Failure Of Endodontic Treatment Research Articles

Micro-CT and histological examination of accessory canals in 34 equine cheek teeth.

Accessory canals and apical deltas have been extensively studied in human dentistry. Their clinical role as a difficult to clean reservoir for bacteria during endodontic treatments has been well described. Many papers describe in detail the pulp anatomy of equine dentition but little attention has been given to their apical ramifications. The goal of this paper is to describe the presence and anatomy of these accessory canals and apical deltas in healthy equine cheek teeth and discuss their possible relevance in the light of equine endodontics. To accomplish this, 15 maxillary and 19 mandibular healthy cheek teeth were collected ranging from Triadan 06 s to 11 s with eruption ages from 4 to 9 years. Their root anatomy was documented in detail based on micro computed tomography images. A subset of 3 teeth also underwent histological examination. Accessory canals were found in all but two teeth examined. Up to 44 accessory canals per tooth have been found with locations ranging from the root furcation down to the apex of the root and with highly variable diameters. Apical deltas in different stages of development were found in 84% of the roots. The presence of accessory canals identified on microCT images could be confirmed using histological examination although some of them were obliterated by reparative dentin. Accessory canals can be found in most equine cheek teeth and add complexity to their endodontic anatomy. This could have important implications for their treatment in case of pulp pathology. In humans, failure to remove bacterial biofilm from such canals has been associated with failure of endodontic treatment. Research on diseased equine teeth is required to gain a better understanding of their clinical relevance in horses.

Predicting early endodontic treatment failure following primary root canal treatment

BackgroundUnderstanding when and why endodontic treatments fail could help clinicians make prognoses and thus improve treatment outcomes. This study was aimed to assess potential predictors of early endodontic treatment failure. We explored factors contributing to the failure of initial root canal treatment were explored, with a specific emphasis on evaluating the influence of the time elapsed since the initial treatment.MethodsThis retrospective cohort study enrolled 1262 patients who sought endodontic treatment at our department and 175 patients were included for analysis. Potential causes of endodontic treatment failure were investigated, such as inadequate obturation quality, inadequate coronal status, the presence of additional untreated canals, anatomical complexity, instrument separation, iatrogenic perforation, cracks, and endodontic-periodontal lesions. The patients were divided into “short-term” and “long-term” groups depending on the time that had passed since the initial treatment (i.e., < 5 and > 10 years, respectively). The causes of failure in the short-term and long-term group were analyzed and compared using logistic regression analyses. Subgroup analysis was performed according to the number of years since the initial treatment in the short-term group to further investigate the association between the time and cause of failure (i.e., < 1, 2, 3, and 4 years, respectively).ResultsUntreated additional canals were present in 21.7% of all cases, and in 36.9 and 6.4% of cases in the short-term and long-term groups, respectively. Multivariable analysis showed that the presence of untreated additional canals was significantly associated with short-term compared to long-term failure. Untreated additional canals were also associated with endodontic failure within 1, 2, 3, and 4 years.ConclusionsThe presence of untreated additional canals was a predictor of endodontic failure within 5 years following initial root canal treatment. To optimize long-term prognosis, it is important to detect and treat all root canals during the initial treatment.

ISOLATION AND IDENTIFICATION OF BIOFILM PRODUCING ENTEROCOCCUS FAECALIS FROM ROOT CANAL

This study was aimed to one of the most prevalent causes for endodontic treatment failure is the presence of Enterococcus faecalis bacterium within teeth root canals. To achieve successful treatment, it is so important to study E. faecalis behavior. The aim of study was to investigate biofilm production and antibiotic sensitivity of E. faecalis isolated from root canals. Results showed isolation of E. feacalis (65%) of samples, identified by specific gene by PCR technique. Most isolates were sensitive to Imipenem and resistant to Erythromycin, Clindamycin, Tetracycline and Trimethoprim. Strong biofilm production was detected among 29.5% of highest antibiotic resistant isolates. The results may indicate that infected root canals with E. feacalis may lead to serious complication for patients.

