Dentistry › Oral Surgery

Endodontics and Root Canal Treatments

Works Count: 68930

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Description

This cluster of papers encompasses a wide range of topics related to endodontic research and practice, including the use of root canal irrigants, properties and applications of mineral trioxide aggregate, the role of Enterococcus faecalis in treatment failure, revascularization techniques, and regenerative endodontics. It also covers the challenges and outcomes of endodontic treatment, the use of nickel-titanium instruments, advancements in imaging with cone beam computed tomography, and the potential for dental pulp regeneration.

Keywords

Root Canal Irrigants; Mineral Trioxide Aggregate; Enterococcus faecalis; Revascularization; Apical Periodontitis; Endodontic Treatment; Regenerative Endodontics; Nickel-Titanium Instruments; Cone Beam Computed Tomography; Dental Pulp Regeneration

Physicochemical Basis of the Biologic Properties of Mineral Trioxide Aggregate

2005-01-21

Nabin Sarkar , R. Caicedo , Priyanshi Ritwik +2 more

Influence of infection at the time of root filling on the outcome of endodontic treatment of teeth with apical periodontitis

1997-09-01

U. Sjögren , David Figdor , Staffan Persson +1 more

Summary This study investigated the role of infection on the prognosis of endodontic therapy by following‐up teeth that had had their canals cleaned and obturated during a single appointment. The … Summary This study investigated the role of infection on the prognosis of endodontic therapy by following‐up teeth that had had their canals cleaned and obturated during a single appointment. The root canals of 55 single‐rooted teeth with apical periodontitis were thoroughly instrumented and irrigated with sodium hypochlorite solution. Using advanced anaerobic bacteriological techniques, post–instrumentation samples were taken and the teeth were then root‐filled during the same appointment. All teeth were initially infected; after instrumentation low numbers of bacteria were detected in 22 of 55 root canals. Periapical healing was followed up for 5 years. Complete periapical healing occurred in 94% of cases that yielded a negative culture. Where the samples were positive prior to root filling, the success rate of treatment was just 68%– a statistically significant difference. Further investigation of three failures revealed the presence of Actinomyces species in each case; no other specific bacteria were implicated in failure cases. These findings emphasize the importance of completely eliminating bacteria from the root canal system before obturation. This objective cannot be reliably achieved in a one‐visit treatment because it is not possible to eradicate all infection from the root canal without the support of an inter–appointment antimicrobial dressing.

Cyclic fatigue testing of nickel-titanium endodontic instruments

1997-02-01

John P. Pruett , David J. Clement , David L. Carnes

Outcome of primary root canal treatment: systematic review of the literature – Part 2. Influence of clinical factors

2007-10-11

Y.‐L. Ng , Vera Mann , S. Rahbaran +2 more

Abstract Aims (i) To carry out meta‐analyses to quantify the influence of the clinical factors on the efficacy of primary root canal treatment and (ii) to identify the best treatment … Abstract Aims (i) To carry out meta‐analyses to quantify the influence of the clinical factors on the efficacy of primary root canal treatment and (ii) to identify the best treatment protocol based on the current evidence. Methodology The evidence for the effect of each clinical factor on the success rate (SR) of primary root canal treatment was gathered in three different ways: (i) intuitive synthesis of reported findings from individual studies; (ii) weighted pooled SR by each factor under investigation was estimated using random‐effect meta‐analysis; (iii) weighted effect of the factor under investigation on SR were estimated and expressed as odds ratio for the dichotomous outcomes (success or failure) using fixed‐ and random‐effects meta‐analysis. Statistical heterogeneity amongst the studies was assessed by Cochran’s (Q) test. Potential sources of statistical heterogeneity were investigated by exploring clinical heterogeneity using meta‐regression models which included study characteristics in the regression models. Results Out of the clinical factors investigated, pre‐operative pulpal and periapical status were most frequently investigated, whilst the intra‐operative factors were poorly studied in the 63 studies. Four factors were found to have a significant effect on the primary root canal treatment outcome, although the data heterogeneity was substantial, some of which could be explained by some of the study characteristics. Conclusions Four conditions (pre‐operative absence of periapical radiolucency, root filling with no voids, root filling extending to 2 mm within the radiographic apex and satisfactory coronal restoration) were found to improve the outcome of primary root canal treatment significantly. Root canal treatment should therefore aim at achieving and maintaining access to apical anatomy during chemo‐mechanical debridement, obturating the canal with densely compacted material to the apical terminus without extrusion into the apical tissues and preventing re‐infection with a good quality coronal restoration.

Mineral Trioxide Aggregate: A Comprehensive Literature Review—Part III: Clinical Applications, Drawbacks, and Mechanism of Action

2010-02-18

Masoud Parirokh , Mahmoud Torabinejad

In vitro Infection and of Dentinal Tubules

1987-08-01

Markus Haapasalo , Dag Ørstavik

An in vitro model for dentinal tubule infection of root canals was developed. Cylindrical dentin specimens, 4 mm high with a diameter of 6 mm and a canal 2.3 mm … An in vitro model for dentinal tubule infection of root canals was developed. Cylindrical dentin specimens, 4 mm high with a diameter of 6 mm and a canal 2.3 mm wide, were prepared from freshly extracted bovine incisors. The cementum was removed from all dentin blocks. The tubules were opened by four-minute treatments with 17% EDTA and 5.25% NaOCl before being infected with Enterococcus faecalis ATCC 29212 in yeast extract-glucose broth. Bacteria rapidly invaded the tubules. After three weeks of incubation, a heavy infection was found 400 micron from the canal lumen, and the front of the infection reached 1000 micron in some blocks. Camphorated paramonochlorophenol (CMCP) and a calcium hydroxide compound, Calasept, were tested for their disinfecting efficacy toward E. faecalis-infected dentin. Liquid CMCP rapidly and completely disinfected the dentinal tubules, whereas CMCP in gaseous form disinfected tubules less rapidly. Calasept failed to eliminate, even superficially, E. faecalis in the tubules. The method used in bacteriological sampling allowed for sequential removal of 100-micron-thick zones of dentin from the central canal toward the periphery. Control specimens were uniformly infected and yielded growth in bur samples up to some 500 microns from the surface. The model proved quite sensitive and seems suitable for in vitro testing of root canal medicaments.

Sealing ability of a mineral trioxide aggregate when used as a root end filling material

1993-12-01

M. Torabinejad , Timothy F. Watson , T. R. Pitt Ford

The antibacterial effect of camphorated paramonochlorophenol, camphorated phenol and calcium hydroxide in the treatment of infected root canals

1985-10-01

Andeŕs S. Byström , Rolf Claesson , Göran Sundqvist

Abstract The bactericidal efficacy of calcium hydroxide, camphorated phenol and camphorated paramonochlorophenol as intracanal dressings was evaluated clinically when the root canals of 65 single‐rooted teeth with periapical lesions were … Abstract The bactericidal efficacy of calcium hydroxide, camphorated phenol and camphorated paramonochlorophenol as intracanal dressings was evaluated clinically when the root canals of 65 single‐rooted teeth with periapical lesions were treated. A bacteriological technique that could detect even small numbers of anaerobic bacteria in the canals was used. After treatment, including intracanal dressing with calcium hydroxide paste (Calasept), bacteria were recovered from one of 35 treated root canals. After use of camphorated phenol or camphorated paramonochlorophenol as the dressing, bacteria were recovered from 10 of 30 treated root canals. The isolated bacteria were predominantly Gram‐positive and anaerobic. There was no indication that specific bacteria were resistant to the treatment. The results indicate that the endodontic treatment of infected root canals can be completed in two appointments when calcium hydroxide paste is used as an intracanal dressing.

Microbiological status of root‐filled teeth with apical periodontitis

1998-01-01

Anders Molander , Claes Reit , Gunnar Dahlén +1 more

The present study examined the microbiological status of 100 root‐filled teeth with radiographically verified apical periodontitis — the pathology (P) group — and of 20 teeth without signs of periapical … The present study examined the microbiological status of 100 root‐filled teeth with radiographically verified apical periodontitis — the pathology (P) group — and of 20 teeth without signs of periapical pathosis — the technical (T) group. In the P group 117 strains of bacteria were recovered in 68 teeth. In most of the cases examined one or two strains were found. Facultative anaerobic species predominated among these isolates (69% of identified strains). Growth was classified as ‘sparse’ or ‘very sparse’ in 53%, and as ‘heavy’ or ‘very heavy’ in 42%. Enterococci were the most frequently isolated genera, showing ‘heavy’ or ‘very heavy’ growth in 25 out of 32 cases (78%). In 11 teeth of the T group no bacteria were recovered, whilst the remairling nine yielded 13 microbial strains. Eight of these grew ‘very sparsely’. It is concluded that the microflora of the obturated canal differs from that found normally in the untreated necrotic dental pulp, quantitatively as well as qualitatively. Nonsurgical retreatment strategies should be reconsidered.

Mechanical preparation of root canals: shaping goals, techniques and means

2005-03-01

Michael Hülsmann , Ove A. Peters , P. M. H. Dummer

Preparation of root canal systems includes both enlargement and shaping of the complex endodontic space together with its disinfection. A variety of instruments and techniques have been developed and described … Preparation of root canal systems includes both enlargement and shaping of the complex endodontic space together with its disinfection. A variety of instruments and techniques have been developed and described for this critical stage of root canal treatment. Although many reports on root canal preparation can be found in the literature, definitive scientific evidence on the quality and clinical appropriateness of different instruments and techniques remains elusive. To a large extent this is because of methodological problems, making comparisons among different investigations difficult if not impossible. The first section of this paper discusses the main problems with the methodology of research relating to root canal preparation while the remaining section critically reviews current endodontic instruments and shaping techniques.

Physical and chemical properties of a new root-end filling material

1995-07-01

M. Torabinejad , C HONG , Fraser McDonald +1 more

Mineral Trioxide Aggregate: A Comprehensive Literature Review—Part I: Chemical, Physical, and Antibacterial Properties

2009-12-11

Masoud Parirokh , Mahmoud Torabinejad

The effects of surgical exposures of dental pulps in germ-free and conventional laboratory rats

1965-09-01

S. Kakehashi , Harold R. Stanley , R.J. Fitzgerald

Characterization of the Apical Papilla and Its Residing Stem Cells from Human Immature Permanent Teeth: A Pilot Study

2008-01-21

Wataru Sonoyama , Yi Liu , Takayoshi Yamaza +4 more

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Intraradicular bacteria and fungi in root-filled, asymptomatic human teeth with therapy-resistant periapical lesions: A long-term light and electron microscopic follow-up study

1990-12-01

Prashant Nair , U. Sjögren , Gunthild Krey +2 more

Long‐term calcium hydroxide as a root canal dressing may increase risk of root fracture

2002-05-27

Jens Ove Andreasen , B. Farik , E.C. Munksgaard

Abstract – It has been proposed (Cvek 1992) that immature teeth are weakened by filling of the root canals with calcium hydroxide dressing and gutta‐percha. The aim of the present … Abstract – It has been proposed (Cvek 1992) that immature teeth are weakened by filling of the root canals with calcium hydroxide dressing and gutta‐percha. The aim of the present study was to test the hypothesis that dentin in contact with calcium hydroxide would show a reduction in fracture strength after a certain period of time. Immature mandibular incisors from sheep were extracted and divided into two experimental groups. Group 1: the pulps were extirpated via the apical foramen. The root canals were then filled with calcium hydroxide (Calasept ® ) and sealed with IRM ® cement, and the teeth were then stored in saline at room temperature for 0.5, 1, 2, 3, 6, 9, or 12 months. Group 2: the pulps were extirpated and the root canals were filled with saline and sealed with IRM ® cement. The teeth were then stored in saline for 2 months. Intact teeth served as controls and were tested immediately after extraction. All teeth were tested for fracture strength in an Instron testing machine at the indicated observation periods. The results showed a markedly decrease in fracture strength with increasing storage time for group 1 (calcium hydroxide dressing). The results indicate that the fracture strength of calcium hydroxide‐filled immature teeth will be halved in about a year due to the root filling. The finding may explain the frequent reported fractures of immature teeth filled with calcium hydroxide for extended periods.

