Conventional Endodontic Treatment Research Articles

Influence of Diclofenac Potassium versus Prednisolone on Postendodontic Pain and Pulpal Interleukin-8 Expression in Symptomatic Irreversible Pulpitis Cases: A Randomized Placebo-controlled Trial

AimThis prospective, randomized, double-blind clinical trial investigated the impact of diclofenac potassium, prednisolone, and placebo as oral premedication on postendodontic pain and pulpal interleukin (IL)-8 expression in patients with irreversible pulpitis. MethodsThirty-six patients undergoing conventional endodontic treatment were assigned into one of 3 groups (n = 12). Pulpal blood samples were taken after access cavity preparation and stored until they were analyzed using enzyme-linked immunosorbent asssay for quantification of IL-8. Postendodontic pain was scored using the visual analogue scale. Outcome data were statistically analyzed using one-way analysis of variance, Kruskal-Wallis, Friedman's, Dunn's, Chi-square, and Fisher's exact tests and Spearman's correlation coefficient. The significance level (α) was set at 0.05. ResultsApart from preoperative pain scores, all groups had similar baseline characteristics (P > .05). Immediate postendodontic pain scores had a significant difference between all groups (P < .05) where placebo group showed the highest score. There was no significant difference between all groups at 6 and 12 hours postoperatively (P > .05). Furthermore, there was no significant difference in the incidence of postendodontic pain and in mean IL-8 levels between the 3 groups (P > .05). ConclusionsThe only impact the premedications had was on the immediate postendodontic pain intensity, and they had no influence on the later time points, incidence of postendodontic pain or pulpal IL-8 levels.

Root Canal Disinfection in Permanent Molars with Apical Lesion by Antimicrobial Photodynamic Therapy: Protocol for a Blind Randomized Clinical Trial.

Objective: The proposed study aims to compare the effectiveness of conventional endodontic treatment (ET) with that of ET associated with antimicrobial photodynamic therapy (aPDT) in patients with apical lesion. Methods: Controlled, double-blind, randomized clinical trial (RCT); superiority study with three parallel arms. Randomization will be conducted in exchange blocks of six, with allocation 1:1:1. The control group will receive conventional ET, while experimental group 1 (EG1) will receive conventional ET + aPDT with laser at 660 nm, fluence of 600 J/cm2; EG2 will receive conventional ET + aPDT with laser at 660 nm, fluence of 1200 J/cm2. The primary outcome will be canal disinfection before treatment, measured by analysis of colony formation (CFU/mL) and the success rate measured after 6 months on the clinical and radiographic evaluations. The mean and standard deviation will be calculated for continuous outcomes, and the CFU/mL mean between groups will be evaluated by ANOVA test. The Chi-squared test will be calculated for binary outcomes. A logistic regression analysis will be performed to assess differences in the success rate between groups, adjusted for the covariates. The Stata 18 software will be used, with a significance threshold of 5%. Conclusions: Few RCTs have evaluated the effectiveness of aPDT in root canal disinfection in patients with permanent dentition presenting apical lesion. New RCTs with larger numbers of participants are needed to support using aPDT as an adjuvant to conventional ET in root canal disinfection for routine use in clinical practice. The trial was registered prospectively in ClinicalTrials.gov (NCT05916859).

Lesion sterilization and tissue repair - A non-instrumental procedure: A systematic review

A primary tooth affected by dental caries involving the pulp tissues along with periradicular tissues need conventional endodontic treatment. Due to certain factors these treatments may be contraindicated. In that case Lesion Sterilization and Tissue Repair (LSTR) therapy is the better option to be preferred. The process of LSTR is to increase the longevity of the primary tooth. This procedure eliminates, sterilizes the canal system, repairs and regenerates the tissue. It needs minimal instrumentation and includes placement of an antibiotic mixture in the pulp chamber to disinfect the root canals. It is also known as Non-instrumental endodontic treatment (NIET).

