Periapical Pathology Research Articles

An institutional protocol including socket alveoplasty and primary closure following dental extractions for patients with an elevated risk of developing medication-related osteonecrosis of the jaw.

Background The purpose of this study was to evaluate the outcomes of alveoplasty and primary closure following dental extractions in patients with an elevated medication-related osteonecrosis of the jaw (MRONJ) risk.Study design A retrospective review of 46 patients with an elevated MRONJ risk was conducted. This included a total of 124 teeth extracted, due to unrestorable caries (n = 46; 37%) and peri-apical pathology (n = 44; 35%).Results Our results showed 0% (n = 0) of patients in our cohort developed MRONJ post-operatively. Most patients were being treated with intravenous zoledronic acid for breast cancer (n = 23; 50%), with an average of 15 doses (range 1-72).Conclusions This study supports the use of alveoplasty and primary closure for patients with an elevated MRONJ risk. The authors highlight the importance of pre-operative cone beam computed tomography imaging, optimisation of immune status, post-operative prophylactic antibiotics, and the delay of bone modifying agents recommencement as influential factors in mitigating risk and favouring successful outcomes.

The provision of dental extractions in patients with established or a history of medication-related osteonecrosis of the jaw.

Patients with existing or a history of medication-related osteonecrosis of the jaw (MRONJ) are considered to be at a higher risk of further developing MRONJ, particularly if dental extractions are necessary. It is assumed that their underlying risk factors predispose them to developing MRONJ and they are allocated into an 'elevated risk group'. There is no evidence to quantify this risk level; however, it has led to an avoidance of dental extractions in this cohort. However, avoidance of dental extractions is not a realistic treatment option to prevent MRONJ and there is emerging evidence that inflammatory dental disease, such as peri-apical pathology or periodontal disease, can trigger the pathogenesis of MRONJ. The current case series retrospectively reviewed 28 patients with existing or a history of MRONJ who underwent dental extractions (n = 65) via our departmental protocol, which includes elective circumferential socket alveoplasty and primary closure. Our outcomes show that MRONJ did not develop at the new extraction site, with a post-operative review period of at least six months. These results provide promising evidence that dental extractions can be performed in this group of patients with <1% risk of developing MRONJ at the new surgical site, if appropriate measures are undertaken.

Analysis of errors in endodontic treatment according to cone-beam computed tomography

AIM. The aim of the study was to study the frequency of errors in endodontic treatment according to cone beam computed tomography.MATERIALS AND METHODS. 71 cone beam computed tomography (CBCT) scans of patients treated by random sampling who sought treatment and consultation in the period 2022–2023 were studied. 256 teeth previously subjected to endodontic treatment with the presence or absence of radiological signs of chronic apical periodontitis were examined. The assessment of the quality of root canal obturation and the features of the anatomical structure of teeth was carried out. The data of the «Ray RAYSCAN alpha 3D» cone beam computed tomograph were studied using the OnDemand3DDental program. The results were considered statistically significant at p&lt; 0.05.RESULTS. In 57.42% of cases, there were no signs of periapical pathology, and in 42.58%, foci of bone destruction in the periapical region were observed. Homogeneously, 58.59% of root canals were sealed to the apex. In 16.79% of cases, the removal of filling material outside the root canal was noted. 10.54% of teeth with insufficient root canal filling depth and 6.64% of teeth with a missing root canal were also identified.CONCLUSIONS. There is a decrease in the incidence of the most common errors of endodontic treatment. The method of cone beam computed tomography is important at the stage of diagnosis and planning of endodontic treatment to assess the features of the internal structure of the tooth.

Minimal intervention in pulpal and periapical pathology

Root canal treatment has been shown to be a predictable procedure with a favourable outcome in the case of pulpitis and apical periodontitis. The most important outcome measure is retention of an asymptomatic and functional tooth. When teeth are lost after root canal treatment, this is often the result of fracture due to weakening. By preventing or postponing root canal treatment, the long-term prognosis of the tooth may be better. Minimal interventions in endodontics are vital pulp therapy (indirect pulp therapy and pulpotomy), postponing and monitoring, and partial revision.

Attitudes of Dental Students towards the Prescription of Antibiotics during Endodontic Treatment.

