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Iparraguirre Nuñovero MF, Hungaro Duarte MA, Kaled Segato AV, da Silva Neto UX, Portela Ditzel Westphalen V, Carneiro E. The effect of intracanal cryotherapy with and without foraminal enlargement on pain prevention after endodontic treatment: a randomized clinical trial. Sci Rep 2024; 14:19905. [PMID: 39191915 PMCID: PMC11349753 DOI: 10.1038/s41598-024-70901-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Accepted: 08/22/2024] [Indexed: 08/29/2024] Open
Abstract
This randomized clinical trial aims to evaluate cryotherapy as a therapeutic option for pain prevention after endodontic treatment with and without foraminal enlargement, in patients with asymptomatic apical periodontitis.120 teeth of patients with preoperative Visual Analogue Scale score indicating zero were treated. Specimens were randomly allocated into 4 groups: Control, Cryotherapy (ICT), Foraminal Enlargement (FE), and Cryotherapy and Foraminal Enlargement (ICT + FE). Working length was determined with an Electronic Apex Locator (EAL). Cryotherapy groups passed through a final irrigation protocol using 20 ml (2.5 ℃) of cold saline solution delivered at working length for 5 min. In FE groups a #40 K-file was used up to the 0.0 mark on the EAL display. Obturation was performed and postoperative pain was checked at 6, 12, 24, 48, and 72 h and 7 days after endodontic treatment.All experimental groups showed an increase in the level of postoperative pain, which started to decrease after 12 h. Foraminal enlargement caused a statistically significant increase in postoperativepain compared to ICT and control groups within the first 6 h (p < 0.05). Cryotherapy did not influence postoperative pain, regardless of whether or not foraminal enlargement was performed.
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Affiliation(s)
- Marcos Felipe Iparraguirre Nuñovero
- Department of Endodontic, School of Medicine and Health Science, Pontifícia Universidade Católica Do Paraná, Imaculada Conceicão, 1155, Prado Velho, Curitiba, PR, 80215-901, Brazil
| | - Marco Antonio Hungaro Duarte
- Department of Restorative Dentistry, Dental Materials and Endodontics, Bauru School of Dentistry, University of São Paulo - USP, Bauru, SP, Brazil
| | - André Vinícius Kaled Segato
- Department of Endodontic, School of Medicine and Health Science, Pontifícia Universidade Católica Do Paraná, Imaculada Conceicão, 1155, Prado Velho, Curitiba, PR, 80215-901, Brazil
| | - Ulisses Xavier da Silva Neto
- Department of Endodontic, School of Medicine and Health Science, Pontifícia Universidade Católica Do Paraná, Imaculada Conceicão, 1155, Prado Velho, Curitiba, PR, 80215-901, Brazil
| | - Vania Portela Ditzel Westphalen
- Department of Endodontic, School of Medicine and Health Science, Pontifícia Universidade Católica Do Paraná, Imaculada Conceicão, 1155, Prado Velho, Curitiba, PR, 80215-901, Brazil
| | - Everdan Carneiro
- Department of Endodontic, School of Medicine and Health Science, Pontifícia Universidade Católica Do Paraná, Imaculada Conceicão, 1155, Prado Velho, Curitiba, PR, 80215-901, Brazil.
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Barbosa AFA, Silva EJNL, Versiani MA, Lima CO, Oliveira LDAPR, Massa GDS, Eustáquio TCDS, Lopes RT, Sassone LM. Effects of increasing instrument size and taper on the disinfection and shaping of mandibular incisors. AUST ENDOD J 2024; 50:341-351. [PMID: 38715465 DOI: 10.1111/aej.12851] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2024] [Revised: 04/17/2024] [Accepted: 04/22/2024] [Indexed: 08/13/2024]
Abstract
This study assessed canal preparation effects on disinfection and dentin preservation. Thirty mandibular incisors were paired into two experimental groups (n = 10). Following contamination, the initial microbial sample was collected. Instruments 30/0.03 (Group 1) and 30/0.05 (Group 2) were employed and a second sample was obtained. Canals were enlarged using instruments 40/0.03 and 40/0.05, respectively, and a third sample was collected. Final irrigation was performed, and sample S4 obtained. A final scan evaluated volume, surface area, unprepared areas, removed dentin and dentin thickness. Data were analysed using Student t-test, Mann-Whitney, Kruskal-Wallis and Dunn tests. A significant difference was observed between S1 and other time points (p < 0.05). Comparison between groups showed no differences in bacterial loads and in the percentage of microbial reduction (p > 0.05). Group 2 exhibited greater reduction in dentin thickness than group 1 in the mesial aspect of the root (p < 0.05). Instrument 30/0.03 might provide effective disinfection and safety during mandibular incisors canal preparation.