The Effect of Combined Ultrasonic Tip and Mechanized Instrumentation on the Reduction of the Percentage of Non-Instrumented Surfaces in Oval/Flat Root Canals: A Systematic Review and Meta-Analysis.

This systematic review and meta-analysis aimed to evaluate the effectiveness of the ultrasonic tip associated with mechanized instrumentation in reducing the percentage of non-instrumented surfaces of human teeth with oval or flattened root canals. The study followed the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines. Pubmed/MEDLINE (Medical Literature Analysis and Retrieval System Online), Scopus, Embase, Web of Science, and Cochrane Library were searched for literature published till October 2022. Only in vitrostudies were included, which compared conventional mechanized endodontic treatment alone against conventional endodontic treatment in association with ultrasonic tips, evaluating the reduction in the percentage of non-instrumented walls (computed microtomography). Four studies were eligible for qualitative and quantitative analysis. The majority of the studies scored low for risk of bias. The meta-analysis comparing protocols demonstrated a reduced percentage of non-instrumented walls in groups using ultrasonic tips after the conventional mechanized technique (p<0.01) with a confidence interval of 1.04 (95%CI: 0.59, 1.50). The ultrasonic tip associated with mechanized instrumentation demonstrates a significant reduction in the percentage of non-instrumented surfaces in oval or flattened canals.

Evaluation of 3D-Printed Dog Teeth for Pre-clinical Training of Endodontic Therapy in Veterinary Dentistry.

Artificial teeth in dental training have become a valuable tool for students to gain hands-on experience in a safe and controlled environment. This training method allows students to practice various dental procedures and develop their skills without putting patients at risk. Artificial teeth can be used to simulate dental conditions, allowing students to gain experience in dealing with various situations and techniques. Although previous studies in human dentistry have demonstrated the feasibility of using 3D-printed teeth for teaching endodontic procedures such as root canal therapy, similar research has yet to be conducted in the veterinary field. This study aimed to assess the feasibility of creating 3D-printed teeth from an adult dog skull and validate their use as an alternative training tool for root canal therapy in this species. For this, cone beam computed tomography images from a medium-sized dog skull were used to replicate its teeth using a digital 3D printing system. Then, artificial mandibular first molar teeth and a 24-question survey were sent to specialized veterinary dentistry practitioners in Brazil to assess their perception of the model's characteristics during endodontic treatment. In conclusion, it was feasible to create 3D-printed models of dog teeth with high accuracy for the endodontic system. Despite the differences in the properties of the two materials between natural and artificial teeth, it was possible to use the artificial tooth as a training device for conventional endodontic treatment in dogs. The reliability level for the survey was reported as good, displaying a reliability coefficient above 0.86.

Cytokine expression of IL-8 before and after root canal treatment in patients with symptomatic apical periodontitis: A clinical trial.

Thirty-six patients were allocated according to their pulp status into two experimental groups (n = 18) receiving the same treatment protocol; group 1: Vital pulps with SAP, and group 2: non-vital pulps with SAP. Conventional endodontic treatment was done on two visits; isolation and disinfection of the operative field were undertaken, and two-stage access cavity preparation was implemented. The first pre-instrumentation peri-apical sample (S1) was collected prior to cleaning and shaping procedures. A 2.5% NaOCl irrigation was used to thoroughly irrigate the canal after performing root canal preparation utilising the ProTaper Next (PTN) rotary system. After 1 week, the second post-instrumentation peri-apical sample (S2) was collected. Using an ELISA kit, the quantity of IL-8 was evaluated following the collection of all samples. In all pre-instrumentation samples, IL-8 was detected (100%). The level of IL-8 expression was significantly decreased from the S1 to S2 of all samples (p < 0.001). The intra-group comparison showed a statistically significant reduction in the level of IL-8 expression between S1 and S2 in both vital and non-vital groups where p < 0.001* in both groups. The inter-group comparison of levels of IL-8 expression (vital and non-vital) revealed a significant difference between both groups regarding the pretreatment sample with the higher levels of IL-8 shown in the non-vital group (p < 0.001). While in the post-treatment sample, both groups showed a significant reduction in the level of IL-8 expression but the difference between them was not statistically significant (p = 0.226). Root canal instrumentation seems to be efficient in decreasing the levels of anti-inflammatory cytokines, namely IL-8. Further research should clarify how intra-canal medicaments affect inflammatory mediator levels.