This study aimed to evaluate the antibiotic-prescribing attitudes of dental students during the management of endodontic infections. This study was conducted in the five faculties of dental medicine in Morocco. A self-administered questionnaire was used and completed online. This questionnaire has three parts: the first includes the socio-demographic data, the second is related to the types of antibiotics prescribed, and the final addresses clinical scenarios in which antibiotics are prescribed. Data were analyzed with Jamovi, and X2 and ANOVA tests were performed. Three hundred and sixty-five students participated in this study. The average duration of antibiotic therapy was 5.87 ± 1.45. Of all the students, 83.8% prescribe amoxicillin first. For patients with penicillin allergy, clindamycin was the most prescribed, amounting to 53.9%. Antibiotics are prescribed for all pulp and periapical pathologies. For acute pulpitis and acute apical periodontitis, a statistically significant difference between the different faculties was noted (p = 0.03). Regarding apical abscesses, antibiotic prescription was more frequent at the public faculty of Casablanca, corresponding to 92.8%. (p = 0.02). It appears from this study that there is a need for faculties to develop innovative teaching models to improve students' level of knowledge on antibiotics and their indications in endodontics.

Assessment of Risk Factors and Prognostic Predictors for Endo-Perio Lesions in Indian Cohorts: An Observational Study.

Endodontic and periodontal tissues exhibit a significant interrelationship, whereby pathologies affecting one tissue can precipitate the involvement of the other. The primary objective of this study was to assess the risk factors associated with endo-perio lesions (EPLs). The secondary objective was to assess the prognostic predictors for such lesions and the prevalence rate of EPLs involving both pulpal and periodontal tissues in Indian cohorts. A prospective observational study was conducted on 2170 teeth with EPLs in Indian adults aged > 18 years. A detailed history of smoking, tobacco chewing, and the development of EPLs was obtained from all patients. Detailed periodontal and endodontic examinations were conducted by two calibrated examiners. Intraoral periapical radiographs (IOPAs) were obtained to diagnose EPLs. The chi-square test of association was used to analyze the association between independent and dependent variables, and the strength of association was presented by Pearsoncontingency coefficient (r). Logistic regression analysis was performed to identify reliable factors for diagnosing EPLs. A statistical significance threshold of 0.05 was established. The prevalence of EPLs involving pulpal and periodontal tissues was 29.49%. Type 1 lesions (EPLs involving only pulpal tissue) were most commonly seen at 41-45 years of age, type 2 lesions (EPLs involving primary pulpal and secondary periodontal tissue), and type 3 lesions (EPLs involving only periodontal tissue) at 26-30 years of age, and type 4 lesions (EPLs involving primary periodontal and secondary pulpal tissue) at 31-35 years of age. The pulp was found to be non-vital in all cases of type 3 lesions, and faulty restoration or improper root canal treatment (RCT) was the main risk factor for such lesions. Occupational trauma was found to be the most common risk factor for type 3 and type 4 lesions. Smoking, age, tooth type, occlusal trauma, faulty restorations and RCT, presence of caries, periapical pathology, periodontitis, bone loss, and pulp vitality were significantly associated with EPLs. Pulp vitality and bone loss were two prognostic predictors of EPLs.

The relationship between severity of periapical periodontitis and next-generation systemic inflammatory biomarkers in children with early childhood caries

IntroductionEarly childhood caries (ECC) is closely associated with poor oral hygiene and cariogenic diet. Untreated ECC results in recurrent odontogenic infections and local and systemic consequences. In this study, our goal is to assess the relationship between the intensity of odontogenic infection-associated periapical periodontitis and new generation of systemic inflammatory markers (SII, NLR, PLR) in ECC-affected children.Material and method95 healthy patients in early childhood and demonstrating periapical periodontitis who underwent dental treatment under general anesthesia (GA) in the last two years were included in the present study. Their periapical statuses were dichotomized as mild and severe. Periapical Index (PAI) scores of 2 and 3 were regarded as “mild” whereas 4 and 5 as “severe”. Of the complete blood test (CBC) parameters, systemic inflammatory index (SII), neutrophil-to-lymphocyte ratio (NLR), platelet–lymphocyte ratio (PLR), neutrophilic granulocyte (NEUT), lymphocyte (LYMPH) and platelet (PLT) were recorded. The relationship between the degree of periapical pathology and the evaluated markers was assessed using Receiver Operating Characteristic (ROC) analysis.ResultsResults of the present study revealed that mean NLR, SII and NEUT index scores of the patients having severe periapical periodontitis were statistically higher than those of the ones with mild pathology (p < 0.05). A positive, statistically significant interrelationship was found between the number of teeth demonstrating a PAI score of severe periapical periodontitis with the signs of exacerbation (PAI 5) and NLR and SII values (p < 0.05). Area under the ROC curve (AUC) values for NLR and SII were determined as 66.8% and 66.6% respectively, indicating that classification performance was sufficient and statistically significant (p < 0.05).ConclusionPostponing the management of odontogenic infections will induce some complications such as, infective endocarditis and cause the systemic inflammatory process to continue by aggravating the systemic effects of local lesions. Thus, underlying mechanism should be eliminated and oral hygiene should be maintained, also novel biomarkers may be recommended to be used for the decision-making process for the teeth with persistent periapical lesions unresponsive to treatment.