Mineral Trioxide Aggregate: A Comprehensive Literature Review—Part II: Leakage and Biocompatibility Investigations

2010-01-27

Mahmoud Torabinejad , Masoud Parirokh

Periapical status of endodontically treated teeth in relation to the technical quality of the root filling and the coronal restoration

1995-01-01

H. A. RAY , Martin Trope

The purpose of this study was to evaluate the relationship of the quality of the coronal restoration and of the root canal obturation on the radiographic periapical status of endodontically … The purpose of this study was to evaluate the relationship of the quality of the coronal restoration and of the root canal obturation on the radiographic periapical status of endodontically treated teeth. Full-mouth radiographs from randomly selected new patient folders at Temple University Dental School were examined. The first 1010 endodontically treated teeth restored with a permanent restoration were evaluated independently by two examiners. Post and core type restorations were excluded. According to a predetermined radiographic standard set of criteria, the technical quality of the root filling of each tooth was scored as either good (GE) or poor (PE), and the quality of the coronal restoration similarly good (GR) or poor (PR). The apical one-third of the root and surrounding structures were then evaluated radiographically and the periradicular status categorized as (a) absence of periradicular inflammation (API) or (b) presence of periradicular inflammation (PPI). The rate of API for all endodontically treated teeth was 61.07%. GR resulted in significantly more API cases than GE, 80% versus 75.7%. PR resulted in significantly more PPI cases than PE, 30.2% versus 48.6%. The combination of GR and GE had the highest API rate of 91.4%, significantly higher than PR and PE with a API rate of 18.1%.

Clinical applications of mineral trioxide aggregate

1999-03-01

Mahmoud Torabinejad , Noah Chivian

Regenerative Endodontics: A Review of Current Status and a Call for Action

2007-02-21

Peter E. Murray , Franklin García‐Godoy , Kenneth Hargreaves

An initial investigation of the bending and torsional properties of nitinol root canal files

1988-01-01

Harmeet Walia , William A. Brantley , Hertzel C. Gerstein

The antibacterial action of sodium hypochlorite and EDTA in 60 cases of endodontic therapy

1985-01-01

Andeŕs S. Byström , G. SUNVQVIST

Summary. In this study the antibacterial effect of irrigating infected root canals with 0.5 and 5 per cent sodium hypochlorite solutions was evaluated clinically. The results indicated that there was … Summary. In this study the antibacterial effect of irrigating infected root canals with 0.5 and 5 per cent sodium hypochlorite solutions was evaluated clinically. The results indicated that there was no difference between the antibacterial effect of these two solutions. The combined use of EDTA and S per cent sodium hypochlorite solution was more efficient than the use of sodium hypochlorite solutions alone. An important observation was that bacteria surviving instrumentation and irrigation rapidly increased in number in the period between appointments when no intracanal medicament was used.

Influence on periapical tissues of indigenous oral bacteria and necrotic pulp tissue in monkeys

1981-12-01

Å. Möller , Lars Fabricius , Gunnar Dahlén +2 more

Abstract – In nine monkeys (Macaca Fascicularis) the pulps of 78 teeth were aseptically necrotized. Twenty‐six of the pulp chambers were kept bacteria‐free by sealing, while 52 were infected by … Abstract – In nine monkeys (Macaca Fascicularis) the pulps of 78 teeth were aseptically necrotized. Twenty‐six of the pulp chambers were kept bacteria‐free by sealing, while 52 were infected by the indigenous oral flora. The results were recorded clinically, radiographically and microbiologically at the begining of the experiment and after 6–7 months. Tje final examination also included histologic recordings. The initiallyt noninfected root canals were all sterile at the final samplings, indicating that the risk of contamination (including hemarogenous) of root canals of this animal is very slight. It was show that noninfected necrotic pulp tissue did not induce inflammatory reactions in the apical tissues. By contrast, teeth with infected pulp tissu showed inflammatory reactions clinically (12/52 teeth) and radiographically (47/52 teeth). Facultatively anaerobic streptococci, coliform rods and obligately anacrobic bacterial strains were most frequently found. In the final samples the number of obligately anaerohic strains increased. Some microogramisms which were isolated in the initial samples were not detected in the final samples. All infected teeth histologically examined showed strong inflammatory reactions in the periapical region.

Microbiologic analysis of teeth with failed endodontic treatment and the outcome of conservative re-treatment

1998-01-01

Göran Sundqvist , David Figdor , Sten Persson +1 more

Root canal anatomy of the human permanent teeth

1984-11-01

Frank J. Vertucci

A comparison of canal preparations in straight and curved root canals

1971-08-01

Sam W. Schneider

Root canal morphology and its relationship to endodontic procedures

2005-03-01

Frank J. Vertucci

The hard tissue repository of the human dental pulp takes on numerous configurations and shapes. A thorough knowledge of tooth morphology, careful interpretation of angled radiographs, proper access preparation and … The hard tissue repository of the human dental pulp takes on numerous configurations and shapes. A thorough knowledge of tooth morphology, careful interpretation of angled radiographs, proper access preparation and a detailed exploration of the interior of the tooth are essential prerequisites for a successful treatment outcome. Magnification and illumination are aids that must be utilized to achieve this goal. This article describes and illustrates tooth morphology and discusses its relationship to endodontic procedures. A thorough understanding of the complexity of the root canal system is essential for understanding the principles and problems of shaping and cleaning, for determining the apical limits and dimensions of canal preparations, and for performing successful microsurgical procedures.

Revascularization of Immature Permanent Teeth With Apical Periodontitis: New Treatment Protocol?

2004-03-19

F. Banchs , M TROPE

Bacteriologic evaluation of the efficacy of mechanical root canal instrumentation in endodontic therapy

1981-08-01

Andeŕs S. Byström , Göran Sundqvist

The presence of bacteria in 17 single-rooted teeth, with periapical lesions, was studied throughout a whole period of treatment. The root canals were irrigated with physiologic saline solution during instrumentation. … The presence of bacteria in 17 single-rooted teeth, with periapical lesions, was studied throughout a whole period of treatment. The root canals were irrigated with physiologic saline solution during instrumentation. No antibacterial solutions or dressings were used. Bacteria were found in all initial specimens from the teeth (median number of bacterial cells 4 x 10(5), range 10(2) - 10(7)) and the number of strains in the specimens ranged from 1 to 10.88% of the strains were anaerobic. The most commonly isolated species were: Peptostreptococcus micros, Peptostreptococcus anaerobius, Fusobacterium nucleatum, Bacteroides oralis, Bacteroides melaninogenicus subsp intermedius and Eubacterium alactolyticum. Mechanical instrumentation reduced the number of bacteria considerably. Specimens taken at the beginning of each appointment usually contained 10(4) - 10(6) bacterial cells and at the end 10(2) - 10(3) fewer. Bacteria were eliminated from the root canals of eight teeth during the treatment. In seven root canals bacteria persisted despite treatment on five successive occasions. There was no evidence that specific microorganisms were implicated in these persistent infections. Teeth where the infection persisted despite being treated five times were those with a high number of bacteria in the initial sample.

Current Challenges and Concepts in the Preparation of Root Canal Systems: A Review

2004-07-23

Ove A. Peters

Post Placement and Restoration of Endodontically Treated Teeth: A Literature Review

2004-04-16

Robert H. Schwartz , John Robbins

Root Canal Irrigants

2006-04-23

Matthias Zehnder

Factors affecting the long-term results of endodontic treatment

1990-10-01

U. Sjögren , Björn Hägglund , Göran Sundqvist +1 more

A prospective study of the factors affecting outcomes of nonsurgical root canal treatment: part 1: periapical health

2011-03-02

Y.‐L. Ng , Vera Mann , K. Gulabivala

Ng Y-L, Mann V, Gulabivala K. A prospective study of the factors affecting outcomes of nonsurgical root canal treatment: part 1: periapical health. International Endodontic Journal, 44, 583–609, 2011. Abstract … Ng Y-L, Mann V, Gulabivala K. A prospective study of the factors affecting outcomes of nonsurgical root canal treatment: part 1: periapical health. International Endodontic Journal, 44, 583–609, 2011. Abstract Aim To investigate the probability of and factors influencing periapical status of teeth following primary (1°RCTx) or secondary (2°RCTx) root canal treatment. Methodology This prospective study involved annual clinical and radiographic follow-up of 1°RCTx (1170 roots, 702 teeth and 534 patients) or 2°RCTx (1314 roots, 750 teeth and 559 patients) carried out by Endodontic postgraduate students for 2–4 (50%) years. Pre-, intra- and postoperative data were collected prospectively on customized forms. The proportion of roots with complete periapical healing was estimated, and prognostic factors were investigated using multiple logistic regression models. Clustering effects within patients were adjusted in all models using robust standard error. Results The proportion of roots with complete periapical healing after 1°RCTx (83%; 95% CI: 81%, 85%) or 2°RCTx (80%; 95% CI: 78%, 82%) were similar. Eleven prognostic factors were identified. The conditions that were found to improve periapical healing significantly were: the preoperative absence of a periapical lesion (P = 0.003); in presence of a periapical lesion, the smaller its size (P ≤ 0.001), the better the treatment prognosis; the absence of a preoperative sinus tract (P = 0.001); achievement of patency at the canal terminus (P = 0.001); extension of canal cleaning as close as possible to its apical terminus (P = 0.001); the use of ethylene-diamine-tetra-acetic acid (EDTA) solution as a penultimate wash followed by final rinse with NaOCl solution in 2°RCTx cases (P = 0.002); abstaining from using 2% chlorexidine as an adjunct irrigant to NaOCl solution (P = 0.01); absence of tooth/root perforation (P = 0.06); absence of interappointment flare-up (pain or swelling) (P =0.002); absence of root-filling extrusion (P ≤ 0.001); and presence of a satisfactory coronal restoration (P ≤ 0.001). Conclusions Success based on periapical health associated with roots following 1°RCTx (83%) or 2°RCTx (80%) was similar, with 10 factors having a common effect on both, whilst the 11th factor 'EDTA as an additional irrigant' had different effects on the two treatments.

The antimicrobial effect of calcium hydroxide as a short‐term intracanal dressing

1991-05-01

U. Sjögren , David Figdor , L Spångberg +1 more

The antibacterial effect of calcium hydroxide as a short-term intracanal dressing was clinically evaluated by applying the medicament for 10 minutes or 7 days in root canals of teeth with … The antibacterial effect of calcium hydroxide as a short-term intracanal dressing was clinically evaluated by applying the medicament for 10 minutes or 7 days in root canals of teeth with periapical lesions. The results showed that the 7-day dressing efficiently eliminated bacteria which survived biomechanical instrumentation of the canal, while the 10-minute application was ineffective.

On the causes of persistent apical periodontitis: a review

2006-03-10

Prashant Nair

Apical periodontitis is a chronic inflammatory disorder of periradicular tissues caused by aetiological agents of endodontic origin. Persistent apical periodontitis occurs when root canal treatment of apical periodontitis has not … Apical periodontitis is a chronic inflammatory disorder of periradicular tissues caused by aetiological agents of endodontic origin. Persistent apical periodontitis occurs when root canal treatment of apical periodontitis has not adequately eliminated intraradicular infection. Problems that lead to persistent apical periodontitis include: inadequate aseptic control, poor access cavity design, missed canals, inadequate instrumentation, debridement and leaking temporary or permanent restorations. Even when the most stringent procedures are followed, apical periodontitis may still persist as asymptomatic radiolucencies, because of the complexity of the root canal system formed by the main and accessory canals, their ramifications and anastomoses where residual infection can persist. Further, there are extraradicular factors -- located within the inflamed periapical tissue -- that can interfere with post-treatment healing of apical periodontitis. The causes of apical periodontitis persisting after root canal treatment have not been well characterized. During the 1990s, a series of investigations have shown that there are six biological factors that lead to asymptomatic radiolucencies persisting after root canal treatment. These are: (i) intraradicular infection persisting in the complex apical root canal system; (ii) extraradicular infection, generally in the form of periapical actinomycosis; (iii) extruded root canal filling or other exogenous materials that cause a foreign body reaction; (iv) accumulation of endogenous cholesterol crystals that irritate periapical tissues; (v) true cystic lesions, and (vi) scar tissue healing of the lesion. This article provides a comprehensive overview of the causative factors of non-resolving periapical lesions that are seen as asymptomatic radiolucencies post-treatment.

