Field Of Endodontics Research Articles

Endodontic medicine: interrelationships among apical periodontitis, systemic disorders, and tissue responses of dental materials.

Endodontic medicine, which addresses the bidirectional relationship between endodontic infections and systemic diseases, has gained prominence in the field of endodontics. There is much evidence showing that while systemic disease may influence the pathogenesis of endodontic infection, endodontic infection can also cause systemic alterations. These alterations include more severe bone resorption and inflammation in the periapical area as well as enhanced systemic disease symptoms. Similarly, many reports have described the impact of systemic diseases on the tissue responses to dental materials. Conversely, the local use of dental materials may show systemic effects in the form of altered production of biomarkers. Thus, studies to better understand the mechanisms related to those connections are extremely important. In this context, the objective of this review was to analyze and discuss the current literature regarding the connections among these three factors-systemic diseases, endodontic infection, and endodontic dental materials-and determine how these connections may interfere in the systemic health status and the endodontic treatment outcomes, which are represented by periapical wound healing.

The Contribution of Indian Endodontists in Rotary Endodontics to Pubmed Database, from 2000-2017.

AIM:This study aimed at assessing the trends of publications of Indian Endodontists in the field of rotary Endodontics in the PubMed database from 2000-2017.METHODS:The date of publication was set from 1st January 2000 to 31st December 2017, wherein keywords entered in the advanced search were “Indian” AND “Dental” AND “Rotary Endodontics”. From the collected articles the following criteria were noted: year of publication, the name of the journal, status of the journal, name of the first author, state of origin and the rotary Endodontic file system used.RESULTS:All data was subjected for statistical analysis by SPSS software version 16. The data were subjected to chi-square test, and a statistically significant difference (p < 0.001) was obtained in the inter-6 yearly interval starting from 2000-2017; in the status of the journal; the state of origin and in the generation of rotary files which were published during the study period.CONCLUSION:The plethora of publications by Indian Conservative Dentists and Endodontists is on the rise, and with the advent of better technology a greater interest in the mechanics and properties of these rotary file systems has invoked greater research work.

Magnification in endodontics: A review of its application and acceptance among dental practitioners.

The application of magnification devices in endodontics is mainly meant for visual enhancement and improved ergonomics. This is crucial especially when long hours are spent in a narrow operating space to treat obscure microanatomy. Nevertheless, application of magnification in endodontics has yet to be introduced into the mainstream practice due to various influences in behavioral patterns. By conducting an extensive literature search in the PubMed database, this narrative review paper depicts the present state of magnification devices, their applications within the endodontic practice, factors that influence their usage, the advantages, and shortcomings, as well as the significances of magnification in the field of endodontics. This review paper will encourage clinicians to employ magnification in their practice for improved outcome.

Effectiveness of technology-enhanced learning in Endodontic education: a systematic review and meta-analysis.

The aim of the present systematic review was to evaluate the effectiveness of technology-enhanced learning (TEL) in the field of Endodontics to improve educational outcomes compared to traditional learning methods. Randomized controlled studies published in English were identified from two electronic databases (PubMed and Scopus) up to May 2018. Two authors independently performed study selection, data extraction and assessed the risk of bias (ROB). Any teaching method using TEL was considered as the intervention, and this was compared to traditional methods. The outcome measuring the effectiveness of learning activities was evaluated by Kirkpatrick's four-level training evaluation model. The four levels of training outcomes are as follows: Reaction, Learning, Behaviour and Results. A meta-analysis was performed to estimate the standardized mean difference (SMD) by the random effects model. In total, 13 studies were included in the systematic review. Only three studies were assessed as 'low' ROB. A meta-analysis could not be performed in the domains of Reaction and Behaviour. No significant difference was observed in knowledge gain (Learning domain) between TEL and traditional methods (SMD, 0.14 (95% CI -0.10 to 0.39) I2 =62.7%). Similarly, no difference was observed in performance (Behaviour domain). A variable response was found in attitude (Reaction domain). From the available evidence, it can be concluded that TEL is equally as effective as traditional learning methods.

