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Eradication of microorganisms present in the root canal system during endodontic therapy is one of the critical factors affecting the final outcome of endodontic treatment. However, even adequate technique of the root canal treatment and use of irrigants according to the established protocol does not lead to the complete elimination of microorganisms during endodontic treatment. The presence of Enterococcus (E.) faecalis inside the root canal system may be an important factor contributing to the failure of the treatment. Introducing agitation techniques in irrigation, such as passive ultrasonic irrigation (PUI) and the use of the activating instrument XP-endo Finisher (XPF), contribute to a better debridement and disinfection of the root canal. This study was conducted on 42 root canals experimentally inoculated with E. faecalis and exposed to three irrigation protocols. These have included a standard irrigation protocol using a syringe and needle, passive ultrasonic irrigation, and activation of the irrigant using an XPF instrument. The reduction in microorganisms was evaluated using the quantitative polymerase chain reaction in real-time (RT-PCR) as well as via the method of determining the number of colony forming units on nutrient medium (CFUs). The results of this study showed that the use of supplementary irrigation protocols, PUI, and XPF led to a significant decrease in the number of microorganisms inside the root canal of experimental teeth. These findings indicate a significant positive impact of these procedures on the disinfection of the root canal system. [ABSTRACT FROM AUTHOR]

Apical lesions are diseases of infectious origin that can cause destruction of the surrounding periapical tissue, including bone tissue and periodontal ligaments, resulting in the loss of the affected teeth. Currently, the microorganisms present in pulp and apical disease are mostly studied as bacteria. However, in recent years, interest has been aroused in the study of viruses that could be present in apical lesions, and how these could affect the progression of disease. In the present study, we conducted a systematic review of the literature to evaluate and synthesize the scientific evidence on the presence of viruses and their possible role in pulpal and apical disease. This systematic review was performed according to the PRISMA reporting guidelines. The search for studies was performed in the PubMed and Web of Science databases. A total of seven studies published in the last 10 years were included. The types of samples used for virus analysis varied from one study to another. In all the included studies, the presence of any of the types of viruses studied was found, either in pulp or apical tissue. Herpesviridae family, Epstein–Barr virus (EBV) and Human cytomegalovirus (HCMV) stood out as the most commonly present in apical lesions. Further studies are required to clarify and understand the pathogenic role of viruses in pulpal and periapical disease. [ABSTRACT FROM AUTHOR]

Objective: To examine the effectiveness of lasers in radiographic periapical healing in endodontic surgery and non-surgical treatment compared to standard or conventional or placebo therapy, a systematic review was designed. Methods: Clinical studies/trials including single or multiple visits endodontic surgical and non-surgical endodontic procedures that involved lasers for periapical healing in comparison with standard or conventional or placebo therapy having at least 6 months of radiographic post-operative follow-up. Participants were adults aged above 12 years, involving intervention in permanent tooth only. Types of study included were Randomized controlled trials only. A systematic review search was conducted in PubMed, EBSCOhost, LILACS, Cochrane Central Register of Controlled Trials (CENTRAL), and Google Scholar, using MeSH words, text words, and Boolean operators. Only Englishlanguage articles published from January 1, 1990 to November 30, 2023 were considered. Only randomized controlled trial was included. A RoB2 tool was utilized to evaluate the Risk of Bias in clinical trials. Results: Out of a total of 676 studies gathered from databases and registers, 7 were eventually included for qualitative analysis. The Risk of Bias 2 tool identifies six studies with an overall low risk and one study with some concerns. Four of the seven trials found no significant difference between the laser and control groups, whereas three showed a significant difference at the 6-month radiography follow-up. Conclusion: We are unable to reach a definite conclusion on whether lasers are effective for periapical healing in endodontic surgery and nonsurgical treatments. More clinical research on the use of lasers in endodontic surgery and non-surgical procedures has to be conducted in future. [ABSTRACT FROM AUTHOR]

Background Aim Methodology Results Conclusion Few studies focus upon patient‐reported outcomes in endodontics.To determine whether full pulpotomy offers a less painful, improved health‐related quality of life (HRQoL) compared with root canal treatment (RCT) in cases of irreversible pulpitis (IP) in the 7 days after the treatment.One hundred sixty‐eight participants presenting with symptoms of IP were randomized to either pulpotomy (n = 86) or RCT (n = 82). Two participants were excluded, 61 participants underwent full pulpotomy with Biodentine (35.7%), 80 had RCT (46.8%), and 25 were randomized to have pulpotomy which progressed to RCT (PRCT) due to uncontrollable bleeding (14.6%). Clinical and radiographic assessments, using CBCT and periapical radiographs, were carried out preoperatively, for the evaluation of the results only CBCT images were used. Pain (VAS) and HRQoL (EQ 5D) assessments were carried out at baseline and Days 1, 3, 5 and 7 post‐baseline. Analysis included descriptive and continuous variables, chi‐squared, Fisher's exact, and two‐sample t‐tests.In pulpotomy and RCT groups, VAS pain decreased significantly over the first week (p < .001). The magnitude of reduction was similar in RCT and pulpotomy (p = .804), RCT and PRCT (p = .179), pulpotomy vs. PRCT (p = .144) and in the comparison of combined RCT /PRCT groups (ORCT) with Pulpotomy (0.729). However, the overall level of VAS pain was significantly higher in the PRCT group than in the Pulpotomy (p = .045) and RCT group (p = .049). Using CBCT, significantly more radiolucencies were found in the PRCT group than in the pulpotomy group and overall teeth presenting with CBCT radiolucencies had significantly higher pain scores (p = .015), particularly at Days 1, 3 and 5. There were significant differences in many OHRQoL domains (Questions 1, 6, 11 and 12) between RCT and PRCT groups with higher frequencies of the impact of oral health problems at Day 0 and Day 7 in the PRCT group.In the treatment of IP, pulpotomy is as effective as RCT in reducing post‐operative pain, and improving QoL and HRQoL, teeth displaying uncontrollable bleeding and periapical radiolucencies detected using CBCT are associated with more intense postoperative pain and lower QoL. [ABSTRACT FROM AUTHOR]

Background: Root canal retreatment is necessary when initial treatment fails. Nickel-titanium systems help remove filling materials; however, some methods can cause canal content extrusion, resulting in inflammation and delayed healing. This study aimed to examine the impact of different preparation techniques and endodontic file systems on apical debris volume to limit material dispersion to periradicular tissues. Methods: Ninety extracted maxillary incisors were evaluated. Simulated apical root resorption was created by removing the apical 2 mm of the root. The teeth were divided into two groups: one filled with a single cone and the other with cold lateral compaction (CLC). Each group was further divided into three subgroups (n = 15 each): Subgroup 1 used Reciproc R25 for removal and R50 for final preparation; Subgroup 2 used ProTaper Universal Retreatment (PTUR) files D1, D2, and D3 for removal and ProTaper Next X5 for finalization; and Subgroup 3 used VDW.Rotate Retreatment (VDW.RotateR) for removal and VDW.Rotate 50.04 for completion. Debris from retreatment was collected in pre-weighed tubes to determine the amount. The apical extrusion data underwent a two-way analysis of variance. Results: The Reciproc group had a mean extruded debris weight of 0.54 ± 0.24 mg, higher than the PTUR (0.28 ± 0.15 mg) and VDW.RotateR (0.39 ± 0.29 mg) groups (p < 0.05). The single-cone technique (SCT) resulted in a mean debris weight of 0.34 ± 0.23 mg, lower than the CLC technique, which had a mean of 0.46 ± 0.27 mg (p < 0.05). SCT had a shorter retreatment duration (111.12 ± 33.46 s) compared to CLC (176.26 ± 52.26 s) (p < 0.05). Conclusion: The Reciproc file system and the CLC obturation technique resulted in greater apical debris extrusion than the other methods. SCT was quicker than CLC. The Reciproc groups are more susceptible to apex extrusion during retreatment. [ABSTRACT FROM AUTHOR]

