Endodontic Cases Research Articles

Management of Challenging Endodontic Case with Six-year Follow-up

Management of Challenging Endodontic Case with Six-year Follow-up

Impact of diabetes mellitus on endodontic treatment outcomes

Diabetes mellitus (DM) is a chronic metabolic disorder that affects various systemic functions, including oral health. Its impact on endodontic treatment outcomes has become a significant concern for dental practitioners. The relationship between DM and endodontic outcomes is complex, involving several pathophysiological mechanisms. Hyperglycemia leads to the formation of advanced glycation end-products, causing vascular dysfunction and impaired blood supply to the pulp, which exacerbates pulpal inflammation and increases the risk of necrosis. Additionally, chronic low-grade inflammation and an impaired immune response in diabetic patients contribute to a higher susceptibility to infections, delayed healing, and compromised tissue repair after endodontic procedures. Diabetic patients often experience lower success rates and prolonged recovery following endodontic treatment due to these systemic challenges. Reduced bone healing, persistent periapical lesions, and altered microbial flora are common complications that can hinder treatment success. Effective management of endodontic treatment in diabetic patients requires a multifaceted approach that includes strict glycemic control, the use of enhanced antimicrobial strategies, and the adoption of minimally invasive techniques to reduce tissue trauma. Additionally, patient education and close monitoring of the healing process are essential for minimizing complications. Understanding the pathophysiological interactions between diabetes and pulpal inflammation, as well as the factors that influence healing and success rates, is crucial for optimizing endodontic care in diabetic patients. By addressing both systemic and local factors, dental practitioners can improve the prognosis of endodontic treatment and ensure better outcomes for patients with diabetes. Ongoing research into the mechanisms underlying these complications will further enhance the ability of clinicians to manage endodontic cases effectively in this growing patient population.

Assessment of the Difference Between General Practitioners and Specialists in Antibiotic Prescription for Emergency Patients

Background:Endodontic emergencies are one of the most common emergencies that dentists face during their career. Objectives: This study aimed to evaluate and assess the difference between general dentists and endodontists in managing endodontic emergency cases. Also, it highlights the risk of bacterial resistance due to an inappropriate antibiotic prescription. Methods: A cross-sectional study conducted at King Abdul-Aziz University Dental Hospital, a self-administered survey was distributed to 521 dental patients. The response rate was 82.9% (432 out of 521). The survey, available in both paper and electronic formats, comprised 24 questions organized into three main sections: the first section collected demographic and medical history data, the second focused on the patients' dental history related to emergencies, and the third detailed the treatment received during emergencies and the methods employed. A Fisher's exact test was utilized to assess significant differences between general dental practitioners and endodontic specialists regarding their initial steps, reasons for treatment, swelling conditions, biting and chewing conditions, and final treatments. Data analysis involved simple descriptive statistics, including percentages, frequency distributions, pie charts, and bar graphs. Statistical significance was determined with a p-value set at ≤ 0.05. Results: The study revealed that decay was the most prevalent reason for endodontic treatment, with immediate treatment being the preferred choice among dentists. Despite the well-documented issue of endodontic treatment failure due to inadequate coronal sealing, the majority of general dentists performed root canal treatments followed by either temporary or permanent restorations. Additionally, the study found that general dentists prescribed antibiotics more frequently than endodontists. Conclusion: The study findings indicate the need to develop intervention programs targeting clinicians to enhance knowledge about prescribing antibiotics for endodontic emergencies.

Comparison of Practice and Knowledge on Endodontic Retreatment amongst the General Practitioners and Endodontists: A Survey

Abstract Introduction: Endodontic retreatment differs from initial root canal treatment. Various factors govern the success of root canal treatment, and failure to achieve any of these may lead to the failure of the therapy. Retreatment decisions differ amongst general practitioners and specialists and are dependent on several factors including educational background, work experience, knowledge and economic resources. A survey was conducted to compare the practice and knowledge regarding endodontic retreatment cases amongst general practitioners and endodontists. Materials and Methods: A questionnaire was constructed with questions based on common practice and knowledge of endodontic retreatment and was distributed to general practitioners and endodontists through electronic means and personal mail. Data were analysed using the Chi-square test. P < 0.05 was considered statistically significant. Results: The results showed that there was no statistical difference in the responses by general dentists and specialists (endodontists). Conclusions: Within the limitations of this survey, it can be concluded that both the general practitioners and specialists (endodontists) have adequate knowledge and follow similar protocols when treating retreatment cases with minor differences in their approach.

