases postoperative pain after endodontic therapy. This study explored the degree and incidence of postoperative pain during root canal therapy, as well as the number of required analgesic doses. We searched PubMed, Scopus, Embase, Web of Science, Cochrane Library, and gray literature from the date of database inception until May 2023. RevMan 5.4 software was used for data analysis. Twelve studies were considered eligible for meta‐analysis. The mean pain scores on days 1 (mean difference [MD] = ‐1.69) and 2 (MD = ‐0.85) differed significantly between the apical patency and non‐patency groups. The odds for pain after 24 h were significantly lower (OR 0.59) in the apical patency group than in the non‐patency group. Furthermore, the mean number of required analgesic doses was not significantly different between the two groups. In conclusion, apical patency significantly alleviated postoperative pain (low‐quality evidence) and reduced the incidence of pain (moderate evidence). However, high‐quality randomized controlled trials are required to validate these findings. [ABSTRACT FROM AUTHOR]

In root canal treatment, regardless of instrumentation technique, the presence of smear layer covering contaminated dentin walls is always a concern. Therefore, irrigation plays an important role in reducing the bacterial load, and to improve the effectiveness of irrigation, different irrigation techniques and equipment have emerged that allow improving the prognosis of endodontic treatment. Literature review research was carried out, which investigated the current equipment that could help obtain better removal of the smear layer from the root canal during endodontic treatment. To do this, an electronic search was carried out in Wiley, Research 4 Life, Elsevier and Springer using a combination of the terms "smear layer", "irrigation techniques", and "agitation in endodontics". Resulting in a total of 63 articles, without language restriction, with certain inclusion criteria, making evident the lack of clinical studies that evaluate the smear layer in certain activation equipment. Among the equipment were: EndoActivator (EA), Vibringe (VB), EndoVac (EV), EDDY (ED), Sonic MM 1500 MicroMega, RinsEndo System (RE), EasyClean (EC), GentleWave (GW) Canal CleanMax (CCM), EQ-S and EndoUltra (EU). And when analyzing the effectiveness of each device in relation to smear layer, no device has been shown to completely eliminate the smear layer from the apical region of the root canal system, regardless of the chemomechanical preparation technique performed, the success It depends a lot on the irrigation protocol carried out, as well as an adequate pre-endodontic restoration that will improve the prognosis of the treatment, according to the researched literature. [ABSTRACT FROM AUTHOR]

Recent evidence suggests that an ever-growing number of pediatric patients require invasive treatments such as root canal therapy (RCT) in their permanent dentition, albeit with little information about risk factors such as prior invasive treatments of pulpotomy or pulpectomy in their primary dentition. Therefore, the primary objectives of this study were to determine the number of pediatric patients who have had any type of invasive treatment in their primary teeth, to assess their association with any subsequent invasive treatment (root canal therapy, extractions) in their permanent dentition, and to assess these trends over time. This retrospective study utilized summary data from a clinical pediatric patient pool (ages 0–17) over the period of 2013–2022. This analysis revealed that pediatric patients requiring pulpotomies and pulpectomies in primary dentition declined between 2013 (n = 417, n = 156) and 2022 (n = 250, n = 12), while root canal therapy (RCT) in permanent dentition increased six-fold from n = 54 to n = 330. In addition, few (7.8%) patients with RCT had a previous history of pulpotomy or pulpectomy, which suggests that invasive treatments performed in primary dentition have no direct association with the subsequent need for invasive treatments in permanent dentition, although more research is needed to determine the explanations for these observations. [ABSTRACT FROM AUTHOR]

Tooth decay, also known as caries, is a significant medical problem that harms teeth. Treatment is based on the removal of the carious material and then filling the cavity left in the tooth, most commonly with amalgam or composite resin. The consequences of filling failure include repeating the filling or performing another treatment such as a root canal or extraction. Dental amalgam contains mercury, and there is a global effort to reduce its use. However, no consensus has been reached regarding whether amalgam or composite resin materials are more durable, and which is the best restorative material, when using randomized clinical trials. To determine which material is superior, we performed a retrospective cohort study using a large database where the members of 58 dental clinics with 440 dental units were treated. The number of failures of the amalgam compared to composite resin restorations between 2014 and 2021 were compared. Our data included information from over 650,000 patients. Between 2014–2021, 260,905 patients were treated. In total, 19,692 out of the first 113,281 amalgam restorations failed (17.49%), whereas significantly fewer composite restorations failed (11.98%) with 65,943 out of 555,671. This study indicates that composite is superior to amalgam and therefore it is reasonable to cease using mercury-containing amalgam. [ABSTRACT FROM AUTHOR]

Background: Pediatric rotary file systems were developed to solve manual file limitations. With many systems available, it may be tricky to select the most appropriate one. Aim: to assess & compare Kedo-S Square, Fanta-AF™-Baby rotary files with manual K-file concerning removed dentin amount, canal transportation, centric ability & root canal taper using CBCT in primary anterior teeth. Design: Extracted Seventy-five upper primary anterior teeth with intact 2/3 root length were collected and divided into three groups based on root canal instrumentation, group-I: prepared using K-file, group-II: prepared using Kedo-S Square, and group-III: prepared using Fanta AF™ Baby file. The teeth were imaged with CBCT before & following canal instrumentation. Then, the removed dentin amount was calculated at each root-canal level. The Kruskal-Wallis test was utilized to statistically analyze study data. Result: The difference among the three groups was highly statistically significant at cervical & apical thirds concerning dentin thickness changes on both mesial & distal sides following canal preparation with the least removed dentin in the Kedo-S Square group(P < 0.0001). Regarding transportation & centering ability, a non-significant difference between the three groups was found. 80% of the Fanta AF™ Baby group had good-tapered preparation compared to the Kedo-S Square (72%) and K-file (40%) groups(P < 0.05). Conclusion: Kedo-S Square was preferable to Fanta-AFTM-Baby & manual K-files in primary root canal preparation. [ABSTRACT FROM AUTHOR]