Endocarditis is a severe infection affecting the heart's inner layer, the endocardium. Its pathophysiology may involve heart valve damage, bacteria adhesion and biofilm formation, potentially leading to fatal complications. Bacteria from various sources, including from endodontic diseases and its treatments may enter the bloodstream provoking this condition. This systematic review aimed to explore the influence of endodontic factors on endocarditis. Searches across PubMed, Embase, Cochrane Library and manual sources yielded 14 relevant articles from 1562 screened studies. Assessment platforms from JBI Critical Appraisal Tools evaluated studies biases. Findings mainly focused on transient bacteraemia as a key indicator of risk correlating bacterial virulence and counts with endocarditis development. Worryingly, multi-species bacteraemia post-endodontic treatment was noted including the genera Enterococcus, Parvimonas, Streptococcus and Staphylococcus. Conclusive validation of the incidence and association between endodontic patients and endocarditis was limited due to a lack of robust longitudinal investigations, such as randomized controlled trials. This emphasizes the need for further research with well-designed methodologies to provide a full understanding of the causative bacterial population and its pathological mechanisms. A current guideline (2023 European Society of Cardiology) was developed to support healthcare professionals in diagnosing and managing infective endocarditis; this 2023 version is introducing a new diagnostic algorithm to aid in patient classification aiming to improve outcomes for this challenging disease. The study was a priori registered on PROSPERO (CRD42023407736). [ABSTRACT FROM AUTHOR]

Apical periodontitis (AP) is the most prevalent chronic inflammatory disease of the teeth. Bone resorption dynamics in symptomatic and asymptomatic AP are still unrecognized. This study examined different inflammatory markers within gingival crevicular fluid, including matrix metalloproteinases 8 (MMP8), tissue inhibitors of metalloproteinases 1 (TIMP1), receptor activator of nuclear factor κB (RANK), its ligand (RANKL), and osteoprotegerin (OPG), to be used in comparing symptomatic apical periodontitis (SAP) and asymptomatic apical periodontitis (AAP) versus healthy teeth. Subjects with SAP, AAP, and a control group were recruited and GCF samples were collected by Periopaper strips. Clinical and radiographical measures were used for diagnosing AP. Levels of MMP8, TIMP, RANK, RANKL, and OPG were determined by ELISA and their abilities to discriminate between examined sites were evaluated by receiver operator characteristic (ROC) curves. All examined biomarkers were statistically significant higher (p < 0.05) in SAP than AAP and the control group, apart from RANK. Significant positive correlations (p < 0.05) were identified between all SAP and AAP biomarkers except TIMP1 and RANK in AAP teeth. TIMP1 and OPG exhibited the highest ability to distinguish between SAP and AAP with areas under the curve of 0.824 and 0.763 in comparing SAP and the control group, and 0.732 and 0.73 when comparing AAP and the control group, respectively. Additionally, TIMP1 and OPG showed the highest AUC of 0.778 and 0.747 when SAP and AAP were compared, respectively. This study concluded that GCF levels of TIMP1 and OPG can be used to differentiate between SAP, AAP, and healthy teeth. [ABSTRACT FROM AUTHOR]

This study, conducted within an educational design research (EDR) framework, assessed the use of customized 3D-printed tooth models at various difficulty levels to enhance mastery learning and deliberate practice in preclinical endodontic training. The EDR was conducted in a preclinical endodontic training involving 42 third-year students. The study focused on developing and evaluating 3D-printed tooth models customized into 3 difficulty levels to facilitate mastery learning for the access opening procedure on upper anterior teeth. To promote deliberate practice, we ensured ample availability of these models. The evaluation combined quantitative analysis, using Friedman and Wilcoxon Signed-Rank tests to assess practice volume and performance, with qualitative feedback from interviews and focus groups, analyzed via content analysis. There was a significant reduction in practice time across the different model levels, with students using an average of 1.5–1.8 models per level. No significant differences in performance scores were observed across levels and natural tooth (P =.333). Feedback highlighted the models' educational value in enhancing dental training, indicating their effectiveness in improving learning experiences and skill development in endodontic education. The innovative design of a 3D-printed tooth model system, which features 3 levels of difficulty and was developed within an EDR framework, allowed for tailored learning progressions and ample practice opportunities. This significantly enhanced the endodontic training experience and skill development by providing varied and realistic challenges. [ABSTRACT FROM AUTHOR]

Objective: This study evaluated the effect of incorporating 1 wt% egg shell powder (ESP) into Biodentine™ (BD) on its physicomechanical properties. Methods: Chicken eggs were ground and sterilized. Then, one wt% ESP was added to BD powder and mixed with BD liquid. The mixture's pH and solubility were measured on 1, 3, 7, and 28 days. The setting time was determined using a Gillmore needle. Compressive strength was measured using a universal testing machine after 1 and 14 days. Surface chemistry was analyzed via FTIR spectroscopy. The findings were compared by independent samples t-test, the repeated measures ANOVA, and the Bonferroni post-hoc test (a = 0.05). Results: pH levels were comparable between the groups (P > 0.05). BD-ESP had a higher setting time than BD (P < 0.001). BD-ESP solubility was significantly higher than BD on day 1 (P = 0.001) but lower on days 7 (P = 0.006) and 28 (P = 0.001). On day 1, BD had higher compressive strength than BD-ESP (P = 0.027), whereas the compressive strength of both groups was comparable on day 14 (P = 0.099). FTIR analysis revealed an additional IR band associated with the phosphate band in the BD-ESP group, suggesting new apatite formation. Conclusions: Incorporating 1% ESP into BD resulted in lower initial solubility but higher solubility after a week and a month, likely due to increased ion dissolution. ESP incorporation also promoted additional apatite formation but negatively impacted the setting time and initial strength of BD. [ABSTRACT FROM AUTHOR]

The inflamed pulp can develop into pulp necrosis and requires endodontic treatment. The failure of endodontic treatment is mainly caused by Enterococcus faecalis infection. The mechanism is mediated by the ability of E. faecalis, as a gram-positive bacterium, to form a biofilm covering the cell membrane, which is known as microbial surface recognizing adhesive matrix molecules (MSCRAMMs). The aim of this study was to identify MSCRAMMs through the expression of lamininγ, High Mobility Group Box I (HMGB1), and type-1 collagen. All groups were prepared for molar cavitation using a round bur and injected with E. faecalis bacteria with a concentration of 100%. They were observed for 24 hours, 72 hours, and 120 hours after injection. The K group was the control group containing rats that were not received a bacterial injection at 24 hours, 72 hours, and 120 hours. After that, the tooth was decalcified using 10% EDTA at 37 °C, which took up to two months. Macrophages were observed using a light binocular microscope. Significant results (p<0.05) were found in laminin γ and HMGB1 between the control with 24 hours groups, also insignificant results (p>0.05) were found between 24 with 72 hours group and 72 with 120 hours group. All groups within the collagen type-1 group were not significant. Both laminin γ and HMGB1 are good parameters to predict Enterococcus faecalis growth phase and biofilms production with the log phase happening before 24 hours and the stationary phase happening after 24 hours. [ABSTRACT FROM AUTHOR]

