Failure Of Endodontic Treatment Research Articles

Mechanistic Insight into the Anti-Bacterial/Anti-Biofilm Effects of Low Chlorhexidine Concentrations on Enterococcus faecalis-In Vitro Study.

Endodontic treatment failures are often linked to the persistence of Enterococcus faecalis in the root canal system. This study aimed to investigate the antibacterial/antibiofilm mechanism of chlorhexidine (CHX), particularly at low concentrations, against E. faecalis, to improve endodontic treatment protocols. The antibacterial activity of CHX (0.125-20 μg/mL) was evaluated against E. faecalis ATCC 29212 using various assays, including planktonic growth inhibition, colony-forming units (CFUs), membrane permeability and potential assays, high-resolution scanning electron microscopy (HR-SEM), confocal laser scanning microscopy of biofilms, biomass and metabolic activity assays on matured biofilm, and quantitative real-time PCR for gene expression. Statistical analysis was performed using Student's t-test and ANOVA. CHX demonstrated concentration-dependent inhibition of E. faecalis, significantly reducing planktonic growth and CFUs. Membrane assays showed increased permeability and depolarization, indicating damage. HR-SEM revealed morphological changes, such as pore formation, while confocal microscopy showed a reduction in biofilm mass and extracellular substances. Gene expression analysis indicated the downregulation of virulence genes and upregulation of stress response genes. CHX at low concentrations disrupts E. faecalis at multiple levels, from membrane disruption to gene expression modulation, affecting mature biofilm. These findings support the refinement of endodontic disinfection protocols to reduce microbial persistence.

Nonsurgical Endodontic Retreatment of a Cystic Apical Lesion Associated with Root Resorption: A Promising Approach

This case report highlights the successful management of a cystic apical lesion associated with root resorption through nonsurgical endodontic retreatment, utilizing calcium-enriched mixture (CEM) cement as an obturating biomaterial. A 35-year-old woman presented with mild discomfort in the mandibular right first molar (#46), with radiographic evidence of a well-defined radiolucent lesion at the apex of the mesial root. The tooth had a history of previous failed endodontic treatment with poor root canal obturation, indicating internal root resorption. Nonsurgical endodontic retreatment was performed, and the canals were filled/sealed with CEM cement. Follow-up radiographs showed a gradual reduction in the size of the cystic lesion. At 54 months, complete bone healing of the cystic apical lesion was evident. This case report provides clinical evidence supporting the potential efficacy of nonsurgical endodontic retreatment using CEM cement in managing certain cystic apical lesions, offering a promising alternative to traditional surgical enucleation, even in cases with inflammatory root resorption. Further research is needed to validate the long-term efficacy of this approach in larger patient populations.

Post extraction palatal socket implants. A case report

The article presents a case report of a 42-year-old man with missing maxillary left first premolar first and second molars due to endodontic treatment failure and symptomatic periapical disease. The article discusses the challenge of replacing maxillary molars with dental implants and presents a surgical approach called Post Extractive Palatal Socket Implant with a “one time one abutment” approach. The article highlights the use of a primary prosthetic implant component to combine the palatal positioning of the implant with the “one time one abutment” approach. The technique aims to optimize osteointegration and periointegration in one surgical time for challenging cases. The article discusses the advantages of such a technique for maxillary molar replacement with dental implants.

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.

Comparative evaluation of postoperative pain and periapical healing after root canal treatment using three different endodontic sealers: A randomized controlled clinical trial.

A randomized controlled clinical trial to evaluate postoperative pain and investigate periapical healing after root canal treatment using eugenol, resin-based, and calcium silicate-based sealers (CSBSs) sealers. Sixty-three individuals diagnosed with apical periodontitis confirmed using cold test and electronic pulp tester, periapical pathology with periapical index score of 2 or more, previous endodontic treatment failure exhibiting a visual analog scale pain score of 3 or above, were enrolled in this investigation. The patients were randomly allocated into three groups and following biomechanical preparation, the canals were obturated using Meta CeraSeal, AH plus, and eugenol-based sealers. Postprocedural pain intensity was assessed at 24 h, 48 h, and 7 days, while periapical healing was evaluated at 3- and 6-month follow-ups. Statistical analysis was done using the Chi-square and Friedman's test. The mean of periapical lesions for Meta CeraSeal (4.7, 1.6), AH Plus (4.68, 3.19), 24 and eugenol-based (2.66, 1.75) at 3 months and 6 months, respectively. The mean & std. deviation of pain scores at 24 h for Meta CeraSeal (0.62 ± 1.857), AH Plus (1.62 ± 1.962), and eugenol-based (0.48 ± 1.250). At 48 h for Meta CeraSeal (0.33 ± 1.528), AH Plus (1.33 ± 1.798). On the 7th day, Meta CeraSeal (0.24 ± 1.091) and AH Plus (0.71 ± 1.384) for eugenol-based at 48 h, and on the 7th day, none of the patients had pain. Evaluation of the apical sealer puff displayed no suggestive variations (P = 0.634). Notably, no analgesics were taken. No suggestive dissimilarity was noted between eugenol, resin-based, and CSBSs sealers.

