Advances in endodontics: Potential applications in clinical practice

Evaluating the Internal Anatomy of Maxillary Premolars in an Adult Saudi Subpopulation Using 2 Classifications: A CBCT-Based Retrospective Study

BACKGROUND Understanding the root canal morphology is important for successful endodontic treatment. This retrospective cone-beam computed tomography (CBCT) study aimed to compare the adult maxillary premolars (MP), root, and canal morphology among a Saudi Arabian subpopulation based on Vertucci and Ahmed classifications. MATERIAL AND METHODS Scans of 1336 MP - 656 first premolars (MFP) and 680 second premolars (MSP) - were analyzed for the number of roots, morphology of the canals, and symmetry among them. The data were grouped based on the traditional preestablished Vertucci system and newer instantaneous code-based Ahmed classification. Comparative analysis was done using the chi-square test. RESULTS Two roots were common in MFP with 84.4% of the population, followed by those with 1 root and those with 3 roots. In MSP, single roots were more common. The results were non-significant with P values of 0.859 and 0.471, respectively. Most of these MFP had Type IV Vertucci configuration/²TNB¹P¹ Ahmed et al code (TN-tooth number, B-buccal canal, P-palatal canal). In MSP, Type I Vertucci/¹TN¹ Ahmed et al code was most common. However, the results were not statistically significant for the PM with P values of 0.997 and 0.732, respectively. Sex-based difference among them for the roots and root canals was also non-significant. Symmetry among PM in opposite quadrants was 87.1% in MFP and 90% in MSP. CONCLUSIONS Two roots with Type IV (²TNB¹P¹) and 1 root with Type I (¹TN¹) were most common in MFP and MSP, respectively. Symmetry among opposing PM was high.

Middle mesial canal in mandibular first molar: A narrative review

Purpose

This review aimed to assess the incidence, anatomical characteristics, identification, and clinical management using conventional techniques and advanced tools to manage MMCs successfully.

Methods

Medline/PubMed and Scopus databases were searched using "Middle mesial canal," "Middle mesial root canal," OR "Accessory mesial canal" keywords from 1 January 1970 and 1 February 2023. The most pertinent articles were chosen for the review from the retrieved articles. In addition, relevant articles were added by manually searching the list of references.

Results

The incidence of MMC is noticeable in younger people, and the confluent canal is the most common type. The majority of MMCs merged with mesiobuccal (MB) canals rather than mesiolingual (ML) canals. Clinical management could be employed using the standard endodontics protocol, and recent radiography technologies, magnification, rotary, and obturation materials can facilitate the procedures.

Conclusion

The possibility of the incidence of MMC is not unusual. Detection and thorough debridement followed by obturation of the canal could increase the success rate of clinical outcomes.

Endodontic Flare-Ups: An Update

Root canal treatment deals with mechanical and chemical cleaning followed by obturation that promotes healing and repair of periradicular tissues. Flare-ups can occur in between or some days after endodontic therapy leading to unscheduled visit by the patient. This complication is characterized by severe pain and/ or swelling. There is a correlation between number of appointments, intracanal medicament used and flare-ups. However, there is no sure procedure that can avoid this complication. Therefore, this review article has discussed about causes and some procedures to prevent and treat flare-ups.

Nationwide Trends of Modern Endodontic Practices Related to Working Length, Instrumentation, Magnification, and Obturation: A Comparative Cross-Sectional Survey Comparing Endodontic and Non-Endodontic Specialties Practicing Root Canal Treatment in India

Aim

The present study was designed to assess trends in contemporary endodontic practice regarding the techniques and materials used in endodontic therapy among dental practitioners from various regions of India.

Methods

A cross-sectional questionnaire-based study was conducted amongst dentists who were pursuing postgraduates in endodontics (PG Endo) and other branches (PG-OB), specialists from other branches (MDS-OB) and specialists in endodontics (MDS-Endo) in various dental colleges representing East, West, North, South, and Central zones through an e-survey using Google forms. State-wise postgraduate dental college lists were obtained from the Dental Council of India (DCI) website. Using a multistage cluster random sampling method and considering the unanticipated response rate, emails were sent to 2100. A 29-item close-ended questionnaire, framed according to different aspects of endodontic treatment, was used to record the responses.

Results

When the distribution of the groups of dentists was compared, the central zone had the highest number of PG-OB (44.2%) and the lowest number of MDS-Endo (8.4%). The electronic apex locator (EAL) method of working length determination has been reported less among MDS-Endo than MDS-OB. The difference between the usage of various methods for working length determination was significant among the different groups in all the zones. (p < 0.0001) Most MDS-Endo preferred the rotary method of instrumentation over the combination method for different zones. The majority of dental practitioners preferred a combination method of instrumentation.

Conclusion

Zone-wise comparisons among dentists showed the majority of general dental practitioners preferred the combination method (radiographs and electronic apex locator) for working length determination. Most MDS-Endo preferred the rotary method of instrumentation over the combination method for different zones. All dental practitioners did not so commonly use magnification in all the zones. The single cone technique was the most opted by dental practitioners of all the zones.