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Affiliation(s)
- Ana Flávia Almeida Barbosa
- Department of Endodontics, School of Dentistry, State University of Rio de Janeiro (UERJ), Rio de Janeiro, Rio de Janeiro, Brazil
| | - Emmanuel João Nogueira Leal Silva
- Department of Endodontics, School of Dentistry, State University of Rio de Janeiro (UERJ), Rio de Janeiro, Rio de Janeiro, Brazil
- Department of Endodontics, School of Dentistry, Grande Rio University (UNIGRANRIO), Rio de Janeiro, Rio de Janeiro, Brazil
| | | | - Carolina Oliveira Lima
- Department of Endodontics, School of Dentistry, State University of Rio de Janeiro (UERJ), Rio de Janeiro, Rio de Janeiro, Brazil
| | | | - Graziela Dos Santos Massa
- Department of Endodontics, School of Dentistry, State University of Rio de Janeiro (UERJ), Rio de Janeiro, Rio de Janeiro, Brazil
| | | | - Ricardo Tadeu Lopes
- Nuclear Engineering Program, Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, Rio de Janeiro, Brazil
| | - Luciana Moura Sassone
- Department of Endodontics, School of Dentistry, State University of Rio de Janeiro (UERJ), Rio de Janeiro, Rio de Janeiro, Brazil
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Ürgüplüoğlu SN, Akıncı L, Şimşek N. Micro-computed tomography analysis of shaping ability of nickel-titanium instruments activated by continuous rotation or adaptive motion. AUST ENDOD J 2024; 50:334-340. [PMID: 38666710 DOI: 10.1111/aej.12850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 04/15/2024] [Accepted: 04/16/2024] [Indexed: 08/13/2024]
Abstract
This study assessed the ability of Twisted File Adaptive (TFA), TruNatomy (TRN) and VDW.Rotate (VR) instruments activated by continuous rotation (CR) and adaptive motion (AM) to shape curved root canals. Thirty mandibular molars with two separate mesial canals 20°-40° curved were collected and scanned using micro-computed tomography (μCT). The canals were then randomly assigned into six groups (n = 10): TRN, VR or TFA instruments activated by CR or AM. TRN groups 17.02, 20.04 and 26.04; VR groups 15.04, 20.05 and 25.06; TFA groups were shaped consecutively using 15K-file, 20.04 and 25.06. After they were shaped, the canals were scanned again. The volume of removed dentin, canal transportation and centring ratio were calculated μCT images. All data were analysed using the Kruskal-Wallis test or one-way analysis of variance (p < 0.05). With both kinematics, the TRN instrument removed the least amount of dentin, the VR-CR and the TFA-AM removed the most (p < 0.05). The transportation and centring ratios among all groups were similar (p > 0.05). The volume of dentin removed, the diameter or design features of the instruments and different kinematics did not affect the centring ratio and the amount of transportation and remained within safe limits. All three instruments activated by either kinematics were found to have similar effectiveness in shaping curved root canals.
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Affiliation(s)
| | - Levent Akıncı
- Department of Endodontics, Faculty of Dentistry, Inonu University, Malatya, Turkey
| | - Neslihan Şimşek
- Department of Endodontics, Faculty of Dentistry, Inonu University, Malatya, Turkey
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de Oliveira SCA, Bueno CEDS, Pelegrine RA, Fontana CE, de Martin AS, Stringheta CP. Debridement ability of the WaveOne Gold and TruNatomy systems in the apical third of root canals: ex vivo assessment. Braz Dent J 2024; 35:5773. [PMID: 39045987 PMCID: PMC11262772 DOI: 10.1590/0103-6440202405773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 02/23/2024] [Indexed: 07/25/2024] Open
Abstract
Cleaning and shaping the root canal system are essential steps for performing successful endodontic therapy, and are challenging procedures in the apical region. This study aimed to conduct an ex vivo assessment of the debridement ability of the WaveOne Gold (Medium 35/.06) and TruNatomy (Medium 36/.03) systems in the apical third of round root canals of mandibular premolars. Forty-eight teeth, extracted for orthodontic or periodontal reasons, were divided into three groups (n=16), as follows: Group C, control (without instrumentation or irrigation); Group WOG, instrumentation with WaveOne Gold; Group TN, instrumentation with TruNatomy. A total of 40 mL of 2.5% sodium hypochlorite and 5 mL of 17% ethylenediamine tetraacetic acid were used per root canal in all the groups. Ten 0.5-μm serial cross-sections per specimen were obtained every 0.2 mm from a 2-mm segment of the apical region, extending from 1 to 3 mm short of the root apex. The sections were stained with hematoxylin-eosin and analyzed under a digital microscope (100x). The percentages of unprepared walls and remaining debris were quantified using ImageJ software. Generalized linear models were used to analyze the results (α=5%). Groups WOG and TN had significantly lower percentages of unprepared walls and remaining debris than Group C (p<0.05). There was no significant difference between groups WOG and TN for either of the variables studied (p>0.05). Instrumentation with the WaveOne Gold Medium and TruNatomy Medium instruments was associated with equivalent percentages of unprepared walls and remaining debris in the apical third of round canals of mandibular premolars.