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Modern Endodontic Surgery Concepts and Practice: A Review

2006-05-07

Syngcuk Kim , Samuel Kratchman

P<scp>athogenesis of</scp> A<scp>pical</scp> P<scp>eriodontitis and the</scp> C<scp>auses of</scp> E<scp>ndodontic</scp> F<scp>ailures</scp>

2004-11-01

Prashant Nair

Apical periodontitis is a sequel to endodontic infection and manifests itself as the host defense response to microbial challenge emanating from the root canal system. It is viewed as a … Apical periodontitis is a sequel to endodontic infection and manifests itself as the host defense response to microbial challenge emanating from the root canal system. It is viewed as a dynamic encounter between microbial factors and host defenses at the interface between infected radicular pulp and periodontal ligament that results in local inflammation, resorption of hard tissues, destruction of other periapical tissues, and eventual formation of various histopathological categories of apical periodontitis, commonly referred to as periapical lesions. The treatment of apical periodontitis, as a disease of root canal infection, consists of eradicating microbes or substantially reducing the microbial load from the root canal and preventing re-infection by orthograde root filling. The treatment has a remarkably high degree of success. Nevertheless, endodontic treatment can fail. Most failures occur when treatment procedures, mostly of a technical nature, have not reached a satisfactory standard for the control and elimination of infection. Even when the highest standards and the most careful procedures are followed, failures still occur. This is because there are root canal regions that cannot be cleaned and obturated with existing equipments, materials, and techniques, and thus, infection can persist. In very rare cases, there are also factors located within the inflamed periapical tissue that can interfere with post-treatment healing of the lesion. The data on the biological causes of endodontic failures are recent and scattered in various journals. This communication is meant to provide a comprehensive overview of the etio-pathogenesis of apical periodontitis and the causes of failed endodontic treatments that can be visualized in radiographs as asymptomatic post-treatment periapical radiolucencies.

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Effects of four Ni–Ti preparation techniques on root canal geometry assessed by micro computed tomography

2001-04-01

Ove A. Peters , K. Schönenberger , A. Laib

Abstract Aim The aim of this study was to compare the effects of four preparation techniques on canal volume and surface area using three‐dimensionally reconstructed root canals in extracted human … Abstract Aim The aim of this study was to compare the effects of four preparation techniques on canal volume and surface area using three‐dimensionally reconstructed root canals in extracted human maxillary molars. In addition, µCT data was used to describe morphometric parameters related to the four preparation techniques. Methodology A micro computed tomography scanner was used to analyse root canals in extracted maxillary molars. Specimens were scanned before and after canals were prepared using Ni–Ti – K‐Files, Lightspeed instruments, ProFile .04 and GT rotary instruments. Differences in dentine volume removed, canal straightening, the proportion of unchanged area and canal transportation were calculated using specially developed software. Results Instrumentation of canals increased volume and surface area. Prepared canals were significantly more rounded, had greater diameters and were straighter than unprepared canals. However, all instrumentation techniques left 35% or more of the canals’ surface area unchanged. Whilst there were significant differences between the three canal types investigated, very few differences were found with respect to instrument types. Conclusions Within the limitations of the µCT system, there were few differences between the four canal instrumentation techniques used. By contrast, a strong impact of variations of canal anatomy was demonstrated. Further studies with 3D‐techniques are required to fully understand the biomechanical aspects of root canal preparation.

Clinical Implications and Microbiology of Bacterial Persistence after Treatment Procedures

2008-09-18

José F. Siqueira , Isabela N. Rôças

Aetiology of root canal treatment failure: why well‐treated teeth can fail

2001-01-01

José F. Siqueira

Abstract Literature review Root canal treatment usually fails when the treatment is carried out inadequately. However, there are some cases in which the treatment has followed the highest standards yet … Abstract Literature review Root canal treatment usually fails when the treatment is carried out inadequately. However, there are some cases in which the treatment has followed the highest standards yet still results in failure. In most of the cases, the endodontic failure results from persistent or secondary intraradicular infection. Extraradicular infections may also be implicated in the failure of some cases. In addition, it has been claimed that a few cases can fail because of intrinsic or extrinsic nonmicrobial factors. The purpose of this paper is to discuss the aetiology of the failure of root canal treatment, particularly in cases of well‐treated root canals. Indications for the treatment of endodontic failures are also discussed.

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Defects in Rotary Nickel-Titanium Files After Clinical Use

2000-03-01

Boonrat Sattapan , Garry J. Nervo , Joseph E.A. Palamara +1 more

Passive ultrasonic irrigation of the root canal: a review of the literature

2007-05-02

L. W. M. van der Sluis , Michel Versluis , M.‐K. Wu +1 more

Abstract Ultrasonic irrigation of the root canal can be performed with or without simultaneous ultrasonic instrumentation. When canal shaping is not undertaken the term passive ultrasonic irrigation (PUI) can be … Abstract Ultrasonic irrigation of the root canal can be performed with or without simultaneous ultrasonic instrumentation. When canal shaping is not undertaken the term passive ultrasonic irrigation (PUI) can be used to describe the technique. In this paper the relevant literature on PUI is reviewed from a MEDLINE database search. Passive ultrasonic irrigation can be performed with a small file or smooth wire (size 10–20) oscillating freely in the root canal to induce powerful acoustic microstreaming. PUI can be an important supplement for cleaning the root canal system and, compared with traditional syringe irrigation, it removes more organic tissue, planktonic bacteria and dentine debris from the root canal. PUI is more efficient in cleaning canals than ultrasonic irrigation with simultaneous ultrasonic instrumentation. PUI can be effective in curved canals and a smooth wire can be as effective as a cutting K‐file. The taper and the diameter of the root canal were found to be important parameters in determining the efficacies of dentine debris removal. Irrigation with sodium hypochlorite is more effective than with water and ultrasonic irrigation is more effective than sonic irrigation in the removal of dentine debris from the root canal. The role of cavitation during PUI remains inconclusive. No detailed information is available on the influence of the irrigation time, the volume of the irrigant, the penetration depth of the instrument and the shape and material properties of the instrument. The influence of irrigation frequency and intensity on the streaming pattern as well as the complicated interaction of acoustic streaming with the adherent biofilm needs to be clarified to reveal the underlying physical mechanisms of PUI.

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Enterococcus faecalis: Its Role in Root Canal Treatment Failure and Current Concepts in Retreatment

2006-01-20

Charles H. Stuart , S SCHWARTZ , Thomas J. Beeson +1 more

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The periapical index: A scoring system for radiographic assessment of apical periodontitis

1986-02-01

Dag Ørstavik , Kasmer Kerekes , Harald M. Eriksen

Abstract A scoring system for registration of apical periodontitis in radiographs is presented. The system is termed the periapical index (PAI) and provides an ordinal scale of 5 scores ranging … Abstract A scoring system for registration of apical periodontitis in radiographs is presented. The system is termed the periapical index (PAI) and provides an ordinal scale of 5 scores ranging from 1 (healthy) to 5 (severe periodontitis with exacerbating features). Its validity is based on the use of reference radiographs of teeth with verified histological diagnoses. Results from studies involving 11 observers and 47 selected radiographs document that the PAI system is reasonably accurate, reproducible and able to discriminate between sub‐populations. It may also allow for results from different researchers to be compared. The system may be suitable for the analysis of periapical radiographs in epidemiological studies, in clinical trials and in retrospective analyses of treatment results in endodontics.

Sealing ability of a mineral trioxide aggregate for repair of lateral root perforations

1993-11-01

Seung Jin Lee , M Monsef , M. Torabinejad

Mechanisms of antimicrobial activity of calcium hydroxide: a critical review

1999-09-01

José F. Siqueira , Hélio Pereira Lopes

Literature review The primary function of calcium hydroxide as a routine intracanal medicament is to provide antimicrobial activity. However, the mechanisms of antimicrobial activity of calcium hydroxide are not well … Literature review The primary function of calcium hydroxide as a routine intracanal medicament is to provide antimicrobial activity. However, the mechanisms of antimicrobial activity of calcium hydroxide are not well known. Physicochemical properties of this substance may limit its effectiveness in disinfecting the entire root canal system. In addition, calcium hydroxide is not effective against all bacterial species found in root canal infections. Association with other medicaments may enhance the efficacy of the intracanal medication in eliminating residual bacteria in the root canal system.

Filling Root Canals in Three Dimensions

1967-11-01

Herbert Schilder

Cleaning and Shaping the Root Canal

1974-04-01

Herbert Schilder

The effect of fluocinolone acetonide, ProRoot MTA and their combination on inflammation and odontogenic differentiation of inflamed human dental pulp cells

2025-06-26

Suphachart Chayawatto , Chatvadee Kornsuthisopon , Pairoj Linsuwanont | Clinical Oral Investigations

Endodontic management of a maxillary premolar with a rare anatomical variation: Case report

2025-06-25

André Luís Martins Leal , Lívia Neri , Beatriz Parma Teixeira +2 more | Research Society and Development

The success of endodontic treatment depends on the quality of cleaning and obturation of the Root Canal System (RCS), which are challenged by morphological variations such as isthmuses, polar areas, … The success of endodontic treatment depends on the quality of cleaning and obturation of the Root Canal System (RCS), which are challenged by morphological variations such as isthmuses, polar areas, and accessory canals. Failure to locate all root canals can result in persistent infections or reinfections, significantly contributing to treatment failure. Upper premolars with three roots represent a rare anatomical variation, requiring a meticulous approach to achieve therapeutic success. This study aims to report the endodontic treatment of a left upper premolar with three roots and three canals, with independent foraminal exits. A 38-year-old male, Caucasian patient, was referred for endodontic treatment of the left second upper premolar. Upon clinical examination, tooth 25 showed an exaggerated response to the vitality test, and the radiographic examination revealed an atypical anatomy with three roots and three canals. The first session was dedicated to locating and performing complete chemical-mechanical preparation of the three canals using stainless steel files (C-pilot®), rotary instruments (Bondent Platinum®). An intracanal medication containing calcium hydroxide combined with 2% chlorhexidine gel was placed for 21 days. In the second visit, the root canal system was obturated with Endofill® sealer. The endodontic treatment of teeth with complex anatomy, such as tooth 25 with three independent canals, emphasizes the need for meticulous planning and the use of advanced technologies for clinical success.

Comparative outcomes of endodontically treated teeth versus dental implant-supported prostheses: a systematic review

2025-06-24

Marta Borda , Salomón Páez‐García , Luisa Murcia +2 more | Acta Odontologica Scandinavica

Objective: The objective of this study was to compare the clinical and patient-related outcomes of root canal therapy (RCT) and dental implants (DIs) in managing severe tooth damage, supporting evidence-based … Objective: The objective of this study was to compare the clinical and patient-related outcomes of root canal therapy (RCT) and dental implants (DIs) in managing severe tooth damage, supporting evidence-based treatment decisions. Material and methods: A systematic review was performed in accordance with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Six databases were searched: Cochrane Library, Embase, Medline, LILACS, Scopus, and Web of Science. Studies comparing clinical and patient-reported outcomes in adult patients treated with either RCT or DIs were included. The Joanna Briggs Institute Critical Appraisal Checklists were used to assess the risk of bias. Due to significant heterogeneity among studies, meta-analysis was not feasible, and findings were synthesised qualitatively. PROSPERO registration: CRD42024584113. Results: Out of 1,876 initial records, 12 studies met inclusion criteria: 7 cohort studies, 4 case-control studies, and 1 randomised controlled trial. Most studies had low to moderate risk of bias. Both RCT and DIs demonstrated high survival rates, with RCT slightly outperforming DIs in terms of success. Failure rates ranged from 0.7% to 12.0%, with no significant differences between treatments. DIs were associated with a higher frequency of postoperative interventions and complications. Patient-reported outcomes such as pain, satisfaction, and quality of life (QoL) were comparable across both modalities. Conclusion: RCT and DIs both offer viable and effective solutions for restoring severely damaged teeth, with high survival and success rates and low failure rates. Both treatments were also associated with favourable patient-reported outcomes, including minimal pain, high satisfaction, and improved QoL. The decision between treatments should consider clinical factors, patient preferences, cost, accessibility, potential complications, and patient-centred outcomes. Shared decision-making is essential for optimal patient care.