Shaping ability of protaper next compared with waveone in late-model three-dimensional printed teeth

BackgroundComparison of the shaping ability of advanced nickel-titanium (Ni-Ti) instruments is of great interest to the field of endodontics. However, the models used to study canal preparation still lack uniformity, relevance to reality and complexity. The aim of this study was thus to compare the shaping abilities of the ProTaper Next (PN) and WaveOne (WO) Ni-Ti instruments in three-dimensional (3D)-printed teeth, which may overcome the present defects of most real teeth and model teeth including 3D S-shaped canals.MethodsSix teeth and their corresponding 3D-printed replicas were prepared using the same kind of Ni-Ti instrument. The pre- and post-preparation volumes, surface areas and transportation of the canals were measured to compare the teeth with their replicas. Twenty 3D-printed teeth with S-shaped canals were used to support the preparation study. The S-shaped canals were then scanned to measure their volumes and surface areas. Next, the two kinds of instruments were used to prepare the 3D-printed canals (n = 10 per group). The volume and surface area of the canals, the transportation along the two curvatures and the percentage of unprepared surface area were measured. Micro-CT and VGstudio2.2 (VG2.2) software were used to perform scans and collect data throughout the research. The paired-samples T test and Kruskal-Wallis H test were used for statistical analysis.ResultsThere was no significant difference between the real canals and the printed ones post-preparation (P > .05). The printed S-shaped root canals had a unified shape, with a small standard deviation and range. The WO group had higher mean values for the volume and superficial area measurements compared with the PN group (P < .05). No differences in the untouched areas were found between the two systems (P > .05). PN caused less transportation at the apical curve than WO did (P < .05).ConclusionsIn conclusion, 3D-printed teeth are suitable for the study of Ni-Ti rotary instruments. Furthermore, the PN rotary system caused less transportation at the apical curve than the WO system did in complicated root canal procedures.

Evaluation of Root Canal Configuration of Permanent Mandibular Anterior Teeth in Egyptian Subpopulation: A Cone Beam Computed Tomography Study

Cone beam computed tomography (CBCT) affords high-quality image with a relatively low radiation doses and low costs. It is considered as a valuable tool in endodontic field as it determines root morphology, number of roots, canals and accessory canals. The aim of the present study was to evaluate the permanent mandibular anterior teeth canal morphology in Egyptian subpopulation. Materials and Methods: A total of 100 patients were enrolled in this study and were assigned in two groups (50 females and 50 males). In each group centrals, laterals and canines of both sides were examined (100 centrals, 100 laterals and 100 canines). CBCT Images were obtained using J Morita CBCT unit and canals were categorized into the five types of Vertucci’s classification. The observer evaluated the images twice with one-week interval between assessments. Results: Type I Vertucci configuration was the most prevalent configuration in our sample and the incidence of this type was slightly higher in female than male samples. Furthermore, type III and V Vertucci configuration were slightly more in males than females. Conclusion: In the present study it was concluded that the root and root canal morphology of Egyptian subpopulation was, in general, comparable to that of other populations and that the incidence of canal variations might occur as a result of ethnicity more than gender.

English

Viguiera arenaria, family Asteraceae, is a plant that contains diterpenoids, which make this species potentially applicable in endodontics. More specifically, V. arenaria contains diterpenes of the pimarane type, which display various classic biological activities. This study evaluates the antibiofilm activity, the time-kill curve, and the inhibitory concentration index of diterpenes of the pimarane type (ent-pimara-8(14),15-dien-19-oic acid, ent-8(14),15-pimaradien-3β-ol, and ent-8(14),15-pimaradien-3β-19-oic acid sodium salt, designated diterpenes I, II, and III, respectively) toward nine anaerobic bacteria commonly found in endodontic infections; this study also assesses the cytotoxic activity of these diterpenes against human fibroblasts. According to the antibiofilm assay, diterpenes I, II, and III inhibit at least 50% of all the bacteria. On the basis of the time-kill curve experiments, the behavior of these diterpenes depends on the tested bacteria, diterpene concentration, and microorganism sensitivity. Synergism of diterpenes I and II with chlorhexidine (CDH) was higher against P. gingivalis (clinical isolate) and Aggregatibacter actinomycetemcomitans (ATCC). As for diterpene III, synergism with CDH is higher against P. micros. As revealed by the XTT assay, none of the diterpenes of the pimarane type tested here are cytotoxic. Hence, diterpenes I, II, and III are promising biomolecules and may provide therapeutic solutions in the field of endodontics. Key words: Antibacterial activity, Asteraceae, cytotoxicity, diterpenes, endodontic infection.