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Affiliation(s)
| | | | - Rina Andréa Pelegrine
- Faculdade São Leopoldo Mandic, Instituto de Pesquisas São Leopoldo Mandic, Endodontia, Campinas, SP, Brazil
| | - Carlos Eduardo Fontana
- Center for Life Sciences, Postgraduate Program in Health Sciences, Pontifícia Universidade Católica de Campinas, Campinas, SP, Brazil
| | | | - Carolina Pessoa Stringheta
- Faculdade São Leopoldo Mandic, Instituto de Pesquisas São Leopoldo Mandic, Endodontia, Campinas, SP, Brazil
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Park KH, Ordinola-Zapata R, Noblett WC, Lima BP, Staley C. The effect of ultrasonic and multisonic irrigation on root canal microbial communities: An ex vivo study. Int Endod J 2024; 57:895-906. [PMID: 37983635 DOI: 10.1111/iej.13996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 10/19/2023] [Accepted: 10/20/2023] [Indexed: 11/22/2023]
Abstract
AIM To analyse the effect of ultrasonic irrigant activation (UIA) and the GentleWave (GW) multisonic irrigation (GW) with minimal instrumentation on the root canal microbial diversity in an ex vivo model that used extracted molars with a history of pulp necrosis. METHODOLOGY Twenty-three mandibular molars were prepared ex vivo for collection of superficial (surface control), pre-treatment and post-treatment samples 24 h after extraction. Samples were divided into two groups: UIA using 6% NaOCl (n = 11) and GW group (n = 12). All samples were processed using quantitative real-time polymerase chain reaction (qPCR) and 16S rRNA next-generation sequencing to measure microbial diversity before and after the antimicrobial treatment. For qPCR, a t-test (α = .05) was used to compare the log10 reduction. The Chao1 and Shannon indices evaluated alpha diversity. Differences in community composition (beta diversity) were evaluated by analysis of similarity (ANOSIM). Kruskal-Wallis test with Bonferroni corrections was performed to evaluate the differences in abundances genera in the samples. RESULTS Quantitative real-time polymerase chain reaction revealed an estimated 1.6 and 2.6 log10 reduction for UIA and GW groups respectively (p = .048). An average of 5 ± 4 and 3 ± 5 operational taxonomic units (OTUs) were found in surface's samples in the UIA and GW group respectively. These values were significantly lower (p < .001) compared to the number of preoperative OTUs in those groups (155 ± 79 and 187 ± 121). In assessing beta diversity, there were no significant differences found in pre-treatment samples (R = .090, p = .070 ANOSIM with Bonferroni corrections). Also, no significant differences in community composition were observed in post-treatment samples (R = -.05, p = .829). After treatment, there was a significant reduction of Eubacterium using conventional treatment with UIA and a significant reduction of Prevotella using minimal instrumentation with GW irrigation (p = .007 and p = .002 respectively). CONCLUSION Quantitative PCR analysis revealed a significant reduction in microbial load for GW group. Overall, diversity changes were similar between UIA and GW irrigation in this ex vivo model that used extracted teeth with a history of pulp necrosis. OTUs obtained from the surface sample were negligible and did not affect the statistical outcome of the study.
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Affiliation(s)
- Ki Hong Park
- Division of Endodontics, Department of Restorative Sciences, School of Dentistry, University of Minnesota, Minneapolis, Minnesota, USA
| | - Ronald Ordinola-Zapata
- Division of Endodontics, Department of Restorative Sciences, School of Dentistry, University of Minnesota, Minneapolis, Minnesota, USA
| | - W Craig Noblett
- Division of Endodontics, Department of Restorative Sciences, School of Dentistry, University of Minnesota, Minneapolis, Minnesota, USA
| | - Bruno P Lima
- Division of Basic Sciences, Department of Diagnostic and Biological Sciences, School of Dentistry, University of Minnesota, Minneapolis, Minnesota, USA
| | - Christopher Staley
- Division of Basic & Translational Research, Department of Surgery, University of Minnesota, Minneapolis, Minnesota, USA
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Sabeti MA, Saqib Ihsan M, Aminoshariae A. The Effect of Master Apical Preparation Size on Healing Outcomes in Endodontic Treatment: A Systematic Review and Meta-Analysis. J Endod 2024; 50:292-298. [PMID: 38135112 DOI: 10.1016/j.joen.2023.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 11/10/2023] [Accepted: 11/12/2023] [Indexed: 12/24/2023]
Abstract
INTRODUCTION The aim of this systematic review was to assess the existing literature and examine whether or not the size of apical enlargement during mechanical preparation affects the outcome of treatment in patients undergoing nonsurgical root canal therapy (NSRCT). METHODS MEDLINE (PubMed), Embase, Cochrane Library, and gray literature were searched (January 2000-May 2023). Study selection and data extraction were performed in duplicate. Eligible studies were critically appraised for risk of bias and quality of evidence and were meta-analyzed to estimate the treatment effects. RESULTS Two studies were included in the meta-analysis. The overall pooled success rate was 75.8%. The success rates of treatment with an apical size ≥ 30 and < 30 were 80.9% and 52.9%, respectively. Cases with an apical size ≥ 30 demonstrated significantly more favorable results (RR = 0.63, 95% Confidence Interval 0.46-0.79, P < .05). The overall quality of evidence was low. CONCLUSIONS With a low certainty of evidence, master apical preparation size ≥ 30 may result in an increased healing outcome in terms of clinical and radiographic evaluations.
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Affiliation(s)
- Mohammad A Sabeti
- Department of Preventive and Restorative Dental Science, UCSF School of Dentistry, San Francisco, California.
| | - Mohammad Saqib Ihsan
- Department of Preventive and Restorative Dental Science, Advanced Education Program in Endodontics, UCSF School of Dentistry, San Francisco, California
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Barbosa AFA, de Lima CO, Antunes BR, Sassone LM, Versiani MA, da Silva EJNL. Effect of the progressive taper enlargement of buccal root canals of three-rooted maxillary molars: A stepwise micro-CT study. AUST ENDOD J 2023; 49:700-710. [PMID: 37489612 DOI: 10.1111/aej.12782] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Revised: 05/16/2023] [Accepted: 07/13/2023] [Indexed: 07/26/2023]
Abstract
This study evaluated unprepared canal areas, volume of dentine removal, and dentine thickness after the progressive enlargement of the buccal canals of 22 maxillary molars, with and without the MB2, using instruments with the same tip size (0.25 mm) but 4 different tapers (0.03, 0.05, 0.06 and 0.08 v). Micro-CT scans were performed after each instrument. Data were compared using a general linear mixed model post hoc comparisons with Kenward-Roger for Wald F tests (α = 5%). After each treatment step, it was observed an increase in the percentage volume of removed dentine and a decrease in the unprepared areas and dentine thickness at the pericervical region of all canals (p < 0.05). The percentage reduction of dentine thickness in MB2 canal was higher than in the mesiobuccal and distobuccal canals (p < 0.05). Knowledge of pre-operative dimensions and dentine thickness before enlargement of buccal canals of maxillary molars is an important factor to avoid excessive dentine removal.