Effect of Three‐Dimensional‐Printed Teeth With Isthmus on Undergraduates’ Pre‐clinical Root Canal Preparation and Obturation Trainings

2025-06-24

Mengting Duan , Yi Luo , Bing Bing Fan +1 more | Journal of Dental Education

ABSTRACT Objectives To evaluate the effect of three‐dimensional (3D)‐printed teeth with isthmus on the pre‐clinical root canal preparation and obturation training of undergraduates. Methods 3D‐printed teeth with isthmus were made … ABSTRACT Objectives To evaluate the effect of three‐dimensional (3D)‐printed teeth with isthmus on the pre‐clinical root canal preparation and obturation training of undergraduates. Methods 3D‐printed teeth with isthmus were made from the micro‐computed tomography data of a lower first molar from a Chinese permanent teeth database. One hundred and four undergraduates performed root canal preparation and obturation in plastic and 3D‐printed teeth within 20 min each using a manikin system. Then, students completed questionnaires, and two independent teachers scored the obturated teeth using X‐rays. Results The plastic teeth scored higher than 3D‐printed teeth in total and the filling density scores ( p < 0.05). All students obturated the isthmus. In questionnaire surveys, during the preparation training, students found plastic teeth better in identifying pulp chamber morphology and root canal orifices (49.41%) and provided a better feeling of drill (56.47%). 54.12% of the students indicated that 3D‐printed teeth provided a better feeling of the pathway and internal conditions of root canals when using K‐files. During the obturation training, over 50% of students felt 3D‐printed teeth had advantages in providing gutta‐percha point grip senses, manipulation tactile sense, and procedural understanding. Over 98% of students agreed that using 3D‐printed teeth with isthmus could enhance learning interest, anatomy understanding, operation skills, and confidence. Conclusions 3D‐printed teeth had evident advantages over traditional plastic teeth in root canal preparation and obturation training. Undergraduates adapted better to the root canal preparation and obturation practices using the 3D‐printed teeth. With improved materials and methods, various root canal systems could possibly be printed for diverse purposes.

An in vitro evaluation of biofilm removal from simulated root canals using sodium hypochlorite irrigation solution at various temperature settings

2025-06-23

Kevser Şenel , İsmail Uzun , Rawan Alqawasmi | PLoS ONE

Using sodium hypochlorite (NaOCl) irrigation solution at various temperatures is common for removing biofilms in root canals and the isthmus. Numerous studies have examined the impact of temperature on biofilm … Using sodium hypochlorite (NaOCl) irrigation solution at various temperatures is common for removing biofilms in root canals and the isthmus. Numerous studies have examined the impact of temperature on biofilm removal in extracted teeth. However, this study aimed to assess the effect of needle irrigation using NaOCl solution heated to different temperatures on the structure of E. faecalis biofilm in artificial teeth produced by 3D printing technology. The isthmus in the mesial canals of 55 artificial tooth samples, which were produced from the 3D model obtained by micro-CT of the mandibular first molars, was evaluated. The standard strain E. faecalis ATCC 19433 was used to infect artificial tooth specimens. The samples were divided into a control group and four experimental groups receiving sodium hypochlorite solutions at 21°C, 45°C, 60°C, and 150°C. Following irrigation, scanning electron microscope (SEM) imaging was conducted at varying magnifications to visualize the remaining biofilm areas in the root canals and the isthmus. The ImageJ program quantified biofilm areas in the isthmus region. Statistical analyses, including Shapiro-Wilks, Kruskal Wallis H, and t-tests, were conducted on the measurements. A p-value of < 0.05 was considered statistically significant. The results did not differ between the control and 21 °C groups (p > 0.05). However, removal areas were larger in the 45°C, 60°C, and 150°C groups than in the control group (p < 0.05). No difference was observed in the biofilm removal efficiency in different isthmus regions (p > 0.05). The findings revealed that an increase in temperature enlarged the removal areas.

A Comparative Analysis of Root Canal Preparation Methods: Assessing Obturation Quality in Rotary Versus Manual Techniques

2025-06-23

Muhammad Zubair Ahmad , Yazeed Sulaiman Alqowaiei | Medical Forum Monthly

Objective: To compare the radiographic quality of root canal obturation in molar teeth prepared using rotary and manual instrumentation techniques performed by undergraduate dental students. Study Design: Cross-sectional analytical study. … Objective: To compare the radiographic quality of root canal obturation in molar teeth prepared using rotary and manual instrumentation techniques performed by undergraduate dental students. Study Design: Cross-sectional analytical study. Place and Duration of Study: This study was conducted at the College of Dentistry, Qassim University, Saudi Arabia, from August 21, 2024, to March 10, 2025. Methods: A total of 60 digital periapical radiographs of molars were retrospectively allocated into two groups based on the root canal instrumentation techniques. Group 1 (n=30): manual stainless-steel files using step-back technique and Group 2 (n=30): Pro Taper Gold (PTG) rotary nickel-titanium (NiTi) files using crown-down technique. All canals were obturated using cold lateral condensation with AH Plus sealer and appropriate gutta-percha points. The quality of obturation was assessed based on three parameters: length, density, and taper. A T-score (0–3) was calculated for each case. Statistical analysis was performed using Chi-square and Mann-Whitney U tests, with a p-value < 0.05 considered statistically significant. Results: Adequate obturation in terms of length, density, and taper was observed in 63.33%, 46.67%, and 36.67% of teeth in the manual group, and in 83.33%, 90%, and 93.33% of teeth in the rotary group, respectively. Statistically significant differences were found in all three parameters between the two groups (p < 0.05 for length; p < 0.001 for density and taper). The overall T-score distribution also showed a significant difference favoring the rotary technique (p < 0.001). No statistically significant associations were observed between obturation quality and either gender or tooth location within the arch (p > 0.05). Conclusion: Rotary instrumentation resulted in significantly better radiographic quality of root canal obturation compared to manual techniques. These findings support the integration of rotary systems into undergraduate endodontic training to enhance treatment outcomes.

Antibacterial effect of catalytic Iron oxide Nanoparticles, Sodium Hypochlorite, Hydrogen Peroxide and Qmix as a final rinse on Enterococcus faecalis colonizing the dentinal tubules of single rooted teeth (an in vitro study)

2025-06-23

Eman Khalifa , Reem Ahmed Lutfy , fatma abu naeem | Research Square (Research Square)

<title>Abstract</title> <bold>Introduction: </bold>Bacterial infection is one of the main causes of pulpal and periapical diseases. Presistent infection is a great challenge for dentists. Several newly introduced irrigants, such as catalytic … <title>Abstract</title> <bold>Introduction: </bold>Bacterial infection is one of the main causes of pulpal and periapical diseases. Presistent infection is a great challenge for dentists. Several newly introduced irrigants, such as catalytic iron oxide and QMix, can help improve the eradication of this infection. <bold>Aim:</bold> Evaluation of antibacterial effcet of catalytic iron oxide nanoparticles with 3% H2O2, iron oxide nanoparticles, 3% H2O2, QMix, and NaOCl as a final rinse on <italic>Enterococcus faecalis </italic>colonizing the dentinal tubules of single rooted teeth. <bold>Materials and methods:</bold> Fifty extracted human permanent single rooted teeth were selected; root canals were prepared using ProTaper Next up to size X4 and irrigated with 3ml of 2.5% NaOCl between each file using a 30-gauge needle in a plastic syringe. Canals were flushed with 5ml of distilled water followed by 5ml of 17% EDTA for 3 minutes then flushed with distilled water again. Final rinse was done with 5ml of: 2.5% NaOCl, QMix, 3%H2O2, IO-NP (0.5 mg/mL) or IO-NP + 3% H2O2 for 5 minutes. Each root was split longitudinally into two halves. One representative half was viewed at standard levels: 6 mm and 12 mm from apex representing apical and middle thirds. Samples were stained by using LIVE/DEAD BacLight bacterial viability kit and inspected using CLSM. <bold>Results:</bold> The comparison between the five irrigant groups revealed that there was a statistically significant difference between all the groups with a p value (<0.001), with the highest value being recorded for IONP + 3% H2O2. <bold>Conclusion: </bold>IO-NP + 3% H2O2 has a higher antibacterial effect in relation to other irrigants.

The success of post-endodontic restorations using different restorative materials in a two years of follow-up

2025-06-22

Sait Güllü , Emre Çulha , Uğur Aydın +1 more | Meandros Medical And Dental Journal

Introduction: Coronal restoration following endodontic therapy is critical for success. Restorations after endodontic treatment should minimize fractures of residual hard tissues, and leaks, and maintain dental function. The aim of … Introduction: Coronal restoration following endodontic therapy is critical for success. Restorations after endodontic treatment should minimize fractures of residual hard tissues, and leaks, and maintain dental function. The aim of this study was to evaluate the success of post-endodontic restorations using various restorative materials over a two-year period. Methods: The study involved 60 individuals aged 18 to 40. The patients were randomly divided into three groups. Conventional composite restorations were used to restore the first group. The second group was treated with a fiber-reinforced composite covered in composite resin. The third group was reconstructed using endocrowns. The restorations were prospectively investigated for two years. Results: In the composite restoration group, two restorations and one tooth were fractured, with two polishable surfaces found on one restoration surface. In the fiber-reinforced resin-supported composite restoration group, one restoration fragmented and one polishable surface was found. In the endocrown restoration group, 2 endocrowns had decementation. No significant difference was observed in periodontal examination including gingival pocket depth, plaque index and bleeding index assessment (p> 0.05). There were no marginal discrepancies and no caries in any of the restorations. At the last appointment, patient satisfaction was evaluated aesthetically and functionally using a visual analog scale. Conclusion: All groups had a 100% survival rate over the two-year follow-up period. According to the patients, there was no functional difference between the restoration groups (p> 0.05); however, aesthetically, restorations with endocrowns were more successful (p

REPARO COMPLETO DA RADIOTRANSPARÊNCIA ÓSSEA PERIAPICAL EXTENSA DE PRÉ MOLAR INFERIOR COM DOIS CANAIS RADICULARES APÓS PREPARO COM SOLLA FILES COLLORS #35.04.

2025-06-21

Rosana Maria Coelho Travassos , Samuel Nogueira Lima , Josué Alves +7 more | Revista fisio&terapia.

The present study aims to report a clinical case of non-surgical endodontic treatment performed on a lower premolar with two root canals and an extensive periapical lesion. A 45-year-old female … The present study aims to report a clinical case of non-surgical endodontic treatment performed on a lower premolar with two root canals and an extensive periapical lesion. A 45-year-old female patient came to the private practice. After a complete clinical examination, endodontic treatment was initiated, with coronal opening, root canal exploration and root canal preparation using Solla Files Collors #35.04, associated with 2.5% sodium hypochlorite as an irrigating solution. The root canal system was obturated using the single cone technique associated with AH Plus endodontic cement. Clinical and radiographic follow-up was performed one year after the canal obturation. It is concluded that successful endodontic therapy is achieved when the diagnosis is correctly made, the canal system is sanitized, and the periapical bone radiolucency is repaired.

