Advances In Endodontics Research Articles

MANAGEMENT OF FURCAL PERFORATION USING BIODENTINE – A CASE REPORT

Management of furcal perforation in a root canal retreatment is often challenging as the outcome of the perforation sealing depends on several parameters. The introduction of several bioactive cements and magnication systems has made the sealing of perforations easier and the outcome more predictable. Current advances in endodontics and biomaterials has made the recovery of tooth structure and function possible even in the most complicated cases. Despite the breakthroughs in techniques and resources, furcal repair remains taxing. This case report shows successful management of multiple furcal perforation with a questionable prognosis in root canal retreatment using biodentine.

Dental Students’ Self-Confidence Level in Performing Endodontic Treatment in Dentistry Faculty of Rafsanjan University of Medical

Introduction: The students’ self-confidence level is a key factor affecting the success of endodontics learning. This study aimed to determine the confidence level of dental students who performing root canal treatment at Rafsanjan University of Medical Sciences in 2021.
 Materials & Methods: In this cross-sectional study a questionnaire including demographic information, endodontic experience, attitude toward confidence in performing different stages of root canal treatment, and suggestions for improving the quality of endodontic education was distributed among 54 dentistry students from 5th and 6th -year during the last month of the academic semester. Data were analyzed using T-test, Pearson, and ANOVA tests (α = 0.05). 
 Results: According to the results, of 49 dental students, 24.5% reported the first cases of root canal treatment to be tough. The lowest confidence was reported for finding all root canals in teeth with multiple root canals, preparing access cavity and understanding and managing root canal treatment risks. According to the results of chi-square analysis test, the total confidence score between 5th and 6th year students was not significantly different (p value = 0.648). Also, the relationship between general selfconfidence and students' self-confidence level was not seen (p value = 0.372). There was no significant relationship between the Confidence level and age, academic year, the difficulty level of the first endodontic treatment, and number of endodontic treatments (p value > 0.05).
 Conclusion: Students had lower self-confidence finding all the canals in multi-canal teeth, in properly handling the treatment risks, and preparing the access cavity. Endodontics training should also be improved by increasing clinical sessions and using recent advances in endodontics.

Editorial: Save the Tooth or Place an Implant: A Routine Dental Decision

Richard Herman, DDS: Single-tooth replacement is frequently considered in most dental practices. Thoughtful diagnostic treatment planning is required when evaluating endodontic vs implant treatment in order to ensure comfort, esthetics, and longevity for the patient. The American Association of Endodontists position statement on implants states that, apart from survival rates, components such as the restorability of the tooth, quality of bone, esthetic demands, cost-benefit ratio, and systemic factors should be taken into account when deciding whether to treat the tooth endodontically or to place a single implant.¹ One study evaluated the 10-year success rate of 1,175 endodontically treated teeth, and the life table analysis reported that 93% of the teeth survived 10 years after endodontic treatment.² Further, it was shown that the ability to locate second mesiobuccal canals increased from 53% to 93% when evaluated under a surgical operating microscope.^3–7 Technologic and technical advances in endodontics continue to enhance a dental treatment regime that has been universally accepted. These advances include the surgical operating microscope, mechanical titanium instrumentation, hydrodynamic irrigation, mineral trioxide aggregate, bioceramics, CBCT, and microsurgical instrumentation. It must be stated that dental implants are an extraordinary service and have made possible some treatment options that were never before imagined. The science of osseointegrated implants has advanced considerably with the development of new implant designs, surface characteristics, materials, and methods. High success rates have helped make single-tooth implants a viable and accepted option for tooth replacement. However, a healthy, natural dentition is still the best alternative requested by patients. Assessing whether to rehabilitate a tooth requiring endodontic treatment or to replace it with an implant involves a challenging and complex decision-making process,⁷ and all treatment decisions must be evidence-based. When comparable criteria are applied to the outcome, survival rates of endodontically treated teeth and single-tooth implants are similar. A compromised tooth should be managed with a multidisciplinary approach (endodontics, periodontics, and prosthetics), and implants should be reserved for the patient with true end-stage tooth failure. Endodontics, periodontics, and implantology should complement each other, not compete. The overall goal is the long-term health of the patient, using the least invasive treatment method possible, and incorporating function, comfort, and esthetics. Richard Herman, DDS Boca Raton, Florida, USA