Tooth Discoloration and Internal Bleaching after the use of Triple Antibiotic Paste for Regenerative Endodontic Treatment of an Immature Necrotic Permanent Tooth: A Case Report

Recently, regeneration of immature necrotic pulp has become an alternative conservative treatment option for young permanent teeth and is a subject of great interest in the field of endodontics. The primary goal of these procedures is to activate the potential of the pulp for dentine deposition and produce a stronger mature root that withstands the forces better. However, the current protocol has potential clinical and biological complications. Amongst them, crown discoloration caused by triple antibiotic paste is deemed to be very frustrating for the dentist and the patient. In the case presented, there was a successful reversal of the crown discoloration by an internal bleaching procedure with superoxol at follow up periods of 3, 6 and 12 months. However, further long-term clinical trials and histological studies are needed to evaluate the long-term outcomes of walking bleach with superoxol in regenerative endodontic procedures.

Bioceramics in endodontics - a review.

Bioceramics are materials which include Alumina, Zirconia, Bioactive glass, Glass ceramics, Hydroxyapatite, resorbable Calcium phosphates, among others. They have been used in dentistry for filling up bony defects, root repair materials, apical fill materials, perforation sealing, as endodontic sealers and as aids in regeneration. They have certain advantages like biocompatibility, non toxicity, dimensional stability and most importantly in endodontic applications, being bio-inert. They have a similarity to Hydroxyapatite, an intrinsic osteo conductive activity and have an ability to induce regenerative responses in the human body. In Endodontics, they can be broadly classified into Calcium Phosphate/ Tricalcium/ Hydroxyapatite based, Calcium Silicate based or mixtures of Calcium Silicate and Phosphates. This review focuses on an overview of Bioceramics, classification and their advantages. It also gives a detailed insight into individual bioceramic materials currently used in the fields of Endodontics along with their properties and applications.

3D Printing - An Advancing Forefront in Imprinting the Inner Dimensions of Tooth with Precision

3D printing is rooting itself as a promising digital technology in the field of dentistry. Emergence of this recent advanced digital science has opened up new perspectives for design and production of 3D models quickly and automatically. The concept of utilizing this technology is to improvise the standards of the treatment provided to the patients, due to more precision and less technique sensitive outcomes. It works on the concept of additive manufacturing, which has its advantages in contrast to the subtractive manufacturing process. It is important to have knowledge about the different 3D printing modalities available as it is not only an upcoming technology in dentistry but also one which is emerging with myriad applications which offer better predictable results in areas of preoperative diagnostic planning, clinical handling and follow up. This article provides an overview on the method and applications of 3D printing with focus primarily in the field of Operative Dentistry and Endodontics.

