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This study compared the efficacy of XP‐Endo Finisher R and R1‐Clearsonic insert in removing filling material remnants from oval canals. Twelve pairs of contralateral premolars were treated and subsequently retreated with Reciproc 50. A supplementary procedure with XP‐Endo Finisher R or R1‐Clearsonic was performed. Micro‐computed tomography was used to quantify the filling material volume in the full canal and apical segment lengths. Intragroup analyses revealed significant reduction of filling material after both procedures, not only in the full canal but also in the apical segment (P < 0.05). The amount of filling material removed with XP‐Endo Finisher R and R1‐Clearsonic was 47.9% and 52.2% in the apical segment (P > 0.05), and 82.1% and 64.6% in the full canal (P < 0.05). None of the instruments was effective in completely removing the filling material from the apical canal, but better results were obtained with XP‐Endo Finisher R in the total canal length. [ABSTRACT FROM AUTHOR]

Objective: This clinical study compared the effectiveness of 7- and 14-day intracanal medications in the reduction of bacteria/endotoxins from primarily infected root canals and determined their antigenicity against macrophages through the levels of cytokines. Methods: Seventy-two primarily infected teeth were randomly divided into six groups according to medication and time of application: 7-day groups = G1, Ca(OH) + saline solution (SSL); G2, Ca(OH) + 2% chlorhexidine (CHX) gel; and G3, 2% CHX gel and 14-day groups = G4, Ca(OH) + SSL; G5, Ca(OH) + 2% CHX gel; and G6, 2% CHX gel (all groups, n = 12). Bacterial and endotoxin samples were collected from root canals and inflammatory cytokines of macrophages supernatants. Culture techniques were used to determine bacterial counts and limulus amebocyte lysate (LAL) assay to quantify endotoxins. IL-1β, TNF-α, and PGE were measured by ELISA-assay. Results: With regard to the bacterial reduction, no differences were found between all protocols tested ( p > 0.05). The CHX protocols (G3 and G6) exhibited the lowest effectiveness against endotoxins ( p < 0.05). All protocols were effective in lowering the levels of IL-1β, TNF-α, and PGE ( p < 0.05), with no difference between the medications tested on days 7 or 14 ( p > 0.05). Particularly, the 7-day CHX-protocol (G3) exhibited the lowest effectiveness in lowering the levels of most cytokines compared to the 14-day protocols (G6) ( p < 0.05). Conclusions: All the 7- and 14-day intracanal medications were effective in reducing bacteria and endotoxins as well as in lowering the levels of inflammatory cytokines, with CHX showing limited effectiveness against endotoxins. Moreover, 7-day CHX-protocol exhibited the lowest effectiveness in lowering the levels of most cytokines compared to the 14-day protocols. Clinical significance: Seven-day CHX protocol is the less effective protocol and should be carefully applied by the clinician. [ABSTRACT FROM AUTHOR]

Objective: The objective of the present study was to carry out a systematic review to analyse the effectiveness of pulp revascularization in the root formation of necrotic immature permanent teeth, as well as the level of scientific evidence regarding this theme.Materials and Methods: The methodology was based on searching electronic databases such as Web of Science, Pubmed, BVS (Medline, Scielo, Lilacs and BBO), Scopus and Cochrane, including manual searches for the references listed in the studies found. The terms used for the literature search were pulp revascularization and endodontics.Results: Initially, 277 articles were identified from the electronic databases; 17 studies remained after analysis and exclusion of duplicates; exclusion criteria also eliminated six articles; 11 remained for evaluation.Conclusions: Although the results found in the present systematic review are relevant, the scientific evidence should be interpreted with caution as the articles report different methods and evaluation parameters. Despite the capacity of the pulp revascularization technique to stimulate the development of the apical closure and thickening of radicular dentin, several aspects still remain unknown, like the key factors of this repair, the type of tissue formed and the long-term prognosis. [ABSTRACT FROM AUTHOR]

