Endodontic Treatment Research Articles

Antimicrobial efficacy of alternative root canal disinfection strategies: An evaluation on multiple working models.

Researching disinfection strategies is pivotal because effectively eliminating bacteria and their byproducts during root canal treatment (RCT) remains a challenge. This study investigated the antimicrobial efficacy of natural antimicrobial compounds, propolis (PRO) and copaiba oil-resin (COR), compared to conventional agents in Endodontics. Antimicrobials were tested against endodontic pathogens via macrodilution with standardized inoculums to determine the minimum inhibitory concentration (MIC) and the minimum bactericidal concentration (MBC). Biofilm killing efficacy were performed using two dual-species biofilms: Enterococcus faecalis (ATCC 29212) and Streptococcus mutans (ATCC 20523) and Streptococcus oralis (J22) and Actinomyces naeslundii (T14V-J1) grown on dentine discs. At the intratubular level (dentine cylinders), dentine tubule contamination was performed with E. faecalis and S. mutans. The specimens were exposed to antimicrobials to simulate their use at different sets of RCT and bacterial viability was quantified using Live/Dead staining via confocal laser scanning microscopy (CLSM). Biofilm characteristics and immediate removal of S. oralis and A. naeslundii biofilm model were evaluated employing optical coherence tomography (OCT) and CFU/mL counting. Statistical tests were applied according to data distribution for each analysis (α=0.05). Macrodilutions showed different effects against endodontic pathogens. Direct contact and intratubular analysis showed that PRO and COR promoted disinfection like conventional agents (p > 0.05). According to OCT analysis, PRO and COR showed similar biofilm reduction after immediate contact (p < 0.05). CFU/mL counting showed decontamination (p < 0.05) after using natural and conventional agents. PRO and COR showed antimicrobial effects, indicating their suitability as complementary approaches in RCT to eliminate as much microbial load as possible.

Imaging Findings, Complications, and Mimics after Common and Advanced Dental Procedures.

Various new dental treatment methods have been introduced in dental clinics, and many new materials have been used in recent years for dental treatments. Dentistry is divided into several specialties, each offering unique treatments, such as endodontics, implantology, oral surgery, and orthodontics. CT and MR images after dental treatment reveal a variety of hard- and soft-tissue changes and dental materials, which often cause image artifacts. Familiarity with posttreatment changes and dental materials is crucial to avoid misinterpretation of image artifacts as true pathologic features, identify complications, and evaluate for recurrent disease. It also is necessary to be aware of conditions that mimic posttreatment changes and know how to differentiate them at imaging. The authors focus on the imaging of expected and unexpected post-dental treatment changes and characteristics of dental materials on CT and MR images in the head and neck region. The article is divided into five sections: (a) imaging after dental implant treatment, (b) imaging after oral surgery, (c) imaging after endodontic treatment, (d) imaging after orthodontic treatment, and (e) imaging effects of dental treatments. Strategies are provided for distinguishing true pathologic features from posttreatment changes, and the importance of understanding dental procedures, the materials used, and their appearances at radiologic imaging is highlighted. Ultimately, this knowledge can enhance radiologists' ability to interpret complex posttreatment imaging findings, improve diagnostic accuracy, and facilitate effective treatment planning for patients with a history of dental procedures. ©RSNA, 2025 Supplemental material is available for this article.

A novel AI model for detecting periapical lesion on CBCT: CBCT-SAM.