Wound Healing Potential of Basil Leaf (Ocimum sanctum L.) Extract Gel: Fibroblast Response in Post-Tooth Extraction Sockets of Wistar Rats

2025-06-21

Dzanuar Rahmawan , Tsamarah Amany Putri , Rudi Irawan | World Journal of Advanced Research and Reviews

Background: Tooth extraction is a minor surgical procedure involving the removal of a damaged or non-restorable tooth from its socket, such as in cases of pulpal necrosis. This procedure results … Background: Tooth extraction is a minor surgical procedure involving the removal of a damaged or non-restorable tooth from its socket, such as in cases of pulpal necrosis. This procedure results in tissue injury that initiates a wound healing process. Fibroblasts play a critical role in the healing phase by synthesizing structural proteins essential for tissue regeneration. Basil leaves (Ocimum sanctum L.) contain active compounds known to enhance fibroblast migration and proliferation, potentially accelerating wound healing. Purpose: This study aimed to evaluate the effect of basil leaf extract gel on the fibroblast count in post-extraction wound healing in Wistar rats (Rattus norvegicus). Methods: This was a laboratory-based experimental study involving 32 male Wistar rats, randomly divided into two groups. The treatment group received 1.5% basil leaf extract gel, while the control group received a gel base of sodium carboxymethyl cellulose (CMC-Na). The wound healing response was evaluated on day 7 post-extraction by assessing fibroblast counts histologically. Results: Administration of 1.5% basil leaf extract gel significantly increased the number of fibroblast on day 7 compared to the control group (p = 0.002). Conclusion: The application of 1.5% basil leaf extract gel positively influences fibroblast proliferation, thus enhancing the healing process of post-tooth extraction wounds in Wistar rats.

Use of Calcium Silicate-Based Materials in the Management of Open Apices: A Case Report

2025-06-21

Bouchra Doumari , Sara Dhoum , Zineb El Hajjoui +1 more | Cureus

An Evaluation of Turkish Dentists’ Approach to Indirect Pulp Capping and Material Preferences: A Questionnaire-Based Survey

2025-06-20

Bahriye Arslan , Batu Can Yaman , Özge Çeliksöz +1 more | Medicina

Background and Objectives: The aim of this study was to evaluate how the indirect pulpcapping treatment approaches and material choices used by dentists actively practicingin Turkey vary according to demographic … Background and Objectives: The aim of this study was to evaluate how the indirect pulpcapping treatment approaches and material choices used by dentists actively practicingin Turkey vary according to demographic data. Materials and Methods: Dentists practicingin Turkey were included in this study. A 13-question survey was used and distributed tothe participants via social media. The statistical analysis of the data obtained from thisstudy was performed using IBM SPSS v23. The chi-square test was used to compare categoricalvariables between groups, and multiple comparisons of the proportions were analyzedusing the Bonferroni correction. The results of the analysis are presented as frequencies(percentages) for categorical data. The significance level was set at p < 0.05. Results:A total of 402 dentists from across Turkey participated in this study. A total of 331participants (82.3%) reported that they performed indirect pulp capping treatment. Themost commonly used materials for indirect pulp capping were Ca(OH)₂-containing liners(73.4%) and glass ionomer cement (58.3%). The use of amalgam and cotton roll isolationwas more common among dentists working in the public sector, whereas rubber damisolation and the use of contemporary materials such as MTA and Biodentine were morefrequently observed among dentists working in the private sector. Conclusions: Significantdifferences were found in the dentists’ indirect pulp capping approaches and the materialsthey used based on their specialty, years of experience, and workplace setting. Thesefindings suggest that dentists’ knowledge and experience regarding indirect pulp cappingshould be enhanced during their education and post-graduation training.

Finite Element Analysis of Stress Distribution in Various Sizes Internal Root Resorption Cavities Filled With Different Materials

2025-06-20

Tunahan Aktaş , Tuğba Koşar | Australian Endodontic Journal

ABSTRACT This study aimed to investigate the stress distribution on dentine, supporting tissues and restorative materials in simulated tooth models with various sized internal resorption cavities obturated with gutta‐percha, MTA … ABSTRACT This study aimed to investigate the stress distribution on dentine, supporting tissues and restorative materials in simulated tooth models with various sized internal resorption cavities obturated with gutta‐percha, MTA or Biodentine. A 3D finite element model was developed using Wheeler's dental atlas. The cortical and trabecular bone, lamina dura, and periodontal ligament were modelled. A healthy tooth served as the control, while the other models featured internal resorption cavities of various sizes in the middle third. In the treated models, the resorption cavities were restored with gutta‐percha, MTA or Biodentine; the apical and coronal thirds were filled with gutta‐percha. Seventeen models were subjected to a 100 N force at a 135° angle. Stress increased with resorption size but decreased after treatment. Gutta‐percha models showed the highest stress on dentine and bone, while Biodentine had the lowest. However, Biodentine accumulated the most stress within the material. Larger resorption cavities increased stress, while Biodentine and MTA transmitted less stress to dentine than gutta‐percha.

Success Rates in Single-Visit Versus Multiple-Visit Root Canal Treatments: A Prospective Study

2025-06-20

Diganta Kumar Borah , Naseem Shah , S. E. Pawar +4 more | Journal of Pharmacy And Bioallied Sciences

A BSTRACT Background: Root canal treatment (RCT) is a widely performed procedure to address dental pulp infections. However, there is still an argument between the efficacy of single-visit versus multiple-visit … A BSTRACT Background: Root canal treatment (RCT) is a widely performed procedure to address dental pulp infections. However, there is still an argument between the efficacy of single-visit versus multiple-visit RCT, particularly concerning success rates, post-operative pain, and patient satisfaction. Objective: To evaluate and compare the success rates, post-operative complications, and patient satisfaction between single-visit and multiple-visit RCTs in a clinical setting. Methods: A randomized clinical trial was conducted with 100 subjects requiring an RCT. Subjects were divided into two groups: single-visit ( n = 50) and multiple-visit ( n = 50) treatments. Success rates were evaluated through clinical symptoms and radiographic healing over a 12-month follow-up. Post-operative pain was measured using a “Visual Analog Scale (VAS)” at 24 hours, 48 hours, and 1 week. Patient satisfaction was assessed through a standardized questionnaire. Results: The success rates were 85% for the single-visit group and 87% for the multiple-visit group, showing no statistically significant difference ( P = 0.67). Post-operative pain was slightly higher in the single-visit group at 24 hours (VAS: 4.5 vs. 3.0, P = 0.03), but pain levels were similar by the one-week mark. Patient satisfaction was higher in the single-visit group (92%) compared to the multiple-visit group (85%). Conclusion: Single-visit and multiple-visit RCTs demonstrated comparable success rates at 12 months. While single-visit treatments resulted in slightly higher post-operative pain initially, they were associated with higher patient satisfaction due to convenience. Both treatment modalities are effective, and the choice should depend on patient-specific factors.

Evaluation of the Accuracy of an Endomotor-Integrated Apex Locator Versus a Standalone Electronic Apex Locator in Teeth with Simulated Apical Root Resorption: An In Vitro Study

2025-06-20

Yunus Emre Çakmak , Damla Erkal , Hatice Harorlı +1 more | European Journal of Therapeutics

Objective: This in vitro study aimed to evaluate and compare the accuracy of an endomotor-integrated apex locator system and a conventional electronic apex locator in determining the working length (WL) … Objective: This in vitro study aimed to evaluate and compare the accuracy of an endomotor-integrated apex locator system and a conventional electronic apex locator in determining the working length (WL) of root canals with simulated apical root resorption, in both straight and curved canal anatomies. Methods: Sixty-seven extracted mandibular molars with either straight distal canals or curved mesiobuccal canals were included. Simulated external apical resorption was created using a standardized protocol. Actual working length was determined under a stereomicroscope. WL was then measured using an integrated system (EndoRadar Pro) and an electronic apex locator (Dentaport ZX) shaping procedures. The differences between actual and measured WL values were calculated. Data were analyzed using the Kolmogorov-Smirnov test and Chi-square test with a ±0.5 mm tolerance range. Results: All tested devices demonstrated clinically acceptable accuracy within the ±0.5 mm range. In curved canals, the integrated system used with ProGlider showed higher accuracy compared to the systems used with PTN X1 and Dentaport ZX; however, this difference was not statistically significant (Pearson Chi-Square, p = 0.128). In straight canals no statistically significant differences were observed (Pearson Chi-Square, p = 0.155). Conclusions: Both integrated system used with EndoRadar Pro and electronic measurements performed with Dentaport ZX provide reliable measurements for WL determination in the presence of apical root resorption. The integrated system used with ProGlider may offer enhanced accuracy in anatomically complex, curved canals, supporting their clinical use in such challenging scenarios.

Effects of different apical preparation sizes and root canal sealers on the fracture resistance of roots aged for 12 months in endodontically retreated mandibular premolars

2025-06-20

Dilek Hançerlioğulları , Sevda Durust Baris , Ali Türkyılmaz +1 more | BDJ

Abstract Objective This study evaluated the effect of different apical preparation sizes and root canal sealers on fracture resistance. Materials and methods In total, 100 mandibular premolars were collected; 90 … Abstract Objective This study evaluated the effect of different apical preparation sizes and root canal sealers on fracture resistance. Materials and methods In total, 100 mandibular premolars were collected; 90 were prepared with the VDW R25 file, obturated with AH Plus a single gutta-percha cone and stored for one month, after which ProTaper Universal Retreatment System instruments were used to remove the root canal filling materials. The K3XF rotary nickel-titanium files (25/0.04, 30/0.04, 35/0.04, 40/0.04, respectively, according to the experimental groups) were used to complete retreatment and obturated with root canal sealer and a single gutta-percha cone per the experimental groups. The root segments were randomly divided into ten experimental groups (n = 10 roots/group) as follows: Negative Control Group 1 (intact tooth group); Positive Control Group 2 (25/0.04 preparation, without obturation); Positive Control Group 3 (30/0.04 preparation, without obturation), Positive Control Group 4 (40/0.04 preparation, without obturation); Group 5A (30/0.04, AH Plus); Group 5B (40/0.04, AH Plus); Group 6A (30/0.04, NeoSealer Flo); Group 6B (40/0.04, NeoSealer Flo); Group 7A (30/0.04, MTA Bioseal); and Group 7B (40/0.04, MTA Bioseal). All the experimental groups were incubated at 37 °C for 12 months in 100% humidity. A universal testing machine measured the fracture resistance of each segment and the results were recorded in Newtons. Results There were no significant differences between the sealers and apical preparation sizes. The root segments obturated with AH-Plus, NeoSealer Flo and MTA Bioseal yield values significantly higher than those in the negative control groups. Conclusions All types of sealer (AH Plus, NeoSealer Flo and MTA Bioseal) exhibited nearly the same fracture resistance in retreated root segments aged 12 months.

Conventional vs. Ready‐To‐Use Bioceramic Cements: In Vitro Bond Strength Performance in Blood‐Contaminated Dentine

2025-06-20

Gabriela Kato Bego , Graziela Bianchi Leoni , Elisandra Márcia Rodrigues +2 more | Australian Endodontic Journal

ABSTRACT This study evaluated the performance of MTA and ready‐to‐use cement (Bio C Repair) in dentine repair under different blood contamination conditions. 120 bovine root dentine‐disks were divided into control … ABSTRACT This study evaluated the performance of MTA and ready‐to‐use cement (Bio C Repair) in dentine repair under different blood contamination conditions. 120 bovine root dentine‐disks were divided into control and blood‐contaminated groups and then subdivided on the basis of cement type and exposure time (immediate or 15‐min delay). The control was stored in a humid environment at 37°C for 28 days, whereas the contaminated group was stored in blood. Push‐out bond strength was assessed using a universal testing machine (1 mm/min). Three samples per subgroup underwent EDS‐X and SEM analysis. MTA exhibited significantly lower bond strength than Bio C Repair ( p < 0.001). Samples exposed to blood showed significantly lower bond strength than controls ( p < 0.001). The 15‐min delay reduced bond strength only in Bio C Repair samples ( p = 0.045). It can be concluded that blood contamination reduced bond strength, with the ready‐to‐use material demonstrating superior performance compared to the conventional bioceramic cement.