Management of external cervical resorption with internal approach: 18 months of follow-up

Introduction: External cervical resorption (ECR) in advance stages may have a probable pulp involvement. In some of these cases, the accessibility of the resorptive process can be performed by an intraradicular approach. Aim: To report the management of an ECR, classified as Class 2cp according to Patel classification, with an internal approach. Case report: A 22-year-old male patient presented a complaint of dentin hypersensitivity related to left maxillary lateral incisor and reported a history of previous dental trauma. Based on the clinical, radiographic and tomographic findings, the left maxillary lateral incisor was diagnosed as symptomatic irreversible pulpitis with ECR class 2cp of Patel classification. The patient was scheduled for endodontic treatment, with an internal approach, and repair of the resorbed area. Intracanal dressing of calcium hydroxide paste was used in the root canal and resorption gaps. The root canal filling was performed in two steps: obturation of the apical and middle third with gutta-percha by lateral condensation technique and obturation of the cervical third and filling the resorbed area with MTA. After 18 months signs and symptoms compatible with success were observed, and the tomographic and radiographic images suggested a successful endodontic treatment and evolutionary process of repair of bone and mineralized dental tissues. Conclusion: Patel class 2cp ECR treatment through an internal approach, including conventional endodontic treatment and recovery of the reabsorbed area with calcium hydroxide and MTA is a viable treatment option, but may cause tooth discoloration.

PERIAPICAL SURGERY WITH TRANSSURGICAL FILLING OF A TOOTH WITH EXTENSIVE PERIAPICAL LESION: CASE REPORT

This paper aims to describe a case of endodontic treatment associated with surgical treatment with apical curettage, apicectomy and transsurgical filling of a right upper lateral incisor with extensive periapical lesion. The patient attended the dental office reporting pain, facial swelling and fever. On clinical examination, an increase in extra and intra-oral volume was observed, affecting the bottom of the right upper sulcus; there was a negative response to the sensitivity test on tooth 12. The periapical radiograph showed the presence of an extensive periapical lesion involving the apices of teeth 11 and 12. In light of these findings, conventional endodontic treatment was chosen. The chemical-mechanical preparation was performed with X1-Blue mechanized files associated with 2.5% sodium hypochlorite and, after three changes of intracanal medication with calcium hydroxide, exudation through the canal persisted. Therefore, a periapical surgery was performed with curettage of the lesion, apicectomy and transsurgical obturation associated with AH Plus sealer. After 7 months of follow-up, complete regression of the periapical lesion was observed. In view of the limitations, the success of this case can be attributed to the association of endodontic treatment with the chosen surgical technique, since a repair of the periapical bone radiolucency was observed.

Photobiomodulation Therapy and Pulp-Regenerative Endodontics: A Narrative Review.

Regenerative endodontic procedures (REPs) were used to recover the dental pulp's vitality in order to avoid the undesirable outcomes of conventional endodontic treatment and to promote dentinal formation, especially for immature permanent teeth. Photobiomodulation therapy (PBMT) exhibits photobiological and photochemical effects for improving the root canal's environmental conditions by compensating for oxidative stress and increasing the blood supply to implanted stem cells and improving their survival. Basic research has revealed that PBMT can modulate human dental pulp stem cells' (hDPSCs) differentiation, proliferation, and activity, and subsequent tissue activation. However, many unclear points still remain regarding the mechanisms of action induced by PBMT in REPs. Therefore, in this review, we present the applications of laser and PBMT irradiation to the procedures of REPs and in endodontics. In addition, the effects of PBMT on the regenerative processes of hDPSCs are reviewed from biochemical and cytological perspectives on the basis of the available literature. Furthermore, we consider the feasibility of treatment in which PBMT irradiation is applied to stem cells, including dental pulp stem cells, and we discuss research that has reported on its effect.

