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Aim To develop a formulation in which calcium hydroxide (Ca(OH)₂) was successfully loaded into poly(lactic-co-glycolic acid) (PLGA) biodegradable nanoparticles (NPs) to be used in the field of endodontics as an intracanal medicament, including NP optimization and characterization, plus drug release profile of the NPs compared with free Ca(OH)₂. Additionally, the depth and area of penetration of the NPs inside the dentinal tubules of extracted teeth were compared with those of the free Ca(OH)₂. Methodology Ca(OH)₂ NPs were prepared using the solvent displacement method. NPs was optimized with a central composite design to obtain a final optimized formulation. The morphology of the NPs was examined under transmission electron microscopy (TEM), and characterization was carried out using X-ray diffraction (XRD), Fourier transform infrared (FTIR) and differential scanning calorimetry (DSC). The drug release profile of the Ca(OH)₂ NPs and free Ca(OH)₂ was evaluated up to 48 h. Finally, the depth and area of penetration inside the dentinal tubules of extracted teeth were examined for both the Ca(OH)₂ NPs and free Ca(OH)₂ using the Mann-Whitney U test to determine any significant differences. Results Utilizing the optimized formulation, the Ca(OH)₂ NPs had an average size below 200 nm and polydispersity index lower than 0.2, along with a highly negative zeta potential and suitable entrapment efficiency percentage. The spherical morphology of the Ca(OH)₂ NPs was confirmed using TEM. The results of the XRD, FTIR and DSC revealed no interactions and confirmed that the drug was encapsulated inside the NPs. The drug release profile of the Ca(OH)₂ NPs exhibited a prolonged steady release that remained stable up to 48 h with higher concentrations than the free Ca(OH)₂. After examination by confocal laser scanning microscopy, Ca(OH)₂ NPs had a significantly greater depth and area of penetration inside dentinal tubules compared with the free drug. Conclusions Ca(OH)₂-loaded PLGA NPs were successfully optimized and characterized. The NPs exhibited a prolonged drug release profile and superior penetration inside dentinal tubules of extracted teeth when compared to Ca(OH)2 .

Objective Tooth autotransplantation with a complete root formation to replace one or more lost teeth is indicated as a cost-effective alternative to implants. The aim of this case report was to describe a successfully guided autotransplantation of a maxillary third molar with fully formed roots into a surgically created socket after orthodontic space opening. Clinical considerations A guided autotransplantation of the maxillary left third molar into the missing maxillary left first molar site was chosen. After virtually orientating donor tooth to confirm its optimum fit, it was deemed necessary to open 4 mm the mesiodistal space. Following the orthodontic movement, a 3-dimensional (3D)-guiding template and a milled surgical guide were manufactured to allow the donor tooth to be transplanted exactly in the planned position. The 2-year follow-up periapical radiograph showed a continuous periodontal space with no signs of apical periodontitis or root resorption. Conclusions Virtual planning and 3D-printed tooth replica combined with guided surgery can simplify the autotransplantation technique for both the clinician and the patient, particularly when the socket has been completely created during surgery. Clinical significance Virtual digital planning, which can accurately calculate the exact space to open orthodontically before an autotransplantation, could prove essential to enhancing the precision of 3D placement of the donor tooth in the recipient site.

Introduction This research studies and compares the shaping ability of WaveOne Gold (WG; Dentsply Tulsa Dental Specialties, Tulsa, OK), the Reciproc Blue (RB; VDW, Munich, Germany), TRUShape (TS, Dentsply Tulsa Dental Specialties), XP-endo Shaper (XP; FKG, La Chaux-de-Fonds, Switzerland), iRace (IR, FKG), and TruNatomy (TN; Dentsply Sirona, Ballaigues, Switzerland) in the preparation of moderately curved canals and using micro–computed tomographic technology. Methods Sixty lower molars with 2 mesial canals were randomly distributed into 6 groups of 10 molars and 20 canals per group (n = 20). Specimens were scanned before and after preparation using the SkyScan 1275 (Bruker microCT, Kontich, Belgium). Group 1 was treated with WG, group 2 with RB, group 3 with TS, group 4 with XP, group 5 with IR, and group 6 with TN. After instrumentation, researchers quantified the changes produced in the canal geometry in terms of surface, volume, structure thickness, surface convexity index, structure model index, percentage of surface touched, and centroids. Wilcoxon and analysis of variance tests were performed to compare the values before and after preparation and the differences between groups. The significance level was established at 5%. Results There were no significant differences between WG and RB (P > .05) and between TN and XP (P > .05). TN had significant differences with WG, RB, TS, and IR (P .05). Conclusions WG and RB and TN and XP had similar shaping effectivity. TS and WG touched the highest percentages of canal surfaces (81% and 73%, respectively) but produced the biggest changes in the canal anatomy. TN and XP better kept the canal anatomy, but TN touched the lowest percentage of canal surface (50%). All the files used were able to clean and to shape moderately curved canals with minimal apical transportation.

Introduction The present study aimed to evaluate anxiety in patients and to monitor their heart rate (HR) and blood oxygenation (SpO2) before, during, and after a root canal treatment (RCT) during the state of alarm in 2 different periods of strict and partial confinement. Methods The patients who required a primary RCT were selected. Demographic, preoperative, and postoperative variables were registered, including perceived dental anxiety, fear, HR, and SpO2. Spearman correlation, chi-square, Mann-Whitney, and Kruskal-Wallis tests were used for frequency distribution and variable interaction, and Wilcoxon and Mann-Whitney tests were used to compare HR and SpO2 between groups and different treatment points. Results Ninety-six patients were included. The median Modified Dental Anxiety Scale scores were 8 (interquartile range [IQR], 6–9.25) and 6 (IQR, 5.5–8) in patients treated during the strict and partial confinement periods. The median fear scores were 2 (IQR, 0–5) and 3 (IQR, 1–5), respectively. Having a previous dental bad experience resulted in higher dental anxiety and fear (P < .05). HR was increased in patients with higher MDAS and fear scores and in those treated during the strict confinement (P < .05). In treatment time points T6 (x-ray taking), and T7 (post-treatment), HR decreased compared with the other evaluated treatment time points (P < .05). No clinical differences were found regarding SpO2. Conclusions Self-perception on dental anxiety and fear was similar to other studies in a nonpandemic context. Patients with higher levels of dental anxiety and those treated in the strict confinement period presented an elevated HR. However, it can be stated that RCT performed by endodontists does not result in a significant alteration in patients.