A Pilot Feasibility Study to Establish Full Pulpotomy in Mature Permanent Teeth with Symptomatic Irreversible Pulpitis as a Routine Treatment in Mexican Public Healthcare Services

Symptomatic irreversible pulpitis is a common dental disease for which root canal treatment (RCT) has been the standard treatment. However, in many countries, RCT is considered a high-cost treatment that is not covered by public healthcare services; this forces patients to have dental extraction as their only option to relieve pain. In the last decade, several investigations have provided evidence that an alternative treatment known as full pulpotomy (FP) could be an alternative for patients who could not afford the cost of an RCT. Nevertheless, evidence is lacking on the success rate that could be obtained if it is performed in a public dental care clinic (PDCC). The present investigation has two main objectives. To be the first approach of a multicentric feasibility study to find out whether an FP performed by a general practice dentist (GPD) in a PDCC could be suitable and establish its success rate and patient satisfaction. Patients attending a PDCC with symptoms of irreversible pulpitis were invited to participate. FP was performed and followed up at 1, 3, 6, 9, and 12 months. The treatment success was assessed by combining three variables, patient satisfaction, clinical, and radiographic outcomes. Forty-one patients from 17 to 78 years old received the intervention. In total, 97.5% were completely satisfied with the treatment and were considered successful since none of the clinical or radiographic variables were present in any of the follow-ups. An FP performed by a GPD in a PDCC could be suitable as a routine treatment for symptomatic irreversible pulpitis due to the excellent success rate and patient satisfaction.

Sealing ability in vitro study and biocompatibility in vivo animal study of different bioceramic based sealers

INTRODUCTION

The effectiveness of root canal therapy in endodontic practice is largely determined by providing a compact fluid-tight closure at the apex of the root canal, which inhibits irritant entry and buildup, which leads to a biological breakdown of the attachment mechanism and failure. During obturation, along with gutta-percha, root canal sealers are employed to fill voids and seal root canals. Root canal sealers come in a variety of shapes and sizes, each with its own set.

AIM

Evaluation of sealing ability in vitro study by using scanning electron microscopy (SEM) and biocompatibility in vivo animals study of BioRoot RCS and meta Biomed bio_ceramic sealer (CeraSeal RCS) and compared the findings with that of Zinc oxide eugenol (ZOE) sealer as control.

MATERIALS AND METHODS

This study utilized two bio_ceramic sealers (BioRoot RCS and meta Biomed bio_ceramic sealer (CeraSeal RCS) and compared the findings with that of ZOE sealer as control. Biocompatibility was determined by examining histopathological biopsy specimens collected from rabbits. Each rabbit had four dentin tubes implanted into the subcutaneous tissues, one for BioRoot RCS, one for CeraSeal RCS, and one for ZOE RCS, with the fourth tube being empty haematoxylin and eosin were used to stain histological sections, and a light microscope was used to evaluate them. Extracted human single canal premolars were used to evaluate the sealing ability. The root canals were divided into three sections (coronal, middle, and apical). SEM was used to assess the adhesion quality at the sealer-dentin interface.

RESULTS

BioRoot and CeraSeal sealers have excellent sealing adaptation and biocompatibility, as well as rapid tissue recovery, while ZOE sealers have a slower recovery of inflammatory reaction results when compared to bio_root and ceraSeal sealers, as well as a less sealing adaptation than the two other bio_ceramic sealers.

CONCLUSION

In general, the two bioceramic sealers tested were biocompatible and capable of sealing or adhesion. While ZOE had less adherence ability and less biocompatibility.

Bioactivity Potential of Bioceramic-Based Root Canal Sealers: A Scoping Review

INTRODUCTION

Bioceramic-based root canal sealers are novel materials with a bioactivity potential that stands out compared with conventional root canal sealers. However, the term bioactivity may be overused and is often misunderstood. Hence, the objective of this study was to synthesize and map key concepts related to the bioactivity analysis of bioceramic-based root canal sealers.

METHODS

The present scoping review is reported in accordance with the PRISMA-ScR Statement and is registered in the Open Science Framework. Two blinded reviewers carried out a comprehensive search in six databases up to January 10th, 2022: MEDLINE, Scopus, Embase, Web of Science, Cochrane Library, and Lilacs/BBO. Eligibility was considered for in vitro and in vivo studies that evaluated the bioactivity potential of bioceramic-based root canal sealers.

RESULTS

A total of 53 studies were included in the qualitative synthesis. In vitro bioactivity was evaluated through the mineralization potential, formation of carbonated apatite on the surface, and the gene expression related to proteins involved in the mineralization process. Meanwhile, for in vivo studies, staining techniques associated with immunohistochemical tests were mainly used to detect mineralization on the material-host tissue interface.

CONCLUSIONS

According to the methodology used, the most prevalent methods to assess bioactivity in acellular form were the immersion of the material in Hank's balanced salt solution, followed by surface observation with scanning electron microscopy and energy dispersive X-ray. In cell cultures, the chosen method was usually Alizarin Red staining, followed by the evaluation of alkaline phosphatase enzymatic activity and the use of molecular biology tests.

Cytocompatibility and bioactive potential of AH Plus Bioceramic Sealer: an in vitro study

Aim

To assess the cytocompatibility and bioactive potential of the new calcium silicate cement‐based sealer AH Plus Bioceramic Sealer (AHPbcs) on human periodontal ligament stem cells (hPDLSCs) compared with the epoxy resin‐based sealer AH Plus (AHP) and the calcium silicate cement‐based sealer Endosequence BC Sealer (ESbcs).

Methodology

Standardized sample discs and 1:1, 1:2 and 1:4 eluates of the tested materials were prepared. The following assays were performed: surface element distribution via SEM–EDX, cell attachment and morphology via SEM, cell viability via a MTT assay, cell migration/proliferation via a wound‐healing assay, osteo/cemento/odontogenic marker expression via RT‐qPCR and cell mineralized nodule formation via Alizarin Red S staining. HPDLSCs were isolated from extracted third molars. Comparisons were made with hPDLSCs cultured in unconditioned (negative control) or osteogenic (positive control) culture media. Statistical significance was established at p < .05.

