Conventional Endodontic Treatment Research Articles

Regenerative Endodontic Procedures With Minced Pulp Tissue Graft in Mature Permanent Teeth: A Clinical Study

IntroductionRegenerative endodontic procedures (REPs) using cell-based approaches have emerged as novel treatment modalities. This clinical study aimed to present the outcomes and explore factors influencing REPs with minced pulp tissue (MP) grafts in a mature tooth. MethodsHealthy patients requiring non-surgical root canal treatment were enrolled. MP obtained from the third molar was grafted into the instrumented, disinfected, and blood-filled root canal. After treatment, patients were evaluated clinically and radiographically. ResultsFollow-ups for 6 cases (male patients aged 20–27) ranged from 19 to 42 months. Radiographically, all the teeth showed favorable outcomes. Among the 6 teeth, 2 showed neither intracanal calcification nor recovery in sensibility tests, and one had no intracanal calcification with an inapplicable sensibility test evaluation. In 2 teeth, intracanal calcification was observed in the apical third; however, there was no recovery in the sensibility tests. One tooth exhibited intracanal calcification in the apical third and showed recovery in the sensibility tests. Considering these outcomes and clinical variables, the size of the apical foramen and the composition of the transplanted pulp tissue were identified as tentative influencing factors. ConclusionsThis exploratory clinical study on simplified cell-based REPs using autologous MP grafts for pulp/dentin regeneration in adult teeth not only enhances our understanding of REPs but also suggests its potential as an alternative treatment option to conventional endodontic treatment.

In-vitro Antimicrobial Activity of Mtad, Photoactivated Disinfection Along with Chlorohexidine on Enterococcus faecalis, Staphylococcus aureus and Candida albicans

This study evaluated the antimicrobial activity of five root canal irrigants against MTCC of Enterococcus faecalis, Staphylococcus aureus, Candida albicans, in-vitro study of the inhibitory activity of PAD in conventional Endodontic Treatment (CET) and also combination of CET with PAD (CHX+PAD). All of these microorganisms were incubated in the presence of an Endodontic irrigant. Agar diffusion tests were performed and colony counts were tested using paper point to evaluate the inhibitory effect of the irrigants. The mean diameters of the inhibition zones for C. albican were 21mm 3% Naocl, 19mm CHX, 0.7PAD, 22mm CHX+PAD, 20mm Fluconazole, 18mm Doxycycline. The zone diameters of the inhibition zones of Enterococcus faecalis were 17mm 0.5% Naocl, 18mm CHX, 12mmPAD, 35mm MTAD, and 19mm PAD+CHX. The Zone Diameter of the inhibition zones of Staphylococcus aureus were 18mmCHX, 12mm PAD, 19mm PAD+CHX, 25mm MTAD, and 19mm 3% NaoCl. Together High inhibitory effect was detected for PAD+CHX and MTAD on all three pathogens. Candida showed more inhibition to all irrigants followed by Staphylococcus aureus and Enterococcus faecalis.

REGRESSÃO DE LESÃO RADIOTRANSPARENTE ÓSSEA APÓS TERAPIA ENDODÔNTICA CONSERVADORA

Periapical lesions are found associated with the apex of a tooth without vitality, after contamination of the root canals, characterized radiographically by the presence of a radiolucent image at the apex of the affected element. The objective of this work is to report the regression of a periapical lesion, with a diagnosis of periapical abscess without fistula, after conventional endodontic treatment, confirmed through radiographic examinations and clinical images. A 24-year-old female patient complained of pain in the right anterior region and, days before the initial consultation, reported drainage of purulent secretion through the gums. In the intraoral physical examination, edema was observed at the bottom of the vestibule close to the incisors, pain on horizontal and vertical percussion and on the periapical radiograph the presence of a radiolucent image was observed close to the apex of tooth 36. A cold pulp sensitivity test was performed, obtaining a negative result. . With the purpose of decontaminating the root canals, endodontic treatment was carried out, using a preparation technique associated with the activation of chemical irrigants and intracanal medication between sessions. After a few weeks, the remission of clinical signs of inflammation and infection was observed and, after 3 months, radiographically, the beginning of repair of the lesion with bone formation was evident. The reported case highlights the importance of effective decontamination of the root canal as a determining factor for the regression process of periapical lesions. A longer period of clinical and radiographic follow-up of the case is necessary to verify complete repair.