Periapical lesions are not always evident on radiographic scans. Sometimes, asymptomatic or initial periapical lesions on cone-beam computed tomography (CBCT) could be missed by inexperienced dentists, especially when the scan has a large field of view and is not for endodontic treatment purposes. Previously, numerous algorithms have been introduced to assist radiographic assessment and diagnosis in the field of endodontics. This study aims to investigate the efficacy of CBCT-SAM, a new artificial intelligence (AI) model, in identifying periapical lesions on CBCT. Model training and validation in this study was performed using 185 CBCT scans with confirmed periapical lesions. Manual segmentation labels were prepared by a trained operator and validated by a maxillofacial radiologist. The diagnostic and segmentation performances of four AI models were evaluated and compared: CBCT-SAM, CBCT-SAM without progressive Prediction Refinement Module (PPR), and two previously developed models: Modified U-Net and PAL-Net. Accuracy was used to evaluated the diagnostic performance of the models, and accuracy, sensitivity, specificity, precision and Dice Similarity Coefficient (DSC) were used to evaluate the models' segmentation performance. CBCT-SAM achieved an average diagnostic accuracy of 98.92% ± 010.37% and an average segmentation accuracy of 99.65% ± 0.66%. The average sensitivity, specificity, precision and DSC were 72.36 ± 21.61%, 99.87% ± 0.11%, 0.73 ± 0.21 and 0.70 ± 0.19. CBCT-SAM and PAL-Net performed significantly better than Modified U-Net in segmentation accuracy (p = 0.023, p = 0.041), sensitivity (p = 0.000, p = 0.002), and DSC (p= 0.001, p= 0.004). There is no significant difference between CBCT-SAM, CBCT-SAM without PPR and PAL-Net. However, with PPR incorporated into the model, CBCT-SAM slightly surpassed PAL-Net in the diagnostic and segmentation tasks. CBCT-SAM is capable of providing expert-level assistance in the identification of periapical lesions on CBCT. The application of artificial intelligence could increase dentists' chairside diagnostic accuracy and efficiency. By assisting radiographic assessment, such as periapical lesions on CBCT, it helps reduce the chance of missed diagnosis by human errors and facilitates early detection and treatment of dental pathologies at the early stage.

Evaluation of the efficiency of smear layer removal during endodontic treatment using scanning electron microscopy: an in vitro study

BackgroundThe smear layer formed during root canal instrumentation negatively affects root canal irrigation activity, which in turn can affect the treatment prognosis of endodontic treatment.AimThe aim of this study is to compare the efficiency of smear layer and debris removal in root canals using different irrigation protocols using scanning electron microscopy (SEM).Materials and methodsThe quality of smear layer removal throughout the root canal was assessed in 30 intact extracted teeth divided into 3 groups according to the irrigation protocol: Group 1: 3% sodium hypochlorite (NaOCL) alternately with 17% ethylenediaminetetraacetic acetate (EDTA) was used. Group 2: 3% NaOCL alternately with 9% etidronate solution diluted with distilled water and Group 3: 9% etidronate solution diluted in 3% NaOCL. The quality of smear layer removal was assessed using scanning electron microscopy (SEM). The nonparametric Mann-Whitney test was used to compare the protocols of irrigations.ResultsThe study showed significant differences in the quality of smear layer removal in the apical part of the root canal. The best results were obtained in the groups using 9% etidronate and 9% etidronate solution diluted in 3% sodium hypochlorite. Conducting a comparative evaluation of the effectiveness of removing the smear layer using 3% NaOCL + 17% EDTA, 3% NaOCL + 9% etidronic acid diluted with distilled water, 3% NaOCL + 9% etidronic acid diluted with 3% hypochlorite showed greater effectiveness of protocols using etidronate. When comparing statistical data, protocols using etidronate were 4 times more effective than EDTA.ConclusionThe smear layer formed during mechanical treatment of the root canal was better removed during irrigation with etidronate solution.

Case Study of a Broken Instrument in a Primary Tooth and Literature Review

Background: Root canal treatment is an important element of dental treatment, and broken instruments are one cause of endodontic treatment failure. Broken instruments are rarely reported in primary teeth because of their inherently wider and relatively straighter root canals. We describe a case of a patient with a broken instrument in a primary tooth and reviewed the literature across three databases. Case presentation: A boy aged 7 years and 2 months was referred to our hospital because of pain persisting despite multiple dental treatments. Radiographic examination revealed a broken instrument in the maxillary right primary second molar. The patient experienced dental fear, so the treatment proceeded with the use of behavioral management and nitrous oxide, after which his pain disappeared. At the age of 9 years and 2 months, eruption of the successive permanent teeth was confirmed, and no pathological findings were observed except enamel hypoplasia. We undertook a literature review across three databases and found only two articles about broken instruments in primary teeth, neither of which described the eruption of the permanent teeth. All three cases involved primary molars. Conclusions: We removed a broken instrument from the root of a primary molar and performed root canal treatment, resulting in a good outcome for the primary molar until it was replaced with successive permanent teeth. Although rare, broken instruments in the roots of primary molars do occur, and care should be taken during root canal treatment of primary molars.

Effectiveness of Root Canal Irrigation and Dressing for the Treatment of Asymptomatic Apical Periodontitis: A Systematic Review Assessing Complementary Timeframes.