Results

A higher peak of Ca²+ was detected from ESbcs compared with AHPbcs and AHP in SEM–EDX. Both AHPbcs and ESbcs showed significantly positive results in the cytocompatibility assays (cell viability, migration/proliferation, attachment and morphology) compared with a negative control group, whilst AHP showed significant negative results. Both AHPbcs and ESbcs exhibited an upregulation of at least one osteo/odonto/cementogenic marker compared with the negative and positive control groups. Both ESbcs and AHPbcs showed a significantly higher calcified nodule formation than the negative and positive control groups, indicative of their biomineralization potential and were also significantly higher than AHP group.

Conclusion

AH Plus Bioceramic Sealer exhibited a significantly higher cytocompatibility and bioactive potential than AH Plus and a similar cytocompatibility to that of Endosequence BC Sealer. Endosequence BC Sealer exhibited a significantly higher mineralization potential than the other tested sealers. The results from this in vitro study act as supporting evidence for the use of AH Plus Bioceramic Sealer in root canal treatment.

Incidence of fracture of ProDesign Logic system instruments: A cross-sectional retrospective study

The aim of the present study was to analyze the incidence of fracture of ProDesign Logic system instruments in endodontic treatments performed by a specialist, in addition to identifying the dental group, arch, and the root canal thirds in which the fractures occurred more frequently. Digital radiographs and medical records were initially analyzed and resulted in the selection of 561 teeth (1302 canals) treated between 2018 and 2020, using the ProDesign Logic system instruments. These data were reassessed to determine the occurrence of fractures and identify the dental group and root canal thirds in which they occurred. Then, the data were statistically analyzed using the Fisher's Exact Test (p < 0.05). The general fracture rates were 8.5 and 3.69%, considering the number of teeth and canals treated, respectively. Mandibular first molars were the teeth most associated with the occurrence of fractures (19.1%). When the arches were compared, there was no statistical difference regarding the number of fractures in the different root canal thirds (p = 0.307). However, they were more frequent in the apical third in both arches (p = 0.000). The incidence of fracture of ProDesign Logic system instruments was relatively high and occurred more frequently in the apical third of molars.

Electrospun Nanofiber Films Suppress Inflammation In Vitro and Eradicate Endodontic Bacterial Infection in an E. faecalis-Infected Ex Vivo Human Tooth Culture Model

Treatment failure of endodontic infections and their concurrent inflammations is commonly associated with microbial persistence and reinfection, also stemming from the anatomical restrictions of the root canal system. Aiming to address the shortcomings of current treatment options, a fast-disintegrating nanofibrous film was developed for the intracanal coadministration of an antimicrobial (ZnO nanoparticles) and an anti-inflammatory (ketoprofen) agent. The electrospun films were fabricated based on polymers that dissolve rapidly to constitute the actives readily available at the site of action, aiming to eliminate both microbial infection and inflammation. The anti-inflammatory potency of the nanofiber films was assessed in an in vitro model of lipopolysaccharide (LPS)-stimulated RAW 264.7 cells after confirming their biocompatibility in the same cell line. The nanofiber films were found effective against Enterococcus faecalis, one of the most prominent pathogens inside the root canal space, both in vitro and ex vivo using a human tooth model experimentally infected with E. faecalis. The physical properties and antibacterial and anti-inflammatory potency of the proposed electrospun nanofiber films constitute a promising therapeutic module in the endodontic therapy of nonvital infected teeth. All manuscripts must be accompanied by an abstract. The abstract should briefly state the problem or purpose of the research, indicate the theoretical or experimental plan used, summarize the principal findings, and point out major conclusions.

Residual antibacterial effects of a mixture of silver nanoparticles/calcium hydroxide and other root canal medicaments against Enterococcus faecalis

Background/purpose

Intracanal medicaments with high residual inhibition effects are used to achieve successful endodontic treatment and prevent reinfection. This in vitro study aimed to assess antimicrobial residual effects of different intracanal medicaments against Enterococcus faecalis (E. faecalis) in root dentin one week after drug therapy.

Materials and methods

Seventy human teeth were standardized to have 15 mm of length and were prepared by ProTaper rotary system. The teeth were randomly divided into six experimental (n = 10) and two control (n = 5) groups and subjected to drug therapy as follows; group CHX: 2% chlorhexidine gel, group CH: calcium hydroxide paste, group CH/CHX: mixture of calcium hydroxide and 2% CHX, group TAP: triple antibiotic paste, group DAP: double antibiotic paste, group CH/AgNPs: mixture of CH paste and silver nanoparticle suspension. After one week, the medicaments were removed from the root canals and E. faecalis was inoculated into the canals. The teeth were incubated at 37 °C for 24 h. Using a size 40 hedstrom file, dentin chips were collected and number of colony forming units were counted.

Results

The difference between all experimental groups was statistically significant in this regard (P < 0.05) except for DAP and TAP groups, in which, no bacterial colony was noted after culture. After DAP and TAP, the lowest colony count was noted in CH/AgNPs, CH/CHX and CHX groups. The highest colony count was noted in CH group.

Conclusion

Our results showed favorable residual antibacterial effects of TAP, DAP and CH/AgNP medicaments after one week of application.

A Comparative Evaluation of Endodontically Treated Root Canals Obturated Using Gutta-percha with Two Different Protocols: An In-vitro Study

OBJECTIVE

The aim of this article is to evaluate the quality of filling in endodontically treated root canals using the lateral condensation technique and modified lateral condensation technique.