Regeneration of immature incisor using platelet rich fibrin: report of a novel clinical application

BackgroundEndodontic treatment of young permanent teeth with necrotic pulp presents a clinical challenge for the dentist, and conventional endodontic treatment will result in tooth fracture along with a poor prognosis. Regenerative endodontics is a new protocol that has been advanced in the last decades for managing immature permanent teeth. Rare successful management of immature permanent incisors using platelet-rich fibrin is a technique-sensitive procedure.Case presentationA 08 years 04 months old female reported the chief complaint of pain in the upper front tooth region for one week. A blunderbuss canal was identified on radiographic examination, and revascularization using platelet-rich fibrin was planned and adopted. After the treatment, apical closure and root lengthening were noted without complications during subsequent follow-ups. Complete periapical healing with greater than 1.5 cm of dentinal thickness was noted.ConclusionRevascularization can be considered a viable treatment option for immature nonvital permanent teeth; with advancements in regenerative medicine and clinical practices, revascularization therapies could be developed as a novel mode of treatment in non-vital and dental traumatic cases.

Evaluation of postoperative pain and healing following regenerative endodontics using platelet-rich plasma versus conventional endodontic treatment in necrotic mature mandibular molars with chronic periapical periodontitis. A randomized clinical trial.

To evaluate the post-operative pain and the healing of necrotic mature permanent mandibular molar teeth with peri-apical periodontitis after conventional endodontic treatment versus after platelet-rich plasma (PRP) revascularization. The protocol of this randomized clinical trial was registered at www. gov with identification number NCT03350841. Twenty-eight patients were included in the study after confirming the diagnosis clinically and radiographically. In the first visit, mandibular molar teeth of both groups were mechanically prepared. Double antibiotic paste was prepared and injected then the cavity that was sealed with glass ionomer. At the second visit, the patients were randomized either to control group where standard endodontic treatment was completed by lateral condensation technique or assigned to intervention group where PRP revascularization technique. The degree of spontaneous pain was assessed using numerical rating scale (NRS) pre-operatively, then post-operatively after 6, 12 h and daily for 5 days. Patients were given a placebo to be administrated in case of pain. An analgesic (ibuprofen 400mg) was prescribed in case of persistent pain. Clinical and radiographic healing was assessed after 6 and 12 months. All demographic, baseline and outcome data were collected and statistically analysed. Regarding the post revascularization/obturation pain, there was no statistically significant difference between severity of pain in the two groups at all time intervals except after 12 h, revascularization group showed statistically significantly higher prevalence of no pain than endodontic treatment group. Regarding the healing; the periapical lesions decrease in size significantly from the pre-operative lesion size in both groups without significant difference between the both groups. Within the limitation of this study, PRP revascularization could be an alternative treatment to root canal treatment but further randomized clinical trials with standardized techniques and long follow up periods are recommended for more reliable results.

Regenerative therapy in young permanent tooth: Case report

Pulp necrosis in immature permanent teeth represents a challenge for clinical management. The dentin wall in immature teeth is thin and the root is short, leading to an unfavorable long-term prognosis due to the risk of root fracture. Regenerative endodontic procedures have been shown to be effective and improve the prognosis of the compromised immature tooth by re-establishing functional pulp tissue that promotes continued root development and immune competence. The objective of the study was to report a case of a young permanent molar, diagnosed with necrosis and incomplete rhizogenesis. A female patient, 08 years old, attended the clinic of the specialization course in Endodontics, Faculty of Dentistry São Leopoldo Mandic, Belo Horizonte Unit. Regenerative therapy was proposed, which involved the following steps: anesthesia, opening, odontometry, minimal instrumentation, disinfection with 2% chlorhexidine gel, irrigation with saline solution, intracanal medication with calcium hydroxide paste, induction of bleeding to form a blood clot, cervical sealing with mineral trioxide aggregate and composite resin. The patient remained symptom-free up to 5 months after treatment. However, radiographically, an increase in the periapical radiolucent area was noted, so it was decided to carry out the conventional endodontic treatment. Regenerative therapy can be an alternative to apexification in immature teeth in cases of irreversible pulpitis and pulp necrosis associated or not with a periapicalesionson. It is a simple treatment with advantageous results as it promotes an increase in the length and thickness of the dentin wall and apical closure as seen in the case described in this work.