Magnetic resonance imaging in endodontics: a literature review

Magnetic resonance imaging (MRI) has recently been used for the evaluation of dental pulp anatomy, vitality, and regeneration. This study reviewed the recent use of MRI in the endodontic field. Literature published from January 2000 to March 2017 was searched in PubMed using the following Medical Subject Heading (MeSH) terms: (1) MRI and (dental pulp anatomy or endodontic pulp); (2) MRI and dental pulp regeneration. Studies were narrowed down based on specific inclusion criteria and categorized as in vitro, in vivo, or dental pulp regeneration studies. The MRI sequences and imaging findings were summarized. In the in vitro studies on dental pulp anatomy, T1-weighted imaging with high resolution was frequently used to evaluate dental pulp morphology, demineralization depth, and tooth abnormalities. Other sequences such as apparent diffusion coefficient mapping and sweep imaging with Fourier transformation were used to evaluate pulpal fluid and decayed teeth, and short-T2 tissues (dentin and enamel), respectively. In the in vivo studies, pulp vitality and reperfusion were visible with fat-saturated T2-weighted imaging or contrast-enhanced T1-weighted imaging. In both the in vitro and in vivo studies, MRI could reveal pulp regeneration after stem cell therapy. Stem cells labeled with superparamagnetic iron oxide particles were also visible on MRI. Angiogenesis induced by stem cells could be confirmed on enhanced T1-weighted imaging. MRI can be successfully used to visualize pulp morphology as well as pulp vitality and regeneration. The use of MRI in the endodontic field is likely to increase in the future.

Regenerative Endodontics.

Regenerative endodontics has been defined as "biologically based procedure designed to replace damaged structures, including dentin and root structures, as well as cells of the pulp-dentin complex." This is an exciting and rapidly evolving field of human endodontics for the treatment of immature permanent teeth with infected root canal systems. These procedures have shown to be able not only to resolve pain and apical periodontitis but continued root development, thus increasing the thickness and strength of the previously thin and fracture-prone roots. In the last decade, over 80 case reports, numerous animal studies, and series of regenerative endodontic cases have been published. However, even with multiple successful case reports, there are still some remaining questions regarding terminology, patient selection, and procedural details. Regenerative endodontics provides the hope of converting a nonvital tooth into vital one once again.

L-mimosine and hypoxia can increase angiogenin production in dental pulp-derived cells

BackgroundAngiogenin is a key molecule in the healing process which has been successfully applied in the field of regenerative medicine. The role of angiogenin in dental pulp regeneration is unclear. Here we aimed to reveal the impact of the hypoxia mimetic agent L-mimosine (L-MIM) and hypoxia on angiogenin in the dental pulp.MethodsHuman dental pulp-derived cells (DPC) were cultured in monolayer and spheroid cultures and treated with L-MIM or hypoxia. In addition, tooth slice organ cultures were applied to mimic the pulp-dentin complex. We measured angiogenin mRNA and protein levels using qPCR and ELISA, respectively. Inhibitor studies with echinomycin were performed to reveal the role of hypoxia-inducible factor (HIF)-1 signaling.ResultsBoth, L-MIM and hypoxia increased the production of angiogenin at the protein level in monolayer cultures of DPC, while the increase at the mRNA level did not reach the level of significance. The increase of angiogenin in response to treatment with L-MIM or hypoxia was reduced by echinomycin. In spheroid cultures, L-MIM increased angiogenin at protein levels while the effect of hypoxia was not significant. Angiogenin was also expressed and released in tooth slice organ cultures under normoxic and hypoxic conditions and in the presence of L-MIM.ConclusionsL-MIM and hypoxia modulate production of angiogenin via HIF-1 differentially and the response depends on the culture model. Given the role of angiogenin in regeneration the here presented results are of high relevance for pre-conditioning approaches for cell therapy and tissue engineering in the field of regenerative endodontics.

Antimicrobial Photodynamic Therapy against Endodontic Enterococcus faecalis and Candida albicans Mono and Mixed Biofilms in the Presence of Photosensitizers: A Comparative Study with Classical Endodontic Irrigants.