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.

A protocol for a comparative evaluation of the fracture resistance of endodontically treated teeth reinforced with Cention N, resin-modified glass ionomer cement (RMGIC) and short fiber reinforced flowable composite as an intraorifice barrier.

Endodontic treatment is the most common method for resolving pulpal and periapical pathology. However, various studies have reported that almost 11%-13% of all teeth that undergo extraction after endodontic treatment show the presence of cracks, craze lines, and vertical root fractures. Teeth with inadequate post endodontic restoration are more prone to fracture and coronal leakage, resulting in the diffusion of oral fluids, bacteria, bacterial products, and possibly root canal treatment failure. Furthermore, studies have advocated the use of endodontically treated teeth with restorative materials that have a similar or higher elastic modulus than the tooth for providing stiffness against forces that cause root fracture. Intraorifice barriers made of restorative materials that can bond to radicular dentin could thus be used to reinforce the radicular dentin while also preventing coronal microleakage. Although the sealing ability of intraorifice barriers has been widely compared in the literature, there have been few studies on the strengthening effect of the materials used in the study as intraorifice barriers when placed into the root canal. As a result, the current in vitro study aims to assess the effect of various materials as intraorifice barriers (Cention N, Resin modified glass ionomer cement, and short fiber reinforced flowable composite) on the force required fracture teeth after root canal treatment. This in vitro study will be done on extracted human mandibular premolars with single root canal where after doing root canal treatment 2-3 mm obturating material would be replaced by intra orifice barriers (Cention N, resin modified glass ionomer cement [RMGIC], and short fiber reinforced flowable composite). The force required to fracture teeth will be calculated using universal testing machine.

Major aspects of minimally invasive endodontic surgery using microsurgery: a systematic review

Introduction: Knowledge about endodontic infections has increased significantly over the last 50 years and, although many issues still require elucidation, endodontics has become the dental science that has the most improved approaches and technologies to increase the success and longevity of treatments dental organs. Endodontic microsurgery has produced highly successful results in preserving teeth with persistent or recurrent cases of periapical periodontitis that could not be successfully treated by non-surgical endodontic approaches. Objective: It was to list the main clinical considerations of minimally invasive endodontic surgery using apical microsurgery, as well as point out the success rate of this technique. Methods: The PRISMA Platform systematic review rules were followed. The search was carried out from January to March 2024 in the Scopus, PubMed, Science Direct, Scielo, and Google Scholar databases. The quality of the studies was based on the GRADE instrument and the risk of bias was analyzed according to the Cochrane instrument. Results and Conclusion: A total of 117 articles were found, 50 articles were evaluated in full and 20 were included and developed in the present systematic review study. Considering the Cochrane tool for risk of bias, the overall assessment resulted in 10 studies with a high risk of bias and 21 studies that did not meet GRADE and AMSTAR-2. Most studies did not show homogeneity in their results, with X2=58.5%&lt;50%. It was concluded that the success of apical endodontic surgery in terms of healing existing periapical pathology, together with a good long-term prognosis, depends on correct diagnosis and planning, as well as the association of surgical techniques, well-executed protocols, and biocompatible materials. The apical endodontic microsurgery approach is predictable and has a high success rate, which resulted from the introduction of cone beam computed tomography, microscope, ultrasonic instruments, and materials such as mineral trioxide aggregate (MTA) and bioceramics for retro-fillings.