Sodium hypochlorite (NaOCl), ethylenediaminetetraacetic acid (EDTA), and calcium hydroxide (Ca(OH)2) are used in root canal treatment. However, further research is needed to assess their effectiveness at time points not considered in previous guidelines. This review complements the systematic review by Rossi-Fedele and Rödig (2023) by considering time points excluded by the latter. A search was conducted in PubMed-MEDLINE, Scopus, EMBASE, Google Scholar, and repositories between March and May 2024. Four studies met the inclusion criteria, providing data from 212 teeth for irrigation and 108 for dressings. No significant differences in pain reduction within 7 days or radiographic reduction of apical lesion size were found between 2% chlorhexidine, 5.25% NaOCl, EDTA, and various NaOCl concentrations. Single and multiple visit protocols also showed no significant differences in postoperative pain.Two studies had a 'low risk' of bias and two 'some concerns'. Evidence suggests that Ca(OH)2 dressings may not offer additional benefits.

Patterns and Practices in the Use of Endodontic Materials: Insights from Romanian Dental Practices

The success of endodontic treatment depends on the correct use of materials during the cleaning and filling of the root canal system. The field of endodontics is constantly evolving with the introduction of new procedures and materials. Despite the continuous development of a wide range of chemical solutions and the introduction of new materials in endodontics, driven by the advances in state-of-the-art technologies, there is still a lack of data on how these advances are adapted to the daily practice of Romanian dentists in this field. The aim of this cross-sectional questionnaire-based study was the evaluation of current trends in endodontic practice, focusing on the materials used by dentists throughout Romania, performed by a number of dentists who graduated from universities in the Northern, Southern, Eastern, Western, and Central zones of Romania. The questions were about the irrigants used, the interim medication, the type of sealant, the filling technique, and the number of endodontic treatment sessions. The majority of participants in the research were general practitioners and endodontists, with some dentists of different specialties performing endodontic treatments in their practices. Statistical analyses were performed using DATAtab version 2024 software. The results obtained from this study provide a valuable resource and database for researchers to access a wide range of information and an apparent trend towards high-performance endodontic materials used in Romania.

Cross-Sectional Analysis of the Challenges Faced by Undergraduate Dental Students During Root Canal Treatment (RCT) and the Oral Health-Related Quality of Life in Patients After RCT

Background and Objectives: This study examined dental students’ challenges with root canal treatment (RCT). It also assessed patients’ perceptions of oral health-related quality of life (OHRQoL). Materials and Methods: The study utilized three prevalidated questionnaires. One questionnaire was administered to dental students to assess their challenges related to various aspects of RCT. Another questionnaire was distributed to patients, comparing demographic factors such as age and gender to the tooth type, pain scores before and after RCT, and socioeconomic status. The third questionnaire focused on patients’ OHRQoL considering age, gender, tooth types, pain, and socioeconomic status using the Oral Health Impact Profile-14 scale (OHIP-14). A total of 75 dental students filled out the survey, and patient-related questionnaires were filled out by 585 patients with the following demographics: age: young adults n = 385 (65.81%), middle-aged adults n = 200 (34.19%); gender: males n = 366 (62.56%), and females n = 219 (37.44%). Categorical data were analyzed using frequency and percentage. Chi-square tests were used for comparative analysis, and one-way ANOVA was used when more than two variables were present. A p-value of ≤0.05 was set as statistically significant. Results: Dental students perceived themselves as competent in performing RCT but faced difficulties with canal localization in middle-aged patients (p &lt; 0.01) and in communicating with female patients (p 0.009). There was a significant difference in preoperative (p 0.007) and postoperative pain levels (p 0.003) when comparing genders. Overall, there was a 30.60% reduction in pain levels. The OHIP-14 scale indicated high patient satisfaction (78.9%), with physical disability (26.16%) and psychological discomfort (23.33%) being the most affected domains. Among different variables, socioeconomic status was statistically significant, with patients of lower socioeconomic status reporting higher satisfaction levels (p 0.02). No significant differences in OHRQoL were found based on age or gender. Conclusions: The OHRQoL was high among patients treated by dental students, with those with a low socioeconomic status being the most satisfied.

Are ultrasonic tips associated with final irrigation protocols effective in removing biofilms in long oval canals and dentinal tubules?