Photodynamic Therapy With Resveratrol and an Nd:YAG Laser for Enterococcus faecalis Elimination.

Enterococcus faecalis is the leading cause of endodontic treatment failures. Despite various conventional disinfection approaches, microorganisms often persist in root canals. Photodynamic therapy (PDT) is an adjunct antimicrobial strategy employing a nontoxic photosensitizer (PS) and light source. This study evaluated the antimicrobial effect of PDT using an Nd:YAG laser and resveratrol (RSV) with or without pigment, and confirmed that RSV is nontoxic as a PS. We employed laser irradiation at a 3W output power, using RSV and red pigment as the PS, on an E. faecalis bacterial solution. Subsequently, colony-forming units were quantified. The impact of RSV on osteoblasts was measured using an MTT assay. E. faecalis counts declined after laser irradiation. The combined application of laser irradiation with RSV, red pigment, or both showed a reduction compared to no irradiation and control groups without RSV and red pigment. The 50% cytotoxic concentration against osteoblast cells from mice incubated with RSV for 48 h was 162 μM. The value with RSV and laser was 201 μM and that with RSV and red pigment was 199 μM. The value with RSV, laser and red pigment was 357 μM. The combination of Nd:YAG laser irradiation and RSV as the PS with pigment was efficacious for E. faecalis elimination without inducing any toxic effects on osteoblasts. This combination holds potential as a root canal irrigation strategy.

Antibacterial Potency of Prabumulih’s Pineapple Leaves Extract (Ananas comosus) Towards Enterococcus faecalis

Introduction: Unsuccessful elimination procedures of Gram-positive bacteria (Enterococcus faecalis) often lead to failure of endodontic treatment. It is necessary to use irrigation solutions to eliminate it from the root canal. The leaves of Pineapple (Ananas comosus) that are widely cultivated in Prabumulih have antibacterial properties due to active compounds such as bromelain enzymes, flavonoids, phenols, saponins, tannins, and alkaloids and have potential as an alternative material for root canal irrigation. Purpose: This study aimed to determine the antibacterial potency of Prabumulih pineapple leaf extract (Ananas comosus) against E. faecalis. Methods: This is an in vitro quasi-experimental laboratory study with a post-test-only control group study design. The test group consisted of Prabumulih pineapple leaf extract at concentrations of 1.56%, 3.125%, 6.25%, and 12,5% obtained using the maceration method. The positive control was NaOCl 2.5%, and distilled water was the negative control. The antibacterial activity of the extract using the disc diffusion method for the inhibition zone test, the dilution method for the minimum inhibitory concentration (MIC) test, and solid dilution for the minimum bactericidal concentration (MBC) test. Results: It showed that Prabumulih pineapple leaves extract has antibacterial potency against E. faecalis with the largest average inhibition zone at a concentration of 12.5% (2.324 mm), MIC at a concentration of 12,5%, and MBC also at a concentration of 12,5%. Conclusion: Prabumulih pineapple leaf extract has antibacterial potency against Enterococcus faecalis.

Exploring the impact of oral bacteria remnants on stem cells from the Apical papilla: mineralization potential and inflammatory response.