In Vitro Investigation of Antibacterial Activity of Gum Arabic Prepared by Two Different Processing Methods against Enterococcus Faecalis

Introduction: Entrococcus faecalis is a known cause of endodontic treatment failure. Synthetic drugs have been preferred for decades, but recently, many plants have been reported for their antibacterial activity. The study was carried out to investigate the antibacterial effect of Gum Arabic (GA) processed with two different processing methods against Enterococcus faecalis.

Can antimicrobial photodynamic therapy serve as an effective adjunct protocol for disinfecting the necrotic root canal system? A randomized controlled study

BackgroundBacterial infection plays an important role in persistent periapical lesions and inadequate disinfection of root canals is considered the biggest factor responsible for endodontic treatment failure. Antimicrobial Photodynamic Therapy (aPDT) has become the latest choice to eradicate microorganisms in root canals.ObjectiveThis study aims to evaluate the effectiveness of Antimicrobial Photodynamic Therapy (aPDT) in bacterial count reduction compared to Passive Ultrasonic Activation (PUI) and Ca(OH)2 dressings.Materials and methodsForty-five anterior single canal teeth with medium-sized periapical lesions (2–5 mm) were divided into three groups according to the disinfecting technique (each group consists of 15 canals with 1:1:1 allocation ratio): Group A: Ca(OH)2 dressing. Group B: Passive Ultrasonic Activation (PUI). Group C: Antimicrobial Photodynamic Therapy (aPDT). Direct bacterial viable count method was used to count the colonies forming units (CFU) before and after the disinfecting and the bacterial count reduction was estimated, the statistical analysis was performed at a 95% confidence level using the Chi-square and Mann–Whitney U test.ResultsaPDT showed no statistically significant difference when compared to passive ultrasonic irrigation (P > 0.05) but showed higher and more promising results when compared to Ca(OH)2 dressings (P < 0.05).ConclusionsaPDT has the ability and effectiveness as a disinfecting technique in necrotic and infected root canals.Clinical significance of the studyThe results of this clinical trial provide that aPDT can be considered an adjunct method for root canal disinfection with the same effectiveness as passive ultrasonic irrigation.

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.

Strategies and mechanisms targeting Enterococcus faecalis biofilms associated with endodontic infections: a comprehensive review.

Enterococcus faecalis is one of the main microorganisms that infects root canals, ranking among the most prevalent microorganisms associated with endodontic treatment failure. Given its pervasive presence in persistent endodontic infections, the successful elimination of Enterococcus faecalis is crucial for effective endodontic treatment and retreatment. Furthermore, Enterococcus faecalis can form biofilms - defense structures that microbes use to fight environmental threats. These biofilms confer resistance against host immune system attacks and antibiotic interventions. Consequently, the presence of biofilms poses a significant challenge in the complete eradication of Enterococcus faecalis and its associated disease. In response, numerous scholars have discovered promising outcomes in addressing Enterococcus faecalis biofilms within root canals and undertaken endeavors to explore more efficacious approaches in combating these biofilms. This study provides a comprehensive review of strategies and mechanisms for the removal of Enterococcus faecalis biofilms.

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.

Microsurgical Management of Nonsurgical Endodontically Treated Fiasco in Natural Permanent Upper Molar Tooth – A Clinical Case Report

Abstract The maxillary first permanent molar presents wide anatomical alterations for root number and their respective canal system. The medial root (mesiobuccal) specifically has been invariably associated to treatment failures when nonsurgical endodontic procedures have been solely carried out. In endodontic treatments, the decision to retreat the failed endodontic treatment with a surgical procedure depends on multiple factors. Evidence about the enduring prognosis of conventional retreatment (nonsurgical) comparative to invasive surgery (root end) remains questionable which requires additional scrutiny. The present case report presents a case of a patient (female, age 53 years) who presented with agony in relation to the maxillary first molar (left-sided) abutment of a four-unit fixed partial denture. Routine endodontic treatment was performed for the affected tooth which showed evidence of failure at 6-month follow-up intervals. Surgical intervention as part of the desired treatment was undertaken with the sealing of the canals done by Portland cement-based repair material. A pursual (6 months) after apicoectomy showed a complete rebuilding of the lateral apical region with freshly laid bone and a complete symptom-free patient. This clinical case report is directed to highlight the prospect of nonconservative clinical procedures once a noninvasive approach produces less anticipated results.

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.