MATERIALS AND METHODS

Thirty-two single-rooted teeth were divided into two groups that were assigned by simple randomization according to the filling technique. Once the endodontic treatment was performed, a periapical radiograph was taken to assess the quality according to the radiographic density and tomography was taken to evaluate the quality according to the tomographic volume of spaces, compared with the post-preparation biomechanical tomography. Finally, we performed a statistical analysis (Student's t-test) to evaluate whether there were differences between the types of filling.

RESULTS

Radiographic radiodensity was 182.89 ± 9.81 and 186.72 ± 6.97 HU for teeth treated with the lateral condensation technique and modified lateral condensation technique, respectively. The void volume was 3.75 ± 2.35 and 2.43 ± 1.18 mm³ for teeth treated with the lateral condensation technique and modified lateral condensation technique, respectively.

CONCLUSION

No significant differences were found between the techniques for both filling quality parameters.

Endodontic postoperative flare-up: An update

Endodontic treatment corresponds to a combined chemical and mechanical approach, followed by a three dimensional hermetic obturation, that eliminate the pulpal and periradiculare disease and boost healing and repair of periradiculare tissue. Despite the advances in the endodontic field, the inter-appointment flare up remains a true nightmare that encounters every dentist. This complication commences a few hours or days after root canal procedures and it is characterized by the development of pain and/or swelling, requiring an unscheduled appointment for emergency treatment. Different studies showed that flare-ups represent a multifactorial phenomenon including mechanical, chemical and microbial factors. In addition, a correlation was found between flare-up and age, gender, tooth type, presence of preoperative pain, tooth condition before treatment, irrigation techniques, number of visits as well as intracanal medication. Moreover, some medicine intake was proved to be efficient in controlling this postoperative pain. However, a clear procedure to avoid its occurrence is yet to be established. In this review, we summarize knowledge about the etiology of flare-up and its related factors. This could be effective in helping dentists to adapt some strategies to prevent it.

A scoping review of four decades of outcomes in non-surgical root canal treatment, non-surgical retreatment and apexification studies. Part 1: process and general results

BACKGROUND

Despite initiatives to standardize reports, variance in study design, outcomes assessed, and tools used are persistent in literature. This review scoped existing literature on endodontic outcome studies for future development of core outcome sets.

DESIGN

Comprehensive literature search of randomized controlled trials, cohort, case-control studies, or case series (≥10 patients), published after 1980, patients aged ≥10 years, and any preoperative pulpal and periapical diagnosis in permanent teeth requiring non-surgical root canal treatment (NS-RCT), retreatment (NS-ReTx), or apexification was performed. Abstracted data were reported through descriptive statistics.

RESULTS

Of 9,957 studies screened, 354 were included. An increase in the quantity of endodontic outcome publications and levels of evidence in their study design was noted over the past four decades. Although 41% of studies included participants aged 26-50, literature including participants aged >50 has increased since 2000. Apexification and NS-ReTx were mostly provided by specialists and postgraduate students. The most common follow-up period was 2-5 years (35%), and most randomized controlled trials (58%) reported follow-up times <1 year. Multiple visit treatment was most common in apexification studies (85%). Deficiency, inconsistency and ambiguity were observed across many reports.

CONCLUSIONS

NS-ReTx and NS-RCT/NS-ReTx studies have increased over the past two decades, particularly those focusing on molars and patients >50 years old. Despite the progress in endodontic research, heterogeneity in reporting styles yield considerable limitations, particularly data standardization challenges and inconsistencies in methods and results reporting. This scoping review highlighted the state of available research and supported the development of standardized guidelines for future investigations.

Endodontic practice amongst Nigerian dentists undergoing postgraduate training

Introduction

this study aimed at finding out current practice of endodontics amongst Nigerian dentists undergoing postgraduate training (also referred to as dental resident doctors) in different institutions across the nation.

Methods

a questionnaire-based, cross sectional study was conducted amongst dentists undergoing postgraduate training. Questions were asked on demographics, protocol for root canal treatment (RCT), materials employed in different stages. Opinions were also sought on satisfaction with their practice and training needs in endodontics. Data were analyzed with SPSS version 20.0 and presented as tables and charts. Significance level was set at p≤0.05.

Results

ninety dentists undergoing postgraduate training (57 males and 33 females) with mean age of 34.81 ± 5.9 years participated in the study. Root canal treatment was mostly done in multiple visits in both single and multi-rooted teeth (p=0.01), only about 15% performed the procedure on multi rooted teeth. Sixty-five (72.2%) never used Rubber dam, stainless steel files were being used by 69%, step down technique of preparation by 53.9% and Sodium hypochlorite was the major irrigant (80%) used. Obturation was majorly with Cold lateral compaction technique (94%), 57.2% delayed definitive restoration for maximum of 1 week and amalgam was still the major material used for posterior teeth as reported by 62.9% of the participants. The majority (55.6%) were not satisfied with their current knowledge and practice and most were those that did not have good undergraduate training (p = 0.05).

Conclusion

the practice of endodontics needs standardization across the nation as it is being advocated in other countries. There is need for hands on-training on endodontics to encourage adoption of new advances in technology, as well as improve the training of postgraduate dentists in endodontics. Also, emphasis should be placed on use of rubber dam in order to minimize the spread of infection and protect the patients from aspiration of small instruments involved in endodontic procedure.