Bacterial persistence is considered one of the main causal factors for regenerative endodontic treatment (RET) failure in immature permanent teeth. This interference is claimed to be caused by the interaction of bacteria that reside in the root canal with the stem cells that are one of the essentials for RET. The aim of the study was to investigate whether prolonged exposure of stem cells from the apical papilla (SCAP) to bacterial remnants of Fusobacterium nucleatum, Actinomyces gerensceriae, Slackia exigua, Enterococcus faecalis, Peptostreptococcaceae yurii, commonly found in infected traumatized root canals, and the probiotic bacteria Lactobacillus gasseri and Limosilactobacillus reuteri, can alter SCAP's inflammatory response and mineralization potential. To assess the effect of bacterial remnants on SCAP, we used UV-C-inactivated bacteria (as cell wall-associated virulence factors) and bacterial DNA. Histochemical staining using Osteoimage Mineralization Assay and Alizarin Red analysis was performed to study SCAP mineralization, while inflammatory and osteo/odontogenic-related responses of SCAPs were assessed with Multiplex ELISA. We showed that mineralization promotion was greater with UV C-inactivated bacteria compared to bacterial DNA. Immunofluorescence analysis detected that the early mineralization marker alkaline phosphatase (ALP) was increased by the level of E. coli lipopolysaccharide (LPS) positive control in the case of UV-C-inactivated bacteria; meanwhile, DNA treatment decreased the level of ALP compared to the positive control. SCAP's secretome assessed with Multiplex ELISA showed the upregulation of pro-inflammatory factors IL-6, IL-8, GM-CSF, IL-1b, neurotrophic factor BDNF, and angiogenic factor VEGF, induced by UV-C-killed bacteria. The results suggest that long term stimulation (for 21 days) of SCAP with UV-C-inactivated bacteria stimulate their mineralization and inflammatory response, while DNA influence has no such effect, which opens up new ideas about the nature of RET failure.

The Effect of Tooth Location on the Success and Failure of Endodontic Treatment: A Systematic Review

Endodontic treatment is preferred to save the inside of the tooth, which is being infected by bacteria. There are many factors that can influence the outcome of an endodontic treatment. One of the most challenging factors is the anatomy of the tooth itself on which the endodontic treatment is planned. The location and type of tooth and structure of the root canal influence the anatomy of the tooth. This study aims to determine the effect of tooth location on the success rate of an endodontic treatment from the existing literature. Eight studies were included in this review with a total sample size of 6,056 patients who underwent endodontic treatment. All studies showed the outcome of endodontic treatment in the context of tooth type. Studies were consistent with the fact that the overall success rate of endodontic treatment is higher in anterior incisors as compared to premolars and molars owing to the number of canals per tooth and the comparative operational difficulty between incisors and molars while performing an endodontic treatment. Therefore, the findings in this review suggest that tooth location is a significant factor that can influence the outcome of endodontic treatment.

Efficacy of Triple Antibiotic Paste and Bromelain Paste As Intracanal Medicament Against Enterococcus faecalis: An In-Vivo Study.

Introduction Microorganisms are pivotal contributors to pulp and periapical pathology, often culminating in endodontic treatment failures. The successful outcome of such treatment hinges on the effective eradication of microbial flora through various interventions, including intracanal medicaments (ICMs). However, Enterococcus faecalis (E. faecalis), a highly adaptive Gram-positive bacterium, exhibits remarkable resilience and can persist even after rigorous disinfection efforts. This study explores the efficacy of two ICMs, calcium hydroxide-based triple antibiotic paste (TAP) and a novel alternative containing bromelain, derived from pineapples, in combating E. faecalis infections in vivo. Methodology This in-vivo study was conducted at Sharad Pawar Dental College and Hospital, Wardha, India, and ethical approval was obtained from the institutional ethical committee. The sample size was calculated using the OpenEpi program (version 3.04.04, Open Source Epidemiologic Statistics for Public Health, www.OpenEpi.com), resulting in 15 participants per group. Inclusion criteria encompassed mandibular premolars with carious involvement but no prior restorations, diagnosed with necrotic or infected pulp, and no significant medical history. Exclusion criteria included systemic conditions, pregnancy, retreatment cases, recent antibiotic therapy, calcified canals, and other contraindications. After proper patient consent, access opening and chemomechanical preparation were performed, and root canals (RCs) were randomly divided into two groups: TAP and bromelain paste (BP). TAP was prepared using ciprofloxacin, metronidazole, and minocycline, while BP comprised bromelain powder mixed with saline. Both groups received intracanal medicaments, followed by temporary sealing. Microbiological samples were collected before and after treatment for analysis. Results E. faecalis count (CFU/mL) before instrumentation for the TAP group was (1.94 x 105[Formula: see text] 7.45 x 103) and for BP group was(1.97 x 105[Formula: see text] 7.70 x 103) with p-value 0.26[Formula: see text] p=0.05, so no significant difference was found between them.E. faecalis count (CFU/mL) after instrumentation for the TAP group was (7.70 x 103 [Formula: see text] 9.11 x 102) and for the BP group was(7.26 x 103 [Formula: see text] 8.43 x 102) with p-value 0.18 [Formula: see text] p=0.05, so no significant difference was found between them. However, the E. faecalis count obtained after seven days of intracanal medicament for the TAP group was (3.63 x 101 [Formula: see text] 5.60) and for the BP group was(3.13 x 101 [Formula: see text] 4.55) with p-value 0.012 < p=0.05, so a significant difference was found between them. This means that when compared with the TAP group, there was a greater amount of reduction in E. faecalis count (CFU/mL) for the BP group seven days after the placement of intracanal medicament, and this reduction was statistically significant. Conclusion This in-vivo study highlights the potential of BP as a more effective intracanal medicament against E. faecalis when compared to the conventional TAP. Bromelain's selectivity for Gram-positive bacteria and its diverse therapeutic properties make it a promising natural alternative for endodontic treatment. Further research is warranted to optimize bromelain's clinical application and assess its potential to enhance endodontic outcomes, potentially revolutionizing the field of endodontics.