This retrospective study used cone-beam computed tomographic (CBCT) imaging to evaluate the differences in the mucosal thickness of the Schneiderian membrane in primary and secondary endodontic lesions.A total of 121 CBCT scans were analyzed. Clinical features such as sex, age, size and volume of the periapical lesion, dimension of the bone, morphology, and relationship between the roots and the mucosal thickness were recorded and analyzed in primary and secondary endodontic lesions in CBCT sagittal and coronal planes. Data were analyzed using the chi-square test, the Mann-Whitney U test, and multiple logistic regression (P.05).Statistical analysis revealed no significant differences in membrane thickness between the primary and secondary lesions in the sagittal and coronal planes (P = .08 and .06). Differences between age groups were statistically significant in both groups (P.05). The volume of the periapical lesions of the secondary endodontic lesions were statistically greater than that of the primary lesions (P.05). Mucosal thickness prevalence increased when the volume of the lesion was greater, and the bone dimension was narrower in maxillary second premolars and first and second molars. Teeth with 2 or more affected roots were directly related to increased sinus mucosa thickening.CBCT images showed no differences in mucosal thickening between primary and secondary endodontic lesions.

Introduction The aim of the present systematic review and meta-analysis was to evaluate the success and survival rate of endodontically treated cracked posterior teeth and to assess the preoperative factors that affect teeth survival. Methods The study protocol was registered on the PROSPERO international prospective database of systematic reviews (CRD42019119091). Electronic search was performed for studies up to November 30, 2018 in the following databases: PubMed, Scopus, and Cochrane. All searches were done following the PRISMA guidelines. Clinical studies evaluating the success and/or the survival rate of cracked teeth that were endodontically treated with at least 1-year follow-up were selected. The Newcastle–Ottawa scale was used to evaluate risk assessment. Publication bias was evaluated with funnel plots, and the Egger's test was performed to test asymmetry. Results From the 410 studies identified through the initial search, 7 studies qualified for the final analysis, all of which were longitudinal cohort studies. The results of the meta-analysis indicated a survival rate of 88% (confidence interval, 0.81–0.94) and a success rate of 82% (confidence interval, 0.78–0.86) after 1 year of follow-up. The presence of a periodontal pocket associated to a crack (relative risk, 1.11) resulted in a higher risk of tooth loss. Patient sex, tooth type, position, the number of cracks present, and preoperative pulp status did not affect treatment survival rate (P > .05). Most of the included studies did not have an accurate record of many variables that could affect the tooth survival. Plus, studies did not present extended follow-up periods or an adequate dropout rate to properly assess treatment outcome and survival. Conclusions According to the results of the present systematic review and meta-analysis, root canal treatment in cracked posterior teeth can be considered a suitable treatment option. The presence of an associated periodontal pocket results in a lower survival rate.

INTRODUCTION: The aim of this study was to assess general anxiety levels in endodontists and dental assistants related to different conditions during the pandemic and lockdown and to evaluate hemodynamic changes in endodontists' heart rate (HR), blood pressure, and blood oxygenation during their workday. METHODS: Anxiety levels in endodontists and dental assistants were recorded weekly during the state of alarm declared because of the coronavirus disease 2019 pandemic. Hemodynamic parameters were monitored using a sphygmomanometer for HR and blood pressure and a pulse oximeter for oxygen saturation. Measurements were taken before and after each root canal treatment as well as on arrival at the clinic and at the end of the working day. Rest data, recorded every Saturday, served as a control. Data analysis was performed using chi-square, paired t, Mann-Whitney, and analysis of variance tests (P < .05). RESULTS: General anxiety decreased over the weeks, with significant differences between weeks 1 and 4 (P < .05). Endodontists perceived higher anxiety levels of anxiety during anesthesia inoculation and dental assistants during the dental unit's disinfection and equipment material (P < .05). There was a significant increase in the cardiovascular response in all endodontists in the clinic registrations compared with rest data (P < .05). Values were higher in the strict confinement period and significant for HR when arriving at the clinic (P < .05). CONCLUSIONS: Levels of general anxiety were higher during the first weeks. The chief perceived factors related to anxiety in endodontists and dental assistants were the risk of contagion and protection measures. Higher HR and blood pressure levels were registered during the workday, especially when arriving at the clinic.

AIM To compare histologically the debridement efficacy of four irrigation techniques in root canals instrumented with a reciprocating single file. METHODOLOGY From recently extracted premolars with vital pulp, 68 were selected and classified as having round canals (mesiodistal diameter similar to buccolingual) or oval-shaped canals (mesiodistal diameter 2.5 times larger than buccolingual) (n = 32, each) by means of bidirectional radiographs. Four additional uninstrumented samples served as histological controls. The root canals of the specimens were accessed and then instrumented with Reciproc R25® and further assigned to one of four experimental groups according to the complementary irrigation technique: Group I, conventional syringe; Group II, passive ultrasonic irrigation; Group III, manual dynamic activation (MDA); and Group IV, EndoActivator® . Roots were then demineralized and the apical 3 mm was multi-sliced and processed for histologic examination. The percentage of residual pulp tissue was calculated at each cross section. Kruskal-Wallis and Mann-Whitney tests were used to evaluate the effects of irrigation technique, root canal shape and level of cross section on the percentage of residual pulp tissue (P 0.05). Round canals retained significantly less percentage of residual pulp tissue compared to oval-shaped canals (P = 0.001). At 3 mm, there was less pulp tissue compared to levels 2 and 1 mm (P

Objective: The purposes of the present study were to evaluate dentine thickness and concavity depth below the furcation level of the mesial canals of the mandibular first and second molars, to examine differences between gender, age, and quadrant, and to prove if there is a relationship between root length and dentine thickness. Methods: Two hundred eleven mandibular first and second molars were included in this study. Samples were divided according to age, gender, quadrant, and root length. Measurements of dentine thickness from the external border of the root canal to the external root surface and concavity depth were recorded 1, 2, and 4 mm below the furcation level. Kruskal–Wallis and Wilcoxon rank sum tests were performed to estimate the influence of different variables, and a multiple regression analysis was performed to evaluate the influence of dentine thickness below the furcation level. Results: First molars had a deeper concavity depth with significant differences in both 1 mm and 2 mm levels than second molars (P0.05). The distal concavity was significantly deeper in the 1 and 2 mm levels (P