Endodontic management of a maxillary second molar with three roots and seven canals using cone-beam computed tomography

The present case highlights the endodontic management of a maxillary second molar with three roots and seven canals. Root canal treatment was performed for the maxillary second molar diagnosed with symptomatic irreversible pulpitis. During the procedure under magnification, extra canals were detected in the mesiobuccal root. Cone-beam computed tomography (CBCT) evaluation confirmed four canals in the mesiobuccal root with Vertucci's Type XXI (4-1) pattern. The distobuccal root exhibited two canals with Vertucci's Type III (1-2-1) configuration. The palatal canal was single and large. A 4 year follow-up revealed satisfactory clinical and radiographic findings. Magnification and CBCT allow us to explore possible anatomic variations with insights to tackle such situations clinically.

A commentary on strategic extraction

BACKGROUND

Advancements in strategies to maintain compromised teeth combined with a greater understanding of risks associated with dental implants invite a reassessment of the benefits of strategic extraction of a tooth with a questionable prognosis or of limited strategic value.

METHODS

Evidence of the management of compromised teeth and decision making for strategic extraction was reviewed. Additionally, the risks for peri-implantitis were evaluated from the perspective of patient centric, biologic, and biomechanical complications.

RESULTS

Recent clinical innovations support a more predictable maintenance of compromised dentition, and the clinical literature provides evidence of the risks associated with dental implants.

CONCLUSIONS

Because of the improvements in dental management of compromised dentition, strategic extraction should be deferred, whenever possible, to avoid complications associated with peri-implantitis.

A comparison of two pulp revascularization techniques using platelet-rich plasma and whole blood clot

Aim:

The aim of this preliminary study was to compare outcomes of two regenerative endodontic protocols in necrotic teeth with open apices.

Methodology:

Forty teeth with open apices in patients with an age range of 15-54 were randomly distributed in two groups: group 1, with whole blood clot in the canal (n=20) and group 2, whole blood with Platelet rich plasma (PRP) in the canal (n=20). Clinical and radiological follow up assessments were undertaken over a period ranging from 6 months to one year. Radiographic Root Area (RRA) was measured using the freeware ImageJ. Statistical analysis was performed using the independent samples t test and the Chi-squared test, the significance level was set at p=0.05.

Results:

There was no difference in the percentage change in RRA between the PRP group and whole blood-clot + PRP group.

Conclusion:

Whole blood clot and PRP are comparable on the grounds of percentage change in RRA and there is no statistically significant difference between the two in a follow-up period of up to one year.

Modern endodontic practices among dentists in India: A comparative cross-sectional nation-based survey

Introduction:

More than 41,000 root canal treatments (RCTs) are performed every day and about 25 RCTs are performed every week by an endodontist. The success rate of endodontic treatment ranges between 86% and 98%; however, the failure rates cannot be ignored which can range up to 20% of the treated cases due to a varied number of reasons including incorrect adoption of working techniques and usage of inappropriate materials. The present study aimed at comparing the practices of various levels of dentists toward RCT in their daily practice.

Methodology:

A cross-sectional, descriptive, questionnaire-based study was conducted among the dental practitioners who have completed the Masters of Dental Surgery (MDS) curriculum in India and postgraduate students in various dental colleges in India. The sample size was achieved to be 1601 at the completion of the study. The response rate for the study was 80.05%. All the dentists practicing RCT either in the clinic or in the college and willing to participate in the study were included in the study. A self-structured questionnaire was used as study tool. SPSS was used to analyze the data.

Results:

A total of 26.7% of the PG students (endodontists) used rubber dam. Majority of the dentists preferred hand instruments (62.36%) over rotary. Almost half (53.09%) of the postgraduates belonging to other branches reported to prescribe drugs.

Conclusion:

The present study showed a varied profile of the dentists with most of them following the basic protocols and techniques of international standards.

Maintenance Evaluation of the Original Anatomy of the Root Canal Diameters Instrumented with Mtwo and BioRace Systems

Objective:The aim of the present study was to evaluate maintenance of the original anatomy of the root canal diameters instrumented with the Mtwo rotary instruments and BioRace file systems. Material and method:Acrylic resin blocks with 160 simulated root canals with an angle curvature 15°-30° were taken into consideration in the present comparative study. The 160 simulated root canals were divided into two groups, each of them containing 80 acrylic resin blocks. Each group was divided into two subgroups (n=40 canals each). The simulated root canals subgroups were prepared with Mtwo and BioRace rotary nickel-titanium instruments. The results were scrutinized using analysis of variance (ANOVA)-test and Tukey's test. The significance level was set at P < 0.05. Results:No significant difference was noted between the Mtwo rotary instruments and BioRace files as they both had equal value in the coronal section (P=.000) in S1 (D1) and S1 (Dpi). The results of Tukey's test revealed a significant difference between the Mtwo rotary instruments and BioRace files in middle and apical section with the value (P=.003) in S3 (Dpi) and S4 (Dpi). The results of Tukey's test found out a significant difference between the Mtwo rotary instruments and BioRace files in the middle and apical section with the respective values (P=.003) in S3 (Ai) and (P=.006) in S4 (Ai). Conclusion:Ccording to the findings of the present study, enlargement of the root canal diameters resulted to be better on the middle and apical section of the canal prepared with Mtwo instruments in comparison with BioRace instruments. Thus, Mtwo instruments will increase the rate of success of endodontic therapy.

Biofilm removal from a simulated isthmus and lateral canal during syringe irrigation at various flow rates: a combined experimental and Computational Fluid Dynamics approach

Aim

(i) To quantify biofilm removal from a simulated isthmus and a lateral canal in an artificial root canal system during syringe irrigation with NaOCl at different concentrations and delivered at various flow rates (ii) to examine whether biofilm removal is further improved by a final high‐flow‐rate rinse with an inert irrigant following irrigation with NaOCl. (iii) to simulate the irrigant flow in these areas using a computer model (iv) to examine whether the irrigant velocity calculated by the computer model is correlated to biofilm removal.