Objective: This study evaluated the effect of incorporating 1 wt% egg shell powder (ESP) into Biodentine™ (BD) on its physicomechanical properties.Methods: Chicken eggs were ground and sterilized. Then, one wt% ESP was added to BD powder and mixed with BD liquid. The mixture’s pH and solubility were measured on 1, 3, 7, and 28 days. The setting time was determined using a Gillmore needle. Compressive strength was measured using a universal testing machine after 1 and 14 days. Surface chemistry was analyzed via FTIR spectroscopy. The findings were compared by independent samples t-test, the repeated measures ANOVA, and the Bonferroni post-hoc test (α = 0.05).Results: pH levels were comparable between the groups (P > 0.05). BD-ESP had a higher setting time than BD (P < 0.001). BD-ESP solubility was significantly higher than BD on day 1 (P = 0.001) but lower on days 7 (P = 0.006) and 28 (P = 0.001). On day 1, BD had higher compressive strength than BD-ESP (P = 0.027), whereas the compressive strength of both groups was comparable on day 14 (P = 0.099). FTIR analysis revealed an additional IR band associated with the phosphate band in the BD-ESP group, suggesting new apatite formation.Conclusions: Incorporating 1% ESP into BD resulted in lower initial solubility but higher solubility after a week and a month, likely due to increased ion dissolution. ESP incorporation also promoted additional apatite formation but negatively impacted the setting time and initial strength of BD.

Abstract Background Root canal retreatment is necessary when initial treatment fails. Nickel-titanium systems help remove filling materials; however, some methods can cause canal content extrusion, resulting in inflammation and delayed healing. This study aimed to examine the impact of different preparation techniques and endodontic file systems on apical debris volume to limit material dispersion to periradicular tissues. Methods Ninety extracted maxillary incisors were evaluated. Simulated apical root resorption was created by removing the apical 2 mm of the root. The teeth were divided into two groups: one filled with a single cone and the other with cold lateral compaction (CLC). Each group was further divided into three subgroups (n = 15 each): Subgroup 1 used Reciproc R25 for removal and R50 for final preparation; Subgroup 2 used ProTaper Universal Retreatment (PTUR) files D1, D2, and D3 for removal and ProTaper Next X5 for finalization; and Subgroup 3 used VDW.Rotate Retreatment (VDW.RotateR) for removal and VDW.Rotate 50.04 for completion. Debris from retreatment was collected in pre-weighed tubes to determine the amount. The apical extrusion data underwent a two-way analysis of variance. Results The Reciproc group had a mean extruded debris weight of 0.54 ± 0.24 mg, higher than the PTUR (0.28 ± 0.15 mg) and VDW.RotateR (0.39 ± 0.29 mg) groups (p

Endocarditis is a severe infection affecting the heart’s inner layer, the endocardium. Its pathophysiology may involve heart valve damage, bacteria adhesion and biofilm formation, potentially leading to fatal complications. Bacteria from various sources, including from endodontic diseases and its treatments may enter the bloodstream provoking this condition. This systematic review aimed to explore the influence of endodontic factors on endocarditis. Searches across PubMed, Embase, Cochrane Library and manual sources yielded 14 relevant articles from 1562 screened studies. Assessment platforms from JBI Critical Appraisal Tools evaluated studies biases. Findings mainly focused on transient bacteraemia as a key indicator of risk correlating bacterial virulence and counts with endocarditis development. Worryingly, multi-species bacteraemia post-endodontic treatment was noted including the genera Enterococcus, Parvimonas, Streptococcus and Staphylococcus. Conclusive validation of the incidence and association between endodontic patients and endocarditis was limited due to a lack of robust longitudinal investigations, such as randomized controlled trials. This emphasizes the need for further research with well-designed methodologies to provide a full understanding of the causative bacterial population and its pathological mechanisms. A current guideline (2023 European Society of Cardiology) was developed to support healthcare professionals in diagnosing and managing infective endocarditis; this 2023 version is introducing a new diagnostic algorithm to aid in patient classification aiming to improve outcomes for this challenging disease. The study was a priori registered on PROSPERO (CRD42023407736).

The use of propolis-based materials within endodontics to promote pulp wound healing or disinfect the root canal system has been a recent focus of scientists and clinicians. This is mainly because of the well-documented antimicrobial, anti-inflammatory, immunomodulatory and wound healing properties of propolis. This scoping review critically appraises the literature on the clinical applications of propolis-based compounds during endodontic therapy of primary and permanent teeth. An electronic literature search was performed in Scopus, PubMed, and Web of Science up to and including October 2023 to identify studies assessing the use of propolis during endodontic therapy of primary and permanent teeth. A combination of relevant Medical Subject Headings (MeSH) terms and keywords was used. Only human clinical studies written in English were included. The identified manuscripts were screened and assessed for inclusion by two independent authors. Eligible manuscripts were then subjected to critical appraisal and data extraction with the information being summarised according to their clinical application. A total of 26 human clinical studies were identified and included in the analysis. Propolis was investigated for use in the primary and permanent dentitions as a direct pulp capping or pulpotomy material as well as in root canal disinfection and root canal filling material of teeth with non-vital pulps. Overall, the included studies reported that the use of propolis was associated with promising outcomes in terms of efficacy to control inflammation, enhance tissue repair, and disinfection of the root canal system. However, a critical appraisal of the studies revealed a range of methodological and reporting deficiencies, resulting in unreliable results and conclusions in terms of the clinical outcomes reported. Although the studies on the use of propolis-based materials in endodontics reported promising clinical outcomes, they had a range of methodological and reporting flaws. Therefore, further well-designed and properly reported controlled clinical studies are essential to derive sound evidence-based conclusions on propolis-based materials. Furthermore, guidelines for quality assurance and safe use of propolis-based materials are necessary to enhance their production for commercial use in endodontics. [ABSTRACT FROM AUTHOR]

This study presents a systematic review with meta-analysis to evaluate the success rates of endodontic retreatments in teeth where separated instruments are located within the roots. The search and selection of studies were conducted across two databases, SCOPUS and PubMed, as well as the Cochrane Library registry, yielding a total of 1620 records. Following the selection process, 11 studies were included in the systematic review. Overall, out of 1133 retreated teeth, there were 172 failures in instrument removal and 55 perforations. The meta-analysis results indicate that failures are more frequent when instruments are located in the apical third, with a failure rate of 21%, compared to an 8.8% failure rate in the middle/coronal third. The anatomy of the root canals, particularly the location of the separated instruments, significantly influences the success rates. [ABSTRACT FROM AUTHOR]

Objective: To determine if the histopathological study is associated with the clinical-radiographic diagnosis of reversible and irreversible pulpitis, in patients from 3 to 8 years of age who come to the UEO. Methodology: Conventional clinical diagnostic methods were used for the clinical-radiographic evaluation of reversible and irreversible pulpitis; Likewise, an excisional biopsy of the pulp tissue of 41 dental organs that presented pulp pathology was performed using dentin cutting spoons. In the research laboratory of the Universidad Autónoma del Estado de México (UAEM), using light microscopy, the pulp tissue was studied by a stomatologist specialist and the histopathological diagnosis of the biopsies was established. Results: The McNemar statistical test (comparison of proportions for related samples) resulted in no statistically significant difference (p>0.05, 95 % CI) between the presumptive diagnosis and the confirmatory diagnosis. Limitations: No limitations were considered Value: An alternative method can be used in places where all means are not available. Conclusions: The histopathological diagnosis confirmed the clinical-radiographic diagnosis in this sample, so it is suggested to use all conventional diagnostic methods to establish a more accurate diagnosis and therefore a better treatment. [ABSTRACT FROM AUTHOR]