The aim of this clinical study was to evaluate and compare the incidence and intensity of postoperative pain following removal of gutta-percha from root canals using rotary and reciprocating instruments.One hundred and sixty patients scheduled for a non-surgical endodontic retreatment were included for evaluation. Preoperative pain was recorded with using a questionnaire with a 10-cm visual analogical scale (VAS). Endodontic filling material was removed with Reciproc (VDW, Munich, Germany) or ProFile (Dentsply Tulsa Dental Specialties, Tulsa, OK) instruments. Patients then recorded their postoperative pain in a VAS pain scale at 4, 8, 16, 24, 48, and 72 h post-treatment. Results were analyzed using the Mann-Whitney U, Kruskal-Wallis, and Chi-square tests. Multivariate logistic and a multiple regression analysis were used to detect the effect of confounding factors.Results showed a direct relation between the intensity of pre-operative pain and that of postoperative pain (P .05). No significant differences were observed between the two groups regarding postoperative pain (P .05) as a qualitative variable. As numerical values, statistically significant differences were found regarding sex and the system used (P .05).The method for pain evaluation was determinant in postoperative pain findings. Endodontic retreatment preparation with Reciproc results in lower values of postoperative pain compared with ProFile. Women are more susceptible to postoperative pain than are men.One of the most significant contributions of this research is the importance given to the method used for pain evaluation. The present study analyzed postoperative pain resulting from the use of reciprocating or continuous rotary instruments during removal of gutta-percha in retreatment procedures.

The aim of this report is to (i) review the current literature on the status of root filled teeth, (ii) analyse the most important factors in decision-making, (iii) discuss the current restorative concepts, and (iv) classify both the evidence and clinical practice in a way that seeks to be clear, understandable and helpful for clinicians. Restoration of root filled teeth represents a challenge for the clinician and remains a controversial subject. The guidelines describe a new classification that is drawn from evidence presented in the literature and also from clinical expertise-based reviews. It describes five categories of teeth.

Treatment options for endodontic failure include nonsurgical or surgical endodontic retreatment, intentional replantation, and extraction with or without replacement of the tooth. The aim of the present study was to determine the impact of cone-beam computed tomographic (CBCT) imaging on clinical decision making among general dental practitioners and endodontists after failed root canal treatment. A second objective was to assess the self-reported level of difficulty in making a treatment choice before and after viewing a preoperative CBCT scan.Eight patients with endodontically treated teeth diagnosed as symptomatic apical periodontitis, acute apical abscess, or chronic apical abscess were selected. In the first session, the examiners were given the details of each case, including any relevant radiographs, and were asked to choose 1 of the proposed treatment alternatives and assess the difficulty of making a decision. One month later, the examiners reviewed randomly the same 8 cases with the additional information from the CBCT data.The examiners altered their treatment plan after viewing the CBCT scan in 49.8% of the cases. A significant difference in the treatment plan between the 2 imaging modalities was recorded for endodontists and general practitioners (P .05). After CBCT evaluation, neither group altered their self-reported level of difficulty when choosing a treatment plan (P = .0524). The extraction option rose significantly to 20% after viewing the CBCT scan (P .05).CBCT imaging directly influences endodontic retreatment strategies among general dental practitioners and endodontists.

BACKGROUND The aim of the present study was to compare clinically the incidence of postoperative pain after endodontic treatment using the Reciproc System, taking into account the operator's experience. MATERIAL AND METHODS One hundred patients scheduled for routine endodontic treatment were enrolled in this study. Endodontic treatment was carried out in a single visit by undergraduate and postgraduate students. The chemomechanical preparation of root canals was performed with Reciproc instruments. Pretreatment and postoperative pain was recorded using a visual analogue scale (VAS). Postoperative pain and the need for analgesic consumption were assessed at 4, 8, 16, 24, 48 and 72 hours post-treatment. The data were analyzed using the Mann-Whitney U and Chi-Square test, and the significance was set at P

Purpose To evaluate the effect of academic training on decision-making in a group of undergraduates who have undergone training in endodontics and implantology. Basic procedures A single group of undergraduate dentistry students (n = 65) was given a survey consisting of 15 endodontic cases. Each case included periapical radiographs and clinical photographs. Students were asked to select one of the eight proposed treatments. In their 4th year, the students first responded to the survey after completing endodontics. One year later, after completing their studies in implantology, the same students completed the same survey again. Main findings Under the conditions of this study, differences in undergraduate training significantly affected treatment decisions. Principal Conclusions Undergraduate decision-making was affected by academic training.

Background/purpose: Chelating agents have been used for the removal of the smear layer on teeth. However, due to inadequate volume and/or penetration of the solutions during irrigation, smear layer removal is less effective in the apical third. The purpose of this study was to compare the efficacy of three chelating solutions with and without manual dynamic irrigation in smear layer removal. Materials and methods: Sixty-six single-root canal teeth were decoronated, instrumented, and divided into six experimental groups (n = 10) and two control groups (n = 3). The groups received a final rinse with 1 mL of 17% EDTA and 5% or 10% citric acid (CA) for 1 minute, with or without manual dynamic activation, followed by a final 3-mL rinse with 4.2% NaOCl (5 minutes). The teeth were then longitudinally split and prepared for environmental scanning electron microscopy analysis. Digital images (500×) were taken for smear layer removal evaluation at 2 mm, 6 mm, and 10 mm from the working length. Results: The most effective smear layer removal occurred with 5% and 10% CA combined with manual dynamic activation (Groups 7 and 8), where significant differences were observed when compared with the EDTA groups (Groups 2 and 6; P 0.05). Conclusion: Manual dynamic activation of CA improves smear layer removal, and a reduction in CA concentration to 5% does not compromise smear layer removal in comparison with higher concentrations.