This study investigated the associations among endodontic instruments, ultrasonic tips and various final irrigation protocols for removing intracanal and intratubular biofilms in long oval canals. One hundred mandibular premolars inoculated with Enterococcus faecalis were divided into two groups: the control group (CG: n = 10), which received no treatment; and the test groups (n = 30), which included saline (SS), sodium hypochlorite (2.5% NaOCl) and chlorhexidine (2% CHX). The samples were prepared with Reciproc® Blue 25/0.08, Flatsonic, Clearsonic and Reciproc Blue 40/0.06. Each test group was divided into three subgroups (n = 10): conventional irrigation (CI) with syringes and needles, passive ultrasonic irrigation (PUI) and continuous ultrasonic irrigation (CUI) with an Irrisonic tip. The root canals were examined using confocal laser scanning microscopy. Mann‒Whitney and Kruskal‒Wallis tests followed by Dunn post hoc tests (p < 0.05) were used for statistical analysis. NaOCl and CHX were effective for intracanal and intratubular decontamination. Saline showed significant decontamination in the intratubular areas when CUI was used. The CI method was the least effective for intracanal decontamination. The use of Flatsonic and Clearsonic ultrasonic tips is promising for root canal disinfection. The disinfection techniques in endodontic treatment focus on the removal of biofilms from long oval canals, which is crucial for effective cleaning during root canal procedures.

Postoperative pain in primary root canal treatments after Er: YAG laser-activated irrigation: a systematic review and meta-analysis.

This systematic review aimed to compare postoperative pain in endodontic treatments using PIPS Er: YAG laser-activated irrigation (LAI) versus conventional needle irrigation. An electronic search was conducted to identify randomized clinical trials (RCT) investigating postoperative pain in patients who underwent root canal treatments in permanent teeth using PIPS Er: YAG laser-activated irrigation or conventional needle irrigation. Two reviewers performed study selection, data extraction, risk of bias assessment (RoB 2.0 tool), and the certainty of evidence (GRADE). The meta-analyses were conducted using Review Manager software (p ≤ 0.05). The mean difference (MD) was chosen as the effect measure, and a random-effect model was employed, along with a 95% confidence interval (CI). The search identified 2864 records, and after selecting, three RCTs were included in the quantitative analysis. The meta-analysis showed a difference in postoperative pain according to the evaluation time. The subgroup meta-analysis revealed that the PIPS Er:YAG showed a significant reduction in the postoperative pain in the 48 hours (MD = -0.78; 95% CI [-1.39, -0.17]; p = 0.01; I² = 69%) compared to the control group. However, no statiscally significant results were found when assessing postoperative pain after 1, 3 and 7 days (95% CI; p > 0.05). The PIPS Er: YAG laser-activated irrigation reduced postoperative pain at 2 days following primary endodontic treatment. However, the certainty of the evidence is low and further RCTs are needed to confirm these results and avoid bias and confounding factors. Registration: PROSPERO registration number: CRD42023432499.

Evaluating the risk of extrusion with laser-activated irrigation techniques in root canal systems: a cadaver-based study.

The objective of this study is to evaluate the incidence and volume of contrast medium extrusion when activated with a laser and to compare these outcomes with those of other irrigation techniques. Sixteen cadaver mandibles containing 116 single-rooted teeth were prepared using conventional rotary instrumentation. The teeth were randomly assigned to four irrigation groups: side-vented needle, sonic irrigation, laser activation at the orifice, and laser activation at the middle third of the canal. Gastrografin, an iodinated contrast medium, was used to simulate irrigants. Cone Beam Computed Tomography (CBCT) scans were obtained pre- and post-irrigation to assess the incidence and volume of extrusion. Two blinded observers evaluated the images for the presence or absence of extrusion. Data were statistically analyzed using ANOVA and chi-square tests. The observers reached a consensus on 116 out of 116 cases, resulting in a percent agreement of 100%. None of the experimental groups, side-vented needle (n = 29), sonic irrigation (n = 29), laser activation at the orifice (n = 29), and laser activation in the middle third (n = 29), demonstrated any radiographic evidence of extrusion. This cadaver-based model, combined with CBCT, provides a clinically relevant assessment of irrigant behavior during endodontic treatment. While the findings from this study suggest that LAI at the orifice or in the middle third of the canal may be a safe method for enhancing irrigation in endodontics, clinicians should remain cautious regarding the potential risks of irrigant extrusion.