Methodology

Ninety‐six artificial root canals with either a simulated isthmus or lateral canal were used. A dual‐species in vitro biofilm was formed in these areas using a Constant Depth Film Fermenter. NaOCl at various concentrations (2, 5 and 10%) or adhesion buffer (control) was delivered for 30 s by a syringe and an open‐ended needle at 0.033, 0.083, or 0.166 mL s⁻¹ or passively deposited in the main root canal (phase 1). All specimens were subsequently rinsed for 30 s with adhesion buffer at 0.166 mL s⁻¹ (phase 2). The biofilm was scanned by Optical Coherence Tomography to determine the percentage of the remaining biofilm. Results were analysed by two 3‐way mixed‐design ANOVAs (α = 0.05). A Computational Fluid Dynamics model was used to simulate the irrigant flow inside the artificial root canal system.

Results

The flow rate during phase 1 and additional irrigation during phase 2 had a significant effect on the percentage of the remaining biofilm in the isthmus (P = 0.004 and P < 0.001). Additional irrigation during phase 2 also affected the remaining biofilm in the lateral canal significantly (P ≤ 0.007) but only when preceded by irrigation at medium or high flow rate during phase 1. The effect of NaOCl concentration was not significant (P > 0.05). Irrigant velocity in the isthmus and lateral canal increased with increasing flow rate and it was substantially correlated to biofilm removal from those areas.

Conclusions

The irrigant flow rate affected biofilm removal in vitro more than NaOCl concentration. Irrigant velocity predicted by the computer model corresponded with the pattern of biofilm removal from the simulated isthmus and lateral canal.

Efficacy of the Rotary Instrument XP-Endo Finisher in the Removal of Calcium Hydroxide Intracanal Medicament in Combination with Different Irrigation Techniques: A Microtomographic Study

OBJECTIVES

This study aims to evaluate the efficacy of the rotary instrument XP-endo Finisher for the removal of Ca(OH)₂ aided by different irrigation regimens.

METHODS

Sixteen double-rooted upper premolar human teeth were selected for the study. Thirty-two canals were prepared using a ProTaper Next rotary system up to X3. Then, the canals were filled with Ca(OH)₂. The volume of Ca(OH)₂ inside the canals was measured by microcomputed tomography (micro-CT). After that, the teeth were randomly allocated into two experimental groups, i.e., A and B (n = 16 canals). In group A, Ca(OH)₂ was removed using the master apical file (X3). In group B, Ca(OH)₂ was removed using a XP-endo finisher. In half of both groups (n = 8), syringe irrigation (SI) was used, while passive ultrasonic irrigation (PUI) was used for the other half. After removal, the remaining volume of Ca(OH)₂ was measured. All data were statistically analyzed using two-way ANOVA with Tukey's post hoc test.

RESULTS

The percentages of remaining Ca(OH)₂ in the apical thirds of all canals were significantly higher as compared with the middle and coronal thirds in all groups (p < 0.05). There was no significant difference between different files and techniques (p > 0.05).

CLINICAL SIGNIFICANCE

This study presents a new method for the removal of Ca(OH)₂ from root canals.

Biocompatibility of Root Canal Sealers: A Systematic Review of In Vitro and In Vivo Studies

(1) Aim: To perform a systematic review of the literature on the biocompatibility of root canal sealers that encompasses the various types of sealers that are commercially available as well as both in vitro and in vivo evidence. (2) Methods: This systematic review has been registered in PROSPERO (ID 140445) and was carried out according to PRISMA guidelines using the following databases: PubMed, Cochrane Library, ClinicalTrials.gov, Science Direct, and Web of Science Core Collection. Studies published between 2000 and 11 June 2019 that evaluated cytotoxicity (cell viability/proliferation) and biocompatibility (tissue response) of root canal sealers were included. (3) Results: From a total of 1249 studies, 73 in vitro and 21 in vivo studies were included. In general, studies suggest that root canal sealers elicit mild to severe toxic effects and that several factors may influence biocompatibility, e.g., material setting condition and time, material concentration, and type of exposure. Bioactive endodontic sealers seem to exhibit a lower toxic potential in vitro. (4) Conclusions: The available evidence shows that root canal sealers exhibit variable toxic potential at the cellular and tissue level. However, the methodological heterogeneity among studies included in this systematic review and the somewhat conflicting results do not allow a conclusion on which type of sealer presents higher biocompatibility. Further research is crucial to achieve a better understanding of the biological effects of root canal sealers.

Endodontic Tendencies in a Very-Low-Income Population Area of Northeastern Brazil

Aim

To gather information regarding endodontic treatment protocols and continuing education attendance of dentists in some cities located in Northeastern Brazil (Sergipe and Bahia States), a region that comprises a very-low-income population.

Methods

A questionnaire containing different questions (e.g., routine treatment protocols, the use of new technologies, time required to conclude the treatment, and attendance in an endodontic continuing education) was distributed to 250 dentists. The collected data were analyzed through descriptive statistics and Poisson regression (p < 0.05).