Aim: Design, produce and assess the viability of a novel nanotechnological antibacterial thermo‐sensible intracanal medicament This involves encapsulating calcium hydroxide (Ca(OH)2) within polylactic‐co‐glycolic acid (PLGA) nanoparticles (NPs) and dispersing them in a thermosensitive gel (Ca(OH)2‐NPs‐gel). In addition, perform in vitro and ex vivo assessments to evaluate tissue irritation and penetration capacity into dentinal tubules in comparison to free Ca(OH)2. Methodology: Reproducibility of Ca(OH)₂‐NPs was confirmed by obtaining the average size of the NPs, their polydispersity index, zeta potential and entrapment efficiency. Moreover, rheological studies of Ca(OH)2‐NPs‐gel were carried out with a rheometer, studying the oscillatory stress sweep, the mean viscosity value, frequency and temperature sweeps. Tolerance was assessed using the membrane of an embryonated chicken egg. In vitro Ca(OH)2 release was studied by direct dialysis in an aqueous media monitoring the amount of Ca(OH)2 released. Six extracted human teeth were used to study the depth of penetration of fluorescently labelled Ca(OH)2‐NPs‐gel into the dentinal tubules and significant differences against free Ca(OH)2 were calculated using one‐way anova. Results: Ca(OH)2‐NPs‐gel demonstrated to be highly reproducible with an average size below 200 nm, a homogeneous NPs population, negative surface charge and high entrapment efficiency. The analysis of the thermosensitive gel allowed us to determine its rheological characteristics, showing that at 10°C gels owned a fluid‐like behaviour meanwhile at 37°C they owned an elastic‐like behaviour. Ca(OH)2‐NPs‐gel showed a prolonged drug release and the depth of penetration inside the dentinal tubules increased in the most apical areas. In addition, it was found that this drug did not produce irritation when applied to tissues such as eggs' chorialantoidonic membrane. Conclusion: Calcium hydroxide‐loaded PLGA NPs dispersed in a thermosensitive gel may constitute a suitable alternative as an intracanal antibacterial medicament. [ABSTRACT FROM AUTHOR]

Dens invaginatus (DI) is one of the developmental dental anomalies that results in an invagination of the enamel organ into the dental papila during odontogenesis. The purpose of this study is to report a case of nonsurgical endodontic treatment of an Oehlers type II DI in a right maxillary lateral incisor with an extensive periapical damage, along with the two-year clinical and tomographic follow-up. A 30-year-old patient was referred for endodontic treatment of tooth #12. On clinical examination, a change in the shape and color of the crown was observed. The tooth responded negative to pulp sensibility, percussion, palpation and mobility tests. After tomographic evaluation, an Oehlers type II DI was visualized, in addition to an extensive periradicular lesion. The diagnosis was asymptomatic apical periodontitis. The treatment was carried out in two sessions, through intense enhancement of the auxiliary chemical substance with passive ultrasonic irrigation, XP-Endo Finisher and the use of hydroxide-based intracanal medication. Appropriate treatment in cases with anatomic variations requires an accurate and early diagnosis based on clinical examination and radiographic images. A two-year follow-up of the present case showed that the correct diagnosis associated with appropriate instrumentation techniques, supplementary disinfection, and adequate three-dimensional sealing of the canal with filling material, resulted in regression of the periradicular lesion and bone repair. [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]

Key Clinical Message: The main objective of root canal therapy is to locate all the canals, cleaning, and shaping, and obturation to obtain fluid tight seal and to heal the periapical lesion if present. The proper cleaning, shaping, and disinfection of the pulp chambers, as well as the filling of the canals, are critical to the efficacy of treatment with root canals. The success of an endodontically treated tooth is dependent on the accuracy of the diagnosis, disinfection, cleaning and shaping, obturation, and finally, the prosthetic rehabilitation management. Root canal therapy should provide a hermatic as well as fluid impenetrable seal which prevents the progression of periapical infection. There are two ways to treat such lesions: surgical and nonsurgical methods. If the root canal is cleaned, shaped, and sealed properly and adequately without the use of a surgical procedure, these lesions will recover during nonsurgical root canal therapy. This case series focuses primarily on the nonsurgical treatment of an enormous periapical lesion and provides evidence that these lesions respond well without surgery. [ABSTRACT FROM AUTHOR]

IntroductionThe objectives of the present study were (1) to describe the anatomy of the endodontic system of the dog's maxillary fourth premolar tooth (MxPM4) in relation to the morphology of the crown, (2) to determine if variations of the endodontic system exist, and (3) to look at the implications for endodontic treatment.MethodsTen MxPM4 were harvested en bloc and scanned using micro-computed tomography (micro-CT).ResultsThe morphology of the pulp chamber mostly corresponded with the shape of the crown. Three pulp horns were clearly visible and related to the paracone, the metacone, and the metastyle. Nevertheless, the pulp horns of the metacone and metastyle could be fused, partially fused or distinct. Other pulp projections were also present, but rarely, in the parastyle, the protocone, and the plesioconule. All teeth showed a noticeable angulation of an average of 150 degrees at the coronal third of the mesiopalatal canal.DiscussionThus, the most common transcoronal approach for root canal treatment does not allow a straight access to the apex. There were also minor variations in the locations of the canal orifices. This first micro-CT study of the MxPM4 in dogs showed anatomical features and variations of the pulp cavity that have not been described before.

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.

Aim of study. The aim of the present study was to assess the prevalence of periapical lesions in root-filled lateral teeth as well as the distribution of periapical lesions according to various factors that can influence the therapeutic outcome. Materials and method. The study group included 163 patients (gender: 58 males, 105 females; mean age 48.13 ± 14.708 yrs.) with at least 2-yrs. follow-up of 412 endodontically treated teeth. Following the radiographic assessment of the root and its periapical area, the root canal treatments were classified as adequate and poor, while the apical lesions was diagnosed on radiographic examen. The quality of coronal marginal sealing (poor, adequate) was assessed by radiographic examen. The distribution of apical lesion was assessed on socio-demographical parameters (gender, age groups), location (maxillary, mandibular), follow-up, quality of root canal filling, status of coronal marginal sealing, occlusal contacts, recurrent caries. Results. Periapical lesions prevalence in root-filled lateral teeth was as follows: gender (males- 47,3%; females- 50,2%); age groups (20-39 yrs.- 41,9%; 40-59 yrs.- 52,4%; ≥60 yrs.- 47,4%); follow-up (2-4 yrs.- 57,7%; 5-8 yrs.- 44,5%) (p=.010*); location (maxillary teeth- 46,1%; mandibular teeth- 54,5%). 58% of teeth with poor coronal marginal sealing, and 59% of teeth with poor root canal fillings were diagnosed with AP. Conclusions. Apical lesions were detected in 49.3% of the lateral root-filled teeth. Molars, poor root canals fillings, poor coronal marginal sealing, presence of recurrent caries were significantly associated with endodontic periapical lesions.