Complications During Root Canal Shaping: A Survey Among Dentists in Morocco

Introduction: Endodontic therapy is a complex procedure that requires a high level of precision due to the intricacies of the root canal system. Despite advancements in endodontic tools and techniques, incidents such as instrument fractures, dentinal plugs, false routes, and root perforations can occur when best practice recommendations are not adhered to. These complications pose a significant public health concern as they can lead to potentially severe infectious complications and ultimately result in endodontic treatment failure. The aim of this study is to elucidate the causes of endodontic complications, particularly during the root canal shaping stage, and to identify strategies for their prevention.Materials and Methods: A cross-sectional, analytical, descriptive, and unidirectional study was conducted on a randomly selected sample of 300 private dentists in Casablanca. The questionnaires were completed anonymously, and statistical analyses were performed using SPSS software. The discussion will be enriched through a comprehensive literature search of major databases, complemented by a series of clinical cases illustrating these complications and the means by which they can be mitigated.Results: The study reveals that 91% of dentists encountered complications during endodontic therapy, with 284 dentists (94.98%) experiencing complications during root canal shaping. The most prevalent complication was instrument fracture, reported by 235 dentists (82.75%). Key contributing factors to these complications included forced file passage, non-adherence to the instrumental sequence, and absence or inadequacy of irrigation. However, these incidents can be averted by adhering to a meticulous treatment protocol and respecting the various steps critical to the success of root canal shaping.Conclusion: In conclusion, there exists a disparity between recommended best practices and the current practices in the field of endodontics, which can lead to multiple complications and subsequent endodontic treatment failures.

A IMPORTÂNCIA DA IRRIGAÇÃO ULTRASSÔNICA PASSIVA PARA O SUCESSO DO TRATAMENTO ENDODÔNTICO: revisão narrativa de literatura

The objective of this study was to highlight the advantages of Passive Ultrasonic Irrigation (PUI) in endodontic treatments, describing its techniques, execution, and effective outcomes. The research was based on a narrative literature review, with a search in national and international databases, using specific keywords. The results demonstrate that the selection of an appropriate irrigating solution is fundamental since the failure of endodontic treatment is often related to the survival of microorganisms in the root canals. The ideal irrigation should be chosen based on the specific needs of each case, considering the chemical properties of the irrigating solutions. PUI is an effective technique for activating irrigating solutions in root canals and may be more efficient in cleaning the canals than simultaneous ultrasonic instrumentation. PUI is particularly useful in curved canals, and a smooth wire can be as effective as a cutting K-file. The study also highlights the continuous evolution of dentistry and the need to invest in advanced technologies to enhance clinical outcomes. It is concluded that PUI is a promising technique that offers significant benefits for the success of endodontic treatments. Its ability to reach challenging areas and its effectiveness in disinfecting root canals emphasize the relevance of the technique in dental practice. It is expected that this knowledge will contribute to improving irrigation protocols and, consequently, the effectiveness of endodontic treatments.