Is clindamycin-modified triple antibiotic paste better than iodoform-based medicament for the treatment of non-vital primary molars using LSTR technique – A randomised clinical trial

Objectives: The objectives of this study were to evaluate and compare the success rate of local application of iodoform-based obturating material (Pulpotec – [Produits Dentaires S.A., Switzerland]) and clindamycin-modified triple antibiotic paste (ClinM-TAP) in pulp chamber using minimally invasive endodontic treatment of carious primary molars indicated for pulpectomy, for 12 months, using clinical and radiographic parameters. Materials and Methods: A randomised clinical trial was conducted in 60 children in the age group of 3–8 years reporting carious primary molars with symptoms of irreversible pulpitis and pulpal involvement clinically, allocated into Group 1 (30) and Group 2 (30). In Group 1, Lesion sterilisation and tissue repair (LSTR) was done using Pulpotec (Produits Dentaires S.A., Switzerland) as medicament and in Group 2, ClinM-TAP (Clindamycin-modified triple antibiotic paste) was used as medicament. Clinical follow-up was done at 3, 6 and 12 months; radiographic follow-up was done at 6 and 12 months. Clinical parameters compared were tenderness on percussion, spontaneous pain, intraoral swelling and sinus/fistula. Radiographic comparison was done based on furcation radiolucency, root resorption and bone regeneration. Both intergroup and intragroup statistical analysis was done using Chi-square test or Fisher exact test, Cochran’s Q Test and Mann–Whitney U-Test for the test of significance. All the statistical tests were performed at 5% significance level. Results: The mean age of patients in the study was 5.25 ± 1.3years with 45% males and 55% females. Both groups showed significant improvement in terms of clinical symptoms from baseline to 12 months. On intergroup comparison clinical parameters, TOP was present in 11.2% and 44% of cases at the end of 12 months in Groups 1 and 2, respectively (P &lt; 0 0.05). On intergroup comparison of radiographic parameters, at the end of 12 months, furcation radiolucency was seen in 32% and 73% (P &lt; 0.05) and root resorption was seen in 16% and 30% cases in Group 1 and 2, respectively (P &gt; 0.05). Overall clinical success rate of Group 1 and Group 2 was 88% and 50%, respectively (P &lt; 0.05) and radiographic success rate was 60% and 27%, respectively (P &lt; 0.05). Conclusion: LSTR using Pulpotec as a medicament has shown promising results in the present study. It could be a better alternative to conventional endodontic treatment in primary teeth. In the present study, ClinM-TAP has shown poor radiographic success; hence, it should be used with caution.

Guided Endodontics in Calcified Root Canals

Introduction: Endoguide is a device that has significantly aids the treatment of calcified root canals. This device involves modern technologies as 3D printing and computed tomography, which increase the accuracy of dental work. Guided endodontics has currently been emphasized because it facilitates more complex endodontic treatments, such as partial or total obliteration of the root canals precluding the conventional endodontic treatment. This method has demonstrated high percentages of safety for both patient and dentist. It is a fast endodontic access system that prevents perforations, unnecessary removal of dentin and tooth structure. This treatment method is more effective than conventional methods for locating calcified root canals due to its accuracy, speed of time and precision of direction.&#x0D; Objective: To review the current literature on Endoguide in calcified root canals, analyze its practice, advantages, disadvantages, indications and limitations.&#x0D; Material and Methods: The study was conducted on 20 papers in Portuguese and English from the year 2016 to April 2022, and a classic article from year 1995, searched in the databases PubMed, Google Scholar and Bireme. The following keywords were used: Calcified canal, Guided endodontics, Endodontic access, Endoguide.&#x0D; Results: This technique showed greater predictability in calcified canals, reducing the risk of perforations and allowing faster and more efficient access, with many advantages, except for its high cost.&#x0D; Conclusion: Based on this literature review, it can be suggested that the Endoguide technique in calcified canals provides great benefits to both dentist and patient, such as reduction of clinical time, agility and confidence in treatment, reduced risk of accidents and complications such as perforations and unnecessary dentin removal.