Aim of study. The aim of the present study was to assess the prevalence of periapical lesions in root-filled lateral teeth as well as the distribution of periapical lesions according to various factors that can influence the therapeutic outcome. Materials and method. The study group included 50 patients (gender: 12 males, 38 females; mean age 51.48 ± 13.218). A total number of 150 anterior root-filled teeth were evaluated at 2-8 yrs. post-treatment. Following the radiographic assessment of the root and its periapical area, the root-canals fillings were classified as adequate and poor. The status of periapical area was assessed on periapical radiographic images. The quality of coronal marginal sealing was assessed as poor or adequate by clinical and radiographic examen. The distribution of apical periodontitis was assessed according to socio-demographical parameters (gender, age groups), location (maxillary, mandibular), follow-up, quality of root canal filling, status of coronal marginal sealing, recurrent caries. Results. The global prevalence of apical periodontitis was 50,7%. The prevalence of apical periodontitis in root-filled anterior teeth was as follows: gender (males- 37,5%; females- 54,2%); age groups (20-39 yrs.- 30%; 40-59 yrs.- 52,9%; ≥60 yrs.- 57,1%); location (maxillary teeth- 42,4%; mandibular teeth- 81,3%). The prevalence of apical periodontitis was 70% in teeth with poor coronal marginal sealing, and 61,4% in teeth with poor root canal fillings. Conclusions. Apical periodontitis was detected in half of the anterior root-filled teeth. The rate of apical periodontitis was significantly increased in maxillary anterior teeth, poor root canals fillings, poor coronal marginal sealing, and root-filled teeth with the presence of recurrent caries.

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.

Introduction: this study aimed to compare the efficacy of two different endodontic activation systems in removing debris from the mesial canals of mandibular molars across root thirds. Methods: the mesial canals of fifteen human mandibular first molars were prepared with files, irrigated with 2.5 % sodium hypochlorite and 17 % EDTA, and divided into three groups (n=5) based on the type of activation: Control (activation with master cone), Ultrasound Irrigation (UI), and Ultra X (Passive Ultrasonic Irrigation - PUI). The roots were sectioned into thirds (cervical, mid, and apical), exposing root canals, and prepared for scanning electron microscopy. A total of 135 microphotographs (3 microphotographs for each root level) were obtained. To determine the most effective activation system, three calibrated endodontic specialists evaluated all images. Data were analyzed using the Kruskal-Wallis test (95 %). Results: the PUI system demonstrated the highest efficacy, followed by UI, while the control was the least efficient (p

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. [ABSTRACT FROM AUTHOR]

Purpose: This study evaluated the dentin bonding strength and biomineralization effect off a recently developed premixed calcium aluminate-based endodontic sealer (Dia-Root Bio Sealer) in comparison with existing calcium silicate-based sealers. Methods: The root canals off 80 mandibular premolars were filled with Dia-Root Bio Sealer, Endoseal MTA, EndoSequence BC Sealer, and AH Plus Bioceramic Sealer. Medial and apical specimens were then obtained by sectioning. The push-out bond strength was measured using the medial specimens, and the failure mode was recorded. Intratubular biomineralization in the apical specimens was analyzed using scanning electron microscopy and energy-dispersive X-ray spectroscopy (EDS). The data were analyzed using one-way analysis of variance followed by the Tukey test (P < 0.05). Results: The push-out bond strength of Dia-Root Bio Sealer was signif- cantly higher than that of the other tested materials, and a cohesive failure pattern was observed in all groups. Dia-Root Bio Sealer also exhibited a signifcantly higher degree of biomineralization than the other groups, and EDS analysis indicated that the biomineralized precipitates were amorphous calcium phosphate. Conclusion: The results of this study indicate that Dia-Root Bio Sealer has the potential to be used as an adequate root canal sealer due to its favorable bonding performance. [ABSTRACT FROM AUTHOR]

Copyright of Aydin Dental Journal is the property of Aydin Dental Journal 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.)

Objectives: The aim was to determine whether premixed calcium silicate-based root canal sealers have better biological properties than AH Plus. Materials and Methods: Searches of studies published up to January 2023 were performed in the PubMed/MEDLINE and EMBASE and via other methods (databases of the International Endodontic Journal, Journal of Endodontics, and gray literature). The inclusion criteria were in vivo animal and in vitro studies that analyzed the response in the dorsal subcutaneous tissue of rats, cell viability, and genotoxicity. Systematic Review Centre for Laboratory Animal Experimentation Risk of Bias (RoB) tool for in vivo studies and modified CONSORT checklist for in vitro were appraised. Meta-analysis was performed using the Stata. Results: Fifty-two studies were included. In the RoB, in vivo studies fulfilled 20%-50% of the items and in vitro 60%-100%. The studies included in the meta-analysis demonstrated better histocompatibility with the premixed calcium silicate-based sealers at 30 days and greater cell viability with these sealers when used in undiluted extracts in experimental period of 72 h and in extracts with 1:2 and 1:4 dilution in 24 and 72 h. In contrast, no difference between materials was found concerning genotoxicity. Conclusion: Premixed calcium silicate-based root canal sealers have better histocompatibility and are less cytotoxic than the epoxy resin-based sealer AH Plus, demonstrating favorable biological behavior. [ABSTRACT FROM AUTHOR]

Key Clinical Message The main objective of root canal therapy is to locate all the canals, cleaning, and shaping, and obturation to obtain fluid tight seal and to heal the periapical lesion if present. Abstract The proper cleaning, shaping, and disinfection of the pulp chambers, as well as the filling of the canals, are critical to the efficacy of treatment with root canals. The success of an endodontically treated tooth is dependent on the accuracy of the diagnosis, disinfection, cleaning and shaping, obturation, and finally, the prosthetic rehabilitation management. Root canal therapy should provide a hermatic as well as fluid impenetrable seal which prevents the progression of periapical infection. There are two ways to treat such lesions: surgical and nonsurgical methods. If the root canal is cleaned, shaped, and sealed properly and adequately without the use of a surgical procedure, these lesions will recover during nonsurgical root canal therapy. This case series focuses primarily on the nonsurgical treatment of an enormous periapical lesion and provides evidence that these lesions respond well without surgery.

Abstract Aim To compare and evaluate the sealing ability of four different commercially available sealers to provide seal against the dye penetration test using a stereomicroscope-an in-vitro study. Material/Method 80 extracted single rooted mandibular premolar with single canal were used in this study. The samples were divided in 4 groups (20 in each) based on sealer. Group I (Diaproseal), Group II (apexit Plus), Group III (MTA Fillapex) and Group IV (Bio-C). The samples were analyzed using a stereomicroscope and data analysis was done with one-way Anova And post hoc Tukey’s test. Result The mean dye penetration score was 1.2400 ± 0.778 mm for Group I. 2.6000 ± 0.897 mm for Group II, 4.2000 ± 0.923 mm for Group III and 4.225 ± 2.055 mm for Group IV. One-way Anova analysis shows that intergroup comparison was statistically significant between the four groups. The post hoc Tukey’s test reveals that the difference was statistically non-significant between group III and group IV. Conclusion It was concluded that between the four groups the Group I (Diaproseal) showed the least dye penetration followed by Group II (Apexit Pus), Group III (MTA Fillapex) and then Group IV (Bio-C), where there was no significant difference between the Group III (MTA Fillapex) and Group IV (Bio-C).