Role of oral microbiota in irreversible pulpitis - Current strategies and future perspectives.

Irreversible pulpitis is an inflammation of the tooth pulp caused by an opportunity-driven invasion of the pulp space by oral microbiota typically prevalent in the oral cavity. Microbial organisms are extensively recognised to be the fundamental cause of endodontic infections and treatment failures. Previously, bacterial species responsible for these infections were largely recognised using conventional microbial culture techniques, lending credence to the widely held belief that anaerobic Gram-negative bacteria frequently enter the pulp space and trigger endodontic infections. The advent of novel technologies grants the advantage of detecting and studying microbial populations via an amalgamation of the modern "Omics" techniques and meticulous bioinformatics analysis, additionally detecting the metatranscriptome, metaproteome and metabolome along with the metagenome. Amongst these analytical strategies, metagenomic analyses are essentially pragmatic for investigating the oral microbiome. Metagenomics favor not only assessment of microbial composition in diseased conditions, but also contributes to detection of novel, potentially pathogenic species inclusive of non-viable bacteria. The present review describes current knowledge of root canal microbiome, including its composition and functional attributes, the novel strategies available for detection of microbiome as well as challenges associated and provides some crucial pointers for areas of future research.

Assessment of Digital Intraoral Periapical Radiograph for the Detection of Apical Root Resorption in Inflammatory Periapical Pathologies: A Radiovisiography Study.

Introduction Resorption often takes the form of external inflammatory root resorption. Apical periodontitis or an apical cyst is the most typical cause of external inflammatory root resorption. Failure of endodontic treatment can occur if severe apical root resorption occurs.This is due to the difficulty of reaching these sites.Apical root resorption is usually discovered during routine radiographs and is usually in its later stages. If the lesion is advanced, extraction is the only viable solution. An accurate diagnosis of incipient root resorption is essential.This research is designed to analyze the effectiveness of digital intraoral periapical radiographs in assessing apical root resorption (ARR) related to periapical pathologies. Material and methods Thiscross-sectional radiographic observational researchwas conductedin a dental college and hospital in central India. Radiovisiography (RVG) images of 190 patients' teeth with inflammatory periapical pathologies were evaluated to determine the presence or absence of resorption in the apical area of the root. After the radiographic assessment of the apical root resorption, the extraction of the affected teeth was done under all aseptic conditions. The periapical tissue was sent for histological analysis and the extracted tooth sample was examined for the presence or absence of apical root resorption. Results In comparison to apical periodontitis, the proportion of severe root resorption patients was significantly higher in abscess and periapical granuloma. Using Pearson's Chi-square test, the difference in patient proportions according to the kind of resorption in the three radiological diagnosis groups was statistically significant with a p-value of 0.0058. Conclusion It was concluded that on radiographic examination, digital intraoral periapical radiographs were found to be accurate in determining periapical apical pathologies and apical root resorption.

Antimicrobial Efficacy of Two Different Calcium Hydroxide Endodontic Dressings on the Eradication of Enterococcus faecalis in Single-Rooted Canals: An In Vitro Study.