Deep learning for determining the difficulty of endodontic treatment: a pilot study

BackgroundTo develop and validate a deep learning model for automated assessment of endodontic case difficulty from periapical radiographs.MethodsA dataset of 1,386 periapical radiographs was compiled from two clinical sites. Two dentists and two endodontists annotated the radiographs for difficulty using the “simple assessment” criteria from the American Association of Endodontists’ case difficulty assessment form in the Endocase application. A classification task labeled cases as “easy” or “hard”, while regression predicted overall difficulty scores. Convolutional neural networks (i.e. VGG16, ResNet18, ResNet50, ResNext50, and Inception v2) were used, with a baseline model trained via transfer learning from ImageNet weights. Other models was pre-trained using self-supervised contrastive learning (i.e. BYOL, SimCLR, MoCo, and DINO) on 20,295 unlabeled dental radiographs to learn representation without manual labels. Both models were evaluated using 10-fold cross-validation, with performance compared to seven human examiners (three general dentists and four endodontists) on a hold-out test set.ResultsThe baseline VGG16 model attained 87.62% accuracy in classifying difficulty. Self-supervised pretraining did not improve performance. Regression predicted scores with ± 3.21 score error. All models outperformed human raters, with poor inter-examiner reliability.ConclusionThis pilot study demonstrated the feasibility of automated endodontic difficulty assessment via deep learning models.

Need for dentists with post-graduate training in endodontology according to members of the Swiss Dental Association

This questionary-based study was financed by the Swiss Society for Endodontology (SSE). At the time of this survey (2022) there were merely 20 board-certified endodontists in Switzerland, and 239 other members of the SSE, i.e. general practitioners with some form of post-graduate endodontic training or a keen interest in the field. The aim of this investigation was to evaluate the need for a higher number of trained endodontists as viewed by the general population of dentists in Switzerland. An electronic questionary in either German, French, or Italian was sent to all 4072 active members of the Swiss Dental Association (SSO). The questionnaire focused on the background of the surveyed dentists, their willingness to refer endodontic cases to a specialist or colleague with a focus on endodontics, their propensity to do so, and their perceived need for endodontists in their region. The response rate was 21%, and was similar between the different regions and cantons. Seventy-nine (9%) of the dentists participating in the survey were members of the SSE, while 16 (2%) were board-certified. Merely 7% of the participants received endodontic referrals themselves, while 81% referred cases in some instances. However, only 13% of participants referred endodontic cases always or regularly. The main reason for not referring was the belief by the surveyed dentists that they could perform the endodontic treatments themselves. Long distance to the next endodontic specialist or expert was the second most frequently given reason not to refer cases. A total of 58% of the participants believed that there were enough endodontists in Switzerland to cover the encountered clinical problems.

Endodontic treatment of severely curved root canals – A case series

Background: It is not uncommon for a dentist to encounter endodontic cases of severely curved root canals. Performing endodontic treatment on severely curved root canals can be a daunting task due to the notable risk of creating an iatrogenic error including ledge, perforation, or even instrument separation. Therefore, radiograph image analysis, proper endodontic treatment planning, selection of appropriate instruments and technique is essential to ensure success in endodontic treatment of severely curved root canals. Purpose: This case series aims to elaborate the instruments and technique to safely negotiate, clean, shape, and seal root canals with severe curvature. Cases: Three patients came to Universitas Airlangga Dental Hospital due to a severe toothache. After anamnesis and examination, diagnosis was established, and endodontic treatment was deemed necessary. During radiographic image analysis, it is visible that the root canal had a severe curvature. Case Managements: Access opening was performed to allow a straight-line access, orifices were preflared, root canals were negotiated, and glide path was established. Then, shaping, cleaning, and sealing can be performed conveniently until the root canal terminus. Subsequently, coronal restoration was fabricated to restore function and esthetics. Conclusion: With proper knowledge, case analysis, appropriate instruments and techniques, severely curved root canals can be safely and predictably negotiated, cleaned, shaped, and sealed.

Effect of different instrumentation techniques on students' performance and outcomes of nonsurgical root canal treatment.