Background. Root canals feature a high incidence of post-treatment flare-ups, characterized by pain, swelling, or discomfort following endodontic procedures, which remain a concern in dental practice. This study aims to evaluate the host-related factors behind the prevalence of post-endodontic flare-ups. Methodology. A retrospective study was conducted on the records of 93 patients who were treated endodontically between January 2017 and December 2021. Data extracted from records included age, medical conditions, diagnosis, and tooth type. SPSS 27.0 was used to analyze the data. Multivariate logistic regression analysis was employed to identify significant predictors while controlling for potential confounding factors. Results. The flare-up rate among patients who had received endodontic treatment was 31.2% in the study population. Multivariate logistic regression analysis demonstrated that age and the presence of a vital pulp were significant predictors of flare-ups. Older patients exhibited an increased likelihood of experiencing flare-ups (p 0.05). Conclusion. The study provided insights into the frequency of post-endodontic flare-ups and the impact of host-related factors on their occurrence. Age and vital pulp were found to be important predictors, highlighting the significance of individualized treatment planning. These results highlight the possibility of improved patient outcomes through a thorough understanding of post-endodontic problems and contribute to evidence-based endodontic practice.

Objective: This study aimed to assess canal morphology of maxillary first molars by analyzing cone beam computed tomography (CBCT) images.Methods: A total of 324 maxillary first molars were collected from the Turkish population and scanned using the in vitro CBCT method. The number of roots and canals, root canal configuration, canal shape, the presence of a C-shaped canal, apical delta, and lateral canal, as well as the distance between radiographic and anatomic apices were examined.Results: The majority of the samples (97.9%) had 3 separate roots; while the remaining teeth had two or four roots (1.5% and 0.6% respectively). CBCT results showed 2, 3, 4, and 5 root canals in 0.3%, 47.9%, 50.3% and 1.5% of the teeth, respectively. All distobuccal (DB) and palatal (P) roots had one canal. The mesiobuccal (MB) roots frequently showed a second mesiobuccal canal (MB2). The most common canal morphology in the MB roots was type I (33.1%), followed by type II and type III (29.0% and 9.8%, respectively). The P and DB roots commonly showed a type I canal configuration. C-shaped canals were rare. The mean distances between radiographic and anatomic apices in MB, DB, and P roots were 0.77 ± 0.45, 1.68 ± 0.9 and 0.91 ± 0.46 mm, respectively.Conclusions: The MB roots of maxillary first molars showed greater variations in their canal anatomy than other roots. These anatomical differences, potentially attributable to ethnic variations, should be considered when performing surgical or nonsurgical root canal treatments on maxillary molars.

Eradication of microorganisms present in the root canal system during endodontic therapy is one of the critical factors affecting the final outcome of endodontic treatment. However, even adequate technique of the root canal treatment and use of irrigants according to the established protocol does not lead to the complete elimination of microorganisms during endodontic treatment. The presence of Enterococcus (E.) faecalis inside the root canal system may be an important factor contributing to the failure of the treatment. Introducing agitation techniques in irrigation, such as passive ultrasonic irrigation (PUI) and the use of the activating instrument XP-endo Finisher (XPF), contribute to a better debridement and disinfection of the root canal. This study was conducted on 42 root canals experimentally inoculated with E. faecalis and exposed to three irrigation protocols. These have included a standard irrigation protocol using a syringe and needle, passive ultrasonic irrigation, and activation of the irrigant using an XPF instrument. The reduction in microorganisms was evaluated using the quantitative polymerase chain reaction in real-time (RT-PCR) as well as via the method of determining the number of colony forming units on nutrient medium (CFUs). The results of this study showed that the use of supplementary irrigation protocols, PUI, and XPF led to a significant decrease in the number of microorganisms inside the root canal of experimental teeth. These findings indicate a significant positive impact of these procedures on the disinfection of the root canal system.

Apical lesions are diseases of infectious origin that can cause destruction of the surrounding periapical tissue, including bone tissue and periodontal ligaments, resulting in the loss of the affected teeth. Currently, the microorganisms present in pulp and apical disease are mostly studied as bacteria. However, in recent years, interest has been aroused in the study of viruses that could be present in apical lesions, and how these could affect the progression of disease. In the present study, we conducted a systematic review of the literature to evaluate and synthesize the scientific evidence on the presence of viruses and their possible role in pulpal and apical disease. This systematic review was performed according to the PRISMA reporting guidelines. The search for studies was performed in the PubMed and Web of Science databases. A total of seven studies published in the last 10 years were included. The types of samples used for virus analysis varied from one study to another. In all the included studies, the presence of any of the types of viruses studied was found, either in pulp or apical tissue. Herpesviridae family, Epstein–Barr virus (EBV) and Human cytomegalovirus (HCMV) stood out as the most commonly present in apical lesions. Further studies are required to clarify and understand the pathogenic role of viruses in pulpal and periapical disease.

Aim : To compare and evaluate the sealing ability of four different commercially available sealers to provide seal against the dye penetration test using a stereomicroscope-an in-vitro study. Material/Method : 80 extracted single rooted mandibular premolar with single canal were used in this study. The samples were divided in 4 groups (20 in each) based on sealer. Group I (Diaproseal), Group II (apexit Plus), Group III (MTA Fillapex) and Group IV (Bio-C). The samples were analyzed using a stereomicroscope and data analysis was done with one-way Anova And post hoc Tukey's test. Result : The mean dye penetration score was 1.2400 ± 0.778 mm for Group I. 2.6000 ± 0.897 mm for Group II, 4.2000 ± 0.923 mm for Group III and 4.225 ± 2.055 mm for Group IV. One-way Anova analysis shows that intergroup comparison was statistically significant between the four groups. The post hoc Tukey's test reveals that the difference was statistically non-significant between group III and group IV. Conclusion : It was concluded that between the four groups the Group I (Diaproseal) showed the least dye penetration followed by Group II (Apexit Pus), Group III (MTA Fillapex) and then Group IV (Bio-C), where there was no significant difference between the Group III (MTA Fillapex) and Group IV (Bio-C). [ABSTRACT FROM AUTHOR]

Copyright of Revista Facultad de Odontología Universidad de Antioquia is the property of Universidad de Antioquia 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.)

Objective The aim of this article was to evaluate the influence of mesial root canal preparation of mandibular molars with the reciprocal systems (RCP) and self-adjusting file (SAF) in the incidence of voids spaces in endodontic obturation performed by modified continuous wave compaction (MCWC) technique, through images obtained in micro-computed tomography (micro-CT). Materials and Methods Mesial roots of 15 mandibular molars, with two independent root canals, were divided into three groups (n = 5/roots), according to the endodontic instrumentation strategy (RCP, SAF, and twisted file [TWF]). After the root canals (n = 10, for each instrumentation system) were filled with MCWC, images of each specimen were obtained by micro-CT followed by three-dimensional reconstruction. The percentage of voids was obtained (in mm 3) in relation of the total volume, cervical–middle, and apical thirds. Statistical Analysis The data obtained were submitted to statistical analysis by Kruskal–Wallis and Dunn tests (p < 0.05). Results With respect to the total volume of root canal, TWF demonstrated a lower percentage in comparison to SAF (p < 0.05). No significant difference was obtained between TWF and RCP or RCP and SAF (p > 0.05). In the apical third, RCP showed a smaller percentage of voids when compared with SAF (p < 0.05); however, TWF demonstrated similarity with RCP and SAF (p > 0.05). The middle–cervical third exhibited no statistically difference between TWF and RCP or RCP and SAF (p > 0.05), whereas TWF was lower than SAF (p < 0.05). Conclusion Root canal preparation of mesial root of mandibular molars with TWF provides a lower incidence of voids in the endodontic filling performed by MCWC. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to compare efficacy in removing filling material remaining in oval and curved canals using different complementary cleaning methods. Material and methods: Sixty single-rooted tooth with oval shaped canal with curvature were prepared up to size 25 and .08 taper, filled and subsequently retreated. The teeth were then scanned in micro-CT and divided into 6 groups (n = 10) according to the complementary cleaning method: CUI with Irrisafe, CUI with NiTiSonic, PUI with Irrisafe, PUI with NiTiSonic, Eddy and XP-endo Finisher R. After, the teeth were newly scanned in micro-CT. The volume of the filling material remaining before and after the application of the complementary methods was calculated and then calculated the percentage of material removed total and in the apical region. Data were submitted to the Kruskal-Wallis, Dunn and Wilcoxcon tests with a significance level of 5%. Results: No suplementary cleaning method completely removed the remaining of filling material, however, all significantly reduced the volume, both in the apical region and in the total root canal (p<0.05). There was no significant difference among the groups tested, regardless of the region analyzed (p>0.05). Conclusion: No method was effective in completely removing the remaining filling material. All complementary cleaning methods significantly reduce the volume of material, with no difference among them. [ABSTRACT FROM AUTHOR]