Background: Sodium hypochlorite (NaOCl) is the most widely used endodontic irrigant because of its excellent antimicrobial, organic tissue dissolving, and lubricating properties. However, it is highly cytotoxic to the periapical tissues. Aim: This study evaluated in vitro the extrusion of 5.25% NaOCl through the apical foramina of mesiobuccal (MB) root canals of maxillary first molars in two experimental conditions: Before apical debridement and after apical debridement with different instrument sizes to ensure direct access to the apical foramen (apical patency). Materials and Methods: Coronal accesses were prepared in 17 teeth and the apical foramina of the distobuccal and palatal root canals were sealed. The teeth were held in acrylic receptacles with the roots turned upwards to reproduce their position in the maxillary dental arch. The receptacles were filled with a starch/KI solution (a reagent that changes its color to blue after contacting NaOCl) covering the roots. The experiment had two phases: P1: Irrigation of the MB canals with 5.25% NaOCl without previous establishment of apical patency; P2: Canal irrigation after use of size 10 K-file and size 15 Flexofile as patency files. Only specimens with no NaOCl extrusion in P1 were assigned to P2. NaOCl was delivered pressureless at the canal entrance. The moment that the starch/KI solution contacted NaOCl was captured on digital photographs. Results and Conclusions: There was no NaOCl extrusion in nine specimens in P1, but all of these teeth had irrigant extrusion in P2. The 5.25% NaOCl used as an endodontic irrigant showed great capacity to extrude beyond both intact and small-sized apical foramina of MB root canals of maxillary first molars. [ABSTRACT FROM AUTHOR]

Root resorption consists of the loss of mineralized tissue (enamel, dentin, and cementum) of the inner or outer surface of the tooth due to the action of clastic cells. The correct diagnosis, the location, degree of tissue destruction, and the type of treatment are obstacles to the resolution of these lesions. The external cervical resorption is initiated in the amelocemental region progressively resorbing cementum, dentin, and enamel, constituting multiples ducts of resorption in an apical direction. This study reports a clinical case of treatment of a tooth affected by external cervical resorption with six-year clinical and radiographic follow-up. A 28-year-old male patient attended the clinic reporting a stain in the element 11. On clinical examination, there was a pinkish stain in the cervical lingual region, small cavitation in the enamel cervical region, and gingival bleeding with no insertion loss. Radiographically was observed a change at the root in the right central incisor, which was diagnosed as external root resorption. The negative response to the pulp sensitivity test confirmed the condition of pulp necrosis, indicating the need for endodontic treatment. To the treatment, it was opted for a minimally invasive approach, with endodontic access, instrumentation, and monthly exchanges of calcium hydroxide, for three months. After this period, the root canal has been filled with gutta-percha and sealer 26, in the apical third. The cervical and medium third were filled with MTA (mineral trioxide aggregate) leaving a central space for later fiberglass posts placing. The fiberglass post has been cemented with resinous cement and the tooth restored with resin composite. After six years of a radiographic control semiannual and annual, noticed normality in the periradicular tissues and disruption of the resorption process, was observed. The clinical management minimally invasive adopted reported in this case presents a viable treatment for external root resorption of the cervical third, especially in anterior teeth., Competing Interests: None., (IJBT Copyright © 2020.)

Objectives: To assess the radiographic appearances of the endodontic treatment in different room lighting conditions and image display devices., Methods: After approval by Research Ethical Board, 20 images were obtained from blocks with one endodontically treated tooth. Of the 20 endodontic treatments conducted in the laboratory, of those the randomly selected 10 teeth (50% of sample) received some quality defect in three parameters-apical limit, adaptation to root canal and homogeneity of the root canal filling material. Digital radiographs (DIGORA® Optime, Soredex, Milwaukee, WI) were obtained, which were evaluated (8 times) by 10 observers in two different conditions of room lighting, with bright (1000 to 1200 lux) and dim light (25 to 50 lux), using two different image display devices, smartphones and laptop computers. The observers assessed the radiographic appearances of the endodontic treatment with respect to quality of each one of three parameters individually. The data of observers' responses in terms of the quality of each parameter were statistically compared using Cronbach's α coefficient, diagnostic tests, π coefficient and ANOVA with Tukey tests, at a significant level setting of 5% (α = 0.05)., Results: The mean of reliability of observer responses ranged from 0.89 (intra-evaluator) to 0.66 (inter-evaluator). The mean values of the receiver operating characteristic (ROC) area were 0.661 (PD = 0.098), with laptop in bright lighting appraising homogeneity of the root canal filling material on the worst performance (ROC area = 0.57), which was statistically significant (p < 0.05), and 0.81 with laptop in dim lighting appraising apical limit on the best performance. Differences (p < 0.05) occurred mainly among parameters used for assessment., Conclusions: Room lighting and image display devices have very little influence in the radiographic appearances of the endodontic treatment. Thus, we suggest the use of smartphones as an acceptable image display device in daily clinical practice in routine bright lighting conditions.