This study compared, retrospectively, the incidence of clinical errors and effects on treatment outcomes, when students were exposed to two different instrumentation techniques: a hybrid rotary technique (HYB), consisting of both hand instrumentation with hand stainless steel and Ni-Ti files plus the use of a rotary system (Vortex Blue, Dentsply Sirona), versus a full reciprocation instrumentation technique (WaveOne Gold [WOG], Dentsply Sirona). A total of 368 endodontic cases (n=184) in anterior and premolar teeth, completed by dental students at the University of Michigan School of Dentistry from 2013 to 2022, were used for the study. The groups were evaluated by two calibrated clinicians, observing the incidence of clinical errors: file separations, over-instrumentation, ledges and transportations. Treatment outcomes were also observed. Data were analyzed statistically by Fisher's exact test and Mann-Whitney U test (p<0.05). No significant difference in file separations, ledges, and transportation was observed between the two groups. However, the WOG Group experienced significantly more over-instrumentation than HYB group, although this did not significantly affect tooth survival or periapical index (PAI). Cases with PAI scores of 5 were found to have significantly less tooth survival compared to the other PAI scores. It can be concluded that both techniques in our study are well suited to advancing the endodontic dental education of students and novice operators, anticipating relatively successful outcomes of tooth survival, as long as the cases selected are less severe in progression preoperatively.

Awareness on antibiotic prescription for endodontic cases among Dentists and Endodontists in Saudi Arabia

The knowledge of Dentists and Endodontists in Saudi Arabia regarding antibiotic prescriptions during and after endodontic treatment is of interest. A self-designed questionnaire survey was utilized to assess the knowledge of dentists across various cities in Saudi Arabia concerning antibiotic usage guidelines for endodontic purposes. A total of 391 participants were included in the study, and the questionnaire was distributed through social platforms like WhatsApp, Instagram, Facebook Messenger, and email. Results revealed that over 80% of participants acknowledged the need for antibiotics in cases of acute apical abscess with cellulitis, with amoxicillin being the most recommended antibiotic by dentists. Interestingly, there was no statistically significant difference in knowledge based on experience or graduation group. In conclusion, while participants demonstrated adequate knowledge about antibiotic prescriptions in endodontic cases, continued awareness of updated guidelines, including the WHO's Essential Medicines List (EML), guidelines by the European Society of Endodontology (ESE) and American Association Endodontists (AAE) is essential for optimal clinical practice.

Investigating the technical quality of undergraduate endodontic treatment in a primary care-based dental school.

Introduction The success of root canal treatment (RCTx) relies on the technical quality of the root canal filling, often assessed through radiographic evaluation.Aims This audit aims to evaluate the technical proficiency of Peninsula Dental School (PDS) undergraduate dental students in RCTx, comparing it with established European standards.Design Conducted as a retrospective study, this evaluation focuses on assessing the technical quality of RCTx performed by undergraduate dental students at PDS across various academic years.Setting PDS, a primary care-based dental school in the UK, serves as the focal point for this evaluation.Materials and methods Reviewed 2021-2022 endodontic cases by supervised undergraduates. Analysed radiographs for obturation, voids and errors based on established benchmarks. Randomly selected unbiased cases, assessing voids, filling proximity, missed canals and canal anatomy preservation.Interventions Comparative analysis of RCTx quality between PDS students and counterparts from other dental schools, exemplified by Dublin Dental University Hospital (DDUH).Results Findings revealed that 62.07% of single-rooted and 60% of multi-rooted teeth treated by PDS students met European standards.Discussion The implications highlight the proficiency of PDS students in RCTx, comparing favourably to DDUH.Conclusion Recommendations emphasise conducting regular educational audits in dental schools to continually enhance RCTx techniques and ensure high-quality clinical teaching.

Periapical Healing Outcome of Endodontic Re-Treatment Using Calcium Silicates Versus Resin-Based Sealers: A Systematic Review.

This systematic review was conducted with the purpose of analyzing the effects of root-end sealers in endodontic re-treatment cases and comparing calcium-based sealers with sealers, which were resin-based. We conducted this review based on the principles of Cochrane systematic type of studies and also based on guidelines of Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA). An exhaustive search was conducted across PubMed, Medline, and Embase databases for the studies, which were based on root end sealers in cases of endodontic re-treatments. The data were then analyzed statistically with the help of SPSS 25.0. It was seen that when comparing pain levels in post-obturation cases with these sealers after 24 hours and 48 hours, not much of statistically noteworthy differences were evident. Mean difference (MD) values at 24 hours were -0.20 with confidence intervals between -0.44 and 0.07 and P value of 0.15, whereas in case of 48 hours, MD was -0.36, CI- 0.65, and P value was 0.03. However, the results were slightly better with calcium-based sealers. Calcium silicate-based root end obturation sealers had similar performance when compared to resin-based sealers when we compared variables like pain intensity, etc.