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Affiliation(s)
- Ana Flávia Almeida Barbosa
- Departament of Endodontics, State University of Rio de Janeiro, Rio de Janeiro, Brazil
- Department of Endodontics, School of Dentistry, Grande Rio University (UNIGRANRIO), Rio de Janeiro, Brazil
| | - Carolina Oliveira de Lima
- Departament of Endodontics, State University of Rio de Janeiro, Rio de Janeiro, Brazil
- Department of Dentistry, Federal University of Juiz de Fora, Governador Valadares, Brazil
| | - Bernardo Rempto Antunes
- Department of Endodontics, School of Dentistry, Grande Rio University (UNIGRANRIO), Rio de Janeiro, Brazil
| | - Luciana Moura Sassone
- Departament of Endodontics, State University of Rio de Janeiro, Rio de Janeiro, Brazil
| | | | - Emmanuel João Nogueira Leal da Silva
- Departament of Endodontics, State University of Rio de Janeiro, Rio de Janeiro, Brazil
- Department of Endodontics, School of Dentistry, Grande Rio University (UNIGRANRIO), Rio de Janeiro, Brazil
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Mamat R, Nik Abdul Ghani NR. The Complexity of the Root Canal Anatomy and Its Influence on Root Canal Debridement in the Apical Region: A Review. Cureus 2023; 15:e49024. [PMID: 38111413 PMCID: PMC10727774 DOI: 10.7759/cureus.49024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/18/2023] [Indexed: 12/20/2023] Open
Abstract
The main goal of root canal treatment is to eliminate the infection in the complex root canal system for the long-term preservation of a functional tooth. Proper debridement of the root canal system, especially in the apical portion, is essential for successful root canal treatment. The complexity of the canal anatomy in the apical region plays a crucial role in reducing the microbial load. Therefore, clinicians must have a thorough knowledge of the anatomy of the root canal system and its variations, especially in the apical portion. Root canal configurations in cross-section have been classified as round, oval, long oval, flattened, or irregularly shaped. Treating oval, long oval, flattened, or irregularly shaped canals is challenging and should be approached differently than a circular canal. Recognizing the root canal shape and apical anatomy determines the different strategies to be used in cleaning, shaping, and obturation to achieve the best result of root canal treatment. The recent development of the instrumentation system improves the treatment outcome for clinicians and patients. This review aimed to discuss the definition, prevalence, and instrumentation for cleaning and shaping in the apical area with the complexity of root canal systems. Therefore, with the aid of this review, we can better understand the variations in the anatomy of the root canal, especially at the apical portion.
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Affiliation(s)
- Rosnani Mamat
- Conservative Dentistry and Endodontics, School of Dental Sciences, Health Campus, Universiti Sains Malaysia, Kota Bharu, MYS
| | - Nik Rozainah Nik Abdul Ghani
- Conservative Dentistry and Endodontics, School of Dental Sciences, Health Campus, Universiti Sains Malaysia, Kota Bharu, MYS
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Usta SN, Silva EJNL, Falakaloğlu S, Gündoğar M. Does minimally invasive canal preparation provide higher fracture resistance of endodontically treated teeth? A systematic review of in vitro studies. Restor Dent Endod 2023; 48:e34. [PMID: 38053776 PMCID: PMC10695733 DOI: 10.5395/rde.2023.48.e34] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 08/17/2023] [Accepted: 08/27/2023] [Indexed: 12/07/2023] Open
Abstract
This systematic review aimed to investigate whether minimally invasive root canal preparation ensures higher fracture resistance compared to conventional root canal preparation in endodontically treated teeth (ETT). A comprehensive search strategy was conducted on the "PubMed, Web of Science, and Scopus" databases, alongside reference and hand searches, with language restrictions applied. Two independent reviews selected pertinent laboratory studies that explored the effect of minimally invasive root canal preparation on fracture resistance, in comparison to larger preparation counterparts. The quality of the studies was assessed, and the risk of bias was categorized as low, moderate, or high. The electronic search yielded a total of 1,767 articles. After applying eligibility criteria, 8 studies were included. Given the low methodological quality of these studies and the large variability of fracture resistance values, the impact of reduced apical size and/or taper on the fracture resistance of the ETT can be considered uncertain. This systematic review could not reveal sufficient evidence regarding the effect of minimally invasive preparation on increasing fracture resistance of ETT, primarily due to the inherent limitations of the studies and the moderate risk of bias.