Current Trends in Endodontic Clinical Practice in Tripoli, Libya: A Cross-Sectional Study

2025-06-20

Farouk Ben Fadl , Mohamed Ben Hakoma | AlQalam Journal of Medical and Applied Sciences

Root canal therapy (RCT) is typically performed in Tripoli, Libya, by general dental practitioners (GDPs), who are more widely available and less expensive than endodontists. Concerns have been expressed about … Root canal therapy (RCT) is typically performed in Tripoli, Libya, by general dental practitioners (GDPs), who are more widely available and less expensive than endodontists. Concerns have been expressed about the quality of RCTs performed by GDPs, presumably due to a lack of equipment or experience, so this study aims to evaluate current endodontic practices in Tripoli, Libya. A cross-sectional study was conducted using a questionnaire distributed to 250 randomly selected Libyan dentists in Tripoli, with 212 fully validated completed responses (84.8% response rate). The data was collected and statistically analyzed. The study sheds light on the current situation of endodontic care in Tripoli, Libya, highlighting both progress and ongoing problems. While many dentists use current techniques, such as electronic equipment to evaluate root canal length (81%) and newer bioceramic sealants (40%), significant gaps exist. For example, only 63% of practitioners habitually utilize rubber dams, a vital step in infection management, and antibiotics are frequently provided inadvertently (9% for pain alone). Traditional treatments, such as cold fillings for canal sealing (43%), remain superior to newer methods, while diagnostic processes, such as canal identification (60% rely solely on visual inspection), are variable. These worries, together with common errors in determining canal length (26%) and sealing canals (20%), lead to a compelling need for training, especially because over half of the dentists questioned are young (57% with ≤5 years' experience). To fill these gaps, we recommend hands-on workshops on advanced instruments (e.g., magnification devices), updated infection control measures, and more specific antibiotic use guidelines. By resolving these issues, Tripoli's dentistry community may better match worldwide standards, resulting in safer, higher-quality care for patients.

Impact of laser and sonic activated irrigation on obturation quality in conservatively prepared mandibular molars: a micro-CT analysis

2025-06-19

Megan Yamaguchi , Ane Poly , Alexander Huynh +1 more | Clinical Oral Investigations

Effect of a Polyhexanide-Based Antiseptic Composition on Dentin Microhardness and Mechanical Properties: An In Vitro Study

2025-06-19

З. С. Хабадзе , Yu. A. Generalova , Oleg Mordanov | Materials

The effect of root canal irrigants on the mechanical properties of dentin is crucial in endodontic treatment planning. While antiseptics such as sodium hypochlorite and EDTA are widely used, their … The effect of root canal irrigants on the mechanical properties of dentin is crucial in endodontic treatment planning. While antiseptics such as sodium hypochlorite and EDTA are widely used, their potential to weaken dentin structure remains a concern. Polyhexanide-based formulations may offer a safer alternative. To assess the impact of a polyhexanide-based antiseptic composition, compared to standard irrigants, on the microhardness, Young’s modulus, and elastic deformation energy of dentin. Sixty extracted human teeth were sectioned and polished to prepare dentin samples. Baseline measurements of Vickers microhardness, Young’s modulus, and elastic deformation work were performed using a Microhardness Tester (CSM Instruments, Switzerland) with a Berkovich indenter. Samples were then divided into six groups (n = 10 per group) and exposed to different irrigants (NaCl 0.9%, NaOCl 3%, chlorhexidine 2%, EDTA 17%, and polyhexanide-based solutions—0.1% and 0.2% Lavasept). Post-treatment measurements were performed. Statistical analysis was conducted using non-parametric tests with Bonferroni correction. Sodium hypochlorite (3%) caused the most pronounced reduction in dentin microhardness and mechanical strength, though not always statistically significant. Polyhexanide-based solutions (0.1% and 0.2% Lavasept) showed a milder effect, with statistically significant changes observed only in elastic deformation energy for 0.2% polyhexanide. EDTA treatment led to severe surface destruction, precluding reliable post-treatment measurements. Polyhexanide-based irrigants demonstrated a more favorable impact on dentin mechanical properties compared to traditional irrigants, supporting their potential use in endodontic protocols aimed at preserving dentin integrity.

Effect of Indirect Pulp Capping Materials On Regional Dentin Seal.

2025-06-19

Roland Frankenberger , Nora Michalowski , Stefanie Amend +2 more | PubMed

The aim of this in-vitro study was to evaluate the effect of different indirect pulp capping (IPC) materials on bond strength to surrounding dentin. Fifty-six human third molars were used … The aim of this in-vitro study was to evaluate the effect of different indirect pulp capping (IPC) materials on bond strength to surrounding dentin. Fifty-six human third molars were used in this study. Occlusal dentin of 42 teeth was exposed. Dentin surfaces (n = 6) were left uncovered (control) or received a 1 × 1 mm central IPC (KL: Kerr life, DY: Dycal, TC: Theracal LC, CL: Calcimol LC, BD: Biodentine, and PR: ProRoot MTA) and were then bonded with Scotchbond Universal adhesive and restored with a composite resin build-up (Filtek™ Z250). After 24 h of water storage, the specimens were cut into sticks, which were marked red (1 mm distance from IPC spot), green (2 mm distance), and blue (3 mm distance). Consequently, µ-TBS tests were performed and analyzed using one-way ANOVA (P 0.05) for normal distributions and Mann-Whitney U-test (P 0.05) for non-normal distributions. Pretesting failures were recorded as 0 MPa. Fracture modes were analyzed under a fluorescence microscope, and interfaces and surfaces of 14 additional specimens were visualized under a scanning electron microscope (SEM). A significant reduction in peripheral seal was only observed for KL (Mann-Whitney U-test, P 0.05). All groups showed increasing bond strengths from the IPC area to the periphery, indicating a certain contamination potential of IPC materials. IPC materials being applied in very deep cavity areas except Kerr Life do not harm peripheral seal to dentin. Especially, hydraulic cements can be used without a negative effect on the peripheral dentin seal.

In Vitro Accuracy of Two Different Electronic Apex Locators Under Various Conditions

2025-06-18

Lucija Koturić Čabraja , Walter Dukić | Applied Sciences

Background: The purpose of this study was to analyze the accuracy of two apex locators using seven different canal irrigants. Methods: Forty multi-rooted extracted teeth were included in this study. … Background: The purpose of this study was to analyze the accuracy of two apex locators using seven different canal irrigants. Methods: Forty multi-rooted extracted teeth were included in this study. The actual canal length (ACL) was determined using a #10 file until the tip was visualized (12× magnification) just within the apical foramen (AF). The teeth were placed in a conductive medium of alginate to test the ACL and electronic canal length (ECL) using both apex locators in various conditions. Seven irrigant solutions were used in the root canal: 0.9% saline, FileEZE EDTA 19%, Glyde EDTA 17%, Consepsis V Chlorhexidine 2% CHX, Chlorcid 3%, citric acid 20%, and EDTA 18%. Results: Within a range of ±0.5 mm from the ACL, Raypex showed an accuracy of 87.5% with 0.9% saline solution, 82.5% with Chlorcid 3%, and 75% with Consepsis V CHX 2% solution. The Ipex showed an accuracy of 82.5% with 0.9% saline solution, 80% with Chlorcid 3%, and 70% with Consepsis V CHX 2% solution. The differences among the canal irrigants were significant for both the Raypex (p = 0.021) and Ipex (p < 0.0001) devices. The mean values showed the greatest variations in ECL accuracy with the combination of Raypex and EDTA 18% (p = 0.042) and with the Ipex and Glyde EDTA 17% (p = 0.026). Conclusions: Canal irrigants have an impact on the accuracy of apex locators. The apex locators showed an accuracy of 80% and greater when 0.9% saline and Chlorcid 3% solutions were used.

Post-operative pain as a risk factor for reduced quality of life after root canal treatment: A prospective clinical study

2025-06-18

Natrah Ahmad Fuad , R. H. Philpott , Marialena Cresta | The Saudi Dental Journal

To evaluate the (i) incidence of post-operative pain after RCT at 24 h, 48 h and 7 days, (ii) factors affecting the incidence of post-operative pain and (iii) patients' post-operative … To evaluate the (i) incidence of post-operative pain after RCT at 24 h, 48 h and 7 days, (ii) factors affecting the incidence of post-operative pain and (iii) patients' post-operative quality of life (PoQoL) at 24 h, 48 h and 7 days. One hundred and sixty two (n = 162) patients underwent either single-visit or multiple-visit RCT or retreatment at the Restorative Department. Post-operative pain was assessed via phone calls at 24 h, 48 h and 7 days via the Numeric Rating Scale (NRS) and Modified Verbal Rating Scale (MVRS) pain assessment tools. The PoQoL was assessed at the same three time points based on an adopted questionnaire which assessed pain on chewing, speaking, sleeping, ability to perform daily activities and social relations as well as the effects of pain on the overall QoL. The incidence of pain and the effects on the PoQoL were evaluated using descriptive analysis while the prognostic factors were evaluated using ordinal logistic regression analysis. Patients who felt pain after instrumentation had mild (24 h n = 24, 48 h n = 23) to moderate pain (24 h n = 13, 48 h n = 13) that decreased after 7 days. Post-obturation discomfort was highest at 24 h (n = 41), reduced at 48 h (n = 31) and 7 days (n = 11).The majority of patients who felt pain after treatment needed analgesics only at 24 and 48 h for pain control. Post-instrumentation and post-obturation pain did not affect patients' overall PoQoL, although many complained of chewing difficulty within 24 to 48 h. Only pre-operative pain within 24 h before treatment was a positive predictive factor for post-instrumentation pain in the simple ordinal logistic regression model. As for the post-obturation pain, molar tooth was associated with 2.5 times higher likelihood of post-obturation pain. Post-operative pain after RCT was common within 24 to 48 h but reduced at 7 days, with a likelihood of chewing difficulty following treatment. The pain felt was mainly mild to moderate, well controlled by analgesics and did not significantly affect the PoQoL. Clinical Trial Registration: ClinicalTrials.gov ID NCT06412263, protocol ID 295316.

The impact of using cold irrigation on postoperative endodontic pain and substance P level: a randomized clinical trial

2025-06-18

Reem Mohammed Amr Sharaf , Tariq Yehia , Maram Obeid | Odontology

Knowledge and Practice of Endodontic Irrigants among Dentists in Benghazi City: A Questionnaire Study

2025-06-18

A. H. Abdullah , Fatma O. Alfeitouri , Iman A Elkumati +1 more | Journal of Research in Dentistry

Aim: This study aimed to evaluate the knowledge and practices related to endodontic irrigation among dentists practicing in Benghazi, Libya. Materials and Methods: A self-administered questionnaire was distributed to 200 … Aim: This study aimed to evaluate the knowledge and practices related to endodontic irrigation among dentists practicing in Benghazi, Libya. Materials and Methods: A self-administered questionnaire was distributed to 200 dentists, with 176 responses collected (response rate: 88%). The questionnaire included 22 questions divided into three parts: demographic information, knowledge of irrigants, and details of irrigation practices during endodontic treatment. Data were analyzed using SPSS 16 software. Results: The majority of respondents were female (80.86%) and general dental practitioners (74.43%), with most working in the private sector (83.16%). Sodium hypochlorite was the most commonly used irrigant, with 86.36% of dentists using it as their primary choice. However, knowledge of the concentration of sodium hypochlorite used was limited, with 31.25% of respondents unsure. Antibacterial capability was ranked as the most important factor in the selection of an irrigant by 60.23% of respondents. Only 39.77% used the recommended volume of 5–10 mL per canal during irrigation. Conclusion: The study reveals varying levels of knowledge and inconsistent practices among dentists in Benghazi regarding endodontic irrigation. There is a need for enhanced education and training to ensure the effective and safe use of irrigants in endodontic procedures. Clinical Significance: Understanding the current trends in endodontic irrigation can help in identifying areas for improvement and ensuring better treatment outcomes in root canal procedures.

In vitro evaluation of 4 mechanized instruments in the retreatment of oval curved root canals: removal of filling material and resistance to cyclic fatigue.