Numerous failures in root canal treatment (RCT), attributed to the persistence of adverse microbiota, prompted researchers to develop a biomaterial with effective antibacterial and antifungal properties. In our systematic review, emphasis was placed on examining the antimicrobial properties of gutta-percha, the most used material for root canal obturation. The review aimed to determine whether gutta-percha demonstrated adequate antibacterial and antifungal features. Additionally, it sought to identify specific substances added to gutta-percha's composition that could enhance the success rate of root canal obturation. On October 30, 2023, electronic searches were systematically performed in the PubMed, Web of Science (WoS), and Scopus databases using the specified keywords: ((antibacterial) OR (antimicrobial)) AND ((gutta-percha) OR guttapercha)). A thorough evaluation commenced, with an initial pool of 330 studies, from which 174 duplicates were methodically identified and removed. The ultimate dataset for qualitative synthesis consisted of 26 studies. The results of the compared studies did not unequivocally indicate whether the use of gutta-percha alone exhibits antibacterial or antifungal effects. Among the six studies demonstrating results supporting gutta-percha's antimicrobial activity, five showed activity against Enterococcus faecalis. Conversely, six studies concluded that gutta-percha lacks any discernible antimicrobial features. One study even suggested that gutta-percha might promote the progression of bacterial development. However, eight out of nine studies demonstrated an increase in gutta-percha's antimicrobial properties after the addition of chlorhexidine. Furthermore, calcium hydroxide and iodoform also improved gutta-percha's properties, showing promising results. Unfortunately, none of the materials added to gutta-percha displayed comprehensive improvement in its antimicrobial efficacy, including activity against Enterococcus faecalis. The review demonstrated the benefit of enhancing gutta-percha with chlorhexidine, calcium hydroxide, and iodoform. Nevertheless, achieving the inactivation of Enterococcus faecalis posed a challenge. [ABSTRACT FROM AUTHOR]

Objectives: In order to test the resistance of rotary instruments to cyclic fatigue fracture and its importance in root canal preparationthe purpose of this study was to see how different tapers (4% and 6%) affected the cyclic fatigue resistance of the Edge File X7 and 2Shape endodontic systems at 45° and 60° canal curvature. Methods: Eighty NiTi files from two different systems (N= 40 each) were used; Group 1: Edge File X7, Group 2: 2Shape. each group was subdivided into four subgroups (N= 10 for each subgroup). The files were evaluated for cyclic fatigue resistance using a modified custom-made static model with 45°and 60° angles having a radius of 3mm and a diameter of 1.5 mm. Each file was rotated in a continuous rotation motion at 300 rpm with 1.2 N.cm torque for TS1, 300 rpm with 2.5 N.cm torque for TS2, and Edge file X7 was used at 300 rpm and 3 N.cm. Until it fractured. The time it took to separate the files was noted. Each file's number of cycles to failure was computed. A Kolmogorov-Smirnova normality test was done for all groups, and a two-way ANOVA was used to statistically examine the data. Results: The ranking of the groups from the highest to the lowest NCF was as follows: EdgeFile 4% 45 degrees (6594.00), EdgeFile 6% 45 degrees (6317.90), EdgeFile 4% 60 degrees (5682.00), EdgeFile 6% 60 degrees (2142.00), 2Shape 4% 45 degrees (2517.00), 2Shape 4% 60 degrees (535.90), 2Shape 6% 45 degrees (474.50), and 2Shape 6% 60 degrees (213.00). Conclusions: Edge File X7 showed better results than the 2Shape system. EdgeFile X7 4% at 45 degrees showed the highest NCF. The 2Shape system 6% at 60 degree that showed lowest NCF. As the canal curvature increased the NCF decreased. Taper 4% is better than taper 6%. [ABSTRACT FROM AUTHOR]

Aim: The aim of the study was to assess the tolerance to the new root canal irrigation fluid RISA after root canal treatment (RCT) by evaluating the subject's postoperative well‐being, postoperative pain (PP) and treatment outcome. Methodology: A single‐arm prospective study with 16 subjects (17 teeth) diagnosed with asymptomatic apical periodontitis. Endodontic treatment in one session performed using RISA for root canal irrigation. Well‐being was assessed on the same day and after 24 h by telephone. For pain intensity, a visual analogue scale was used at 0–5 days. Clinical and radiographic evaluations were performed at ≥12 months. Well‐being, occurrence of PP and outcome were qualitatively reported. Friedman test for paired samples and Spearman correlation coefficient were used. Significance was set at p <.05. Results: At the same day and after 24 h, 14/16 subjects felt 'good'. 9/16 presented intra‐ or extra‐oral swelling. The frequency of PP ≥36 (weak) was 82.4%. On the same day, 1 and 2 days postoperatively, there was more pain compared with preoperative pain p <.05. At Day 3, PP equalled preoperative pain (p >.05). 62.5% of subjects needed analgesics Day 0–2. The recall rate was 94.1%, and resolution of apical periodontitis was observed in 87.5%. Conclusions: The well‐being of subjects was good, and the overall PP intensity was low. However, postoperative intra‐ and extra‐oral swelling occurred often. At the recall visit, the effectiveness of the RCT with RISA appeared high (87.5%). The encouraging outcome results plus the fact that RISA has a broader action range than NaOCl in vitro, justify further work on the RISA solution. To reduce postoperative swelling, it is advised to further investigate the optimal way of application of RISA in the laboratory before clinical application is recommended. [ABSTRACT FROM AUTHOR]