Prevalence of Enterococcus faecalis and Candida albicans in endodontic retreatment Cases: A comprehensive study

IntroductionEndodontic treatment failures often stem from the presence of microbial pathogens, particularly Enterococcus faecalis and Candida albicans. This study systematically assesses the prevalence of E. faecalis and C. albicans in endodontic retreatment cases, aiming to explore their impact on treatment outcomes. MethodsEmploying a systematic sampling approach, 30 patients with a history of previous endodontic treatment were selected. Rigorous clinical and radiographic assessments were conducted, following standardized protocols for root canal sample collection. Microbiological analysis, utilizing selective culture media, was employed to identify and quantify E. faecalis and C. albicans. Statistical analyses, including chi-square and logistic regression tests, were performed. ResultsThe study involved 30 patients undergoing endodontic retreatment, with comprehensive clinical and radiographic evaluations for cases with and without periradicular lesions. Microbiological analysis unveiled a significant prevalence of E. faecalis and C. albicans, establishing a robust association between these pathogens and retreatment failure. These findings underscore the critical need for targeted antimicrobial interventions to enhance the overall success rates of endodontic retreatment procedures. ConclusionThis study highlights the substantial prevalence of E. faecalis and C. albicans in endodontic retreatment cases, emphasizing the importance of identifying and effectively managing these pathogens for successful treatment outcomes. The notable association between these microbial agents and retreatment failure underscores the imperative for tailored antimicrobial strategies to enhance the efficacy of endodontic retreatment procedures.

Ex vivo evaluation of the accuracy of four electronic foraminal locators during endodontic retreatment.

The present study aimed to evaluate the accuracy of four different Electronic Foraminal Locators (EFLs): Root ZX II (J. Morita, Tokyo, Japan), RomiApex A15 (Romidan, Kiryat-Ono, Israel), FinePex (Schuster, Porto Alegre, Brazil) and VDW Gold (VDW, Munich, Germany), in determining root length during endodontic retreatment steps. Twenty-seven human unirooted teeth had their crowns sectioned to standardize the teeth to 17 mm. The actual tooth length was visualized with an operating microscope and a #15 file juxtaposed to the apical foramen. Teeth were instrumented with files R25 and R40, and at the end of each instrumentation, measurements of root canal lengths were made with files #25 and #40. Then, the teeth had their root canals filled with standardized Gutta-Percha R40 cones and Endofill cement, and after seven days, they were uncovered with R25 and R40 files, respectively. New measurements were made with #25 and #40 files between the uncovering with each file. The data were statistically analyzed by ANOVA and Chi-square tests, considered significant when P<0.05. All devices tended to under-measurement when the obturating material was partially removed with the R25 file. When the canals were uncovered with the R40 instrument, the effectiveness of the appliances increased significantly (P<0.05). At 0.40 mm diameter, the mean accuracy of the Romiapex A15 appliance was statistically lower than the other EFLs (P<0.001), showing a tendency to over-measurement. In conclusion, all the tested appliances showed similar efficacy when acceptable limits were observed. The permanence of the remaining filling material in the apical third influenced the accuracy and efficacy of EFLs in endodontic retreatment cases. Key words:Endodontics, odontometry, apical foramen.

Dental undergraduate students’ perception of the endodontic specialty

Objectives: This study aimed to assess the perception and understanding of the endodontic specialty among dental students and newly graduated dentists at Ajman University/College of Dentistry. It also examined their satisfaction with preclinical training, the use of magnification in learning, and their interest in pursuing endodontics as a future career. Materials and Methods: A structured questionnaire with 20 multiple-choice questions was distributed to 540 dental students and interns. The questionnaire assessed participants’ satisfaction with preclinical training, confidence in treating patients, and the impact of magnification (specifically, dental operative microscope) on their learning experience. The survey also explored participants’ interest in pursuing endodontics as a career. Descriptive statistics were used for data analysis. Results: The study found that the majority of participants expressed high confidence in diagnosing and treating endodontic cases (83.5%). Perception did not significantly differ based on gender, level of study, teeth treated, or the experience of the supervising instructor (P &lt; 0.00). Conclusion: Overall, Ajman University dental students and interns showed satisfactory perception of the endodontic specialty. The study highlights the importance of modifying the undergraduate dental curriculum to provide more preclinical training on extracted teeth, with a focus on working length determination and radiograph taking. These changes can help reduce stress associated with endodontic procedures, improve treatment outcomes, and enhance patient satisfaction.