Radiographic Evaluation of Regenerative Endodontic Procedures and Apexification Treatments with the Assessment of External Root Resorption

IntroductionThis multicentered cohort study evaluated the radiographic outcomes of regenerative endodontic procedures (REPs) and apexification treatments (APEX) of immature teeth with endodontic disease. Materials and MethodsThis cohort study included a retrospective record review and prospective data collection of pediatric patients with teeth treated with REPs or APEX between 2005 and 2014. Data including the presence of a periapical lesion, external root resorption, obliteration, apical hard tissue, apical closure, intracanal calcifications, and radiographic root area (RRA) change based on measurements were collected/measured from radiographic images. Univariate and multivariate analyses were conducted. ResultsThe cohort included 190 subjects (204 teeth (92 REPs; 112 APEX)). The frequency of pretreatment periapical pathology was similar between cases in which the clinical treatment failed versus successful treatment cases. However, the frequency of pretreatment external root resorption was higher in failed cases than in successful cases (P = .007). The mean RRA change was greater than twenty percent in 21% of the REPs cases. In traumatized teeth, REPs resulted in less hard tissue formation than other endodontic disease etiologies measured by RRA (P = .001). Fifty-three percent of cases with ERR (16/30) showed signs of healing/arrest and were mostly treated with REPs (11/16). ConclusionsThe presence of ERR negatively affected the treatment outcome. There was significant variability in RRA change in REPs. Signs of healing/arrest of the resorptive lesion were radiographically visible in many cases treated with REPs.

Effect of Iatrogenic Extrusion of Calcium Hydroxide Paste on Periapical Tissues with Periapical Pathology : A Case Report

Effect of Iatrogenic Extrusion of Calcium Hydroxide Paste on Periapical Tissues with Periapical Pathology : A Case Report

Assessment of Mesiobuccal Canals in Endodontically Treated Teeth in Indore Population by Cone Beam Computed Tomography: A Cross-Sectional Study.

Owing to the complicated anatomical nature of maxillary molars, untreated root canals may directly affect the outcome of root canal therapy. Therefore, cone beam computed tomography (CBCT) scanis an important tool in the evaluation of root canal systems, particularly for the detection of the second mesiobuccal(MB2) canalin maxillary molars. The current study was undertaken to detect and evaluate filled/unfilled MB2 canals in endodontically treated, asymptomatic maxillary molars, and its correlation with periapical pathology by utilizing cone beam computed tomography (CBCT). A retrospective study of 80 CBCTs of patients underwent scanning for various treatment modalities, with asymptomatic endodontically treated permanent maxillary first molars selected. Data collection occurred between January and June 2023. CBCT machine used was KODAK 9000 (Rochester, NY: Carestream Health) (Complementary Metal Oxide Semiconductor {CMOS} sensor, continuous mode and 12-28 sec scan time, 90-500 μm voxel size, and 5x3.5 cm field of view {FOV}). The axial images at mid-root level were used to assess the presence of the MB2 canal. The study included 39 (48.8%) right maxillary first molars and 41 (51.3%) left maxillary first molars. Overall, in 62 (77.5%) maxillary first molars, MB2 was missed by the practicing dentist, and in 13 (16.3%) maxillary first molars MB2 canal was not present. Of all the maxillary first molars with MB2 canal (n=67), 53 (79.1%) canals had a periapical infection, five (7.5%) showed widening of periodontal ligament space whereas nine (13.4%) had no abnormality. MB2 canals were present in the majority of cases and most of the unfilled MB2 canals showed evidence of periapical radiolucencies and showed a direct impact on the prognosis.

Assessment of the quality of root canal obturation of teeth with destructive forms of periodontitis using Silpex (SEM studies)

AIM. To evaluate the effectiveness of using the material Sealpex with gutta-percha pins using the lateral condensation method for permanent obturation of the root canals of teeth with periapical pathology and pathologically destroyed apical constriction.MATERIAL AND METHODS. The root canals of 94 teeth with destructive forms of periodontitis were filled with Sealpex. Depending on the degree of apical constriction, patients were divided into three groups. Follow-up of patients was carried out for 4 years.RESULTS. Using SEM, in 80% of cases, single micro cracks were detected between the dentin of the root canal wall and the sealer. In the area of wide apical openings, the fit of the material is loose, and it is removed beyond the root apex. The material diffuses into the root dentin. Statistical studies have shown a high percentage of successful treatment of destructive forms of periodontitis with the use of Sealpex.CONCLUSIONS. Endo-sealant extended beyond the apex of the root canal does not mean dense obturation of the apical foramen. The presence of micropores and microcracks in the endosealant can be regarded as evidence of poor sealing of the channel. The use of Sealpex is especially effective when filling teeth of groups, I and II with destructive forms of periodontitis