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Affiliation(s)
- Sıla Nur Usta
- Department of Endodontics, Gulhane Faculty of Dentistry, University of Health Sciences, Ankara, Turkey
| | | | - Seda Falakaloğlu
- Department of Endodontics, Faculty of Dentistry, Istanbul Health and Technology University, Istanbul, Turkey
| | - Mustafa Gündoğar
- Department of Endodontics, Faculty of Dentistry, University of Medipol, İstanbul, Turkey
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Bürklein S, Arias A. Effectiveness of root canal instrumentation for the treatment of apical periodontitis: A systematic review and meta-analysis. Int Endod J 2023; 56 Suppl 3:395-421. [PMID: 35670625 DOI: 10.1111/iej.13782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 05/31/2022] [Accepted: 06/01/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND The development of endodontic instruments has rapidly advanced, but their impact on endodontic outcome parameters remains unclear. OBJECTIVES This systematic review aimed to answer the following PICOT questions: In patients with apical periodontitis (P) what is the effectiveness of root canal instrumentation ([Q1] performed with contemporary techniques [I] in comparison with 'traditional' techniques [C]] and ([Q2] performed with contemporary engine-driven NiTi instruments [I] compared with other types of contemporary engine-driven NiTi instruments [with different design and/or technology] [C]) in terms of clinical and patient-related outcomes (O)? METHODS After PROSPERO protocol registration, a literature search was conducted using Clarivate Analytics' Web of Science, Scopus, PubMed and Cochrane Central Register of Controlled Trials. Grey literature and major journal contents were examined. Two independent reviewers performed the study selection, data extraction and appraisal of included studies. A quantitative meta-analysis was considered, and statistical heterogeneity and overall quality of evidence were assessed. RESULTS Nine studies were identified showing substantial methodological differences. Five studies addressed PICOT 1 and three PICOT 2, whereas one study aimed both. A random-effects meta-analysis model was considered for the outcome 'radiographic evidence of normal periodontal ligament space or reduction of apical lesion size' (PICOT 1) based on three studies with 332 evaluable participants and showed that contemporary instrumentation was associated with a more favourable outcome (p = .005) compared with root canal preparation with stainless steel instruments (odds ratio = 2.07 [95%-confidence interval = 1.25-3.44]) with no evidence of statistical heterogeneity (I2 = 0%) but low quality of evidence. DISCUSSION Albeit a few studies fulfilled eligible criteria, no study had a low risk of bias. Compelling evidence indicating significantly different outcome rates using different endodontic instruments when treating teeth with apical periodontitis is lacking. CONCLUSIONS In terms of healing, the results of the meta-analysis determined the higher effectiveness of root canal instrumentation performed with contemporary techniques in comparison with conventional stainless steel instruments in patients with apical periodontitis followed for a minimum of 1 year with low quality of evidence. No differences could be demonstrated between preparations with traditional stainless steel and contemporary NiTi instruments for other clinical and patient-related outcomes. REGISTRATION PROSPERO (CRD42021274642).
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Affiliation(s)
| | - Ana Arias
- School of Dentistry, Complutense University, Madrid, Spain
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11
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Tavares KIMC, Pinto JC, Santos-Junior AO, Duarte MAH, Guerreiro-Tanomaru JM, Tanomaru-Filho M. Effect of Additional Apical Preparation on Retreatment of Curved Root Canals Filled with Different Sealers. Eur J Dent 2023; 17:636-641. [PMID: 36075266 PMCID: PMC10569835 DOI: 10.1055/s-0042-1750693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022] Open
Abstract
OBJECTIVE This study assessed the influence of additional apical preparation on material removal during retreatment of curved root canals filled with different sealers. MATERIALS AND METHODS Twelve mesial roots of mandibular molars with two separate canals and curvature between 25 and 35 degrees were selected. The working length was established 1-mm short of the apical foramen, and all the root canals were prepared using ProDesign R (PDR) 25/0.06. After preparation, the root canals were divided in two groups (n = 12) and filled by continuous wave condensation technique with NeoMTA Plus or AH Plus. All the root canals were retreated using rotary ProDesign Logic RT 25/0.08, reciprocating PDR 25/0.06 and apical preparation with PDR 35/0.05. Additional apical preparation was performed with ProDesign Logic (PDL) 50/0.01. The samples were scanned using a Skycan 1176 micro-computed tomography (micro-CT), voxel size 8.74 µm, before and after the retreatment procedures. Percentages of remaining filling material were evaluated. STATISTICAL ANALYSIS The data were submitted to paired and unpaired t-tests (α = 0.05). RESULTS Percentage of remaining filling material was similar between the root canals filled with NeoMTA Plus or AH Plus sealer after retreatment using PDR 35/0.05, and after additional apical preparation using PDL 50/0.01 (p > 0.05). However, PDL 50/0.01 significantly decreased the percentage of remaining filling material in the apical third after the additional apical preparation for both sealers (p < 0.05). CONCLUSION NeoMTA Plus or AH Plus did not influence the retreatment of curved root canals. ProDesign Logic 50/0.01 promoted greater filling material removal in the apical third.