Objective: To assess the effect of different irrigating solutions (Normal saline, 5.25% NaOCl and 90% Ethanol) on apical sealing ability of resin based root canal sealer filled with single cone obturation technique in extracted teeth. Methods: From March 2022 to September 2022, the case control research was carried out at the Department of Operative Dentistry, Karachi Medical and Dental College in Karachi. Sample size of 30 single root teeth were decoronated and roots were divided into Group A and B. Group B is subdivided into two cases according to the type of irrigating solution used. Group A irrigation solutions include 5ml of Normal saline solution, while group B include 5ml of 5.25% Sodium Hypochlorite and 5ml of 90% Ethanol solution. Teeth were prepared, obturated, placed in 2% methylene blue dye and extent of dye penetration was done under a digital stereomicroscope and maximum leakage was measured by using software. Data was analyzed on SPSS version 26.0. Results: All solutions were normally distributed. While comparing both groups, Ethanol has the lowest mean value of dye penetration i.e. 1.07±0.63 which means that this irrigating solution has least micro leakage and provides effective seal of resin sealer to the root canal wall filled by using single cone obturating technique. Case group irrigation solutions has significant p-value i.e. 0.000 which indicates absolute absence of micro leakage. Upon Comparison of mean value of Sodium Hypochlorite and Ethanol, Ethanol is more efficient irrigation solution as it has shown lesser dye penetration as compared to Sodium Hypochlorite. Conclusion: It has been concluded that among all the solutions, Ethanol has proved to be the most effective irrigation solution followed by Sodium Hypochlorite, showed least dye penetration and hence least micro leakage. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to assess canal morphology of maxillary first molars by analyzing cone beam computed tomography (CBCT) images. Methods: A total of 324 maxillary first molars were collected from the Turkish population and scanned using the in vitro CBCT method. The number of roots and canals, root canal configuration, canal shape, the presence of a C-shaped canal, apical delta, and lateral canal, as well as the distance between radiographic and anatomic apices were examined. Results: The majority of the samples (97.9%) had 3 separate roots; while the remaining teeth had two or four roots (1.5% and 0.6% respectively). CBCT results showed 2, 3, 4, and 5 root canals in 0.3%, 47.9%, 50.3% and 1.5% of the teeth, respectively. All distobuccal (DB) and palatal (P) roots had one canal. The mesiobuccal (MB) roots frequently showed a second mesiobuccal canal (MB2). The most common canal morphology in the MB roots was type I (33.1%), followed by type II and type III (29.0% and 9.8%, respectively). The P and DB roots commonly showed a type I canal configuration. C-shaped canals were rare. The mean distances between radiographic and anatomic apices in MB, DB, and P roots were 0.77 ± 0.45, 1.68 ± 0.9 and 0.91 ± 0.46 mm, respectively. Conclusions: The MB roots of maxillary first molars showed greater variations in their canal anatomy than other roots. These anatomical differences, potentially attributable to ethnic variations, should be considered when performing surgical or nonsurgical root canal treatments on maxillary molars. [ABSTRACT FROM AUTHOR]

The aim of the study was to evaluate the influence of resin cement material types on tooth with endocrown and onlay restorations. The first molar was scanned using Micro‐CT and underwent a modelling process to obtain the 3D model for computational simulation. Eight models were simulated in the current study with two loading conditions (720N vertical load and 200N oblique load), two types of restoration (onlay and endocrown restorations), and two resin cement variants (dual‐cure resin cement and light‐cure resin cement). The tooth with onlay restoration showed a significant stress reduction (up to 70%) when using light‐cure resin cement compared to dual‐cure resin cement. In contrast, types of cement did not affect stress distribution in the tooth with endocrown restoration. The current study found that dual‐cure resin cement was preferable in Endocrown and Onlay restorations, due to dual‐cure resin cement provided better bond strength compared to light‐cure resin cement. [ABSTRACT FROM AUTHOR]

The purpose of this study was to assess the effect of a calcium silicate‐based sealers (CeraSeal) and an epoxy resin‐based sealer (AH Plus) on cytotoxicity and cell migration of stem cell from the human apical papilla (hSCAPs) by using the Alamar Blue, Annexin V‐FICT and wound healing assays. In Alamar Blue assay, hSCAPs exposed to undiluted CeraSeal extract had significantly higher cell viability compared with that observed when cells were treated with AH Plus in all experimental period (p < 0.001). The flow cytometry analysis confirmed the comparison on viable cells and indicated that AH Plus increased apoptosis compared to CeraSeal and the control groups (p < 0.001). Additionally, AH Plus exhibited significantly lower level of cell migration than CeraSeal and the control for up to 48 h observation (p < 0.01). In summary, calcium silicate‐based sealer (CeraSeal) is less cytotoxic and more biocompatible than epoxy resin‐based sealer (AH Plus). [ABSTRACT FROM AUTHOR]

Objectives: In order to test the resistance of rotary instruments to cyclic fatigue fracture and its importance in root canal preparationthe purpose of this study was to see how different tapers (4% and 6%) affected the cyclic fatigue resistance of the Edge File X7 and 2Shape endodontic systems at 45° and 60°canal curvature. Methods: Eighty NiTi files from two different systems (N= 40 each) were used; Group 1: Edge File X7, Group 2: 2Shape. each group was subdivided into four subgroups (N= 10 for each subgroup). The files were evaluated for cyclic fatigue resistance using a modified custom-made static model with 45°and 60° angles having a radius of 3mm and a diameter of 1.5 mm. Each file was rotated in a continuous rotation motion at 300 rpm with 1.2 N.cm torque for TS1, 300 rpm with 2.5 N.cm torque for TS2, and Edge file X7 was used at 300 rpm and 3 N.cm. Until it fractured. The time it took to separate the files was noted. Each file's number of cycles to failure was computed. A Kolmogorov-Smirnova normality test was done for all groups, and a two-way ANOVA was used to statistically examine the data. Results: The ranking of the groups from the highest to the lowest NCF was as follows: EdgeFile 4% 45 degrees (6594.00), EdgeFile 6% 45 degrees (6317.90), EdgeFile 4% 60 degrees (5682.00), EdgeFile 6% 60 degrees (2142.00), 2Shape 4% 45 degrees (2517.00), 2Shape 4% 60 degrees (535.90), 2Shape 6% 45 degrees (474.50), and 2Shape 6% 60 degrees (213.00). Conclusions: Edge File X7 showed better results than the 2Shape system. EdgeFile X7 4% at 45 degrees showed the highest NCF. The 2Shape system 6% at 60 degree that showed lowest NCF. As the canal curvature increased the NCF decreased. Taper 4% is better than taper 6%.

Objective: The aim of this study was to explore the factors associated with the survival of root canal treated teeth in a practise-based study setting in a 5-year period. Material and methods: This retrospective study used data from the electronic patient registration system of the public dental services of the City of Oulu, Finland. The inclusion criteria for this study were patients aged ≥ 20 years who had root canal treatment (RCT) that was initiated in 2014. One RCT per patient was included in the study. A total of 713 patients met the inclusion criteria. The outcome variable for this study was the extraction of the RCT tooth during the 5-year period. Explanatory variables included age, diagnosis, tooth type (incisive, canine, premolar, molar), RCT technique (manual, motorized), time from RCT initiation to final restoration and type of final restoration (composite, glass ionomer, fixed dental prosthesis). To evaluate the association between the outcome variable and explanatory variables, Cox regression analyses were performed. Results: The overall survival rate was 91%. The middle-aged (40–59-years-old) and the oldest (60 and older) patients had a two-fold risk of extraction compared to younger (20–40-years-old) patients. Similarly, a short length of time from RCT initiation to final restoration (0–14 days) resulted in a nearly three times higher risk of extraction compared to a longer period (≥ 90 days). Conclusions: The 5-year survival rate of RCTs seems high. Extractions were more common among patients over 40 years of age and if the RCT was completed shortly after its initiation.

Objective: The aim of the study was to assess the awareness of patients visiting the dental Outpatient Department of JSS Dental College Hospital regarding coronavirus symptoms and their willingness to get dental treatment done during this period. Materials and Methods: Five hundred and twenty-five patients in the age group of 25–65 years who reported to the department of conservative dentistry and endodontics during 6 months were assessed for coronavirus symptoms using a questionnaire of descriptive statistics and analysis. Results: Patients were willing to undergo treatment during the pandemic (97%). Conclusion: Irrespective of the coronavirus, patients seem to be keen to get either their restorative or endodontic treatment done, which shows that the patients are not completely aware of the spread of COVID-19 infection and awareness programs have to be conducted to educate people.