Prescription of antibiotics during endodontic treatments: Survey of senegalese dentists

: Irrational antibiotic prescribing is a phenomenon common to several countries, including Senegal.The aim of this study was to assess the level of antibiotic prescribing among Senegalese dental surgeons during the management of pulpal and periapical pathologies. This descriptive, analytical, cross-sectional study involved 132 dentists regularly registered with the Senegalese Dental Surgeons' Association.Data were collected and analyzed using SPSS version 17.0 software (SPSS, Inc., Chicago, IL, USA).The results of X2 tests showed a statistically significant difference between the private and public sectors for the management of root resorption (P≤0.005).: In patients with penicillin allergy, clindamycin was the first-line treatment (31.1%), followed by metronidazole combined with spiramycin (25%) and azithromycin 500mg (22.7%).: As with previous studies carried out in other countries, this study shows that very few practitioners make appropriate use of antibiotics for pulpal and periapical pathologies.

Cone-beam computed tomographic evaluation to estimate the prevalence of palatogingival groove in the maxillary anterior teeth and its radiographic characteristics: An institutional retrospective study.

The purpose of the study was to radiographically evaluate the prevalence of palatogingival groove (PG) in the East Indian population in the maxillary anterior teeth in different genders, its unilateral/bilateral presentation, classified based on its radiographic characteristics, to determine the prevalence of different types, which could help in future treatment planning. The design of the study was a retrospective study. Analysis of 429 maxillary anterior teeth (144 central incisors, 145 lateral incisors, and 139 canines) in 72 cone-beam computed tomography scans was done (31 males and 41 females, mean age 27.3 ± 7.63). Demographic details of patients and characteristics of PG, i.e. location, extension, depth, and type, were recorded. The presence of alveolar bone loss and periapical pathology was noted. An overall prevalence of PG was found to be 2.33% (n = 10), with PG being detected in 2 (1.388%) central incisors, 8 (5.51%) lateral incisors, and 0 (0%) canines. Eight of the patients had a unilateral presence, while one patient reported with bilateral presence, implying a significantly higher predilection of unilateral occurrence (P = 0.02). The prevalence was found to be higher in females (n = 8). The teeth were categorized as either having Type I (6 teeth), Type II (3 teeth), or Type III (1 teeth). Three of the 10 PGs were present in the mesial, six in the mid-palatal, and one in the distal portion of the palatal surface. The prevalence of PG in the maxillary incisors in this cohort is 2.33%. The maxillary lateral incisors are the most affected teeth. Unilateral presentation is more common.

Assessment of Systemic Condition and Smoking Impact Over Incidence of Apical Periodontitis.

This study aimed to assess the prevalence of apical periodontitis in a subset of the population of south-eastern Romania and to analyze the overall health status of the group of patients with apical periodontitis. The medical and dental history, including age, gender, background, presence of smoking, level of education, the total number of teeth present and with apical periodontitis, and the general health status were recorded from a total of 200 patients. The periapical status was analyzed using an orthopantomogram and periapical radiographs of teeth that were diagnosed with periapical lesions by the same dental professional. The periapical status was classified according to the periapical index (PAI), withapical periodontitis being present if the PAI score ≥3. The majority of patients were female (58.5%), with secondary or higher education from urban areas and the mean number of teeth with apical periodontitis was 2.29 ± 1.26, with a median of 2 teeth. A total of 17.1% of patients were smokers, these patients had two more teeth with periapical pathology, and 16% of all patients had general diseases, the most common of which was cardiovascular disease (8.2%). Compared with those without the disease, these patients had a higher number of teeth with apical periodontitis (median = 2.5, IQR = 2-4 vs. median = 2, IQR = 1-3). As a result, this scientific research suggests an association between smoking, cardiovascular disease, and gastritis with apical periodontitis, but no association could be demonstrated between apical periodontitis and other systemic diseases.