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Affiliation(s)
- Karina I. M. C. Tavares
- Department of Restorative Dentistry, School of Dentistry, São Paulo State University, Araraquara, São Paulo, Brazil
| | - Jader C. Pinto
- Department of Restorative Dentistry, School of Dentistry, São Paulo State University, Araraquara, São Paulo, Brazil
| | - Airton O. Santos-Junior
- Department of Restorative Dentistry, School of Dentistry, São Paulo State University, Araraquara, São Paulo, Brazil
| | - Marco A. H. Duarte
- Department of Dentistry, Endodontics and Dental Materials, School of Dentistry, University of São Paulo, São Paulo, Brazil
| | | | - Mario Tanomaru-Filho
- Department of Restorative Dentistry, School of Dentistry, São Paulo State University, Araraquara, São Paulo, Brazil
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12
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Ismail HH, Obeid M, Hassanien E. Efficiency of diode laser in control of post-endodontic pain: a randomized controlled trial. Clin Oral Investig 2023; 27:2797-2804. [PMID: 36662285 PMCID: PMC10264274 DOI: 10.1007/s00784-023-04864-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Accepted: 01/10/2023] [Indexed: 01/21/2023]
Abstract
OBJECTIVES As post-endodontic pain control is one of the main targeted addressed in endodontics, our aim was delignated to compare two different methods for low-level laser application utilizing diode laser: low-level laser therapy (LLLT) and laser-activated irrigation (LAI) in the control of post-endodontic pain. MATERIALS AND SUBJECTS A total of 180 patients received single-visit root canal treatment; they were randomly allocated into 3 equal groups. Group I received LAI, group II received LLLT, and group III served as control with normal root canal treatment and mock laser intervention (ML group). Postoperative pain was recorded using visual analogue scale (VAS) after 24, 48, and 72 h. Data were tabulated and statistically analyzed. RESULTS At 24 h, there was a statistically significant difference between median pain scores in the three groups (P value < 0.001) with ML group scored highest score followed by LAI and then LLLT group. At 48 h, there was a statistically significant difference between the three groups (P value < 0.001), with ML group scoring highest median pain scores while LLLT and LAI showed statistical insignificant scores. At 72 h, there was no statistically significant difference between the 3 groups (P value = 0.179). CONCLUSION LLLT is superior to LAI and ML group in the control of immediate postoperative pain after 24 h while after 48 h both LAI and LLLT were equally effective, but they still showed significant differences when compared to ML group. CLINICAL RELEVANCE Diode laser can be used by clinicians as it decreases the post-endodontic pain in patients with symptomatic apical periodontitis undergoing endodontic treatment.
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Affiliation(s)
- Hend H Ismail
- Dept of Endodontics, Faculty of Dentistry, Ain Shams University, Cairo, Egypt
| | - Maram Obeid
- Dept of Endodontics, Faculty of Dentistry, Ain Shams University, Cairo, Egypt.
| | - Ehab Hassanien
- Dept of Endodontics, Faculty of Dentistry, Ain Shams University, Cairo, Egypt
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13
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Taha NA, Abzaid AM, Khader YS. A randomized controlled clinical trial of pulpotomy vs root canal therapy in mature teeth with irreversible pulpitis: Outcome, quality of life, and patients' satisfaction. J Endod 2023:S0099-2399(23)00210-8. [PMID: 37080387 DOI: 10.1016/j.joen.2023.04.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 04/03/2023] [Accepted: 04/05/2023] [Indexed: 04/22/2023]
Abstract
INTRODUCTION Vital pulp therapy (VPT)is increasingly practiced as an alternative treatment to root canal therapy (RCT) in teeth with carious pulp exposure. The aim of this study was to compare the outcome, quality of life and patient satisfaction after full pulpotomy and RCT in mature teeth with irrevrsible pulpitis. METHODS Sixty mature permanent molar teeth with carious pulp exposure and a diagnosis of irreversible pulpitis were randomly divided into 2 groups (n=30). The first group was treated with full pulpotomy using Biodentine and the second group was treated with RCT. Pain level was recorded preoperatively and at 1, 2, 3, 5 and 7 days. Clinical and radiographic assessment was done at 6 and 12 months follow up, one case in each group did not attend. Based on the Oral Health Impact Profile questionnaire (OHIP-17) and 7 semantic differential scales, quality of life (QOL) and patients' satisfaction were evaluated and compared statistically. RESULTS Pulpotomy and RCT had comparable success rates (27/29, 93%). Pain levels at day 1 after pulpotomy were significantly lower than after RCT (p=0.037), less patients required analgesics (p=0.028), and pulpotomy provided pain relief in a shorter time compared to RCT. Both treatments improved the OHIP QOL of patients without significant differences (60.29, 64.1% at 1 year). Patients' satisfaction with pulpotomy was higher than RCT in terms of the time involved, intraoperative pain, pleasantness, and cost (p <0.05). CONCLUSIONS Full pulpotomy could be an alternative treatment to RCT in mature teeth with carious pulp exposure and symptomatic irreversible pulpitis, based on the clinical, radiographic success rates and patients' satisfaction.
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Affiliation(s)
- Nessrin A Taha
- Department of Conservative Dentistry, Faculty of Dentistry, Jordan University of Science and Technology, Irbid, Jordan.
| | - Alaa M Abzaid
- Department of Conservative Dentistry, Faculty of Dentistry, Jordan University of Science and Technology, Irbid, Jordan
| | - Yousef S Khader
- Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
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14
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Aazzouzi-Raiss K, Ramírez-Muñoz A, Mendez S PM, Vieira GCS, Aranguren J, Pérez AR. Effects of Conservative Access and Apical Enlargement on Shaping and Dentin Preservation with Traditional and Modern Instruments: A Micro-computed Tomographic Study. J Endod 2023; 49:430-437. [PMID: 36646164 DOI: 10.1016/j.joen.2023.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 12/17/2022] [Accepted: 01/09/2023] [Indexed: 01/15/2023]
Abstract
INTRODUCTION This ex vivo study aimed to evaluate the shaping abilities and preservation of dentin with traditional and modern instruments after using sizes 25 and 40 in oval canals of mandibular incisors with conservative access. METHOD Thirty mandibular incisors with single straight oval canals were selected and assigned into 2 groups (n = 15) according to the instrument system used during preparation, Slim Shaper (SS) plus Apical Shaper (AS) and Protaper Gold (PG). The samples were subjected to micro-computed tomography before and after preparation with sizes 25 and 40. The shaping parameters evaluated included canal volume and surface area, amount of unprepared root canal walls, and reduction in pericervical dentin. RESULTS Canal volume and surface area were significantly increased after enlargement with each instrument size (P < .01). The percentage of unprepared areas showed a significant intragroup decrease after using PG F2 and F4 or SS 3 and AS (P < .05). Intergroup comparison showed no significant differences. Pericervical dentin was reduced in all groups. The intragroup comparison only revealed a significant reduction (P < .01) between PG F2 and F4. In addition, a significant decrease in pericervical dentin (P < .05) was observed between PG F4 40/.06 and AS 40/.03. No significant differences were observed between PG F2 25/.08 and SS 3 25/.04. CONCLUSION Increasing the instrumentation size from 25 to 40 significantly reduces the percentage of unprepared areas regardless of the system used. In addition, using a modern system with a regressive taper allows the maintenance of pericervical dentin without compromising shaping efficacy in the apical third of the mandibular incisors with oval canals and conservative access.