2025-06-18

Murilo Priori Alcalde , Letycia Accioly Simões Coelho , Jussaro Alves Duque +3 more | Journal of Research in Dentistry

Aims: The aim was to compare different system in removing filling material and the cyclic fatigue alteration of these instruments after retreatment of oval curved canals. Materials and methods: Sixty … Aims: The aim was to compare different system in removing filling material and the cyclic fatigue alteration of these instruments after retreatment of oval curved canals. Materials and methods: Sixty single-rooted teeth with oval curved canals were instrumented, filled and micro-CT scanned. The teeth were divided according to endodontic retreatment file (n=15): Reciproc (R), Reciproc Blue (RB), Pro-R (PR), ProDesign Logic RT (RT). The teeth were scanned and the volume of the filling material measured. The working time of the size-25 files during retreatment was recorded and these and fifteen new ones were submitted to the cyclic fatigue test. Data were submitted to statistical analysis (?<5%). Results: RT was faster than the other instruments and reduced the total volume of filling material more compared to RB and PR (p<0.05). More cycles to fracture were observed in the RB and RT compared to the R and PR (p<0.05). Conclusions: Based on the proposed objectives and the methodology used, TruNatomy 26.04 RT presented lower volume of remaining filling material and was faster in endodontic retreatment. RB and RT showed greater resistance to cyclic fatigue.

TRATAMENTO ENDODÔNTICO DO DENTE ANTERIOR COM INSTRUMENTAÇÃO ROTATÓRIA – RELATO DE CASO

2025-06-18

Rosana Maria Coelho Travassos , Samuel Nogueira Lima , Maria Regina Almeida De Menezes +6 more | LUMEN ET VIRTUS

Paciente do sexo masculino, 39 anos, sem histórico de doenças sistêmicas, procurou consultório particular, queixando-se de dor no dente 21 após traumatismo dentário. O dente não respondeu ao teste de … Paciente do sexo masculino, 39 anos, sem histórico de doenças sistêmicas, procurou consultório particular, queixando-se de dor no dente 21 após traumatismo dentário. O dente não respondeu ao teste de sensibilidade pulpar. Após a anestesia, o dente foi isolado e o acesso coronário foi realizado utilizando- se broca diamantada 1013. A irrigação foi realizada Hipoclorito de Sódio a 2,5%. O preparo do canal foi realizado com Lima Solla Collors #70.03 com movimentos de entrada e saída em toda extensão do canal radicular até alcançar o comprimento de trabalho estabelecido. A patência foraminal, ultrapassando em 1 mm da saída do forame apical, realizada com a lima de Glide path Solla Collors 16/02. A obturação foi realizada pela técnica do cone único associado ao cimento AHPlus Jet). Conclui-se que a lima Solla Collors rotatória determinou uma eficiente formatação e modelagem do sistema de canais radiculares.

RETRATAMENTO EDODÔNTICO NÃO-CIRÚRGICO EM MOLAR INFERIOR COM LIMAS SOLLAS RECIPROCANTES

2025-06-18

Rosana Maria Coelho Travassos , Samuel Nogueira Lima , Maria Regina Almeida de Menezes +7 more | LUMEN ET VIRTUS

Este estudo relatou retratamento endodôntico de em molar inferior com limas Sollas Reciprocantes. Paciente de 42 anos de idade, gênero feminino foi encaminhada para especialista em endodontia para retratamento do … Este estudo relatou retratamento endodôntico de em molar inferior com limas Sollas Reciprocantes. Paciente de 42 anos de idade, gênero feminino foi encaminhada para especialista em endodontia para retratamento do dente 37. Clinicamente apresentou-se assintomático, e o exame radiográfico periapical observou-se material radiopaco semelhante à guta percha e uma obturação do canal inadequada (sub-obturação do canal radicular, além de imagem radiolúcida presente na região apical do dente. A desobturação do canal radicular foi realizada com lima Reciprocante Solla Files Collors #R25, com pequenos avanços e recuo, e pincelamento contra as paredes do canal radicular para melhor limpeza e remoção do material obturador. Dando sequência, realizou-se a odontometria eletrômica com o localizador apical Root ZX, determinando o comprimento real do dente. A patência foraminal foi executada com as limas #16.02 e o repreparo do canal realizado com Lima Reciprocante Solla Files Collors #R40, nos canais mesiais e #R50 no canal distal, determinando-se uma ampliação e modelagem apropriada à anatomia do canal. Conclui-se que as Limas Solla Files Collors foi efetiva no retratamento e modelagem dos canais radiculares.

A stereomicroscopic assessment of the apical microleakage of different types of endodontic sealers: an in-vitro study

2025-06-18

Bakr Al-Obaidi | Romanian Journal of Stomatology

Background. The purpose of this in-vitro study was to compare the extent of dye penetration through the apical foramen following root canal obturation carried out using two different root canal … Background. The purpose of this in-vitro study was to compare the extent of dye penetration through the apical foramen following root canal obturation carried out using two different root canal sealers, in combination with the warm vertical condensation technique. Materials and methods. In this in-vitro study, fifty sound permanent maxillary single-rooted premolars were selected and decoronated to maintain the working length at 12 mm. The samples were biomechanically instrumented and obturated with ProTaper gutta-percha coated with two different endodontic sealers: bioceramic (CeraSeal) and zinc oxide eugenol (ZOE)-based sealer. After endodontic treatment, the specimens were divided into two groups depending on the sealer used. The samples were then immersed in 1% methylene blue dye for 120 hours. Next, the roots were sectioned longitudinally into two halves to expose the canal’s apical third. The depths of dye infiltration were recorded in each group and analyzed using stereomicroscopic examination. Data was analyzed using an independent samples t-test with SPSS software, and a significance level was set at p < 0.05. Results. All samples (n = 50 overall) demonstrated apical microleakage. The samples with ZOE sealer exhibited significantly greater dye penetration lengths (p < 0.05) compared to those with CeraSeal sealer. Furthermore, dye penetration values were reduced in the samples sealed with CeraSeal, indicating that obturation with a bioceramic sealer seems more promising in providing better apical sealing ability than ZOE sealer. Conclusion. Within the limitations of this study, CeraSeal demonstrated better apical sealing ability of the root canal than the ZOE sealer. However, complete apical microleakage cannot be prevented.

Effectiveness of Irrigation Protocols in Endodontic Therapy: An Umbrella Review

2025-06-18

Manuel J. Orozco-Gallego , Eliana Pineda Vélez , Wilder J. Rojas‐Gutiérrez +2 more | Dentistry Journal

Background: With the inclusion of evidence-based dentistry, numerous systematic reviews (SRs) and meta-analyses (MAs) have been conducted in endodontics with the best available scientific evidence to improve diagnosis and treatment. … Background: With the inclusion of evidence-based dentistry, numerous systematic reviews (SRs) and meta-analyses (MAs) have been conducted in endodontics with the best available scientific evidence to improve diagnosis and treatment. Objective: To synthesize the scientific evidence on the effectiveness of irrigation protocols in endodontic therapy. Methods: Following the umbrella review methodology (UR), a comprehensive literature search was conducted using scientific and grey literature databases. A quality evaluation and a descriptive analysis of the included SRs and MAs were conducted. Quantitative comparability between MAs was carried out. Results: Four descriptive SRs and nine MAs were included. Eight articles evidenced high methodological quality. Studies showed the effectiveness and efficacy depending on the study design, the findings of primary clinical trials, and factors related to the type of irrigant, concentration, volume, and irrigation systems. Variability between irrigants and protocols was observed. Follow-up periods extend from hours to years, and there were different study samples. SRs and MAs evidenced limitations regarding methodological aspects. Low overlap of the primary studies was found. Quantitative analyses indicated greater efficacy in microbial reduction and apical healing in favor of passive ultrasonic irrigation (PUI; RD -0.15; 95% CI -0.28, -0.01; p = 0.03; I2 = 60%; RD -0.09; 95% CI -0.16, -0.02; p = 0.01; I2 = 0%, respectively). Conclusions: This UR highlights the importance of root canal disinfection, emphasizing sodium hypochlorite (NaOCl) as the primary irrigant. Enhanced activation methods, such as PUI and lasers, improve irrigant efficiency, while alternatives like chlorhexidine (CHX) offer better biocompatibility. Standardized protocols and evidence-based clinical guidelines are needed. PROSPERO register: CRD42023409044.

Aloe Vera as an Adjunct in Endodontic Irrigation: Impact on Dentin Bond Strength and Cytotoxicity

2025-06-18

Lucas David Galvani , Ester Alves Ferreira Bordini , Diana Gabriela Soares +5 more | Materials

This study evaluated the effects of mechanical agitation of Aloe vera Barbadensis Miller solution at different concentrations using passive ultrasonic irrigation (PUI), XP Endo Finisher (XPF), XP Clean (XPC), and … This study evaluated the effects of mechanical agitation of Aloe vera Barbadensis Miller solution at different concentrations using passive ultrasonic irrigation (PUI), XP Endo Finisher (XPF), XP Clean (XPC), and Easy Clean (ECL), compared to conventional endodontic irrigation (CIE), on bond strength and adhesive failure patterns in the cervical, middle, and apical thirds of the root canal. Aloe vera solutions at 1%, 3%, and 5% were tested to reverse collagen fiber collapse induced by hypochlorous acid, a free radical released by 2.5% sodium hypochlorite, which impairs dentin hybridization and the light curing of resin cement. Fiberglass posts were cemented using an etch-and-rinse adhesive system (Ambar; FGM) and conventional dual resin cement (Allcem Core) in root dentin across all thirds. Human teeth underwent chemical-mechanical preparation, and the Aloe vera solution was agitated using the CIE, PUI, XPF, XPC, or ECL protocols. Slices from each root third were evaluated under a stereomicroscope at 10× magnification and subjected to the push-out test. Cytotoxicity was assessed by applying various Aloe vera concentrations to stem cells from the apical papilla (SCAPs) for 24 h, followed by analysis of cell metabolism (Alamar Blue), viability (Live/Dead), and proliferation (F-actin). Aloe vera demonstrated significant biological activity and enhanced bond strength, particularly at 3% and 5%, irrespective of the agitation method or root third. Thus, it can be concluded that using Aloe vera solution is an alternative for pre-treatment before the cementation of fiberglass posts with conventional dual-cure resin cement in endodontically treated dentin.

TRATAMENTO ENDODÔNTICO COM ÁPICE ABERTO REALIZADO EM DUAS SESSOES UTILIZANDO COMO MEDICAÇÃO O BIO-C-TEMP

2025-06-18

Rosana Maria Coelho Travassos , Gustavo Moreira de Almeida , Paulo Jonas dos Santos Júnior +7 more | Aracê.

Paciente, 18 anos , sexo masculino, sem histórico de doenças sistêmicas, compareceu ao consultório particular para tratamento endodôntico do dente 21. Durante exame clínico, relatou traumatismo nesse dente a mais … Paciente, 18 anos , sexo masculino, sem histórico de doenças sistêmicas, compareceu ao consultório particular para tratamento endodôntico do dente 21. Durante exame clínico, relatou traumatismo nesse dente a mais de 10 anos, A radiografia periapical, comprovou ápice aberto e presença de lesão periapical. Após anestesia e o acesso coronário com broca esférica de número 1014. A exploração do canal radicular realizada com lima K de número 80. A odontometria radiográfica realizada com a lima 100 e a instrumentação manual realizada com lima K de número 140 associado a copiosa irrigação com Clorexidina a 2%, e soro fisiológico com o intuito de determinar a sanificação dos canais radiculares. A medicação intracanal, BIO-C Temp permaneceu por um período de 15 dias. A obturação do sistema de canais radiculares foi realizada pela técnica da condensação lateral ativa, associada ao cimento BIO-C Sealer. Concluiu-se que o tratamento em dentes imaturos é viável, tendo sucesso clínico com a combinação de boa medicação intracanal e de materiais como hidróxido de cálcio e BIO-C Temp, e uma boa adaptação do cone principal de guta-percha.