Magnification in endodontics

Over the past few decades, technological advances in endodontics have taken quantum leaps from conventional hand files to rotary system and from direct vision to magnification. Magnification helps the user not only to see more, but to see well. The application of magnification devices in endodontics is mainly meant for visual enhancement and improved ergonomics. This is crucial especially when long hours are spent in a narrow operating space to treat obscure microanatomy. Magnification aids assist in producing higher quality procedures due to better precision and accuracy. Using the microscope aids improved ergonomics for the operator. Using loupes or microscopes improves the clarity in treatment plan as well as its execution. The magnification aids with camera and video monitor attached, enhance the patient education and better documentation. A strong consideration should be given to adopt using the concept of magnification. Nevertheless, application of magnification in dentistry has yet to be introduced into the mainstream practice due to various influences in behavioural patterns. This review intended to explain the significances of magnification in the field of endodontics as well as use of these tools in dental procedures for better accuracy, handling and thoroughness, which will lead to fewer procedural errors.

Recent Advances in Endodontics – A Perspective Review

Contemporary endodontics has seen an unprecedented advance in technology and materials. This article aimed to review some of the challenges and advances in the following sections: (1) Magnification, (2) LASER, (3) NiTi files, (4) Irrigation activation systems, and (5) CAD CAM. Jointly, these advances are aimed at improving the state of the art and science of root canal treatment and restoring the tooth back to function in the oral cavity

Endodontic management of a mandibular premolar with a concurrent occurrence of dental anomalies

Developmentally abnormal teeth presenting a complex root canal morphology requires special endodontic management. The present case report demonstrates successful endodontic management of a mandibular first premolar with an unusual concurrent occurrence of a double tooth and dens evaginatus with a C-shaped canal configuration in a 21-year-old patient that was diagnosed with pulpal necrosis with symptomatic apical periodontitis. In this case, the use of cone-beam computed tomography and the dental operating microscope contributed remarkably to the diagnosis and treatment of the complex root canal morphology of the anomalous tooth. Therefore, the use of recent advances in endodontics is strongly recommended in such cases to ensure predictable and successful results.

Role of single visit endodontics in contemporary dental practice – A review

The main objective of performing root canal therapy is to eliminate the bacteria from the root canal and seal it with various newer filling materials. If the treatment is thoroughly done it helps in faster periapical healing. Single visit endodontic treatment had numerous drawbacks primarily about the post-operative pain and failure of the treatment effect. With recent advances in endodontics the single visit therapy has become more predictable and lessened intraoperative procedure and has increased operators comfort. In this review article indications and contraindications of single visit endodontics, success rates and myths related to it are discussed.

Endodontic Treatment in Artificial Deciduous Teeth through Manual and Mechanical Instrumentation: A Pilot Study.

ABSTRACT“In vitro” studies seek to simulate actual biological conditions in the laboratory providing principles to be studied later. To facilitate the development of new techniques of root instrumentation in primary teeth and to ensure the integrity and function of the element, this study aimed to demonstrate the technological advances in endodontics through endodontic treatment performed on artificial primary teeth using a rotary instrumentation system and reciprocation. Instrumentation of the root canal was performed via a manual, rotary, and Reciproc system. Results showed that current systems can facilitate endodontic treatment in one session. These procedures become increasingly easy with the help of technological advances in dentistry.How to cite this articleHecksher F, Vidigal B, et al. Endodontic Treatment in Artificial Deciduous Teeth through Manual and Mechanical Instrumentation: A Pilot Study. Int J Clin Pediatr Dent 2019;12(1):15–17.

‘Cone Beam Computed Tomography in Endodontics’Editors‐in‐Chief: PatelShanon, HarveySimon, ShemeshHagay, DurackConor Published by Quintessence Publishing (ISBN: 978‐1‐85097‐291‐4) provides up to date information on one of the most significant recent advances in Endodontics.

‘Cone Beam Computed Tomography in Endodontics’<i>Editors‐in‐Chief</i>: PatelShanon, HarveySimon, ShemeshHagay, DurackConor Published by Quintessence Publishing (ISBN: 978‐1‐85097‐291‐4) provides up to date information on one of the most significant recent advances in Endodontics.

Influence of File Motion on Shaping, Apical Debris Extrusion and Dentinal Defects: A Critical Review.