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Affiliation(s)
| | - Ana Ramírez-Muñoz
- Department of Endodontics, Rey Juan Carlos University, Alcorcón, Madrid, Spain
| | | | | | - José Aranguren
- Department of Endodontics, Rey Juan Carlos University, Alcorcón, Madrid, Spain
| | - Alejandro R Pérez
- Department of Endodontics, Rey Juan Carlos University, Alcorcón, Madrid, Spain; Private Practice in Porto, Porto, Portugal.
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15
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Neelakantan P, Vishwanath V, Taschieri S, Corbella S. Present status and future directions ‐ Minimally invasive root canal preparation and periradicular surgery. Int Endod J 2022; 55 Suppl 4:845-871. [DOI: 10.1111/iej.13750] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 04/06/2022] [Accepted: 04/11/2022] [Indexed: 11/30/2022]
Affiliation(s)
- P. Neelakantan
- Faculty of Dentistry The University of Hong Kong Hong Kong SAR
| | - V. Vishwanath
- Faculty of Dentistry The University of Hong Kong Hong Kong SAR
| | - S. Taschieri
- Department of Biomedical Surgical and Dental Sciences Università degli Studi di Milano Milan Italy
- IRCCS Istituto Ortopedico Galeazzi Milan Italy
- Department of Oral Surgery Institute of Dentistry I. M. Sechenov First Moscow State Medical University Moscow Russia
| | - S. Corbella
- Department of Biomedical Surgical and Dental Sciences Università degli Studi di Milano Milan Italy
- IRCCS Istituto Ortopedico Galeazzi Milan Italy
- Department of Oral Surgery Institute of Dentistry I. M. Sechenov First Moscow State Medical University Moscow Russia
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16
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Silva EJNL, de Lima CO, Barbosa AFA, Lopes RT, Sassone LM, Versiani MA. The impact of TruNatomy and ProTaper Gold instruments on the preservation of the periradicular dentin and on the enlargement of the apical canal of mandibular molars. J Endod 2022; 48:650-658. [PMID: 35181453 DOI: 10.1016/j.joen.2022.02.003] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 01/25/2022] [Accepted: 02/07/2022] [Indexed: 02/08/2023]
Abstract
INTRODUCTION This study aimed to evaluate the preservation of the periradicular dentin and the enlargement of the apical canal of mandibular molars with TruNatomy and ProTaper Gold instruments. METHODS Twenty mandibular molars were scanned in a micro-CT device, anatomically paired, and distributed into 2 groups (n=10). In the ProTaper Gold group, mesial and distal canals were prepared up to F2 (25/.08v) and F3 (30/.09v) instruments, while in the TruNatomy group, mesial and distal canals were enlarged until Prime (26/.04v) and Medium (36/.03v) instruments, respectively. After a new scan, surface area, volume, unprepared areas, transportation, percentage of dentin removal, and dentin thickness parameters were calculated. Data were compared between groups using Mann-Whitney, Student t-test, and the non-metric multidimensional scaling test with alpha set at 5%. RESULTS No difference was found between groups regarding unprepared canal areas and reduction of dentin thickness (P > 0.05). Transportation was lower than 0.1 mm in all groups and statistical differences were observed only at the apical third of the mesiobuccal canal with lower values in the TruNatomy group. ProTaper Gold removed more dentin than TruNatomy at the coronal level of mesial roots (1.8% and 1.0%, respectively) (P < 0.05). CONCLUSIONS TruNatomy and ProTaper Gold were efficient for performing canal preparation in mandibular molars. The tested systems were similar in terms of untouched canal walls and remaining dentin thickness, and slightly different in the apical transportation of mesial canals and percentage of dentin removal at the coronal third, but without clinically significant errors.
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Affiliation(s)
- Emmanuel J N L Silva
- Departament of Endodontics, State University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil.
| | | | | | - Ricardo Tadeu Lopes
- Nuclear Engineering Program, Federal University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Luciana Moura Sassone
- Departament of Endodontics, State University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil
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17
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Chaniotis A, Ordinola Zapata R. Present status and future directions -Management of curved and calcified root canals. Int Endod J 2022; 55 Suppl 3:656-684. [PMID: 35106792 DOI: 10.1111/iej.13685] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 01/14/2022] [Accepted: 01/18/2022] [Indexed: 12/01/2022]
Abstract
Root canal curvature and calcification introduce factors that increase the risk of procedural accidents during root canal treatment. The inability to achieve patency to the apical third, asymmetrical dentine removal leading to transportation, perforation and instrument fracture inside the curved trajectories are some of the procedural problems that might jeopardize the management of intraradicular infection and result in poor treatment outcomes. In fact, curved and constricted canals introduce such complexity that total instrumentation concepts and specially designed instruments have been developed to deal with the challenge. This narrative review seeks to provide and consolidate the principles necessary for understanding the dynamics of curved and constricted canal management and to improve the understanding for future developments in this field.