The aim of this study was to evaluate and compare the shaping ability of XP-endo Shaper (XP; FKG Dentaire, La Chaux-de-Fonds, Switzerland) and TRUShape (TS; Dentsply/Tulsa Dental Specialties, Tulsa, OK) during the preparation of moderated curved root canals using micro-computed tomographic imaging.Twenty human maxillary premolars with 2 roots were randomly separated into 2 groups of 10 teeth, which were scanned before and after root canal preparation using the SkyScan 1275 X-ray microtomograph (Bruker micro-CT, Kontich, Belgium) at a nominal resolution of4 μm. Premolars and irrigant were maintained at 37° before and during preparation; group 1 was treated using XP and group 2 with TS. After preparation, researchers measured the amount of dentin removed, untreated superficies of canal walls, root canal volume, degree of canal transportation, and centering ability. Values of central tendency and dispersion were calculated using Statgraphics Centurion XV software (StatPoint Technologies, Inc, Warrenton, VA); means and median were compared using the Mann-Whitney-Wilcoxon test. The level of significance was set at 5% (P.05).No significant statistical differences were observed between the 2 groups in shaping ability, untreated superficies of canal walls, degree of canal transportation, and centering ability (P.05).Instrumentation of moderately curved root canals using the XP single file and the TS file system were equally effective. XP and TS maintained the original anatomy of the root canals and showed a similar percentage of untreated canal walls, centered ability, and minimal apical transportation.

Introduction The current systematic review and meta-analysis aimed to evaluate the success rate of partial pulpotomy in treating permanent posterior teeth with carious vital pulp exposure. A secondary aim was to assess the prognostic factors using a meta-regression. Methods An electronic search was performed for studies from January 1950 to November 2018 in the following databases: PubMed, ScienceDirect, and Cochrane. All searches were performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Clinical studies evaluating the success rate of cariously exposed vital human permanent posterior teeth treated with a partial pulpotomy were selected. Only randomized clinical trials and prospective clinical studies were included for evaluation. The Newcastle-Ottawa Scale and the Cochrane Collaboration’s tool were used to evaluate risk assessment. Results From the 218 studies identified through the initial search, 11 studies qualified for the final analysis (5 randomized clinical trials and 6 prospective studies). The results of the meta-analysis indicate a success rate of 98% (confidence interval [CI]: 0.94–1), 96% (CI: 0.92–0.99), and 92% (CI: 0.83–0.97) after 6 months and 1 and 2 years of follow-up. Examining the probable prognostic factors using meta-regression analysis, only preoperative pulp status (P = .001) was identified as a significant factor, with studies including teeth with the presumptive diagnosis of irreversible pulpitis displaying significantly lower results. The final solution, pulp capping material, apex closure, and the age of the patient did not affect the treatment success rate (P > .05). Conclusions The available data suggest that a partial pulpotomy results in high success rates in treating cariously exposed permanent posterior teeth up to 2 years. Six months of monitoring can be considered an appropriate period when evaluating the success of a partial pulpotomy although more clinical and radiographic controls are essential to ensuring success.

Objectives The aim of this prospective study was to investigate the correlation between the intensity of preoperative pain and the presence of postoperative pain, taking into account the variables sex, tooth type, arch, and tooth vitality. Methods Two hundred and seventy patients with pulpal pathology who were scheduled for routine endodontic treatment were enrolled in this study. Conventional endodontic treatment was carried out in a single visit. The chemomechanical preparation of root canals was performed with ProTaper instruments, and canals were obturated with a warm gutta-percha obturation technique. A structured questionnaire was used to record data on sex, age, type of tooth, location and pulp diagnosis. Patients were asked to record their preoperative and postoperative pain using a 10-cm visual analogue scale (VAS). Postoperative pain and the need for analgesic consumption were assessed at 4, 8, 16, 24, 48 and 72 h post-treatment. The data were analyzed using the Mann–Whitney U and chi-square test, and the significance was set at P Results The mean level of pain after root canal treatment was 2.58 ± 2.80 on a VAS between 0 and 10. Variables that were associated with a higher preoperative pain intensity (female, mandible and molar) also had a higher value of postoperative pain ( P > .05). Conclusions Within the limitations of this study, it can be concluded that the presence of preoperative pain is the variable that most influences the prevalence of postoperative pain. Clinical significance Pain management should be an integral part of dental treatment. The present study analyses the incidence of postoperative pain that should be expected by patients with different intensity of pain before root canal treatment.

According to the high number of articles published on invasive cervical resorption (ICR), this pathology, as commonly believed, is a more frequent form of cervical resorption. ICR is often misdiagnosed as internal resorption or caries, which leads to inappropriate treatment and even unnecessary tooth loss. Despite a correct diagnosis, the treatment of this type of hyperplastic invasive external resorption poses a challenge for the clinician. The Heithersay classification and the use of cone-beam computed tomographic imaging have increased our knowledge of the pathology and helped improve its prognosis. Nevertheless, there is no standard protocol for the treatment of this type of lesion. This article proposes a treatment protocol for ICR based on the pattern and location of resorption. Three treatment approaches (internal access, external access, and intentional replantation) are presented through 3 clinical cases.

Autotransplantation exhibits a number of advantages compared with other treatment options (ie, dental implants or fixed partial prostheses), such as greater resistance to occlusal loading, maintenance of the periodontal ligament and surrounding bone, and the potential for better esthetics. The aim of this study was to determine clinical outcomes for autotransplanted teeth with complete root formation using 3-dimensional–printed guiding templates and tooth replicas. Twenty-seven third molars with completely formed roots were autotransplanted. Each donor tooth and recipient site were examined clinically and radiographically (periapical radiographs). A selective cone-beam computed tomographic scan was taken of each donor tooth and recipient site. The images of the selected donor teeth were segmented and saved as stereolithography files. Similar to virtual planning of dental implants, correct angulation, rotation, and accurate positioning of the donor teeth were predefined using the stereolithography files. According to the virtually defined positions and dimensions of the donor teeth, 3-dimensional guiding templates and donor tooth replicas were printed. All autotransplantations were performed according to 1 treatment protocol and surgical technique. In 22 of the 24 transplanted teeth, no inflammation occurred during the healing period. At 2 years, no pathologic radiolucency or tooth resorption was observed in the 22 donor teeth. The autotransplanted teeth fulfilled the success criteria in 22 cases for a 91.7% success rate. Digital planning could potentially provide an accurate alternative to current autotransplantation techniques.