Evaluation of stress patterns in teeth with endodontic treatment and periapical lesions as abutments for fixed prosthesis: a finite element analysis study

BackgroundExamining stress distributions in abutment teeth with periapical lesions is essential for understanding their biomechanical impact on dental structures and tissues. This study uses finite element analysis (FEA) to evaluate these stress patterns under occlusal forces, aiming to enhance treatment strategies and prosthetic designs.MethodsThree FEA models were created: a healthy mandibular premolar (Model 1), a premolar with a single crown and a lesion repaired using a fiber-post (Model 2), and 3) a premolar with a lesion repaired using fiber-post to support a four-member bridge (Model 3). A 300 N occlusal static stress was given to each model at a 45° angle to the long axis of the tooth, namely at the lingual inclination of the buccal-cusp. Deformation behaviour and maximum equivalent stress distributions were simulated on the all components, including the bony structure for each model.ResultsThe study showed a reduction in equivalent stress levels in trabecular and cortical bone, crown, cementum, and PDL under occlusal force, from Model 1 to Model 3. The Von Mises yield criteria values of the tooth models differed depending on the prosthetic restorations, with the highest value seen in Model 2 (133.87 MPa). Similar locations in all models showed concentrated equivalent stresses for all components. The periapical lesion area exhibited relatively low stress values for Models 2 and 3, at 0.061 MPa and 0.039 MPa, respectively. The largest level of stress was seen in the cervicobuccal areas of the tooth in all models.ConclusionProsthetic restorations on teeth with periapical lesions resulted in varying stress and biomechanical responses in the tooth and surrounding bone tissue. These teeth can serve as abutments in a four-unit bridge when subjected to optimal occlusal stresses, based on the findings.

Prevalence of molar incisor hypomineralization and demands for treatment according to the severity of its clinical manifestation.

Assess the prevalence and severity of molar incisor hypomineralization (MIH) in children 6- to 12-year-old and correlate MIH severity with the complexity of treatment demands. Between March and October 2023, 2,136 children were screened for MIH by two calibrated examiners. MIH severity was categorized in mild, moderate, severe, and very severe. Treatment requirements were categorized in basic, intermediate, and complex. The prevalence of MIH was 15.5% (n = 331), 158 (47.7%) mild/moderate and 173 (52.3%) severe/very severe. Among the 126 children with atypical caries/restoration, cusp involvement was observed in 60.3%, endodontic treatment was necessary in 24.6%, only 15% needed restorations limited to two tooth surfaces with no cusp involvement. Extraction due to MIH was observed in 2.7%. The prevalence of MIH was in accordance with previous literature. Whenever a restorative treatment was necessary, it often involved multiple tooth surfaces and cusps. The complexity of treatment demands increased with age. It is necessary that oral health policymakers pay special attention to children with MIH to ensure appropriate treatment. MIH represents a challenge, especially severe cases with enamel post-eruptive breakdown and caries, requiring extensive restorations. MIH prevalence was assessed in a considerable large sample and the correlation between MIH severity and the complexity of treatment demands was analyzed. More than half of children exhibiting atypical caries/restorations required complex restorative treatment, involving multiple tooth surfaces and cusps. The manuscript prompts a reflection on the importance of evaluating whether the restoration will extend to cusp areas before determining the appropriate technique and material for treatment.

Clinically oriented automatic three-dimensional enamel segmentation via deep learning

BackgroundEstablishing accurate, reliable, and convenient methods for enamel segmentation and analysis is crucial for effectively planning endodontic, orthodontic, and restorative treatments, as well as exploring the evolutionary patterns of mammals. However, no mature, non-destructive method currently exists in clinical dentistry to quickly, accurately, and comprehensively assess the integrity and thickness of enamel chair-side. This study aims to develop a deep learning work, 2.5D Attention U-Net, trained on small sample datasets, for the automatical, efficient, and accurate segmentation of enamel across all teeth in clinical settings.MethodsWe propose a fully automated computer-aided enamel segmentation model based on an instance segmentation network, 2.5D Attention U-Net. After data annotation and augmentation, the model is trained using manually annotated segmented enamel data, and its performance is evaluated using the Dice similarity coefficient metrics. A satisfactory image segmentation model is applied to generate a 3D enamel model for each tooth and to calculate the thickness value of individual enclosed 3D enamel meshes using a normal ray-tracing directional method.ResultsThe model achieves the Dice score on the enamel segmentation task of 96.6%. This study provides an intuitive visualization of irregular enamel morphology and a quantitative analysis of three-dimensional enamel thickness variations. The results indicate that enamel is thickest at the incisal edges of anterior teeth and the cusps of posterior teeth, thinning towards the roots. For posterior teeth, the enamel is thinnest at the central fossae area, with mandibular molars having thicker enamel in the central fossae compared to maxillary molars. The average enamel thickness of maxillary incisors, canines, and premolars is greater than that of mandibular incisors, while the opposite is true for molars. Although there are individual variations in enamel thickness, the average enamel thickness graduallly increases from the incisors to the molars among all teeth within the same quadrant.ConclusionsThis study introduces an automatic, efficient, and accurate 2.5D Attention U-Net system to enhance precise and efficient chair-side diagnosis and treatment of enamel-related diseases in clinical settings, marking a significant advancement in automated diagnostics for enamel-related conditions.