Bacterial pulp infections are considered the most common cause of endodontic treatment failure. Enterococcus faecalis was isolated from most cases of failure of endodontic treatment. Therefore, using the appropriate intra-canal dressing is essential for successful treatment. The improved formula used in calcium hydroxide PLUS points ensures more calcium hydroxide is released over a longer period and more space to release calcium hydration. This in vitro research aimed to evaluate the differences in the efficacy between Ca(OH)2paste and PLUS points as an endodontic dressing in eradicating E. faecalis growth inside infected single-rooted canals. Thirty mandibular first premolars with single canals were extracted for orthodontic reasons and were prepared after cutting their crowns to standardize the length of the roots to 17 mm, root preparation, and isolating E. faecalis. The infected sample root canals were contaminated with the prepared bacterial suspension, and the sample was incubated in the incubator under air conditions at 37°C for seven days, counting the bacteria colonies. Then, the bacterial units were counted before applying the drug, applying Ca(OH)2 paste in the first group and Ca(OH)2 PLUS points in the second group. The bacterial units were counted, and the number of bacteria was compared between the two substances applied to the samples, measuring the intracanal dressings' effectiveness. Wilcoxon signed-rank tests were used to detect significant differences. Results: The results showed a statistically significant difference in the bacterial count of E. faecalis before and after applying the dressing of Ca(OH)2 paste from a mean of 11.89 to a mean of 3.18 (p=0.003) and no statistical difference in applying Ca(OH)2 PLUS points from mean 11.98 to mean 10.50 (p>0.05). Within the limits of the current in vitro study, the Ca(OH)2 paste cones were more effective than Ca(OH)2 PLUS points in eradicating E. faecalis growth inside the infected single-rooted canals.

Effect of the Gap between Cemented Posts and Remaining Gutta-Percha on the Clinical Outcome of Endodontically Treated Teeth Managed by Undergraduate Dental Students: A Prospective Study with 4 Years of Follow-Up

It is common to detect a gap between the apical portion of the post and the most coronal part of gutta-percha in a root canal during post and core treatment in endodontically treated teeth. It may compromise the seal that gutta-percha material provides in the root canal filling, leading to apical leakage, which is often thought to be one of the most common causes for failure of endodontic treatment. The prevention of apical leakage to achieve a complete apical seal and its effect on periapical health of endodontically treated teeth of post and core in long term clinical research remains unanswered. Post and core treatment were provided to 100 patients by undergraduate students in the year 2016–2017. A total of 70 patients in all were called back to the Prosthodontic Clinic for follow-up care after 4 years to assess the clinical result in terms of the gap between the post-operative and residual gutta-percha. The cemented posts were divided into three groups depending on the space between the cemented post end and the remaining gutta-percha: group I revealed no gaps, group II revealed gaps between &gt;0.1 and 1 mm, and group III revealed gaps more than 1 mm. The periapical index (PAI) was used to determine the apical condition of each tooth. Chi-square test was used for evaluating the data, and a p-value of 0.05 was considered statistically significant. A total of 28.6% post and core treated teeth were found diseased while 71.4% teeth were found normal. In group I, 90% of the teeth and in group II, 66.7% of teeth were evaluated as normal; however, in group III, 41.2% teeth were found diseased. In endodontically treated teeth restored with a post and core, a gap between the apical end of the post and the coronal section of the residual gutta-percha was associated with a greater prevalence of disease. The post and core treatment by undergraduate students achieved a clinically acceptable outcome in terms of the gap between the post end and the remaining gutta-percha.

Microbiological Profile of Primary Teeth with Irreversible Pulpitis and Pulp Necrosis with/without Abscess and their Susceptibility to Three Antibiotics as Intracanal Medication.