Effects of Final Root Canal Irrigants in Conventional and Regenerative Endodontic Treatments: A Systematic Review

Background: The effectiveness of final root canal irrigants is crucial for successful conventional and regenerative endodontic treatments. This study aimed to systematically review the impact of final irrigants on dentin, disinfection, and regenerative potential in endodontic therapies. Methods: MEDLINE, Cochrane Library, and Web of Science databases were electronically searched for articles on final irrigants in conventional and regenerative endodontics, evaluating effects on dentin, smear layer, fracture resistance, stem cells, growth factors, and antimicrobial properties. The risk of bias was assessed using the Systematic Review Centre for Laboratory Animal Experimentation risk of bias tool. Results: Overall, 25 eligible studies were included in this review after screening 2842 articles. Commonly assessed irrigants included ethylenediaminetetraacetic acid (EDTA) (21 studies), sodium hypochlorite (NaOCl; 12 studies), and citric acid (6 studies). EDTA could enhance growth factors but could weaken dentin. NaOCl affected dentin despite its antimicrobial benefits. Nanoparticles, chitosan, peracetic acid (PAA), and citric acid showed potential benefits. A meta-analysis was not performed due to methodological heterogeneity. Conclusion: In general, optimized irrigation strategies balancing disinfection, biocompatibility, and regenerative potential are necessary. More research is required to develop improved irrigation protocols. Registration: PROSPERO CRD42023420406.

Exploring deep caries management and barriers to the use of vital pulp treatments by primary care dental practitioners.

The European Society of Endodontology outlines best practices for the management of deep caries and the pulp. Despite evidence supporting vital pulp treatments (VPTs) as predictable alternatives to conventional endodontic treatment, studies have shown they are not widely adopted in the UK. This study aimed to explore the barriers to implementation of VPTs by primary care general dental practitioners (GDPs). Qualitative one-to-one semi-structured online interviews were conducted with purposively sampled UK GDPs. Interview transcripts were analysed using reflexive thematic analysis. Recurring themes were iteratively refined as additional transcripts were reviewed. Eleven participants were interviewed. A range of barriers to the provision of VPTs were identified, which aligned with two core themes: 'Motivational barriers to service provision' and 'Educational access & opportunities'. Sub-themes included lack of access to materials and equipment, deficiencies in knowledge of treatment (including protocols, outcomes and prognosis), lack of confidence (in treatment efficacy and clinical ability), time constraints and public dental service funding and remuneration. This study identifies barriers to the widespread adoption of VPTs among primary care GDPs in public and private settings. Economic constraints, practitioner confidence, time limitations and educational gaps are key challenges. Addressing these may require systemic changes such as policy interventions, education and improved resource allocation.

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.

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).

ANXA1 Enhances the Proangiogenic Potential of Human Dental Pulp Stem Cells.

Dental trauma is highly prevalent in children and adolescents, alongside tooth decay. This condition mainly induces pulp contamination, pulp necrosis, and tooth avulsion in the clinical context. The disturbance to root growth is prone to occur in immature permanent teeth. However, conventional endodontic treatment may not achieve favorable outcomes in these cases, necessitating conducting relevant exploration. Therefore, this study was performed to examine the impact of Annexin A1 (ANXA1) on the vascular repair of dental pulp using human dental pulp stem cells (DPSCs). Specifically, RNA sequencing (RNA-Seq) and functional clustering analyses were employed to identify key genes involved in pulp regeneration. ANXA1 was detected in DPSCs and may correlate with pulp restoration. However, it remains undefined about the potential of ANXA1 to promote the angiogenetic differentiation of DPSCs. The results of this study revealed that the addition of ANXA1 significantly enhanced the secretion of vascular endothelial growth factor-A (VEGF-A) in DPSCs. Moreover, the incubation of DPSCs with ANXA1 resulted in a higher expression level of endothelial markers and promoted vessel formation through the upregulation of the phosphorylated p38 (p-p38) pathway. The in vivo results corroborated that the ANXA1 group exhibited more blood vessels and an increased ratio of positive staining for CD31. In conclusion, these findings indicate that ANXA1 enhances the in vivo and in vitro vascularization of DPSCs, and the activation of p-p38 may play a pivotal role in mediating the differentiation process.

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.