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Affiliation(s)
- Antonis Chaniotis
- Private practice, National and Kapodistrian University of Athens, Dental School, Athens, Greece
| | - Ronald Ordinola Zapata
- Division of Endodontics, School of Dentistry, University of Minnesota, Minneapolis, Minnesota, USA
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18
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Pacheco-Yanes J, Gazzaneo I, Campello AF, Marceliano-Alves MF, Estrela C, Bueno MR, Lopes RT, Rôças IN, Alves FRF, Siqueira JF. Planned Apical Preparation Using Cone-Beam Computed Tomographic Measures: A Micro-Computed Tomographic Proof of Concept in Human Cadavers. J Endod 2021; 48:280-286. [PMID: 34871632 DOI: 10.1016/j.joen.2021.11.016] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 10/12/2021] [Accepted: 11/29/2021] [Indexed: 10/19/2022]
Abstract
INTRODUCTION This study assessed the amount of unprepared surface areas at the apical 4-mm segment of the root canal after a planned preparation based on cone-beam computed tomography (CBCT) measurements. METHODS Eighteen posterior mandible segments were obtained from cadavers and scanned using CBCT and micro-computed tomographic (micro-CT) imaging. CBCT images were used to measure the largest initial canal diameter from 29 root canals of premolars at 1, 2, 3, and 4 mm short of the apical foramen. Each measurement was used to select a master apical instrument with size/taper that was 1 diameter larger to prepare the apical 4 mm of each particular root canal. A post-preparation micro-CT scan was obtained, and the unprepared canal areas were calculated. RESULTS A very high amount of surface areas over the apical 4 mm of the root canal was included in the final preparation (mean >90%). The unprepared areas ranged from as low as 3.7% to a maximum of 14.6% (mean and median, 9.2% and 9.1%, respectively). CONCLUSIONS The proposed planned apical root canal preparation resulted in optimized root canal shaping with a substantial amount of prepared surface areas. The protocol used also resulted in a conservative canal enlargement using final instruments that were 1 size larger than the initial largest canal diameter.
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Affiliation(s)
- Juan Pacheco-Yanes
- Faculty of Dentistry, Department of Dental Research, Iguaçu University (UNIG), Nova Iguaçu, Rio de Janeiro, Brazil
| | - Isbelia Gazzaneo
- Faculty of Dentistry, Department of Dental Research, Iguaçu University (UNIG), Nova Iguaçu, Rio de Janeiro, Brazil
| | - Andrea F Campello
- Faculty of Dentistry, Department of Dental Research, Iguaçu University (UNIG), Nova Iguaçu, Rio de Janeiro, Brazil
| | - Marília F Marceliano-Alves
- Faculty of Dentistry, Department of Dental Research, Iguaçu University (UNIG), Nova Iguaçu, Rio de Janeiro, Brazil
| | - Carlos Estrela
- School of Dentistry, Department of Endodontics, Federal University of Goiás, Goiânia, Brazil
| | | | - Ricardo T Lopes
- Department of Nuclear Energy, Rio de Janeiro Federal University, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Isabela N Rôças
- Faculty of Dentistry, Department of Dental Research, Iguaçu University (UNIG), Nova Iguaçu, Rio de Janeiro, Brazil; Postgraduate Program in Dentistry, University of Grande Rio (UNIGRANRIO), Rio de Janeiro, Rio de Janeiro, Brazil
| | - Flávio R F Alves
- Faculty of Dentistry, Department of Dental Research, Iguaçu University (UNIG), Nova Iguaçu, Rio de Janeiro, Brazil; Postgraduate Program in Dentistry, University of Grande Rio (UNIGRANRIO), Rio de Janeiro, Rio de Janeiro, Brazil.
| | - José F Siqueira
- Faculty of Dentistry, Department of Dental Research, Iguaçu University (UNIG), Nova Iguaçu, Rio de Janeiro, Brazil; Postgraduate Program in Dentistry, University of Grande Rio (UNIGRANRIO), Rio de Janeiro, Rio de Janeiro, Brazil
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Aminoshariae A, Azarpazhooh A, Diogenes AR, Fouad AF, Glickman GN, Kishen A, Letra AM, Levin L, Roda RS, Setzer FC, Tay FR, Hargreaves KM. Insights into the September 2021 Issue of the JOE. J Endod 2021; 47:1337-1339. [PMID: 34429215 DOI: 10.1016/j.joen.2021.07.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
| | - Amir Azarpazhooh
- Faculty of Dentistry University of Toronto, Toronto, Ontario, Canada
| | - Anibal R Diogenes
- University of Texas Health San Antonio School of Dentistry, San Antonio, Texas
| | - Ashraf F Fouad
- University of Alabama at Birmingham, Birmingham, Alabama
| | | | - Anil Kishen
- Faculty of Dentistry University of Toronto, Toronto, Ontario, Canada
| | - Ariadne M Letra
- University of Texas Health Science Center at Houston School of Dentistry, Houston, Texas
| | | | | | - Frank C Setzer
- University of Pennsylvania School of Dental Medicine, Philadelphia, Pennsylvania
| | - Franklin R Tay
- The Dental College of Georgia, Augusta University, Augusta, Georgia
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