Results

A total of 199 dentists practicing endodontic treatment in the cities of Aracaju (n = 58), Salvador (n = 83), and towns of Estância (n = 8), Itabaiana (n = 16), Itabaianinha (n = 5), Lagarto (n = 10), Ribeirópolis (n = 3), Simão Dias (n = 6), and Tobias Barreto (n = 10) participated in this research. Most of the respondents have concluded their graduation in Dentistry in less than 10 years (62.3%), with nearly 75.4% of the sample having attended postgraduation education in the field. Regarding treatment protocols, the frequency for using rotary/reciprocating systems and for always using rubber dam isolation during root canal treatment (RCT) was 78% and 62%, respectively, which was also more prevalent among dentists who attended a continuous education program (p < 0.05). Lastly, the professionals who attended (p < 0.05) to a continuous education program in Endodontics were more frequently associated to performing incisors and molars RCT in one clinical appointment (p < 0.05).

Conclusions

The results of this survey indicated that even in an area where most of the population has low-income conditions, the professionals are seeking for knowledge by attending to postgraduation programs, following the new tendencies in Endodontics with most of the professionals having employed technological resources.

The effect of different chelating agents on the push-out bond strength of proroot mta and endosequence root repair material

Purpose

This study aimed to evaluate the effects of 17% ethylenediaminetetraacetic acid (EDTA), 7% maleic acid (MA), and 10% citric acid (CA) on the push-out bond strength of ProRooT MTA and Endosequence Root Repair Material (ERRM) putty.

Materials and methods

Eighty single-rooted extracted human teeth were instrumented to obtain a standardized immature teeth model. Based on the chelating agents tested, the specimens were randomly divided into three experimental groups: Group 1 (17% EDTA), Group 2 (7% MA), Group 3 (10% CA), and Group 4 (Positive Control) (n=20 for each group). Each group was further classified into two subgroups: Group A (ProRoot MTA) and Group B (Endosequence Root Repair Material (ERRM) putty) (n=10 for each subgroup). After irrigation and placement of cements, teeth were stored at 37°C and in 100% humidity for a week. A total of 240 dentine discs (three discs per teeth) were obtained and subjected to push-out assay. Data was analyzed using two-way analysis of variance and Tukey's post hoc t-test.

Results

Both types of chelating agent and calcium silicate-based cement were significantly associated with the push-out bond strength values. The push-out bond strength was significantly less for CA as compared to EDTA or MA. ERRM had higher bond strength values than ProRoot MTA (p<0.05).

Conclusion

The use of chelating agents increased the push-out bond strength of CSC. Regardless of tested chelating agents, ERRM had higher bond strength values than ProRoot MTA.

Tecnologia a serviço da Endodontia: avanços no diagnóstico e tratamento de canais radiculares

A Endodontia é a especialidade da Odontologia que cuida da prevenção, diagnóstico e tratamento das afecções que acometem a polpa dental, a cavidade endodôntica e os tecidos periodontais adjacentes. O tratamento endodôntico, considerado complexo e desgastante para o paciente e operador, durante anos vem sendo foco de atenção para estudiosos da área e indústria especializada. O objetivo deste estudo de revisão de literatura foi apresentar, de forma sucinta, a evolução tecnológica dedicada à endodontia nas últimas décadas e suas consequências na atualidade. Muitos foram os estudos que acarretaram no desenvolvimento de aparelhos, instrumentos, materiais e técnicas hoje utilizadas visando a simplificação, agilização e aumento da taxa de sucesso do tratamento endodôntico. Entre os principais incrementos na endodontia podemos citar os modernos instrumentos endodônticos, os sofisticados motores e aparelhos controlados eletronicamente e alguns materiais. Esses, modificaram significativamente a forma de realizar algumas etapas do tratamento como a odontometria, o preparo químico-mecânico, a obturação, o reparo de perfurações e, ainda, o diagnóstico por imagem, tornando a endodontia mais segura, eficiente, rápida, com maior previsibilidade e menos cansativa para profissional e paciente.

Outcome of Initial Endodontic Treatment Performed, by One Specialist, in 122 Tunisian Patients: A Retrospective Study

Objective

To assess the 6- to 24-month outcome of endodontic treatments performed, by one specialist, and to identify prognostic factors that may influence initial endodontic treatment outcome (IETO).

Methods

One hundred and forty-six patients out of 163 were included. A number of 201 teeth were endodontically treated, and an overall number of 408 canals were obturated. Of these, 165 teeth received initial endodontic treatment (IET). The criteria of the European Society of Endodontology were used to assess the IETO. The level of significance was set at p < 0.05%.

Results

Apical periodontitis (AP) was present in 42.5% of all cases, with a PAI >3 in 28.5%. The success rate (SR) was 91.5%. It was significantly higher in vital teeth (97%) than in devital teeth (87.7%) (p=0.04); however, a lower SR was recorded in teeth with AP (p=0.02). The lesion healed in 60 teeth (85.7%), decreased in size in 4 teeth (5.7%), and increased in size in 6 teeth (8.5%). A higher SR was obtained when a permanent restoration was present (94%) than absent (68.7%) (p=0.005).

Conclusion

Within the limitations of the study, pulp and periapical status and permanent restoration are found to be strong outcome predictors.

Does adding an instrument after root preparation with Reciproc® R25 increase bacterial reduction?

Aim

The aim of this study was to compare the bacterial reduction achieved with reciprocating instruments such as Reciproc^® R25 (VDW GMBH, Munich, Germany) and Reciproc^® R25 combined with rotary file Mtwo 40.04 (VDW GMBH) during root canal preparation.