Synthesis, characterization, and application of methylene blue functionalized reduced graphene oxide for photodynamic therapy in root canal treatment

Synthesis, characterization, and application of methylene blue functionalized reduced graphene oxide for photodynamic therapy in root canal treatment

Major clinical outcomes of the endodontic infections and gut microbiota axis: a systematic review

Introduction: Endodontic therapy aims to shape, clean, and disinfect the root canal, and is performed by removing all pulp tissue or necrotic remains and microorganisms present in the root canal system. The gut microbiota or specific microbial metabolites not only locally influence the host's inflammatory responses, nutritional intake, or intestinal barrier function, but are also related to the immune and metabolic systems. In addition to antimicrobial activity, calcium hydroxide has properties such as dissolution of organic remnants, anti-inflammatory action, inhibition of inflammatory resorptions, and physical barrier function. Objective: To present the main considerations and clinical outcomes of the relationship between gut microbiota and endodontic infections and highlight endodontic treatment with calcium hydroxide, showing the mechanisms of antibacterial action. Methods: The PRISMA Platform systematic review rules were followed. The search was conducted from September to October 2024 in the Scopus, PubMed, Science Direct, Scielo, and Google Scholar databases. The quality of the studies was based on the GRADE instrument and the risk of bias was analyzed according to the Cochrane instrument. Results and Conclusion: 102 articles were found, 25 were evaluated in full and 09 were included and developed in the present systematic review study. Considering the Cochrane tool for risk of bias, the overall assessment resulted in 35 studies with a high risk of bias and 22 studies that did not meet GRADE and AMSTAR-2. Most studies did not show homogeneity in their results, with X2=79.2%&lt;50%. It was concluded that, in the setting of endodontic therapy, the presence of microorganisms, particularly gramnegative anaerobes, in the root canal system and cementum resorption gaps after root canal treatment is considered one of the main causes of persistent periapical lesions and, therefore, of endodontic treatment failure. The gut microbiota or specific microbial metabolites not only locally influence the patient's inflammatory responses, nutritional intake, or intestinal barrier function, but are also related to the immune and metabolic systems. The change in the microbiota of the oral-gut axis and its interactions with Helicobacter pylori may be potential targets for the diagnosis and infectious treatment of Helicobacter pylori. Calcium hydroxide in endodontics is the most widely used medication to combat pathology-causing bacteria, but when used alone it may not be able to eliminate these microorganisms. The combination of other medications incorporated into calcium hydroxide contributes to positive results with the elimination of more resistant bacteria.

The efficiency of single-session photobiomodulation on healing of periapical bone lesions using CBCT: a randomized clinical trial

As photobiomodulation is growing in the dental field the aim of this prospective, two-arm clinical trial was to assess the radiographic changes for chronic periapical bone lesions related to mandibular molars after primary root canal therapy with or without applying Diode laser on soft tissue. The samples were randomly divided into a Laser group and a mock laser (ML) group. Preoperative CBCT images were compared 12 months later with postoperative CBCT to gauge the changes in the volume of the bony lesion by two observers. The kappa coefficient was calculated to assess the intra-observer agreement. Data were presented as median, mean, and standard deviation (SD) values. For parametric data (age), a Student’s t-test was used. Qualitative data (Gender) was presented as frequencies and percentages and then analyzed by Chi-square test. The Wilcoxon signed-rank test was used to compare CBCT measurements pre- and post-treatment. The significance level was set at P ≤ 0.05. The collected data in this study showed that there was no statistically significant difference between median volumes of the periapical lesion in the Laser and ML groups (P-value = 0.564, Effect size = 0.237) and (P-value = 0.452, Effect size = 0.310), respectively while, there was a statistically significant decrease in the volume of periapical lesion post-treatment within each group (P-value < 0.001). The size of the periapical bony lesion decreased significantly after conventional endodontic treatment whether Laser was applied or not. The study protocol was enrolled as NCT04311905 at www.clinicaltrials.gov database on (17/03/2020) after the approval of the Ethics Committee, Faculty of Dentistry, Ain Shams University (FDASURecID091703).