Endodontic biofilms eradication from the infected root canal system remains as the primary focus in endodontic field. In this study, it was assessed the efficacy of antimicrobial Photodynamic Therapy (aPDT) with the Zn(II)chlorin e6 methyl ester (Zn(II)e6Me) activated by red light against monospecies and mixed biofilms of Enterococcus faecalis and Candida albicans. The results were compared with the ones obtained with Rose Bengal (RB), Toluidine Blue-O (TBO), the synthetic tetracationic porphyrin (TMPyP) as well as classical endodontic irrigants (3% NaOCl, 17% EDTA and 2% CHX). The antimicrobial efficacy of aPDT toward monospecies and mixed biofilms was quantified resorting to safranin red method. The changes of biofilm organization and of cellular ultrastructure were evaluated through several microscopy techniques (light, laser confocal and transmission electron microscopy). Zn(II)e6Me once activated with light for 60 or 90 s was able to remove around 60% of the biofilm’s biomass. It was more efficient than TBO and RB and showed similar efficiency to TMPyP and classical irrigants, CHX and EDTA. As desirable in a PS, Zn(II)e6Me in the dark showed smaller activity than TMPyP. Only NaOCl revealed higher efficiency, with 70–90% of the biofilm’s biomass removal. The organization of biofilms and the normal microbial cell ultrastructure were extensively damaged by the presence of Zn(II)e6Me. aPDT with Zn(II)e6Me showed to be an efficient antimicrobial strategy deserving further studies leading to a future clinical usage in endodontic disinfection.

Antibacterial Efficacy of Neem, Triphala, Green Tea, and Combination of Neem with Triphala Extract against Enterococcus faecalis: An in vitro Study

ABSTRACT Introduction The main objective of root canal treatment is to disinfect the entire root canal system, and irrigation is an important step in reducing the bacterial load from the root canal system. However, irrigants currently used in the field of endodontics have their share of limitations, and the search for an ideal root canal irrigant continues. The use of herbal extracts as endodontic irrigants is today gaining popularity. Aims and objectives To evaluate and compare the antimicrobial potential of herbal extracts, such as neem (Azadirachta indica), triphala (Terminalia chebula), green tea (Camellia sinensis), and combination of neem and triphala as endodontic irrigants against Enterococcus faecalis. Materials and methods Freshly prepared extracts of neem, triphala, green tea, and 2% chlorhexidine were used to assess the antimicrobial efficiency against E. faecalis using the agar well diffusion test. Agar plates were incubated at 370°C for 24 hours in an incubator. The diameter of bacterial inhibition zones around each well was recorded to the nearest size in mm. Results Higher mean zone of inhibition was recorded in chlorhexidine followed by neem extract and combination of neem and triphala than triphala and green tea extract respectively. The lowest mean zone of inhibition was found in green tea extract. Conclusion From the present study, it can be concluded that neem leaf extract shows comparable zones of inhibition with that of chlorhexidine and combination of neem and triphala. How to cite this article Singhal AC, Jain AS, Tiwari J, Surana P, Saini N. Antibacterial Efficacy of Neem, Triphala, Green Tea, and Combination of Neem with Triphala Extract against Enterococcus faecalis: An in vitro Study. Int J Experiment Dent Sci 2017;6(2):65-67.

Intraoperative Use of CBCT for Identification and Localization of Calcified Canals: A Clinical Technique

Localization of calcified canals has always been a challenge in the field of endodontics. The following report of three cases describes a technique for the identification and negotiation of obliterated canals by use of cone beam computed tomography (CBCT) intraoperatively. Canal orifices could not be found clinically in all three cases. Gutta-percha points were placed and compacted at the position where the canal orifices were estimated to be. Intraoperative CBCT was taken, and the distance between the gutta-percha points and the canal orifices was calculated at all planes of space in the first two cases. In the third case, only one canal orifice could be identified due to obliteration of the other canals.

Biomimetic Materials in Dentistry

With the arrival of technology, during the last two decades, numerous changes have been made in the field of restorative dentistry. This article reviews the various biomimetic materials and its biological properties in the field of restorative dentistry and endodontics. Biomimetic materials, with their biocompatible nature and excellent physico-chemical properties are widely used nowadays. They can function as long lasting esthetic and restorative materials, cements, root repair materials, root canal sealers and filling materials, which have the advantages of enhanced biocompatibility, high strength, sealing ability and antibacterial properties. New biomimetic materials have demonstrated the ability to overcome some of the significant limitations of earlier generation materials. Although in vitro studies, the uses of biomimetic materials in restorative dentistry endodontic have given encouraging results, randomized and double-blind clinical studies of sufficient length with these materials are needed to confirm long-term success following their use.