Materials and Methods

Fifty mesiobuccal root canals of maxillary molars were contaminated with Enterococcus faecalis broth culture and then an initial bacterial sample was collected from the root canal with paper cones and plated on brain-heart infusion agar. The root canals were divided into four groups as follows: Reciproc^® R25 (n = 20) and Reciproc^® R25 combined with Mtwo 40.04 instrument (n = 20). The negative controls consisted of five uncontaminated root canals and the positive control consisted of five contaminated roots that were not subjected to any decontamination procedure. Irrigation was performed using sodium chloride. After instrumentation, samples were collected with paper cones and the rate of bacterial reduction was calculated. Microbiological testing (colony-forming units [CFUs]) was performed to quantify the decontamination obtained by the proposed protocols. Statistical analysis was performed by paired t-test and analysis of variance test.

Results

Both techniques significantly reduced the number of bacteria in the root canal (P < 0.05), with no significant difference among them (P > 0.05).

Conclusion

The addition of the instrument Mtwo 40.04 after the root preparation with the instrument R25 does not improve its decontamination capability.

Sealing Ability of Alkaline Endodontic Cements versus Resin Cements

Penetration of oral bacteria through root fillings leads to their long term failure. Dimensionally stable alkaline cements have been developed. A saliva challenge model was used to compare resistance to bacterial penetration of these alkaline cements to conventional root fillings that combine gutta percha (GP) with epoxy resin sealers. A sample of 140 human roots with single straight canals prepared to standard length and canal size were obturated with mineral trioxide aggregate (MTA) (Nex MTA or MTAmix), with an alkaline calcium hydroxide hard setting cement (Supercal), or with GP and a resin cement (either AH-Plus or Zirmix). Negative control roots were sealed with wax, while positive controls were left open. The test assemblies were gamma sterilised, then the coronal root face was exposed daily to fresh stimulated human saliva diluted in broth. Bacterial penetration was determined by assessing growth in sterile brain-heart infusion (BHI) medium in contact with the root apex. Using Kaplan–Meier survival analysis, in order of performance from highest to lowest: Negative control, Supercal, Nex MTA, Zirmix, MTAmix, GP + AH-Plus, and the positive control. In addition, statistically significant differences were noted between Supercal and AH-Plus, and between the two MTA cements. It can be concluded that alkaline cements, particularly Supercal, can show considerable resistance to bacterial penetration from constant saliva challenge, and provide superior sealing ability in comparison to resin cements. While this property is due mostly to dimensional stability, the release of hydroxide ions could be a contributing factor to impaired bacterial survival, and this aspect should be explored further.

Predictors, prevention, and management of postoperative pain associated with nonsurgical root canal treatment: A systematic review

Postoperative pain after root canal treatment can be reduced by applying recent advances in endodontic techniques and equipment. This systematic review includes current knowledge about pain after nonsurgical root canal treatment, including predictors, related factors, effects of recent advances, and management. A literature search was performed using the PubMed, ScienceDirect, and Cochrane Library databases for articles published between 1990 and 2016. Search keywords included postoperative pain, nonsurgical treatment, single visit, recent advances in endodontics, and management of postoperative pain with endodontic treatment. Only original research studies were included; editorials, reviews, brief notes, conference proceedings, and letters to the editor were excluded. The initial search yielded 4941 articles, which were assessed and filtered using the selection criteria. Sixty-five studies met the inclusion criteria and were included in the review. The findings showed that pain after nonsurgical root canal treatment occurred in 3–69.3% of patients. Microorganisms were identified as the primary contributors to postoperative pain, and there was no significant difference in postoperative pain between single- and multiple-visit treatments. Postoperative pain after root canal treatment ranges from mild to moderate and occurs even after optimally performed procedures. Furthermore, adequate management of postoperative pain is often considered an indicator of clinical excellence. Application of recently developed endodontic techniques and devices will reduce postoperative pain. Furthermore, a flexible, severity-based drug administration plan can be used to control and manage pain after root canal treatment. Application of the current research findings will reduce pain following root canal treatment and improve patient outcomes.

Pulpo-Periodontal Regeneration: Management of Partial Failure Revascularization

The aim of this work is to present a case of management of an open apex on a lower molar by using tissue engineering, with two endodontic procedures in the same tooth. We had to resort to pulp regeneration on the distal root and apexification with MTA on the mesial roots after the failure of regenerative therapy on those ones. The management consisted in scheduling regular follow-ups combined with X-rays. After 24 months, the radiological control has shown pulpo-periodontal regeneration associated with walls thickening and distal root elongation and periapical ad integrum healing.

In vitro and ex vivo microbial leakage assessment in endodontics: A literature review

The aim of this study was to perform a literature review of published in-vitro and ex-vivo studies, which evaluated microbial leakage in endodontics in the past 10 years. A comprehensive electronic literature search was carried out in PubMed database for English articles published from 2005 to 2016 using the keywords “endodontics,” “in vitro,” “ex vivo,” “microbial leakage,” “microbial penetration,” “saliva,” “Enterococcus faecalis,” “E. faecalis,” “endodontic sealers,” “temporary filling material,” “apical plug,” “mineral trioxide aggregate,” and “MTA.” The keywords were combined using Boolean operators AND/OR. Based on our search strategy, 33 relevant articles were included in the study. There are three main methods for assessment of bacterial microleakage, namely, (A) the dual-chamber leakage model, (B) detection of bacteria using a scanning electron microscope (SEM), and (C) polymerase chain reaction. All bacterial leakage models have some limitations and may yield different results compared to other microleakage evaluation techniques (i.e., dye penetration, fluid filtration, or electrochemical tests). The results of SEM correlated with those of microbial leakage test in most studies. Microbial leakage test using saliva better simulates the clinical setting for assessment of the leakage of single or mixed bacterial species.