Advances in endodontics have enabled the evolution of file manufacturing processes, improving performance beyond that of conventional files. In the present study, systems manufactured using state of the art methods and possessing special properties related to NiTi alloys (i.e., CM-Wire, M-Wire and R-Phase) were selected. The aim of this review was to provide a detailed analysis of the literature about the relationship between recently introduced NiTi files with different movement kinematics and shaping ability, apical extrusion of debris and dentin defects in root canal preparations. From March 2016 to January 2017, electronic searches were conducted in the PubMed and SCOPUS databases for articles published since January 2010. In vitro studies performed on extracted human teeth and published in English were considered for this review. Based on the inclusion criteria, 71 papers were selected for the analysis of full-text copies. Specific analysis was performed on 45 articles describing the effects of reciprocating, continuous and adaptive movements on the WaveOne Gold, Reciproc, HyFlex CM and Twisted File Adaptive systems. A wide range of testing conditions and methodologies have been used to compare the systems. Due the controversies among the results, the characteristics of the files used, such as their design and alloys, appear to be inconsistent to determine the best approach.

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

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

Attitudes of general practice dentists in private dental clinics in Almadinah Almunawarah toward novel endodontic technologies

ObjectiveThe purpose of this study was to evaluate the current trends and the adoption of new technologies in endodontic treatment by general practitioners in private dental clinics in Almadinah Almunawarah. MethodsA questionnaire was distributed randomly to 70 general practitioners working in private dental clinics in Almadinah Almnourah, Saudi Arabia. After one week, the questionnaires were hand-collected. Sixty-three dentists (90%) returned the questionnaire. The study was conducted between February and May 2014. ResultsThe results indicated that 100% of the general practitioners did not use any magnification device during root canal treatments; 11% of the respondents used digital X-ray equipment, 12.7% used an electronic apex locator, 38% used NiTi rotary instrumentation in root canal preparations, 100% did not use any adjunctive device for irrigant activation and 100% did not use new devices or techniques for root canal obturations. ConclusionsThis study provides data regarding the current trends and attitudes of general practitioners in private dental clinics in Al-Madinah Al-Monawarah regarding novel technologies in endodontic treatment and reveals the gap between the new advances in endodontics and clinical practice, as well as the need to improve root canal treatment in private dental practices.

Advances in endodontics: Potential applications in clinical practice.

Contemporary endodontics has seen an unprecedented advance in technology and materials. This article aimed to review some of the challenges and advances in the following sections: (1) endodontic imaging, (2) root canal preparation, (3) root canal disinfection, (4) root canal filling, and (4) regenerative endodontic procedures (REPs). Jointly, these advances are aimed at improving the state of the art and science of root canal treatment.

Effects of antimicrobial photodynamic therapy and surgical endodontic treatment on the bacterial load reduction and periapical lesion healing. Three years follow up

Besides the advances in endodontics, there are situations in which surgery is necessary to retain a tooth that otherwise would be extracted. This study analyzes the microbial reduction after conventional periapical surgery followed by antimicrobial photodynamic therapy (aPDT) in 3 years follows up. Twenty-eight teeth needing periapical surgery were enrolled in this study. Microbiological samples were taken after: (1) accessing the lesion, (2) surgical procedure, and (3) aPDT. The teeth received a full mucoperiosteal flap, osteotomy with a high-speed bur, manual curettage of lesion and of the root, root-end resection and retrograde cavities prepared using ultrasonic retro-tips. After the conventional procedure the cavities received an aqueous solution of methylene blue (60 μM, 3 min) and were irradiated with a diode laser λ=660 nm (6 min, 15 J). After aPDT, a retrograde filling with mineral trioxide aggregate, flap re-positioning, and sutures conventionally ended the procedure. In all the cases, a periapical X-ray exam was taken before and after the surgical procedure. The microbiological samples showed an overall significant reduction, surgical procedure achieved a mean reduction of about 3.5 log while aPDT achieved a 5 log reduction. After 36 months of follow up the patients had, in average a reduction of 78% of the periapical lesion area. It appears that surgical endodontic treatment associated with antimicrobial photodynamic therapy highly improves the microbial reduction compared to the traditional technique and this could directly affect the treatment prognosis and periapical lesion healing.

ENDODONTİDE İRRİGASYON AKTİVASYON YÖNTEMLERİ

Until today, with technological advances in endodontics, many different irrigation delivery and agitation techniques have been developed in order to increase the success of a root canal treatment. These systems categorize as manual or mechanical agitation techniques. Since its introduction, these systems has become increasingly more useful in clinical applications such as delivering of irrigation solutions to the root canal, removing debris smear layer from root cannal. The aim of this review is to summarize and discuss the available information concerning present irrigant agitation methods available in endodontics and to provide a critique of irrigation methods and their debridement efficacy in endodontics