Efficacy of the non-instrumentation endodontic treatment with CTZ paste in primary molars: Protocol of a multicenter randomized clinical trial with two years of follow-up

Objective: There is a lack of high-quality evidence on the efficacy of the non-instrumentation endodontic treatment (NIET) in primary molars, compared to the conventional endodontic treatment technique. This protocol describes a multicenter randomized clinical trial that aims to evaluate the efficacy of a NIET technique for primary molars using a paste containing antibiotics (chloramphenicol and tetracycline – CTZ group) compared to a control group of conventional technique and root filling with zinc oxide eugenol (ZOE). Methodology: Children aged 3 to 9 years (N=218) will be randomly allocated to one of the groups: CTZ or ZOE. In CTZ, after the location of root canals entrance, irrigation will be performed using 1% sodium hypochlorite and CTZ paste will be placed over the root canal entrances, with no instrumentation of the root canals. In ZOE group, manual instrumentation of root canals with endodontic K-files will be performed, and then, the root canals will be filled with ZOE paste. At the same appointment, teeth will be restored with a double-seal of glass ionomer and a bulk fill resin composite. Children will be followed-up for 6, 12, 18 and 24 months. The primary endpoint will be the success of endodontic treatments evaluated by clinical and radiographic criteria after 24 months. Conclusions: NIET with CTZ paste could be an option to manage primary teeth, once the technique could have non-inferior efficacy to the conventional technique that involves root canal instrumentation. The approach could have good acceptance from children and parents considering the reduced clinical time.

Multidisciplinary approach for management of cemental tear with apical periodontitis: A case report

Objectives: Cemental tear is a specific type of root surface fracture that can lead to rapid periodontal attachment loss. Tooth associated with cemental tear show mobility of tooth, resorption of alveolar bone, and inflammation that persists even after root canal treatment. Cemental tears are difficult to diagnose when characteristic fractures are not observed on radiographs, and often misdiagnosis as periapical or periodontal lesions. refore, an accurate diagnosis is essential for suc-cessful treatment of cemental tears and a multidisciplinary approach that involves both endodontic periodontal treatment, and periodontal surgery is required. The aim of this case report is to present the treatment and outcome of cemental tear which was managed with two differ-ent surgical treatment regimes. In the first case, after conventional endodontic treatment, cemental fragment was removed through open flap surgery, and regeneration treatment was performed by guided tissue regeneration (GTR) and bone graft. In the second case, after conventional endodontic treatment, apicoectomy and removal of cemental fragments were performed through replantation of tooth, followed by guided tissue regeneration (GTR) and bone graft. In both cases, follow-up of more than 6 months was performed, symptoms subsided and recovery of periapical alveolar bone was observed on radiographs.

Unraveling the enigma: A case report

The purpose of this case report is to emphasize the importance of cone-beam computed tomography (CBCT) and dental operating microscope for endodontic treatment on mandibular second premolar with three separate roots. In endodontics, the possible existence of extra canals must be considered before endodontic treatment is instituted. A wide morphological variation of the mandibular second premolar is known to exist. The incidence of a three-rooted mandibular second premolar is approximately 0.4%. A 43-year-old female patient was referred for endodontic treatment on the mandibular second premolar. IOPA revealed three roots, and hence for confirmation, a CBCT image was taken and root canal treatment was performed under an operating microscope for enhanced visualization. This case report describes the successful endodontic treatment of a mandibular second premolar with three separate roots and canals filled using gutta-percha and AH Plus. Clinical significance: Conventional endodontic treatment can be performed on a tooth with complex root canal morphology using an operating microscope.