Effectiveness of simvastatin with antibiotics compared to other material on clinical and radiographic outcomes following non-surgical endodontic treatment

Postoperative endodontics complications can influence the patient's quality of life. One method of lesion sterilization and tissue repair (LSTR) therapy combines simvastatin with metronidazole, ciprofloxacin, and minocycline, which are used for primary teeth. This review assesses the clinical and radiographic effects of combining simvastatin with antibiotics compared with other materials on pediatric patients. The study protocol was registered on the International Prospective Register of Systematic Reviews with registration number CRD42024552895. The following electronic databases were utilized to search Randomized Clinical Trials (RCTs): MEDLINE(PubMed), Cochrane Central Register of Controlled Trials (CENTRAL), Web of Science, Scopus, Embase, and OVID up to and including July 2024. The Cochrane Risk of Bias tool was used to evaluate the potential for bias in randomized clinical studies. In the initial search through electronic databases and registers, 1368,764 studies were found, and 8 RCTs met the eligibility criteria. Six out of 8 studies showed that combining simvastatin with antibiotics was effective clinically and radiographically following non-surgical endodontic treatment compared to other treatment modalities. This review suggests that combining simvastatin with antibiotics may be effective clinically and radiographically following non-surgical endodontic treatment. However, further studies are needed to confirm the potential of that combination in non-surgical endodontic management.

Fracture resistance of endodontically treated teeth restored with CAD-CAM milled and prefabricated post-and-core systems.

To compare the effect of post-and-core material type and production technique on the fracture resistance of teeth. Sixty human maxillary central incisors were used for the study. Root canal treatments were performed, and the post cavities were created. The teeth were divided into six groups (n = 10) according to post material and production method: prefabricated glass-fiber post (PF), zirconia post (PZ), titanium post (PT), and CAD-CAM produced glass-fiber post (CF), zirconia post (CZ), titanium post (CT). All post-and-core restorations were luted with resin cement (RelyX U200). Static loading was applied on the luted metal copings using a universal testing machine to measure fracture resistance. The effect of material and production method on fracture resistance was evaluated with two-way ANOVA test. Tukey HSD test was used in post hoc analyses. Significance was evaluated at p < 0.05 level. In the CAD-CAM post-and-cores, the fracture resistance of zirconia was significantly higher (809 N) than titanium (569 N) and glass-fiber (342 N). In the prefabricated posts, the fracture resistance of zirconia was significantly higher than glass-fiber (445 N), while there was no significant difference between zirconia (605 N) and titanium (538 N) materials. Zirconia posts demonstrated the highest and CAD-CAM glass-fiber posts demonstrated the lowest fracture resistance compared to other types of post materials. Additional studies are needed to confirm if CAD-CAM glass-fiber posts may be considered an effective alternative treatment.

Clinical Anatomy of the Maxilla

The upper jaw is the most important structure of the middle third of the face. It is of great functional and aesthetic importance, and is also a clinically critical area in which a variety of surgical interventions are performed, such as the installation of dental implants, cyst removal, and endodontic dental treatment. To avoid iatrogenic complications of these manipulations (bleeding and/or neurological disorders), detailed knowledge of maxillary anatomy is required. This review, based on modern literature data and our own observations, outlines the clinical anatomy of the upper jaw with a description of the features of its morphology, identified using cone beam computed tomography, a modern technology for visualizing the bone structures of the maxillofacial region used in clinical practice. A description of a number of structures, such as the accessory infraorbital foramina, canalis sinuosus, alveolo-antral artery, nasopalatine (incisive) canal and maxillary sinus septa, is absent in human anatomy textbooks for students and is not detailed in Russian-language medical journals. The article presents radiographic images of these structures, their linear dimensions, frequency of occurrence in the population, and provides classifications of individual variants of intraosseous canals. The practical significance of each of these anatomical variations is discussed. All images used in the article are original and have not been published previously.