Retreatment of endodontics using hybrid instrumentation in a tooth with periapical pathology

Aim: Report a clinical case of endodontic retreatment using a hybrid instrumentation technique, L&amp;C paste associated with glycerin as intracanal medication and bioceramic cement. Methods: A 42-year-old male, melanoderma patient, attended the Nilton Lins University Dentistry clinic complaining of tooth fracture and sensitivity in the upper frontal region and pain on chewing. The image exams, showed a bone radiolucense on the root tip, suggestive of a periapical lesion. Clinicaly, pain on vertical percussion was observed. The findings indicated an unsatisfactory primary endodontic treatment. Given the characteristics presented, endodontic reintervention in two sessions was chosen. Results: After the endodontic obturation, the patient was followed through a year. During the months of follow-up, it was observed decrease of the radiolucense on the root tip, as well as the appearance of radiopaque areas, suggestive of bone formation, indicating the effectiveness of the proposed treatment. Conclusion: Therefore, the endodontic reintervention using hybrid instrumentation technique, L&amp;C paste associated with glycerin as intracanal medication and bioceramic cement, showed a satisfactory result in the controlling of the infection. After 1 year, signs of bone remodeling can be seen, meeting the heal expectations predicted in the case planning, leaving the tooth suitable for prosthetic rehabilitation and return to its function.

A protocol for a comparative evaluation of the fracture resistance of endodontically treated teeth reinforced with Cention N, resin-modified glass ionomer cement (RMGIC) and short fiber reinforced flowable composite as an intraorifice barrier

Background: Endodontic treatment is the most common method for resolving pulpal and periapical pathology. However, various studies have reported that almost 11%–13% of all teeth that undergo extraction after endodontic treatment show the presence of cracks, craze lines, and vertical root fractures. Teeth with inadequate post endodontic restoration are more prone to fracture and coronal leakage, resulting in the diffusion of oral fluids, bacteria, bacterial products, and possibly root canal treatment failure. Furthermore, studies have advocated the use of endodontically treated teeth with restorative materials that have a similar or higher elastic modulus than the tooth for providing stiffness against forces that cause root fracture. Intraorifice barriers made of restorative materials that can bond to radicular dentin could thus be used to reinforce the radicular dentin while also preventing coronal microleakage. Although the sealing ability of intraorifice barriers has been widely compared in the literature, there have been few studies on the strengthening effect of the materials used in the study as intraorifice barriers when placed into the root canal. As a result, the current in vitro study aims to assess the effect of various materials as intraorifice barriers (Cention N, Resin modified glass ionomer cement, and short fiber reinforced flowable composite) on the force required fracture teeth after root canal treatment. Methods: This in vitro study will be done on extracted human mandibular premolars with single root canal where after doing root canal treatment 2-3 mm obturating material would be replaced by intra orifice barriers (Cention N, resin modified glass ionomer cement [RMGIC], and short fiber reinforced flowable composite). The force required to fracture teeth will be calculated using universal testing machine.

Major factors for the effectiveness of apical endodontic microsurgery: a systematic review

Introduction: Apical endodontic microsurgery is a technique developed by the evolution of traditional apical endodontic surgery approaches and technologies. This enhancement was possible since the introduction of equipment like cone beam computed tomography, microscope, ultrasonic instruments, and biocompatibility root-end material filling, increasing the predictability and long-term success rates and survival of teeth. Objective: It explored and developed the main factors for the effectiveness of apical endodontic microsurgery. Methods: The PRISMA Platform systematic review rules were followed. The search was carried out from October to December 2023 in the Scopus, PubMed, Science Direct, Scielo, and Google Scholar databases. The quality of the studies was based on the GRADE instrument and the risk of bias was analyzed according to the Cochrane instrument. Results and Conclusion: A total of 118 articles were found, 43 articles were evaluated in full and 36 were included and developed in the present systematic review study. Considering the Cochrane tool for risk of bias, the overall assessment resulted in 28 studies with a high risk of bias and 21 studies that did not meet GRADE and AMSTAR-2. Most studies did not show homogeneity in their results, with X2=57.5%&lt;50%. It was concluded that the success of apical endodontic surgery in terms of healing existing periapical pathology, together with a good long-term prognosis, depends on correct diagnosis and planning, as well as the association of surgical techniques, well-executed protocols, and biocompatible materials. The apical endodontic microsurgical approach is predictable and has a high success rate, which resulted from the introduction of cone beam computed tomography, microscope, ultrasonic instruments, and materials such as MTA and bioceramics for retro-fillings.