3-YEAR FOLLOW-UP OF REGENERATIVE ENDODONTIC TREATMENTS WITH THE APPLICATION OF CONCENTRATED GROWTH FACTOR AS SCAFFOLD: NINE CASES

The aim of this case series is to present 3-year clinical and radiographic follow-ups of nine regenerative endodontic treatment cases using concentrated growth factor in necrotic immature permanent teeth. Nine patients aged 8-21 years were referred to our clinic. According to clinical and radiographic examinations, it was decided to perform RET. After the working length determination, teeth were irrigated with 2.5% NaOCl and activated with EndoActivator. Root canals were instrumented with XP-endo Finisher-R file. 20 mL of 17% EDTA was used as final irrigation, and calcium hydroxide and temporary fillings were placed. Two weeks later, roots were irrigated with 17% EDTA and 5 mL distilled water and dried with paper points. Bleeding was induced into the coronal part of the root canal. Concentrated growth factor (obtained from the patient’s blood) was placed into the root canals. Biodentine was placed on the blood clot and permanent restorations were made with resin composite. At 3-year follow-up, clinical and radiographic healing was observed in 5 patients. In the other 4 patients, persistent infection and sinus-tract formation were detected at different time periods. Although RET is a promising treatment that aims to preserve teeth vitally, more randomized clinical research is needed due to its unpredictable results.

Assessing Inter-rater Reliability of the Dental Practicality Index and the American Association of Endodontists Endodontic Case Difficulty Assessment Form among Undergraduates

Dental Practicality Index (DPI) and American Association of Endodontists Endodontic Case Difficulty Assessment (AAECDA) form potentially can guide clinicians in making clinical decisions and triaging in large practices and academic settings. Nonetheless, the reliability and validity should be evaluated before institution-wide implementation. This study aimed to evaluate the inter-rater reliability of the DPI and AAECDA forms. Ten randomly selected, trained students rated 25 cases with both forms. The itemby-item inter-rater and overall reliability were estimated with Gwet’s agreement coefficient (AC2) and intraclass correlation coefficient (ICC), respectively. The association between clinical decisions and the scores was analysed with the Generalised Estimating Equation. The inter-rater reliability of DPI was generally very good (AC2 = 0.81–1.00), except context (good; AC2 = 0.718; 95% confidence interval [CI] = 0.575–0.861). The inter-rater reliability of AAECDA was generally very good (AC2 = 0.81–1.00) and good (AC2 = 0.61–0.80), except the radiographic appearance of the canal(s) (fair; AC2 = 0.424, 95% CI = 0.263–0.585). Moderate overall inter-rater reliability of AAECDA (ICC = 0.53, 95% CI = 0.38–0.70) and DPI (ICC = 0.62, 95% CI = 0.48–0.77) was observed. Referral to an endodontist was positively associated with AAECDA score (odds ratio [OR] = 1.323, 95% CI = 1.145–1.52, p &lt; 0.001). The decision of tooth extraction was positively associated with the DPI score (OR = 1.983, 95% CI = 1.539–2.555; p &lt; 0.001). In conclusion, DPI and AAECDA are methods with moderate inter-rater reliability when used among dental students.

Intentional Replantation to Seal Apical and Lateral Canals in A Failed Endodontically Treated Tooth: A Case Report

Intentional replantation (IR) is often viewed as a last-resort intervention for failed endodontically treated teeth. This case report presents the successful management of symptomatic apical and lateral lesions through IR, highlighting its potential as an effective solution for challenging endodontic cases. A 45-year-old female patient presented with persistent pain and recurrent labial swelling in the vicinity of her left anterior tooth. Cone-beam computed tomography revealed endodontic lesions at both the apical and mesial aspects of tooth #21, leading to a diagnosis of symptomatic apical periodontitis. The IR procedure involved meticulous preparation and sealing of both apical and lateral canals with calcium-enriched mixture cement. One-year post-treatment, the patient remained asymptomatic, with clinical and radiographic assessments demonstrating a favorable prognosis and evidence of bone healing. This case demonstrates the successful management of symptomatic apical and lateral lesions through IR, offering an effective solution for challenging endodontic cases.

Molecular Identification of Candida albicans in Endodontic Retreatment Cases by SYBR Green I Real-time Polymerase Chain Reaction and its Association with Endodontic Symptoms.

