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Objective: The aim of this systematic review was to evaluate the influence of maintaining apical patency (AP) in endodontic treatment outcome. Methodology: An electronic database search was performed in PubMed, Cochrane Library, LIVIVO, LILACS, and EBSCO host from inception till July 2024. The data from the included articles were extracted and the quality was assessed using the Cochrane Collaboration tool and ROBINS-I tool. Results: Five articles were included for the qualitative synthesis, and all the included articles were determined to have a low risk of bias. Maintaining the AP resulted in two-fold increase in the healing outcome with long-term follow-up. Conclusion: It can be concluded from this systematic review that maintaining AP is likely to enhance the endodontic treatment outcome. However, more long-term clinical studies are required to further evaluate the possible influence of AP. Registration: The protocol of this review was registered in the PROSPERO database with registration number: CRD42022374966. [ABSTRACT FROM AUTHOR]

Introduction: Maxillary molars may frequently require root canal therapy and can have complex anatomy. It is important to locate and treat the second mesiobuccal canal to significantly improve prognosis. Aim of the Study: The purpose of this study was to evaluate direct vision, dental operating microscope (DOM), selective dentin removal under DOM, and cone beam computed tomography (CBCT) in clinical detection of second mesiobuccal root canal (MB2) in maxillary molars. Materials and Methods: A total of 122 maxillary first and second molars indicated for root canal treatment were included in our study. Following access cavity preparation, the presence of MB2 canal orifice was assessed in four stages. Stage I: with direct vision. Stage II: under DOM, Stage III: after selective dentin removal under DOM and Stage IV: teeth in which MB2 canal was not identified by Stage III were further investigated with CBCT. The number of canals identified during each stage was analyzed statistically. Results: Clinical detection of MB2 canal in our study was 90%, with 93% in maxillary first molar and 86% in maxillary second molar. 64% MB2 canals were located at Stage I (direct vision) which improved to 84% at Stage II (under DOM) and 90% at Stage III (selective dentin removal under DOM). CBCT investigation (Stage IV) further improved the identification of MB2 canal leading to overall prevalence of 93%. Conclusion: The results of our study demonstrated that MB2 canal can be clinically detected in up to 90% of maxillary molars by the use of DOM and selective dentin removal. CBCT investigation is indicated when MB2 canals are not clinically detected.

Aim: The aim of this study was to compare the anesthetic efficacy of 4% articaine and 2% lidocaine as supplementary buccal infiltration after failed inferior alveolar nerve block (IANB) in patients with symptomatic irreversible pulpitis. Methods: MESH terms and specific keywords were used to search Scopus, EBSCOhost, Cochrane Library, and PubMed. Randomized clinical trials were among the included articles that compared the anesthetic efficacy of 4% articaine or 2% lignocaine as supplementary buccal infiltration following a failed IANB in patients with chronic irreversible pulpitis. Results: Five of the 871 studies that were reviewed were given full-text reading considerations, and three studies were subjected to qualitative analysis after meeting the inclusion and exclusion criteria. In 234 patients altogether, patients anesthetized with 4% articaine buccal infiltration had a success rate of 61%–83.3% in the 118 patients in the 4% articaine BI group and 116 patients in the 2% lidocaine BI group. Conclusion: Supplemental buccal infiltration with 4% articaine in permanent mandibular molars was associated with greater anesthetic efficacy than the 2% lignocaine in patients with symptomatic irreversible pulpitis after unsuccessful IANB. [ABSTRACT FROM AUTHOR]

Aim: The purpose of this study was to compare equivalent stresses in mandibular first molar restored with endocrowns made of ceramic and indirect composites using three-dimensional (3D)-finite element analysis (FEA). Materials and Methods: Two 3D finite element models of mandibular first molar were designed. One model of intact tooth without any restoration was uses as a control. Another mandibular molar model with endocrown as postendodontic restoration was generated where the tooth was simulated with extensive coronal loss and divided into five groups with different materials such as lithium disilicate, zirconia, feldspathic, resin nanoceramic, and polymer infiltrated ceramic network (PICN). An axial loading force of 300 N at five diverse contacts areas was applied on the occlusal surface. Stress distribution at various regions of tooth, concentrating mainly on root dentin and alveolar bone, was measured using the Von Mises stress criteria by FEA software. Results: The lowest stress concentration in root dentin was seen in the cervical root region of resin nanoceramic endocrown group followed by PICN endocrown, feldspathic ceramic endocrown, intact tooth, zirconia endocrown, and lithium disilicate endocrown. In alveolar bone, the result showed that the lowest stress value was seen in resin nanoceramic endocrown, followed by PICN endocrown, zirconia endocrown, feldspathic endocrown, intact tooth, and lithium disilicate endocrown. Conclusion: Endocrown materials with the modulus of elasticity similar to that of dentin showed better stress distribution than the materials with high modulus of elasticity. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to compare the two nickel–titanium (NiTi) instruments on root dentin thickness using cone-beam computed tomography (CBCT) and ability to remove the smear layer using scanning electron microscope (SEM). Materials and Methods: The effect of two NiTi rotary instruments such as XP Endo shaper and ProTaper Gold (PTG) in retaining adequate dentin thickness and debridement (i.e., removal of smear layer) was evaluated in vitro using CBCT and SEM. After cleaning and shaping of the root canal with adequate irrigation, the effect of two NiTi instrument systems at 3 mm (apical), 6 mm (middle), and 9 mm (coronal) levels on buccal, lingual, mesial, and distal aspects in terms of amount of dentin removal and smear layer removal was evaluated. The data were analyzed using student's unpaired t-test with a significance of P ≤ 0.05. Results: Both NiTi instrument systems had no statistically significant difference in amount of dentin removal at all three levels and on all four aspects. In smear layer removal, PTG had significantly better efficacy compared to XP Endo shaper at the coronal third of root canal. Conclusion: Instrumentation with XP Endo Shaper and PTG showed a similar amount of dentin removal. PTG has a significant effect on smear layer removal compared to XP Endo Shaper only at the coronal third of root canal. [ABSTRACT FROM AUTHOR]