The primary aim of this literature review is to delineate the key inflammatory cytokines involved in the pathophysiology of pulp inflammation. By elucidating the roles of these cytokines, a deeper comprehension of the distinct stages of inflamed pulp can be attained, thereby facilitating more accurate diagnostic strategies in endodontics. The PRISMA statement and Cochrane handbook were used for the search strategy. The keywords were created based on the review question using the PICO framework. The relevant studies were meticulously assessed according to predefined inclusion and exclusion criteria for this systematic review. A rigorous quality checklist was implemented to evaluate each included study, ensuring scrutiny for both quality and risk-of-bias assessments. The initial pilot search conducted on PubMed, Scopus, Cochrane, and WoS databases yielded 9 pertinent articles. Within these articles, multiple cytokines were identified and discussed as potential candidates for use in endodontic diagnosis, notably including IL-8, IL-6, TNF-α, and IL-2. These cytokines have been highlighted due to their significant roles in the inflammatory processes associated with pulp pathology. The identification of specific inflammatory cytokines holds promise for enhancing endodontic diagnostic procedures and exploring diverse treatment modalities. However, the current body of research in this area remains limited. Further comprehensive studies are warranted to fully elucidate the potential of cytokines in refining diagnostic techniques in endodontics. [ABSTRACT FROM AUTHOR]

Introduction: The root canal obturating material provides a three-dimensional fluid-impervious seal. Root canal sealers play a major role in providing a seal between the core material and the tooth for the long-term success of endodontic treatment. Aim: To evaluate the intratubular penetration and Bond Strength (BS) and push-out BS of AH Plus, GuttaFlow 2, and GuttaFlow Bioseal sealers. Materials and Methods: The in-vitro study was conducted in the Department of Conservative Dentistry and Endodontics at Ranjeet Deshmukh Dental College and Research Centre, Nagpur, Maharashtra, India, from October 2019 to April 2021. A total of 75 human mandibular first premolars were decoronated at the Cemento-enamel Junction (CEJ) with a standardised length of 16 mm. The root canal was prepared using the crown-down technique with HyFlex Electrical Discharge Machining (EDM) rotary files and divided into three groups: Group-I: AH Plus, Group-II: GuttaFlow 2, and Group-III: GuttaFlow Bioseal. 0.1% Rhodamine B dye was added to the sealer and obturated using the single cone technique. These samples were transversely sectioned into beams at the middle third of the root. A confocal laser scanning microscope was used to evaluate the depth of sealer penetration in the dentinal tubule, and a Universal Testing Machine was utilised to measure the push-out BS (MPa). The recorded data were subjected to statistical analysis {one-way Analysis of Variance (ANOVA) test, Tukey's post-hoc test, and Pearson's correlation coefficient}. Results: The results obtained indicated that there was a significant difference in the depth of penetration and push-out BS of AH Plus and GuttaFlow 2 sealers (p <0.0001). However, there was no significant difference found between AH Plus and GuttaFlow Bioseal sealers (p=0.206). In addition, there was no significant difference in the correlation between intratubular penetration and push-out BS of the sealers (negative correlation). Conclusion: Considering the results, the GuttaFlow Bioseal sealer was found to have comparable clinical performance with AH Plus sealer; hence, it can be used as an acceptable root canal sealer. [ABSTRACT FROM AUTHOR]

Endodontic retreatment is a procedure to remove root canal filling material from the tooth, followed by cleaning, shaping, and obturation of the canals. Treatment outcomes may be influenced by incomplete removal of filling materials. The present literature review aimed to identify the techniques and materials used to remove Bioceramic Sealers (BCS) from the root canal system using Micro-Computed Tomography (Micro-CT) and Scanning Electron Microscopy (SEM). A search of the PubMed, Web of Science, Scopus, Science Direct, and Google Scholar databases using applicable keywords such as "BCS" and "calcium silicate-based sealer" and "retreatment" and "retreatability" and "micro-CT" and "SEM" identified studies on techniques and materials used to remove BCSs from the root canal system, as assessed by micro-CT and SEM. A total of 46 studies were included in the review. Of these, 32 studies used Nickel-titanium (NiTi) rotary instruments, 11 used reciprocating systems, and three compared continuous nickel-titanium rotary and reciprocating systems with rotary systems and reciprocation in removing filling materials. Apical patency and Working Length (WL) could be achieved in a canal obturated with gutta-percha and a BCS. The review revealed that removing filling materials using various instrumentation protocols can be successful but incomplete. Both rotary and reciprocating systems can efficiently remove root-filling material. Using supplemental techniques can improve the cleanliness of the root canal during retreatment. Solvents require less time to reach the WL and achieve patency; however, they leave a larger amount of residual root canal-filling material than non solvents. Additionally, the formation of dentinal microcracks remains controversial during the non surgical retreatment of canals filled using BCSs. [ABSTRACT FROM AUTHOR]