Recent Advances in Endodontic Visualization: A Review

Advances in endodontics in the past two decades have given endodontists important new tools save natural dentition. By providing both intense focused light as well as a high degree of magnification, the endoscope, orascope, dental loupes and operating microscopes has become an important part of the armamentarium for many endodontists. Each instrument has inherent advantages and disadvantages. Here, we describe the recent advances as well as the traditional magnification tools in field of endodontics. The art of dentistry is based on precision. The human naked eye is capable of distinguishing fine detail, but it is no match for what can be accomplished when an image is sharpened and enlarged. The microscope and other forms of magnification fill that need, especially for accomplishing endodontic procedures. (1)Enhanced magnification and illumination opened the eyes of endodontic surgeons the intricate and complex root canal system. This advancement resulted in miniaturization of the endodontist's armamentarium. (2) Todays innovative and high-tech optical systems can deliver amazing depths-of-field and wide fields of view that enable the dentist view a complete oral cavity in focus without having move. (3)The use of optical magnification instruments such as endoscopes, orascopes, loupes and microscopes enables the endodontist magnify a specified treatment field beyond that perceived by the naked eye. (4) II. Endoscopes The term endoscopy is derived from the Greek language and is literally translated as endon (within) and skopion (to see), hence the meaning, to see within. Early endoscopists such as Hippocrates in 377 BC used primitive tube-like instruments for endoscopy. (5) With major advances in the field of medicine, a breakthrough in optical quality was achieved in 1960 by an English physician, Hopkins, who created a rod lens series that led important advancements in the field of view, magnification, and focal length of the endoscope, resulting in a clearer image.(6) The field of endoscopy has expanded further with the introduction of the dental endoscope. The use of rod-lens endoscope in endodontics was first reported in literature in 1979. (7) It was helpful in diagnosing dental fractures. The traditional endoscope used in medical procedures consists of rigid glass rods and can be used in apical surgery and non-surgical endodontics. The flexible and semi-flexible endoscopes can be very valuable addition the armamentarium. The endoscope is flexible due special nitinol coating (Figure. 1). The optical part which is 0.9 mm of diameter, is a piece of equipment that enables the practitioner a magnification of up 20X with clear picture with wide angle. A 2.7mm lens diameter, a 70o angulation, and a 3 cm long rod-lens are recommended for surgical endodontic visualization and a 4mm lens diameter, a 30o angulation, a 4 cm long rod-lens are recommended for non-surgical visualization through an occlusal access opening. (Figure.2a & 2b) (8) The rod-lens endoscope provides clinicians greater magnification, greater clarity as compared the microscopes and the loupes and the non-fixed field of vision. Non fixed field of vision is the ability view treatment field at various angles and distances without losing depth of field and focus. (9) The Modular endoscope system (Sialotechnology Ltd., Ashkelon, Israel) being based on modern technology of microendoscopes is used in small channel organs (salivary gland ductal system, tear canals) and is designed enable the practitioner work inside the root canal with magnification and instrument access. The system includes three parts:  endoscopic compact system,  optical part that includes ocular part and the endoscope, and  handpiece with a disposable part. (Figure. 3) (10)

Mechanized Instrumentation of Root Canals Oscillating Systems

Cleaning and shaping are important steps in the root canal treatment. Despite the technological advances in endodontics, K and Hedstroen files are still widely used. In an attempt to be more effective in preparing the root canals, faster and more cutting efficient kinematic, alloys and design alternatives utilizing mechanically oscillating or rotary files are proposed. Even with all these technological innovating alternatives, the preparation of root canals remains a challenge.

Methodologies for assessment of apical and coronal leakage of endodontic filling materials: a critical review

Apical leakage continues to be a topic of great interest, because in spite of the advances in Endodontics, clinical failures still occur. Most failures are probably attributed to the proliferation of bacteria that remain viable after chemical-mechanical preparation and cause periapical tissue irritation. Coronal leakage has aroused researchers' interest over the last few years, since canals may be re-contaminated after loss of coronal sealing or fracture of the remaining tooth. In this review, the various methodologies used for assessing root canal sealing capacity are critically analyzed, as they are not standardized, which makes it difficult to compare the results obtained when different methodologies are used, even though the same substrate is being assessed.

Advances in endodontics.

Progress in diagnosis, prevention of diseases, treatment of exposed pulp, root canal treatment, retreatment and surgery is reported. Contemporary biological research techniques could set the foundation for a more rational approach to treatment. Pulp inflammation may be prevented by inhibiting bacteria from colonising dentine surfaces. Specific factors could be synthesised to stimulate normal dentine deposition over pulp exposures. Significant improvements have been made in instruments and techniques available for root canal treatment and surgery but there is no clinical evidence that they improve periapical healing.