The ineffective disinfection potential of conventional intracanal medicaments to eliminate enteropathogens from root canal systems leads to their persistence contributing to endodontic treatment failures. Hence, the use of appropriate intracanal medicament becomes the essential phase to accomplishing comprehensive decontamination of the root canal system. When applied topically as an intracanal medicament, antibiotics eradicate residual microorganisms from tortuous endodontic spaces, minimizing the risk of systemic toxicity. To evaluate the prevalence of various bacterial species associated with signs of irreversible pulpitis and pulp necrosis with/without abscess in primary teeth root canals and their susceptibility against three antimicrobial agents. The pulp tissue and organic debris were retrieved from deciduous teeth (n = 50) from children between the age of 3-10 years and cultured. The bacterial identification and antibacterial profiling of isolated bacteria were done against clindamycin, metronidazole, and doxycycline through minimum inhibitory concentration (MIC) and minimum bactericidal concentration (MBC) assay. The MIC and MBC of each antibiotic were expressed as mean ± standard deviation (SD), range, and standard error (SE of the mean). The intergroup comparisons were done by the Kruskal-Wallis test, while intragroup pair-wise comparisons were done using the Wilcoxon signed-rank test. The confidence level will be set at 95%. Aerobic bacteria were found in 54%, microaerophilic bacteria in 76%, facultative anaerobes in 26%, and obligatory anaerobes were isolated from 30% of teeth. The intragroup and intergroup comparisons of test agent MIC revealed a nonsignificant difference (p > 0.05). The intragroup MBC comparisons of all the test agents revealed statistically nonsignificant (p > 0.05), while intergroup comparisons demonstrated nonsignificant (p > 0.05) to highly significant difference (p < 0.001). Clindamycin demonstrated promising antibacterial activity against most of the isolated bacteria, while against metronidazole and doxycycline, most of the bacteria were moderate to highly resistant. Determining the antibacterial agents' efficacy along with modifications can help to target maximum pathogenic microbes and reduce catastrophic endodontic therapy failures. Dahake PT, Kothari S. Microbiological Profile of Primary Teeth with Irreversible Pulpitis and Pulp Necrosis with/without Abscess and their Susceptibility to Three Antibiotics as Intracanal Medication. Int J Clin Pediatr Dent 2023;16(2):312-320.

Incidence of Endodontic Failure Cases in the Department of Conservative Dentistry and Endodontics, DY Patil School of Dentistry, Navi Mumbai.

Endodontic and restorative treatment goal is to restore occlusion and normal function of a tooth and provide stability to the dental arch. Root canal bacterial infection and apical periodontitis profoundly impact the management and outcome of endodontic treatments. The crucial goal of nonsurgical root canal therapy (NSRCT) is the mechanical removal of infected tissues and the chemical killing of bacteria. The present study assessed the outcomes and factors associated with the failure of primary endodontic treatment. A total of 250 teeth from 219 patients (104 male and 146 female) were examined in the Conservative Dentistry and Endodontics department, who reported symptomatic root canal-treated teeth. Data through clinical examination and radiographic examination was recorded on a proforma designed for the study of each patient regarding endodontic failure. According to the type of tooth maximum number of teeth that were reported with failure are the molars (67.6%), followed by premolar (14.0%), incisor (12.8%), and lastly, canines (5.6%). Based on the location of affected teeth, the maximum teeth that presented with failed root canal treatment were from mandibular posteriors (51.2%), followed by maxillary posteriors (31.60%), maxillary anterior (13.2%), mandibular anterior (4.0%). Endodontic failures were mostly found in underfilled root canals and poorly sealed post-endodontic coronal restoration and strong association with peri-apical radiolucency.

Non-Thermal Atmospheric Pressure Plasma Application in Endodontics.

The failure of endodontic treatment is frequently associated with the presence of remaining microorganisms, mainly due to the difficulty of eliminating the biofilm and the limitation of conventional irrigation solutions. Non-thermal atmospheric pressure plasma (NTPP) has been suggested for many applications in the medical field and can be applied directly to biological surfaces or indirectly through activated liquids. This literature review aims to evaluate the potential of NTPP application in Endodontics. A search in the databases Lilacs, Pubmed, and Ebsco was performed. Seventeen manuscripts published between 2007 and 2022 that followed our established inclusion criteria were found. The selected manuscripts evaluated the use of NTPP regarding its antimicrobial activity, in the direct exposure and indirect method, i.e., plasma-activated liquid. Of these, 15 used direct exposure. Different parameters, such as working gas and distance from the apparatus to the substrate, were evaluated in vitro and ex vivo. NTPP showed a disinfection property against important endodontic microorganisms, mainly Enterococcus faecalis and Candida albicans. The antimicrobial potential was dependent on plasma exposure time, with the highest antimicrobial effects over eight minutes of exposure. Interestingly, the association of NTPP and conventional antimicrobial solutions, in general, was shown to be more effective than both treatments separately. This association showed antimicrobial results with a short plasma exposure time, what could be interesting in clinical practice. However, considering the lack of standardization of the direct exposure parameters and few studies about plasma-activated liquids, more studies in the area for endodontic purposes are still required.