Recent microbiological studies have expressed ever-increasing concerns about Candida albicans as a causal factor in the failure of endodontic treatments. Real-time quantitative polymerase chain reaction (qPCR), including the SYBR Green I system, is a technique in which a fluorescent dye is incorporated into the double-stranded DNA that is produced during DNA polymerase activity. This study aimed to determine the relative prevalence of Candida albicans in root canals of retreatment cases and its association with endodontic symptoms. In the present cross-sectional/analytical study fifty subjects were selected. Clinical features and radiographic status of the teeth were also evaluated. After access cavity preparation, the retrieved material and dentinal chips removed from the root canal were transferred into 1.5-mL microtubes, followed by storage at -20ºC until used for DNA extraction. A DNeasy Tissue Kit was used to extract DNA using the DNeasy protocol for animal tissues. Master Plus SYBR Green I (Jena Bioscience, Germany) was used in a Rotor-gene Real-time PCR System for real-time PCR. The relationship between the presence of Candida albicans and the clinical and radiographic features were analyzed using McNemar's test. There was a significant relationship between the radiographic findings in endodontically treated teeth and the presence of Candida albicans. However, there was no significant relationship between the presence of Candida albicans and any of the clinical symptoms. In spite of the limitations of this study, we concluded that Candida albicans was associated with root canal infections in endodontic retreatment cases, but there was no relationship between root canal infections and the clinical symptoms.

Comparison of the Physical Properties of Three Resin-Based Root Canal Sealers: An In-Vitro Study.

Objectives: This in-vitro study aimed to evaluate the physical properties of three resin-based root canal sealers, including BETA-RCS, AH26, and Adseal. Materials and Methods: Flowability, film-thickness, solubility, and radiopacity of BETA-RCS, AH26, and Adseal sealers were evaluated according to ISO 6876/2012 specifications. Three samples of each sealer were used to test each of the properties. Results: The results revealed that the flow rate (mm) of BETA-RCS, Adseal, and AH26 were 23.06±1.58, 22.5±4.23, and 21.85±1.71, respectively. Film-thickness values (µm) for BETA-RCS, Adseal, and AH26 sealers were 52.33±2.51, 18.66±0.57, and 52±2, respectively. No significant difference was observed regarding film-thickness between AH26 and BETA-RCS (P>0.05), while Adseal showed significantly lower film-thickness (P˂0.05). The highest and lowest solubility were related to BETA-RCS and Adseal, respectively. However, all sealers had acceptable solubility and radiopacity. Conclusion: The findings of the current study suggested that all three root canal sealers including BETA-RCS, AH26, and Adseal had similar properties based on ISO 6876 standard criteria. As such, they could be viable choices for facilitating effective root canal procedures. Further long-term clinical studies are warranted to assess their performance and success rates in actual endodontic cases.

Dynamic Navigation System vs. Free-Hand Approach in Microsurgical and Non-Surgical Endodontics: A Systematic Review and Meta-Analysis of Experimental Studies.

(1) Background: A Dynamic Navigation System (DNS) is an innovative tool that facilitates the management of complex endodontic cases. Despite the number of advantages and limitations of this approach, there is no evidence-based information about its efficiency in comparison with that of the traditional method in endodontics. (2) Objectives: We aimed to explore any beneficial effects of the DNS and compare the outcomes of DNS vs. free-hand (FH) approaches for non-surgical and microsurgical endodontics. (3) Methods: A literature search was conducted in August 2023 to identify randomized, experimental, non-surgical, and microsurgical endodontic studies that compared the DNS with FH approaches. The procedural time (ΔT, s), substance loss (ΔV, mm3), angular deviation (ΔAD, °), coronal/platform linear deviation (ΔLD_C, mm), and apical linear deviation (ΔLD_A, mm) were recorded and analyzed. Quality and risk of bias assessments were conducted according to the Quality Assessment Tool For In Vitro Studies. A meta-analysis was performed using mean difference and standard deviation for each outcome, and heterogeneity (I2) was estimated. p < 0.05 was considered significant. (4) Results: One-hundred and forty-six studies were identified following duplicate removal, and nine were included in the systematic review and meta-analysis. The overall risk of bias was classified as low. The DNS was found to be more accurate and efficient than the FH approach was, resulting in a significantly shorter operation time (p < 0.00001) and less angular (p ≤ 0.0001) and linear deviation (p ≤ 0.01). For substance loss, the advantage of the DNS was significant only for microsurgery (p = 0.65, and p < 0.005, for non-surgical and microsurgical procedures, respectively). A reduced risk of iatrogenic failure using the DNS was observed for both expert and novice operators. (5) Conclusions: The DNS appears beneficial for non-surgical and microsurgical endodontics, regardless of the operator's experience. However, appropriate training and experience are necessary to access the full advantages offered by the DNS.