Comparative evaluation of four different sterilization methods on contaminated endodontic files

Background: The reuse of instruments in the field of endodontics leads to cross infection due to contamination with microbes as the instruments come into direct contact with saliva, blood, and infected tissues. Since microbes are considered to be the major cause of endodontic failures, sterilization of endodontic instruments is mandatory for maintaining asepsis to prevent cross-contamination from one person to other. Hence, the present study was conducted to compare the effectiveness of four different methods of sterilizing contaminated endodontic files. Materials and Methods: A total of 48 stainless steel K files were divided into four groups based on the sterilization method followed – Group A: Autoclave, Group B: Glass bead sterilization, Group C: Glutaraldehyde, and Group D: Quitanet Plus (aldehyde-free solution). In all the tested groups, half of the files were contaminated with Escherichia coli and remaining with Enterococcus faecalis. Then, presterilization colony counts were recorded, followed by sterilization through respective methods. Later, the sterilized files were rinsed with distilled water and 100 ul of the diluted concentration was transferred and cultured onto the respective agar plates to determine the total microbial reduction. Results: Autoclave showed complete effectiveness in reducing the microbial count followed by Quitanet Plus, glass bead sterilizer, and glutaraldehyde. Conclusion: Autoclave is considered to be the best sterilization technique to prevent cross infection in endodontic therapy.

Cone Beam Computed Tomography Evaluation of Root Canal Anatomy in Primary Molars: An in vitro Study

ABSTRACT Introduction Endodontic treatment requires knowledge of root canal morphology and its commonly occurring variation. The utility and relevance of cone beam computed tomography (CBCT) to the practice of endodontics is reported with increasing frequency in the field of endodontics for successful procedures. Therefore, the present study is undertaken to assess the variation in number and morphology of the root canals of primary molars. Materials and methods Extracted primary molars with at least two-thirds of intact root, and 7 to 12 mm length were cleaned in water and stored in 0.5% sodium hypochlorite for 1 week. Thereafter, the anatomy of the root canals of these primary molars was assessed through CBCT. Results In the present study, the majority of canals were ribbon shaped. Accessory canals were few and maximum number was found to be present in mesiobuccal root of maxillary first molar and the least in mesiobuccal root of mandibular second molar. Conclusion The CBCT proved to be as accurate as the gold standard in studying the presence of accessory canals with clinical applicability. This study highlights the usefulness of CBCT imaging for accurate diagnosis of the unusual canal morphology. How to cite this article Joshi N, Deshpande A, Poonacha KS, Bargale S, Naik K, Mehta D. Cone Beam Computed Tomography Evaluation of Root Canal Anatomy in Primary Molars: An in vitro Study. Int J Clin Dent Res 2017;1(1):15-19.

The Comparison of Job Stress among Dental Professionals of Dentistry Faculty Members of Tabriz University

Several studies have so far focused on occupational stress among dentists and the results have shown that many factors can cause stress. However, the level of stress among experts in the fields of dentistry has not yet been studied in Iran. The aim of this study is to examine the causes and levels of job stress among dental professionals in Tabriz University of Medical Sciences. This cross-sectional study included all dental professionals of Dentistry Faculty; an overall of 55 subjects in Tabriz were studied in this research and their level of stress was evaluated using "The Health and Safety Executive Management Standards Indicator Tool" (HSE stress questionnaire) from September up to October 2014. The level of stress in each dental specialty was examined descriptively (mean, standard deviation). Statistical analysis was performed using SPSS 20. The findings of the study showed that the highest stress among dental professionals from different fields was observed in the field of oral and maxillofacial radiology; fields of oral medicine, endodontics, oral and maxillofacial surgery and pediatric dentistry ranked later. The lowest stress was seen among orthodontics specialists. Based on the results of the present study, the rate of job stress varied significantly among dental professionals.