Cone beam computed tomography (CBCT) is a relatively new method that produces three-dimensional (3D) information of the maxillofacial skeleton, including the teeth and their surrounding tissue, with a lower effective radiation dose than traditional CT scans. Specific endodontic applications for CBCT are being identified as the use of this technology becomes more common. CBCT has great potential to become a valuable tool for diagnosing and managing endodontic problems, as well as for assessing root fractures, apical periodontitis, resorptions, perforations, root canal anatomy and the nature of the alveolar bone topography around teeth. This article aims to review cone beam technology and its advantages over CT scans and conventional radiography, to illustrate current and future clinical applications in endodontic practice, and to highlight areas of further research of CBCT in endodontics. Specific case examples illustrate how treatment planning has changed with the images obtained with CBCT technology compared with only periapical radiography.

Introduction We investigated the root canal configuration of maxillary premolars in a Spanish population by using cone-beam computed tomography. Methods Images of 804 maxillary first and second premolars were obtained from 620 patients who underwent cone-beam computed tomography scanning during preoperative assessment (before implant surgery, orthodontic treatment, dentoalveolar trauma diagnosis, or difficult root canal treatment). We determined tooth position, number of roots, root canal configuration (Vertucci's classification), number of root canals, and number of apical foramina per root and used the χ 2 test to analyze the correlation between root number and tooth position. Results In the maxillary first premolar group ( n = 430), 46% ( n = 198) had 1 root, 51.4% ( n = 221) had 2 roots, and 2.6% ( n = 11) had 3 roots. Most exhibited a type IV canal configuration ( n = 227, 52.8%). Single-rooted teeth had a more variable canal configuration, whereas most 2-rooted teeth showed a type IV configuration ( n = 215, 97.3%). In the maxillary second premolar group ( n = 374), 82.9% ( n = 310) had 1 root, 15.5% ( n = 58) had 2 roots, and 1.6% ( n = 6) had 3 roots. The majority of single-rooted second premolars exhibited a type I configuration ( n = 147, 47.2%). Overall, type VIII canals were only observed in 3-rooted teeth. No statistical correlation was evident between root number and gender and tooth position. Conclusions There was a high frequency of 2-rooted and single-rooted teeth among maxillary first and second premolars, respectively. The canal morphology of single-rooted teeth was highly variable.

Introduction: The purpose of this study was to investigate the incidence of apical periodontitis (AP) in endodontically treated teeth with and without periodontal involvement. Methods: The records of 602 patients with 775 root canal–treated teeth were initially examined. Only teeth with adequate root canal filling, adequate coronal restoration, and no AP (periapical index = 1) were selected for further investigation. A total of 194 teeth were included in this cohort study. Age, sex, history of diabetes mellitus, smoking, hypertension, and immunodeficiency disorders were recorded. Two groups were made according to the periodontal status of the patients. The control group included periodontally healthy patients and the periodontal group patients with periodontal disease receiving nonsurgical periodontal treatment. After an observation period of at least 2 years, the incidence of AP was scored using the periapical index. The relationship between patients' variables and AP was conducted using the Cohen kappa test, the chi-square test, odds ratio (OR), and logistic regression analysis. Results: Newly emerged AP was found in 14% of periodontally involved teeth and in 3% of nonperiodontal involved teeth (P

The aim of the study was to compare the K3 and K3XF systems (SybronEndo, Glendora, CA) after 1 and 2 uses by evaluating apical transportation, working length loss, and working time in a manikin model.Mesial canals of 40 extracted first mandibular molars were instrumented. Radiographs taken after instrumentation with #25, #30, #35, and #40 files were superimposed on the preoperative image in both mesiodistal and buccolingual angulations. AutoCAD (Autodesk Inc, San Rafael, CA) was used to measure working length loss and apical transportation at 0, 0.5, and 1 mm from the working length (WL). The working time was measured. Group comparison was analyzed using post hoc Tukey honestly significant difference tests (P.05).No significant differences were found in apical transportation, working length loss between K3 and K3XF systems, or between the number of uses. Significant differences were found when canal enlargement was performed to a #35-40 (P.05). K3 instrumentation performed significantly faster (29.6 ± 15.4) than with the K3XF system (40.2 ± 17.7) (P.05). No differences were observed in working time when comparing the number of uses.K3 and R-phase K3XF rotary systems shaped curved root canals safely with minimal apical transportation, even up to a 40/04 file.

This study provides a morphological characterization of the inner anatomy of the root canals of permanent first and second molars in Chalcolithic and early Bronze Age human fossils using cone-beam computed tomography. The general evolutionary trend in present-day human dentition is related to morphological simplification. As little is known about when this trend appeared in Homo sapiens populations, the aim of this work is to test the presence of modern radicular morphology 4,400 years ago. Fifty-four permanent first and second maxillary and mandibular molars of 17 individuals were included in the study. All maxillary first and second molars showed three separate roots. Almost all the lower molars analyzed (100% of first molars and 75% of second molars) had two separate roots. More differences in the canal system configuration were documented in the maxillary mesiobuccal roots than in the palatal or distobuccal roots. The most variable tooth in root and canal configuration is the maxillary second molar. It should be pointed out that 12.5% of the teeth analyzed showed a C-shaped root configuration.

Purpose Evidence-based research appears to conflict on the potential risk of electromagnetic interference (EMI) between piezoelectric units (Pzs) and implantable cardioverters and defibrillators (ICDs). The purpose of this study was to observe whether the EMI produced by Pzs is hazardous for ICDs. Materials and Methods A cross-sectional study of 6 Pzs was conducted in vitro for EMI using an ICD system. To simulate the human body's electrical resistance, electrographic recordings were made of the ICD and lead that were immersed in a bath of saline solution. The variables investigated were the presence of EMI, the distance between the ICD and the Pz, and signal intensity, damage, and type of damage to the ICD and lead. Each series of tests was repeated 3 times, beginning with a 15-second baseline recording (control), until all recording conditions had been covered. Each Pz was recorded under the following conditions: less than 2 cm from the tip of the ICD lead; less than 2 cm from the ICD; less than 2 cm from the lead body and coils; and 15 cm from the lead or the ICD (R4). Results In the positive control (direct contact between the lead or the ICD with the Pz switched on), the ICD detected electrical activity as false heart activity. However, after covering all test conditions, no EMI was produced by the Pzs. Conclusion No EMI or permanent changes in the functioning of the ICD were detected in vitro.