Aplicação clínica de um cimento endodôntico à base de resina epóxi em retratamento endodôntico: relato de caso

2025-06-18

Maria Helena Costa , Geovanna de Castro Bizarria , Sarah de Araújo Mendes Cardoso +5 more | Brazilian Journal of Health Review

Este trabalho apresenta um relato de caso clínico de retratamento endodôntico do dente 23 (canino superior esquerdo) em uma paciente de 30 anos, atendida na Associação Brasileira de Odontologia (ABO) … Este trabalho apresenta um relato de caso clínico de retratamento endodôntico do dente 23 (canino superior esquerdo) em uma paciente de 30 anos, atendida na Associação Brasileira de Odontologia (ABO) em Fortaleza-CE, Brasil. A paciente apresentava lesão de cárie recidiva, infiltração e lesão periapical, necessitando de retratamento endodôntico quatro anos após o tratamento inicial. O procedimento envolveu a remoção da restauração insatisfatória e da lesão de cárie, seguido pela desobturação do canal utilizando instrumentos rotatórios e manuais. A irrigação foi realizada com clorexidina gel 2% e soro fisiológico, seguida pela obturação com gutapercha Medium Extra Longo-Odous de Deus e cimento endodôntico Sealer Plus. O caso demonstra a importância de um planejamento cuidadoso e da utilização de técnicas e materiais modernos para alcançar o sucesso no retratamento endodôntico, destacando a relevância da desinfecção e vedação adequadas dos canais radiculares para evitar infecções secundárias.

Chemical and Biological Properties of C-Point Obturation Cones

2025-06-18

Marina Angélica Marciano , Paulo Palma , Ana Cristina Padilha Janini +7 more | Biomimetics

This study evaluated the chemical composition and subcutaneous tissue biocompatibility of C-Point, a root canal filling material, compared to ProTaper gutta-percha cones (control). Material characterization was conducted using scanning electron … This study evaluated the chemical composition and subcutaneous tissue biocompatibility of C-Point, a root canal filling material, compared to ProTaper gutta-percha cones (control). Material characterization was conducted using scanning electron microscopy with energy-dispersive spectroscopy (SEM-EDS). For biocompatibility assessment, both materials were implanted subcutaneously in the dorsal connective tissue of sixteen albino rats (n = 8 per group). Histological evaluation of inflammatory infiltrate intensity was performed at 30 and 60 days post-implantation, with statistical analysis (significance set at p < 0.05). SEM-EDS analysis revealed distinct elemental compositions: C-Point primarily contained zirconium and cobalt ions, while gutta-percha cones demonstrated a strong zinc signature with trace amounts of barium, aluminum, and sulfur. Both materials exhibited similar particulate morphology with radiopaque inclusions. Histologically, no significant difference in inflammatory response was observed between C-Point and gutta-percha at any time point (p > 0.05). All specimens developed a fibrous encapsulation. The inflammatory profile showed temporal dynamics, with lymphocyte predominance during early stages that progressively diminished by the study endpoint. These findings demonstrate that while C-Point possesses a unique elemental profile dominated by zirconium, its tissue biocompatibility parallels that of conventional gutta-percha obturation materials. However, due to the absence of mechanical testing and the limited in vivo follow-up period, the long-term stability of the material remains uncertain.

An In Vitro Comparative Evaluation of Three Different Solvents in the Retreatment of Teeth Obturated using Bioceramic Sealer

2025-06-18

Venkitachalam Ramanarayanan , Krishnan Venugopal , Asha Joseph +3 more | The Journal of Contemporary Dental Practice

Ficha de Cynodon septenarius

2025-06-17

André Luiz Netto Ferreira , Bruno Francelino de Melo , Bruno Stefany Feitoza Barros +7 more | Datasets - Sistema SALVE - ICMBio

A CASE REPORT ON INTERNAL BLEACING OF A DISCOLORED CENTRAL INCISOR USING 35% HYDROGEN PEROXIDE

2025-06-17

Aryo Sutowijoyo , Prima Nerito | Biofaal Journal

A patient presented with tooth discoloration due to trauma, which had caused a tooth to become non-vital. Such trauma can damage the pulp tissue, eventually leading to necrosis and discoloration … A patient presented with tooth discoloration due to trauma, which had caused a tooth to become non-vital. Such trauma can damage the pulp tissue, eventually leading to necrosis and discoloration over time. In cases like this, internal bleaching is a treatment procedure aimed at improving the color of non-vital teeth. Discoloration of teeth after endodontic treatment often raises concerns for both patients and dentists. Whitening the tooth after root canal treatment is important to restore its original color before a permanent restoration is placed. The objective of this report is to present the successfull outcome of internal bleaching in patient who had undergone root canal treatment en years earlier. A 39-year-old male presented with a complaint of discoloration in the right maxillary central incisor. The patient had a history of root canal treatment on the tooth performed ten years prior. Radiographic examination confirmed that tooth 11 had undergone root canal treatment. Internal bleaching was performed on tooth 11, which appeared darker than the adjacent teeth. Whitening was carried out using 35% hydrogen peroxide. By the fourth visit (one week after the third application), the tooth color had changed to shade D3, which matched the desired color. This indicated a significant improvement in shade. Internal bleaching using 35% hydrogen peroxide resulted in color enhancement consistent with patients expectations. The treatment proved effective in restoring the esthetics of a non-vital tooth discolored due to trauma.

Evaluation of the Accuracy of the Access Cavities Prepared by Undergraduate Dental Students at Tripoli University

2025-06-17

Radya Shanaq , Mohamed Hshad , Mohamed Issa | Khalij-Libya Journal of Dental and Medical Research

Access cavity efficiency is essential and a critical component of the clinical abilities needed for successful root canal treatment. It requires precise, professional hand skills, as well as a holistic … Access cavity efficiency is essential and a critical component of the clinical abilities needed for successful root canal treatment. It requires precise, professional hand skills, as well as a holistic cavity design based on radiographic interpretation and the clinical appearance of the accessible tooth. This study aimed to evaluate the quality of access cavity modalities performed by undergraduate dental students (n=73) at the Faculty of Dentistry, University of Tripoli. Students' access cavities, as well as the strengths and limitations of access cavity preparation in pri-clinic, were visually and radiographically assessed. The data were analyzed using descriptive statistics, frequencies, and percentages. Independent samples t-tests were used to compare the performance of male and female students in each of the parameters studied. The results indicated that students with relative skill in access and absence of overhangs received the highest score of 1.63 out of the evaluated features. Furthermore, the flaring score of 1.37 indicates a reasonable mastery of this aspect of the method. Nonetheless, the scores for Morphology (1.15) and Coronal Preservation (1.27) suggest areas that require further development and training. Undergraduate students demonstrate acceptable proficiency, particularly in achieving proper access and minimizing structural overhangs. However, the variation in scores for morphology and coronal root preservation indicates that these areas require further attention and need curricular enhancements and more targeted preclinical training to allow for full skill.

Multimethod assessment of design, mechanical and metallurgical characteristics of ProTaper Ultimate, TruNatomy Glider, ProGlider, Hyflex EDM and WaveOne Gold Glider glide path instruments

2025-06-17

Tuğba Türk , Cangül Keskin , Doğan Çetin +1 more | Odontology

Abstract Nickel–titanium (NiTi) glide path instruments have been developed to enhance performance, but their mechanical and metallurgical properties vary significantly among different systems. This study compared the design, mechanical, and … Abstract Nickel–titanium (NiTi) glide path instruments have been developed to enhance performance, but their mechanical and metallurgical properties vary significantly among different systems. This study compared the design, mechanical, and metallurgical properties of six nickel–titanium (NiTi) glide path instruments using a multimethod approach. A total of 420 ProGlider (PG) (16/.02–.06), WaveOne Gold Glider (WOGG) (15/.02–.06) and glide path files from the ProTaper Ultimate (PTU Slider) (16/.02–.06), TruNatomy (TNG) (17/.02), and Hyflex EDM (HF EDM) 10.05 and 15.03 systems were analyzed. Design features were assessed using a dental operating microscope and scanning electron microscopy (SEM). Mechanical properties, including static and dynamic cyclic fatigue, torsional resistance, bending resistance, and buckling resistance, were tested following standardized protocols. Metallurgical properties were evaluated through differential scanning calorimetry (DSC), SEM, energy dispersive spectrometry (EDS), and Vickers microhardness testing. Statistical analyses were performed using the Shapiro–Wilk test to assess normality, followed by appropriate parametric or non-parametric tests, including ANOVA with post-hoc Tukey and Kruskal–Wallis H tests with Bonferroni correction ( α = 0.05). Design analysis revealed no major defects or deformations. WOGG and PG exhibited the highest cyclic fatigue resistance, while HF EDM 15.03 had the greatest torsional resistance. PTU Slider demonstrated the highest bending and buckling resistance. Metallurgical analysis indicated differences in phase transformation behavior, with TN Glider showing a two-stage phase transformation. Significant differences were observed among the tested instruments in terms of design, mechanical properties, and metallurgical characteristics. The multimethod approach provided a comprehensive understanding of these instruments, highlighting their suitability for clinical use based on specific mechanical and metallurgical properties. This multimethod analysis highlights significant differences in cyclic fatigue, torsional resistance, and flexibility among glide path instruments. WOGG and PG may be preferred for curved canals due to their superior fatigue resistance, HF EDM 15.03 for calcified canals requiring higher torsional strength, and PTU Slider for cases needing increased resistance to bending and buckling.

Root canal irrigants and their role in the adhesion of pre-endodontic restorations

2025-06-16

Jacopo Francinelli , Claudia Mazzitelli , Uroš Josić +7 more | Clinical Oral Investigations

ENDODONTIA GUIADA NO MANEJO DE CANAIS CALCIFICADOS: EVIDÊNCIAS ATUAIS E RELATO DE CASO

2025-06-16

I. Matos , Ana Paula Ignácio Pontes Leal , Yasmin de Sousa Paiva +5 more | Aracê.

INTRODUCTION: Calcified root canals can manifest as pulp nodules or pulp obstruction, resulting in narrow canals that are difficult to access and visualize. Guided endodontics is an approach that represents … INTRODUCTION: Calcified root canals can manifest as pulp nodules or pulp obstruction, resulting in narrow canals that are difficult to access and visualize. Guided endodontics is an approach that represents a minimally invasive alternative for the endodontic treatment of teeth with calcification. Objective: This study aims to conduct an integrative literature review and report a clinical case on the use of guided endodontics as a safe and effective alternative for treating calcified teeth. MATERIALS AND METHODS: The literature search was conducted in the PUBMED database using the descriptors: (Cone-beam computed tomography) AND (dental pulp calcification) AND (root canal therapy) in English, covering the period from 2015 to 2025. Thirty-eight articles were found. Full-text articles were included, and after a critical reading of titles and abstracts, case reports and studies unrelated to the topic were excluded, resulting in 8 selected articles. A 26-year-old patient reported tooth discoloration and a history of trauma over 10 years ago. Radiographs showed total obliteration of the canal in tooth 21 and periapical bone rarefaction. Cone-beam computed tomography (CBCT) was performed for planning, and guided endodontics was chosen. Tomographic images and intraoral scanning enabled the fabrication of a surgical guide. Conservative access was performed without perforations, and the canal was successfully instrumented and filled. After six months, the patient remained asymptomatic. RESULTS: The guided technique showed high accuracy in locating calcified root canals, with a 93% success rate. It was effective for both endodontists and general practitioners, reducing treatment time and tooth substance loss. The technique prevented complications such as perforations and deviations, being safer than the conventional approach. Dynamic navigation allowed for a faster and more predictable procedure, especially for less experienced professionals. However, it requires training and may not be suitable for professionals with visualization or control difficulties. Despite its high accuracy, it requires additional radiographs and careful planning. CONCLUSION: Guided endodontics is an effective technique for treating calcified canals, offering greater precision, less damage to dental structure, and predictability, and can be used regardless of the operator's experience.

Evaluation of the Bond Strength of Bioglass-Based Root Canal Filling Materials

2025-06-15

Maja Namjesnik , Ivan Šalinović , Uzay Koç Vural +3 more | Acta Stomatologica Croatica

Potential of irrigants and medicaments in regenerative endodontics: insights from a systematic review on dentin growth factor release

2025-06-15

Carolina de Castro Oliveira , Fernanda de Oliveira Ferreira , J. Puppin-Rontani +2 more | Odontology

Single-Visit Endodontic Therapy and Root Canal Identification Practices among Croatian Dentists: Insights from a National Survey

2025-06-15

Josipa Sović , Sanja Šegović , Ivona Bago +2 more | Acta Stomatologica Croatica