Microleakage Evaluation of Temporary Restorations Used in Endodontic Treatment-An Ex Vivo Study.

(1) Background: Coronal microleakage can lead to endodontic treatment failure. This study aimed to compare the sealing ability of different temporary restorative materials used during endodontic treatment. (2) Methods: Eighty sheep incisors were collected, uniformized in length, and access cavities were performed, except for in the negative control group, where the teeth were left intact. The teeth were divided into six different groups. In the positive control group, the access cavity was made and left empty. In the experimental groups, access cavities were restored with three different temporary materials (IRM®, Ketac™ Silver, and Cavit™) and with a definitive restorative material (Filtek Supreme™). The teeth were submitted to thermocycling, and two and four weeks later, they were infiltrated with 99mTcNaO4, and nuclear medicine imaging was performed. (3) Results: Filtek Supreme™ obtained the lowest infiltration values. Regarding the temporary materials, at two weeks, Ketac™ Silver presented the lowest infiltration, followed by IRM®, whereas Cavit™ presented the highest infiltration. At four weeks, Ketac™ Silver remained with the lowest values, whereas Cavit™ decreased the infiltration, comparable to IRM®. (4) Conclusion: Regarding temporary materials, Ketac™ Silver had the lowest infiltration at 2 and 4 weeks, whereas the highest infiltration was found in the Cavit™ group at two weeks and in the IRM® group at 4 weeks.

Evaluation of root canal morphology of mandibular central and lateral incisor in Mosul city by using CBCT

Background: Lower incisor endodontic treatment failures are primarily due to missing canals, notably the lingual canal. Aim: The incisors' root architecture and the number of canals of the mandibular would be evaluated using computed tomography using a cone beam (CBCT). Methods: 220 patients with age (18-75) years who visited Al Noor Dental Center in Mosul over the course of two years had their 780 central and lateral incisors of the jaw evaluated using 3D CBCT images. The classification of the Vertucci system was applied to determine how the root canal was shaped. Results: A comparison between the incisors of lateral and central canal shape using the Vertucci method, the number of central incisors with only one root was higher than the lateral incisors with the roots of the same number. Where it was found that the central incisors of the first type are 377 teeth, while the number of incisors Lateral 358, the number of incisors in the second type was 5 teeth, and the lateral 3 teeth. Conclusions: The root morphology of the sexes differs significantly. Various morphological alterations should be anticipated by the dental professional when undertaking endodontic treatment. To ascertain the morphological traits of the conductor's anterior tooth roots, additional research is required.

Apicoectomy for Periapical Lesion Treatment after Post Endodontic Failure on First Maxillary Premolar (Case Study)

Introduction. Factors that cause failure of endodontic therapy include incomplete cleaning and shaping of root canals and unhermetic obturation. Endodontic failure can lead to periapical lesions. Apicoectomy is one of endodontic surgery treatment choice to preserving the tooth with endodontic treatment failure. Aim. The aim of this report was to show that in cases of failure of root canal treatment could be treat without extraction, however there was an alternative treatments such as apicoectomy that could be used to preserve the tooth and its function in the oral cavity.Case. A male 32 years old patient came to dentist with persistent pain on upper left first premolar. The tooth had been endodontically treated for ten years. Clinical examination tooth #24 had porcelain fused to metal on it, percussion test (+), bite test (+), pain on palpation. Radiographic examination showed that tooth #24 had fabricated post without gutta percha obturation on apical third. There was 3 mm round periapical lesion on the distal side of the tooth. Procedure Apicoectomy and retrograde filling with Mineral Trioxide Aggregate (MTA) and bone graft was performed to eliminate that periapical lesion. Conclusion Apicoectomy is one of main choice to preserve post endodontic tooth with periapical lesion and post core crown on it, as long as possible in oral cavity Keywords : Apicoectomy, Periapical lesion, Post endodontic treatment failure