Introduction Difficult handling, long setting time, and potential discoloration are important drawbacks of white mineral trioxide aggregate (WMTA). The development of Biodentine, a recently developed calcium silicate–based material (CSM), has overcome some of these shortcomings; however, there are no available data on its color stability. A previous study showed that WMTA discolors under light irradiation in an oxygen-free environment. The present study evaluated the influence of light irradiation and oxygen on the color stability of 5 CSMs. Methods Fifteen samples of 5 CSMs (ProRoot WMTA, Angelus WMTA, White Portland Cement [PC], PC with bismuth oxide, and Biodentine) were divided into 5 groups. Each group was exposed to different oxygen and light conditions. A spectrophotometer was used to determine the color of each specimen at 0, 120 seconds, and 5 days. Data were analyzed by using analysis of variance and Tukey honestly significant difference test. Results The materials PC with bismuth oxide, Angelus WMTA, and ProRoot WMTA showed dark discoloration after light irradiation in an oxygen-free environment, which was statistically significantly different from Biodentine and PC. In groups that were exposed to no light irradiation or to an oxygen atmosphere, all materials showed color stability over time, and no significant differences were observed among them. PC and Biodentine maintained color stability in all conditions over time and showed no significant differences. Conclusions The combination of light and anaerobic conditions (similar to those in clinical situations) results in differences in color of the tested CSMs during a period of 5 days, of which Biodentine and PC demonstrated color stability.

Aim To evaluate in vivo the performance of the iPex and Root ZX electronic apex locators (EALs) in the presence of several irrigant solutions: 2.5% sodium hypochlorite (NaOCl) and 2% chlorhexidine (CHX). Methodology Thirty-two single-rooted human teeth that were scheduled for extraction were selected. Teeth with metallic restorations, fractures, root resorption, pulp necrosis or open apices were not included The working length (WL) was determined electronically for the root canals with the iPex and Root ZX EALs in the presence of two different irrigant solutions, 2.5% NaOCl and 2% CHX. After the teeth had been extracted, a size 10 K-file was used to determine the reference working length (RWL), which was established at 0.5 mm short of the major foramen. In each case, the RWL was subtracted from the electronic measurements. Positive values indicated electronic measurements that exceeded the RWL (long measurements), whereas negative values indicated measurements that were short of the RWL. The values obtained with the different irrigants and EALs were compared using the paired t-test. Significance was set at P 0.05). However, significant differences were observed between the readings of the iPex and Root ZX, irrespective of whether 2.5% NaOCl or 2% CHX was used as the irrigant (P

Clinical information and diagnostic imaging are essential components of preoperative diagnosis. The aim of this study was to determine the influence of cone-beam computed tomographic (CBCT) imaging on clinical decision-making choices among different specialists (prosthodontists, endodontists, oral surgeons, and periodontists) in endodontic treatment planning. A secondary objective was to assess the self-reported level of difficulty in making a treatment choice before and after viewing a preoperative CBCT scan.In accordance with the endodontic case difficulty guidelines of the American Association of Endodontists, 30 endodontic cases with varying degrees of complexity were selected. Each case included clinical photographs, digital periapical radiographs, and a small-volume CBCT scan. In the first evaluation, examiners were given all the information of each case, except the CBCT scan. Examiners were asked to select one of the proposed treatment alternatives and assess the difficulty of making a decision. One month later, the examiners reviewed randomly the same 30 cases with the additional information from the CBCT data.The CBCT scans only had a significant influence on the treatment plan when the endodontic case was classified as high difficulty (P .05). The level of difficulty in choosing a treatment choice was significantly more difficult after viewing a preoperative CBCT scan (P .05), with the exception of the endodontists (P = .033). After viewing the CBCT scan, the extraction option increased significantly (P.05).CBCT imaging has a substantial impact on endodontic decision making among specialists, particularly in high difficulty cases.

Background The objective of the study was to evaluate and compare how apical enlargement with K3 and K3XF nickel-titanium (NiTi) rotary instruments reduces the root thickness in the danger zone and affects canal transportation and centering ability in mandibular molar mesial canals in a manikin extracted tooth model. Material and Methods Seventy-two mesial root canals of first mandibular molars were instrumented. Initial and post-instrumentation Cone Beam Computed Tomography scans were performed after root canal preparation up to size 25, 30, 35 and 40 files. Canal transportation, canal centering and remaining root dentin thickness toward the danger zone were calculated in sections 1, 2 and 3 mm under the furcation level. Data were analyzed using non-parametric Kruskal-Wallis analysis of variance at a significance level of P < 0.05. Results K3 instruments removed more dentin toward the danger zone compared with K3XF instruments (P< .05) and significant differences in dentin thickness were found when canal enlargement was performed to a #35-40 with both systems (P< 0.05). No significant differences in canal transportation and centering ability were found between systems, except when canal enlargement was performed to a #40 (P = 0,0136). No differences were observed when comparing the number of uses in both systems (P> 0.05). Conclusions Under the conditions of this study K3 removed a significant amount of dentin at the furcation level compared with the R-Phase K3XF rotary system in curved root canals. Enlargement to a 35-40/04 file removed significantly more dentin with both systems. Key words:K3, K3XF, R-phase, center ability, canal transportation, dentin thickness, increased apical enlargement, danger zone, dentin thickness.

Introduction Inflammatory external root resorption (IERR) requires damage or loss of the protective layer and an inflammatory process in the unprotected root surface. Infection of the pulp space can occur after a serious injury and stimulate an inflammatory response. When the inflammatory stimulus is long-standing, the destructive phase will continue until the stimulation is removed. Methods This article describes the use of cone-beam computed tomography scanning in the diagnosis and management of a perforating IERR in tooth #10 with a 17-month follow-up and histologic examination after extraction for orthodontic reasons. Results The histologic examination showed a cementum-like tissue interposed within the dentin defect. The cementum-like tissue was eosinophilic and irregular or poorly demarcated in some parts. Fibrous ligament tissue and no inflammatory response could be identified. Conclusions Mineral trioxide aggregate was shown to be suitable for the treatment of perforating IERR, and this finding agrees with the results observed in different studies conducted with animals.