Resolution of chronic secondary rhinosinusitis of odontogenic origin after endodontic treatment: A case report

Introduction: A case of successful resolution of odontogenic rhinosinusitis after endodontic treatment is presented. Case Report: The patient previously diagnosed with rhinosinusitis presented with an active parulid between the 25 and 26 teeth. The sinus tract-tracing indicated 26 tooth as the source and periapical radiography showed a chronic apical periodontitis lesion. A cone beam computed tomography (CBCT) demonstrated hyperdense imaging on the floor of the left maxillary sinus of posterior teeth region, and rupture of the cortical bone of sinus floor and thickening of its membrane. The odontogenic localized secondary rhinosinusitis was diagnosed. Conventional endodontic treatment was performed with intracanal medication. Nine months later, the patient returned without symptoms and the new CBCT showed no periradicular lesion, corticalization of the maxillary sinus floor, and no sinus disease. Conclusion: The dental resolution of presented case showed that patients with unsuccessful previous treatment for rhinosinusitis may suffer from endodontic diseases, which may fail without the dentist’s approach. The presented case showed that the implemented treatment protocol was effective to improve the patient’s health, as well shows the necessity of proper approach to achieve success.

An Updated Review on Properties and Indications of Calcium Silicate-Based Cements in Endodontic Therapy.

Regarding the common use of calcium silicate cements (CSCs) in root canal therapy, their position in the context of past and present dentistry agents can provide a better understanding of these materials for their further improvement. In this context, the present review article addresses a wide range of recent investigations in the field of CSC-based products and describes details of their composition, properties, and clinical applications. The need for maintaining or reconstructing tooth structure has increased in contemporary endodontic treatment approaches. This research thus discusses the attempts to create comprehensive data collection regarding calcium ion release, bond strength, alkalinizing activity and bioactivity, and the ability to stimulate the formation of hydroxyapatite as a bioactive feature of CSCs. Sealing ability is also highlighted as a predictor for apical and coronal microleakage which is crucial for the long-term prognosis of root canal treatment integrity. Other claimed properties such as radiopacity, porosity, and solubility are also investigated. Extended setting time is also mentioned as a well-known drawback of CSCs. Then, clinical applications of CSCs in vital pulp therapies such as pulpotomy, apexification, and direct pulp capping are reviewed. CSCs have shown their benefits in root perforation treatments and also as root canal sealers and end-filling materials. Nowadays, conventional endodontic treatments are replaced by regenerative therapies to save more dynamic and reliable hard and soft tissues. CSCs play a crucial role in this modern approach. This review article is an attempt to summarize the latest studies on the clinical properties of CSCs to shed light on the future generation of treatments.

Endodontic Microsurgery of Mandibular Second Molars Using the Bony Lid Approach: A Case Series

Endodontic microsurgery is important for preservation of natural teeth with symptomatic apical periodontitis when conventional endodontic treatment is neither feasible nor effective. The thick buccal cortex, poor visibility, and potential neurovascular complications can make microsurgical procedures of mandibular second molars infeasible. With the aid of cone-beam computed tomography, the bony lid approach was applied in 10 cases of endodontic microsurgery of mandibular second molars at the VIP Center, Hangzhou Stomatology Hospital between 2019 and 2020. In all cases, the clinical and radiographic findings at the 24- or 36-month follow-up revealed complete healing of the periapical lesions. The bony lid technique contributed to precise root-end localization and helped avoid excessive postoperative pain or unfavorable healing that occurred in cases of excessive alveolar bone resection. Some clinical tips on preserving the cortical bone, obtaining precise access, and improving surgical efficiency have been proposed in this report.