The purpose of this review was (i) to conduct a literature review on the prevalence and morphologic classification of mandibular first molars with disto-lingual (DL) roots, and (ii) to discuss the clinical approach to diagnosis and root canal treatment of these teeth. A search was carried out on electronic (MEDLINE, PubMed and Cochrane) and hand databases, which covered all publications from 1970 to December 2011. Two reviewers independently assessed the studies and recorded type of study, origin and sample sizes, number of teeth with three roots and type of root canal configuration. Forty-five studies were identified with a total of 19,056 mandibular first molar teeth. The frequency of DL roots was 14.4% and was associated with certain ethnic populations. The most common canal configuration of mesial and distal roots was Vertucci types IV and I, respectively. No significant differences were observed in the prevalence of DL roots according to gender. Variable results related to side were observed as well as a trend in bilateral occurrence. The root length of the DL roots was in general shorter than that of the disto-buccal roots (DB). Most DL roots had a greater angle of curvature and a smaller radius of curvature in a bucco-lingual orientation. The best methods to identify DL roots are a 25° mesial parallax periapical radiograph or cone-beam computed tomography (CBCT). A trapezoidal shape access cavity is desirable to locate the orifice of the DL canal. Clinicians should be aware of the variable furcation levels during coronal pre-flaring or post-space preparation to avoid furcal/strip perforations and a weakening of DL roots.

Gonzalez Sanchez JA, Duran-Sindreu F, de NoeS, MercadeM, Roig M. Centring ability and apical transporta- tion after overinstrumentation with ProTaper Universal and ProFile Vortex instruments. International Endodontic Journal, 45, 542-551, 2012. Aim To evaluate morphological changes to the major foramen after overinstrumentation with ProTaper Universal and ProFile Vortex Ni-Ti rotary instruments. Methodology Twenty-eight mesiobuccal canals of maxillary and mandibular first molars were divided into two groups of 14 canals each. The root canals were prepared with ProTaper Universal or ProFile Vortex instruments. ProTaper and Vortex instruments were used until the file tip protruded 1 mm beyond the working length (0.5 mm beyond the major foramen). The major foramen was photographed before and after overinstrumentation with each file of the two systems used. The images were superimposed and evaluated using Adobe Photoshop. The parameters evaluated were canal transportation, centring ability and shape of the major foramen. Transportation and centring ability were calculated in two directions: the direction of maximum curvature (MC) and a direction vertical to the maximum curvature (VC). Measurements of canal transportation and centring ability were analysed by anova followed by post hoc least significance difference (LSD) multiple comparisons. Results No significant differences were observed amongst the different instruments with respect to centring ability in either direction (P > 0.05). The F3 ProTaper Universal instrument was associated with a higher mean values for transportation in the direction of MC (P < 0.05) than the S1, S2 and F1 ProTaper Universal instruments and the size 15, 0.06 taper, size 20, 0.06 taper, and size 25, 0.06 taper ProFile Vortex instruments. The size 30, 0.06 taper ProFile Vortex instrument had a larger mean value for transportation in the direction of MC (P < 0.05) than the S1 ProTaper Universal and size 15, 0.06 taper ProFile Vortex instruments. The S1, S2, F1, F2 and F3 ProTaper Universal files and the size 15, 0.06 taper, size 20, 0.06 taper, size 25, 0.06 taper, and size 30, 0.06 taper ProFile Vortex files produced an oval foramen in 71%, 71%, 85%, 85%, 71%, 71%, 85%, 85% and 89% of the cases, respectively. Conclusions In most samples, the ProTaper Uni- versal and ProFile Vortex files produced transportation of the major foramen and created an oval-shaped major foramen after overinstrumentation.

Root fractures occur more frequently in fully erupted permanent teeth with closed apices in which the completely formed root is solidly supported in the bone and periodontium. The consequences can be complex because of combined damage to the pulp, dentine, cementum, bone, and periodontium. Management of horizontal root fractures and lateral luxation depends on several factors, with the result that various clinical modalities have been suggested. This case report describes the treatment and 10-year follow-up of two maxillary central incisors, one with horizontal root fracture and the other with lateral luxation, treated with mineral trioxide aggregate and root canal treatment, respectively.

Abella F, Mercade M, Duran-Sindreu F, Roig M. Managing severe curvature of radix entomolaris: three-dimensional analysis with cone beam computed tomography. International Endodontic Journal, 44, 876–885, 2011. Abstract Aim To present a case of a mandibular first molar with an additional distolingual root [radix entomolaris (RE)] and to discuss the use of cone beam computed tomography (CBCT) for its identification and management during root canal treatment. Summary A 52-year-old Caucasian woman was referred for root canal treatment of the right mandibular first molar (tooth 46). After clinical and radiographic examination, a symptomatic irreversible pulpitis was diagnosed. Three periapical radiographs with different horizontal angulations revealed the presence of an additional distolingual root. This extra root, termed RE, has an incidence of

Invasive cervical resorption is a relatively uncommon form of external root resorption that may lead to tooth loss. This article presents the clinical and radiologic diagnoses and treatment modalities of invasive cervical resorption in 2 patients. In the first case, we did a slow orthodontic forced eruption to make the bone grow coronally. After 6 months, the tooth was extracted and an immediate implant was placed. Eight months later a zirconia crown was cemented. In the second case, we performed root canal treatment followed by a composite reconstruction of the defect. These 2 cases illustrate different approaches based on the extent of the defect.

Marfisi K, Mercade M, Plotino G, Duran-Sindreu F, Bueno R, Roig M. Efficacy of three different rotary files to remove gutta-percha and Resilon from root canals. International Endodontic Journal, 43, 1022–1028, 2010. Abstract Aim To evaluate the efficacy of ProTaper Retreatment files, Mtwo Retreatment files and Twisted Files for removal of gutta-percha and Resilon in straight root canals. Methodology Ninety single root canals were instrumented and randomly allocated into 6 groups of 15 specimens each with regards to the filling material and instruments used. Group 1: gutta-percha/ProTaper; Group 2: Resilon/ProTaper; Group 3: gutta-percha/Mtwo; Group 4: Resilon/Mtwo; Group 5: gutta-percha/Twisted Files; Group 6: Resilon/Twisted Files. For all roots, the following data were recorded: procedural errors, duration of retreatment, canal wall cleanliness through optical microscope and cone beam computed tomography (CBCT). Data were statistically analysed, and the level of significance was set at P = 0.05. Results No system completely removed the root filling material from root canal walls. No significant differences were observed between the rotary systems in terms of the area of filling material left within the canals (P > 0.05). There were statistically significant differences between the filling materials: Resilon/Real Seal had less residual material than gutta-percha/AH plus (CBCT: P = 0.01; microscope: P = 0.018). Mtwo Retreatment files were more rapid when removing filling material than ProTaper Retreatment files (P = 0.19) and Twisted Files (P = 0.04). Conclusions No system removed the root filling materials entirely. Mtwo Retreatment files required less time to remove root filling material than the other instruments. Resilon was removed significantly better from the canal walls than gutta-percha, irrespective of the rotary instruments used.

Gonzalez Sanchez JA, Duran-Sindreu F, AlbuquerqueMatos M, Garcia Caraban˜o T, Mercade Bellido M,Morello Castro S, Roig Cayo´nM. Apical transportationcreated using three different patency instruments. InternationalEndodontic Journal, 43, 560–564, 2010. Aim To evaluate root canal transportation at themajor foramen through the use of stainless steel size08 K-Flex files, size 10 reamers, and XF finger spreaderswhen used as patency instruments.Methodology One hundred and two mesiobuccalcanals of maxillary and mandibular first molars wererandomly divided into three groups (34 canals each).Size 08 stainless steel K-Flex files, size 10 stainless steelreamers and stainless steel XF finger spreaders wereused as patency instruments in groups A, B and Crespectively. The major foramen was photographedbefore and after instrumentation. The images weresuperimposed and then evaluated using Photoshop todetermine the frequency of apical transportation. Thestatistic analysis was performed using v 2 test.Results Transportation was detected in 22% of thespecimens; 9% in group A, 12% in group B and 44% ingroup C. Significant differences were observed betweengroups A and C (P = 0.0025) and between groups Band C (P = 0.0069), but not between groups A and B(P = 1.00).Conclusions No transportation was found in themajority of the samples when size 08 K-Flex files andsize 10 stainless steel reamers were used. The XF fingerspreaders, when used to maintain apical patency,caused the greatest transportation of the major fora-men.Keywords: apical transportation, patency file, rootcanal preparation.

This in vivo and in vitro study investigated the influence of pulpal vitality on the optical properties of teeth over a 1-month period. We monitored two specific areas (2-mm-thick pure enamel and 3-mm-thick enamel-dentine complex) in 10 teeth against two backgrounds (white and black) using a calibrated reflectance spectrophotometer at the following time points: before extraction (T0); immediately after extraction (T1); at 1-day post-extraction (T2); at 1-week post-extraction (T3); and 1-month post-extraction (T4). We recorded tooth colour based on the Commission Internationale d'Eclairage L*a*b* model and translucency and analysed these characteristics over time using analysis of variance. The 2-mm-thick pure enamel area showed significant changes (p > 0.05) in L*, a* and b* values between before and 1 month after extraction (T0-T4). Translucency was detectable between (T0-T3) and (T0-T4). The 3-mm-thick enamel-dentine complex also exhibited significant differences (p > 0.05) in L*, a* and b* values within (T0-T4). Translucency value changes significantly (p > 0.05) within the first day (T0-T2) and (T0-T3). CIEDE 2000 DE values revealed no statistically significant differences (p Within the limitations of this study, we conclude that the optical characteristics (i.e. colour and translucency) of teeth change after extraction. The results help understanding the precise moment when the colour of extracted tooth changes to identify optimum time to use a tooth for scientific investigation and determine whether it is necessary to extract pulp tissue beforehand.

Objectives To compare the efficacy of Reciproc® (VDW GmbH) and ProFile® (Dentsply Maillefer) instruments at removing gutta-percha from straight and curved root canals ex vivo filled using the cold lateral condensation and GuttaMaster® (VDW GmbH) techniques. Material and Methods Forty mesial roots of mandibular molars with two curved canals and 80 single-rooted teeth with straight root canals, a total of 160 root canals, were randomly assigned to eight groups (canals per group = 20) according to filling technique, retreatment instrument and root canal curvature as follows: Group I, cold lateral condensation/ProFile®/straight; Group II, cold lateral condensation/ProFile®/curved; Group III, cold lateral condensation/Reciproc®/straight; Group IV, cold lateral condensation/Reciproc®/curved; Group V, GuttaMaster®/ProFile®/straight; Group VI, GuttaMaster®/ProFile®/curved; Group VII, GuttaMaster®/Reciproc®/straight; and Group VIII, GuttaMaster®/Reciproc®/curved. The following data were recorded: procedural errors, retreatment duration and canal wall cleanliness. Means and standard deviations were calculated and analysed using the Kruskal-Wallis test, one-way analysis of variance and Tukey’s test (P < 0.05). Results Reciproc® instruments were significantly faster than ProFile® instruments at removing GuttaMaster® from both straight (P = 0.0001) and curved (P = 0.0003) root canals. Reciproc® were statistically more effective than ProFile® instruments in removing GuttaMaster® from straight root canals (P = 0.021). Regardless of filling technique or retreatment instrument, gutta-percha was removed more rapidly from curved than from straight root canals (P = 0.0001). Conclusions Neither system completely removed filling material from the root canals. Compared with ProFile® instruments, Reciproc® instruments removed GuttaMaster® filling material from straight and curved root canals more rapidly.

Introduction White mineral trioxide aggregate (WMTA) has been reported to cause dental discoloration. A previous study on the color stability of 5 calcium silicate–based materials investigated the color stability of Biodentine (Septodont, Saint-Maur-des-Fosses, France) in different experimental environments; however, no data are available on the color stability of teeth restored with Biodentine. In this study, we assessed the color stability under artificial light of ex vivo human teeth restored coronally with WMTA or Biodentine. Methods Cavities were prepared on coronal tooth specimens and restored with WMTA + composite ( n = 16), Biodentine + composite ( n = 16), or composite alone (control, n = 3). Color was assessed spectrophotometrically at 6 time points (initial, 1 week, 2 weeks, 1 month, 3 months, and 6 months), and color difference values were calculated. Statistical analysis was performed using analysis of variance and the Fisher least significant difference test for which P Results The WMTA group showed discoloration at 1 week, which increased over time. The Biodentine and control groups showed color stability and were not significantly different from one another. Conclusions Teeth treated with WMTA exhibited discoloration, whereas those treated with Biodentine maintained color stability throughout the study. However, further in vivo studies are necessary to corroborate these results.